Public Hospitals In Malaysia Research Articles

Exploring Mentoring Skills to Assist New Nurses: Mentors’ and Mentees’ Perspectives

Studies on Western context have reported on the mentor skills needed such as the role of interpersonal comfort in mentoring relationships as well as the role of age in mentoring relationships. There are limited studies in exploring the effectiveness on the most relevant skills needed by mentors in assisting the new nurses toward becoming an effective healthcare provider in the Malaysian public hospital context. The mentors’ roles can be summarized into the general and specific role on the basis of the goal and the purpose of the mentoring. Mentor roles can be very broad and almost include everything under the sky of learning contract, therefore, the need to be more specific and clear direction in order to have clear understanding between the mentor, mentee and the organization. Data were collected from four pairs of mentors and mentees (eight informants) working in a public hospital in Sarawak, Malaysia, using open-ended questionnaires and analysed using content analysis. Findings revealed that the required skills of the mentors to better assist new nurses at the workplace can be captured through the acronym S.K.I.L.L.S. Hence, the nurses’ -management training and development programme related to S.K.I.L.L. acronym is relevant to be conducted among the new nurses. This strategy suggested because too many and unspecified roles may bring negative experiences for both mentor and mentee which may result in dysfunctional mentoring.

EQ-5D-3L health state utility values in transfusion-dependent thalassemia patients in Malaysia: a cross-sectional assessment

PurposeThere is a gap of information describing the health state utility values (HSUVs) of transfusion-dependent thalassemia (TDT) patients in Malaysia. These values are useful in the assessment of health-related quality of life (HRQoL), economic evaluations and provide guidance to disease management decisions. The objective of this study was to estimate and derive HSUVs associated with the treatment and complications of TDT patients in Malaysia using the EQ-5D-3L instrument.MethodsA cross-sectional survey using the EQ-5D-3L instrument was conducted between May to September 2018 across various public hospitals in Malaysia. Using a multi-stage sampling, patients diagnosed with TDT and receiving iron chelating therapy were sampled. The findings on the EQ-5D-3L survey were converted into utility values using local tariff values. A two-part model was used to examine and derive the HSUVs associated with the treatment and complications of iron overload in TDT.ResultsA total of 585 patients were surveyed. The unadjusted mean (SD) EQ-5D-3L utility value for TDT patients were 0.893 (0.167) while mean (SD) EQ VAS score was 81.22 (16.92). Patients who had more than two iron overload complications had a significant decline in HRQoL. Patients who were on oral monotherapy had a higher utility value of 0.9180 compared to other regimen combinations.ConclusionLower EQ-5D-3L utility values were associated with patients who developed iron overload complications and were on multiple iron chelating agents. Emphasizing compliance to iron chelating therapy to prevent the development of complications is crucial in the effort to preserve the HRQoL of TDT patients.

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

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

Evaluation of the tolerability and effectiveness of Tenecteplase in patients with ST-Segment-Elevation Myocardial Infarction in a Secondary Hospital in Malaysia: A Retrospective Case Series

BackgroundIn Malaysia, knowledge regarding the clinical efficacy of tenecteplase (TNK), a fibrin-specific tissue-plasminogen activator, is limited.ObjectivesTo evaluate the effectiveness and tolerability of TNK in patients with ST-segment-elevation myocardial infarction in a secondary referral Malaysian hospital.MethodsThis was a single-center retrospective case series based on the medical records of patients with ST-segment-elevation myocardial infarction admitted to the cardiac care unit between January 2016 and May 2019. Data regarding the mortality status and date of death were collected from the database of the National Registration Department of Malaysia.ResultsData for 30 patients with ST-segment-elevation myocardial infarction, who received weight-adjusted doses of TNK, were analyzed. The patients’ mean (SD) age was 62 (14) years, and 77% were men. The median time to treatment was 265 minutes (interquartile range = 228–660 minutes), and the clinical success rate of thrombolysis was 79%. The overall all-cause in-hospital mortality rate was 33%. The 1-year survival rates were higher in patients achieving a time to treatment ≤360 minutes (P = 0.03), with a trend toward greater survival in this group at 30 days. Similarly, a trend toward lower in-hospital all-cause mortality was observed in this group (21% vs 50%; P = 0.12). Only 1 patient (3%), who had a HAS-BLED score based on hypertension, abnormal liver/renal function, stroke history, bleeding history or predisposition, labile international normalized ratio, old age, drug/alcohol use of 5, developed major bleeding that required blood transfusion. No cases of ischemic stroke, nonmajor bleeding, in-hospital reinfarction, or TNK-induced allergic reaction were identified.ConclusionsWe hypothesized that the mortality-related outcomes of TNK in patients with ST-segment-elevation myocardial infarction were influenced by TTT, with TTT ≤360 minutes indicating a better prognosis than TTT >360 minutes. TNK-induced bleeding-related complications were minimal in low-risk patients. Further local studies are needed to compare TNK's profile with that of streptokinase, which is a common agent currently used in clinical practice in Malaysian public hospitals. (Curr Ther Res Clin Exp. 2021; 82:XXX–XXX)

Energy Performance Contracting Initiative in Malaysian Public Hospitals

Ministry of Health Malaysia (MOH) has integrated sustainability program in the management of its assets particularly hospital buildings in line with the national sustainability goals and the United Nation Sustainable Development Goals. The fundamental sustainability change is significant since 2015 in the public healthcare sector where green business practice is more appreciable through formation of policy and sustainability related programme. Public hospital in Malaysia are very high energy consumers, therefore various energy projects have been implemented through Energy Performance Contracting (EPC). EPC projects in MOH is intended to deliver energy expenditure savings as well as to offset hospital building carbon footprint. EPC practice in government hospitals have managed to offset about 15.7 ktonne carbon emission in 2019 or about 16% of Government building national emission reduction target. Energy project such as energy efficient chiller retrofit, LED lighting retrofit and solar thermal hot water are some of the EPC initiatives by MOH in public hospitals. The energy projects not only serve to meet the overall Hospital Facility Management Contract sustainability goals but also to complement the green building target for Malaysian Healthcare building by 2025. The aim of this paper is to review the development of the EPC projects in public healthcare sector and its impact on government energy spending as well as to the climate.

The Practice of Patient Education among Public Hospital Nurses in Malaysia

Patient education is the process of influencing patient behaviour with using a combination method such as teaching, counselling and behaviour modification techniques to increasing the knowledge and maintain or improve health. Patient education is one way of communication between patient and nurses, which provides the necessary knowledge for enhancing patient care and potentially affecting their health outcomes. By doing the exploration on the current patient education practice, the study perhaps to overcome the issue of hospital readmission and patient able to manage their activities of daily living after receiving effective patient education. The study aims to investigate the perception and practice of patient education among nurses in one of the public hospital in Malaysia. The objective of this study was to identify the perception and factors influencing the practice of patient education among public hospital nurses. Stratified Random Sampling was used for the sampling technique. A total of 246 staff nurses were involved in this study. A self-administered questionnaire was used in this study for obtained data. Statistical Package for the Social Sciences (SPSS) for Windows, version 21 was used to analyse the data. The study revealed that most of the nurses perceived patient education as a high priority in nursing care and it was nursing responsibility to provide patient education. Findings indicated that lack of time, inadequate staffing and lack of knowledge were significant factors that influenced the practice of patient education. Years of working experience among the nurses was found to be significantly associated with priority for patient teaching. In conclusion, public hospital nurses were having a positive attitude towards patient education but could not practice completely. In order to enhance patient education, a more strategy is required to address inadequate staffing, lack of time, and lack of knowledge. This study needs to be extended into further research in order to enhance the nurses’ roles as patient educators. Keywords: Patient education, nurses, practice eISSN: 2398-4287© 2020. The Authors. Published for AMER ABRA cE-Bs by e-International Publishing House, Ltd., UK. This is an open access article under the CC BYNC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning & Surveying, Universiti Teknologi MARA, Malaysia. DOI: https://doi.org/10.21834/ebpj.v5i15.2476.

Factors associated with influenza vaccine uptake amongst health care workers in a public hospital in Malaysia

Background: Health care workers (HCWs) are at risk of acquiring influenza virus infection compared to the general population and may potentially transmit the virus to patients. Therefore, influenza vaccine is an important preventive strategy to overcome this problem. However, the vaccination coverage among HCWs is low despite the availability of vaccines in hospitals. The objective of this study is to study the uptake of influenza vaccine in HCWs and to determine the factors influencing the vaccine uptake. In 2018, a total of 506 HCWs from various departments in Hospital Tengku Ampuan Rahimah Klang (HTAR), a public hospital in Malaysia, received influenza vaccination Methods and materials: Amongst the 506 HCWs, 286 were staff nurses, 74 were doctors, 64 were pharmacists while 82 were from other categories in the supporting staff group. In our study we decided to focus on departments with highest risk of exposure namely medical, anaesthesiology and paediatric departments. We also focused on highly at risk HCWs whom were the doctors and staff nurses. A cross sectional study using questionnaire survey was conducted Results: 160 HCWs were selected from the four departments, comprising 80 vaccinated and 80 unvaccinated HCWs in the year 2018. Among those 80 HCWs who took the vaccine, 82.5% were staff nurses and only 13% were doctors. The staff nurses were more likely to get vaccinated (OR 5.15, p = 0.2569) compared to the doctors in HTAR. Among those who were not vaccinated, 42.5% reported that they did not have time to get vaccinated while 20% expressed their fear for side effects. The rest of the respondents (37.5%) reported that they disliked needles, unaware about the vaccine and fear of getting sick after being vaccinated. Amongst the recommendations suggested by some of the HCWs to increase vaccine uptake were up scaling promotion using social media, CME, campaign leaflets, posters (47.5%) and fixing scheduled days to take the vaccines (9.4%). This study shows that promotion and education are vital to improve the uptake of influenza vaccination. Conclusion: The lack of uptake amongst doctors needs to be addressed urgently.

The outcome of three-factor Prothrombin Complex Concentrate (3F-PCC) in warfarin reversal: A single center retrospective cohort study

IntroductionThree-factor Prothrombin Complex Concentrate (3F-PCC) containing factors II, IX and X was introduced to Malaysian public hospitals for warfarin reversal since 2017. Local studies on the outcomes of 3F-PCC use are limited. ObjectiveThis study aimed to determine the extent of target international normalized ratio (INR) achievement and adverse drug reactions (ADRs) associated with 3F-PCC use in warfarin reversal. Materials and methodsThis retrospective cohort study analyzed data from adult patients on warfarin who received 3F-PCC for anticoagulation reversal between September 2017 to January 2020. Study endpoints included achievement of target INR, ADRs and in-hospital mortality. ResultsSeventy-seven patients with a median age of 65.0 (55.5–75.0) years comprising of 50.6% (n ​= ​39) men were included. Fifty-one patients required 3F-PCC for life-threatening (29.9%, n ​= ​23) and clinically significant (36.4%, n ​= ​28) bleeding. Initial INRs ranged from 1.69 to undetectable high (>24). All patients had INR reduction, of which 40.3% (n ​= ​31) achieved target INR whereas 6.5% (n ​= ​5) achieved INR below target range. Median INR reduced from 4.14 (2.89–8.13) to 1.57 (1.33–1.97). Race, gender, age, initial INR and concomitant use of adjuvant reversal therapy did not affect target INR achievement. Three (3.9%) out of four ADRs observed were associated with mortality including suspected acute coronary syndrome (n ​= ​2) and disseminated intravascular coagulopathy (n ​= ​1) among those with life-threatening bleeding. The incidence of in-hospital mortality was 19.5% (n ​= ​15). ConclusionThe use of 3F-PCC (Prothrombinex-VF®) produces variable reduction in INR in our population without apparent risk of thromboembolic events and in-hospital mortality.

Assessments of Dietary Characteristics, Adherence and Glycemic Control in Individuals with Type 2 Diabetes: A Sampled from a Selected Public Hospital in Malaysia

Assessments of Dietary Characteristics, Adherence and Glycemic Control in Individuals with Type 2 Diabetes: A Sampled from a Selected Public Hospital in Malaysia

Quality measures of a multicentre universal newborn hearing screening program in Malaysia.

To evaluate and discuss the outcomes of the universal newborn hearing screening program conducted at four public hospitals in Malaysia. A retrospective analysis of the universal newborn hearing screening database from each hospital was performed. The database consisted of 28,432 and 30,340 screening results of babies born in 2015 and 2016, respectively. Quality indicators (coverage rate, referral rate, return for follow-up rate, and ages at screening and diagnosis) were calculated. Overall coverage rate across the four hospitals was 75% in 2015 and 87.4% in 2016. Over the two years, the referral rates for the first screening ranged from 2.7% to 33.93% with only one hospital achieving the recommended benchmark of <4% in both years. The return for follow-up rates for each participating hospital was generally below the recommended benchmark of ≥95%. The mean age at screening was 3.9 ± 1.2 days and 3.3 ± 0.4 days, respectively. The mean age at diagnosis for 70 infants diagnosed with permanent hearing loss was 4.7 ± 0.7 months in 2015 and 3.6 ± 0.9 months in 2016. Quality measures for the universal newborn hearing screening program in four public hospitals in Malaysia were lower than the required standards. Nevertheless, some quality indicators showed statistically significant improvements over the two years. Next steps involve identifying and implementing the best practice strategies to improve the outcome measures and thus the quality of the program.

Exploring Communication Processes in Referral Pathways for Chronic Disease Management: Malaysian Public Primary Health care Experiences

BACKGROUND: Referrals are a two-way communication between healthcare facilities to enable information transfer for the continuity of patient care. The Enhanced Primary Healthcare (EnPHC) initiative, a complex intervention package to improve non-communicable disease (NCD) management, introduced improvements to the NCD&amp;rsquo;s referral mechanism from primary healthcare clinics to the hospital. This study explores the communication process between the Malaysian public primary healthcare and hospital for chronic care management.&amp;nbsp; &#x0D; &#x0D; METHOD: A qualitative exploratory study using purposive sampling was done in all twenty EnPHC intervention clinics. In-depth interviews and focus group discussions were carried out among all healthcare providers working in EnPHC clinics. The 47 interview sessions were audio-recorded, transcribed verbatim, and analyzed thematically.&#x0D; &#x0D; RESULTS: A total of 97 healthcare providers participated. Three main themes of the communication process between the primary health care and hospital during the implementation of EnPHC intervention emerged from the analysis. These are; (1) structured information relay, (2) no show appointment tracking via various communication devices has strengthened the mechanism to monitor the referred patient appointment scheduling and their adherence to the appointment, and (3) inter-facility networking facilitated the implementation of EnPHC&amp;rsquo;s referral mechanism.&#x0D; &#x0D; CONCLUSION: The EnPHC referral mechanism created a platform for PHC clinics and hospitals to communicate and build rapport to help ensure care continuity for NCD patients. The traditional method of communication between healthcare facilities should change and instead start using the newest or most current, advanced technology.

Role stressors and turnover intention among doctors in Malaysian public hospitals: work–family conflict and work engagement as mediators

PurposeThis study aims to investigate the role of work–family conflict (WFC) and work engagement (WE) and its influence on role stressors and turnover intention among medical doctors in Malaysian public hospitals. Doctors who experience higher work stress will inevitably experience WFC, consequently triggering their intention to quit.Design/methodology/approachA total of 202 structured questionnaire responses were collected from medical doctors in four Malaysian public hospitals. The study used partial least squares structural equation modeling (SmartPLS 3.0) for hypotheses testing.FindingsAs hypothesized, WFC encourages turnover intention while WE mitigate the relationship between role ambiguity (RA)-TI. RA is also observed to reduce WE, which, in turn, increases the intention to quit. Findings showed that both role conflict and WFC share a positive relationship with TI while WE and TI are negatively related. Furthermore, it was found that WE and WFC are significant mediators in the RA and TI relationship. WFC is also reported to be a significant mediator between the RC and TI relationship.Research limitations/implicationsThe causality effects remain limited due to the nature of the cross-sectional design. Future studies should use a longitudinal approach to gauge a better understanding of these relationships.Practical implicationsThis study provides insights for policymakers in resolving the increase of turnover issues by providing support and relieving medical doctors’ stress levels. Health directors should be encouraged to focus on the key aspects that may directly affect the well-being of medical doctors and eventually reduced staff turnover.Originality/valueThe study contributes to existing knowledge by measuring variables such as job demand (RS and WFC), personal resources (WE) and job outcomes (TI) in the public health care sector. Additionally, research involving COR theory in Asian countries like Malaysia remains relatively underexplored.

The Impact of Social Support on Nurses’ Motivation: A Cross-Sectional Study in Malaysia

Motivation is exceptionally crucial in influencing the quality of health care work outcomes. In view of the mounting challenges and stressful work environment faced by nurses, social support has been identified as an essential resource that helps promote their work motivation. The central aim of this study is to explore three forms of social support (perceived organizational support, perceived supervisory support, and perceived peer support) on nurses' motivation. Cross-sectional data were collected via questionnaires from a sample of 354 nurses working in Malaysian public hospitals. The hypothesized model was tested using partial least squares method. Our results disclosed that all forms of social support have positive effects on motivation.

DETERMINANTS OF PATIENT SATISFACTION ON INTERIOR DESIGN QUALITY OF PUBLIC HOSPITALS IN MALAYSIA

Being in a hospital can be a stressful experience especially to the patients. The importance of design quality as a trigger to patients' satisfaction is becoming a topic of significant relevance as it also impacts the building operation. This study aims to determine the factors influencing the patients' satisfaction toward the interior design quality of inpatient units at public hospitals in Malaysia. Self-administered questionnaires were distributed among 483 inpatients from 5 Obstetrics and Gynaecology wards at public hospitals in the Klang Valley region. The Structural Equation Model (SEM) technique was applied to examine the causal relationship and to test the hypothesis of the patients' satisfaction toward the interior design quality. The results revealed that space planning (β = 0.265), lighting (β = 0.263), furniture (β = 0.243), and color (β = 0.138) have a significantly positive effect on patients' satisfaction toward the interior design quality. Whereas way-finding, safety, air quality and accessibility have no significant effect on the patients' satisfaction. This study concludes that certain qualities of interior design have great impact on patients' satisfaction. The findings proved that revamping the inpatient units' space planning can lead to significant patient experience improvements, while the aspect of accessibility is the least concern to the patients when they stay in the hospital. This study provides input to help designers, architects and hospital planners to evaluate their priorities in planning and designing better hospitals in the future.

Fatigue and recovery among Malaysian doctors: the role of work-related activities during non-work time.

ObjectivesThis paper aims to estimate the level of acute fatigue, chronic fatigue and intershift recovery among doctors working at public hospitals in Malaysia and determine their inter-relationship and their association with work-related activities during non-work time.DesignCross-sectional.SettingSeven core clinical disciplines from seven tertiary public hospitals in Malaysia.ParticipantsStudy was conducted among 330 randomly-sampled doctors. Response rate was 80.61% (n=266).ResultsThe mean score of acute fatigue, chronic fatigue and intershift recovery were 68.51 (SD=16.549), 54.60 (SD=21.259) and 37.29 (SD=19.540), respectively. All these scores were out of 100 points each. Acute and chronic fatigue were correlated (r=0.663), and both were negatively correlated with intershift recovery (r=−0.704 and r=−0.670, respectively). Among the work-related activities done during non-work time, work-related ruminations dominated both the more frequent activities and the association with poorer fatigue and recovery outcomes. Rumination on being scolded/violated was found to be positively associated with both acute fatigue (adjusted regression coefficient (Adj.b)=2.190, 95% CI=1.139 to 3.240) and chronic fatigue (Adj.b=5.089, 95% CI=3.876 to 6.303), and negatively associated with recovery (Adj.b=−3.316, 95% CI=–4.516 to –2.117). Doing work task at workplace or attending extra work-related activities such as locum and attending training were found to have negative associations with fatigue and positive associations with recovery. Nevertheless, doing work-related activities at home was positively associated with acute fatigue. In terms of communication, it was found that face-to-face conversation with partner did associate with higher recovery but virtual conversation with partner associated with higher acute fatigue and lower recovery.ConclusionsWork-related ruminations during non-work time were common and associated with poor fatigue and recovery outcomes while overt work activities done at workplace during non-work time were associated with better fatigue and recovery levels. There is a need for future studies with design that allow causal inference to address these relationships.

Streptokinase and streptokinase card: questionnaire validation to evaluate knowledge among post‐STEMI patients in a Malaysian Tertiary Hospital

AbstractBackgroundAlthough recombinant tissue plasminogen activator has become the first‐line thrombolytic agent, streptokinase remains in use in acute ST‐elevation myocardial infarction (STEMI) patients in Malaysian public hospitals. In a state hospital in Malaysia, all post‐STEMI patients given streptokinase are counselled and issued with a streptokinase card by pharmacists. Due to its highly antigenic nature, knowledge of streptokinase and the streptokinase card serve as an important alert to healthcare providers. This study aimed to develop a validated questionnaire on evaluating knowledge of streptokinase and streptokinase card among post‐STEMI patients.MethodsA Malay language questionnaire was developed based on literature review and standard streptokinase counselling checklist. The questionnaire consists of three parts: demographics, knowledge of streptokinase and understanding of streptokinase card. The content of the questionnaire was revised by eight experts (emergency specialists, physicians and pharmacists) and six patients were interviewed via telephone 2 weeks after being issued with a streptokinase card, to test for comprehensibility. Then, a telephone survey was conducted June‐December 2017 involving another 60 patients to test for construct validity and reliability.ResultsThe questionnaire was finalised by decreasing the overall number of items from 6 to 5 (Section B) and 6 to 4 (Section C). The overall measurement of sample adequacy (MSA) was 0.758. Bartlett's test was highly significant (&lt;0.001). The Cronbach's alpha values for Sections B and C were 0.747 and 0.841, respectively.ConclusionOur nine‐item questionnaire is a valid and reliable instrument to assess knowledge of streptokinase and the streptokinase card among Malaysian post‐STEMI patients.

Parking Characteristics in Malaysia Public Hospitals

Parking in public hospitals has been a significant issue for public, authorities and parking operators running the facility within the hospital compound. In view to the fact that private vehicles are the preferred mode of choice for commuting in Malaysia, the issue could not get any better. This paper attempts to evaluate parking characteristics in public hospitals in Malaysia. Parking characteristics at six public hospitals in Peninsular Malaysia were investigated. Secondary data were obtained from Ministry of Health. License Plate methodwas used to collect parking demand data as a primary data for a period of 12 hours at public hospitals.Parking duration, parking turnover and parking index were determined to investigate parking scenario at each respective study sites. It was found that long parking hours was a nature in public hospitals with average parking duration of almost 4 hours/veh. Higher parking turnover rate was also observed for public bay area. The average parking index for all hospitals was also more than 100% in which it exceeding the capacity. The actual parking demand was found to be higher than the provided parking space at all public hospitals under investigation and it is also far below the specified various guidelines except for EPU guideline.

Public Hospital Pharmacists' Perceptions and Knowledge of Antibiotic Use and Resistance: A Multicenter Survey.

Antimicrobial Stewardship Program (ASP) has been implemented in major public hospitals in Malaysia, with pharmacists playing a key role in ensuring the appropriate use of antibiotics. This survey aimed to assess the practices, perceptions, and knowledge of public hospital pharmacists on antibiotic use and resistance. A cross-sectional survey involving pharmacists from six public hospitals in Penang was conducted using a self-administered validated questionnaire. The majority of pharmacists perceived that polypharmacy (92%, n = 270) and overuse of broad-spectrum antibiotics (85%, n = 252) can potentially induce resistance of microorganisms and that ensuring the rational use of antibiotics is a shared responsibility between clinicians and pharmacists (94%, n = 278). A large majority of the pharmacists think that formal training in infectious disease should be a pre-requisite for pharmacists in ASP (93%, n = 273). In terms of antibiotic selection, the availability of antibiotics in hospital (81%, n = 234) and patient’s clinical condition (68%, n = 196) are more of a concern to the pharmacists. A total of 65% of the respondents (n = 192) demonstrated good levels of knowledge with a mean knowledge score of 10.1 out of 13 (95% CI: 9.95; 10.31). Pharmacists from the managerial level, ward pharmacy, in-patient, and medication therapy adherence clinic (MTAC) unit had better knowledge of antibiotics compared to pharmacists from other units (p < 0.001). Antibiotic knowledge gap had been identified among pharmacists in different work settings, and longer years of service does not warrant good antibiotic knowledge.

In vivo Slit Scanning Confocal Microscopic Observation in a Patient with Keratoconus Wearing Miniscleral Contact Lens for One Year: A Case Report

The purpose of the present case report was to evaluate corneal microstructure in a patient with keratoconus wearing miniscleral contact lens (MS CL) for 1 year. A 38 years old patient diagnosed with stage III keratoconus in right eye and corneal graft (penetrating keratoplasty) in left eye was referred to optometry department of a public hospital in Malaysia. Based on the MS CLs fitting performance on the patient’s eye, MS CLs were prescribed in both eyes. However, patient opted for MS CL only in the right eye. In vivo slit scanning confocal microscopy was performed at baseline and after 1 year of contact lens wear in right eye. Qualitative analysis was done using a grading scale designed by Hollingsworth et al. (2005a), while quantitative analysis was performed using NAVIS software in a fixed frame of 0.06 mm². After 1 year of MS CL wear, qualitative observation of right cornea showed no change in stromal haze and architecture of nerve fibers. However, morphological alterations like dark bands were observed both in anterior and posterior stroma along with tendency of clustering keratocyte nuclei in posterior stroma. Quantitative analysis showed that anterior and posterior stroma keratocyte density and endothelium cell density were relatively low after 1 year of MS CL wear (817.3, 667.2, and 2577 cells/mm², respectively) caompared to baseline observation (850.7, 705.0, and 2666 cells/mm², respectively). Mean cell area of anterior stroma, posterior stroma and endothelium were also different in post MS CL wear. Polymegathism and pleomorphism calculated by NAVIS software were varied after 1 year (49.6% and 37.5%, respectively) compared to baseline (67.1% and 29.6%, respectively). In the discussed case, noticeable changes were observed in corneal microstructure after 1 year of MS CL wear. Thereby, in conclusion we recommend future studies with more number of keratoconic eyes wearing MS CLs to emphasize the findings on microstructural changes in keratoconic cornea wearing MS CLs.

A Prospective Cohort Study of Factors Associated with Empiric Antibiotic De-escalation in Neonates Suspected with Early Onset Sepsis (EOS).

BackgroundProlonged empiric antibiotic use, resulting from diagnostic uncertainties, in suspected early onset sepsis (EOS) cases constitutes a significant problem. Unnecessary antibiotic use increases the risk of antibiotic resistance. Furthermore, prolonged antibiotic use increases the risk of mortality and morbidity in neonates. Proactive measures including empiric antibiotic de-escalation are crucial to overcome these problems.MethodsThis was a prospective cohort study conducted in the neonatal intensive care units of two public hospitals in Malaysia. Neonates with a gestational age greater than 34 weeks who were started on empiric antibiotics within 72 h of life were screened. The data were then stratified according to de-escalation and non-de-escalation practices, where de-escalation practice was defined as narrowing down or discontinuation of empiric antibiotic within 72 h of treatment.ResultsA total of 1045 neonates were screened, and 429 were included. The neonates were then divided based on de-escalation (n = 207) and non-de-escalation (n = 222) practices. Neonates under non-de-escalation practices showed significantly longer durations of antibiotic use compared to those under de-escalation practices (p < 0.05), with no difference in treatment outcomes. Five factors were found to be associated with de-escalation of antibiotics. They are cesarean section delivery, exposure to antenatal steroids, nil history of maternal pyrexia, absence of meconium-stained amniotic fluid, and normal C-reactive protein ≤ 0.5 mg/dL (p < 0.05).ConclusionsEmpiric antibiotic de-escalation appears feasible as a routine form of treatment for EOS in late preterm and term neonates.