1.Final Year Allied Health Profession, Midwifery and Nursing Students’ Attitudes towards Interprofessional Education
Malaysian Journal of Health Sciences 2019;17(2):17-24
Evaluation of pre-qualifying interprofessional education (IPE) programmes is important in exploring its effectiveness. The University of the West of England Interprofessional Questionnaire (UWE IPQ) has been rigorously validated, yet few studies using this tool have been published. We aimed to explore the attitudes of final year allied health profession (AHP), midwifery and nursing students towards IPE in this study. Differences between students’ attitudes towards IPE according to gender, undergraduate programmes, academic background and experience were also explored. A total of 103 participants, AHP (n=10), midwifery (n=19) and nursing (n=74) students took part in the study. This study design used a cross-sectional questionnaire survey, and was conducted within the Faculty of Health Sciences, University of Southampton. The validated UWE IPQ was administered to a volunteer sample of final year AHP, nursing and midwifery students in June 2010. Findings revealed that majority of the students rated their communication and teamwork skills (76.7%), interprofessional learning (74.8%) and interprofessional relationships (92.2%) positively, but they held negative attitudes towards interprofessional interactions (69.9%). Significant differences were found between participants’ attitudes towards interprofessional learning in relation to undergraduate programmes (p=0.01) and prior working experience in health and social care (p=0.03). IPE has shaped the students’ views regarding their collaborative learning and teamwork. Therefore, introducing IPE initiative from the beginning of the pre-qualifying stage at universities would motivate them to become interprofessional collaborative-ready professionals.
2.Extending the Roles of Community Pharmacists: Views from General Medical Practitioners
Azmi Sarriff ; Nazri Nordin ; Mohamed Azmi Ahmad Hassali
The Medical Journal of Malaysia 2012;67(6):577-581
This study investigates the views of general medical
practitioners (GP) to the extended role of the community
pharmacists (CP). A self-administered questionnaire was
distributed to all private clinics (n=438) run by GPs in the state of Penang. The questionnaire asked GP’s views on
ideas for new services provided by community pharmacists.
Three hundred and twenty-seven questionnaires were
collected, giving a response rate of 74.5%. More than 50% of respondents were in favour of the community pharmacist
involvement in activities of providing public health
education (58.7%), contacting GPs on matters related to
prescribing and prescription errors (56.0%), and referring
patients who exhibit drug-related problems (53.0%).
However, the respondents had a mixed opinion regarding
the roles of CPs in smoking cessation programme (34.8%)
and providing drug information to physicians (43.0%).
Additional research is needed to explain GPs attitudes
towards the acceptability of the new role of the pharmacist.
4.A Comparative Study of Different Induction Techniques (Propofol-Placebo, Propofol-Ephedrine and Propofol-Placebo-Crystalloid) on Intubating Conditions after Rocuronium Administration
Muhd Helmi Azmi ; Karis Misiran
Medicine and Health 2007;2(2):103-109
This was a prospective randomized double blind controlled study to compare intubating
conditions at 60 seconds with rocuronium 0.6 mg/kg by using three different induction
techniques: propofol-placebo (PP), propofol-ephedrine (PE) and propofol-placebocrystalloid
(PC). Ninety patients were included and randomly allocated to receive one of
the three combinations. The patients were induced using fentanyl 2 μg/kg, followed by
propofol 2.5 mg/kg with normal saline as placebo (Group PP and Group PC) or ephedrine
70 μg/kg (Group PE) given over 30 seconds. Subsequently, rocuronium 0.6 mg/kg was
given over five seconds and endotracheal intubations were performed 60 seconds later.
Intubating conditions were clinically acceptable in all patients except in four patients in PP
group, who had poor intubating conditions. The proportion of excellent intubating
conditions was significantly highest in Group PE (94%) followed by Group PC (81%) and
lowest in Group PP (50%). In conclusion, induction with propofol-ephedrine and propofol-placebo-crystalloid combinations provided significantly better intubating conditions than
propofol alone, when rocuronium 0.6 mg/kg was used for intubation at 60 seconds.
5.Drug Utilization Review of Potassium Chloride Injection Formulations Available in a Private Hospital in Kuching, Sarawak, Malaysia
Mohammad Hirman Melissa ; Sarriff Azmi
Malaysian Journal of Medical Sciences 2013;20(4):47-55
Background: The concentrated potassium chloride injection is a high-alert medication and replacing it with a pre-mixed formulation can reduce the risks associated with its use. The aim of this study was to determine the clinical characteristics of patients receiving different potassium chloride formulations available at a private institution. The study also assessed the effectiveness and safety of pre-mixed formulations in the correction of hypokalaemia.
Methods: This was a retrospective observational study consisting of 296 cases using concentrated and pre-mixed potassium chloride injections in 2011 in a private hospital in Kuching, Sarawak, Malaysia.
Results: There were 135 (45.6%) cases that received concentrated potassium chloride, and 161 (54.4%) cases that received pre-mixed formulations. The patients’ clinical characteristics that were significantly related to the utilization of the different formulations were diagnosis (P < 0.001), potassium serum blood concentration (P < 0.05), and fluid overload risk (P < 0.05). The difference observed for the cases that achieved or maintained normokalaemia was statistically insignificant (P = 0.172). Infusion-related adverse effects were seen more in pre-mixes compared to concentrated formulations (6.8% versus 2.2%, P < 0.05).
Conclusion: This study provides insight into the utilization of potassium chloride injections at this specific institution. The results support current recommendations to use pre-mixed formulations whenever possible.
Potassium Chloride
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Electrolytes
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Drug Utilization Review
6.Exploring the Halal Status of Cardiovascular, Endocrine, and Respiratory Group of Medications
Azmi Sarriff ; Hadeer Akram Abdul Razzaq
Malaysian Journal of Medical Sciences 2013;20(1):69-74
Muslim consumers have special needs in medical treatment that differ from non-Muslim consumers. In particular, there is a growing demand among Muslim consumers for Halal medications. This descriptive exploratory study aims to determine the Halal status of selected cardiovascular, endocrine, and respiratory medications stored in an out-patient pharmacy in a Malaysian governmental hospital. Sources of active ingredients and excipients for each product were assessed for Halal status based on available information obtained from product leaflets, the Medical Information Management System (MIMS) website, or manufacturers. Halal status was based on the products’ sources and categorized into Halal, Mushbooh, or Haram. The proportions of Halal, Mushbooh, and Haram products were at 19.1%, 57.1%, and 23.8%, respectively. The percentage of active ingredients for cardiovascular/endocrine products that were assessed as Haram was 5.3%; for respiratory medications, it was only 1.1%. For excipients, 1.7% and 4.8% fall under the category of Haram for cardiovascular/endocrine products and respiratory products, respectively. Ethanol and magnesium stearate were found to be the common substances that were categorized as Haram and Mushbooh.
7.Survival Difference between Surgery Versus Non-Surgery for the Treatment of Hepatocellular Carcinoma Patients at Liver Centre, Malaysia
Azmawati MN1 ; Azmi MT 1 ; Krishnan R2
Journal of Surgical Academia 2011;1(2):10-18
Hepatic resection, the only treatment that offers long term survival for patients with Hepatocellular carcinoma (HCC), have shown significant improvement in results over the past decades. The aim of the study was to compare the survival between patients receiving and not receiving surgery. A retrospective cohort study measured the survival of newly diagnosed cases of HCC patients who underwent treatment in Selayang Hospital from 1 January 2003 till 31 December 2006. Survival time was measured from the date of diagnosis until the subjects died or until the end of study period (31 December 2007). Overall survival was significantly longer in surgery group in comparison with non-surgery group with a median survival of 43 and 20 months, respectively (p<0.001). The following factors were noted to have improved survival duration with surgical resection; Child Pugh Class B patients, tumor size less or more than 4cm and number of nodules less than 3. Subgroup analysis showed improved survival duration with surgical resection among patients with Child Pugh Class B with tumor size less than 4cm or with nodule less than 3 and patients who had less than 3 nodules, even with tumor size of less or more than 4cm. Multivariate Cox Re-gression showed surgical intervention significantly improved survival time for overall patients (Adjusted HR: 1.5) while non-surgery improved survival in patients with tumor size less than 4cm (Adjusted HR: 0.4). Surgical resection significantly improved the survival duration in overall patients while non-surgical procedure improved survival if the tumor size was less than 4cm.
8.Bleeding Risk Factors with Enoxaparin for Patients with NSTEMI/UA in HUKM
Noraida Mohamed Shah ; Azmi Sarriff ; Rosnani Hashim
Malaysian Journal of Health Sciences 2008;6(1):23-24
Low-molecular-weight heparins (LMWHs) are antithrombotic agents utilised in the treatment of acute coronary syndromes. They have been shown to be
more effective than unfractionated heparins (UFHs) in reducing ischeamic events, which include death, myocardial infarction (MI) and urgent revascularisation. Enoxaparin is one of the products of LMWHs. Its safety and
efficacy has been proven in the ESSENCE and TIMI IIB studies. This study was carried out to identify risk factors that may affect bleeding complications
associated with the use of enoxaparin for non-ST-elevation MI (NSTEMI) or unstable angina (UA) in Universiti Kebangsaan Malaysia Hospital (HUKM).
This observational, longitudinal study was conducted on patients who were admitted to the Coronary Care Unit (CCU), Coronary Rehabilitation Ward (CRW), Medical 1 and Medical 2 wards at HUKM and initiated on enoxaparin
for NSTEMI/UA from 22nd of March until 22nd of April 2004. A total of 40 patients were included in the study with median age of 65 years, male to female ratio of
3:1, diagnosed with NSTEMI (55%) and UA (45%). 45% of patients developed an episode of bleeding and among them 83.3% (15 patients) characterised by
haematuria. Higher percentages of women (80%) and those with creatinine clearance of < 30ml/min (100%) had incidence of bleeding as compared to
men (50%) and those with creatinine clearance ≥ 30 ml/min, respectively (p <0.05 for both parameters). Age, enoxaparin dose and duration of therapy,
smoking and concomitant aspirin/ticlopidine therapy did not significantly affect the incidence of bleeding. In conclusion, renal impairment and gender
were associated with bleeding in relation with the use of enoxaparin that may require dose adjustments.
9.Bacteriological study of diabetic foot infections
Khairul Azmi ABD KADIR ; Muppidi SATYAVANI ; Ketan PANDE
Brunei International Medical Journal 2012;8(1):19-26
Introduction: Foot infections are one of the major complications of diabetes mellitus and a significant risk factor for lower extremity amputation. Providing effective antimicrobial therapy is an important component in treating these infections. This study assesses the microbial isolates of patients with diabetic foot infections and their antibiotic susceptibility pattern. Materials and Methods: A retrospective study of 75 patients with diabetic foot infections admitted to RIPAS hospital between June 2008 and June 2010 was undertaken. Bacteriological specimens were obtained and processed using standard hospital procedure for microbiological culture and sensitivity testing. Results: Overall, 40 (54%) patients had subcutaneous infections, 22 (29%) had infected superficial ulcers, seven (9%) had infected deep ulcers involving muscle tissues and six (8%) had osteomyelitis. A total of 98 pathogens were isolated. Forty percent of the patients had polymicrobial infection, 39 (52%) had single organism and 6(8%) had no growth. Gram-negative bacteria (67%) were more commonly isolated than gram-positive bacteria (30%). The three most frequently found gram-negative organisms were Pseudomonas aeruginosa (19.4%), Klebsiella pneumoniae (15.3%), and Acinetobacter spp. (10.2%) and gram-positive organisms were Staphylococcus aureus (10.2%), Streptococcus pyogenes (7.1%) and Methicillin resistant Staphylococcus aureus [MRSA] (7.1%). Vancomycin was found to be the most effective against gram-positive bacteria while amikacin was the most effective against gram-negative bacteria based on antibiotic testing. Conclusion: In 40% of diabetic feet infection was polymicrobial. Staphylococcus aureus and Pseudomonas aeruginosa were the most common gram-positive and gram-negative organisms respectively. This study helps us to choose the empirical antibiotics for cases of diabetic foot infections.
Diabetic Complications
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Diabetic Foot
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Microbiology
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Bacteriology
10.Inflammation of the Gums
Intan Suhana Munira Mat Azmi ; Farha Ariffin ; Hassan Basri Mukhali
Malaysian Family Physician 2020;15(1):71-73
An 18-year-old woman presented to the clinic with painless bleeding of her gums upon brushing her
teeth. The bleeding stopped spontaneously, and there was no other bleeding tendency. On further
questioning, the patient had irregular menses and was taking the oral contraceptive pills (OCP)
Diane-35ED® to regulate her menses. She had been on this medication for four months. She was not
on any other medication and had no chronic illness.