Pharmacy value-added services (PVAS) include any innovative pharmacy activities to facilitate and aid the refilling of medications. In Malaysia, the government has invested in infrastructure development, promotional activities, and manpower to enhance PVAS utilization. In this study, PVAS data for the years 2019 and 2020 that were obtained from all public health facilities in the state of Selangor, Malaysia, were analyzed to identify the pattern of PVAS utilization. A reduction in the total number of new and refill prescriptions was observed in 2020. The number of patients enrolled in a PVAS program increased by 44.5% in 2020. Overall, totals of 222,358 and 416,635 prescriptions were supplied through the PVAS programs in 2019 and 2020, respectively. The most common PVAS that was newly offered in 2020 was the medicines by post (locally known as Ubat Melalui Pos) service. The service was also the most utilized PVAS by patients in 2020. The average waiting time per prescription for patients receiving their medications from the outpatient pharmacies at the hospitals increased slightly in 2020 but was reduced at the health clinics. Activities such as campaigns to promote PVAS can be undertaken to further enhance the utilization of the services at public health facilities.
Navigated by Ensite array system, the ablation catheter was approached to the source of tachycardia. At this site, the atrial electrocardiogram in tachycardia was 23 ms before onset of surface ECG P wave, and 52 ms in duration (Figure 3). After excluding phrenic nerve stimulation by high output (8 v, 1 ms) pacing using the ablation electrode, radiofrequency current was delivered up to 60 s in sinus rhythm under the same condition with the ablation of the typical atrial flutter. No more tarchycardia could be induced by programmed atrial stimulation, even with the presence of isoproterelol infusion. After operation, 24 hours telemetric ECG was monitored with no tachycardia identified. SNRT has been increasingly diagnosed by electrophysiological study since it was considered as a theoretical cause of supraventricular
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