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Shrestha S, Iqbal A, Teoh SL, Khanal S, Gan SH, Lee SWH, Paudyal V. Impact of pharmacist-delivered interventions on pain-related outcomes: An umbrella review of systematic reviews and meta-analyses. Res Social Adm Pharm 2024; 20:34-51. [PMID: 38514293 DOI: 10.1016/j.sapharm.2024.03.005] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/09/2024] [Accepted: 03/12/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION Pain is a significant healthcare challenge, impacting millions worldwide. Pharmacists have increasingly taken on expanded roles in managing pain, particularly in primary and ambulatory care contexts. This umbrella review aims to systematically evaluate evidence from published systematic reviews that explore the impact of pharmacist-delivered interventions on clinical, humanistic, and economic outcomes related to pain. METHODS A systematic search was conducted across six electronic databases, including Ovid Embase, MEDLINE, CINAHL, Scopus, CENTRAL, APA PsycINFO, and DARE, from inception until June 2023. Prior to inclusion, two independent reviewers assessed study titles and abstracts. Following inclusion, an assessment of the methodological quality of the included studies was conducted. AMSTAR 2 was used to evaluate the methodological quality of the included SRs. RESULTS From 2055 retrieved titles, 11 systematic reviews were included, with 5 out of 11 being meta-analyses. These SRs encompassed diverse pharmacist-led interventions such as education, medication reviews, and multi-component strategies targeting various facets of pain management. These findings showed favorable clinical outcomes, including reduced pain intensity, improved medication management, enhanced overall physical and mental well-being, and reduced hospitalization durations. Significant pain intensity reductions were found due to pharmacists' interventions, with standardized mean differences (SMDs) ranging from -0.76 to -0.22 across different studies and subgroups. Physical functioning improvements were observed, with SMDs ranging from -0.38 to 1.03. Positive humanistic outcomes were also reported, such as increased healthcare provider confidence, patient satisfaction, and quality of life (QoL). QoL improvements were reported, with SMDs ranging from 0.29 to 1.03. Three systematic reviews examined pharmacist interventions' impact on pain-related economic outcomes, highlighting varying cost implications and the need for robust research methodologies to capture costs and benefits. CONCLUSION This umbrella review highlights the effectiveness of pharmacist-delivered interventions in improving clinical, humanistic, and economic outcomes related to pain management. Existing evidence emphasises on the need to integrate pharamacists into multi-disciplinary pain management teams. Further research is needed to investigate innovative care models, such as pharmacist-independent prescribing initiatives within collaborative pain management clinics.
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Affiliation(s)
- Sunil Shrestha
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia.
| | - Ayesha Iqbal
- Office of Lifelong Learning and the Physician Learning Program, Faculty of Medicine and Dentistry, University of Alberta, AB, T6G1C9, Edmonton, Canada.
| | - Siew Li Teoh
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia.
| | - Saval Khanal
- Health Economics Consulting, Norwich Medical School, University of East Anglia, Bob Champion Research & Education Building, UEA Research Park Rosalind Franklin Rd, NR4 7UQ, Norwich, United Kingdom.
| | - Siew Hua Gan
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia.
| | - Shaun Wen Huey Lee
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia; School of Pharmacy, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Selangor, Malaysia; Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well Being Cluster, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia; Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia.
| | - Vibhu Paudyal
- School of Pharmacy, College of Medical and Dental Sciences, University of Birmingham Edgbaston, Birmingham, United Kingdom; Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom.
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Jong FJX, Ooi DJ, Teoh SL. The effect of oil pulling in comparison with chlorhexidine and other mouthwash interventions in promoting oral health: A systematic review and meta-analysis. Int J Dent Hyg 2024; 22:78-94. [PMID: 37635453 DOI: 10.1111/idh.12725] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 05/11/2023] [Accepted: 08/06/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVES A meta-analytic review was performed to critically synthesize the evidence of oil pulling on improving the parameters of gingival health, plaque control and bacteria counts against chlorhexidine and other mouthwash or oral hygiene practices. METHODS Databases including Medline, Embase and bibliographies were searched from inception to 1 April 2023. Randomized controlled trials (RCTs) with 7 days or longer duration of oil pulling with edible oils in comparison to chlorhexidine or other mouthwashes or oral hygiene practice concerning the parameters of plaque index scores (PI), gingival index scores (GI), modified gingival index scores (MGI) and bacteria counts were included. Cochrane's Risk of Bias (ROB) tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework were employed to determine the quality of evidence. Two authors independently conducted study selection and data extraction. Meta-analyses of the effect of oil pulling on the parameters were conducted using an inverse-variance random-effects model. RESULTS Twenty-five trials involving 1184 participants were included. Twenty-one trials comparing oil pulling (n = 535) to chlorhexidine (n = 286) and non-chlorhexidine intervention (n = 205) were pooled for meta-analysis. More than half of the trials (n = 17) involved participants with no reported oral health issues. The duration of intervention ranged from 7 to 45 days, with half of the trials using sesame oil. When compared to non-chlorhexidine mouthwash interventions, oil pulling clinically and significantly improved MGI scores (Standardized mean difference, SMD = -1.14; 95% confidence interval [CI]: -1.31, -0.97). Chlorhexidine was more effective in reducing the PI scores compared to oil pulling, with an SMD of 0.33 (95% CI: 0.17, 0.49). The overall quality of the body of evidence was very low. CONCLUSIONS There was a probable benefit of oil pulling in improving gingival health. Chlorhexidine remained superior in reducing the amount of plaque, compared to oil pulling. However, there was very low certainty in the evidence albeit the clinically beneficial effect of oil pulling intervention.
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Affiliation(s)
- Freda Jia Xin Jong
- Department of Psychology, School of Medical and Life Sciences, Sunway University, Bandar Sunway, Malaysia
| | - Der Jiun Ooi
- Department of Oral Biology and Biomedical Sciences, Faculty of Dentistry, MAHSA University, Selangor, Malaysia
| | - Siew Li Teoh
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
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Kuan WC, Chee KH, Kasim S, Lim KK, Dujaili JA, Lee KKC, Teoh SL. Validity and measurement equivalence of EQ-5D-5L questionnaire among heart failure patients in Malaysia: a cohort study. J Med Econ 2024; 27:607-617. [PMID: 38557412 DOI: 10.1080/13696998.2024.2337563] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 03/28/2024] [Indexed: 04/04/2024]
Abstract
AIM This study aimed to examine the validity of EQ-5D-5L among HFrEF patients in Malaysia, and to explore the measurement equivalence of three main language versions. METHODS We surveyed HFrEF patients from two hospitals in Malaysia, using Malay, English or Chinese versions of EQ-5D-5L. EQ-5D-5L dimensional scores were converted to utility scores using the Malaysian value set. A confirmatory factor analysis longitudinal model was constructed. The utility and visual analog scale (VAS) scores were evaluated for validity (convergent, known-group, responsiveness), and measurement equivalence of the three language versions. RESULTS 200 HFrEF patients (mean age = 61 years), predominantly male (74%) of Malay ethnicity (55%), completed the admission and discharge EQ-5D-5L questionnaire in Malay (49%), English (26%) or Chinese (25%) languages. 173 patients (86.5%) were followed up at 1-month post-discharge (1MPD). The standardized factor loadings and average variance extracted were ≥ 0.5 while composite reliability was ≥ 0.7, suggesting convergent validity. Patients with older age and higher New York Heart Association (NYHA) class reported significantly lower utility and VAS scores. The change in utility and VAS scores between admission and discharge was large, while the change between discharge and 1MPD was minimal. The minimal clinically important difference for utility and VAS scores was ±0.19 and ±11.01, respectively. Malay and English questionnaire were equivalent while the equivalence of Malay and Chinese questionnaire was inconclusive. LIMITATION This study only sampled HFrEF patients from two teaching hospitals, thus limiting the generalizability of results to the entire heart failure population. CONCLUSION EQ-5D-5L is a valid questionnaire to measure health-related quality of life and estimate utility values among HFrEF patients in Malaysia. The Malay and English versions of EQ-5D-5L appear equivalent for clinical and economic assessments.
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Affiliation(s)
- Wai Chee Kuan
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Selangor, Malaysia
| | - Kok Han Chee
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sazzli Kasim
- Department of Internal Medicine (Cardiology), Faculty of Medicine, Universiti Teknologi MARA (UITM), Jalan Hospital, Selangor, Malaysia
- Cardiac Vascular and Lung Research Institute (CaVaLRI), Universiti Teknologi MARA (UITM), Jalan Hospital, Selangor, Malaysia
| | - Ka Keat Lim
- Department of Population Health Sciences, School of Life Course & Population Sciences, King's College London, London, United Kingdom
| | - Juman Abdulelah Dujaili
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Selangor, Malaysia
- Swansea University Medical School, Swansea University, Wales, United Kingdom
| | | | - Siew Li Teoh
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Selangor, Malaysia
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Yong ASJ, Lim KK, Fox-Rushby J, Ismail F, Hamzah E, Cheong MWL, Teoh SL. A Longitudinal Evaluation of the Preferences of Patients With Advanced Cancer for Quality of Life and Survival in Malaysia: A Discrete Choice Experiment. Value Health 2023; 26:1772-1781. [PMID: 37741445 DOI: 10.1016/j.jval.2023.08.009] [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] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 08/03/2023] [Accepted: 08/11/2023] [Indexed: 09/25/2023]
Abstract
OBJECTIVES This study aims to quantify the preferences of patients with advanced cancer for quality of life (QoL) outcomes versus survival extension in Malaysia. The secondary aim of this study is to explore the change in preferences over time. METHODS A discrete choice experiment was developed to include 7 attributes valued in cancer management: physical, psychological and social functioning, pain control, survival, place of death, and cost. Patients were recruited via convenience sampling from 2 Malaysian public hospitals. The survey questionnaire was administered to patients within 6 months of their cancer diagnosis with a follow-up 3 months later. Conditional logit regression was used to estimate the preference weight, relative attribute importance, and willingness to pay. RESULTS One hundred valid responses were collected at baseline and 45 at follow-up. Respondents placed higher values on QoL improvements from severe to moderate or mild levels and to achieve home death over survival extension from 6 to 18 months. However, additional improvements (from moderate to mild) in some of the QoL outcomes were not valued as highly as life extension from 12 to 18 months, showing that it was vital for patients to avoid being in "severe" health dysfunction. Improving physical dysfunction from severe to mild yielded 3 times as much value as additional 1-year survival. After 3 months, the respondents' preferences changed significantly, with increased relative attribute importance of physical functioning, pain control, and cost. CONCLUSIONS As QoL outcomes are valued more than survival, palliative care should be introduced as early as possible to alleviate suffering related to advanced cancer.
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Affiliation(s)
- Alene Sze Jing Yong
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia
| | - Ka Keat Lim
- Faculty of Life Sciences and Medicine, School of Life Course and Population Sciences, King's College London, London, England, UK
| | - Julia Fox-Rushby
- Faculty of Life Sciences and Medicine, School of Life Course and Population Sciences, King's College London, London, England, UK
| | - Fuad Ismail
- Department of Radiotherapy & Oncology, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak
| | | | | | - Siew Li Teoh
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia.
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Omran S, Leong SL, Blebil A, Mohan D, Teoh SL. Effectiveness of pharmacogenomics educational interventions on healthcare professionals and health professions students: A systematic review. Res Social Adm Pharm 2023; 19:1399-1411. [PMID: 37586945 DOI: 10.1016/j.sapharm.2023.07.012] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 07/29/2023] [Accepted: 07/30/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND The field of pharmacogenomics is rapidly advancing, but its adoption and implementation remain slow and lacking. Lack of pharmacogenomics knowledge among healthcare professionals is the most frequently cited barrier to adopting and implementing pharmacogenomics in clinical settings. OBJECTIVES This study aimed to critically evaluate and determine the effectiveness of educational interventions in improving pharmacogenomics knowledge and practice. METHODS Four electronic databases were searched: MEDLINE, EMBASE, CENTRAL, and PsycINFO. Studies on pharmacogenomics educational interventions for health care professionals and students with pre- and post-intervention assessments and results were included. No restrictions were placed on time, language, or educational contexts. The educational outcomes measured include both objective and subjective outcomes. The pharmacogenomics competency domains used to judge educational interventions are based on the competency domains listed by the American Association of Colleges of Pharmacies (AACP). The National Heart, Lung, and Blood Institute of the National Institutes of Health was used for the quality assessment of pre-post studies with no control group and the controlled intervention studies. No meta-analysis was conducted; the data were synthesized qualitatively. The systematic review was reported in accordance with the PRISMA statement. RESULTS Fifty studies were included in this review. All included studies integrated the AACP pharmacogenomics competency domains into their educational interventions. Most of the studies had educational interventions that integrated clinical cases (n = 44; 88%). Knowledge was the most frequently evaluated outcome (n = 34; 68%) and demonstrated significant improvement after the educational intervention that integrated AACP pharmacogenomics competency domains and employed active learning with clinical case inclusion. CONCLUSION This review provided evidence of the effectiveness of educational interventions in improving pharmacogenomics knowledge and practice. Incorporating pharmacogenomics competency domains into education and training, with patient cases for healthcare professionals and students, dramatically improved their pharmacogenomics knowledge, attitudes, and confidence in practice.
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Affiliation(s)
- Safa Omran
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia.
| | - Siew Lian Leong
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia
| | - Ali Blebil
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia
| | - Devi Mohan
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia
| | - Siew Li Teoh
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500, Subang Jaya, Selangor, 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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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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Kuan WC, Sim R, Wong WJ, Dujaili J, Kasim S, Lee KKC, Teoh SL. Economic Evaluations of Guideline-Directed Medical Therapies for Heart Failure With Reduced Ejection Fraction: A Systematic Review. Value Health 2023; 26:1558-1576. [PMID: 37236395 DOI: 10.1016/j.jval.2023.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/13/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVES Decision-analytic models (DAMs) with varying structures and assumptions have been applied in economic evaluations (EEs) to assist decision making for heart failure with reduced ejection fraction (HFrEF) therapeutics. This systematic review aimed to summarize and critically appraise the EEs of guideline-directed medical therapies (GDMTs) for HFrEF. METHODS A systematic search of English articles and gray literature, published from January 2010, was performed on databases including MEDLINE, Embase, Scopus, NHSEED, health technology assessment, Cochrane Library, etc. The included studies were EEs with DAMs that compared the costs and outcomes of angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, angiotensin-receptor neprilysin inhibitors, beta-blockers, mineralocorticoid-receptor agonists, and sodium-glucose cotransporter-2 inhibitors. The study quality was evaluated using the Bias in Economic Evaluation (ECOBIAS) 2015 checklist and Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 checklists. RESULTS A total of 59 EEs were included. Markov model, with a lifetime horizon and a monthly cycle length, was most commonly used in evaluating GDMTs for HFrEF. Most EEs conducted in the high-income countries demonstrated that novel GDMTs for HFrEF were cost-effective compared with the standard of care, with the standardized median incremental cost-effectiveness ratio (ICER) of $21 361/quality-adjusted life-year. The key factors influencing ICERs and study conclusions included model structures, input parameters, clinical heterogeneity, and country-specific willingness-to-pay threshold. CONCLUSIONS Novel GDMTs were cost-effective compared with the standard of care. Given the heterogeneity of the DAMs and ICERs, alongside variations in willingness-to-pay thresholds across countries, there is a need to conduct country-specific EEs, particularly in low- and middle-income countries, using model structures that are coherent with the local decision context.
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Affiliation(s)
- Wai-Chee Kuan
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Ruth Sim
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Wei Jin Wong
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Juman Dujaili
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia; Swansea University Medical School, Swansea University, Swansea, Wales, UK
| | - Sazzli Kasim
- Department of Internal Medicine (Cardiology), Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, Malaysia
| | | | - Siew Li Teoh
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia.
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9
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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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10
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Yong ASJ, Cheong MWL, Hamzah E, Teoh SL. A qualitative study of lived experiences and needs of advanced cancer patients in Malaysia: Gaps and steps forward. Qual Life Res 2023:10.1007/s11136-023-03401-5. [PMID: 36964453 PMCID: PMC10038386 DOI: 10.1007/s11136-023-03401-5] [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] [Accepted: 03/10/2023] [Indexed: 03/26/2023]
Abstract
PURPOSE Due to the high burden of cancer-related suffering, it is paramount to understand the gaps in cancer care that lead to suffering. Advanced cancer patients have unmet needs and challenges that differ from those with early-stage cancer due to the rapid disease progression. By exploring advanced cancer patients' lived experiences and needs from the physical, psychological, social, and spiritual aspects, this study aims to identify gaps in the Malaysian health system and propose contextualised measures to improve cancer care. METHODS Semi-structured, in-depth interviews were conducted to explore advanced cancer patients' lived experiences and needs from the physical, psychological, social, and spiritual aspects. The interviews were then transcribed and coded. Themes were developed from the codes using iterative thematic approach. RESULTS The lived experiences and needs of nineteen patients converged into four major themes: disruption to daily lives, psychosocial and spiritual support system, information needs, and financial needs. This study described predominantly how cancer impacted patients' lives and livelihood, how patients coped with their psychological conditions after diagnosis, the need for effective communication and trust in a multicultural society, and how finance affected access to and experience of cancer care. CONCLUSION Advanced cancer patients had different needs beyond receiving medical treatments. A concerted effort is required from clinicians, allied health professionals, social workers, support groups, and family members to understand and fulfil these needs.
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Affiliation(s)
- Alene Sze Jing Yong
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia
| | | | | | - Siew Li Teoh
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia.
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11
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Shrestha S, Khatiwada AP, Sapkota B, Sapkota S, Poudel P, KC B, Teoh SL, Blebil AQ, Paudyal V. What is "Opioid Stewardship"? An Overview of Current Definitions and Proposal for a Universally Acceptable Definition. J Pain Res 2023; 16:383-394. [PMID: 36798077 PMCID: PMC9926985 DOI: 10.2147/jpr.s389358] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 01/19/2023] [Indexed: 02/11/2023] Open
Abstract
Introduction Opioid stewardship has been widely used to promote rational use, monitoring and discontinuation of opioid therapy; however, its definition and scope of practice remain unclear. Objective To synthesize definitions of opioid stewardship proposed by clinical practice guidelines and professional societies, and to offer a proposal for a universally acceptable definition. Methods Systematic literature searches were performed (earliest records to May 2022) in six databases (MEDLINE, EMBASE, APA PsycINFO, Scopus, and CENTRAL) and grey sources guidelines development bodies and professional societies through Google. The conventional but widely applied content analysis and word frequencies were used to analyze the definitions and scope of practice. Results After removing duplicates, 449 articles were retrieved (439 databases and registers and 11 from other sources), 19 of which included a definition of "opioids stewardship". A total of 12 themes was identified in the definitions, including 1) improvement or appropriateness of prescribing opioids use, 2) mitigation of risk from opioids, 3) monitoring opioid use, 4) evaluation of opioid use, 5) judicious opioid use, 6) appropriateness of opioid disposal, 7) identification and treatment of opioid use disorder, 8) reduction in mortality associated with opioid overdoses, 9) appropriate procurement practices, 10) appropriate storage, 11) promoting better communications between patients and prescribers including education provision and 12) patient-centered decision-making. Conclusion Opioid stewardship is inconsistently defined across professional and research literature. While there is a greater focus on appropriateness and need for improvement of prescribing and monitoring of opioid use, the importance of communications between patients and prescribers, and patient involvement in both prescribing and deprescribing decision-making remains sparse. A comprehensive definition has been proposed as part of the work. There is a need to develop and validate the proposed definition and scope of practice to promote rationale for opioid prescribing, use and attainment of favourable outcomes through international consensus involving practitioners, researchers, and patients.
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Affiliation(s)
- Sunil Shrestha
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Selangor, 47500, Malaysia,Correspondence: Sunil Shrestha; Vibhu Paudyal, Tel +60 102874113, Email ; ;
| | | | - Binaya Sapkota
- Department of Pharmaceutical Sciences, Nobel College, Kathmandu, Nepal
| | - Simit Sapkota
- Department of Clinical Oncology, Civil Service Hospital, Minbhawan, Kathmandu, Bagmati Province, Nepal,Department of Clinical Oncology, Kathmandu Cancer Center, Tathali, Bagmati Province, Nepal
| | - Prabhat Poudel
- Nepal Medical College Hospital, Kathmandu, Province Bagmati, Nepal
| | - Bhuvan KC
- College of Public Health, Medical & Veterinary Sciences, James Cook University, Townsville, QLD, Australia,Faculty of Pharmacy and Pharmaceutical Sciences Monash University Parkville Campus Parkville, Melbourne, VIC 3052, Australia
| | - Siew Li Teoh
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Selangor, 47500, Malaysia
| | - Ali Qais Blebil
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Selangor, 47500, Malaysia
| | - Vibhu Paudyal
- School of Pharmacy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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12
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Shrestha S, Blebil AQ, Teoh SL, Sapkota S, KC B, Paudyal V, Gan SH. Clinical pharmacists' intervention on pain management in cancer patients (PharmaCAP trial): study protocol for a randomized controlled trial. J Pharm Policy Pract 2023; 16:14. [PMID: 36694232 PMCID: PMC9875431 DOI: 10.1186/s40545-022-00505-0] [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: 04/22/2022] [Accepted: 12/12/2022] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Evidence-based services to support cancer patients with pain via clinical pharmacy services are currently lacking. Therefore, there is a need to undertake a randomized controlled trial (RCT) to explore the effectiveness of clinical pharmacists (CPs)' input into the multidisciplinary team (MDT) in providing better therapeutic outcomes for cancer pain management. OBJECTIVES The main aim of this pilot RCT is to determine the feasibility and preliminary efficacy of integrating CPs into the MDT for cancer pain management on the clinical outcomes of cancer patients experiencing pain. METHODS This study protocol outlines two-armed multicenter pilot RCT. Cancer patients suffering from pain will be randomly allocated to receive either clinical pharmacy services, i.e., PharmaCAP trial intervention from the CP, or the usual standard care (i.e., control group). Patients will be recruited consecutively from two hospitals in Kathmandu valley, Nepal. The outcomes will be assessed at baseline (pre-intervention) and 4 weeks post-intervention. The primary feasibility outcomes will include eligibility rate, recruitment rate, willingness to participate, acceptability of screening procedures and random allocation, possible contamination between the groups, intervention fidelity and compliance, treatment satisfaction, and patient understanding of the provided interventions. Subsequently, the primary clinical outcome, i.e., pain intensity of cancer patients, will be assessed. The secondary clinical outcomes will include health-related quality of life (HRQoL), anxiety, depression, adverse drug reactions, and patient medication compliance following the integration of CP into the healthcare team. DISCUSSION The feasibility and potential for integrating CP involvement in MDT to improve clinical outcomes of cancer patients with pain will be evaluated through the PharmaCAP trial. TRIAL REGISTRATION ClinicalTrials.gov NCT05021393. Registered on 25th August 2022.
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Affiliation(s)
- Sunil Shrestha
- grid.440425.30000 0004 1798 0746School of Pharmacy, Monash University Malaysia, 47500 Subang Jaya, Selangor Malaysia
| | - Ali Qais Blebil
- grid.440425.30000 0004 1798 0746School of Pharmacy, Monash University Malaysia, 47500 Subang Jaya, Selangor Malaysia
| | - Siew Li Teoh
- grid.440425.30000 0004 1798 0746School of Pharmacy, Monash University Malaysia, 47500 Subang Jaya, Selangor Malaysia
| | - Simit Sapkota
- Department of Clinical Oncology, Kathmandu Cancer Center, Tathali, Bhaktapur, Bagmati Province, Nepal ,grid.459414.90000 0004 7535 1294Department of Clinical Oncology, Civil Service Hospital, Minbhawan, Kathmandu, Bagmati Province, Nepal
| | - Bhuvan KC
- grid.440425.30000 0004 1798 0746School of Pharmacy, Monash University Malaysia, 47500 Subang Jaya, Selangor Malaysia ,grid.1011.10000 0004 0474 1797College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD Australia ,grid.1002.30000 0004 1936 7857Faculty of Pharmacy and Pharmaceutical Sciences, Monash University Parkville Campus Parkville, Melbourne, VIC 3052 Australia
| | - Vibhu Paudyal
- grid.6572.60000 0004 1936 7486School of Pharmacy, College of Medical and Dental Sciences, Sir Robert Aitken Institute for Medical Research, University of Birmingham Edgbaston, Birmingham, B15 2TT UK
| | - Siew Hua Gan
- grid.440425.30000 0004 1798 0746School of Pharmacy, Monash University Malaysia, 47500 Subang Jaya, Selangor Malaysia
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13
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Yong ASJ, Lim YH, Cheong MWL, Hamzah E, Teoh SL. Willingness-to-pay for cancer treatment and outcome: a systematic review. Eur J Health Econ 2022; 23:1037-1057. [PMID: 34853930 DOI: 10.1007/s10198-021-01407-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 11/03/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Understanding patient preferences in cancer management is essential for shared decision-making. Patient or societal willingness-to-pay (WTP) for desired outcomes in cancer management represents their preferences and values of these outcomes. OBJECTIVE The aim of this systematic review is to critically evaluate how current literature has addressed WTP in relation to cancer treatment and achievement of outcomes. METHODS Seven databases were searched from inception until 2 March 2021 to include studies with primary data of WTP values for cancer treatments or achievement of outcomes that were elicited using stated preference methods. RESULTS Fifty-four studies were included in this review. All studies were published after year 2000 and more than 90% of the studies were conducted in high-income countries. Sample size of the studies ranged from 35 to 2040, with patient being the most studied population. There was a near even distribution between studies using contingent valuation and discrete choice experiment. Based on the included studies, the highest WTP values were for a quality-adjusted life year (QALY) ($11,498-$589,822), followed by 1-year survival ($3-$198,576), quality of life (QoL) improvement ($5531-$139,499), and pain reduction ($79-$94,662). Current empirical evidence suggested that improvement in QoL and pain reduction had comparable weights to survival in cancer management. CONCLUSION This systematic review provides a summary on stated preference studies that elicited patient preferences via WTP and summarised their respective values. Respondents in this review had comparable WTP for 1-year survival and QoL, suggesting that improvement in QoL should be emphasised together with survival in cancer management.
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Affiliation(s)
- Alene Sze Jing Yong
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia
| | - Yi Heng Lim
- School of Biosciences, Taylor's University, Subang Jaya, Selangor, Malaysia
| | - Mark Wing Loong Cheong
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia
| | | | - Siew Li Teoh
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia.
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14
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Shrestha S, Kc B, Blebil AQ, Teoh SL. Pharmacist Involvement in Cancer Pain Management: A Systematic Review and Meta-Analysis. J Pain 2022; 23:1123-1142. [PMID: 35151871 DOI: 10.1016/j.jpain.2022.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 12/10/2021] [Accepted: 02/05/2022] [Indexed: 06/14/2023]
Abstract
This review aimed to critically evaluate the impact of pharmacist involvement in managing pain in cancer patients. Databases (including MEDLINE, Embase and CENTRAL) were searched with a broad search strategy for studies involving pharmacists and cancer pain management until February 10, 2021. The quality of studies and evidence were assessed using standardized tools and GRADE, respectively. A random-effects model was used for meta-analysis. Sixty-four studies were included. Common interventions delivered by the pharmacists were medication review, patient education, adverse drug reactions (ADRs) detection and management, pharmacological recommendations (in dosing and pharmacotherapy choice), and pain assessment. A pooled analysis of 3 randomized control trials showed a significant reduction in pain intensity with a standardized mean difference (SMD) of 0.35 [95% confidence intervals (CI): -0.55, -0.16]. Pooled analyses from nonrandomized studies of interventions also showed significant results in reduction of ADRs with an odds ratio of 0.69 (95% CI: 0.61, 0.79) and improvement in quality of life with SMD of 0.80 (95% CI: 0.29, 1.32). Thus, pharmacists significantly improve the clinical outcomes of cancer patients related to pain. This indicates the involvement of pharmacists directly or in collaboration with healthcare professionals in the oncology team is highly beneficial for the patients. PERSPECTIVES: This systematic review presents a comprehensive evaluation of pharmacist involvement in cancer pain management. This shows the importance of direct involvement of the pharmacist or as an important member of the multidisciplinary oncology team.
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Affiliation(s)
- Sunil Shrestha
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia
| | - Bhuvan Kc
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia; College of Public Health, Medical & Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Ali Qais Blebil
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia; Department of Pharmacy, Al Rafidain University College, Baghdad, Iraq
| | - Siew Li Teoh
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia.
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15
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How CW, Teoh SL, Loh JS, Tan SLK, Foo JB, Ng HS, Wong SYW, Ong YS. Emerging Nanotheranostics for 5-Fluorouracil in Cancer Therapy: A Systematic Review on Efficacy, Safety, and Diagnostic Capability. Front Pharmacol 2022; 13:882704. [PMID: 35662688 PMCID: PMC9158334 DOI: 10.3389/fphar.2022.882704] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/07/2022] [Indexed: 11/13/2022] Open
Abstract
The conventional concept of using nanocarriers to deliver chemotherapeutic drugs has advanced to accommodate additional diagnostic capability. Nanotheranostic agents (NTA), combining both treatment and diagnostic tools, are an ideal example of engineering-health integration for cancer management. Owing to the diverse materials used to construct NTAs, their safety, effectiveness, and diagnostic accuracy could vary substantially. This systematic review consolidated current NTAs incorporating 5-fluorouracil and elucidated their toxicity, anticancer efficacy, and imaging capability. Medline and Embase databases were searched up to March 18, 2022. The search, selection, and extraction were performed by the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines to ensure completeness and reproducibility. Original research papers involving 5-fluorouracil in the preparation of nanoparticles which reported their efficacy, toxicity, and diagnostic capability in animal cancer models were recruited. The quality of included studies was assessed using the Collaborative Approach to Meta-Analysis and Review of Animal Data from Experimental Studies (CAMARADES) checklist. Nine studies were eligible for the systematic review. There was no significant toxicity reported based on animal weight and organ histology. Complete tumor remission was observed in several animal models using chemo-thermal ablation with NTAs, proving the enhancement of 5-fluorouracil efficacy. In terms of imaging performance, the time to achieve maximum tumor image intensity correlates with the presence of targeting ligand on NTAs. The NTAs, which are composed of tumor-targeting ligands, hold promises for further development. Based on the input of current NTA research on cancer, this review proposed a checklist of parameters to recommend researchers for their future NTA testing, especially in animal cancer studies. Systematic Review Registration: website, identifier registration number.
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Affiliation(s)
- Chee Wun How
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Malaysia
| | - Siew Li Teoh
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Malaysia
| | - Jian Sheng Loh
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Malaysia
| | - Stella Li Kar Tan
- School of Pharmacy, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Malaysia
| | - Jhi Biau Foo
- School of Pharmacy, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Malaysia.,Centre for Drug Discovery and Molecular Pharmacology (CDDMP), Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Malaysia
| | - Hui Suan Ng
- China-ASEAN College of Marine Sciences, Xiamen University Malaysia, Sepang, Malaysia
| | | | - Yong Sze Ong
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Malaysia
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16
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Tang YW, Teoh SL, Yeo JHH, Ngim CF, Lai NM, Durrant SJ, Lee SWH. Music-based Intervention for Improving Sleep Quality of Adults without Sleep Disorder: A Systematic Review and Meta-analysis. Behav Sleep Med 2022; 20:241-259. [PMID: 33896299 DOI: 10.1080/15402002.2021.1915787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Listening to music is often used as a self-help intervention to improve sleep quality, but its efficacy among individuals without sleep disorder remains unclear. METHODS A search was performed on five databases to identify for studies that examined the use of music-based intervention to improve sleep quality among individuals without sleep disorder. Random-effects meta-analysis was performed, and the certainty of evidence was evaluated using GRADE (Grading of Recommendations Assessment, Development and Evaluation). RESULTS Twenty-two articles which recruited 1,514 participants were included for review. Meta-analysis of six studies including 424 participants did not find an improvement in sleep quality among recipients of music-based intervention compared to those with standard care (mean difference: -0.80; 95% CI: -2.15 to 0.54, low-quality evidence). Subgroup analysis showed a clear improvement in sleep quality when interventions were administered for at least 3 weeks (-2.09; -3.84 to -0.34, n = 3). No difference in terms of sleep onset latency (standardized mean difference (SMD) -0.32; 95% CI -0.88 to 0.25, n = 4, very-low quality evidence) and sleep efficiency (SMD: -0.59; 95% CI -3.15 to 1.97, n = 2, very-low quality evidence) were observed. The effect of music-based intervention on anxiety, depression and quality of life were mixed with suggestions of possible benefits. CONCLUSION Music-based intervention in addition to standard care appears to be a promising strategy to improve sleep quality when delivered for 3 week or longer. However, effects are inconsistent across studies and larger randomized controlled studies reporting long-term outcomes are needed before it can be recommended for routine use. PROSPERO REGISTRATION CRD42018081193.
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Affiliation(s)
- Yee Woon Tang
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia.,Hospital Dutchess of Kent, Sandakan
| | - Siew Li Teoh
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia
| | - Julie Hsiao Hui Yeo
- School of Medicine, Taylor's University Lakeside Campus, Subang Jaya, Malaysia.,Hospital Sultanah Bahiyah,Ministry of Health, Alor Setar, Malaysia
| | - Chin Fang Ngim
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Johor, Malaysia
| | - Nai Ming Lai
- School of Medicine, Taylor's University Lakeside Campus, Subang Jaya, Malaysia.,Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Subang Jaya, Selangor, Malaysia
| | - Simon James Durrant
- Lincoln Sleep Research Centre and School of Psychology, University of Lincoln, Lincoln, UK
| | - Shaun Wen Huey Lee
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia.,Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Subang Jaya, Selangor, Malaysia.,School of Pharmacy, Taylor's University Lakeside Campus, Subang Jaya, Malaysia
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17
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Abstract
BACKGROUND Task shifting is an approach to help address the shortage of healthcare workers through reallocating human resources but its impact on primary care is unclear. OBJECTIVES To provide an overview of reviews describing task shifts from physicians to allied healthcare workers in primary care and its impact on clinical outcomes. METHODS Six electronic databases were searched up to 15 December 2020, to identify reviews describing task shifting in primary care. Two reviewers independently screened the references for relevant studies, extracted the data and assessed the methodological quality of included reviews using AMSTAR-2. RESULTS Twenty-one reviews that described task shifting in primary care were included. Task shifted include provision of care for people with chronic conditions, medication prescribing, and health education. We found that task shifting could potentially improve several health outcomes such as blood pressure, HbA1c, and mental health while achieving cost savings. Key elements for successful implementation of task shifting include collaboration among all parties, a system for coordinated care, provider empowerment, patient preference, shared decision making, training and competency, supportive organisation system, clear process outcome, and financing. CONCLUSION Evidence suggests that allied healthcare workers such as pharmacists and nurses can potentially undertake substantially expanded roles to support physicians in primary care in response to the changing health service demand. Tasks include providing care to patients, independent prescribing, counselling and education, with comparable quality of care.
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Affiliation(s)
- Siew Lian Leong
- Faculty of Pharmacy, Cyberjaya University College of Medical Sciences, Selangor, Malaysia
| | - Siew Li Teoh
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
| | - Weng Hong Fun
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia.,Institute for Health Systems Research, National Institutes of Health, Shah Alam, Malaysia
| | - Shaun Wen Huey Lee
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia.,Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO) Health and Well-being Cluster, Global Asia in the 21st Century (GA21) platform, Monash University, Bandar Sunway, Malaysia.,Faculty of Health & Medical Sciences, School of Pharmacy, Taylor's University, Selangor, Malaysia
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18
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Thong JJA, Ting RSK, Teoh SL. Causal Attribution and Emotion Expression of Suffering Among Southeast Asian Indigenous Peoples: A Systematic Review Study. Journal of Humanistic Psychology 2021. [DOI: 10.1177/00221678211036333] [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
Indigenous people, particularly minorities in Southeast Asia (SEA), often face hardships due to colonization, displacement, and deforestation. However, studies on their subjective suffering experiences are sparse. Therefore, the present study aimed to conduct a systemic review of literature concerning SEA indigenous people’s cognition and emotion in suffering events. A rigorous literature search following PRISMA guidelines was conducted on the following databases–Scopus, EbscoHost, Ovid (PsychArticles and PsycInfo), Proquest. Embase, Ovid Medline, and Google Scholar using keyword categories for “SEA,” “cognition” or “emotion,” and “suffering events.” The initial search resulted in 6,383 articles, but only 11 empirical studies (containing qualitative or quantitative original data) were included after careful screening. Next, a thematic synthesis method was used to summarize the findings. Two themes of causal attribution of suffering were identified—supernatural reasons and negative impact of interactions with outsiders. Four themes of emotional expression of suffering were identified—physical actions and gestures, communal practices, somatic symptoms, and behavior adaptations. Our findings correspond with the ecological rationality theory, where indigenous people still function as strong-ties societies that capitalize on external-oriented mental strategies and cognitive styles. The identification of unique forms of cognition and modes of emotional expression holds implications toward building an equitable humanistic psychology.
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Affiliation(s)
- Justine Jian Ai Thong
- Department of Psychology, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
| | - Rachel Sing Kiat Ting
- Department of Psychology, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
| | - Siew Li Teoh
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
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19
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Loo KY, Letchumanan V, Ser HL, Teoh SL, Law JWF, Tan LTH, Ab Mutalib NS, Chan KG, Lee LH. COVID-19: Insights into Potential Vaccines. Microorganisms 2021; 9:605. [PMID: 33804162 PMCID: PMC8001762 DOI: 10.3390/microorganisms9030605] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/25/2021] [Accepted: 03/01/2021] [Indexed: 02/07/2023] Open
Abstract
People around the world ushered in the new year 2021 with a fear of COVID-19, as family members have lost their loved ones to the disease. Millions of people have been infected, and the livelihood of many has been jeopardized due to the pandemic. Pharmaceutical companies are racing against time to develop an effective vaccine to protect against COVID-19. Researchers have developed various types of candidate vaccines with the release of the genetic sequence of the SARS-CoV-2 virus in January. These include inactivated viral vaccines, protein subunit vaccines, mRNA vaccines, and recombinant viral vector vaccines. To date, several vaccines have been authorized for emergency use and they have been administered in countries across the globe. Meanwhile, there are also vaccine candidates in Phase III clinical trials awaiting results and approval from authorities. These candidates have shown positive results in the previous stages of the trials, whereby they could induce an immune response with minimal side effects in the participants. This review aims to discuss the different vaccine platforms and the clinical trials of the candidate vaccines.
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Affiliation(s)
- Ke-Yan Loo
- Novel Bacteria and Drug Discovery Research Group (NBDD), Microbiome and Bioresource Research Strength (MBRS), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Malaysia; (K.-Y.L.); (V.L.); (H.-L.S.); (J.W.-F.L.); (L.T.-H.T.)
| | - Vengadesh Letchumanan
- Novel Bacteria and Drug Discovery Research Group (NBDD), Microbiome and Bioresource Research Strength (MBRS), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Malaysia; (K.-Y.L.); (V.L.); (H.-L.S.); (J.W.-F.L.); (L.T.-H.T.)
| | - Hooi-Leng Ser
- Novel Bacteria and Drug Discovery Research Group (NBDD), Microbiome and Bioresource Research Strength (MBRS), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Malaysia; (K.-Y.L.); (V.L.); (H.-L.S.); (J.W.-F.L.); (L.T.-H.T.)
| | - Siew Li Teoh
- School of Pharmacy, Monash University Malaysia, Bandar Sunway 47500, Malaysia;
| | - Jodi Woan-Fei Law
- Novel Bacteria and Drug Discovery Research Group (NBDD), Microbiome and Bioresource Research Strength (MBRS), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Malaysia; (K.-Y.L.); (V.L.); (H.-L.S.); (J.W.-F.L.); (L.T.-H.T.)
| | - Loh Teng-Hern Tan
- Novel Bacteria and Drug Discovery Research Group (NBDD), Microbiome and Bioresource Research Strength (MBRS), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Malaysia; (K.-Y.L.); (V.L.); (H.-L.S.); (J.W.-F.L.); (L.T.-H.T.)
- Clinical School Johor Bahru, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Johor Bahru 80100, Malaysia
| | - Nurul-Syakima Ab Mutalib
- Novel Bacteria and Drug Discovery Research Group (NBDD), Microbiome and Bioresource Research Strength (MBRS), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Malaysia; (K.-Y.L.); (V.L.); (H.-L.S.); (J.W.-F.L.); (L.T.-H.T.)
- UKM Medical Molecular Biology Institute (UMBI), UKM Medical Centre, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Kok-Gan Chan
- Division of Genetics and Molecular Biology, Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur 50603, Malaysia
- International Genome Centre, Jiangsu University, Zhenjiang 212013, China
| | - Learn-Han Lee
- Novel Bacteria and Drug Discovery Research Group (NBDD), Microbiome and Bioresource Research Strength (MBRS), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Malaysia; (K.-Y.L.); (V.L.); (H.-L.S.); (J.W.-F.L.); (L.T.-H.T.)
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Teoh SL, Ngorsuraches S, Lai NM, Chaiyakunapruk N. Consumer Preferences and Willingness to Pay for Nutraceuticals: A Discrete Choice Experiment. Value Health Reg Issues 2021; 24:167-172. [PMID: 33714105 DOI: 10.1016/j.vhri.2020.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 01/22/2020] [Revised: 09/15/2020] [Accepted: 09/28/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Globally, nutraceuticals have been increasingly used. Nevertheless, the consumer preferences for nutraceuticals have not been quantitatively investigated. This study used discrete choice experiment (DCE) to examine consumer preferences and willingness to pay for nutraceuticals. METHODS Four attributes (ie, the scientific proof of effectiveness, the scientific proof of safety, the source of recommendation, and cost) were identified from a systematic review and focus group interviews. They were used to develop a DCE questionnaire. Consumers at community pharmacies in Malaysia were asked to respond to 8 DCE choice sets. A conditional logit model was employed to obtain the relative importance of each attribute and to estimate respondents' WTP for nutraceuticals. RESULTS A total of 111 valid responses were analyzed. A negative constant term in the developed model indicated that generally the respondents preferred not to use nutraceuticals before they considered the study attributes. The respondents preferred nutraceuticals with no side effect, clear evidence of effectiveness, and recommendation of a healthcare professional. The respondents were willing to pay $252/month more for nutraceuticals proven with no side effect than for those without proof of safety, and $102/month more for nutraceuticals proven with clear effectiveness than for those without proof of effectiveness. CONCLUSIONS Consumers weighed relatively high on the availability of safety and effectiveness proofs when they chose nutraceuticals. The study highlights on the crucial need to inform consumers using clinical evidences of nutraceuticals as the information is highly preferred by consumers.
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Affiliation(s)
- Siew Li Teoh
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
| | - Surachat Ngorsuraches
- Department of Health Outcomes Research and Policy, Harrison School of Pharmacy, Auburn University, Auburn, AL, USA
| | - Nai Ming Lai
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia; School of Medicine, Taylor's University Malaysia, Selangor, Malaysia
| | - Nathorn Chaiyakunapruk
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia; Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA.
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Teoh SL, Letchumanan V, Lee LH. Can Mindfulness Help to Alleviate Loneliness? A Systematic Review and Meta-Analysis. Front Psychol 2021; 12:633319. [PMID: 33716901 PMCID: PMC7947335 DOI: 10.3389/fpsyg.2021.633319] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/28/2021] [Indexed: 01/03/2023] Open
Abstract
Objective: Mindfulness-based intervention (MBI) has been proposed to alleviate loneliness and improve social connectedness. Several randomized controlled trials (RCTs) have been conducted to evaluate the effectiveness of MBI. This study aimed to critically evaluate and determine the effectiveness and safety of MBI in alleviating the feeling of loneliness. Methods: We searched Medline, Embase, PsycInfo, Cochrane CENTRAL, and AMED for publications from inception to May 2020. We included RCTs with human subjects who were enrolled in MBI with loneliness as an outcome. The quality of evidence was assessed using Cochrane's Risk of Bias (ROB) tool and Grading of Recommendations Assessment, Development, and Evaluation (GRADE). A random-effects model was used for meta-analysis. Results: Out of 92 articles identified, eight studies involving 815 participants were included in this study. Most (7/8) trials conducted a minimum of 8 weeks of MBI. Most of the trials (5/8) used UCLA-Loneliness Scale. A pooled analysis combining three trials and compared with wait-list showed significant improvement in loneliness score reduction using the UCLA-R scale with MD of -6.33 [95% confidence interval (CI): -9.39, -3.26]. Subgroup analysis with only two Cognitively-Based Compassion Training (CBCT) trials also showed similar MD of -6.05 (95% CI: -9.53, 2.58). The overall quality of evidence (GRADE) was low. Conclusions: Mindfulness intervention with an average length of 8-week duration significantly improved the population's loneliness level with no mental health issue. However, this evidence had a low GRADE level.
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Affiliation(s)
- Siew Li Teoh
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
| | - Vengadesh Letchumanan
- Novel Bacteria and Drug Discovery (NBDD) Research Group, Microbiome and Bioresource Research Strength, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia
| | - Learn-Han Lee
- Novel Bacteria and Drug Discovery (NBDD) Research Group, Microbiome and Bioresource Research Strength, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia
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Teoh SL, Lai NM, Vanichkulpitak P, Vuksan V, Ho H, Chaiyakunapruk N. Clinical evidence on dietary supplementation with chia seed (Salvia hispanica L.): a systematic review and meta-analysis. Nutr Rev 2019; 76:219-242. [PMID: 29452425 DOI: 10.1093/nutrit/nux071] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 11/14/2022] Open
Abstract
Context Chia seed is a popular dietary supplement, taken mainly for its high content of alpha-linolenic acid, vegetable protein, and dietary fiber, yet information about its clinical effects is lacking. Objective This review aims to summarize the clinical evidence regarding the use of chia seed for a wide variety of health conditions. Data Sources A number of databases, including PubMed and Embase, were searched systematically. Study Selection Randomized controlled trials that assessed the clinical effects of chia seed consumption in human participants were included. The quality of trials was assessed using the Cochrane Risk of Bias Tool. Data Extraction Data on study design, blinding status, characteristics of participants, chia seed intervention, comparator, clinical assessment, duration of intake, interval of assessment, and study funding status were extracted. Meta-analysis was performed. Results Twelve trials were included. Participants included healthy persons, athletes, diabetic patients, and individuals with metabolic syndrome. Pooling of results showed no significant differences except for the following findings of subgroup analysis at higher doses of chia seed: (1) lower postprandial blood glucose level (mean difference [MD] of -33.95 incremental area under the curve [iAUC] [mmol/L × 2 h] [95%CI, -61.85, -6.05] and -51.60 iAUC [mmol/L × 2 h] [95%CI, -79.64, -23.56] at medium doses and high doses, respectively); (2) lower high-density lipoprotein in serum (MD of -0.10 mmol/L [95%CI, -0.20, -0.01]); and (3) lower diastolic blood pressure (MD of -7.14 mmHg [95%CI, -11.08, -3.19]). The quality of all evidence assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was low or very low. All trials employed only surrogate markers as outcomes. Conclusions Future trials with improved methodological quality, well-described clinical events, and validated surrogate markers as outcomes are needed to support the potential health benefits of chia seed consumption. Systematic Review Registration PROSPERO registration no. CRD42015029990.
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Affiliation(s)
- Siew Li Teoh
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
| | - Nai Ming Lai
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
- School of Medicine, Taylor's University, Selangor, Malaysia
| | | | - Vladimir Vuksan
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada, and the Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; the Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; and the Division of Endocrinology & Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Hoang Ho
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada, and the Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Canada
| | - Nathorn Chaiyakunapruk
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
- Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand; the School of Pharmacy, University of Wisconsin, Madison, Wisconsin, USA; and the Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes, Health and Well-being Cluster, Global Asia Platform in the 21st Century (GA21) Platform, Monash University Malaysia, Selangor, Malaysia
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Teoh SL, Ngorsuraches S, Lai NM, Bangpan M, Chaiyakunapruk N. Factors affecting consumers' decisions on the use of nutraceuticals: a systematic review. Int J Food Sci Nutr 2019; 70:491-512. [PMID: 30634867 DOI: 10.1080/09637486.2018.1538326] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
There is a high and increasing global prevalence of nutraceuticals use. This study aims to systematically review and critically appraise all available evidence to identify the factors affecting consumers' decisions in taking nutraceuticals. Questionnaire, interview or focus group studies which directly reported factors affecting consumers' decisions in using nutraceuticals were included. A thematic synthesis method was employed to synthesis the findings from the included studies. Out of the 76 studies included, the key factors identified as the most important factors motivating consumers to take nutraceuticals were the perceived health benefits and safety of nutraceuticals, as well as the advice from healthcare professionals, friends and family. The identified barriers to take nutraceuticals were a lack of belief in the health benefit of nutraceuticals, the high cost of nutraceuticals and consumers' lack of knowledge about nutraceuticals. As a chief course of recommendation for the use of nutraceuticals, healthcare professionals should strive to utilise reliable information from clinical evidence to help consumers in making an informed decision in using nutraceuticals. Future studies should explore the possible ways to improve channelling clinical evidence information of nutraceuticals to the public.
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Affiliation(s)
- Siew Li Teoh
- a School of Pharmacy , Monash University Malaysia , Selangor , Malaysia
| | - Surachat Ngorsuraches
- b Department of Health Outcomes Research and Policy, Harrison School of Pharmacy , Auburn University , Auburn , AL , USA
| | - Nai Ming Lai
- c School of Medicine , Taylor's University Malaysia , Selangor , Malaysia.,d Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia Platform in the 21st Century (GA21) Platform , Monash University Malaysia , Bandar Sunway , Selangor , Malaysia
| | - Mukdarut Bangpan
- e Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), Social Science Research Unit, Department of Social Science, UCL Institute of Education , University College London , London , UK
| | - Nathorn Chaiyakunapruk
- a School of Pharmacy , Monash University Malaysia , Selangor , Malaysia.,d Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia Platform in the 21st Century (GA21) Platform , Monash University Malaysia , Bandar Sunway , Selangor , Malaysia.,f Center of Pharmaceutical Outcomes Research (CPOR), Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences , Naresuan University , Phitsanulok , Thailand.,g School of Pharmacy , University of Wisconsin , Madison , WI , USA
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Hussan F, Adib Ridzuan NR, Teoh SL, Abdul Rashid N, Othman F, Baharum SN. Polygonum minus ethanolic extracts attenuate cisplatin–induced oxidative stress in the cerebral cortex of rats via its antioxidant properties. Asian Pac J Trop Biomed 2019. [DOI: 10.4103/2221-1691.258999] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Amro MS, Teoh SL, Norzana AG, Srijit D. The potential role of herbal products in the treatment of Parkinson's disease. Clin Ter 2018; 169:e23-e33. [PMID: 29446788 DOI: 10.7417/t.2018.2050] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Parkinson's disease (PD) is a multifactorial disorder of the nervous system in which there is a progressive loss of dopaminergic neurons. There is a disturbance in the movement in PD and these include resting tremors, rigidity, bradykinesia or akinesia, disturbance, posture and freezing (motor block). The substantia nigra and other parts of the brain are commonly affected. The disorder could be related to oxidative stress and there is an important role of reactive oxygen species (ROS). A number of herbal products contain active components which are known to possess antioxidant action. Hence, the potential role of herbal products in treating PD cannot be undermined. In the present narrative review, the main aim is to discuss the pathogenesis of PD, define the role of different potential herbal extracts on its pathogenesis which may form the basis of treatment. We also discuss in detail the active chemical compounds present each herb which are effective in the treatment of PD. These herbs include Baicalei, Erythrina velutin, Resveratrol, Peganum Harmal, Curcuma longa (Zingiberaceae), Carthamus tinctorius L. (Safflower), Pueraria lobate, Juglandis Semen (Walnut), Tianma Gouteng Yin (TGY), Lycium barbarum L fruit, Mucuna pruriens (Velvet bean), Chunghyuldan (CHD), Paeoniae Alba Radix. The present review may be beneficial for designing future drugs for effective treatment of PD.
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Affiliation(s)
- M S Amro
- Department of Anatomy, Universiti Kebangsaan Malaysia Medical Centre, 56000 Kuala Lumpur, Malaysia
| | - S L Teoh
- Department of Anatomy, Universiti Kebangsaan Malaysia Medical Centre, 56000 Kuala Lumpur, Malaysia
| | - A G Norzana
- Department of Anatomy, Universiti Kebangsaan Malaysia Medical Centre, 56000 Kuala Lumpur, Malaysia
| | - D Srijit
- Department of Anatomy, Universiti Kebangsaan Malaysia Medical Centre, 56000 Kuala Lumpur, Malaysia
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Teoh SL, Kotirum S, Hutubessy RCW, Chaiyakunapruk N. Global economic evaluation of oral cholera vaccine: A systematic review. Hum Vaccin Immunother 2018; 14:420-429. [PMID: 29099647 PMCID: PMC5806687 DOI: 10.1080/21645515.2017.1392422] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 09/15/2017] [Accepted: 10/11/2017] [Indexed: 12/25/2022] Open
Abstract
World Health Organization recommends oral cholera vaccine (OCV) to prevent and control cholera, but requires cost-effectiveness evidence. This review aimed to provide a critical appraisal and summary of global economic evaluation (EE) studies involving OCV to guide future EE study. Full EE studies, published from inception to December 2015, evaluating OCV against cholera disease were included. The included studies were appraised using WHO guide for standardization of EE of immunization programs. Out of 14 included studies, almost all (13/14) were in low- and middle-income countries. Most studies (11/14) evaluated mass vaccination program. Most of the studies (9/14) incorporated herd protective effect. The most common influential parameters were cholera incidence, OCV coverage, herd protection and OCV price. OCV vaccination is likely to be cost-effective when targeted at the population with high-risk of cholera and poor access to health care facilities when herd protection effect is incorporated and OCV price is low.
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Affiliation(s)
- Siew Li Teoh
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
| | - Surachai Kotirum
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
- Social and Administrative Pharmacy Department, Faculty of Pharmacy, Rangsit University, Muang, Pathumthani, Thailand
| | | | - Nathorn Chaiyakunapruk
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
- Center of Pharmaceutical Outcomes Research (CPOR), Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences; Naresuan University, Phitsanulok, Thailand
- School of Pharmacy, University of Wisconsin, Madison, USA
- Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
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Teoh SL, Chong HY, Abdul Aziz S, Chemi N, Othman AR, Md Zaki N, Vanichkulpitak P, Chaiyakunapruk N. The economic burden of schizophrenia in Malaysia. Neuropsychiatr Dis Treat 2017; 13:1979-1987. [PMID: 28814869 PMCID: PMC5546820 DOI: 10.2147/ndt.s137140] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Schizophrenia (SCZ) is a highly debilitating disease despite its low prevalence. The economic burden associated with SCZ is substantial and mainly attributed to productivity loss. To improve the understanding of economic burden of SCZ in the low- and middle-income country regions, we aimed to determine the economic burden of SCZ in Malaysia. METHODS A retrospective study was conducted using a prevalence-based approach from a societal perspective in Malaysia with a 1 year period from 2013. We used micro-costing technique with bottom-up method and included direct medical cost, direct non-medical cost, and indirect cost. The main data source was medical chart review which was conducted in Hospital Kuala Lumpur (HKL). The medical charts were identified electronically by matching the unique patient's identification number registered under the National Mental Health Schizophrenia Registry and the list of patients in HKL in 2013. Other data sources were government documents, literatures, and local websites. To ensure robustness of result, probabilistic sensitivity analysis was conducted. RESULTS The total estimated number of treated SCZ cases in Malaysia in 2015 was 15,104 with the total economic burden of USD 100 million (M) which was equivalent to 0.04% of the national gross domestic product. On average, the mean cost per patient was USD 6,594. Of the total economic burden of SCZ, 72% was attributed to indirect cost, costing at USD 72M, followed by direct medical cost (26%), costing at USD 26M, and direct non-medical cost (2%), costing at USD 1.7M. CONCLUSION This study highlights the magnitude of economic burden of SCZ and informs the policy-makers that there is an inadequate support for SCZ patients. More resources should be allocated to improve the condition of SCZ patients and to reduce the economic burden.
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Affiliation(s)
- Siew Li Teoh
- School of Pharmacy, Monash University Malaysia, Selangor
| | - Huey Yi Chong
- School of Pharmacy, Monash University Malaysia, Selangor
| | - Salina Abdul Aziz
- Department of Psychiatry and Mental Health, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Norliza Chemi
- Department of Psychiatry and Mental Health, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Abdul Razak Othman
- Department of Psychiatry and Mental Health, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Nurzuriana Md Zaki
- Department of Psychiatry and Mental Health, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | | | - Nathorn Chaiyakunapruk
- School of Pharmacy, Monash University Malaysia, Selangor.,Center of Pharmaceutical Outcomes Research (CPOR), Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.,School of Pharmacy, University of Wisconsin, Madison, WI, USA.,Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Selangor, Malaysia
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Abstract
BACKGROUND Schizophrenia is one of the top 25 leading causes of disability worldwide in 2013. Despite its low prevalence, its health, social, and economic burden has been tremendous, not only for patients but also for families, caregivers, and the wider society. The magnitude of disease burden investigated in an economic burden study is an important source to policymakers in decision making. This study aims to systematically identify studies focusing on the economic burden of schizophrenia, describe the methods and data sources used, and summarize the findings of economic burden of schizophrenia. METHODS A systematic review was performed for economic burden studies in schizophrenia using four electronic databases (Medline, EMBASE, PsycINFO, and EconLit) from inception to August 31, 2014. RESULTS A total of 56 articles were included in this review. More than 80% of the studies were conducted in high-income countries. Most studies had undertaken a retrospective- and prevalence-based study design. The bottom-up approach was commonly employed to determine cost, while human capital method was used for indirect cost estimation. Database and literature were the most commonly used data sources in cost estimation in high-income countries, while chart review and interview were the main data sources in low and middle-income countries. Annual costs for the schizophrenia population in the country ranged from US$94 million to US$102 billion. Indirect costs contributed to 50%-85% of the total costs associated with schizophrenia. The economic burden of schizophrenia was estimated to range from 0.02% to 1.65% of the gross domestic product. CONCLUSION The enormous economic burden in schizophrenia is suggestive of the inadequate provision of health care services to these patients. An informed decision is achievable with the increasing recognition among public and policymakers that schizophrenia is burdensome. This results in better resource allocation and the development of policy-oriented research for this highly disabling yet under-recognized mental health disease.
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Affiliation(s)
- Huey Yi Chong
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
| | - Siew Li Teoh
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
| | | | - Surachai Kotirum
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
| | | | - Nathorn Chaiyakunapruk
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia; Center of Pharmaceutical Outcomes Research (CPOR), Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand; School of Pharmacy, University of Wisconsin, Madison, WI, USA; School of Population Health, University of Queensland, Brisbane, Australia
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Selveindran NM, Hong JYH, Idris AM, Teoh SL, Leong KSW, Zain FM. Turner syndrome and growth hormone therapy: a review on growth response. Int J Pediatr Endocrinol 2015. [PMCID: PMC4428779 DOI: 10.1186/1687-9856-2015-s1-p37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Norzana AG, Farihah HS, Fairus A, Teoh SL, Nur AK, Faizah O, Das S. Higher division of the tibial nerve in the leg: gross anatomical study with clinical implications. Clin Ter 2013; 164:1-3. [PMID: 23455733 DOI: 10.7417/ct.2013.1501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Tibial nerve is a branch of the sciatic nerve and it is the main nerve innervating the muscles of the back of the leg. The tibial nerve divides into medial and lateral plantar nerves. The level of division may be important for surgical purpose. The main aim of the present study was to observe the exact level of division of the tibial nerve and discuss its clinical implications. MATERIALS AND METHODS A total of 20 cadaveric limbs (irrespective of left or right side) were taken randomly. The posterior compartment of the thigh and leg was dissected to trace the tibial nerve and its branches. The specimens were subjected to measurements with respect to an arbitrary horizontal line passing through tip of medial malleolus and the calcaneum. All the specimens were photographed. RESULTS In 5 cases (25%), the tibial nerve divided deep to the flexor retinaculum. In 15 cases (75%) cases, the tibial nerve divided at a distance of 3.5 cm - 6.5 cm (average 5 cm) above the medial malleolus. CONCLUSION The tibial nerve and its divisions are important for performing successful nerve blocks and insertion of plates while treating fractures. Variations may account for the various discrepancies between the electromyographic tests and clinical tests.
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Affiliation(s)
- A G Norzana
- Department of Anatomy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Zar CT, Teoh SL, Das S, Zaiton Z, Farihah HS. Use Piper sarmentosum as an effective antidiabetic supplement in South East Asia: a review. Clin Ter 2012; 163:505-510. [PMID: 23306747] [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: 06/01/2023]
Abstract
Herbs with antidiabetic activity have a potential role to play. Herbal medicines have been widely used in South East Asia because of lesser side effects and cost effectiveness. The main aim of this review article was to disseminate important information regarding the use of herbal products in oxidative stress involved in diseases like diabetes mellitus. The article highlights some of the traditional medicinal plants which have been widely used in South East Asia with special emphasis on Piper sarmentosum. Piper sarmentosum have been reported to possess varying degree of hypoglycemic, antidiabetic and other additional properties. The antioxidant properties of the herbs may be effective in controlling the oxidative damage produced during diabetes mellitus. The review article highlights the positive role of traditional herbs towards diabetes mellitus and also describes its complications.
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Affiliation(s)
- C T Zar
- Department of Anatomy, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abd Aziz, 50300, Kuala Lumpur, Malaysia
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Taridi NM, Yahaya MF, Teoh SL, Latiff AA, Ngah WZW, Das S, Mazlan M. Tocotrienol rich fraction (TRF) supplementation protects against oxidative DNA damage and improves cognitive functions in Wistar rats. Clin Ter 2011; 162:93-98. [PMID: 21533313] [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: 05/30/2023]
Abstract
AIM Oxidative stress is caused by imbalance between the productions of reactive oxygen species (ROS) and antioxidant defense mechanisms. Palm oil antioxidants such as tocotrienol rich fraction (TRF) is known to have neuroprotective effects on neurones by acting against free radical induced neuronal cell death. This study was undertaken to elucidate the effect of TRF on oxidative DNA damage and cognitive functions in experimental rats. MATERIALS AND METHODS A total of 20 male Wistar rats (aged 3 months) were divided into 2 groups: (i) control group fed with distilled water and (ii) experimental group fed with TRF (200 mg/ kg body weight) for 8 months. DNA damage was determined using Comet assay. Antioxidant enzymes like superoxide dismutase (SOD), glutathione peroxidase (GPx) and catalase (CAT) were assessed in the blood. The Morris Water Maze (MWM) test was used to evaluate the cognitive functions. RESULTS DNA damage was significantly reduced in the experimental group supplemented with TRF compared to the control group (p <0.05). In the group supplemented with TRF, the percentage of DNA damage was 2.87 ± 0.48% compared to 5.96 ± 0.43% in the control group. SOD, GPx, and CAT enzyme activities increased in experimental group. Results from MWM showed improvement in cognitive functions as determined by latency to target platform, swim path and average speed between TRF and control groups. CONCLUSIONS Continuous supplementation of TRF for 8 months reduced DNA damage and exhibited positive influence in spatial learning and memory.
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Affiliation(s)
- N M Taridi
- Departments of Biochemistry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
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Keat EC, Razak SS, Fadil NM, Yusof FM, Chan LH, Chyi FK, Teoh SL, Das S, Latiff AA, Mazlan M. The effect of Piper betel extract on the wound healing process in experimentally induced diabetic rats. Clin Ter 2010; 161:117-120. [PMID: 20499023] [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: 05/29/2023]
Abstract
BACKGROUND Piper betel (PB) possesses antimicrobial, antifungal, antioxidant and wound healing properties due to its powerful antioxidant effect. Diabetes mellitus (DM) is a metabolic disorder which is associated with complications like impaired wound healing, nephropathy and neuropathy. The main aim of the study was to study the wound healing properties of PB. MATERIALS AND METHODS A total of 33 male Sprague-Dawley rats (250-300 g) were taken and divided into 3 groups: Group I (control) comprising of 14 rats; Group II (diabetic untreated) comprising of 9 rats; Group III (diabetic treated) comprising of 10 rats. After 10 days of acclimatization, the animals were fasted overnight and diabetes was induced by administration of streptozotocin (45 mg/Kg body weight in a single dose, through tail vein) to group II and III animals. Four 6 mm-diameter full thickness skin excision wounds were created and PB extract (50 mg diluted in 0.1 ml of normal saline) was applied locally for 10 days in group III. The group I and II received normal saline (0.1 ml) for 10 days. The total protein content and the wound contraction rate were determined. RESULTS The wound contraction rate of group III (35.03 +/- 2.96) was higher as compared to group II (18.40 +/- 3.87) with p = 0.014. The total protein content for group III was 106.39 +/- 4.46 as compared to group II (72.86 +/- 12.86) with p = 0.050. CONCLUSION PB acted as a protective agent in the early phase of wound healing by increasing total protein content and wound contraction rate.
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Affiliation(s)
- E C Keat
- Department of Anatomy, Faculty of Medicine, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Malaysia
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Zailan N, Abdul Rashid AH, Das S, Abdul Mokti NA, Hassan Basri J, Teoh SL, Wan Ngah WZ, Mohd Yusof YA. Comparison of Chlorella vulgaris dressing and sodium alginate dressing: an experimental study in rats. Clin Ter 2010; 161:515-521. [PMID: 21181079] [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: 05/30/2023]
Abstract
BACKGROUND AND AIMS Chlorella vulgaris (CV) is a green microalgae enriched with nutrients, vitamins, minerals and chlorophyll. The aim of our study was to evaluate the potential wound healing effects of CV as a dressing while comparing it to sodium alginate dressing. MATERIALS AND METHODS Fifteen Sprague-Dawley rats were divided into three groups consisting of control (normal-wound with no dressing), CV and sodium alginate dressings. Wound was created on the dorsal surface of rats using a 6-mm sterilized punch biopsy. The wounds were examined on days 3, 6, 9 and 12 for dryness, exudation, contraction, period of epithelialization, complete wound closure and scar formation. All rats were sacrificed on day 12 and the granulation tissue formed on the wound was excised for the histological examination using Hematoxylin and Eosin stain (H&E). RESULTS The wound's size treated with CV dressing was significantly reduced (p<0.05) compared to the control and sodium alginate treated wounds. H&E staining showed that CV dressing minimized the formation of scar tissue during the healing process. Although there was no statistically significant difference in the complete wound closure and period of epithelialization among the groups, a significant difference was observed regarding the dryness, exudation and scar formation in the wound. CONCLUSION CV extract can be used as an effective supplement for wound dressing.
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Affiliation(s)
- N Zailan
- Departments of Biochemistry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
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Laitiff AA, Teoh SL, Das S. Wound healing in diabetes mellitus: traditional treatment modalities. Clin Ter 2010; 161:359-364. [PMID: 20931161] [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: 05/30/2023]
Abstract
The healing of wound is a complex process which requires the interactions of different cells and extracellular molecules. The normal wound healing process can be divided into four overlapping phases i.e. haemostasis, inflammation, proliferation and remodeling. In diseased condition like diabetes mellitus, the wound healing process is grossly impaired, resulting in chronic wounds which fail to heal. In the past decades, several researchers have tested various traditional medicines obtained from the plants for their wound healing properties. Such traditional plants are Aloe vera, Calotropis procera, Portulaca oleracea, Acalypha langiana, Plagiochasma appendiculatum and Momordica charantia. Perhaps one of the most popular and easily available plant is Momordica charantia (bitter gourd). The present article presents an extensive review on the impaired wound healing process in diabetes mellitus and highlights the use of traditional medicines in diabetic wounds.
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Affiliation(s)
- A A Laitiff
- Department of Anatomy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
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Teoh SL, Abd Latiff A, Das S. Histological changes in the kidneys of experimental diabetic rats fed with Momordica charantia (bitter gourd) extract. Rom J Morphol Embryol 2010; 51:91-95. [PMID: 20191126] [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: 05/28/2023]
Abstract
Momordica charantia (MC) or bitter gourd is widely known for its antidiabetic properties. The aim of the present study was to observe the protective effect of MC extract on the kidneys of streptozotocin-induced diabetic rats. Eighteen male Sprague-Dawley rats (n=18) weighing 200+/-50 g were taken for the study. The study comprised of three groups i.e. a non-diabetic, diabetic untreated and diabetic treated with MC extract, with each group comprising of six (n=6) rats. Diabetes was induced in the overnight fasted rats by intramuscular injection of streptozotocin (50 mg/kg body weight). The MC extract (50 mg/kg body weight) was administered via oral gavage. Both the kidneys were collected on the tenth day following treatment. Histological study using Verhoeff's van Gieson (VvG) and Periodic Acid-Schiff (PAS) stains were performed. The kidneys of the diabetic rats showed thickening of the basement membrane of the Bowman's capsule, edema and hypercellurarity of the proximal tubules, necrosis and hyaline deposits. These features were found to be reversed when the MC extract was administered to the experimental animals. The MC extract acted as an antioxidant thereby preventing the oxidative damage involved in the diabetic kidney. The administration of MC extract prevents oxidative damage in diabetic nephropathy.
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Affiliation(s)
- S L Teoh
- Department of Anatomy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
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Teoh SL, Latiff AA, Das S. The effect of topical extract of Momordica charantia (bitter gourd) on wound healing in nondiabetic rats and in rats with diabetes induced by streptozotocin. Clin Exp Dermatol 2009; 34:815-22. [PMID: 19508570 DOI: 10.1111/j.1365-2230.2008.03117.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Momordica charantia (MC; bitter gourd) is a traditional herb commonly used for its antidiabetic, antioxidant, contraceptive and antibacterial properties. It is also used for the rapid healing of wounds. AIM To observe the topical effect of MC extract on the wound-healing process in rats with diabetes induced by streptozotocin. METHODS In total, 72 Sprague-Dawley rats were used for the study. The animals were subdivided into two groups: a nondiabetic group (n = 36) and a group with diabetes induced by streptozotocin (n = 36). Both groups were subdivided further into a nontreated control group (n = 18), and a topically treated group with MC extract administered daily (n = 18). The wound was inflicted with a 6-mm punch-biopsy needle on the dorsal aspect of the thoracolumbar region. The animals were killed on the days 1, 5 and 10 after wound creation. The rate of wound closure and the total protein content was estimated. Histological study of the wound tissue at days 5 and 10 was also performed. RESULTS The diabetic group exhibited delayed wound healing as compared to the normal group. Interestingly, the diabetic group treated with topical MC extract showed better results than the nontreated group. CONCLUSION Results show that administration of MC extract improves and accelerates the process of wound healing in diabetic animals.
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Affiliation(s)
- S L Teoh
- Department of Anatomy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Teoh SL, Latiff AA, Das S. A histological study of the structural changes in the liver of streptozotocin-induced diabetic rats treated with or without Momordica charantia (bitter gourd). Clin Ter 2009; 160:283-286. [PMID: 19795081] [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: 05/28/2023]
Abstract
AIM Diabetic liver is associated with biochemical, physiological and pathological changes. The aim of the present study was to evaluate the histological changes following administration of Momordica charantia (MC) in the streptozotocin (STZ) induced diabetic rats. MATERIALS AND METHODS Eighteen Sprague-Dawley rats (n=18) were taken for this study. The animals were divided into 3 groups:- non-diabetic (n=6), untreated diabetic (n=6) and diabetic treated with MC extract (n=6). Diabetes was induced in the experimental rats via intravenous injection of streptozotocin (45 mg/kg body weight). MC extract (50 mg/kg body weight) was administered orally to the treated diabetic rats 10 days following induction. The liver tissues were collected on the 10th day following treatment and the histological study was performed using different staining methods which included hematoxylin and eosin (H&E), Verhoeff's van Gieson (VvG) and periodic acid Schiff (PAS). RESULTS The liver of the diabetic rats showed involvement of the hepatocytes with features of inflammation. The portal triad in the diabetic liver showed extensive involvement in terms of accumulation of mucopolysaccharide deposits. Liver damage in the diabetic animals showed features of healing with administration of the MC extract. CONCLUSIONS The MC extract due to its antioxidant role may be helpful in reversing the changes in the liver in diabetes mellitus.
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Affiliation(s)
- S L Teoh
- Department of Anatomy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
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Ong LC, Boo NY, Chandran V, Zamratol SM, Allison L, Teoh SL, Nyein MK, Lye MS. Relationship between head growth and neurodevelopmental outcome of Malaysian very low birthweight infants during the 1st year of life. Ann Trop Paediatr 1997; 17:209-16. [PMID: 9425375 DOI: 10.1080/02724936.1997.11747888] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A prospective study was carried out to (i) compare head growth patterns of 103 very low birthweight (VLBW, < 1500 g) Malaysian infants and 98 normal birthweight (NBW, 2500- < 4500 g) controls during the 1st year of life; and (ii) examine the relationship between neurodevelopmental outcome at 1 year of age and occipito-frontal head circumferences (OFC) at birth and at 1 year of age in VLBW babies. When compared with those of NBW infants at birth, mid-infancy and 1 year of age, the mean OFC ratios (observed/expected OFC at 50th percentile) of VLBW infants were significantly lower (p < 0.001). Small-for-gestational-age (SGA) VLBW babies had significantly lower mean OFC ratios than their appropriate-for-gestational-age (AGA) VLBW counterparts at birth (p < 0.001), but this difference was no longer seen at mid-infancy or at 1 year of age. Logistic regression analysis showed that abnormal late neonatal cranial ultrasound findings (odds ratio 8.5, 95% confidence interval 4.12-22.07; p < 0.001) and each additional day of oxygen therapy (odds ratio 1.15, 95% confidence interval 1.00-4.45; p = 0.045) were significant risk factors associated with neurodevelopmental disability at 1 year of age, while mean OFC ratios at birth or at 1 year of age were not. Poor postnatal head growth per se did not predict disability, but probably reflected the consequences of "brain injury" as evidenced by abnormal brain scans.
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Affiliation(s)
- L C Ong
- Department of Paediatrics, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
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Ong LC, Boo NY, Chandran V, Zulfiqar A, Zamratol SM, Allison L, Teoh SL, Nyein MK, Lye MS. Neurodevelopmental outcome of Malaysian very low birth weight infants: predictive value of cranial ultrasound appearances. Singapore Med J 1997; 38:108-11. [PMID: 9269376] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The aim of the study was to determine the predictive value of cranial ultrasound scans done in the neonatal period for neurodevelopmental outcome of the Malaysian very low birthweight (VLBW, < 1500 grams) infants assessed at 12 months of corrected age. Of the 101 infants studied, 68 (67.3%) were neurodevelopmentally normal at one year of age, 18 (17.8%) had major and 15 (14.9%) had minor neurodevelopmental impairment. Neurodevelopmental outcome was normal in 66/88 (75.0%) infants who did not have severe intraventricular haemorrhage (IVH) or periventricular intraparenchymal echo densities (PVE) in the first week of life, and in 57/73 (78.1%) with uncomplicated scans at discharge. In contrast, 11/13 (84.6%) with parenchymal echo densities or severe intraventricular bleed in the early neonatal period and 17/28 (60.7%) with complicated scans at discharge had adverse sequelae. There was a significant association between lesions seen on cranial ultrasound in the neonatal period and subsequent neurodevelopmental impairment. Late neonatal ultrasound scans appear to be a better predictor of short-term neurodevelopmental outcome than early scans.
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Affiliation(s)
- L C Ong
- Department of Paediatrics, Faculty of Medicine, Universiti Kebangsaasn Malaysia, Kuala Lumpur
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Boo NY, Ong LC, Lye MS, Chandran V, Teoh SL, Zamratol S, Nyein MK, Allison L. Comparison of morbidities in very low birthweight and normal birthweight infants during the first year of life in a developing country. J Paediatr Child Health 1996; 32:439-44. [PMID: 8933407 DOI: 10.1111/j.1440-1754.1996.tb00946.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To compare the morbidities in the very low birthweight (VLBW; < 1500 g) and normal birthweight (NBW; > or = 2500 g) Malaysian infants during the first year of life. METHODOLOGY Prospective observational cohort study of consecutive surviving VLBW infants and randomly sampled NBW infants born in the Kuala Lumpur Maternity Hospital between 1 December 1989 and 31 December 1992. Infants were followed up regularly during the first year of life, after correction for prematurity. RESULTS Compared with NBW infants (n = 106), VLBW infants (n = 127) had significantly higher risk of failure to thrive (odds ratio [OR] = 8.0, 95% confidence intervals [CI]: 1.1 to 354.3), wheezing (OR = 3.7, 95% CI: 1.6 to 9.3), rehospitalization (OR = 2.3, 95% CI: 1.1 to 5.0), cerebral palsy (OR = 8.6, 95% CI: 2.0 to 77.6), neurosensory hearing loss (OR = 12.0, 95% CI: 1.7 to 513.6) and visual loss (7.9 vs 0%, P = 0.002). The mean mental developmental index (MDI) and mean psychomotor developmental index (PDI) at 1 year of age were significantly lower among VLBW infants (MDI 99 [SD = 28], PDI 89 [SD = 25]) than NBW infants (MDI 106 [SD = 18], PDI 101 [SD = 18]) (95% CI for difference between means being MDI: -14.1 to -1.7; and PDI: -17.6 to -6.0). Logistic regression analysis showed that among VLBW infants: (i) male sex, Malay ethnicity and bronchopulmonary dysplasia were significant risk factors associated with wheezing; (ii) longer duration of oxygen therapy during the neonatal period, seizures after the post-neonatal period and wheezing were significant risk factors associated with rehospitalization; and (iii) longer duration of oxygen therapy during the neonatal period was a significant risk factor associated with adverse neurodevelopmental outcome during the first year of life. CONCLUSIONS Compared with NBW infants, VLBW Malaysian infants had significantly higher risks of physical and neuro-developmental morbidities.
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Affiliation(s)
- N Y Boo
- Department of Paediatrics, Faculty of Medicine, National University of Malaysia, Malaysia
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Teoh SL, Boo NY, Ong LC, Nyein MK, Lye MS, Au MK. Duration of oxygen therapy and exchange transfusion as risk factors associated with retinopathy of prematurity in very low birthweight infants. Eye (Lond) 1995; 9 ( Pt 6):733-7. [PMID: 8849541 DOI: 10.1038/eye.1995.186] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [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: 02/02/2023] Open
Abstract
One hundred and thirteen consecutive infants with a very low birthweight of less than 1500 g were followed prospectively for 6 months to determine the incidence of retinopathy of prematurity (ROP) and associated risk factors. Of this group, 36 (31.9%) infants developed ROP (13 infants had stage 1 ROP, nine had stage 2, six had stage 3, six had stage 4, and two had cicatricial stage ROP). Stepwise logistic regression analysis of various potential risk factors (birthweight, gestation, duration of oxygen therapy, duration of ventilation, highest documented PaO2 and exchange transfusion) showed that only two risk factors were significantly associated with the development of ROP. These risk factors were: the duration of oxygen therapy (p = 0.0005) and exchange transfusion during the neonatal period (odds ratio 5.754, 95% confidence interval 1.002 to 32.997, p = 0.049). The equation of the regression model is: log (odds of developing ROP) = -0.8395 + 0.1447 (OXY)- 0.8750 (ET), where OXY is the duration of oxygen therapy in days, ET = -1 when there was a history of exchange transfusion, and ET = 1 when there was no history of exchange transfusion.
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Affiliation(s)
- S L Teoh
- Department of Ophthalmology, National University of Malaysia
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Teoh SL, Amarjeet K. A comparative study of branch retinal vein occlusion and central vein occlusion amongst Malaysian patients. Med J Malaysia 1993; 48:410-415. [PMID: 8183164] [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: 05/22/2023]
Abstract
A retrospective study of 95 patients with retinal vein occlusion was carried out to determine the clinical presentation and pattern of distribution in the local Malaysian population. There was no significant difference found in its distribution with regards to sex. In comparing branch retinal vein occlusion with central retinal vein occlusion, no significant differences were found in its racial distribution. Branch retinal vein occlusion occurred more commonly among the older patients whereas the converse is true for central retinal vein occlusion. Reduced vision represents the commonest mode of presentation. Hypertension, diabetes mellitus, hyperlipidaemia and haematological disorders are important associated systemic conditions.
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Affiliation(s)
- S L Teoh
- Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan, Malaysia
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Abstract
The visual acuity, the difference in sensitivity of the two eyes to light (brightness ratio), and contrast sensitivity were assessed in 28 patients with chronic open angle glaucoma and compared with those of 41 normal controls of similar ages and visual acuity. The results obtained were related to the results of Tübingen visual field analysis in patients with glaucoma. Twenty-four of the 28 glaucoma patients (86%) had a significant disparity in brightness ratio between the two eyes. This was found to match the frequency of visual field loss. Moreover, there was a significant relationship between the interocular differences in brightness sense and the difference in the degree of visual field loss between the two eyes. Of the glaucoma patients 39% had sum contrast sensitivities outside the normal range for age-matched normal controls. No significant correlation was found between the interocular difference in brightness sense and the visual acuity or the interocular difference in sum contrast sensitivity. It is concluded that, in the presence of a normal visual acuity, the brightness ratio test warrants evaluation as a potential screening test for chronic open angle glaucoma.
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Affiliation(s)
- S L Teoh
- Department of Ophthalmology, National University of Malaysia, Kuala Lumpur
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