ObjectivesTo develop and validate Osteoporosis Prevention and Awareness Tool (OPAAT) in Malaysia.MethodsThe OPAAT was modified from the Malaysian Osteoporosis Knowledge Tool and developed from an exploratory study on patients. Face and content validity was established by an expert panel. The OPAAT consists of 30 items, categorized into three domains. A higher score indicates higher knowledge level. English speaking non-osteoporotic postmenopausal women ≥50 years of age and pharmacists were included in the study.ResultsA total of 203 patients and 31 pharmacists were recruited. Factor analysis extracted three domains. Flesch reading ease was 59.2. The mean±SD accuracy rate was 0.60±0.22 (range: 0.26-0.94). The Cronbach’s α for each domain ranged from 0.286-0.748. All items were highly correlated (Spearman’s rho: 0.761-0.990, p<0.05), with no significant change in the overall test-retest scores, indicating that OPAAT has achieved stable reliability. Pharmacists had higher knowledge score than patients (80.9±8.7vs63.6±17.4, p<0.001), indicating that the OPAAT was able to discriminate between the knowledge levels of pharmacists and patients.ConclusionThe OPAAT was found to be a valid and reliable instrument for assessing patient’s knowledge about osteoporosis and its prevention in Malaysia. The OPAAT can be used to identify individuals in need of osteoporosis educational intervention.

Background: In this systematic review we aimed to appraise the evidence relating to the measurement properties of unidimensional tools to quantify pain after surgery. Furthermore, we wished to identify the tools used to assess interference of pain with functional recovery. Methods: Four electronic sources (MEDLINE, Embase, CINAHL, PsycINFO) were searched in August 2020. Two reviewers independently screened articles and assessed risk of bias using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. Results: Thirty-one studies with a total of 12 498 participants were included. Most of the studies failed to meet the methodological quality standards required by COSMIN. Studies of unidimensional assessment tools were underpinned by low-quality evidence for reliability (five studies), and responsiveness (seven studies). Convergent validity was the most studied property (13 studies) with moderate to high correlation ranging from 0.5 to 0.9 between unidimensional tools. Interpretability results were available only for the visual analogue scale (seven studies) and numerical rating scale (four studies). Studies on functional assessment tools were scarce in which only one study included an 'Objective Pain Score;' a tool assessing pain interference with respiratory function and had low-quality for convergent validity. Conclusions: This systematic review challenges the validity and reliability of unidimensional tools in patients after surgery. We found no evidence that any one unidimensional tool has superior measurement properties in assessing postoperative pain. In addition, because promoting function is a crucial perioperative goal, psychometric validation studies of functional pain assessment tools are needed to improve pain assessment and management. Clinical trial registration: PROSPERO CRD42020213495.

Summary This retrospective cohort study on adults undergoing colectomy from 2010 to 2019 used linked primary (Clinical Practice Research Datalink), and secondary (Hospital Episode Statistics) care data to determine the prevalence of persistent postoperative opioid use following colectomy, stratified by pre‐admission opioid exposure, and identify associated predictors. Based on pre‐admission opioid exposure, patients were categorised as opioid‐naïve, currently exposed (opioid prescription 0–6 months before admission) and previously exposed (opioid prescription within 7–12 months before admission). Persistent postoperative opioid use was defined as requiring an opioid prescription within 90 days of discharge, along with one or more opioid prescriptions 91–180 days after hospital discharge. Multivariable logistic regression analyses were conducted to obtain odds ratios for predictors of persistent postoperative opioid use. Among the 93,262 patients, 15,081 (16.2%) were issued at least one opioid prescription within 90 days of discharge. Of these, 6791 (45.0%) were opioid‐naïve, 7528 (49.9%) were currently exposed and 762 (5.0%) were previously exposed. From the whole cohort, 7540 (8.1%) developed persistent postoperative opioid use. Patients with pre‐operative opioid exposure had the highest persistent use: 5317 (40.4%) from the currently exposed group; 305 (9.8%) from the previously exposed group; and 1918 (2.5%) from the opioid‐naïve group. The odds of developing persistent opioid use were higher among individuals who used long‐acting opioid formulations in the 180 days before colectomy than those who used short‐acting formulations (odds ratio 3.41 (95%CI 3.07–3.77)). Predictors of persistent opioid use included: previous opioid exposure; high deprivation index; multiple comorbidities; use of long‐acting opioids; white race; and open surgery. Minimally invasive surgical approaches were associated with lower odds of persistent opioid use and may represent a modifiable risk factor.

Background Assessing patient satisfaction regarding a pharmacy ambulatory care service is important as patient satisfaction is a determinant of the viability and sustainability of the service provided. Objective To develop and validate the Ambulatory Care Patient Satisfaction Questionnaire in Malaysia. Setting A public hospital in Malaysia with two outpatient pharmacies. The main outpatient pharmacy has an average waiting time of 1-2 h; whilst PharmCARE (which prepares repeat prescriptions in advance) has an average waiting time of 5-15 min. Method Our instrument was developed based on literature review, a theoretical framework and an expert panel. The initial version consisted of 20 Likert-type items (where a higher score indicates higher satisfaction) was administered to patients/carers who were ≥ 21 years, from November 2015 to June 2016 at baseline and 2 weeks later. Main outcome measure The psychometric properties of the instrument. Results A total of 200/220 participants agreed to participate (response rate = 90.9%): main outpatient pharmacy = 114, PharmCARE = 86. Flesch reading ease was 51.9. The final version consists of 17 items with five domains measuring information (4 items), accessibility (4 items), relationship (4 items), outcomes (2 items) and continuity of care (3 items). Participants who collected their medications from PharmCARE [78.0% (72.8-81.3)] were significantly more satisfied than participants from the main outpatient pharmacy [72.0% (68.0-76.0), p < 0.001]. The overall Cronbach's alpha value was 0.839. Kappa values ranged from 0.681 to 0.914. Conclusion Our instrument was found to be a valid and reliable instrument to assess satisfaction of patients towards an ambulatory care pharmacy service in Malaysia.

Scientists from around the world are studying the effects of microgravity and cosmic radiation via the “off-Earth” International Space Station (ISS) laboratory platform. The ISS has helped scientists make discoveries that go beyond the basic understanding of Earth. Over 300 medical experiments have been performed to date, with the goal of extending the knowledge gained for the benefit of humanity. This paper gives an overview of these numerous space medical findings, critically identifies challenges and gaps, and puts the achievements into perspective toward long-term space traveling and also adding benefits to our home planet. The medical contents are trifold structured, starting with the well-being of space travelers (astronaut health studies), followed by medical formulation research under space conditions, and then concluding with a blueprint for space pharmaceutical manufacturing. The review covers essential elements of our Earth-based pharmaceutical research such as drug discovery, drug and formulation stability, drug–organ interaction, drug disintegration/​bioavailability/​pharmacokinetics, pathogen virulence, genome mutation, and body’s resistance. The information compiles clinical, medicinal, biological, and chemical research as well as fundamentals and practical applications.