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Parimala Vijai Indrian,1 Wei Wen Chong,1 Anizah Ali,2 Adliah Mhd Ali1 1Centre of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia; 2Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, MalaysiaCorrespondence: Adliah Mhd Ali, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, 50300, Malaysia, Tel +603-92897286, Fax +603-26983271, Email adliah@ukm.edu.myBackground: The patient-centred counselling tools are a comprehensive resource to assist community pharmacists in providing effective treatment choices and assisting with decision-making.Aim: To identify and select suitable tools community pharmacists use with targeted patient-centred outcomes for dispensing contraceptives.Methods: Five electronic databases, Web of Science, Cochrane Library, PubMed, Scopus, and Google Scholar as additional sources for published and unpublished studies, were searched to identify literature for contraceptive tools or strategies for pharmacists to decide on contraceptive choice and dispensing by pharmacist. Studies involving pharmacists or tools suitable for pharmacists from any country, published since 1990 were considered.Results: A total of 21 publications met the inclusion criteria. Robvis’ tool was used for visualizing the risk of bias for each result. There were three studies that used the tools specifically by community pharmacists and others focused on general family planning users and pharmacists. The suitability of patient-centred interventions in community pharmacy settings was further evaluated.Conclusion: The evidence for special tools for pharmacists for dispensing contraceptives in community settings is limited and further research is needed to develop and evaluate novel interventions for pharmacists in community settings.Keywords: contraception, patient-centred, community pharmacist, family planning, counselling tools, dispensing contraceptives

Fahmi Hassan,1,2 Ernieda Hatah,1 Wei Wen Chong,1 Adliah Mhd Ali1 1Fakulti Farmasi, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia; 2Jabatan Farmasi, Hospital Tengku Ampuan Rahimah, Klang, Selangor, MalaysiaCorrespondence: Ernieda Hatah, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, 50300, Malaysia, Tel +60392897328, Fax +603-26983271, Email ernieda@ukm.edu.myBackground: Diabetes mellitus (DM) is a chronic metabolic disorder affecting millions globally. Adherence to treatment is crucial for effective management.Objective: To compare clinical outcomes, specifically changes in haemoglobin A1c (HbA1c) and fasting blood sugar (FBS) levels, between DM patients who completed the pharmacist-managed Diabetes Medication Therapy Adherence Clinic (DMTAC) sessions and those who did not, and to identify risk factors associated with non-completion of DMTAC.Methods: This multicenter, retrospective study included patients with DM attending DMTAC at five Ministry of Health centers from January 2018 to December 2020. Patients were categorized based on their completion of DMTAC sessions: those who completed at least four sessions and those who did not as per DMTAC protocol. The changes in HbA1c and FBS levels between the groups were analyzed. Logistic regression was employed to identify risk factors for non-completion of DMTAC.Results: A total of 198 patients were included, comprising 49% male with a mean age of 56.52, ± 12.91 years. The complete group consisted of 49% (n=99) of the patients, while the did not complete group included 50.5% (n=100). A statistically significant reduction in FBS levels from initial to final measurements was observed in the complete group compared to the did not complete group (P=0.024). Female gender, higher education levels, and a longer duration since DM diagnosis were significantly associated with non-completion of DMTAC.Conclusion: Diabetic patients attending at least four DMTAC sessions showed potential improvements in FBS levels. To enhance attendance at DMTAC sessions, healthcare professionals should focus on patients identified with risk factors for non-completion of DMTAC.Keywords: pharmacist-managed clinic, glycemic control, HbA1c, medication adherence, type 2 diabetes mellitus

Lai San Kong,1 Farida Islahudin,1 Leelavathi Muthupalaniappen,2 Wei Wen Chong1 1Centre of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, 50300, Malaysia; 2Department of Family Medicine, Medical Faculty, Universiti Kebangsaan Malaysia, Kuala Lumpur, 56000, MalaysiaCorrespondence: Wei Wen ChongFaculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, 50300, MalaysiaTel +60 3-9289-7118Email weiwen@ukm.edu.myBackground: Identifying knowledge gaps regarding antibiotic use and resistance is important for future interventional strategies. There is limited information on Malaysia’s general public’s knowledge and expectations on antibiotic use.Purpose: To assess the knowledge of antibiotic use and resistance, expectations from antibiotic prescription, and identify inappropriate practices related to antibiotic use among Malaysia’s general public.Materials and Methods: A nationwide cross-sectional survey was conducted among Malaysians aged 18 years and above from each state, from May to November 2019. Participants were recruited via quota sampling, followed by convenient sampling. A validated self-administered questionnaire was used to collect data.Results: Of the 1971 respondents recruited, 56.6% had engaged in at least one inappropriate practice; particularly, not completing the antibiotic course (48.8%). The mean total knowledge score was 8.57± 4.24 (total 20). The majority incorrectly believed that antibiotics work on viral infections (79.1%) and colds and coughs (77.0%). Less than half of them believed that antibiotics could be stopped when symptoms improved (42.8%). Most respondents incorrectly perceived that antibiotic resistance occurs when the body becomes resistant to antibiotics (90.2%) and antibiotic resistance is not an issue in the country (62.9%). More than half the participants expected antibiotics to be prescribed for self-limiting symptoms (fever: 62.9%, sore throat: 57.2%, cold or flu: 50.9%). Respondents with better knowledge were less likely to engage in inappropriate antibiotic use (never engaged: 9.26± 4.40 versus had engaged: 8.11± 4.00, p< 0.001), and expect doctors to discuss with them the need for antibiotics (agree/strongly agree: 9.03± 4.25 versus neutral: 6.62± 3.91 versus disagree/strongly disagree: 8.29± 4.00, p< 0.001).Conclusion: Knowledge gaps in the role of antibiotics and understanding of antibiotic resistance should be considered whtpen designing future educational strategies for the general public.Keywords: antibiotic use, antibiotic resistance, knowledge, expectation, inappropriate practice, general public

Elaine Kan,1,2 Suzana Mustafa,1 Wei Wen Chong,2 Chandini Menon Premakumar,2 Noraida Mohamed Shah2 1Pharmacy Department, Kuala Lumpur Hospital, Ministry of Health, Kuala Lumpur, Malaysia; 2Centre of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, MalaysiaCorrespondence: Noraida Mohamed ShahCentre of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, MalaysiaTel +60 3 9289 8038Email noraida_mshah@ukm.edu.myContext: Pain is a common and distressing symptom among cancer patients. Opioid analgesics are the mainstay of cancer pain management, and adequate adherence plays an important role in achieving good pain control.Purpose: To determine the level of adherence to opioid analgesics in patients with cancer pain and to identify factors that may influence the adherence.Patient and Methods: This was a cross-sectional study conducted from March to June 2018 at two tertiary care hospitals in Malaysia. Study instruments consisted of a set of validated questionnaires; the Medication Compliance Questionnaire, Brief Pain Inventory and Pain Opioid Analgesic Beliefs─Cancer scale.Results: A total of 134 patients participated in this study. The patients’ adherence scores ranged from 52– 100%. Factors with a moderate, statistically significant negative correlation with adherence were negative effect beliefs (rs= − 0.53, p< 0.001), pain endurance beliefs (rs = − 0.49, p< 0.001) and the use of aqueous morphine (rs = − 0.26, p=0.002). A multiple linear regression model on these predictors resulted in a final model which accounted for 47.0% of the total variance in adherence (R2 = 0.47, F (7, 126) = 15.75, p< 0.001). After controlling for other variables, negative effect beliefs were the strongest contributor to the model (β = − 0.39, p< 0.001) and uniquely explained 12.3% of the total variance.Conclusion: The overall adherence to opioid analgesics among Malaysian patients with cancer pain was good. Negative effects beliefs regarding cancer pain and opioids strongly predicted adherence.Keywords: beliefs, cancer pain, compliance, opioid analgesic

Yew Keong Ng,1 Noraida Mohamed Shah,1 Ly Sia Loong,2 Lay Ting Pee,3 Sarina Anim M Hidzir,4 Wei Wen Chong1 1Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia; 2Department of Pharmacy, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia; 3Department of Pharmacy, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia; 4Department of Pharmacy, Hospital Sungai Buloh, Selangor, Malaysia Purpose: This study investigated patients’ and pharmacists’ attitudes toward concordance in a pharmacist–patient consultation and how patients’ attitudes toward concordance relate to their involvement and self-efficacy in decision making associated with medication use.Subjects and methods: A cross-sectional study was conducted among patients with chronic diseases and pharmacists from three public hospitals in Malaysia. The Revised United States Leeds Attitudes toward Concordance (RUS-LATCon) was used to measure attitudes toward concordance in both patients and pharmacists. Patients also rated their perceived level of involvement in decision making and completed the Decision Self-Efficacy scale. One-way analysis of variance (ANOVA) and independent t-test were used to determine significant differences between different subgroups on attitudes toward concordance, and multiple linear regression was performed to find the predictors of patients’ self-efficacy in decision making.Results: A total of 389 patients and 93 pharmacists participated in the study. Pharmacists and patients scored M=3.92 (SD=0.37) and M=3.84 (SD=0.46) on the RUS-LATCon scale, respectively. Seven items were found to be significantly different between pharmacists and patients on the subscale level. Patients who felt fully involved in decision making (M=3.94, SD=0.462) scored significantly higher on attitudes toward concordance than those who felt partially involved (M=3.82, SD=0.478) and not involved at all (M=3.68, SD=0.471; p

Yong Hui Nies,1 Farida Islahudin,1 Wei Wen Chong,1 Norlia Abdullah,2 Fuad Ismail,3 Ros Suzanna Ahmad Bustamam,4 Yoke Fui Wong,5 JJ Saladina,2 Noraida Mohamed Shah1 1Faculty of Pharmacy, 2Department of Surgery, 3Department of Radiotherapy and Oncology, Universiti Kebangsaan Malaysia Medical Centre, 4Department of Radiotherapy and Oncology, Hospital Kuala Lumpur, Kuala Lumpur, 5Department of Radiotherapy and Oncology, National Cancer Institute, Putrajaya, Malaysia Purpose: This study investigated breast cancer patients’ involvement level in the treatment decision-making process and the concordance between patients’ and physician’s perspectives in decision-making. Participants and methods: A cross-sectional study was conducted involving physicians and newly diagnosed breast cancer patients from three public/teaching hospitals in Malaysia. The Control Preference Scale (CPS) was administered to patients and physicians, and the Krantz Health Opinion Survey (KHOS) was completed by the patients alone. Binary logistic regression was used to determine the association between sociodemographic characteristics, the patients’ involvement in treatment decision-making, and patients’ preference for behavioral involvement and information related to their disease. Results: The majority of patients preferred to share decision-making with their physicians (47.5%), while the second largest group preferred being passive (42.6%) and a small number preferred being active (9.8%). However, the physicians perceived that the majority of patients preferred active decision-making (56.9%), followed by those who desired shared decision-making (32.8%), and those who preferred passive decision-making (10.3%). The overall concordance was 26.5% (54 of 204 patient–physician dyads). The median of preference for information score and behavioral involvement score was 4 (interquartile range [IQR] =3–5) and 2 (IQR =2–3), respectively. In univariate analysis, the ethnicity and educational qualification of patients were significantly associated with the patients’ preferred role in the process of treatment decision-making and the patients’ preference for information seeking (p

Wei Wen Chong,1,2 Parisa Aslani,1 Timothy F Chen1 1Faculty of Pharmacy, The University of Sydney, Sydney, NSW, Australia; 2Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia Background: Recent studies have shown that pharmacists have a role in addressing antidepressant nonadherence. However, few studies have explored community pharmacists' actual counseling practices in response to antidepressant adherence-related issues at various phases of treatment. The purpose of this study was to evaluate counseling practices of community pharmacists in response to antidepressant adherence-related issues. Methods: A simulated patient method was used to evaluate pharmacist counseling practices in Sydney, Australia. Twenty community pharmacists received three simulated patient visits concerning antidepressant adherence-related scenarios at different phases of treatment: 1) patient receiving a first-time antidepressant prescription and hesitant to begin treatment; 2) patient perceiving lack of treatment efficacy for antidepressant after starting treatment for 2 weeks; and 3) patient wanting to discontinue antidepressant treatment after 3 months due to perceived symptom improvement. The interactions were recorded and analyzed to evaluate the content of consultations in terms of information gathering, information provision including key educational messages, and treatment recommendations. Results: There was variability among community pharmacists in terms of the extent and content of information gathered and provided. In scenario 1, while some key educational messages such as possible side effects and expected benefits from antidepressants were mentioned frequently, others such as the recommended length of treatment and adherence-related messages were rarely addressed. In all scenarios, about two thirds of pharmacists explored patients' concerns about antidepressant treatment. In scenarios 2 and 3, only half of all pharmacists' consultations involved questions to assess the patient's medication use. The pharmacists' main recommendation in response to the patient query was to refer the patient back to the prescribing physician. Conclusion: The majority of pharmacists provided information about the risks and benefits of antidepressant treatment. However, there remains scope for improvement in community pharmacists' counseling practice for patients on antidepressant treatment, particularly in providing key educational messages including adherence-related messages, exploring patients' concerns, and monitoring medication adherence. Keywords: simulated patients, antidepressant medications, medication adherence, community pharmacist

Background: The high prevalence of noncommunicable diseases and the growing importance of social media have prompted health care professionals (HCPs) to use social media to deliver health information aimed at reducing lifestyle risk factors. Previous studies have acknowledged that the identification of elements that influence user engagement metrics could help HCPs in creating engaging posts toward effective health promotion on social media. Nevertheless, few studies have attempted to comprehensively identify a list of elements in social media posts that could influence user engagement metrics., Objective: This systematic review aimed to identify elements influencing user engagement metrics in social media posts by HCPs aimed to reduce lifestyle risk factors., Methods: Relevant studies in English, published between January 2006 and June 2023 were identified from MEDLINE or OVID, Scopus, Web of Science, and CINAHL databases. Included studies were those that examined social media posts by HCPs aimed at reducing the 4 key lifestyle risk factors. Additionally, the studies also outlined elements in social media posts that influenced user engagement metrics. The titles, abstracts, and full papers were screened and reviewed for eligibility. Following data extraction, narrative synthesis was performed. All investigated elements in the included studies were categorized. The elements in social media posts that influenced user engagement metrics were identified., Results: A total of 19 studies were included in this review. Investigated elements were grouped into 9 categories, with 35 elements found to influence user engagement. The 3 predominant categories of elements influencing user engagement were communication using supportive or emotive elements, communication aimed toward behavioral changes, and the appearance of posts. In contrast, the source of post content, social media platform, and timing of post had less than 3 studies with elements influencing user engagement., Conclusions: Findings demonstrated that supportive or emotive communication toward behavioral changes and post appearance could increase postlevel interactions, indicating a favorable response from the users toward posts made by HCPs. As social media continues to evolve, these elements should be constantly evaluated through further research., (©Yan Yee Yip, Mohd Makmor-Bakry, Wei Wen Chong. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 22.11.2024.)

Modern consumption patterns lead to massive waste, which poses challenges in storage and highlights the urgent need for more sustainable product development. Customer feedback on products plays a crucial role in product design, yet previous studies overlooked these invaluable insights. In response, this study introduces a novel systematic methodology that integrates the strengths of text mining, Quality Function Deployment (QFD), and the Theory of Inventive Problem Solving (TRIZ). Text mining techniques are utilized to extract customer requirements from online platforms, while QFD is used to translate these requirements into technical specifications. By integrating the contradiction matrix from TRIZ theory with the triptych, technical conflicts are resolved. The design process for next-generation smart glasses is employed as an illustrative case to validate the proposed integrated innovation design approach. Analytical outcomes suggest that the introduced methodology can effectively address sustainable product design challenges and sets the stage for future advancements in smart glasses., (© 2024. The Author(s).)

Background: Cardiovascular disease (CVD) is a leading cause of death and disability worldwide, imposing a significant burden on patients and healthcare systems. The role of pharmacists in reducing cardiovascular disease (CVD) is pivotal as they play an essential part in the healthcare team, particularly in medication management and patient education. Pharmacists are well-positioned to contribute to the prevention and control of CVD through various roles, including medication management and patient education. This study aims to investigate the current involvement of community pharmacists in Malaysia, specifically in cardiovascular diseases-related health promotion activities and dyslipidemia management, including their perceived barriers., Method: This cross-sectional survey was conducted among community pharmacists in all 14 states of Malaysia between November 2021 and July 2022. The self-administered survey was shared to relevant groups through various social media platforms., Results: A total of 312 community pharmacists were involved in the survey. Majority of the respondents were females (66%), with a mean age (SD) of 32.9 (8.4) years. Most of the respondents showed satisfactory practice for patient counselling, but improvements are needed particularly in risk assessment and collaborative care aspect. Most of them expressed their interest for dyslipidemia management training (89.4%). Lack of access to medical records (71.2%) and lack of CVD-related educational materials (70.8%) were the two main perceived barriers identified., Conclusion: Community pharmacists in Malaysia provide a satisfactory role in the provision of cardiovascular disease-related health promotion activities, especially in providing patient counselling. Strengthening collaborative care is essential for providing comprehensive and patient-centered intervention in dyslipidemia management. This requires ongoing efforts to address and overcome existing barriers for effective teamwork and coordination among healthcare professionals., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Ismail et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Effective communication that integrates the value of patient-centered care is important in healthcare encounters. Communication skills training (CST) has been indicated as effective in improving patient-centered communication behaviors. However, there is a paucity of studies on the impact of CST among Malaysian hospital pharmacists., Objective: This study aimed to evaluate the effects of a patient-centered CST program on patient-centered communication scores, communication self-efficacy, and attitudes toward concordance among pharmacists in public hospitals., Methods: A communication skills training (CST) program was conducted among hospital pharmacists. This training intervention was developed based on patient-centered communication frameworks and techniques, namely the Four Habits Model and motivational interviewing. A pre-test/post-test quasi-experimental design was implemented for the evaluation. Pharmacists underwent pre-test/post-test audiotaped simulated consultations and completed questionnaires, including the Revised United States-Leeds Attitudes Toward Concordance scale (RUS-LATCon) and Communication Self-Efficacy scale. The Four Habits Coding Scheme (FHCS) was used to evaluate patient-centered communication scores from the audiotapes, and the Wilcoxon signed-rank test was used to analyze for differences in the pre- and post-intervention scores., Results: A total of 38 pharmacists from four tertiary hospitals participated in this study and completed the pre-test. However, due to the impact of COVID-19, only 23 pharmacists completed the post-test data collection. Improvements were noted in the FHCS scores post-training, including items related to exploring patients' concerns, acceptability, and barriers to treatment. Based on the questionnaire, there was an improvement in recognizing patients' needs and potential medication uncertainty and an increase in the overall communication self-efficacy scores after the training., Conclusions: CST may help improve the adoption of patient-centered communication in pharmacists' consultations with patients., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Background/Introduction: The shelter-in-place orders and social distancing regulations on account of the COVID-19 pandemic have impacted lifestyles, including the use of cannabis. The purpose of this scoping review is to summarize both the gray and academic literature on the use of cannabis during the pandemic. Materials and Methods: A total of 11 databases, including 2 medical databases, 7 social science databases, and 2 gray literature databases were searched resulting in 316 titles and abstracts of which 76 met inclusion criteria. Results: Nine themes emerged: (a) prevalence and trends of cannabis use during COVID[1]19; (b) demographics; (c) profile of mode of consumption; (d) context of using cannabis (i.e., solitary use vs. in groups); (e) factors contributing to use; (f) factors inhibiting use; (g) adverse clinical and psychiatric outcomes of cannabis use during the pandemic; (h) similarities between EVALI (E-Cigarette or Vaping Product Use-Associated Lung Injury) and COVID-19 symptoms; (i) implications for policy and practice. Studies published until February 2, 2021 were included in this review. Discussion: Findings have highlighted that feelings of boredom, depression, and anxiety during the pandemic have contributed to an increase in the use of cannabis. Furthermore, accessibility to cannabis was noted to affect use during the pandemic. Adverse psychiatric and clinical outcomes were associated with the increased use of cannabis. Conclusion: Practitioners and policymakers are called to employ harm reduction strategies to respond to increasing cannabis use. There is a need for population-based studies and further examination of factors contributing to the increased use of cannabis during the pandemic and associated negative consequences.

Antimicrobial resistance has negatively impacted patient outcomes and increased healthcare costs. Antimicrobial stewardship (AMS) includes all activities and policies to promote the judicious use of antimicrobials. Pharmacists are key players in AMS models worldwide. However, there is a research gap in the role of pharmacists as antimicrobial stewards in Malaysia. This study aimed to explore hospital pharmacists' perspectives on their roles in, and barriers and facilitators to the implementation of AMS strategies. Individual, semi-structured interviews were conducted with 16 hospital pharmacists involved in AMS activities from 13 public hospitals in Kuala Lumpur and Selangor. Audio-taped interviews were transcribed verbatim and imported into NVivo software version 10.0 (QSR). A thematic analysis method was used to identify themes from the qualitative data until theme saturation was reached. Respondents perceived pharmacists as having important roles in the implementation of AMS strategies, in view of the multiple tasks they were entrusted with. They described their functions as antimicrobial advisors, antimicrobial guardians and liaison personnel. The lack of resources in terms of training, manpower and facilities, as well as attitudinal challenges, were some barriers identified by the respondents. Administrative support, commitment and perseverance were found to be facilitators to the role of pharmacists in AMS. In conclusion, pharmacists in public hospitals play important roles in AMS teams. This study has provided insights into the support that AMS pharmacists in public hospitals require to overcome the barriers they face and to enhance their roles in the implementation of AMS strategies.

Background: Patient-centred care (PCC) has been suggested to provide benefits such as improved patient-healthcare provider communication and better disease self-management to patients. The practice of PCC should involve all healthcare professionals, including pharmacists who are well-positioned in providing pharmaceutical care to patients. However, a better understanding of the factors that can affect the practice of PCC in pharmacists' consultations is needed., Objective: To explore the perceptions of Malaysian hospital pharmacists and patients on the barriers and facilitators of a PCC approach in pharmacist consultations., Design: This study employed a qualitative, explorative semi-structured interview design., Setting and Participants: Interviews were conducted with 17 patients and 18 pharmacists from three tertiary hospitals in Malaysia. The interviews were audiotaped and transcribed verbatim. Emerging themes were developed through a constant comparative approach and thematic analysis., Results: Three themes were identified in this study: (i) patient-related factors (knowledge, role expectations, and sociocultural characteristics), (ii) pharmacist-related factors (personalities and communication), and (iii) healthcare institutional and system-related factors (resources, continuity of care, and interprofessional collaboration). Pharmacists and patients mentioned that factors such as patients' knowledge and attitudes and pharmacists' personality traits and communication styles can affect patients' engagement in the consultation. Long waiting time and insufficient manpower were perceived as barriers to the practice of PCC. Continuity of care and interprofessional collaboration were viewed as crucial in providing supportive and tailored care to patients., Conclusion: The study findings outlined the potential factors of PCC that may influence its implementation in pharmacist consultations. Strategic approaches can be undertaken by policymakers, healthcare institutions, and pharmacists themselves to address the identified barriers to more fully support the implementation of PCC in the pharmacy setting., Competing Interests: The authors have declared that no competing interests exist.

Objective: To evaluate the impact of an educational training program on the knowledge, attitude and perceived barriers of community pharmacists (CPs) towards obesity and overweight management. Methods: This interventional study, which consisted of an educational training program, was conducted on a single cohort of Malaysian CPs. Thirty CPs attended the educational training program. The educational training program was delivered through didactic lectures, case studies and small group discussions, and consisted of various sessions covering different topics related to weight management. A validated questionnaire was used to assess the impact of the intervention on the CPs' knowledge, attitude, and perceived barriers. Results: The overall mean knowledge score increased both immediately after (14.93 ± 1.62) and 30 days following the intervention (17.04 ± 2.51), and the increment was statistically significant 30 days following the intervention ( p = 0.001) compared to both pre-intervention and immediate-post intervention stages. After the intervention, the participants had a more positive attitude towards the provision of weight management service (WMS) in community pharmacies. They had significantly stronger perceptions about the importance of their role to manage overweight and obesity and their professional competence to treat obese patients. In addition, the barrier of not having space in pharmacy to perform proper counselling for weight management and the barrier of not having training sessions in the area of obesity management were perceived to be significantly less important post-intervention. Conclusion: This study showed the potential positive impact of an educational training program on CPs knowledge, attitudes and perceived barriers towards WMS., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Verma, Chong, Taha and Paraidathathu.)

Objective: To qualitatively explore the perspectives of community pharmacists in Malaysia on their roles in weight management, and the barriers and facilitators in the expansion of these roles. Methods: A purposive sampling method was used to recruit community pharmacists in Klang Valley, Malaysia. Semi-structured individual interviews were conducted with community pharmacists, with an interview guide, from May 2018 to January 2019. The interviews were conducted in person (face-to-face). All interviews were audio-recorded with consent and transcribed verbatim. The interview transcripts were analyzed thematically, whereby emerging themes were coded and grouped into categories. Results: Twenty-four community pharmacists were recruited, with years of experience in pharmacy practice ranging from 2 to 40 years. Participants described their perceptions on the different weight management interventions where they emphasized the importance of a comprehensive lifestyle intervention and viewed that it should be the first-line intervention. Participants regarded their weight management service as easily accessible or approachable since community pharmacies are often the first point of call for patients seeking advice for their conditions before consulting doctors. Barriers identified by community pharmacists were mainly organizational in nature, which included lack of private consultation rooms, lack of time, and lack of qualified staff. Participants also described the need for training in weight management. Conclusion: Community pharmacists in Malaysia believed that they can positively contribute to the area of weight management. They cited multiple roles that they could play in weight management interventions and services. The roles cited include provision of education and advice, including on lifestyle modifications, drug therapy, weight loss products and supplements, and monitoring and providing referrals to other healthcare professionals. However, barriers would need to be addressed, including through pharmacist training, to strengthen and improve community pharmacists' roles and contributions in weight management service., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Verma, Chong, Taha and Paraidathathu.)

Non-communicable diseases (NCDs) are an increasing problem worldwide, including in Malaysia. National surveys have been performed by the government but had poor coverage in east Malaysia, particularly in rural regions. This study aimed to describe the achievement of target therapeutic outcomes in the control of diabetes mellitus (DM), hypertension (HPT), and dyslipidemia (DLP) among diabetic patients in rural east Malaysia. A cross-sectional study was conducted among DM patients who visited the NCDs clinic in Lundu Hospital, Sarawak, Malaysia, from Jan to March 2016. In total, 214 patients (male, 37.9%; female, 62.1%) were recruited using a systemic sampling method. Multiple logistic regression models were applied to estimate the adjusted odds ratio (AOR) and confidence interval (CI) for the target therapeutic achievement in the control of DM, HPT, and DLP. Compared to the national average, therapeutic target achievement in Lundu was higher for DM (43.0% vs. 23.8%), equal for DLP (35.8% vs. 37.8%) but lower for HPT (30.9% vs. 47.9%). DM patients who had at least yearly HbA1c monitoring (AOR 2.30, 95% CI 1.04-5.06, P = 0.039), and those 58.7 years or older (AOR 2.50, 95% CI 1.32-4.74, P = 0.005) were more likely to achieve the therapeutic target for DM. Health promotion and public education regarding HPT needs to be emphasized in rural Malaysia. HbA1c monitoring at least once a year was one of the important factors associated with achieving DM control in rural east Malaysia. Accessibility to HbA1c tests and monitoring should be ensured for diabetic patients.

Antibiotics are commonly prescribed among older adults, and inappropriate use of antibiotics has been noted. However, there is limited information about their knowledge and expectations for antibiotics. This study aimed to assess older adults' knowledge of antibiotic use and resistance, their expectations for antibiotics and the relationship between knowledge, expectation and inappropriate practices related to antibiotic use. A cross-sectional survey involving respondents aged 60 years and above was conducted, using a validated questionnaire. A lack of knowledge about the role of antibiotics was observed, whereby more than half of the respondents incorrectly believed that antibiotics can treat viral infections (53.5%) and colds and coughs (53.7%). Also, 67.9% of respondents incorrectly believed that antibiotic resistance occurs when the body becomes resistant to antibiotics. Almost half of the respondents would expect antibiotics for symptoms of self-limiting viral infections. Respondents who answered correctly for the role of antibiotics in viral infections were more likely not to expect antibiotics for cold, flu and cough ( p < 0.001). Respondents who answered correctly regarding the need to adhere to antibiotics were more likely to have completed their antibiotic course ( p < 0.001). Future educational initiatives should provide key information on the role of antibiotics and the importance of complying with antibiotics in this population.

In Malaysia, sharp increment in the prevalence of obesity over the last four decades has been documented. Community pharmacists (CPs) are strategically placed to tackle obesity by providing weight managements services (WMS) to general public. This study assessed the attitudes, practices and perceived barriers of Malaysian CPs to the provision of WMS. A cross-sectional, descriptive survey was conducted, and responses related to attitudes, practices and perceived barriers of CPs were collected using five-point Likert scale. A total of 550 pharmacists who worked across six states of Malaysia (Selangor, Federal Territory of Kuala Lumpur, Pulau Pinang, Johor, Sabah, and Melaka) participated in this study. Most of the CPs strongly agreed that over eating ( n = 312, 56.7%) and sedentary lifestyles ( n = 297, 54.0%) contribute to obesity and overweight. Most of them also strongly agreed that exercise training is an effective weight reduction strategy ( n = 285, 51.9%), but they were generally not in favor of surgery ( n = 231, 42% disagreed/strongly disagreed). CPs generally perceived barriers related to a lack of staff to provide WMS ( n = 308, 56.0% agreed/strongly agreed) and ethical and legal issues associated with sales of products/drugs for obesity management ( n = 285, 51.9% agreed/strongly agreed). Sociodemographic and practice characteristics such as age group, type of pharmacy, highest education qualification, and employment status of CPs influenced the attitudes, practices and perceived barriers associated with WMS. In terms of age, CPs who were aged less then 30 years expressed significantly stronger agreement that medication adherence is beneficial for weight loss compared to those CPs between 41-50 years. Additionally, CPs who were pharmacy owners provided significantly more frequent BMI measurement and patient information materials as part of their weight management practices compared to CPs who worked as a part timer/locum. This study could be taken as a baseline study on Malaysian CPs' perceptions on WMS.

Background: Obesity is now widely regarded as a main contributor to poor health. Involvement of community pharmacists can be a valuable tool in obesity management. However, there is still a lack of data in Malaysia on the potential involvement of and opportunities for community pharmacists in providing weight management services. Thus, it is essential to investigate the perceptions of the general public on weight management services in the community pharmacy setting. To evaluate the general public's perceptions on weight management services by community pharmacists in terms of perceived availability, utilization and factors influencing acceptability of services., Methods: A descriptive, cross sectional-survey was conducted using a self-administered questionnaire comprising of sections that focused on public preferences and options on weight management approaches, perceived availability of extended services and resources provided by community pharmacists in relation to weight management, utilization of these services and resources, and factors influencing acceptability of weight management services provided by community pharmacists. The questionnaires were distributed to the general public aged 18 years and above in Klang Valley, Malaysia., Results: A total of 730 respondents with a median age of 31 years participated in this study. Majority of respondents ranked dieticians as their preferred first line of consultation, with only about a quarter of respondents ranking community pharmacists as their preferred first or second line of consultation. Although more than half show of the study respondents perceived that community pharmacies they had visited offered services for measuring weight, height, blood pressure, blood glucose and blood cholesterol, fewer perceived that community pharmacies provided advice on physical activity and healthy eating to achieve weight loss. Additionally, majority of the respondents indicated that they had not utilized these services. However, most respondents perceived that community pharmacists should provide weight management services. The main factors influencing acceptability show of services included training of pharmacists, payment, waiting time and the issue of privacy., Conclusion: The findings of this study demonstrated that the majority of respondents were in support of weight management services in community pharmacy; however only a low percentage reported utilizing these services. Factors influencing acceptability of services included payment, waiting time and the issue of privacy. With adequate training among pharmacists and increased awareness of services among the public, community pharmacists could play a larger and important role in addressing the issue of obesity in Malaysia., Competing Interests: Ethical approval (approval no. NF-016-14) for this study was obtained from the Ethics Committee of the UKM Medical Centre, Cheras, Kuala Lumpur, Malaysia. Participation in the study was voluntary and no compensation was paid to the participants. Written consent were taken from the respondents. Confidentiality and anonymity was maintained.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Background: Shared decision-making (SDM) is an important component of patient-centred care. However, there is limited information on its implementation in Malaysia, particularly in chronic diseases such as hypertension., Objective: The objective of this study was to examine perceived involvement and role preferences of patients with hypertension in treatment decision-making., Methods: A cross-sectional survey was conducted among 210 patients with hypertension in a teaching hospital in Malaysia., Results: The majority of respondents agreed that their doctor recognized that a decision needs to be made (89.5%) and informed them that different options are available (77.1%). However, respondents' perceived level of involvement in other aspects of treatment decision-making process was low, including in the selection of treatment and in reaching an agreement with their doctor on how to proceed with treatment. In terms of preferred decision-making roles, 51.4% of respondents preferred a collaborative role with their physicians, 44.8% preferred a passive role while only 1.9% preferred an active role. Age and educational level were found to be significantly related to patient preferences for involvement in SDM. Younger patients (<60 years) and those with higher educational level preferred SDM over passive decision-making (ρ < 0.01). Encouragement from health care providers was perceived as a major motivating factor for SDM among patients with hypertension, with 91% of respondents agreeing that this would motivate their participation in SDM., Conclusion: Preferences for involvement in decision-making among patients with hypertension are varied, and influenced by age and educational level. Physicians have a key role in encouraging patients to participate in SDM., (© The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Chromosomal microarray (CMA) is currently the first-tier genetic test for patients with idiopathic neuropsychiatric diseases in many countries. Its improved diagnostic yield over karyotyping and other molecular testing facilitates the identification of the underlying causes of neuropsychiatric diseases. In this study, we applied oligonucleotide array comparative genomic hybridization as the molecular genetic test in a Chinese cohort of children with DD/ID, autism or MCA., Results: CMA identified 7 clinically significant microduplications and 17 microdeletions in 19.0% (20/105) patients, with size of aberrant regions ranging from 11 kb to 10.7 Mb. Fourteen of the pathogenic copy number variant (CNV) detected corresponded to well known microdeletion or microduplication syndromes. Four overlapped with critical regions of recently identified genomic syndromes. We also identified a rare de novo 2.3 Mb deletion at 8p21.3-21.2 as a pathogenic submicroscopic CNV. We also identified two novel CNVs, one at Xq28 and the other at 12q21.31-q21.33, in two patients (1.9%) with unclear clinical significance. Overall, the detection rate of CMA is comparable to figures previously reported for accurately detect submicroscopic chromosomal imbalances and pathogenic CNVs except mosaicism, balanced translocation and inversion., Conclusions: This study provided further evidence of an increased diagnostic yield of CMA and supported its use as a first line diagnostic tool for Chinese individuals with DD/ID, ASD, and MCA.

Copy number variants (CNVs) represent a substantial source of genomic variation in vertebrates and have been associated with numerous human diseases. Despite this, the extent of CNVs in the zebrafish, an important model for human disease, remains unknown. Using 80 zebrafish genomes, representing three commonly used laboratory strains and one native population, we constructed a genome-wide, high-resolution CNV map for the zebrafish comprising 6,080 CNV elements and encompassing 14.6% of the zebrafish reference genome. This amount of copy number variation is four times that previously observed in other vertebrates, including humans. Moreover, 69% of the CNV elements exhibited strain specificity, with the highest number observed for Tubingen. This variation likely arose, in part, from Tubingen's large founding size and composite population origin. Additional population genetic studies also provided important insight into the origins and substructure of these commonly used laboratory strains. This extensive variation among and within zebrafish strains may have functional effects that impact phenotype and, if not properly addressed, such extensive levels of germ-line variation and population substructure in this commonly used model organism can potentially confound studies intended for translation to human diseases.

Background: Targeting of the renin angiotensin system (RAS) reduces tumour growth in experimental models of cancer. We aimed to establish if combined targeting of the 'classical' and 'alternative' arms of the RAS could result in synergistic inhibition of colorectal cancer (CRC) liver metastases., Methods: Immediately following induction of CRC liver metastases through intrasplenic injection of murine CRC cells, treatment with irbesartan (AT1R blocker; 50 mg/kg/day s.c.), captopril (ACE inhibitor; 750 mg/kg/day i.p.), CGP42112A (AT2R agonist; 0.6 μg/kg/hr i.p.), and/or ANG-(1-7) (24 μg/kg/hr i.p.) began and continued for 21 days. Liver to body weight ratio and/or stereology were used as a measure of tumour burden. Immunohistochemistry was used to determine AT1R and VEGF expression as well as proliferation (Ki67), apoptosis (active caspase 3) and angiogenesis (CD34)., Results: Combined RAS therapies failed to improve upon single arm therapies. However, while irbesartan previously inhibited tumour growth in this model, in the current experiments irbesartan failed to affect tumour burden. Subsequent analysis showed a cancer-cell specific upregulation of the angiotensin II type I receptor (AT1R) in irbesartan-insensitive compared to irbesartan-sensitive tumours. The upregulation of AT1R was associated with an increase in proliferation and VEGF expression by cancer cells. While animals bearing irbesartan-sensitive tumours showed a marked decrease in the number of proliferating cells in the liver and VEGF-expressing infiltrating cells in the tumour following AT1R treatment, these were unchanged by treatment in animals bearing irbesartan-insensitive (high AT1R expressing) tumours., Conclusions: Although the results do not support increased efficacy of combined treatment, they provide intriguing evidence of the importance of RAS expression in determining patient response and tumour growth potential and suggest that components of the RAS could be used as biomarkers to aid in patient selection.

Cigarette smoke is one of the risk factors for gastric cancer and nicotine has been reported to promote tumor growth. Deregulation of microRNA (miRNA) and cyclooxygenase-2 (COX-2) expressions are hallmarks of many cancers including gastric cancer. Here, we used an miRNA array platform covering a panel of 95 human miRNAs to examine the expression profile in nicotine-treated gastric cancer cells. We found that miR-16 and miR-21 were upregulated upon nicotine stimulation, transfection with anti-miR-16 or anti-miR-21 significantly abrogated cell proliferation. In contrast, ectopic miR-16 or miR-21 expression exhibited a similar stimulatory effect on cell proliferation as nicotine. Nicotine-mediated IkappaBα degradation and nuclear factor-kappa B (NF-κB) translocation dose-dependently. Knockdown of NF-κB by short interfering RNA (siRNA) or specific inhibitor (Bay-11-7085) markedly suppressed nicotine-induced cell proliferation and upregulation of miR-16 and miR-21. Interestingly, NF-κB-binding sites were located in both miR-16 and miR-21 gene transcriptional elements and we showed that nicotine enhanced the binding of NF-κB to the promoters of miR-16 and miR-21. Furthermore, activation of COX-2/prostaglandin E₂ (PGE₂) signaling in response to nicotine was mediated by the action of prostaglandin E receptors (EP2 and EP4). EP2 or EP4 siRNA or antagonists impaired the nicotine-mediated NF-κB activity, upregulation of miR-16 and miR-21 and cell proliferation. Taken together, these results suggest that miR-16 and miR-21 are directly regulated by the transcription factor NF-κB and yet nicotine-promoted cell proliferation is mediated via EP2/4 receptors. Perhaps this study may shed light on the development of anticancer drugs to improve the chemosensitivity in smokers.

Background: Blockade of the angiotensin (ANG) II type 1 receptor (AT1R) inhibits tumour growth in several cancers, including colorectal cancer (CRC) liver metastases. While AT1R blockade has been extensively studied, the potential of targeting the antagonistically acting AT2R in cancer has not been investigated. This study examined the effect of AT2R activation with the agonist CGP42112A in a mouse model of CRC liver metastases., Results: In vitro, mouse CRC cell (MoCR) proliferation was inhibited by treatment with CGP42112A in a dose dependent manner while apoptosis was increased. Immunofluorescent staining for key signalling and secondary messengers, PLA2 and iNOS, were also increased by CGP42112A treatment in vitro. Immunohistochemical staining for proliferation (PCNA) and the apoptosis (active caspase 3) markers confirmed a CGP42112A-associated inhibition of proliferation and induction of apoptosis of mouse CRC cells (MoCR) in vivo. However, angiogenesis and vascular endothelial growth factor (VEGF) appeared to be increased by CGP42112A treatment in vivo. This increase in VEGF secretion by MoCRs was confirmed in vitro. Despite this apparent pro-angiogenic effect, a syngenic orthotopic mouse model of CRC liver metastases showed a reduction in liver to body weight ratio, an indication of tumour burden, following CGP42112A treatment compared to untreated controls., Conclusions: These results suggest that AT2R activation might provide a novel target to inhibit tumour growth. Its potential to stimulate angiogenesis could be compensated by combination with anti-angiogenic agents.

Cyclooxoygenase (COX)-2 overexpression is involved in gastric carcinogenesis. While high-salt intake is a known risk factor for gastric cancer development, we determined the effects of high salt on gastric chemical carcinogenesis in COX-2 transgenic (TG) mice. COX-2 TG mice were developed in C57/BL6 strain using the full-length human cox-2 complementary DNA construct. Six-week-old COX-2 TG and wild-type (WT) littermates were randomly allocated to receive alternate week of N-methyl-N-nitrosourea (MNU, 240 p.p.m.) in drinking water or control for 10 weeks. Two groups of mice were further treated with 10% NaCl during the initial 10 weeks. All mice were killed at the end of week 50. Both forced COX-2 overexpression and high-salt intake significantly increased the frequency of gastric cancer development in mice as compared with WT littermates treated with MNU alone. However, no additive effect was observed on the combination of high salt and COX-2 expression. We further showed that MNU and high-salt treatment increased chronic inflammatory infiltrates and induced prostaglandin E(2) (PGE(2)) production in the non-cancerous stomach. Whereas high-salt treatment markedly increased the expression of inflammatory cytokines (tumor necrosis factor-alpha, interferon-gamma, interleukin (IL)-1 beta and IL-6) in the gastric mucosa, COX-2 overexpression significantly altered the cell kinetics in the MNU-induced gastric cancer model. In conclusion, both high salt and COX-2 overexpression promote chemical-induced gastric carcinogenesis, possibly related to chronic inflammation, induction of PGE(2), disruption of cell kinetics and induction of inflammatory cytokines.