Publications

Antibiofilm Activity of Activated Carbon Film Wound Dressing

    DOI: 10.52494/BSGG1185
    by Rafeka Mohd Fauzi and Shiow-Fern Ng.
    Vol. 9 No. 2 (2023): Malaysian Journal of Pharmacy / Published: December 31, 2023
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    Abstract

    Background: Biofilm is a structured community of bacterial cells enclosed in a self-produced matrix containing 80% extracellular polymeric substances (EPS). When biofilms are present on the wound surface, they impair optimal penetration of antimicrobials resulting in delayed healing. Chronic wounds are likely to be impacted since the wound may be moist and purulent which are conducive for biofilm growth. Objective: To develop and characterise hydrogel films containing AC at various concentrations and to study the antibiofilm activities of the produced films through in vitro approach on two common biofilm strains, Staphylococcus aureus, and Pseudomonas aeruginosa. Methods: An approach was suggested in this study by utilising the high adsorptive capacity of activated carbon (AC) loaded into PVP/CMC hydrogel film wound dressing to disrupt and inhibit the biofilms present on the wound surface. Results: The results obtained showed that the developed hydrogel films containing AC at different concentrations (0.1%, 0.5%, 1.0%, 1.5% and 2.0%) provided a balanced moist environment to the wound surface with adequate swelling properties. Characterisation of the AC films also showed satisfactory mechanical properties indicating the films were durable and flexible, thus suitable for wound application. Antibiofilm study was conducted via XTT assay by treating biofilms of two common bacterial strains, Staphylococcus aureus and Pseudomonas aeruginosa with the AC hydrogel films. Findings showed AC exerted antibiofilm activity by inhibiting more than 50% of biofilm growth on P. aeruginosa biofilm, with AC 0.5% achieving the highest biofilm inhibition (62.41±8.48%). However, there was lack of evidence to support AC hydrogel films in inhibiting biofilm produced by S. aureus because there was no significant difference (p<0.05) in biofilm inhibition when compared to AC 0%. Conclusion: Although AC hydrogel films showed promising results on P. aeruginosa biofilm inhibition, its application in wound dressing as antibiofilm agent may be limited especially on multispecies biofilm due to its lack of activity towards S. aureus. Further investigations are required to assess antibiofilm activity of AC hydrogel films on other bacterial strains and its mechanism of biofilm inhibition.

    Knowledge, Practices & Attitudes Towards Adverse Drug Reaction Reporting among Public Healthcare Professionals in West Pahang

      DOI: 10.52494/MEYA2148
      by Tze Seong Chen, Kien Seang Kwong, Sai Hong Lee, Noor Ashikin Nordin, Chiew Ping Tan, Mohd Faiz Mohd Wahiza, Yi Heng Lim, Nurul Syahamah Shakar and Nuraini Arshad.
      Vol. 9 No. 2 (2023): Malaysian Journal of Pharmacy / Published: December 31, 2023
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      Abstract

      Background: The World Health Organization identifies adverse drug reactions (ADRs) as unintentional and harmful reactions to drugs, which are among the leading causes of death in many nations. ADR under-reporting is a threat to pharmacovigilance. Objective: The objectives of this study were to evaluate the knowledge, practices & attitudes towards ADR reporting among public healthcare professionals and to determine factors that lead to underreporting of ADR in public health facilities (hospitals and clinics) in West Pahang, Malaysia. Methods: This was a cross-sectional, questionnaire-based observational study conducted in 2021 with respondents consisting of healthcare professionals from all hospitals and health clinics in West Pahang. Data was collected from March 2021 to April 2021 via a validated questionnaire. Results: A total of 400 questionnaires were distributed and 344 healthcare professionals took part in the study, with an 86% response rate. The majority of survey respondents selected positive responses in the area of knowledge and attitude, but not in the area of practice for ADR reporting. It was found that 95.3% of respondents had good knowledge, 11% had good practices and 52% had good attitudes towards ADR reporting. Over half of respondents (53.2%) believed that it is nearly impossible to conclude that a drug is the cause of a particular adverse event. Fifty percent of respondents believed they would be held accountable for the ADR which occurred once they reported it. The majority of the respondents (68%) thought that really serious ADRs were already documented when the drugs were marketed. Conclusion: The majority of healthcare professionals in West Pahang showed good knowledge and attitude, but poor practice in ADR reporting. Insecurity, fear of admitting harm, complacency, and ignorance were the discouraging factors that led to the underreporting of ADR among healthcare professionals from West Pahang.

      Deferoxamine injection practice assessment and common administration errors among adult thalassaemia patients

        DOI: 10.52494/BYSJ2389
        by Muhammad Nasri Yusoff, Toh Kit Yeng, Chua Peck Wei, Nurul Izzati Liyana Azlan and Atikah Ali Jaafar.
        Vol. 9 No. 2 (2023): Malaysian Journal of Pharmacy / Published: December 31, 2023
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        Abstract

        Background: Thalassaemia is a hereditary blood disorder characterised by defective globin chains, which results in haemolysis and impaired erythropoiesis. Routine blood transfusion is required, which may lead to iron overload in a long run. Deferoxamine (DFO) provides effective iron chelation in thalassaemia patients, however, challenges were faced among patients, especially in ensuring proper drug administration techniques. Objective: The study aim is to describe the current DFO administration practice, common administration errors, patient compliance towards iron chelation therapy and to identify factors associated with serum ferritin levels. Methods: A cross-sectional study among adult thalassaemia patients was done from January 2019 until November 2020. Patients were assessed for DFO injection practices and compliances. A DFO score was used to assess steps of dilution and administration of DFO, categorised as good (score 75-100%), satisfactory (score 60-74%), and fail (score <60%). Compliance was assessed using a validated 7-questions survey; a score of less than 27 marks dictated non-compliance. A multivariate linear regression was used to identify factors associated with high serum ferritin level (>1000 µg/L). Results: Twenty-four patients were included in the study. For administration practice, 79.2% were able to administer independently. Abdomen was the most favoured injection site and most patients administered DFO at night. Although 75% of the patients had a good DFO score, DFO administration errors persist. The compliance rate was low (29.2%), and majority reported more than 4 times per month of missed doses. Working status (4664.13, 95% CI 1609.41-7718.86, p=0.005) and frequent missed dose (1152.39, 95% CI 382.18-1922.6, p=0.005) were identified as factors associated with serum ferritin level, controlling for other factors. Conclusion: DFO administration errors persist among thalassaemia patients. Patients who are working and non-compliant were identified to be associated with high serum ferritin level. Effective counselling method may be needed to properly educate patients on DFO administration and improve patients’ compliance.

        The Effects of Intermittent Fasting on Cardiovascular Health of Prediabetes and Type 2 Diabetes Mellitus (T2DM) Patients: A Systematic Review

          DOI: 10.52494/DRHI9315
          by Muhammad Naif Hafizin Afdzal Rasif, Amirah Farhana Nazri and May Khin Soe.
          Vol. 9 No. 2 (2023): Malaysian Journal of Pharmacy / Published: December 31, 2023
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          Abstract

          Background: Type 2 diabetes mellitus and prediabetes are showing an increasing number of cases and are predicted to keep increasing over the years. Both conditions have a 2-3-fold increased risk of developing cardiovascular diseases. Intermittent fasting is one of the forms of dietary intervention being practiced in preventing and managing these conditions and their associated complications. There are many reported benefits of intermittent fasting for health, but no specific studies discussed regarding the effect of this practice on cardiovascular health of these patients. Objective: This study is aiming to systematically review the benefits of intermittent fasting on cardiovascular health of these groups of patients. Methods: This systematic review followed the guideline of PRISMA and was registered at PROSPERO with the registration number of CRD42022378349. A systematic literature search was conducted in PubMed, Scopus, Cochrane Library, Google Scholar and by using snowball technique. The articles retrieved were independently screened by two authors against the eligibility criteria in stages of title, abstract and full text. The risk of bias in the included studies were assessed independently by two authors using the Joanna Briggs Institute critical appraisal checklist. Data from all the included articles were extracted using a predetermined template. Results: Twelve studies were included in this study. Six studies recorded low risk of bias while the other six studies had moderate risk of bias. Three studies recorded significant reduction for both systolic and diastolic blood pressure, and 3 studies showed significant improvement in the lipid profiles at the end of intervention. Conclusion: Intermittent fasting is beneficial for cardiovascular health of prediabetes and type 2 diabetes mellitus patients mainly by improving both systolic and diastolic blood pressure and the lipid profiles. Randomized controlled trials that investigate specifically the benefits of this practice on the cardiovascular health of these populations are needed to confirm the findings.

          Psychological Morbidities among Trainee Pharmacists in Major Government Hospitals in Sarawak

            DOI: 10.52494/BHKZ7878
            by Grace Hie King Chieng and Lee Chee Pan.
            Vol. 9 No. 1 (2023): Malaysian Journal of Pharmacy / Published: June 30, 2023
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            Abstract

            Introduction: Trainee pharmacists in Malaysia are required to undergo a one-year training program during which they have to fulfill the requirements of their training logbooks. The logbook outlines the jobs and tasks that should be performed by the trainee pharmacists during their attachment at various pharmacy units. Upon the completion of their internship, they should acquire adequate professional knowledge, skills, and attitudes in order to prepare themselves to deal with life-long professional challenges independently. Objective: The objectives of this study were to determine the prevalence of depression, anxiety and stress among trainee pharmacists in major government hospitals in Sarawak, to compare the level of psychological morbidities among trainee pharmacists among training centers, and to explore the factors associated with the psychological morbidities during pharmacy training. Method: This was a cross-sectional study involving 55 trainee pharmacists in major government hospitals in Sarawak over a period of two months, from 24th December 2019 to 28th February 2020, using a validated questionnaire, the Depression, Anxiety, and Stress Scale (DASS 21). Additional questions regarding socio-demographic variables were also included in the survey. Results: The prevalence of psychological morbidities for trainee pharmacists was found to be 14.5% for depression, 38.2% for anxiety, and 7.2% for stress, respectively. Local program graduates had 5.41 times higher odds of developing depression as compared to foreign or twinning program graduates. Furthermore, non-Sarawakian trainee pharmacists had 7.9 times higher odds for developing anxiety as compared to trainee pharmacists who originated from Sarawak. Conclusion: Anxiety was found to be the most common psychological symptom experienced by trainee pharmacists in Sarawak training centers. The origin of trainees and place of graduation were significantly associated with anxiety and depression,n respectively. Attention should be focused on the early recognition of psychological morbidities among healthcare professionals.

            Exploring Job Satisfaction, Organizational Commitment and the Intention to Stay or Leave the Public Workforce Among Fully Registered Pharmacists (FRP) in Miri Hospital

              DOI: 10.52494/WHWJ5181
              by Mee Yien Kiing and Ling Weng Wong.
              Vol. 9 No. 1 (2023): Malaysian Journal of Pharmacy / Published: June 30, 2023
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              Abstract

              Background: Pharmacy services have expanded tremendously over the past few decades to provide comprehensive patient-centered pharmaceutical care. This expansion inevitably places a growing demand on the pharmacy workforce. Positive correlations have been established between job satisfaction and key factors such as motivation, job performance, productivity, organizational commitment and most importantly patient safety and satisfaction. Methods: A cross-sectional survey was conducted among all fully registered pharmacists (FRPs) in Miri Hospital using a questionnaire that has been previously validated (n = 47). This questionnaire consists of four parts with aims to capture the demographic profile of the respondents, factors affecting job satisfaction, assessment of job satisfaction and organizational commitment and assessment of decision to stay or leave their current employer, the Ministry of Health (MOH). Participants were also invited to express their opinion on how to improve the pharmacy service in the public workforce through open- ended question. Results: A total of 42 pharmacists (response rate 85.7%) in Miri Hospital participated in this survey. Most of the respondents in this study were female (81%) and of Chinese ethnicity (78.6%), with a median age of 31 years old. The proportion of single and married respondents were similar (54.8% and 45.2% respectively). The length of employment of the respondents in MOH ranged from 3 to 13 years, with a median of 7 years. The mean job satisfaction and organizational commitment scores were 60.81 (standard deviation (SD) 8.70) and 56.48 (SD 7.21) respectively out of a maximum possible score of 90.0. 95.2% of the respondents indicated strong inclination to remain in their current job. Conclusion: Gaining insight into the factors which influence job satisfaction and organizational commitment holds significance in reducing the turnover rate of pharmacists and enhancing their productivity levels. Our study showed moderate job satisfaction and organizational commitment among pharmacists in Miri Hospital. Job satisfaction does not seem to differ for all respondents; nevertheless, female respondents were found to be more committed the organization.

              Cost Outcomes of Conversion from Simple Syrup to X-Temp® Suspension in Production of Extemporaneous Oral Morphine Solution in Hospital Tengku Ampuan Afzan

                DOI: 10.52494/WSRB3977
                by Khairul Naim Zainal Abidin and Nurul Amira Haji Zunaidi.
                Vol. 9 No. 1 (2023): Malaysian Journal of Pharmacy / Published: June 30, 2023
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                Abstract

                Introduction: Oral morphine solution is produced extemporaneously in Hospital Tengku Ampuan Afzan (HTAA). Currently, X-Temp® oral suspension system (OSS), a commercially produced drug vehicle, is used to substitute Simple Syrup in the production of oral morphine solution. Within general hospitals, particularly in HTAA, there are no published documents or official studies on the cost comparison of using Simple Syrup and X-Temp® OSS in the production of extemporaneous oral morphine solution. Materials and method: This is a retrospective study on the batches of oral morphine solution produced using Simple Syrup and X-Temp® OSS. Data were obtained from Psychotropics and Dangerous Drug Registers, Excel data and other relevant databases. All data were further analysed and presented in tables, graphs, and charts whenever applicable and necessary. Results: The median cost per batch of oral morphine with Simple Syrup is RM71.73 (IQR: RM 0.986), which is cheaper than oral morphine with X-Temp® OSS (RM547.68, IQR: RM273.84). There is a significant difference in terms of cost per batch of production between both groups (p=0.0001), where oral morphine with X-Temp® OSS has a higher median score compared to oral morphine with Simple Syrup. Oral morphine with X-Temp® OSS was produced less frequently than oral morphine with Simple Syrup. Thus, the total time spent for production per year is lesser with the use of X-Temp® OSS. The odds of disposing of oral morphine solution were significantly lower in oral morphine with X-Temp® OSS, compared to oral morphine with Simple Syrup. (OR = 43.52; 95% CI = 20.33 – 93.13; p=0.0001). Conclusion: The direct cost of X-Temp® OSS in the production of oral morphine solution is higher, but the indirect costs are lower, hence making it more beneficial in terms of reducing the use of human resources, saving time & minimizing wastage.

                Deriving a more Accurate Method to Calculate Creatinine Clearance when using Two Levels of Serum Creatinine (C0 and C24) in Patients with Rapidly Improving Kidney Function: A Simulation Approach

                  DOI: 10.52494/LDSX9210
                  by Yen Ping Ng, Jin Yi Choo, Cheng Hoon Yap, Boon Seng Tan, Yee Mei Ng and Jing Ng.
                  Vol. 9 No. 1 (2023): Malaysian Journal of Pharmacy / Published: June 30, 2023
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                  Abstract

                  Background Acute kidney injury (AKI) is a common complication in hospitalized patients and is associated with a high mortality rate. A precise estimation of creatinine clearance (Clcr) is of great importance in daily clinical practice, particularly among critically ill patients with unstable kidney function, in guiding drug dosage adjustment. Clcr can be determined precisely through a simple laboratory method (amount of total urinary creatinine divided by the average of two consecutive serum creatinine concentrations) in patients with stable kidney function. However, in patients with rapidly improving kidney function, Clcr determined by the laboratory method can produce highly variable and inaccurate results due to the non-linear changes in plasma creatinine concentrations. Aim To determine the magnitude of discrepancies of Clcr calculated using the two-point average method to the actual Clcr and derive a correction factor for creatinine clearance determined by the two-point average method. Methods Patients with improving kidney functions were simulated. The actual urinary creatinine clearance, Ae 0-24, was subsequently calculated using area under the curve (AUC) 0-24 hours via Simpson’s approximation. Creatinine clearances were then calculated using Ae 0-24 / AUC0-24 and the 2-point average method. Results When Clcr improved greater than 35 ml/min, Clcr estimated by the 2-points method deviated significantly in progress from the actual Clcr whereby it underestimated the Clcr by 38%. The derived correction factor is 65 • [Clcr(ne)/ 33]. The correlation between actual Clcr and Clcr with correction factor was reported as R2 = 0.9882. Conclusion During the improvement kidney function, measuring urinary creatinine clearance using the 2-points average method can produce highly inaccurate Clcr measurement, particularly at Clcr ≥ 35 ml/min. The correction factor derived is found to be able to address the mentioned pitfall with low error.

                  Exploring Patients’ Experiences with a Pharmacy Drive-Through Medication Dispensing Service: A Qualitative Study

                    DOI: 10.52494/CDZM4052
                    by Kamarudin Ahmad, Khai Ying Ang, Pik Sze Wong, Nur Aqilah Alimin, Irene Yeu Xin Huong, Shirlie Chai, Bradley Lawrence and Chuo Yew Ting.
                    Vol. 9 No. 1 (2023): Malaysian Journal of Pharmacy / Published: June 30, 2023
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                    Abstract

                    Introduction: The pharmacy drive-through service (P.D.T.S.) is an innovative medication dispensing service that aims to reduce the hurdles of collecting medications. Through the P.D.T.S., patients may have the convenience of getting medication at the drive-through pharmacy counter. By conducting a qualitative study, we explored the user’s experiences of P.D.T.S. in a public specialist hospital in Miri, Sarawak State of Malaysia. Methods: The P.D.T.S. users who consented to participate were invited to a semi-structured phone interview. We go in-depth on the awareness, barriers, application, improvements, and benefits of the P.D.T.S. The interviews lasted, on average, 15 minutes or until achieving data saturation. Audio recordings were transcribed verbatim, and the transcripts were analysed thematically. Result: Participants perceived the P.D.T.S. as convenient and gave them a sense of safety through physical distancing while collecting their medications. On the contrary, they experienced confusion with the instructions on using P.D.T.S. and some degree of inflexibility, especially in the appointment setting. Conclusion: The users of P.D.T.S. had both positive and negative experiences with P.D.T.S. The negative aspect must be improved, especially the user’s instructions and the appointment system.

                    Pharmacy Staffs’ Perceptions and Opinion on the Drive-Through Pharmacy Service During Covid-19 Pandemic at One of the University Teaching Hospitals in Malaysia

                      DOI: 10.52494/OQKB6308
                      by Roz Azinur Che Lamin, Ahmad Farid Mohd Jamil, Fadhlul Aqilah Fakhrul Anuar, Dennoel Eku, Nur Liyana Saharudin and Nursyuhadah Othman.
                      Vol. 9 No. 1 (2023): Malaysian Journal of Pharmacy / Published: June 30, 2023
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                      Abstract

                      Amidst the COVID-19 pandemic that imposed movement control order, most patient had difficulties in collecting the medication. Therefore, drive-thru pharmacy was perceived as the safer and most convenient option to minimal the infection risks. This study aimed to assess the perception and opinion of the pharmacy staffs about the necessities of drive-thru pharmacy service during COVID-19 pandemic. A cross-sectional study was conducted in one of the university teaching hospitals in Malaysia, from February to May 2022. The respondents were among staffs in various pharmacy units. The staff perceptions and opinion of drive-thru pharmacy in preventing the spread of infectious diseases in the community was determined using descriptive analysis while the open-ended question was analyzed thematically. All (n=109) respondents positively acknowledge the importance of drive-thru pharmacy in reducing the risk of virus infection. The staff agreed that drive-thru service is helpful for patients who are busy with their daily routine (n=103; 94.5%), reduces patients’ waiting time for picking up their medications and perceived that drive-thru Services are useful for senior citizen or caretaker (n=95; 87.2%). In conclusion, although 89 (82.0%) of the respondents highlighted the importance of drive-thru service especially during the spike of the COVID-19 pandemic, thirteen respondents (12.0%) raised hesitate to agree with the implementation of this service due to issue of manpower and satisfied with the existing pharmacy value added services (PVAS) at the hospital. Therefore, re-evaluation of the needs of drive-thru pharmacy during COVID-19 pandemic based on the patients and caregivers’ perception should be conducted in future