Cost-Effectiveness Analysis of Granisetron-Based versus Standard Antiemetic Regimens in Low-Emetogenic Chemotherapy: A Hospital-based Perspective from Malaysia

Keat, Chan Huan,Ghani, Norazila Abdul Asian Pacific Journal of Cancer Prevention 2013 Asian Pacific journal of cancer prevention Vol.14 No.12

Background: In a prospective cohort study of antiemetic therapy conducted in Malaysia, a total of 94 patients received low emetogenic chemotherapy (LEC) with or without granisetron injections as the primary prophylaxis for chemotherapy-induced nausea and vomiting (CINV). This study is a retrospective cost analysis of two antiemetic regimens from the payer perspective. Materials and Methods: This cost evaluation refers to 2011, the year in which the observation was conducted. Direct costs incurred by hospitals including the drug acquisition, materials and time spent for clinical activities from prescribing to dispensing of home medications were evaluated (MYR 1=$0.32 USD). As reported to be significantly different between two regimens (96.1% vs 81.0%; p=0.017), the complete response rate of acute emesis which was defined as a patient successfully treated without any emesis episode within 24 hours after LEC was used as the main indicator for effectiveness. Results: Antiemetic drug acquisition cost per patient was 40.7 times higher for the granisetron-based regimen than for the standard regimen (MYR 64.3 vs 1.58). When both the costs for materials and clinical activities were included, the total cost per patient was 8.68 times higher for the granisetron-based regimen (MYR 73.5 vs 8.47). Considering the complete response rates, the mean cost per successfully treated patient in granisetron group was 7.31 times higher (MYR 76.5 vs 10.5). The incremental cost-effectiveness ratio (ICER) with granisetron-based regimen, relative to the standard regimen, was MYR 430.7. It was found to be most sensitive to the change of antiemetic effects of granisetron-based regimen. Conclusions: While providing a better efficacy in acute emesis control, the low incidence of acute emesis and high ICER makes use of granisetron as primary prophylaxis in LEC controversial.

Development of an Electro-Optic Mooring System for Oceanographic Buoy

Keat, Kok-Choon,Park, Soo-Hong The Korea Institute of Information and Commucation 2009 Journal of information and communication convergen Vol.7 No.2

This study is part of a project to develop and improve mooring systems for oceanographic use that include an electro-optical sensor, 1MHz Nortek Aquadopp Doppler Profiler and AIRMAR multipurpose Sensor. The adaption of Doppler current profilers to measure directional wave spectra has provided a new instrumentation approach to coastal and nearshore oceanographic studies. The HEIOB is developed are light weight and of a compact design, and can be easily installed in marine environment. Since there are no base station and gateways in marine environments, we selected CDMA and Orbcomm to send the data information. Therefore, the data can be sent by either e-mail service or Short Message Service (SMS). This paper will present some of scientific sensor results regarding real-time oceanographic and meteorological parameters such as wind spend, wind direction, wave direction, and etc. The modeling and test results highlight the engineering challenges associated with designing these systems for long lifetimes. It can also be used in future application to build wave observation buoy network in real-time using multiple ubiquitous buoys that share wave data and allow analysis of multipoint, multi-layer wave profiler.

Characteristics of Thiamine Uptake by the BeWo Human Trophoblast Cell Line

Keating, Elisa,Lemos, Clara,Azevedo, Isabel,Martel, Fatima Korean Society for Biochemistry and Molecular Biol 2006 Journal of biochemistry and molecular biology Vol.39 No.4

Little is known concerning the mechanisms responsible for the transplacental transfer of thiamine. So, the aim of this work was to characterize the placental uptake of thiamine from the maternal circulation, by determining the characteristics of $^3H$-thiamine uptake by a human trophoblast cell line (BeWo). Uptake of $^3H$-thiamine (50-100 nM) by BeWo cells was: 1) temperature-dependent and energy-independent; 2) pH-dependent (uptake increased as the extracellular medium pH decreased); 3) $Na^+$-dependent and $Cl^-$-independent; 4) not inhibited by the thiamine structural analogs amprolium, oxythiamine and thiamine pyrophosphate; 5) inhibited by the unrelated organic cations guanidine, N-methylnicotinamide, tetraethylammonium, clonidine and cimetidine; 6) inhibited by the organic cation serotonin, and by two selective inhibitors of the serotonin plasmalemmal transporter (hSERT), fluoxetine and desipramine. We conclude that $^3H$-thiamine uptake by BeWo cells seems to occur through a process distinct from thiamine transporter-1 (hThTr-1) and thiamine transporter-2 (hThTr-2). Rather, it seems to involve hSERT. Moreover, chronic (48 h) exposure of cells to caffeine ($1\;{\mu}M$) stimulated and chronic exposure to xanthohumol and iso-xanthohumol (1 and $0.1\;{\mu}M$, respectively) inhibited $^3H$-thiamine uptake, these effects being not mediated through modulation of the expression levels of either hThTr-1 or hSERT mRNA.

Can Granisetron Injection Used as Primary Prophylaxis Improve the Control of Nausea and Vomiting with Low-Emetogenic Chemotherapy?

Keat, Chan Huan,Phua, Gillian,Kassim, Mohd Shainol Abdul,Poh, Wong Kar,Sriraman, Malathi Asian Pacific Journal of Cancer Prevention 2013 Asian Pacific journal of cancer prevention Vol.14 No.1

Background: The purpose of this study is to examine the risk of uncontrolled chemotherapy-induced nausea and vomiting (CINV) among patients receiving low emetogenic chemotherapy (LEC) with and without granisetron injection as the primary prophylaxis in addition to dexamethasone and metochlopramide. Materials and Methods: This was a single-centre, prospective cohort study. A total of 96 patients receiving LEC (52 with and 42 without granisetron) were randomly selected from the full patient list generated using the e-Hospital Information System (e-His). The rates of complete control (no CINV from days 1 to 5) and complete response (no nausea or vomiting in both acute and delayed phases) were identified through patient diaries which were adapted from the MASCC Antiemesis Tool (MAT). Selected covariates including gender, age, active alcohol consumption, morning sickness and previous chemotherapy history were controlled using the multiple logistic regression analyses. Results: Both groups showed significant difference with LEC regimens (p<0.001). No differences were found in age, gender, ethnic group and other baseline characteristics. The granisetron group indicated a higher complete response rate in acute emesis (adjusted OR: 0.1; 95%CI 0.02-0.85; p=0.034) than did the non-granisetron group. Both groups showed similar complete control and complete response rates for acute nausea, delayed nausea and delayed emesis. Conclusions: Granisetron injection used as the primary prophylaxis in LEC demonstrated limited roles in CINV control. Optimization of the guideline-recommended antiemetic regimens may serve as a less costly alternative to protect patients from uncontrolled acute emesis.

Improving Safety-Related Knowledge, Attitude and Practices of Nurses Handling Cytotoxic Anticancer Drug: Pharmacists' Experience in a General Hospital, Malaysia

Keat, Chan Huan,Sooaid, Nor Suhada,Yun, Cheng Yi,Sriraman, Malathi Asian Pacific Journal of Cancer Prevention 2013 Asian Pacific journal of cancer prevention Vol.14 No.1

Background: An increasing trend of cytotoxic drug use, mainly in cancer treatment, has increased the occupational exposure among the nurses. This study aimed to assess the change of nurses' safety-related knowledge as well as attitude levels and subsequently to assess the change of cytotoxic drug handling practices in wards after a series of pharmacist-based interventions. Materials and Methods: This prospective interventional study with a before and after design requested a single group of 96 nurses in 15 wards actively providing chemotherapy to answer a self-administered questionnaire. A performance checklist was then used to determine the compliance of all these wards with the recommended safety measures. The first and second assessments took 2 months respectively with a 9-month intervention period. Pharmacist-based interventions included a series of technical, educational and administrative support measures consisting of the initiation of closed-system cytotoxic drug reconstitution (CDR) services, courses, training workshops and guideline updates. Results: The mean age of nurses was $32.2{\pm}6.19$ years. Most of them were female (93.8%) and married (72.9%). The mean knowledge score of nurses was significantly increased from $45.5{\pm}10.52$ to $73.4{\pm}8.88$ out of 100 (p<0.001) at the end of the second assessment. Overall, the mean practice score among the wards was improved from $7.6{\pm}5.51$ to $15.3{\pm}2.55$ out of 20 (p<0.001). Conclusions: The pharmacist-based interventions improved the knowledge, attitude and safe practices of nurses in cytotoxic drug handling. Further assessment may help to confirm the sustainability of the improved practices.

Southeast Asia in International History: Justification and Exploration

( Ooi Keat Gin ) 부산외국어대학교 아세안연구원(구 부산외국어대학교 동남아지역원) 2020 Suvannabhumi Vol.12 No.2

Despite its centrality at a pivotal crossroads of both land and sea of East-West trade, communications and travel, the region now known as Southeast Asia provides very few scholarly works situating or featuring it in an international context. Because of this paucity, there is immense scope for exploration. But prior to further explorations, justification is needed to establish that Southeast Asia, as a region, is a subject of interest, relevance, and significance in a global context. Southeast Asia was home to several empires whose reach transcended the region and beyond. Southeast Asia in, and as part of international history as an area of study is therefore justifiable. Moreover, other factors come into play, viz. geography, resources, migration, diffusion of ideas and beliefs from without and accommodation from within, shared experience of imperialism and colonialism, decolonization, and the Cold War, and the collective fate under the Association of Southeast Asian Nations (ASEAN), that further bolster its rationalization as a component of international history. Explorations, on the other hand, examine issues and obstacles that contribute to the paucity of works on Southeast Asia in international history. Furthermore, in contextualizing Southeast Asia in international history, there might appear challenges that need to be identified, confronted, and resolved.

An Obscure Etiology for Headache : Sphenoid Sinus Disease

Lee, Keat-Jin,Yanagisawa, Ken Yonsei University, College of Medicine 1988 Yonsei medical journal Vol.29 No.3

Characteristics of Thiamine Uptake by the BeWo Human Trophoblast Cell Line

( Elisa Keating ),( Clara Lemos ),( Isabel Azevedo ),( Fatima Martel ) 생화학분자생물학회 2006 BMB Reports Vol.39 No.4

Eclectic Sociocultural Traditions of the Baba Nyonya of George Town, Penang, Malaysia

( Ooi Keat Gin ) 부산외국어대학교 동남아지역원 2017 Suvannabhumi Vol.9 No.2

Strategically situated between the East-West maritime crossroads, the peoples of Southeast Asia over the centuries witnessed the comings and goings of traders from territories from East Asia, South Asia, West Asia and Europe. There were also those from North America that crossed the Pacific for commercial profits in this region. Foreign traders undoubtedly in the course of their visits and sojourns had liaisons with local women, some engaged in marriages. Offspring of these interracial miscegenation possessed rather unique characteristics. As a community, they were identified with the Malay term, peranakan, from the root word, “anak” meaning “child,” hence “offspring” or “descendent”. Specific terms - Baba Nyonya, Tionghoa-Selat, Chitty, Jawi Pekan, Pashu, Kristang - referred to particular groups. Although socially they appeared ‘neither here nor there’, members of mixed parentage were able to carve an especial niche in the local environment throughout Southeast Asia, conspicuously in urban, port-cities where trade and commerce predominated. Following in the footsteps of their progenitor, the Peranakan acted as intermediaries, comprador between foreign and indigenous enterprises, profiting financially and socially from trade and commerce. Tapping on the author’s personal experiences and first-hand observations, complementing with oral sources, and support from secondary materials, this present essay explores, discusses, and analyzes the eclectic sociocultural practices and traditions of the Baba Nyonya of George Town, Penang. Purposeful intention is to further enlighten our understanding, and in turn, our appreciation, of these ever increasingly diminishing communities and their cultures across Southeast Asia.

Borne of the Cold War: Malaya/Malaysia from a Historical Perspective, c. 1950’s-c.1990’s

OOI Keat Gin 부산외국어대학교 아세안연구원 2016 Suvannabhumi Vol.8 No.2

Malaya attained independence on August 31, 1957 from Britain. However this new nation faced a communist insurgency known today as the “Malayan Emergency” (1948-1960). Then in 1961, Tunku announced a wider federation of “Malaysia”, viz. Malaya, British Crown Colonies of Singapore, Sarawak and North Borneo, and the protectorate of Brunei. Countering communism was a principal motive for “Malaysia”. Sarawak’s leftist elements were rejected with an armed opposition. Malaysia was formed excluding Brunei. Amidst its birth pangs, Malaysia faced hostile neighbors Indonesia and the Philippines; the former objected by way of Konfrontasi (1963-1967) while the latter laid claim to Sabah (formerly North Borneo). Malaya/ Malaysia was borne in the midst of the Cold War (1947–1991), a bipolar world between the US and the USSR. Malaya/Malaysia is utilized as a case of analysis and evaluation in the context of the twin trends of continuities and transformations in tracing the historical developments from the 1950’s to the 1990’s. The risks, motives, and challenges that prompted the shift in foreign relations reveal as much of the personality of the political leadership, the prevailing situations, and conditions from within and circumstances from without.