Hypofractionated (2.75 Gy per fraction) versus Conventionally Fractionated Primary Radiotherapy for T2N0M0 Carcinoma of the Glottis

Abstract Introduction Radiotherapy provides excellent outcome in early stage glottic cancer; however, the optimal radiotherapy dose fractionation remains unknown. Objective To investigate the outcome of patients with T2N0M0 treated with either hypofractionated (HypoFxn) or conventionally fractionated radical (ConFxn) radiotherapy. Methods According to our institutional protocol, patients with T2N0M0 glottic cancer can be treated either with ConfFxn or HypoFxn radiotherapy, as per clinician's and patient's choice, following shared decision making discussing the advantages and disadvantages of both modalities. A total of 77 patients with T2N0M0 squamous cell carcinoma of glottis treated with either HypoFxn 55Gy in 20 fractions (n = 19) or ConFxn 63 to 65Gy in 30 fractions (n = 58) were included. Results With median follow-up of 3.4 years, there was no significant difference in disease-free survival (median: HypoFxn = 65.2 months, and ConFxn = 75.3 months; p = 0.874), local recurrence free survival rates (median: HypoFxn = 78.8 months vs. ConFxn = 81.2 months; p = 0.274), and overall survival (median: HypoFxn = 65.9 months vs. ConFxn = 67.7 months; p = 0.532). Elective neck irradiation was given to 43 patients, all in the ConFxn group, and this was associated with poorer local control (p = 0.027). The use of radiotherapy modality, three-dimensional conformal radiotherapy (3DRT) versus intensity modulated radiotherapy (IMRT), was not a prognostic factor (p = 0.36). In the HypoFxn group, grade III acute dysphagia requiring nasogastric tube was 16%, compared with 25% in the ConFxn group (p = 0.446). Conclusion HypoFxn radiotherapy provides a comparable treatment outcome with acceptable toxicity. The addition of prophylactic irradiation of the neck lymph nodes has no impact on regional control.

Evaluation of Drug-related Knowledge and Clinical Skills among Future Healthcare Professionals

Background: The main objective of this study was to determine and compare current drug-related knowledge and clinical skills in terms of medication error identification among future healthcare professionals. Methods: Study participantswere asked to identify errors in three different prescriptions. Around 15 minutes were given to complete the questionnaire without using any references in a classroom setting. The medication error identificationrate was calculated based on the number of students that have identified the errors correctly.Results: Among 225 respondents, significant differences were found between the three groups,i.e. Prescription 1 p=0.001, Prescription 2 p=0.023, Prescription 3 p=0.024. Pharmacy students had highermedication erroridentification rate compared to medical and nursing students.Conclusion: Final year pharmacy students were found to have the best drug-related knowledge and clinical skills in terms ofmedication error identification

A Point Prevalence Survey of Antimicrobial Usage for Surgical Site Infections- A Pilot Perspective from Holy Makkah, Saudi Arabia

Introduction:This study aimed to assess the incidence, microbiological features and management of surgical site infections (SSIs). Methodology:All patients in the surgical ward were followed from admissions until discharge during the study period. Only hospitalized patients with certain SSIs within 30 days of surgeries were included in the study. Results:A total of 457 patients were followed during the study period. Interestingly, only 9 (1.9 %) of the patients developed SSIs. Most of the patients were males 6 (66.7%) and Saudi nationals 7 (77.8 %). The most common surgical procedures were laparoscopic and orthopedic surgeries with a similar rate of 3 (3.3 %).Conclusion:This study revealed that the incidence of SSIswas quite lower atthe hospital where the study was conducted and different types of antibiotics were used and recommended for prophylaxis

Quality Use of Medicines among Makkah Residents, Saudi Arabia

Introduction:Quality Use of Medicines (QUoM) is of utmost importance regarding the safetyand overall healthcare of the consumers/patients. This study aimed to explore the general usage pattern and attitude of the Makkah community about the safe use of medicines i.e. QUoM Methods:Face to face interviewswere done to administer questionnaires among patients from two hospitals and four primary care centers dealing with patients from rural and urban areas in the Holly Makkah region.Results:A total of 554 patients were enrolled while the majority of them were lived in urban areas (n=457,82%). Around 419 (76%) responder were females and 531(96%) were living with their family and had up to college education(n=174,31%).We found that most of the respondents were diabetic(185,33%) and hypertensive (n=172,31%).Most of the patients (207,37%) stated that they preferred to get drug information from healthcare professionals.Conclusion:This periodic mapping of appropriate medication usage among patients/consumers is indeed an important effort to explore issues on QUoM

Knowledge of Root Canal Treatment and Its Association with Patients’ Demographics – A Cross-Sectional Insight

Introduction:Endodonticsisthedivisionofdentistrythatmainlydealtwiththephysiology,pathophysiology,pathologyandmorphologyofhumandentaltissues.Thestudydeterminedtheknowledgeamongpatientswhounderwentrootcanaltreatment(RCT).Methods:Across-sectionalstudywascarriedamongRCTpatientsvisitingvariousdentalclinics.Avalidatedself-administeredquestionnaireincludinginformationrelatedtoknowledgeaboutRCTwasusedtocollectrequireddata.StatisticalPackageforSocialScience(SPSS)Version22.0wasusedtoanalyzethedata Results:RegardingtheRCTknowledge,itwasrevealedthatpatientswithpreviousRCThistorywerehavingbetterknowledgethanpatientswithoutRCThistoryorthosewhowereplanningtoundergoforRCTprocedure(p=<0.001).DifferencesbetweensmokingstatusandRCTknowledgewerealsostatisticallysignificant(p=0.048).Conclusion:Inconclusion,moderateknowledgewasobservedamongpatientswhounderwentRCTorthosewhowereplanningtoperformRCT

Determinants of Oral Health-Related Quality of Life among Patients on Root Canal Treatment

Introduction: Several determinants directly affect the Oral Health-related Quality of Life (OHRQoL) of root canal treatment (RCT) patients like knowledge, attitude, perceptions, age, gender, marital status, smoking and pre-exposure history of RCT. This study determined the sociodemographic determinants of OHRQoLamong patients underwent RCT.Methods: This cross-sectional study determiningthe OHRQoL of patients on RCTwas conducted among patients visiting various dental clinics. A self-administered and validated questionnaire comprising of four OHRQoL themes was used to collect the data.Statistical Package for Social Science (SPSS) ver. 22.0 was used to analyze the data.One-way ANOVA and independent t-test were used to determine the p-value.Results: For each theme of the OHRQoL research tool, its association was statistically significant with at least one demographic determinant ofthe RCT patients. A total of 26.3% of the participantswere males and 73.7% were females.Among the RCT patients, 38.5% were single whereas 61.5% were married. Conclusion: In conclusion, a moderately-good level of OHRQoL was observed among the patients on RCT.

A Cross-sectional Assessment of Quality of Life among Pharmacy Academics

Introduction: These days, living a good quality life has become a luxury rather than a necessity and investigating the quality of life (QoL) across teaching professionals seems to be beneficial. This study aimed to determine the association between demographic and socioeconomic variables and the QoL among pharmacy academics. Methods: Stratified random sampling was applied to collect data using a pre-validated and self-administered questionnaire the Duke Health Profile (DHP). Statistical Package for Social Science (SPSS) ver. 22.0 was used to analyze the descriptive and inferential data.Results: One hundred and fifty-five pharmacy academics were included in this study where majority 98 (63.2%) were males and 57 (36.8%) were females. The majority 74.2% weremarried and 68.4% were having more than 5 years of teaching experience. A total of 123 ofthe pharmacy academics were more than 35 years old which accounted for 79.4% of the respondents. Various determinants like age, residence, gender, administrative position, marital status, monthly income, and teaching experience are the main factors affecting QoL among pharmacy academics. Conclusion: From the present study it could be concluded that QoL among pharmacy academics was significantly influenced by numerous socio-economic and demographic determinants

Health-Related Quality of Life among University Healthcare Academics

Introduction: Having a good health-related quality of life (HRQoL) is important to ensure good job performance. However, it is subjective and it cannot be measured easily. This study aimed to evaluate HRQoL among universityhealthcare academics in public andprivate universities.Method:In this study,a stratified random sampling approach was employed. The strata were created based on departments in the universities. Arandom sample from each stratum was taken in a number proportional to the stratum's size when compared to the overall target population. A validated questionnaire comprising two sections was administered online to collect the data. Descriptive and inferential statistical analysis (Mann-Whitney U test and Kruskal Wallis H test) were applied using SPSS version 22.Results: Out of all the total 130 respondents, 57 (43.8%) were from a private university and the other 73 (56.2%) were from a public university. There were 61 (46.9%) male respondents and 69 (53.1%) female respondents. HRQoL according to the studied domains of the DUKE health profile was associated with various demographic and socioeconomic variables such as type of institution, department/faculty, age, gender, number of children,and years of experience.Conclusion:The demographic and socioeconomic variables were strongly associated with the HRQoL among university healthcare academics.

Out-of-pocket Healthcare Costs of COPD Exacerbation Episodes: A Hidden Cost and Growing Strain on Family Budgets

Introduction: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) appears to be the main reason for hospitalization among chronic obstructive pulmonary disease (COPD) patients. This study aimed to evaluate the substantial economic burden of COPD in terms of out-of-pocket costs (OOPCs) among COPD patients. Methods: This study consisted of 67 consenting patients with AECOPD. A cross-sectional study was performed via convenience sampling. Data were gathered based on per episode of exacerbation and the calculation of OOPCs was done based on direct and indirectcosts. Results:This study showed that the mean length of hospital stay for four severity levels (according to GOLD guidelines) was 3.4, 7.2, 10.3 and 14.1 days, respectively. The mean OOPCs per episode of exacerbation according to the severity level were 139.1, 153.3, 171.4 and 365.8 USD, respectively Conclusion: Impacts of OOPCs regarding AECOPD episodes on healthcare resources are worthy of attention. Cost estimation from patients’ perspective especially OOPCs estimation is important in decision and policy-making to improve healthcare states of a population

Career Satisfaction among Community Pharmacists

Objective: This study's objective was to determine the level of career satisfaction among practicing Community Pharmacists (CPs) and the impact of various factors on career satisfaction. Methods: This cross-sectional study used a self-administered instrument to accessthe current level of career satisfaction among CPs. The survey instrument questions were adopted from previous studiesand werecontextualized to suit studyobjectivesand revalidated using face and content validation. The study instrument was distributed and collected. Results: A total of 172 responses from CPswere received, 112(65.1%) from males and 60(34.9%) from females. The difference in age categories was significantly profound in theless than 34 years old group being 113(65.7%) compared withthe more than 34 years old being 59(34.3%). Around 98(57%) were working in chain pharmacies and 74(43%) in independent pharmacy stores. The study result showed126 (73.3%) were unsatisfiedin their careers and 46(26.7%) were satisfied. Conclusion:Age and working experience are both major contributing factors to career satisfaction levels. Only 36.5% reported having higher career satisfaction levels among total participated CPs

Management, Medication Use and Economic Burden of Asthma among Hajj and Umrah Pilgrims

Introduction:During Hajj and Umrah season, asthma-related acute admissions produce the enormous burden on healthcare facilities and causes delay in admissions for more severe cases, e.g. myocardial infarction,cardiac failureand severe trauma cases. Therefore, the snapshot of asthma-related admissions during the Hajj and Umrah season was determined by asthma-related admissions and medication use and economic burden during Hajj and Umrah pilgrimage season. Methodology:All asthma-related admissions during the month of Ramadan (fasting month) and Hajj pilgrimage were assessed from patients’data retrospectively. The convenience sampling strategy was used to retrievestudy variables. Statistical Package for Social Science (SPSS) Version 22.0 was used to analyze the data.Results:A total of 271 patients were selected as per inclusion criteria, the majority of them were males 153 (56.5%), while most of them were Saudi 70 (35.8%) and Egyptians 86 (31.7%). During hospitalization, the common treatment for acute exacerbations was inhaled corticosteroids 224 (86.3%), IV corticosteroids 129 (47.6%), Inhaled short-acting beta-agonists 244 (90%) and inhaled bronchodilators (ipratropium bromide) 237(87.5 5%). Conclusion:This periodic mapping of asthma-related admissions and its management during these massive gathering events is indeed a significant effort to explore issues of acute asthma exacerbations management and to provide information to plan for future interventions and policies.

How Do Out-of-Pocket Expenditures Affect Healthcare: A Qualitative Insight of Acute Exacerbation among Asthma Patients

Introduction: This study was designed todetermine the out of pocket costs (OOPCs) of acute exacerbation of asthma (AEA) in asthma patients attending a public hospital.Methodology:A cross-sectionalstudy was done by interviewing the patients using the convenience sampling technique. Data were obtained based on per episode of AEA. OOPCs were calculated based on direct and indirect costs. A total of 128patients participated in the study. The data were analyzed with SPSS ver 23.Results: The study group comprised of 88 males (68.8%), 57 (44.5%) singles and 67 (52.3%) less than 40 years of age. There were considerable differences found between the severity levels and lengths of hospital stay towards theOOPCs. Conclusion:The severity of the AEA and length of stay in the hospital increase the per episode OOPCs of AEA among asthma patients

Pharmacoeconomic Analysis of Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Introduction:Chronic obstructive pulmonary disease (COPD) imparts a substantial economic burden on an individual and society. Exacerbation of COPD (ECOPD) is the primary cost driver for this burden as it usually associated with hospital admissions of COPD patients. The present study aimed to determine the direct costs of acute ECOPD among COPD patients.Methods:A total of 90 eligible patients with acute ECOPD who were admitted to the hospital were involved in this study. A convenient sampling technique was used during data collection. Cost data were collected according to the expenditures and existing information. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 23.0. TheSpearman's rank test was used to observe the differences (correlations) between the Govt perspective and the patient perspective.Results:The direct costs per episode of acute ECOPD were determined according to the Anthonisen criteria for evaluating acute ECOPD. The mean direct costs for severity III, severity I and severity I were 89.1, 134.8 and 178.2 USD respectively. The cost of acute ECOPD was positively associated with disease severity, length of hospital stay and the number of co-morbidities.Conclusion:Acute ECOPD patients consume a considerable amount of healthcare resources and pose a significant economic burden on the government

Health-related Quality of Life among Community Pharmacists

Introduction:The role of community pharmacists (CPs) has kept on changing. Due to the evolving role of CPs, it is important to know its impact on the health-related quality of life (HRQoL) among CPs. Besides, the literature on the HRQoL of CPs is not being enriched, there is an urge to carry out a study to evaluate the HRQoL among CPs. This study aimed to examine the association between the socio-demographic factors and the HRQoLamongCPs. Methodology: A set of questions related to the HRQoL has been adopted from a pre-validated questionnaire, the Duke Health Profile and contextualized it to measure study outcomes. The target population in this study was the registered CPs that were practicing. The site of the study included all the chain and independent pharmacies. Statistical Package for Social Science (SPSS)version 22.0 was used to analyze the data and the significance level was set at p≤0.05. Variousdomains of the Duke Health Profile (DHP) were calculated using the provided formula Results: A total of 172 respondents were included in this study. Several HRQoL domains were significantly associated with socio-demographic factors. The univariate analysis illustrated that mental and general healthstatehad significant associations with age, practice setting was significantly associated with the mental health state, the salary was significantly associated with self-esteem and mental health was significantly associated with length of service and practice setting. Dysfunction dimensions of anxiety, anxiety-depression, and pain were significantly associated withgender. Conclusion: Gender, age, length of service, salary and practice setting were the risk factors for HRQoL among CPs

Predictors of Job and Workplace Satisfaction among Community Pharmacists

Aims: This study aimed to assess the current levels of job and workplace satisfactionamong community pharmacists (CPs) and to explore the factors that can affect their job and workplace satisfaction. Methods: A self-administered research tool (questionnaire) was developed based on previously published literature. After its reliability and validity measurements, the questionnaire was distributed to the target population and data was collected. Data wereentered into Statistical Package for Social Science (SPSS) ver. 22.0 and analyzed using descriptive statistics, chi-square,and multiple regression analysis. The level of significance (α) was set at 0.05.Results: CPs reported high satisfaction (76.7%) concerning their jobs. Only 23.3% of them were not satisfied with their current job. Univariate analysis showed that job and workplace satisfactionamong CPs was not significantly associated with gender, age, length of service, position and salary. However, the univariate analysis demonstrated a significant difference between practice settings and job and workplace satisfactionwith p= 0.013. Among the respondents, those who worked in the chain pharmacies (83.7%) expressed greater job and workplace satisfaction, which is 16% higher than those working in independent pharmacies (67.6%). Therefore, practice setting was shown as the predictor of job and workplace satisfactionamong CPs by using multiple regression analysis. Conclusion: Overall, CPswere relatively satisfied with their current job. Our results had reinforced previous studies that reported that practice settings can affect pharmacists’ job and workplace satisfaction.

Medication Errors Identification Rates by Healthcare Students

Introduction:Medication errors caused devastating consequences affecting both the healthcare system and the patient’s trust. Junior doctors, pharmacists, and nurses are prone to make these mistakes. Thus, this study served a purpose to evaluate the pharmacological knowledge of the healthcare students (HCSs) i.e. pharmacy, medical, and nursing studentsthroughdetecting errors in the prescriptions, as this will reflect their performance once they come in real practice.Methodology:A cross-sectional, descriptive study was conducted using a validated research tool consisting ofdemographics attributes (gender, race, duration of pre-university and age) as well as three prescriptions. The research tool was distributed to final year HCSs. Demographic data of the respondents were required to investigate the contributing factors in medication errors’ identification. Data obtained were analyzed using descriptive and inferential statistics by using SPSS ver. 22.Results: 197 students responded to this study. Findings show that pharmacy students yield high percentages compared to medical and nursing students in identifying errors in the prescriptions. 91.1% of pharmacy students were successful in recognizing the errors in prescription 1, 55.0% in prescription 2 whereas 96.2% in prescription 3. There wasa significantassociation betweenthe age of the respondents and their ability in identifying the errors (p=0.012). No significant relationship was observed between race, gender and duration of pre-university in identifying the mistakes in the prescriptions (p>0.05).Conclusion: Pharmacy students had the highest percentage ofmedication error identification rates probably in light of the pharmacy curriculum focuses mainlyon pharmacology and therapeutic monitoring. This study portrays the importance of additional clinical training in undergraduate programs to enhance student’s pharmacological knowledge and their attitude towards patient safety practices

Primary Concurrent Chemoradiation in Head and Neck Cancers withWeekly Cisplatin Chemotherapy: Analysis of Compliance, Toxicity and Survival

Abstract Introduction Concurrent chemoradiation is the standard of care in inoperable locally advanced squamous cell head and neck cancers. The most widely accepted schedule of concomitant cisplatin is 100mg/m2 given on a 3 weekly basis but the optimal regime is unknown. Objective The objective of this study is to assess the tolerability, compliance, and clinical outcomes of weekly cisplatin (40mg/m2). Methods During the period of January 2007-December 2009, we analyzed retrospectively 122 patients with histologically proven squamous cell carcinoma of head and neck (nasopharynx, oropharynx, larynx, hypopharynx, and oral cavity) treated with definitive chemoradiation. All patients received 63 Gy in 30 daily fractions with concomitant weekly cisplatin 40mg/m2. We assessed treatment toxicities and patient compliance. We estimated overall survival using the Kaplan-Meier method. Results Sixty-eight percent of patients managed to complete all six cycles of chemotherapy while 87% of patients completed at least 5 cycles of weekly cisplatin. Incidence of grade 3/4 toxicity was as follows: mucositis 33%, dermatitis 41%, dysphagia 15%, mouth/neck pain 17%, neutropenia 2%, and renal impairment 3%. 53% patients required at least one hospital admission for symptom control. The 5-year overall survival rate was 60%. Conclusion Concurrent chemoradiotherapy using weekly cisplatin at 40mg/m2 per week is an effective, well tolerated regimen allowing most patients to receive at least 5 cycles of chemotherapy. However, a phase III randomized control trial comparing the standard dose of 100mg/m2 cisplatin tri-weekly with a weekly regimen is needed to establish the long term clinical outcome.

Guideline adherence and control of diabetes mellitus with or without co-morbidities in various wards of a tertiary hospital in Malaysia.

To assess the adherence of physicians involved in the management of diabetes mellitus with or without co-morbidities with reference to Clinical Practice Guideline 2009 given by Ministry of Health Malaysia in the tertiary care hospital, Pinang General Hospital Malaysia. Cross-sectional study was done at tertiary care hospital, Penang, Malaysia. The total 51 physicians and 1020 patient’s prescriptions written by same physicians were taken from the record of the Penang General Hospital (20 prescriptions for each enrolled physician). All 1020 patients were suffering from diabetes mellitus with or without co-morbidities. These patients were recruited from the different wards of the Penang General Hospital. Depending on the recommendations of CPG 2009 the prescriptions of patients were divided into adherent and non-adherent prescriptions. The overall good level of physician adherence was seen with respect to the recommendations of CPG 2009 in all prescriptions. A statistically significant negative association (Ф= 0.094, p-value=0.003) was observed between diabetes mellitus control and co-morbidities. CPG adherent had statistically weak negative association (Ф= -0.081, p-value=0.010) with patients having co-morbidities. No statistically significant association was observed between CPG adherence and any other co-morbidity. The study explored the several features of prescription pattern of physicians involved in the management of diabetes mellitus with or without co-morbidities and recognized the need for improvement in their prescription pattern for treating the diabetes mellitus.

Guideline adherence and control of diabetes mellitus with or without co-morbidities in various wards of a tertiary hospital Malaysia.

To assess the adherence of physicians involved in the management of diabetes mellitus with or without co-morbidities with reference to Clinical Practice Guideline 2009given by Ministry of Health Malaysia in the tertiary care hospital, Pinang General Hospital Malaysia. Cross-sectional study was done at tertiary care hospital, Penang, Malaysia. The total 51physicians and 1020 patient’s prescriptions written by same physicians were taken from the record of the Penang General Hospital (20 prescriptions for each enrolled physician). All 1020 patients were suffering from diabetes mellitus with or without co-morbidities. These patients were recruited from the different wards of the Penang General Hospital. Depending on the recommendations of CPG 2009 the prescrip-tions of patients were divided into adherent and non-adherent prescriptions. The overall good level of physician adherence was seen with respect to the recommendations of CPG2009 in all prescriptions. A statistically significant negative association (Ф= 0.094, p-value=0.003) was observed between diabetes mellitus control and co-morbidities. CPG adherent had statistically weak negative association (Ф= - 0.081, p-value=0.010) with patients having co-morbidities. No statistically significant association was observed between CPG adherence and any other co-morbidity. The study explored the several features of prescription pattern of physicians involved in the management of diabetes mellitus with or without co-morbidities and recognized the need for improvement in their prescription pattern for treating the diabetes mellitus.