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Malaysia has experienced its most significant socio-economic setback since the outbreak of COVID-19. Amid this unprecedented health and humanitarian crisis, various stakeholders, including the government, businesses, and community members, generously provided livelihood assistance in various forms to help affected Malaysians, alleviating issues such as hunger, food insecurity, and cash flow constraints. However, the impact of these efforts would not have been as profound without the media's coverage. During the pandemic lockdown, over 80% of Malaysians turned to smartphones and online news to stay abreast of COVID-19 updates. Online news outlets evidently played a pivotal role in safeguarding livelihoods. Drawing upon crisis-response reporting and framing theory, this study examined COVID-19 response reporting in leading Malaysian online news portals. The researchers content analyzed a total of 860 news articles from 2020 through 2021. The findings indicate that these portals not only provided timely information on livelihood relief efforts but also vigorously advocated for more mature pandemic-response policies. Additionally, practical analyses were featured to inspire better-informed decision making during challenging times. However, several limitations were linked to the lack of more balanced and "softer" news coverage. The findings are poised to enrich the literature on little-explored crisis-response reporting. [ABSTRACT FROM AUTHOR]

Background: Connected devices that allow people with diabetes to monitor their blood glucose levels remotely with data visualization have been shown to improve self-care behavior in diabetes management. However, their effectiveness and usability for a low-middle-income, racially diverse population are unknown.Objective: This study aims to evaluate the effects of remote telemonitoring with team-based management on people with uncontrolled type 2 diabetes.Design: This was a pragmatic 52-week cluster-randomized controlled study among 11 primary care government practices in Malaysia.Participants: People with type 2 diabetes aged 18 and above, who had hemoglobin A1c ≥ 7.5% but less than 11.0% within the past 3 months and resided in the state of Selangor.Intervention: The intervention group received home gluco-telemonitors and transmitted glucose data to a care team who could adjust therapy accordingly. The team also facilitated self-management by supporting participants to improve medication adherence, and encourage healthier lifestyle and use of resources to reduce risk factors. Usual care group received routine healthcare service.Main Measure: The primary outcome was the change in HbA1c at 24 weeks and 52 weeks. Secondary outcomes included change in fasting plasma glucose, blood pressure, lipid levels, health-related quality of life, and diabetes self-efficacy.Results: A total of 240 participants were recruited in this study. The telemonitoring group reported larger improvements in glycemic control compared with control at the end of study (week 24, - 0.05%; 95% CI - 0.10 to 0.00%) and at follow-up (week 52, - 0.03%; - 0.07 to 0.02%, p = 0.226). Similarly, no differences in other secondary outcomes were observed, including the number of adverse events and health-related quality of life.Conclusion: This study indicates that there is limited benefit of replacing telemedicine with the current practice of self-monitoring of blood glucose. Further innovative methods to improve patient engagement in diabetes care are needed.Trial Registration: ClinicalTrials.gov identifier: NCT02466880. [ABSTRACT FROM AUTHOR]

Purpose: To determine the amount of waste produced from phacoemulsification surgeries and ways to curtail the problem. Setting: Miri Hospital, Sarawak, Malaysia. Design: Prospective study. Methods: Phacoemulsification surgery cases were included in this study; nonphacoemulsification surgeries were excluded. The waste was subdivided into 3 main categories, general waste, clinical waste, and sharps. The waste produced by ophthalmologists and trainees was accounted for separately. The mean weight of waste per case was obtained by dividing the total weight of waste produced with the total number of cases. Results: The total waste produced from a total of 203 cases of phacoemulsification surgeries was 167.965 kg, of which, 95.063 kg (56.6%) were clinical waste, 63.197 kg (37.6%) were general waste, and 9.705 kg (5.8%) were sharps; 32.193 kg (50.9%) out of the general waste pool were recyclable waste products. The mean waste production per case of phacoemulsification surgery for an ophthalmologist was 0.814 kg, 1.086 kg per case for a trainee. A case of phacoemulsification surgery would produce 0.282 kg of carbon dioxide equivalents in the setup based on the recyclable general waste. Conclusions: The average waste produced per case of phacoemulsification surgery in Miri Hospital was 0.827 kg. After excluding the recyclable material, the average waste produced per case was 0.669 kg. Following the 3 R's principles (reduce, reuse, and recycle) in the handling of waste production might reduce environmental impact. [ABSTRACT FROM AUTHOR]

Introduction: Untreated iron deficiency (ID) can lead to severe anaemia, requiring blood transfusion, or increased mortality risk. Globally intravenous (IV) iron is increasingly recognised as a recommended option for patients. This study aims to evaluate the budget impact associated with introducing a new intravenous (IV) iron, ferric derisomaltose (Monofer® [IIM]) as one of the treatment options for the management of ID in the Ministry of Health Malaysia (MOHM) setting. Methods: A 5-year budget impact model was developed from 2020 to 2024 for patients with ID that require a high iron dose (≥500 mg), using the perspective of MOHM. The model was built with four external medical specialists, each with experience and deep knowledge of ID management, to support estimations on the future development of iron use in Malaysia. Results: Compared to the current market mix with the existing IV iron products (i.e., iron sucrose and iron dextran), a cost-saving of MYR 53,910 could be achieved with the introduction of IIM in 2020. The uptake of IIM into MOHM over five years is estimated to lead to an overall budget saving of MYR 11,837,524 over a 5-year time horizon. Conclusion: The use of IIM in place of the current IV iron products in MOHM resulted in a significant cost saving by reducing the number of visits required to achieve the targeted iron dose and the shorter IV infusion time with IIM. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to examine the validity of EQ-5D-5L among HFrEF patients in Malaysia, and to explore the measurement equivalence of three main language versions., Methods: We surveyed HFrEF patients from two hospitals in Malaysia, using Malay, English or Chinese versions of EQ-5D-5L. EQ-5D-5L dimensional scores were converted to utility scores using the Malaysian value set. A confirmatory factor analysis longitudinal model was constructed. The utility and visual analog scale (VAS) scores were evaluated for validity (convergent, known-group, responsiveness), and measurement equivalence of the three language versions., Results: 200 HFrEF patients (mean age = 61 years), predominantly male (74%) of Malay ethnicity (55%), completed the admission and discharge EQ-5D-5L questionnaire in Malay (49%), English (26%) or Chinese (25%) languages. 173 patients (86.5%) were followed up at 1-month post-discharge (1MPD). The standardized factor loadings and average variance extracted were ≥ 0.5 while composite reliability was ≥ 0.7, suggesting convergent validity. Patients with older age and higher New York Heart Association (NYHA) class reported significantly lower utility and VAS scores. The change in utility and VAS scores between admission and discharge was large, while the change between discharge and 1MPD was minimal. The minimal clinically important difference for utility and VAS scores was ±0.19 and ±11.01, respectively. Malay and English questionnaire were equivalent while the equivalence of Malay and Chinese questionnaire was inconclusive., Limitation: This study only sampled HFrEF patients from two teaching hospitals, thus limiting the generalizability of results to the entire heart failure population., Conclusion: EQ-5D-5L is a valid questionnaire to measure health-related quality of life and estimate utility values among HFrEF patients in Malaysia. The Malay and English versions of EQ-5D-5L appear equivalent for clinical and economic assessments.

Objectives: The healthcare system aspires to ensure improved access to treatment while working within the existing financial constraints and increasing demands. Patient access schemes (PASs) are initiated to improve access. This study seeks the stakeholders' views on the PAS in the public healthcare sector in Malaysia., Methods: This is an exploratory qualitative study using a web-based online survey and semistructured interviews. The participants were recruited by purposive sampling, where the Ministry of Health of Malaysia staff, pharmaceutical organization personnel, and patient advocacy organization personnel with experience in PAS were invited to participate. A total of 42 consenting participants answered the survey, whereas the face-to-face interview had 8 participants. Interviews were thematically analyzed using the qualitative data analysis software NVivo V.12. The Medical Research and Ethics Committee, Ministry of Health of Malaysia, approved the study., Results: Only finance-based PAS was reportedly implemented, and it covered drugs for antineoplastic or immunomodulating therapy, alimentary tract and metabolism, sensory organs, and systemic hormonal preparations. A total of 3 major themes were identified. High upfront cost and high budget impact are a major concern leading to the need for PAS. Identifying the treatment needs was a major concern as well. The readiness of the health system to implement PAS will determine whether the PAS can be successfully implemented. Challenges similar to other jurisdictions were observed in Malaysia, concerns on data availability, the responsibility of the stakeholders, and the need for a legal framework., Conclusion: Most stakeholders responded positively that the PAS would grow. Trust among stakeholders and a structured access plan would enhance the implementation and ensure its success., (Copyright © 2022 International Society for Health Economics and Outcomes Research. Published by Elsevier Inc. All rights reserved.)

Purpose: To report the predisposing factors, microorganisms, antibiotic sensitivity associated with bacterial keratitis, and treatment outcomes in Miri, Borneo which has a tropical climate., Methods: This is a retrospective study on patients presenting with microbial keratitis in Miri, Sarawak, Borneo over a 7-year period from January 1, 2010 until December 31, 2016. Demographic data, predisposing factors, culture and sensitivity results together with treatment outcomes were studied., Results: There were a total of 221 cases treated as microbial keratitis with a peak age group of 21 to 30 years. The predisposing factors were trauma (49.3%), improper contact lens usage (29.1%), ocular surface diseases (5.9%), ocular surgeries (0.9%), drugs (1.8%), and other factors (19.0%). Occupational injuries among oil palm plantation workers was the leading cause within the trauma cohort (28.8%). Corneal scraping was performed in 189 cases, 61.4% of them yielded positive cultures. The cultures demonstrated that 49.1% were of bacterial origin, 46.6% were fungal, and 4.3% showed mixed growth. The most common bacteria isolated was Pseudomonas aeruginosa, which was sensitive toward ceftazidime and gentamicin antibiotics. One hundred ninety-two cases (86.9%) were treated with purely topical medication, whereas 29 cases (13.1%) required further interventions., Conclusion: The commonest predisposing factor for microbial keratitis was trauma. With the nearby oil palm industries, we report a corresponding increase of incidence in fungal keratitis at our center. Culture and sensitivity reports from corneal scrapings are essential in treatment guidance; however, more than a third of the microbial keratitis cases studied were culture-negative. The organisms cultured reflect the profile expected in tropical climates. Fortunately, there was no increase in resistance rates observed for the commonly used antibiotics.

Purpose: The purpose of this paper is to review the findings from an audit of the implementation of a consultation-liaison psychiatry (CLiP) database in all inpatients referred to a CLiP service at the largest hospital in Malaysia with the aim of improving the quality CLiP services., Design/methodology/approach: All inpatient referrals to the CLiP team were recorded over a three-month period and compared to previous audit data from 2017. Four audit standards were assessed: the reporting of referrals, timeliness of response indication of reason for referral and presence of a management plan., Findings: The compliance of reporting using the CLiP form was 70.1 per cent compared to 28 per cent in the audit data from 2017 after interventions were conducted. Analysis of the completed CLiP form reveals that 89 per cent of referrals were seen within the same working day. All referrals included the reason for referral. The most common reason for referral was for depressive disorders, but post-assessment, delirium was the most common diagnosis. In total, 87.8 per cent satisfied the audit criteria for a completed written care plan., Originality/value: Specialised CLiP services are relatively new in Malaysia and this is the first paper to examine the quality of such services in the country. Interventions were effective in improving the compliance of reporting using the CLiP database. The findings suggest that the CLiP services are on par with international audit standards. Furthermore, data from this clinical audit can serve as a benchmark for the development of national operating policies in similar settings., (© Emerald Publishing Limited.)

Objective: Telemedicine has been promoted as an economical and effective way to enhance patient care, but its acceptance among patients in low-income and middle-income countries is poorly understood. This study is aimed to explore the experiences and perspectives of people with type 2 diabetes mellitus that used telemedicine to manage their condition., Design: In-depth and focus group interviews were conducted with participants who have engaged in telemedicine. Questions included were participants' perception on the programme being used, satisfaction as well as engagement with the telemedicine programme. All interviews and focus groups were audio-recorded and transcribed verbatim. Data were analysed using a thematic approach., Participants and Setting: People with type 2 diabetes (n=48) who participated in a randomised controlled study which examined the use of telemedicine for diabetes management were recruited from 11 primary care clinics located within the Klang Valley., Results: Twelve focus groups and two in-depth interviews were conducted. Four themes emerged from the analysis: (1) generational difference; (2) independence and convenience, (3) sharing of health data and privacy and (4) concerns and challenges. The main obstacles found in patients using the telemedicine systems were related to internet connectivity and difficulties experienced with system interface. Cost was also another significant concern raised by participants. Participants in this study were primarily positive about the benefits of telemedicine, including its ability to provide real-time data and disease monitoring and the reduction in clinic visits., Conclusion: Despite the potential benefits of telemedicine in the long-term care of diabetes, there are several perceived barriers that may limit the effectiveness of this technology. As such, collaboration between educators, healthcare providers, telecommunication service providers and patients are required to stimulate the adoption and the use of telemedicine.NCT0246680., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)