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Are contemporary antifungal doses sufficient for critically ill patients? Outcomes from an international, multicenter pharmacokinetics study for screening antifungal exposure in intensive care units— the SAFE‑ICU study
Get PDFPurpose
Appropriate antifungal therapy is a major determinant of survival in critically ill patients with invasive fungal disease. We sought to describe whether contemporary dosing of antifungals achieves therapeutic exposures in critically ill patients.
Methods
In a prospective, open-label, multicenter pharmacokinetic study, intensive care unit (ICU) patients prescribed azoles, echinocandins, or polyene antifungals for treatment or prophylaxis of invasive fungal disease were enrolled. Blood samples were collected on two occasions, with three samples taken during a single dosing interval on each occasion. Total concentrations were centrally measured using validated chromatographic methods. Pharmacokinetic parameters were estimated using noncompartmental methods. Antifungal dosing adequacy was assessed using predefined PK/PD targets.
Results
We included 339 patients from 30 ICUs across 12 countries. Median age 62 (interquartile range [IQR], 51–70) years, median APACHE II score 22 (IQR, 17–28), and 61% males. Antifungal therapy was primarily prescribed for treatment (80.8%). Fluconazole was the most frequently prescribed antifungal (40.7%). The most common indication for treatment was intra-abdominal infection (30.7%). Fungi were identified in 45% of patients, of which only 26% had a minimum inhibitory concentration available. Target attainment was higher for patients receiving prophylaxis (> 80% for most drugs). For patients receiving treatment, low target attainment was noted for voriconazole (57.1%), posaconazole (63.2%), micafungin (64.1%) and amphotericin B (41.7%).
Conclusion
This study highlights the varying degrees of target attainment across antifungal agents in critically ill patients. While a significant proportion of patients achieved the predefined PK/PD targets, wide variability and subtherapeutic exposures persist
Hubung kait antara penglibatan remaja di pusat aktiviti remaja dengan kemakmuran
Get PDFZaman remaja merupakan fasa peralihan yang penting dalam perkembangan kehidupan tetapi belum banyak kajian yang melibatkan pengalaman positif mereka seperti kemakmuran individu dijalankan di Malaysia. Kajian ini meneliti tentang penglibatan remaja di pusat aktiviti remaja di luar waktu persekolahan, yang boleh menyumbang kepada kemakmuran mereka. Berfokuskan kepada Kafe@TEEN di Pulau Pinang, kajian ini melihat hubung kait antara penglibatan remaja dalam aktiviti-aktiviti kreatif dan keterikatan sosial yang boleh menyumbang kepada kemakmuran individu. Seramai 132 orang remaja berumur antara 13 hingga 18 tahun yang merupakan ahli pusat aktiviti remaja Kafe@TEEN, Pulau Pinang telah terlibat dalam kajian ini. Mereka dipilih berdasarkan kaedah pensampelan bertujuan. Soal selidik yang terdiri daripada lima bahagian iaitu maklumat demografi, penglibatan di Kafe@TEEN, penglibatan dalam aktiviti-aktiviti kreatif, keterikatan sosial dan kemakmuran individu telah diedarkan kepada peserta kajian. Dapatan kajian ini menunjukkan bahawa terdapat hubungan yang signifikan antara penglibatan remaja di Kafe@TEEN dan keterikatan sosial dengan kemakmuran individu. Walau bagaimanapun, tiada hubungan yang signifikan antara aktivitiaktiviti kreatif dan kemakmuran. Dapatan kajian menunjukkan kepentingan penglibatan dalam aktiviti di pusat aktiviti remaja di luar waktu persekolahan seperti pusat aktiviti remaja Kafe@TEEN terhadap kemakmuran individu. Kajian ini juga menonjolkan peranan penglibatan aktiviti masa senggang di luar waktu persekolahan yang lebih jelas dan spesifik yang menyumbang kepada kemakmuran individu. Golongan remaja haruslah digalakkan untuk lebih terlibat dalam aktiviti masa senggang di luar waktu persekolahan khususnya di pusat aktiviti remaja seperti Kafe@TEEN bagi meningkatkan kemakmuran. Dorongan ibu bapa dan inisiatif pihak kerajaan untuk memperbanyakkan pusat aktiviti remaja seumpama ini juga diperlukan. Lebih banyak kajian pada masa akan datang perlu dijalankan bagi melihat sumbangan faktor lain seperti keusahawanan sosial terhadap kemakmuran golongan remaja khususnya dalam konteks aktiviti di luar waktu persekolahan
The landscape of the Malaysian healthcare sector during COVID-19 : a network perspective
No full textThe COVID-19 pandemic has profoundly impacted the global economy, including financial markets, and significantly affected the healthcare sector
in Malaysia with disruptions to supply chains and increased demand for services.
Complex network analysis has been used to understand the pandemic’s ramifications, modelling the financial market with companies as vertices and asset price
correlations as edges. Filtering techniques like the minimum spanning tree were employed to unveil crucial relationships. The study aimed to investigate COVID-19’s
impact on the Malaysian healthcare sector and identify pivotal companies. Results
showed significant changes in the sector’s financial network during the pandemic,
indicating increased interconnectedness. The study’s implications include highlighting the pandemic’s influence on the sector and its improved resilience, identifying
key players for informed investment decisions, and providing valuable insights for
policymakers, investors, and stakeholders to make informed decisions in these unprecedented times
Box-Behnken design and molecular docking assisted quenching spectrofluorimetric method for the quantitation of citalopram HBr in commercial dosage forms
Get PDFA simple, sensitive and accurate spectrofluorimetric method was presented for the determination of citalopram hydrobromide (CTM) in tablets. The method was based on the quenching of bovine serum albumin (BSA) fluorescence with CTM at pH 7.4. The fluorescence intensities were measured at 342 nm after excitation at 279 nm. Various factors affecting the quenching of BSA fluorescence were optimized by response surface methodology (RSM) through Box-Behnken design (BBD. The plot of F0/F versus CTM concentration was linear in the concentration range of 10–100 µg mL-1. The limit of detection (LOD) and limit of quantitation (LOQ) were 2.08 and 6.30 µg mL-1, respectively The molar combining ratio between CTM and BSA was 1:1. The complementary modified green analytical procedure index (ComplexMoGAPI) was 90%. The effect interference of common excipients found in tablets was investigated. Percent recoveries of CTM was ranged from 99.92 to 100.27% in tablets
Bridging the gap in organ donation: a comprehensive analysis of knowledge, attitude, and willingness among undergraduate nursing students at IIUM Kuantan, Malaysia
Get PDFOrgan donation involves transferring healthy organs to those in need, and nursing students, as future healthcare providers, are key to public education on this topic. Despite the critical demand for organs, donor shortages persist globally due to public misconceptions. Nursing students' knowledge, attitudes, and willingness are pivotal, yet limited research explores these factors in the Malaysian context. To assess knowledge, attitudes, and willingness toward organ donation among IIUM Kuantan undergraduate nursing students. A quantitative cross-sectional survey was conducted at the Kulliyyah of Nursing, IIUM Kuantan, using an online questionnaire. Data on demographics, knowledge, attitude, and willingness were analyzed using descriptive statistics, Independent T-tests, and One-way ANOVA. Among 227 respondents, over 50% had fair knowledge of organ donation, 91.6% had positive attitudes, and 64.3% expressed high willingness. Year of study was not significantly associated with knowledge, attitude, or willingness (p > 0.05). Gender was significantly associated with willingness (p = 0.001) but not with knowledge or attitude (p > 0.05). Enhancing nursing students' knowledge, attitudes, and willingness toward organ donation is crucial for addressing global donor shortages and saving live
Thalassemia awareness and screening practices: a study on knowledge, perceptions, and attitudes among nursing undergraduates at International Islamic University Malaysia (IIUM)
Get PDFBackground: Thalassemia is a significant public health concern in Malaysia, particularly
among certain ethnic groups. Healthcare providers play a crucial role in managing and
preventing the disorder, making it essential to assess their knowledge, awareness, and
attitudes (KAA). Problem Statement: Despite thalassemia’s prevalence, there is limited
research on the preparedness of nursing students to address the condition, potentially
indicating gaps in education and readiness for professional roles. Objective: This study
evaluates the KAA of thalassemia among undergraduate nursing students at the
International Islamic University Malaysia (IIUM).Method: A cross-sectional survey of
191 nursing students used a structured questionnaire to assess demographic factors,
knowledge, awareness, and attitudes towards thalassemia screening. Statistical
analyses, including Chi-square tests and logistic regression, were conducted to identify
key factors influencing KAA. Results: Of the participants, 73.3% demonstrated good
knowledge, and 99.0% exhibited high awareness of thalassemia. Positive attitudes
towards screening were seen in 86.9% of students, with attitudes significantly linked
to academic progression (p = 0.03). Conclusion: The findings highlight the need for
improved educational programs on thalassemia in nursing curricula, with a focus on
genetic counselling and early screening, to enhance the management and prevention
of thalassemia in Malaysia
Bridging the gap in palliative care education: analysing knowledge and attitudes among undergraduate nursing students at IIUM Kuantan, Pahang, Malaysia
No full textThe growing global demand for palliative care is driven by an ageing population and the increasing prevalence of both infectious and non-communicable diseases. Previous research has highlighted inadequate knowledge and uncertain attitudes towards palliative care among nursing students worldwide. This study aimed to assess the knowledge and attitudes of nursing students at the International Islamic University Malaysia (IIUM), Kuantan, towards palliative care. A cross-sectional study was conducted involving 227 nursing students selected through simple random sampling. The findings indicated that the participants demonstrated good to moderate knowledge of palliative care, with a neutral overall attitude. Significant associations were identified between knowledge of palliative care and sociodemographic factors, including age, gender, year of study, clinical attachment experience and experience in caring for dying patients. Similarly, attitudes towards palliative care were significantly associated with the year of study and clinical attachment experience. This study underscores the importance of identifying knowledge gaps and enhancing attitudes toward palliative care among nursing students. It is recommended that further research be conducted in Malaysia to explore these aspects comprehensivel
Knowledge and attitude of nursing and medical students towards the use of AR/VR as anaApproach for TTX
Get PDFIntroduction and Objective: Augmented reality/virtual reality (AR/VR) has been recognised as a great
technology to be used in many fields, especially in emergency and disaster management. This technology also
can be applied in one of the disaster exercises which is a tabletop exercise (TTX). TTX is where a group,
discusses a simulation of an emergency led by a facilitator. This study aimed to determine the level of
knowledge and attitude of nursing and medical students and its association with sociodemographic data
towards the use of AR/VR as an approach to TTX in emergency and disaster preparedness.
Methods: A quantitative cross-sectional study with convenience sampling study was conducted among 211
IIUM Kuantan Campus nursing and medical students from April to June 2022. Data were collected using
questionnaires through Google form which is available in English language. The questionnaire for student’s
knowledge and attitude on AR/VR was self-developed and a reliability test was conducted with reliability of
0.72 and 0.865 for knowledge and attitude respectively.
Results: Majority of respondents have high knowledge and displayed positive attitudes towards the use of AR/
VR as an approach to TTX in emergency and disaster preparedness. It was found that frequency of playing on a
computer, or mobile games is statistically significant with attitudes on the use of AR/VR. While no significant
difference was identified between gender, ownership of computer/mobile devices and period of daily of
internet use with attitudes towards the use of AR/VR.
Conclusion: The use of AR/VR in the field of emergency and disaster can be very useful. It is hope that this
advance technology can be implemented by the National Disaster Management Agency as well as in the field
of healthcare education to have a community that is well prepared with emergency and disaster situation