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Chew CC, Lim XJ, Letchumanan P, George D, Rajan P, Chong CP. The effectiveness of pharmacist-led educational model in adult patients with allergic rhinitis: a single-center randomized control trial protocol (AR-PRISE RCT). Trials 2024; 25:279. [PMID: 38664701 PMCID: PMC11044482 DOI: 10.1186/s13063-024-08111-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Allergic rhinitis is a chronic respiratory disorder that significantly impacts patients' quality of life (QoL) and work performance. Pharmacists are recognized as suitable professionals to provide patient education and pharmaceutical care for managing allergic rhinitis patients. However, local clinical practice guidelines, particularly regarding pharmaceutical care in public healthcare institutions, are lacking. This study protocol outlines a randomized controlled trial (RCT) designed to evaluate the effectiveness of a pharmacist-led educational model (AR-PRISE Model) in managing allergic rhinitis in adult patients compared to standard pharmaceutical care. The AR-PRISE model delivers patient educational material and a pharmaceutical care algorithm. METHOD This is a 6-month, single-center, prospective, randomized, two-arm, and parallel-group controlled trial. The trial recruits patients attending the otorhinolaryngology clinics of a tertiary referral hospital. Participants are randomized into control or intervention groups in a 1:1 ratio using permuted block randomization. The total number of participants estimated is 154, with each group requiring 77 participants. The control group receives standard pharmaceutical care, while the intervention group receives pharmacist-led education according to the AR-PRISE model. Both groups are assessed for middle turbinate endoscopy findings, disease severity, knowledge level, symptom control, medication adherence, and QoL at baseline and the end-of-study follow-up (day 180 ± 7). Depending on feasibility, intermediate follow-ups are conducted on days 60 ± 7 and 120 ± 7, either virtually or face-to-face. During intermediate follow-ups, participants are assessed for symptom control, medication adherence, and QoL. The intention-to-treat analysis includes all participants assigned to each group. An independent T-test compares the mean difference in knowledge level between the two groups. A two-way repeated measures ANOVA analysis is employed to determine between-group differences for scores of symptom control, adherence rate, and QoL. A P-value < 0.05 is considered statistically significant. DISCUSSION This study protocol will provide a framework for conducting a randomized controlled trial (RCT) to evaluate the effectiveness of pharmacist-led education intervention in managing allergic rhinitis within public healthcare settings. The parameters measured in this trial will quantify outcomes associated with improvements in symptoms and QoL. By systematically assessing these outcomes, we aim to contribute valuable insights into the role of pharmacist-led interventions in enhancing the management of allergic rhinitis in public healthcare settings. TRIAL REGISTRATION ClinicalTrials.gov NCT06027736 . Registered on 9 July 2023-retrospectively registered.
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Affiliation(s)
- Chii-Chii Chew
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Minden, Penang, 11800, Malaysia
| | - Xin-Jie Lim
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health, Level 4, Ambulatory Care Centre (ACC), Jalan Raja Ashman Shah, Ipoh, Perak, 30450, Malaysia.
| | - Pathma Letchumanan
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Raja Permaisuri Bainun, Ministry of Health, Ipoh, Perak, Malaysia
| | - Doris George
- Pharmacy Department, Hospital Taiping, Ministry of Health, Taiping, Perak, Malaysia
| | - Philip Rajan
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health, Level 4, Ambulatory Care Centre (ACC), Jalan Raja Ashman Shah, Ipoh, Perak, 30450, Malaysia
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Raja Permaisuri Bainun, Ministry of Health, Ipoh, Perak, Malaysia
| | - Chee Ping Chong
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Minden, Penang, 11800, Malaysia
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Chang CT, Chan HK, Cheah WK, Tan MP, Ch'ng ASH, Thiam CN, Abu Bakar NA, Yau WK, Abu Hassan MR, Rajan P, Tan KC, Ambigapathy S, Vengadasalam P, Zaman Huri S, Arvinder-Singh HS, Thum CC, Chung WM, Ooi JH, Sabki NH, Lee HP, Mohd Shariff SM, Azman MA, Teoh SL, Lee SWH. Development of a Malaysian potentially inappropriate prescribing screening tool in older adults (MALPIP): a Delphi study. J Pharm Policy Pract 2023; 16:122. [PMID: 37858273 PMCID: PMC10588247 DOI: 10.1186/s40545-023-00630-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/03/2023] [Indexed: 10/21/2023] Open
Abstract
INTRODUCTION Polypharmacy and potentially inappropriate medications (PIM) are common among older adults. To guide appropriate prescribing, healthcare professionals often rely on explicit criteria to identify and deprescribe inappropriate medications, or to start medications due to prescribing omission. However, most explicit PIM criteria were developed with inadequate guidance from quality metrics or integrating real-world data, which are rich and valuable data source. AIM To develop a list of medications to facilitate appropriate prescribing among older adults. METHODS A preliminary list of PIM and potential prescribing omission (PPO) were generated from systematic review, supplemented with local pharmacovigilance data of adverse reaction incidents among older people. Twenty-one experts from nine specialties participated in two Delphi to determine the list of PIM and PPO in February and March 2023. Items that did not reach consensus after the second Delphi round were adjudicated by six geriatricians. RESULTS The preliminary list included 406 potential candidates, categorised into three sections: PIM independent of diseases, disease dependent PIM and omitted drugs that could be restarted. At the end of Delphi, 92 items were decided as PIM, including medication classes, such as antacids, laxatives, antithrombotics, antihypertensives, hormones, analgesics, antipsychotics, antidepressants, and antihistamines. Forty-two disease-specific PIM criteria were included, covering circulatory system, nervous system, gastrointestinal system, genitourinary system, and respiratory system. Consensus to start potentially omitted treatment was achieved in 35 statements across nine domains. CONCLUSIONS The newly developed PIM criteria can serve as a useful tool to guide clinicians and pharmacists in identifying PIMs and PPOs during medication review and facilitating informed decision-making for appropriate prescribing.
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Affiliation(s)
- Chee Tao Chang
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Malaysia.
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Malaysia.
| | - Huan Keat Chan
- Clinical Research Centre, Hospital Sultanah Bahiyah, Ministry of Health Malaysia, Alor Setar, Malaysia
- Clinical Research Centre, Hospital Taiping, Ministry of Health Malaysia, Taiping, Malaysia
| | - Wee Kooi Cheah
- Department of Medicine, Hospital Taiping, Ministry of Health Malaysia, Taiping, Malaysia
| | - Maw Pin Tan
- Ageing and Age-Associated Disorders Research Group, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Department of Medical Sciences, School of Healthcare and Medical Sciences, Sunway University, Petaling Jaya, Malaysia
| | - Alan Swee Hock Ch'ng
- Clinical Research Centre, Hospital Seberang Jaya, Ministry of Health Malaysia, Seberang Jaya, Malaysia
| | - Chiann Ni Thiam
- Department of Medicine, Hospital Sultanah Bahiyah, Ministry of Health Malaysia, Alor Setar, Malaysia
| | - Nor Azlina Abu Bakar
- Medical Department, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Malaysia
| | - Weng Keong Yau
- Medical Department, Hospital Kuala Lumpur, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Muhammad Radzi Abu Hassan
- Clinical Research Centre, Hospital Sultanah Bahiyah, Ministry of Health Malaysia, Alor Setar, Malaysia
| | - Philip Rajan
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Malaysia
| | - Kar Choon Tan
- Hepatological Department, Hospital Selayang, Ministry of Health Malaysia, Selayang, Malaysia
| | | | | | - Surina Zaman Huri
- Psychiatry Department, Hospital Sultan Ismail, Ministry of Health Malaysia, Johor Bahru, Malaysia
| | - H S Arvinder-Singh
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Malaysia
- Department of Community Medicine, Hospital University Kebangsaan Malaysia, Bangi, Malaysia
| | - Chern Choong Thum
- Department of Psychiatry, Hospital Sultan Abdul Aziz Shah, Universiti Putra Malaysia, Serdang, Malaysia
| | - Wai Mun Chung
- Emergency and Trauma Department, Hospital Taiping, Taiping, Malaysia
| | - Jun How Ooi
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Noor Hamizah Sabki
- Pharmacy Department, Hospital Taiping, Ministry of Health Malaysia, Taiping, Malaysia
| | - Hooi Peng Lee
- Pharmacy Department, Hospital Kuala Lumpur, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | | | - Muhammad Azuan Azman
- Pharmacy Department, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Malaysia
| | - Siew Li Teoh
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Malaysia
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Chew CC, Lim XJ, Letchumanan P, Narayanan MS, Rajan P, Chong CP. Development and validation of a pharmacist-led education model in allergic rhinitis management: a multi-phase study. J Pharm Policy Pract 2023; 16:116. [PMID: 37794504 PMCID: PMC10548631 DOI: 10.1186/s40545-023-00625-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 09/27/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Patient education is identified as one of the core and fundamental management strategies in the management of allergic rhinitis. The Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines developed guidance for the management of allergic respiratory disease, and the guidelines are applicable to the international context. The ARIA guidelines for the pharmacy have specifically encouraged the creation of local pharmacist-led intervention in allergic rhinitis management. This study aims to develop a pharmacist-led educational model using a multi-phase study approach. METHOD In phase one, we conducted a literature review using four databases to extract relevant articles and clinical practice guidelines published between 2017 and 2022. The information was structured into a questionnaire consisting of patient education material (10 domains with 130 items) and pharmacist counseling scopes (15 domains with 43 items), with each item having a rating scale ranging from 1 (lowest) to 9 (highest) level of agreement. Fifty-two panellists, including otorhinolaryngologists and pharmacists, were invited to complete the questionnaire. A consensus agreement was considered when at least 70% of panellists scored 7 to 9 (critically important). A two-round survey was conducted, and descriptive analysis, inter-rater reliability (≥ 0.5-1 indicate moderate to excellent reliability), variation in the relative interquartile (VRIR < 0.3 indicate good stability), and variation in the coefficient of variation (VCV < 40% considered consensus achieved) were performed. In phase two, patient education material was developed into audio-visual format, and in phase three, patients rated its understandability and actionability using a validated Patient Education Materials Assessment Tool. RESULTS In the round one Delphi survey, 43 panellists responded, with 171 out of 173 items achieving "consensus agreement" (75.4-100%). In the second survey, 32 out of 43 panellists responded, with most items (171 out of 173 items) stable across rounds and all items had acceptable internal consistency (VCV: - 12.21-15.81). Two items did not achieve "consensus agreement" (64%) but improved in round two (92.9%), however, instability was observed (VRIR: 0.36). These two items were retained in the model due to achieving the minimum level of agreement and internal consistency (VCV = 15.81). Inter-rater reliability was 0.608 and 0.970 in the respective rounds. Patients rated the educational material as understandable (81.8-100%) and actionable (100%). CONCLUSION The validated pharmacist-led education model, with its educational materials tested on end-users, provides structured patient education and pharmaceutical care in assisting patients with allergic rhinitis. The educational material allows the delivery of standardized information by the healthcare providers to the patients. Further research on the effectiveness of this model in improving patients' symptom control and quality of life is warranted.
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Affiliation(s)
- Chii-Chii Chew
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Minden, Penang, Malaysia
| | - Xin-Jie Lim
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health, Level 4, Ambulatory Care Centre (ACC), Jalan Raja Ashman Shah, 30450, Ipoh, Perak, Malaysia.
| | - Pathma Letchumanan
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Raja Permaisuri Bainun, Ministry of Health, Ipoh, Perak, Malaysia
| | - Maithrea Suresh Narayanan
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Raja Permaisuri Bainun, Ministry of Health, Ipoh, Perak, Malaysia
| | - Philip Rajan
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health, Level 4, Ambulatory Care Centre (ACC), Jalan Raja Ashman Shah, 30450, Ipoh, Perak, Malaysia
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Raja Permaisuri Bainun, Ministry of Health, Ipoh, Perak, Malaysia
| | - Chee Ping Chong
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Minden, Penang, Malaysia
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Chang CT, Teoh SL, Cheah WK, Lee PJ, Azman MA, Ling SH, Chuah ASC, Sabki NH, George D, Oh HL, Goh JY, Lee SH, Foong WK, Lee JCY, Chan HK, Teoh LR, Lim XJ, Rajan P, Lee SWH. Impact of deprescribing intervention on potentially inappropriate medications and clinical outcomes among hospitalized older adults in Malaysia: a randomized controlled trial (REVMED RCT) protocol. J Pharm Policy Pract 2023; 16:113. [PMID: 37789376 PMCID: PMC10546756 DOI: 10.1186/s40545-023-00621-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/20/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Polypharmacy and the use of potentially inappropriate medications (PIMs) are prevalent among older patients admitted to hospitals, posing a heightened risk of adverse drug events. This trial aims to evaluate the effectiveness of a pharmacist-led deprescribing intervention in reducing medications, PIM and improving clinical outcomes, using the locally developed Malaysian Potentially Inappropriate Prescribing Screening tool in Older Adults (MALPIP). METHODS This is an 18-month cluster-randomized, open-label, parallel-arm controlled trial conducted at 14 public hospitals in the Perak state of Malaysia. Patients aged 60 and above, who have at least one medication and one comorbidity are eligible. A stratified-cluster randomization design is employed, with 7 hospitals assigned to the control arm and 7 hospitals assigned to the intervention arm. The MALPIP screening tool will be used in the intervention group to review the medications. If PIM is detected, the pharmacists will discuss with doctors and decide whether to stop or reduce the dose. The primary outcomes of this trial are the total number of medications and number of PIM. The secondary outcomes include fall, emergency department visits, readmissions, quality of life and mortality. Outcomes will be measured during enrolment, discharge, 6, 12, and 18 months. DISCUSSION This REVMED trial aims to test the hypothesis that a pharmacist-led deprescribing intervention initiated in the hospital will reduce the total number of medications and PIM 18 months after hospital discharge, reducing fall, emergency department visits, readmissions, mortality and lead to improvement in quality of life. Trial findings will quantify the clinical outcomes associated with reducing medications and PIM for hospitalized older adults with polypharmacy. TRIAL REGISTRATION NUMBER This trial was prospectively registered at clinicaltrials.gov (NCT05875623) on the 25th of May 2023. NCT05875623 Clinicaltrials.gov URL: NCT05875623 registered on 25th July 2023.
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Affiliation(s)
- Chee Tao Chang
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Perak, Malaysia.
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Malaysia.
| | - Siew Li Teoh
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Malaysia
| | - Wee Kooi Cheah
- Clinical Research Centre, Hospital Taiping, Ministry of Health Malaysia, Taiping, Malaysia
- Department of Medicine, Hospital Taiping, Ministry of Health Malaysia, Taiping, Malaysia
| | - Pei Jia Lee
- Pharmacy Department, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Malaysia
| | - Muhammad Azuan Azman
- Pharmacy Department, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Malaysia
| | - Shiau Hui Ling
- Pharmacy Department, Hospital Seri Manjung, Ministry of Health Malaysia, Seri Manjung, Malaysia
| | - Angie Su Ching Chuah
- Pharmacy Department, Hospital Seri Manjung, Ministry of Health Malaysia, Seri Manjung, Malaysia
| | - Noor Hamizah Sabki
- Pharmacy Department, Hospital Taiping, Ministry of Health Malaysia, Taiping, Malaysia
| | - Doris George
- Pharmacy Department, Hospital Taiping, Ministry of Health Malaysia, Taiping, Malaysia
| | - Hoey Lin Oh
- Pharmacy Department, Hospital Slim River, Ministry of Health Malaysia, Slim River, Malaysia
| | - Jing Yi Goh
- Pharmacy Department, Hospital Slim River, Ministry of Health Malaysia, Slim River, Malaysia
| | - Siew Huang Lee
- Pharmacy Department, Hospital Kuala Kangsar, Ministry of Health Malaysia, Kuala Kangsar, Malaysia
| | - Wai Keng Foong
- Pharmacy Department, Hospital Batu Gajah, Ministry of Health Malaysia, Batu Gajah, Malaysia
| | - Jason Choong Yin Lee
- Perak Pharmaceutical Services Division, Ministry of Health Malaysia, Tanjung Rambutan, Malaysia
| | - Huan Keat Chan
- Clinical Research Centre, Hospital Sultanah Bahiyah, Ministry of Health Malaysia, Alor Setar, Malaysia
| | - Lee Rhui Teoh
- Pharmacy Department, Hospital Sungai Siput, Ministry of Health Malaysia, Sungai Siput, Malaysia
| | - Xin Jie Lim
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Perak, Malaysia
| | - Philip Rajan
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Perak, Malaysia
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Chang CT, Teoh SL, Rajan P, Lee SWH. Explicit potentially inappropriate medications criteria for older population in Asian countries: A systematic review. Res Social Adm Pharm 2023:S1551-7411(23)00281-4. [PMID: 37277240 DOI: 10.1016/j.sapharm.2023.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/16/2023] [Accepted: 05/30/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Explicit potentially inappropriate medications (PIM) criteria are commonly used to identify and deprescribe potentially inappropriate prescriptions among older patients. Most of these criteria were developed specifically for the Western population, which might not be applicable in an Asian setting. The current study summarizes the methods and drug lists to identify PIM in older Asian people. METHODS A systematic review of published and unpublished studies were carried out. Included studies described the development of explicit criteria for PIM use in older adults and provided a list of medications that should be considered inappropriate. PubMed, Medline, EMBASE, Cochrane CENTRAL, CINAHL, PsycINFO, and Scopus searches were conducted. The PIMs were analyzed according to the general conditions, disease-specific conditions, and drug-drug interaction classes. The qualities of the included studies were assessed using a nine-point evaluation tool. The kappa agreement index was used to evaluate the level of agreement between the identified explicit PIM tools. RESULTS The search yielded 1206 articles, and 15 studies were included in our analysis. Thirteen criteria were identified in East Asia and two in South Asia. Twelve out of the 15 criteria were developed using the Delphi method. We identified 283 PIMs independent of medical conditions and 465 disease-specific PIMs. Antipsychotics were included in most of the criteria (14/15), followed by tricyclic antidepressants (TCAs) (13/15), antihistamines (13/15), sulfonylureas (12/15), benzodiazepines (11/15), and nonsteroidal anti-inflammatory drug (NSAIDs) (11/15). Only one study fulfilled all the quality components. There was a low kappa agreement (k = 0.230) between the included studies. CONCLUSION This review included 15 explicit PIM criteria, which most listed antipsychotics, antidepressants, and antihistamines as potentially inappropriate. Healthcare professionals should exercise more caution when dealing with these medications among older patients. These results may help healthcare professionals in Asian nations to create regional standards for the discontinuation of potentially harmful drugs for elderly patients.
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Affiliation(s)
- Chee Tao Chang
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Malaysia; Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Malaysia
| | - Siew Li Teoh
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Malaysia
| | - Philip Rajan
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Malaysia; School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Malaysia
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Chew CC, Lim XJ, Narayanan MS, Letchumanan P, Rajan P, Chong CP. The Trend of the Burden of Allergic Rhinitis Pre- and Post-COVID-19 Pandemic in the Urban Population of Perak, Malaysia. Indian J Otolaryngol Head Neck Surg 2023:1-8. [PMID: 37362103 PMCID: PMC10228421 DOI: 10.1007/s12070-023-03896-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/22/2023] [Indexed: 06/28/2023] Open
Abstract
Aims This study aims to determine the trend of allergic rhinitis (AR) prevalence in a tertiary hospital between 2017 and 2022, and to compare its prevalence pre- and post-COVID-19 pandemic. Methods This was a cross-sectional study involving the extraction of all Malaysian patients' medical records who were diagnosed with AR and attended the otorhinolaryngology outpatient clinic of a government-funded tertiary hospital in Malaysia between 2017 and 2022. Results 3,744 cases out of the 57,968 first-encounter outpatient visits to the otorhinolaryngology clinic were extracted for analysis. Overall, the prevalence of AR cases ranged from 1.83 to 9.23% between 2017 and 2022. There was a significant drop of 21.38 to 70.22% between the pre- and post-COVID-19 pandemic (p < 0.001). Males (0.34 to 1.60%) were more prevalent in the 6 to 18 year old than females (0.09 to 1.23%). The trend shifted with age, whereby females (0.50 to 2.45%) experienced a higher prevalence than males (0.21 to 1.77%) as they aged from 19 to 59. The Malay (1.01 to 4.59%) demonstrated a two-time higher prevalence than the Chinese (0.30 to 2.01%) and Indian (0.40 to 2.14%) ethnicities. After stratifying by gender and ethnicity, Indian women (0.17 to 1.09%) had a higher rate of AR than their Chinese counterparts (0.12 to 0.99%) across all years. Conclusion The AR prevalence consistently ranged from 8.14 to 9.23% pre-pandemic. A remarkable drop was observed post-pandemic, ranging from 1.83 to 6.40%. A gender shift from male to female predominance as age progressed. The Malay had the highest prevalence of AR.
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Affiliation(s)
- Chii-Chii Chew
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia
| | - Xin-Jie Lim
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health, Ipoh, Perak, Malaysia
| | - Maithrea Suresh Narayanan
- Department of Otorhinolaryngology, Hospital Raja Permaisuri Bainun, Ministry of Health, Ipoh, Perak, Malaysia
| | - Pathma Letchumanan
- Department of Otorhinolaryngology, Hospital Raja Permaisuri Bainun, Ministry of Health, Ipoh, Perak, Malaysia
| | - Philip Rajan
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health, Ipoh, Perak, Malaysia
- Department of Otorhinolaryngology, Hospital Raja Permaisuri Bainun, Ministry of Health, Ipoh, Perak, Malaysia
| | - Chee Ping Chong
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia
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Kumareysh VV, Kumarasamy G, Letchumanan P, Rajan P, Md Shukri N. Huge Long Standing Staghorn Rhinolith in a Young Adult. Indian J Otolaryngol Head Neck Surg 2023; 75:1053-1055. [PMID: 37206833 PMCID: PMC10188877 DOI: 10.1007/s12070-023-03611-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 02/17/2023] [Indexed: 03/02/2023] Open
Abstract
Rhinolith is an uncommon condition that usually happens due to mineralisation of calcium and magnesium salts over a retained foreign body inside the nasal cavity for long period of time. Here we report one such case of a 33-year-old lady who presented to us with long standing intermittent epistaxis and on examination rhinolith was discovered.
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Affiliation(s)
- Vijay V. Kumareysh
- Department of Otorhinolaryngology, Hospital Raja Permaisuri Bainun, Ipoh, Perak Malaysia
- Department of Otorhinolaryngology-Head & Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Guhan Kumarasamy
- Department of Otorhinolaryngology, Hospital Raja Permaisuri Bainun, Ipoh, Perak Malaysia
| | - Pathma Letchumanan
- Department of Otorhinolaryngology, Hospital Raja Permaisuri Bainun, Ipoh, Perak Malaysia
| | - Philip Rajan
- Department of Otorhinolaryngology, Hospital Raja Permaisuri Bainun, Ipoh, Perak Malaysia
| | - Norasnieda Md Shukri
- Department of Otorhinolaryngology-Head & Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
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Chang CT, Mohd Shariff SM, Abu Bakar NS, Ramzuzzaman NS, Lim CK, Lim EYJ, Ong PS, Lee JM, Tan AY, Kamis SF, Liew WM, Low YM, George D, Voo JYH, Tan HS, Rajan P, Lee SWH. Polypharmacy and potentially inappropriate medications among hospitalized older adults with COVID-19 in Malaysian tertiary hospitals. J Pharm Policy Pract 2023; 16:2. [PMID: 36635766 PMCID: PMC9836327 DOI: 10.1186/s40545-022-00504-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 12/11/2022] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Older adults are among the most vulnerable groups during the COVID-19 epidemic, contributing to a large proportion of COVID-19-related death. Medication review and reconciliation by pharmacist can help reduce the number of potentially inappropriate medications but these services were halted during COVID-19. AIM To assess the prevalence and factors associated with inappropriate medicine use among older populations with COVID-19. METHODS This was a cross-sectional, retrospective analysis of medications among hospitalized older adults with COVID-19. Potentially inappropriate medication use was categorized using the Beer's and STOPP criteria. RESULTS Combining both criteria, 181 (32.7%) of the 553 patients were identified to have used at least one or more potentially inappropriate medication. A marginally higher number of inappropriate medications was documented using the Beers 2019 criteria (151 PIM in 124 patients) compared to STOPP criteria (133 PIMS in 104 patients). The long-term use of proton pump inhibitors (n = 68; 12.3%) and drugs which increases the risk of postural hypotension were the most commonly reported PIM (n = 41; 7.4%). Potentially inappropriate medication use was associated with previous history of hospital admission in the past 12 months (Odds ratio [OR]: 2.27; 95% CI 1.29-3.99) and higher number of discharge medications. CONCLUSIONS Nearly, one in three older adults with COVID-19 had been prescribed a PIM, and the proportion of older adults with polypharmacy increased after discharge. This highlights the importance of having clinical pharmacist conducting medication reviews to identify PIMs and ensure medication appropriateness.
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Affiliation(s)
- Chee-Tao Chang
- Clinical Research Centre (CRC) HRPB Ipoh, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Malaysia ,grid.440425.30000 0004 1798 0746School of Pharmacy, Monash University Malaysia, Subang Jaya, Malaysia
| | | | - Nur Suriana Abu Bakar
- Pharmacy Department, Hospital Sungai Buloh, Ministry of Health Malaysia, Sungai Buloh, Malaysia
| | | | - Chun Kiat Lim
- Pharmacy Department, Hospital Sungai Buloh, Ministry of Health Malaysia, Sungai Buloh, Malaysia
| | - Eddy Yew Joe Lim
- Pharmacy Department, Hospital Sungai Buloh, Ministry of Health Malaysia, Sungai Buloh, Malaysia
| | - Peng Seng Ong
- grid.477137.10000 0004 0573 7693Pharmacy Department, Hospital Pulau Pinang, Ministry of Health Malaysia, George Town, Malaysia
| | - Jie Min Lee
- grid.477137.10000 0004 0573 7693Pharmacy Department, Hospital Pulau Pinang, Ministry of Health Malaysia, George Town, Malaysia
| | - Aie Yen Tan
- Pharmacy Department, Hospital Sultan Ismail, Ministry of Health Malaysia, Johor Bahru, Malaysia
| | - Siti Fatimah Kamis
- Pharmacy Department, Hospital Sultan Ismail, Ministry of Health Malaysia, Johor Bahru, Malaysia
| | - Wei Mun Liew
- Pharmacy Department, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Malaysia
| | - Yuet Man Low
- Pharmacy Department, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Malaysia
| | - Doris George
- Pharmacy Department, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Malaysia
| | - James Yau Hon Voo
- Pharmacy Department, Hospital Duchess of Kent, Ministry of Health Malaysia, Sandakan, Malaysia
| | - Hoo Seng Tan
- Pharmacy Department, Hospital Duchess of Kent, Ministry of Health Malaysia, Sandakan, Malaysia
| | - Philip Rajan
- Clinical Research Centre (CRC) HRPB Ipoh, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Malaysia ,grid.452879.50000 0004 0647 0003School of Medicine, Faculty of Health and Medical Sciences, Taylor’s University, Subang Jaya, Malaysia
| | - Shaun Wen Huey Lee
- grid.440425.30000 0004 1798 0746School of Pharmacy, Monash University Malaysia, Subang Jaya, Malaysia
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9
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Chang CT, Lim XJ, Chew CC, Rajan P, Chan HK, Abu Hassan MR, Akmal Shafie A, Lee SWH. Preferences and willingness of accepting COVID-19 vaccine booster: Results from a middle-income country. Vaccine 2022; 40:7515-7519. [PMID: 36371369 PMCID: PMC9622382 DOI: 10.1016/j.vaccine.2022.10.057] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 09/18/2022] [Accepted: 10/24/2022] [Indexed: 11/07/2022]
Abstract
The recent wave of COVID-19 cases has led to the potential need for booster doses. We surveyed 6,294 people and found that 87.6% reported willingness to take a booster dose, with vaccine efficacy rate being the most common reason cited to accept booster dose. Differences in acceptance rates were noted among those working in non-health related sectors, different ethnic groups as well as those who had taken viral vector vaccines.
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Affiliation(s)
- Chee Tao Chang
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Malaysia,School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Selangor, Malaysia
| | - Xin-Jie Lim
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Malaysia
| | - Chii-Chii Chew
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Malaysia,School of Pharmaceutical Sciences, Universiti Sains Malaysia, Malaysia
| | - Philip Rajan
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Malaysia
| | - Huan-Keat Chan
- Clinical Research Centre, Hospital Sultanah Bahiyah, Ministry of Health Malaysia, Malaysia
| | | | | | - Shaun Wen Huey Lee
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Selangor, Malaysia,School of Pharmacy, Faculty of Health & Medical Sciences, Taylor’s University, Jalan Taylors, Selangor, Malaysia,Center of Global Health, Perelman School of Medicine, University of Pennsylvania, PA, USA,Corresponding author at: School of Pharmacy, Jalan Lagoon Selatan, Bandar Sunway, 47500 Subang Jaya, Selangor, Malaysia
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10
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Tao CC, Lim XJ, Amer Nordin A, Thum CC, Sararaks S, Periasamy K, Rajan P. Health system preparedness in infectious diseases: perspective of Malaysia, a middle-income country, in the face of monkeypox outbreaks. Trop Med Health 2022; 50:87. [PMID: 36404319 PMCID: PMC9676886 DOI: 10.1186/s41182-022-00479-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/01/2022] [Indexed: 11/22/2022] Open
Abstract
The World Health Organization declared monkeypox as a Public Health Emergency of International Concern on July 23, 2022. As of July 25th, 2022, there were 16,016 laboratory-confirmed cases reported worldwide with 5 deaths. Malaysia's Health Ministry has developed a five-point strategy to prepare for the impending threat of the infectious disease, encompassing early detection of monkeypox, consolidation of laboratory diagnostic facilities, case management and treatment, cluster management, and strengthening public awareness. Crisis and disaster preparedness within a nation's health system is paramount to preventing disease spread. Various strategies for developing resilience in the face of global infectious disease spread were discussed. The current disease preparedness and response framework and guidelines in Malaysia have established a health system that is proactive and responsive to any potential infectious disease outbreaks. Despite this, the future remains unpredictable, and ongoing fortification is required as events unfold.
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Affiliation(s)
- Chang Chee Tao
- Clinical Research Centre (CRC), Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, 30450 Ipoh, Perak Malaysia ,grid.440425.30000 0004 1798 0746School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Xin-Jie Lim
- Clinical Research Centre (CRC), Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, 30450 Ipoh, Perak Malaysia
| | - Awatef Amer Nordin
- grid.415759.b0000 0001 0690 5255Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, Malaysia
| | - Chern Choong Thum
- grid.11142.370000 0001 2231 800XDepartment of Psychiatry, Universiti Putra Malaysia Teaching Hospital, Serdang, Malaysia
| | - Sondi Sararaks
- grid.415759.b0000 0001 0690 5255Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, Malaysia
| | - Kalaiarasu Periasamy
- grid.415759.b0000 0001 0690 5255Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, Malaysia
| | - Philip Rajan
- Clinical Research Centre (CRC), Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, 30450 Ipoh, Perak Malaysia
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11
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Rajan P. Feasibility study of a randomised controlled trial of aspirin and/or vitamin D3 for men with early prostate cancer on active surveillance with Prolaris® testing. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02463-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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12
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Chang CT, Ong SY, Lim XJ, Chew LS, Rajan P. Managing nirmatrelvir/ritonavir during COVID-19: pharmacists’ experiences from the Perak state of Malaysia. J Pharm Policy Pract 2022; 15:70. [PMID: 36274169 PMCID: PMC9589596 DOI: 10.1186/s40545-022-00469-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 10/13/2022] [Indexed: 11/10/2022] Open
Abstract
AbstractNovel therapeutic agents for SARS-CoV-2 have emerged over time, serving to reduce the severity of the disease, admission and mortality, especially among high-risk populations. Oral nirmatrelvir/ritonavir (Paxlovid®) was found to reduce the risk of disease progression. Pharmacists played multiple roles in handling the COVID-19 pandemic. This article highlights the roles of pharmacists in managing nirmatrelvir/ritonavir within the Malaysian context. Pharmacists were actively involved in Paxlovid® inventory management. To ensure the balance between supply and demand of new therapeutic drugs, pharmacists in health facilities constantly monitor the inventory levels of the medications. As Paxlovid® was initially reserved for a certain population who met the clinical eligibility criteria based on a scoring system, pharmacists were required to screen and exclude patients with non-indications or contraindications to the medication. During dispensing, pharmacists convey clear instructions on how to take the medications to ensure adherence and medication safety. The novel nature of the medications necessitates pharmacists to counsel patients regarding its indication, the mode of action, actions to take when missing a dose or overdose happens, side effects, storage and disposal methods, as well as mechanism of reporting adverse drug reactions. Pharmacists were required to follow-up all patients via phone call on Day 3 and Day 5 post-initiation, examining both adherence and adverse drug reactions associated with Paxlovid®. Pharmacists experienced multiple challenges in managing Paxlovid®, particularly due to increased workload, suboptimal follow-up response, stringent medication storage requirements, and adherence issues. Universal research and innovation initiatives were proposed to improve the delivery of novel therapeutic agents in the future health system.
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13
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Affiliation(s)
- Chee Tao Chang
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Malaysia
| | - Chern Choong Thum
- Department of Psychiatry, Universiti Putra Malaysia Teaching Hospital, Serdang, Malaysia
| | - Xin Jie Lim
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Malaysia
| | - Chii Chii Chew
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Malaysia
| | - Philip Rajan
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Malaysia
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14
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Chew CC, Lim XJ, Low LL, Lau KM, Kari M, Shamsudin UK, Rajan P. The challenges in managing the growth of indigenous children in Perak State, Malaysia: A qualitative study. PLoS One 2022; 17:e0265917. [PMID: 35320328 PMCID: PMC8942260 DOI: 10.1371/journal.pone.0265917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 03/09/2022] [Indexed: 11/25/2022] Open
Abstract
Indigenous peoples in Peninsular Malaysia, known as Orang Asli, have been associated with the problem of malnutrition. Approximately 40% of their children are underweight. Indigenous peoples' distinct social, cultural, and economic traits, which differ from those of the dominant communities in which they live, may pose significant challenges for health care providers (HCPs) in addressing the malnutrition issue. This study explores challenges encountered by HCPs, with at least six months of experience in monitoring the growth parameters of Orang Asli children residing in Perak State in Peninsular Malaysia. A cross-sectional study was conducted between December 2020 and June 2021, involving three focus group discussions and three in-depth interviews. Thematic analysis was used. A total of 19 participants (6 nurses, 5 nursing managers, 4 medical officers, 2 nutritionists, a family medicine specialist, and a paediatrician) took part in this study. The challenges were summarized into four themes: (I) accessibility to nutrition, (II) accessibility to healthcare services, (II) skills of HCPs, and (IV) challenges of implementing nutrition programs. The inability of the Orang Asli children to access nutritious food was due to poverty, different perceptions of life priorities, and the practice of food taboos among the communities. Inadequate infrastructure and transportation discourage parents from bringing their children to healthcare facilities. The belief in and preference for traditional healing, the practice of semi-nomadic lifestyles, and fear of HCPs and their timid nature were factors that prevented Orang Asli children from accessing healthcare services. HCPs need to equip themselves with cross-cultural communication and interaction skills and adapt their skills to environmental challenges to overcome unexpected encounters in mobile clinics. The non-exposed food items, the risk of food basket sharing with other family members, and community feeding programs' coordination were the challenges to be addressed when implementing nutrition programmes for Orang Asli children. The challenges of HCPs are multifactorial and require a multifaceted approach. There is a need for joint efforts of stakeholders, from communities and non-governmental organisations (NGOs) to the health authorities, to address the challenges of HCPs.
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Affiliation(s)
- Chii-Chii Chew
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health, Ipoh, Malaysia
| | - Xin-Jie Lim
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health, Ipoh, Malaysia
| | - Lee-Lan Low
- Institute for Health Systems Research, Ministry of Health, Ipoh, Malaysia
| | - Kin-Mun Lau
- Perak State Health Department, Ministry of Health, Ipoh, Ipoh, Malaysia
| | - Maziana Kari
- Perak State Health Department, Ministry of Health, Ipoh, Ipoh, Malaysia
| | | | - Philip Rajan
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health, Ipoh, Malaysia
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15
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Winters D, Mehmi A, Odedra A, Buttleman S, Ancheta J, Allchorne P, Rajan P, Khan S, Green J. 171 Developing & Centralising a Nurse-Led Local Anaesthetic (La) Transperineal (Tp) Biopsy Service During Covid: A Success Story. Br J Surg 2022. [PMCID: PMC9383536 DOI: 10.1093/bjs/znac039.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Introduction During the first COVID-19 wave, the BAUS Section of Oncology issued guidance to minimise risks of sepsis and general anaesthesia at prostate biopsy. Consequently, and as a result of diminished diagnostics capacity on Trust acute sites, we implemented a centralised network-wide nurse-led LA TP biopsy service on a COVID-secure “green” site and abandoned trans-rectal biopsies. We evaluated the impact of this service improvement on patient waiting times before and after national lockdown in March 2020. Method Classic Quality Improvement (QI) methodology was used with continuous data collection and waiting list management by clinical staff with standard admin support. Balancing measurements were collected. Run charts were used to confirm whether a change led to a real and sustainable improvement. Results The number of days waiting, from time of request to date of biopsy, is presented in the following run chart. The mean waiting time for those pre lockdown was 145 days (SD 57) whereas post lockdown was 23 days (SD 20). This identified that there was a significant difference between the average waiting time pre and post lockdown (U = 55.5, p = <0.001) There were also reductions in waiting time when subcategorised into planned Active Surveillance cases, target cases and delayed cases. Conclusions Centralising the TP biopsy service and converting to a nurse led LA service has led to reductions in waiting lists and was safely expedited and resilient even in the COVID-19 pandemic. Allowing a second advanced TP practitioner to be fully trained, during COVID. The service was highly valued by patients and staff.
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Affiliation(s)
- D. Winters
- Newham University Hospital, London, United Kingdom
| | - A. Mehmi
- Newham University Hospital, London, United Kingdom
| | - A. Odedra
- Whipps Cross University Hospital, London, United Kingdom
| | - S. Buttleman
- Whipps Cross University Hospital, London, United Kingdom
| | - J. Ancheta
- Whipps Cross University Hospital, London, United Kingdom
| | - P. Allchorne
- Whipps Cross University Hospital, London, United Kingdom
| | - P. Rajan
- St Bartholemew's Hospital, London, United Kingdom
| | - S. Khan
- Newham University Hospital, London, United Kingdom
| | - J.S.A. Green
- Whipps Cross University Hospital, London, United Kingdom
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16
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Nathan A, Ng A, Mitra A, Davda R, Sooriakumaran P, Patel S, Fricker M, Kelly J, Shaw G, Rajan P, Sridhar A, Nathan S, Payne H,. Comparative effectiveness analysis of oncological and functional outcomes after salvage radical treatment with surgery or radiotherapy following primary focal or whole-gland ablative therapy for localised prostate cancer. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01040-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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17
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Cazzaniga W, Pearce A, Tanabalan C, Rajan P, Kinsella N, Reid A, Huddart R, Nicol D. Medium to long term health-related quality of life and treatment-related side-effects in patients treated with a single dose of adjuvant carboplatin for high-risk seminoma – results from a pilot study. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00648-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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18
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Cazzaniga W, Pearce A, Tanabalan C, Rajan P, Kinsella N, Reid A, Huddart R, Nicol D. Health-related quality of life and treatment-related side-effects in patients who have been in remission from testicular cancer for 12-24 months. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00649-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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19
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Nathan A, Ng A, Mitra A, Sooriakumaran P, Davda R, Patel S, Fricker M, Kelly J, Shaw G, Rajan P, Sridhar A, Nathan S, Payne H. Comparative Effectiveness Analyses of Salvage Prostatectomy and Salvage Radiotherapy Outcomes Following Focal or Whole-Gland Ablative Therapy (High-Intensity Focused Ultrasound, Cryotherapy or Electroporation) for Localised Prostate Cancer. Clin Oncol (R Coll Radiol) 2021; 34:e69-e78. [PMID: 34740477 DOI: 10.1016/j.clon.2021.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/27/2021] [Accepted: 10/20/2021] [Indexed: 11/25/2022]
Abstract
AIMS Ablative therapy, such as focal therapy, cryotherapy or electroporation, aims to treat clinically significant prostate cancer with reduced treatment-related toxicity. Up to a third of patients may require further local salvage treatment after ablative therapy failure. Limited descriptive, but no comparative, evidence exists between different salvage treatment outcomes. The aim of this study was to compare oncological and functional outcomes after salvage robot-assisted radical prostatectomy (SRARP) and salvage radiotherapy (SRT). MATERIALS AND METHODS Data were collected prospectively and retrospectively on 100 consecutive SRARP cases and 100 consecutive SRT cases after ablative therapy failure in a high-volume tertiary centre. RESULTS High-risk patients were over-represented in the SRARP group (66.0%) compared with the SRT group (48.0%) (P = 0.013). The median (interquartile range) follow-up after SRARP was 16.5 (10.0-30.0) months and 37.0 (18.5-64.0) months after SRT. SRT appeared to confer greater biochemical recurrence-free survival at 1, 2 and 3 years compared with SRARP in high-risk patients (year 3: 86.3% versus 66.0%), but biochemical recurrence-free survival was similar for intermediate-risk patients (year 3: 90.0% versus 75.6%). There was no statistical difference in pad-free continence at 12 and 24 months between SRARP (77.2 and 84.7%) and SRT (75.0 and 74.0%) (P = 0.724, 0.114). Erectile function was more likely to be preserved in men who underwent SRT. After SRT, cumulative bowel and urinary Radiation Therapy Oncology Group toxicity grade I were 25.0 and 45.0%, grade II were 11.0 and 11.0% and grade III or IV complications were 4.0 and 5.0%, respectively. CONCLUSION We report the first comparative analyses of salvage prostatectomy and radiotherapy following ablative therapy. Men with high-risk disease appear to have superior oncological outcomes after SRT; however, treatment allocation does not appear to influence oncological outcomes for men with intermediate-risk disease. Treatment allocation was associated with a different spectrum of toxicity profile. Our data may inform shared decision-making when considering salvage treatment following focal or whole-gland ablative therapy.
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Affiliation(s)
- A Nathan
- University College London, London, UK; University College London Hospitals NHS Trust, London, UK; The Royal College of Surgeons of England, London, UK.
| | - A Ng
- University College London, London, UK
| | - A Mitra
- University College London Hospitals NHS Trust, London, UK
| | - P Sooriakumaran
- University College London Hospitals NHS Trust, London, UK; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - R Davda
- University College London Hospitals NHS Trust, London, UK
| | - S Patel
- University College London, London, UK
| | | | - J Kelly
- University College London, London, UK; University College London Hospitals NHS Trust, London, UK
| | - G Shaw
- University College London, London, UK; University College London Hospitals NHS Trust, London, UK
| | - P Rajan
- University College London Hospitals NHS Trust, London, UK
| | - A Sridhar
- University College London, London, UK; University College London Hospitals NHS Trust, London, UK
| | - S Nathan
- University College London, London, UK; University College London Hospitals NHS Trust, London, UK
| | - H Payne
- University College London, London, UK; University College London Hospitals NHS Trust, London, UK
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20
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Chew LS, Yeo YL, Chang CT, Chew CC, George D, Rajan P. Satisfaction among patients and caregivers receiving value-added services during the COVID-19 pandemic outbreak in a tertiary hospital in the Perak state of Malaysia. Journal of Pharmaceutical Health Services Research 2021. [DOI: 10.1093/jphsr/rmab057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Objectives
Patient satisfaction was used as an indicator of service quality in the public hospitals. The pharmacy value-added services (VAS) were intensified after the COVID-19 outbreak, and evaluation of user’s satisfaction was important for service improvement.
Methods
This was a single-centre, cross-sectional, web-based study in the outpatient pharmacy in a tertiary hospital in the Perak state of Malaysia. Patients and caregivers aged 18 years and above, received at least one prescription refill using the pharmacy VAS from April to September 2020, were included. The questionnaire was adapted from a validated tool, underwent face and content validation before dissemination. The link was disseminated to the targeted population through short messages service (SMS).
Key findings
Out of 1200 invited people, 303 agreed to participate. Majority of the respondents were male (160, 52.8%), Chinese (156, 51.5%), with tertiary education (201, 66.3%) and retiree (112, 37.0%). Out of a maximum score of 5, the overall mean satisfaction score was 4.42 (SD: 0.55). The respondents were most agreeable to time-saving benefits of the pharmacy VAS (4.56 ± 0.63). Majority of the respondents felt that pharmacy VAS had made their life easier (290, 95.7%) and planned to recommend the pharmacy VAS to others (292, 96.4%) Respondents aged more than 60 (versus age 18–35, β = 2.375, P < 0.001) and those who used drive-through service (versus SPUB, β = 2.272, P = 0.001) reported higher satisfaction scores. Several suggestions were made for service improvement, including longer operating hours (18, 6.0%), upgraded communication system (9, 3.0%), smoother registration process (9, 3.0%), more polite staff (9, 3.0%), selection of preferred postage delivery time (6, 2.0%) and promotion of VAS (4, 1.3%)
Conclusions
Majority of the respondents were highly satisfied towards the pharmacy VAS. Future studies should compare the satisfaction of VAS with traditional counter service to compare the level and factors that contributed to the users’ satisfaction.
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Affiliation(s)
- Lan-Sim Chew
- Pharmacy Department, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Perak, Malaysia
| | - Yee-Ling Yeo
- Pharmacy Department, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Perak, Malaysia
| | - Chee-Tao Chang
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Perak, Malaysia
| | - Chii-Chii Chew
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Perak, Malaysia
| | - Doris George
- Pharmacy Department, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Perak, Malaysia
| | - Philip Rajan
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Perak, Malaysia
- Otolaryngology Department, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Perak, Malaysia
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21
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Nathan A, Hanna N, Rashid A, Patel S, Phuah Y, Flora K, Fricker M, Cleaveland P, Kasivisvanathan V, Williams N, Miah S, Shah N, Hines J, Collins J, Sridhar A, Kelkar A, Briggs T, Kelly J, Shaw G, Sooriakumaran P, Rajan P, Lamb B, Nathan S. 141 New Guidelines to Reduce Unnecessary Blood Tests, Delayed Discharge and Costs Following Robot Assisted Radical Prostatectomy. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.1070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Objectives
Routine postoperative blood tests (POBT) following robot assisted radical prostatectomy (RARP) are used to evaluate the impact of surgery on pre-existing co-morbidities and to detect early complications. This practice dates back to an era of open surgery, when blood loss and complication rates were higher. We propose new guidelines to improve the specificity of POBT.
Method
The cases of 1040 consecutive patients who underwent a primary or salvage RARP at two large tertiary urology centres in the United Kingdom were retrospectively reviewed to form new guidelines. The new guidelines were prospectively validated in a sample of 300 patients.
Results
Derivation Dataset: 3% and 5% had intra- and post-operative Clavien-Dindo complications, respectively. 15% had clinical concerns postoperatively. 0.9% required perioperative transfusion. 78% had routine blood tests without clinical concerns, none of whom developed a complication. 98% of complications were suspected by clinical judgement. 6% of patients had a discharge delay of ≥ 1 day due to delayed or incomplete blood tests. Validation Dataset: No significant difference existed in complication, clinical concern or transfusion rates between the derivation and validation datasets. Number of POBT requested reduced by 73% (p < 0.001). The new guidelines improved POBT sensitivity for complications from 98% to 100% and specificity from 0% to 74%. Discharge delays reduced from 6% to 0% (p = 0.008). Cost savings were £178 per patient.
Conclusions
Postoperative complications and transfusion following RARP are rare. Routine POBT without clinical indication are unnecessary and inefficient. A guideline-based approach to POBT can reduce costs and optimise discharge without compromising patient safety or care.
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Affiliation(s)
- A Nathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- University College London, London, United Kingdom
| | - N Hanna
- Department of Uro-oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- University of Cambridge, Cambridge, United Kingdom
| | - A Rashid
- Department of Uro-oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- University of Cambridge, Cambridge, United Kingdom
| | - S Patel
- University College London, London, United Kingdom
| | - Y Phuah
- University College London, London, United Kingdom
| | - K Flora
- University College London, London, United Kingdom
| | - M Fricker
- Newcastle University, Newcastle, United Kingdom
| | - P Cleaveland
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - V Kasivisvanathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - N Williams
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - S Miah
- Department of Uro-oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - N Shah
- Department of Uro-oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - J Hines
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - J Collins
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - A Sridhar
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - A Kelkar
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - T Briggs
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - J Kelly
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - G Shaw
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - P Sooriakumaran
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - P Rajan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Barts Cancer Institute, CR-UK Barts Centre, Queen Mary University of London, London, United Kingdom
| | - B Lamb
- Department of Uro-oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - S Nathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
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22
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Nathan A, Fricker M, De Groote R, Arora A, Phuah Y, Flora K, Patel S, Kasivisvanathan V, Sridhar A, Shaw G, Kelly J, Briggs T, Rajan P, Sooriakumaran P, Nathan S. 283 Salvage Versus Primary Robot-Assisted Radical Prostatectomy: A Propensity-Matched Comparative Effectiveness Study from A High-Volume Tertiary Centre. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.1075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aim
Salvage Robot-Assisted Radical Prostatectomy (sRARP) is a potential treatment option for locally recurrent Prostate Cancer after non-surgical primary treatment. There are minimal data comparing outcomes between propensity-matched salvage and primary Robot-Assisted Radical Prostatectomy (RARP). We compare perioperative, oncological, and functional outcomes of sRARP with primary RARP and between sRARP post-whole and focal gland therapy.
Method
1:1 propensity-matched comparison of 146 sRARP with primary RARP from a cohort of 3,852 consecutive patients from a high-volume tertiary centre.
Results
There were no significant differences in patient characteristics between the salvage and primary RARP groups. Grade III-V Clavien-Dindo complication rates were 1.3% and 0% in the salvage and primary groups, respectively (p = 0.310). Median (IQR) follow-up was 16 (10,30) and 21 (13,33) months in the salvage and primary groups, respectively. BCR rates were 30.8% and 13.7% in the salvage and primary groups, respectively (p < 0.001). Pad-free continence rates were 79.1% and 85.4% at two years in the salvage and primary groups, respectively (p = 0.160). ED rates were 95.2% and 77.4% in the salvage and primary groups, respectively (p < 0.001). Comparing the whole gland and focal gland groups, BCR rates were 33.3% and 29.1%, respectively (p = 0.687), pad-free continence rates were 66% and 89.3%, respectively (p = 0.001), and ED rates were 98.3% and 93%, respectively (p = 0.145).
Conclusions
SRARP has similar perioperative but inferior oncological outcomes to primary RARP. Continence rates are similar to primary RARP, but potency is worse. Perioperative and oncological outcomes of sRARP after focal gland therapy are similar but continence outcomes are superior compared to sRARP after whole gland therapy.
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Affiliation(s)
- A Nathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- University College London, London, United Kingdom
| | - M Fricker
- University of Newcastle, Newcastle, United Kingdom
| | - R De Groote
- Department of Urology, Onze Lieve Vrouw Hospital Aalst, Aalst, Belgium
| | - A Arora
- Department of Urology, Tata Memorial Hospital, Mumbai, India
| | - Y Phuah
- University College London, London, United Kingdom
| | - K Flora
- University College London, London, United Kingdom
| | - S Patel
- University College London, London, United Kingdom
| | - V Kasivisvanathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- University College London, London, United Kingdom
| | - A Sridhar
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - G Shaw
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - J Kelly
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - T Briggs
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - P Rajan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Barts Cancer Institute, CR-UK Barts Centre, Queen Mary University of London, London, United Kingdom
| | - P Sooriakumaran
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - S Nathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
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23
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Chew CC, Lim XJ, Chang CT, Rajan P, Nasir N, Low WY. Experiences of social stigma among patients tested positive for COVID-19 and their family members: a qualitative study. BMC Public Health 2021; 21:1623. [PMID: 34488693 PMCID: PMC8419662 DOI: 10.1186/s12889-021-11679-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 08/30/2021] [Indexed: 11/10/2022] Open
Abstract
Background Social stigma against persons infected with COVID-19 is not uncommon. This qualitative study aimed to explore the experience of social stigma among COVID-19 positive patients and their family members. Method This cross-sectional study was conducted between April to June 2020 in Malaysia. Patients who have recovered from COVID-19 for at least 1 month and their family members who were tested with negative results, Malaysian and aged 18–65 years old were purposively sampled. Cold call method was employed to recruit patients while their family members were recruited by their recommendations. Telephone interviews were conducted with the participants after obtaining their verbal consent. Results A total of 18 participants took part in this study. Three themes emerged from the interviews: (Ι) experience of stigmatization, (ΙΙ) perspective on disease disclosure, and (ΙΙΙ) suggestion on coping and reducing stigma. The participants expressed their experiences of being isolated, labelled, and blamed by the people surrounding them including the health care providers, neighbours, and staff at the service counters. Some respondents expressed their willingness to share their experience with others by emphasizing the importance of taking preventive measure in order to stop the chain of virus transmission and some of them chose to disclose this medical history for official purpose because of fear and lack of understanding among the public. As suggested by the respondents, the approaches in addressing social stigma require the involvement of the government, the public, health care provider, and religious leader. Conclusion Individuals recovered from COVID-19 and their families experienced social stigma. Fear and lack of public understanding of the COVID-19 disease were the key factors for non-disclosure. Some expressed their willingness to share their experience as they perceived it as method to increase public awareness and thereby reducing social stigma. Multifaceted approaches with the involvement of multiple parties including the government, non-governmental organization as well as the general public were recommended as important measures to address the issues of social stigma.
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Affiliation(s)
- Chii-Chii Chew
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ipoh, Ministry of Health, Malaysia, Bainun, Level 4, Ambulatory Care Centre (ACC), Jalan Raja Ashman Shah, 30450, Ipoh, Perak, Malaysia
| | - Xin-Jie Lim
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ipoh, Ministry of Health, Malaysia, Bainun, Level 4, Ambulatory Care Centre (ACC), Jalan Raja Ashman Shah, 30450, Ipoh, Perak, Malaysia
| | - Chee-Tao Chang
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ipoh, Ministry of Health, Malaysia, Bainun, Level 4, Ambulatory Care Centre (ACC), Jalan Raja Ashman Shah, 30450, Ipoh, Perak, Malaysia.
| | - Philip Rajan
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ipoh, Ministry of Health, Malaysia, Bainun, Level 4, Ambulatory Care Centre (ACC), Jalan Raja Ashman Shah, 30450, Ipoh, Perak, Malaysia.,Otolaryngology Department, Raja Permaisuri Bainun Hospital, Ministry of Health, Ipoh, Malaysia
| | - Nordin Nasir
- Hospital Raja Permaisuri Bainun, Ministry of Health, Ipoh, Malaysia
| | - Wah-Yun Low
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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24
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Rajan P. Challenges faced by Otorhinolaryngology (ORL) services, Malaysia, in the current pandemic. Med J Malaysia 2021; 76:1-2. [PMID: 34558548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
No abstract provided.
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Affiliation(s)
- P Rajan
- Hospital Raja Permaisuri Bainun, Department of Otorhinolaryngology, Ipoh, Perak, Malaysia
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25
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Mann GS, Rajan P, Sawali H. Otorhinolaryngology services at a district hospital in Sabah, Malaysia during the COVID-19 Pandemic. Med J Malaysia 2021; 76:39-41. [PMID: 34558557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
No abstract provided.
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Affiliation(s)
- G S Mann
- Hospital Tawau, Department of ORL, 91007, Tawau, Malaysia.
| | - P Rajan
- Hospital Raja Permaisuri Bainun, Department of ORL and Clinical Research Centre, Ipoh, Malaysia
| | - H Sawali
- Hospital Queen Elizabeth, Department of ORL, Kota Kinabalu, Malaysia
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26
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Fricker M, Nathan A, Hannah N, Rashid A, Patel S, Phuah Y, Flora K, Cleaveland P, Kasivisvanathan V, Williams N, Miah S, Shah N, Hines J, Collins J, Sridhar A, Kelkar A, Briggs T, Kelly J, Shaw G, Sooriakumaran P, Rajan P, Lamb B, Nathan S. O50 New guidelines to reduce unnecessary blood tests, delayed discharge and costs following robot assisted radical prostatectomy. Br J Surg 2021. [DOI: 10.1093/bjs/znab282.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Introduction
Routine postoperative blood tests (POBT) are used to evaluate the impact of surgery on pre-existing co-morbidities and to detect early complications. This practice dates back to an era of open surgery, when blood loss and complication rates were higher. We propose new guidelines to improve the specificity of POBT.
Method
The cases of 1040 consecutive patients who underwent a primary or salvage RARP at two large tertiary urology centres in the United Kingdom were retrospectively reviewed, and new guidelines were designed. The guidelines were prospectively validated in a cohort of 300 patients.
Result
Derivation Dataset 3% and 5% had intra- and post-operative Clavien-Dindo complications, respectively. 15% had clinical concerns postoperatively. 0.9% required perioperative transfusion. 78% had routine blood tests without clinical concerns, none of whom developed a complication. 98% of complications were suspected by clinical judgement. 6% of patients had a discharge delay of ≥ 1 days due to delayed or incomplete blood tests.
Validation Dataset No significant difference existed in complication, clinical concern or transfusion rates between the derivation and validation datasets. New guidelines improved sensitivity for complications from 98% to 100% and specificity from 0% to 74%. The number of blood tests requested reduced by 73% (P < 0.001). Discharge delays reduced from 6% to 0% (P = 0.008). Cost savings were £178 per patient.
Conclusion
Postoperative complications and transfusion following RARP are rare. Routine POBT without clinical indication are unnecessary and inefficient. A guideline-based approach to POBT can reduce costs and optimise discharge without compromising patient safety or care.
Take-home Message
Routine postoperative blood tests following robot assisted radical prostatectomy are often unnecessary. A guideline-based approach can reduce costs and optimise patient care.
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Affiliation(s)
| | - A Nathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
- University College London
| | - N Hannah
- Department of Uro-oncology, Cambridge University Hospitals NHS Foundation Trust
- University of Cambridge
| | - A Rashid
- Department of Uro-oncology, Cambridge University Hospitals NHS Foundation Trust
- University of Cambridge
| | | | | | | | - P Cleaveland
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
| | - V Kasivisvanathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
| | - N Williams
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
| | - S Miah
- Department of Uro-oncology, Cambridge University Hospitals NHS Foundation Trust
| | - N Shah
- Department of Uro-oncology, Cambridge University Hospitals NHS Foundation Trust
| | - J Hines
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
| | - J Collins
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
| | - A Sridhar
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
| | - A Kelkar
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
| | - T Briggs
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
| | - J Kelly
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
| | - G Shaw
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
| | - P Sooriakumaran
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
- Nuffield Department of Surgical Sciences, University of Oxford
| | - P Rajan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
- Barts Cancer Institute, CR-UK Barts Centre, Queen Mary University of London
| | - B Lamb
- Department of Uro-oncology, Cambridge University Hospitals NHS Foundation Trust
| | - S Nathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust
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27
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Chang CT, Rajan P, Hoe VCW. Filtering Facepiece Respirators for Healthcare Workers Protection in the Time of COVID-19 Pandemic. Malays J Med Sci 2021; 28:151-154. [PMID: 34285653 PMCID: PMC8260073 DOI: 10.21315/mjms2021.28.3.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 01/12/2021] [Indexed: 01/09/2023] Open
Abstract
Protecting healthcare workers (HCWs) who are in the frontline during the time of the COVID-19 pandemic is paramount. The filtering facepiece respirators (FFRs) or N95 respirator is one of the personal protective equipment (PPE) used to protect HCWs exposed to airborne pathogens in clinical practice or when performing aerosol generating procedures. The FFRs should be able to serve the intended purpose without causing additional health and safety hazards for the HCWs. The following commentary will provide some basic information on selecting correct FFRs and conducting fitness test.
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Affiliation(s)
- Chee Tao Chang
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia
| | - Philip Rajan
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia
| | - Victor Chee Wai Hoe
- Centre for Epidemiology and Evidence-based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia,Occupational Safety Health and Environmental Unit, Universiti Malaya Medical Centre, Kuala Lumpur, Malaysia
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28
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Nathan A, Fricker M, De Groote R, Arora A, Phuah Y, Flora K, Pavan N, Kasivisvanathan V, Collins J, Kelkar A, Sridhar A, Shaw G, Rajan P, Kelly J, Briggs T, Sooriakumaran P, Nathan S. Salvage versus primary robot-assisted radical prostatectomy: A propensity-matched comparative effectiveness study from a high-volume tertiary center. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01569-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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29
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Nathan A, Hanna N, Rashid A, Patel S, Phuah Y, Flora K, Sharma A, Cleaveland P, Kasivisvanatha V, William N, Mia S, Collin J, Sridha A, Kelka A, Sha N, Kell J, Briggs T, Shaw G, Sooriakumaran P, Rajan P, Lamb B, Nathan S. 236 Novel Guidelines to Avoid Routine Blood Tests After Robotic Assisted Radical Prostatectomy (RARP). Br J Surg 2021. [DOI: 10.1093/bjs/znab134.388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Patients undergoing RARP commonly require routine post-operative blood tests. This practice dates from an era of open surgery, with increased blood loss and complications. We aim to improve specificity of blood test requests with novel guidelines.
Method
1039 consecutive RARP patients at two tertiary urology centres in the UK were audited. Novel guidelines constructed based on risk stratified evidence from the initial audit were used to prospectively audit 133 patients.
Results
16% had clinical concerns post-operatively. 1% and 4% had an intra- and post-operative complication. Intra- or post-operative clinical judgement flagged post-operative complications in 99.9%. 80% had routine blood tests with no clinical concerns. 6% had delayed discharge due to delayed processing of blood tests. 0.9% received a peri-operative transfusion.
Re-Audit Novel guidelines reduced the number of blood tests requested from 100% to 36%. Specificity in diagnosing a complication improved from 0% to 67%. Discharge delays reduced from 6% to 0% and no post-operative complications were missed (sensitivity 100%).
Conclusions
Routine blood tests, without an indication, did not flag any additional post-operative complications. Blood transfusion is rare for RARP. Novel guidelines to request post-operative blood tests will reduce costs and discharge delays whilst maintaining appropriate patient safety and care.
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Affiliation(s)
- A Nathan
- University College London Hospitals, London, United Kingdom
| | - N Hanna
- Cambridge University Hospitals, Cambridge, United Kingdom
| | - A Rashid
- Cambridge University Hospitals, Cambridge, United Kingdom
| | - S Patel
- University College London Hospitals, London, United Kingdom
| | - Y Phuah
- University College London Hospitals, London, United Kingdom
| | - K Flora
- University College London Hospitals, London, United Kingdom
| | - A Sharma
- University College London Hospitals, London, United Kingdom
| | - P Cleaveland
- University College London Hospitals, London, United Kingdom
| | | | - N William
- University College London Hospitals, London, United Kingdom
| | - S Mia
- Cambridge University Hospitals, Cambridge, United Kingdom
| | - J Collin
- University College London Hospitals, London, United Kingdom
| | - A Sridha
- University College London Hospitals, London, United Kingdom
| | - A Kelka
- University College London Hospitals, London, United Kingdom
| | - N Sha
- Cambridge University Hospitals, Cambridge, United Kingdom
| | - J Kell
- University College London Hospitals, London, United Kingdom
| | - T Briggs
- University College London Hospitals, London, United Kingdom
| | - G Shaw
- University College London Hospitals, London, United Kingdom
| | | | - P Rajan
- University College London Hospitals, London, United Kingdom
| | - B Lamb
- Cambridge University Hospitals, Cambridge, United Kingdom
| | - S Nathan
- University College London Hospitals, London, United Kingdom
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30
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Chew CC, Rajan P. Controversies on the Use of Ultraviolet Rays for Disinfection During the COVID-19 Pandemic. Malays J Med Sci 2021; 28:117-119. [PMID: 33679228 PMCID: PMC7909359 DOI: 10.21315/mjms2021.28.1.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/24/2020] [Indexed: 12/05/2022] Open
Abstract
During the coronavirus disease 2019 (COVID-19) pandemic, the use of ultraviolet (UV) rays to disinfect skin areas, clothes and other objects at the entry/exit points of public spaces has been widely discussed by stakeholders. While ultraviolet germicidal irradiation (UVGI) has been shown to effectively inactivate coronaviruses, including severe acute respiratory syndrome coronavirus (SARS-CoV)-1 and Middle East respiratory syndrome coronavirus (MERS-CoV), no specific evidence proves that it effectively inactivates the new SARS-CoV-2 virus that causes COVID-19. Because UV rays damage human tissue, UVGI should be used with caution and not directly on human skin. Various guidelines recommend that UVGI should not be used as a sole agent for disinfecting surfaces or objects but as an adjunct to the latest standard disinfecting procedures.
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Affiliation(s)
- Chii Chii Chew
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia Level 4, Ambulatory Care Centre (ACC), Ipoh, Perak, Malaysia.,School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinang, Malaysia
| | - Philip Rajan
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia Level 4, Ambulatory Care Centre (ACC), Ipoh, Perak, Malaysia.,Department of Ear, Nose and Throat (ENT), Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Perak, Malaysia
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31
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Nathan A, Hanna N, Rashid A, Patel S, Phuah Y, Flora K, Cleaveland P, Kasivisvanathan V, Miah S, Collins J, Sridhar A, Kelkar A, Hines J, Kelly J, Shah N, Briggs T, Shaw G, Sooriakumaran P, Rajan P, Lamb B, Nathan S. Novel guidelines to avoid routine blood tests after Robot Assisted Radical Prostatectomy (RARP). EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)35850-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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32
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Thottiyen S, Kuruvilla R, George A, Rajan P, Sajan P, Subhash VC, Varghese JC. Ankle Brachial Index vs Transcutaneous Partial Pressure of Oxygen for Predicting Healing of Diabetic Foot Ulcers with Peripheral Arterial Disease: a Comparative Study. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02587-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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33
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Korotun M, Hahn S, Quintero L, Rajan P, Iakovou A, Mayo P, Greenberg H. 0649 Ultrasound Assessment of Tongue Movement as a Predictor of Response to Hypoglossal Nerve Stimulation (HGNS). Sleep 2020. [DOI: 10.1093/sleep/zsaa056.645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
HGNS is an approved therapy for obstructive sleep apnea (OSA). Initial setting of HGNS voltage is based on observation of anterior tongue movement, which may not reflect opening of the retroglossal airway. We developed an ultrasonographic (US) technique to assess tongue movement with HGNS. We correlated US measures of tongue movement at the initial HGNS voltage setting with the AHI determined by PSG/HSAT on HGNS therapy.
Methods
Eleven subjects implanted with INSPIRE™ (HGNS) were enrolled at least one month post-implantation. Initial HGNS voltage was determined while awake and semi-recumbent and set to achieve visualized anterior tongue protrusion at a tolerable stimulation voltage. A curvilinear probe (5-2MHz) was placed longitudinally in the submental region at the midline with the indicator pointed anteriorly. Hyoid bone excursion (HBE) with stimulation was used as a marker of base of tongue movement. PSG or HSAT was performed to determine AHI with HGNS. Responders were defined as those with a reduction in AHI ≥50% and an AHI <20 events/hr.
Results
N=11, 6M, 5F, Age=66.5 ±18.4 years, BMI=27.9±2.7 kg/m2. Pre-treatment AHI=38.8±13.4/hr, T-90%=10.5±16.7%. Mean HBE in responders=1.02±0.17cm vs 0.76±0.20cm in non-responders (p=0.006). Best subsets regression analysis performed using post-treatment AHI as the dependent variable and age, BMI, baseline AHI, HBE and HGNS voltage as independent variables showed that HBE (coef. -29.1, p=0.038) and BMI (coef. 2.6, p=0.018) were independent predictors of response.
Conclusion
We demonstrated that ultrasound assessment of HBE during HGNS may be a useful tool to predict response to therapy and guide HGNS settings. HBE, rather than voltage, predicted post-treatment AHI.
Support
None.
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Affiliation(s)
| | - S Hahn
- Northwell Health, New Hyde Park, NY
| | | | - P Rajan
- Northwell Health, New Hyde Park, NY
| | | | - P Mayo
- Northwell Health, New Hyde Park, NY
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34
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Randhawa AS, Balasubramaniam A, Rajan P, Mohamad I. Migratory foreign body in the neck. Pediatr Med Rodz 2020. [DOI: 10.15557/pimr.2019.0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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35
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De Laere B, Crippa A, Ghysel C, Ost P, Rajan P, Eklund M, Dirix L, Grönberg H, Lindberg J. Elevated driver mutational burden or number of perturbed pathways and poor response to abiraterone or enzalutamide in metastatic castration-resistant prostate cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz239.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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36
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Prasad G, Rajan P, Antony VT, Shaji PK. Distribution Pattern and Population Characteristics of <i>Impatiens johnii</i> E. Barnes, A Stenotopic Endemic and Endangered Balsam in The Mountain Landscape of Munnar, Kerala, India. CURR SCI INDIA 2018. [DOI: 10.18520/cs/v115/i10/1960-1962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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37
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Kumarasamy G, Rajan P, Zahidi M, Mohamad I. Pinna granular cell tumor in a child. Indian J Otol 2018. [DOI: 10.4103/indianjotol.indianjotol_114_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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38
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Ngui LX, Tang IP, Rajan P, Prepageran N. Bilateral Simultaneous Cochlear Implant in Children and Adults—a Literature Review and Clinical Experience. Curr Otorhinolaryngol Rep 2017. [DOI: 10.1007/s40136-017-0165-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Prasad G, Rajan P, Bhavadas N. <b>Feasibility study on the vegetative propagation of four endemic rare balsams (<I>Impatiens</I> spp.) through stem cuttings for conservation and management in Idukki District, Kerala, India</b>. J Threat Taxa 2017. [DOI: 10.11609/jott.3370.9.10.10846-10849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Ex situ conservation by vegetative propagation was successfully established in the endemic rare balsam species Impatiens anaimudica, I. elegans, I. disotis and I. phoenicea of the Western Ghats. The experiment was done in an open environmental nursery at Munnar exposed to constant temperature (7–24 0C) and relative humidity (70–100 %) throughout the study period. These favourable conditions provided a suitable platform for the establishment. We observed a significant difference in the regeneration patterns of the four species. I. elegans started to regenerate after the 10th day of planting with high success, while I. disotis showed a 30% success rate. After maturation all species were transplanted to natural ecosystems.
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Abstract
Severe extensive deep neck abscess in an infant is uncommon. We share the case of a previously well 4-month old infant who was referred for a 4-day history of fever, lethargy and left lateral neck swelling. Contrast-enhanced CT scan revealed a large 5.3×8 cm collection involving the left parapharyngeal and retropharyngeal space, causing significant airway narrowing. 40 mL of frank pus was drained via intraoral incision and drainage with the aid of endoscope, and undesirable complications from an external approach were averted. The infant was extubated 48 hours postsurgery and was discharged home well after completion of 1 week of intravenous antibiotics. The child was discharged well from our follow-up at 1 month review. We discuss the pathophysiology of deep neck space abscesses, its incidence in the paediatric population and the various management options.
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Affiliation(s)
- Anusha Balasubramanian
- Department of Otorhinolaryngology, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia.,Department of Otorhinolaryngology, Hospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia
| | - J Redzwan Shah
- Department of Otorhinolaryngology, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia
| | - Norzi Gazali
- Department of Otorhinolaryngology, Hospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia
| | - Philip Rajan
- Department of Otorhinolaryngology, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia
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41
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Rajan P, Teh HM, Prepageran N, Kamalden TIT, Tang IP. Endoscopic Cochlear Implant: Literature Review and Current Status. Curr Otorhinolaryngol Rep 2017. [DOI: 10.1007/s40136-017-0164-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Boo WH, Rajan P, Ching SM, Lee PY. Juvenile recurrent respiratory papillomatosis: A rare masquerade of asthma. Malays Fam Physician 2015; 10:45-48. [PMID: 27099660 PMCID: PMC4826580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Juvenile recurrent respiratory papillomatosis (JRRP) is a rare condition. The varied presentation of this condition predisposes to misdiagnosis and potential life-threatening airway obstruction. In this paper, we have reported a case of JRRP presenting as severe respiratory distress and consequently mistreated as asthmatic attack culminating in a near fatal acute airway obstruction.
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Affiliation(s)
- W H Boo
- Woi Hon Boo (Corresponding author) MD, Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia.
| | - P Rajan
- Philip Rajan MBBS, MMed ORL-HNS, MFST (Edin), Department of Otorhinolaryngology, Hospital Raja Permaisuri Bainun, 30990 Ipoh, Perak, Malaysia
| | - S M Ching
- Siew Mooi Ching MD, MMed Family Medicine, Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - P Y Lee
- Ping Yein Lee MBBS, MMed Family Medicine, Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia.
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Otake Y, Leonard S, Reiter A, Rajan P, Siewerdsen JH, Gallia GL, Ishii M, Taylor RH, Hager GD. Rendering-Based Video-CT Registration with Physical Constraints for Image-Guided Endoscopic Sinus Surgery. Proc SPIE Int Soc Opt Eng 2015; 9415. [PMID: 25991876 DOI: 10.1117/12.2081732] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
We present a system for registering the coordinate frame of an endoscope to pre- or intra- operatively acquired CT data based on optimizing the similarity metric between an endoscopic image and an image predicted via rendering of CT. Our method is robust and semi-automatic because it takes account of physical constraints, specifically, collisions between the endoscope and the anatomy, to initialize and constrain the search. The proposed optimization method is based on a stochastic optimization algorithm that evaluates a large number of similarity metric functions in parallel on a graphics processing unit. Images from a cadaver and a patient were used for evaluation. The registration error was 0.83 mm and 1.97 mm for cadaver and patient images respectively. The average registration time for 60 trials was 4.4 seconds. The patient study demonstrated robustness of the proposed algorithm against a moderate anatomical deformation.
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Affiliation(s)
- Y Otake
- Department of Computer Science, Johns Hopkins University, Baltimore MD, USA ; Graduate School of Information Science, Nara Institute of Science and Technology, Nara, Japan
| | - S Leonard
- Department of Computer Science, Johns Hopkins University, Baltimore MD, USA
| | - A Reiter
- Department of Computer Science, Johns Hopkins University, Baltimore MD, USA
| | - P Rajan
- Department of Computer Science, Johns Hopkins University, Baltimore MD, USA
| | - J H Siewerdsen
- Department of Boimedical Engineering, Johns Hopkins University, Baltimore MD, USA
| | - G L Gallia
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University, Baltimore MD, USA
| | - M Ishii
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University, Baltimore MD, USA
| | - R H Taylor
- Department of Computer Science, Johns Hopkins University, Baltimore MD, USA
| | - G D Hager
- Department of Computer Science, Johns Hopkins University, Baltimore MD, USA
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Abstract
Infratemporal fossa abscess is a rare and challenging condition to diagnose and manage. A few reported cases have been mostly due to odontogenic infections and were managed by external or intraoral drainage. This is the first reported case of an infratemporal fossa abscess that was successfully managed by endoscopic drainage via a transmaxillary approach.
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Affiliation(s)
| | - Philip Rajan
- Department of ENT, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia
| | - Anusha Balasubramanian
- Department of ENT, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia Department of Otorhinolaryngology-Head and Neck Surgery, Universiti Sains Malaysia, KotaBharu, Kelantan, Malaysia
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Rajan P. The child with suspected hearing loss. Malays Fam Physician 2013; 8:65-67. [PMID: 25606288 PMCID: PMC4170474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- P Rajan
- The child with suspected hearing loss
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Rotimi VO, Salako NO, Mokaddas E, Philip L, Rajan P. High Frequency of Isolation of Antibiotic-Resistant Oral Viridans Streptococci from Children in Kuwait. J Chemother 2013; 17:493-501. [PMID: 16323437 DOI: 10.1179/joc.2005.17.5.493] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Antimicrobial resistance among the Viridans group of streptococci (VGS) has emerged as a hindrance to effective antibiotic therapy. Our objective was to evaluate the prevalence of antibiotic-resistant VGS in healthy children. Plaque samples were collected from tooth and tongue surfaces of 102 healthy subjects. Serially diluted samples were inoculated onto BHI agar plates and Mitis Salivarius Agar (MSA) plates and incubated as appropriate. Representative colonies were identified to species level by standard methods. Susceptibility of the VGS was performed by determining the minimum inhibitory concentrations (MICs) of 11 antibiotics using Etest. Of the 540 VGS isolates from both sites, 58% were from the tooth surfaces and 42% from the tongue. The most prevalent were S. salivarius (21.5%) and S. sanguis (16.3%). Imipenem and vancomycin had excellent activities. Resistance rates to trimethoprim, amoxicillin, piperacillin, erythromycin, cefuroxime and cephalothin, were 60.7, 40.8, 34.7, 32.6, 27.5 and 25.3%, respectively. Resistance rates to penicillin and clindamycin were 15.9% and 15.4%, respectively. The majority of the erythromycin-resistant isolates were from the tongue; 41% versus 29%. At the species level, 26% and 23% of S. salivarius and 23% and 14% of S. mutans from the tooth and tongue, respectively were resistant to penicillin. The data show species-related and site-related variations in the susceptibility pattern and an emerging high prevalence of antibiotic-resistant VGS. The difference in the susceptibilities between the species underscores the importance of accurate-identification and the need for surveillance of antimicrobial resistance among clinical isolates in our hospitals.
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Affiliation(s)
- V O Rotimi
- Department of Microbiology, Faculty of Medicine, Kuwait University, Safat.
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Rajan P. Avionics Systems (Guest Editorial). DEFENCE SCI J 2013. [DOI: 10.14429/dsj.63.4269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Plichta JK, Lapetino S, Rumas N, Rajan P, Godellas C, Perez C. Abstract P1-02-01: Flat epithelial atypia diagnosed on breast core biopsy: what next? Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p1-02-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Historically, atypical ductal hyperplasia (ADH) identified on breast core biopsy has been associated with a 20% upgrade to malignancy at surgical excision. Recent literature has suggested a downward trend in such upgrade rates, possibly related to the use of larger gauge core biopsy devices. It is still unclear if this applies to other high-risk lesions, such as flat epithelial atypia (FEA). As core biopsy techniques and imaging have improved, it is critical to review the correlation between FEA diagnosed on core biopsy and malignancy at final surgical excision.
Methods: We performed a retrospective chart review of our institution's medical record from 2009 to 2011 to identify all patients who (1) underwent breast core biopsy, (2) were initially diagnosed with FEA without malignancy (in situ or invasive carcinoma), and (3) proceeded with surgical excision at our institution.
Results: Of the 726 breast core biopsies performed between 2009 and 2011, we identified 14 patients who met our inclusion criteria. Three patients were upgraded to malignancy following surgical excision (21%). The median age was 53.5 years, and the average breast cancer risk assessment scores were 3.5% 5-year and 18.9% lifetime. All patients underwent pre-biopsy mammogram, and four were further evaluated with ultrasound; no patients underwent a breast MRI. All of the imaging abnormalities were initially classified as BI-RADS 4, including five masses/densities and nine with suspicious calcifications. Only one patient reported the lesion as palpable on presentation and this was eventually upgraded to malignancy. All patients underwent image-guided core biopsies, including 13 stereotactic, vacuum-assisted and one ultrasound-guided, vacuum-assisted. Nine patients had 9-gauge core needle biopsies, while the remaining four patients had 11, 12, or 14-gauge needle biopsies, and this did not vary between years. Following surgical excision, three of the 14 patients (21%) were upgraded pathologically to ductal carcinoma in situ (DCIS; n=1) or invasive ductal carcinoma (n = 2). All three of these patients had 9-gauge core biopsies prior to surgical excision. Of note, four patients also had concurrent ADH on initial biopsy, although none of these were pathologically upgraded to malignancy. Of the upgrades, one patient proceeded with a definitive lumpectomy (negative sentinel lymph node biopsy) and one underwent bilateral mastectomy. The third patient is planning to undergo ipsilateral mastectomy for a subsequent diagnosis of multi-centric breast disease, including identification of an ipsilateral DCIS lesion distant from the primary lesion.
Conclusions: The use of a larger gauge core biopsy needle (e.g. 9-gauge) may yield superior tissue sampling and should likely be considered as the standard of care in the evaluation of image-detected breast abnormalities. In addition, biopsy results should not be considered definitively non-malignant when a high-risk lesion is identified. While there may be a trend towards not excising some of these high-risk lesions, we believe that a core biopsy demonstrating FEA still warrants surgical excision.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P1-02-01.
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Affiliation(s)
- JK Plichta
- Loyola University Medical Center, Maywood, IL
| | - S Lapetino
- Loyola University Medical Center, Maywood, IL
| | - N Rumas
- Loyola University Medical Center, Maywood, IL
| | - P Rajan
- Loyola University Medical Center, Maywood, IL
| | - C Godellas
- Loyola University Medical Center, Maywood, IL
| | - C Perez
- Loyola University Medical Center, Maywood, IL
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Abstract
The first local anaesthetic operating list faced by a Core Surgical Trainee (CT) can appear a daunting task. Fresh from Foundation Year (FY) posts, (s)he will lack experience in basic surgical techniques. At present, there is no formal training in minor surgical skills for FY doctors, and exposure to operative surgery can be variable. This review provides an introduction and practical guide to the operative management of minor surgical pathologies.
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Affiliation(s)
- P Rajan
- Beatson Institute for Cancer Research, Glasgow, G61 1BD.
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Barry L, Ahmad I, Pokrovska T, Rajan P. Current management options for the small renal mass in a solitary kidney. Scott Med J 2012; 57:157-62. [PMID: 22859808 DOI: 10.1258/smj.2012.012022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The widespread use of cross-sectional imaging has resulted in an increase in the frequency of incidentally identified small renal masses (SRMs). With high cancer-specific survival rates following radical nephrectomy, there is an increasing patient cohort at risk of developing a metachronous contralateral tumour. Nephron-sparing surgery (NSS) has been shown to reduce progression of chronic kidney disease, being the impetus to utilize NSS for the management of SRMs in an anatomical or functional solitary kidney. At present, open partial nephrectomy is the gold standard treatment for an SRM in a solitary kidney; however, there are a number of other minimally invasive options, including laparoscopic partial nephrectomy, and in situ ablative procedures. In addition, variables such as warm and cold ischaemia and renal vascular clamping have been shown to affect outcomes. In this review, we summarize contemporary management options focusing specifically on oncological and functional outcomes.
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Affiliation(s)
- L Barry
- Royal Alexandra Hospital, Paisley, Scotland, UK
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