Search

Objectives This study aims to examine and develop a better understanding of (1) the factors that affect the stress of both their professional and personal lives, (2) the aspects of professional and personal life that affect their satisfaction and fulfilment and (3) what they need to achieve satisfaction and fulfilment in their professional and personal lives. Methods A cross-sectional study using a questionnaire was developed. The questionnaire contained 8 questions designed to collect qualitative data on the factors affecting the stress, satisfaction and fulfilment in the professional and personal lives of early career pharmacists (ECPs). Questionnaire responses were analysed using a qualitative content analysis approach and themes describing influential factors were developed. Key findings Some of the factors that contribute to the stress, satisfaction and fulfilment of ECPs were identified. The stressors identified include the workplace environment and relationships with colleagues, the demands of a pharmacist career, the lack of career advancement pathways, job insecurity, relationships and their weaknesses. Factors contributing to satisfaction and fulfilment included supportive work environments and relationships, being appreciated and making a difference, growth, supportive relationships and self-care. Conclusions Supporting the well-being of ECPs is important for a resilient, engaged and effective pharmacy workforce. Key interventions include eliminating job insecurity, establishing clear career pathways, improving work environments and relationships and investing in the development of clinical, technical, communication and managerial skills.

Purpose Due to the high burden of cancer-related suffering, it is paramount to understand the gaps in cancer care that lead to suffering. Advanced cancer patients have unmet needs and challenges that differ from those with early-stage cancer due to the rapid disease progression. By exploring advanced cancer patients' lived experiences and needs from the physical, psychological, social, and spiritual aspects, this study aims to identify gaps in the Malaysian health system and propose contextualised measures to improve cancer care. Methods Semi-structured, in-depth interviews were conducted to explore advanced cancer patients' lived experiences and needs from the physical, psychological, social, and spiritual aspects. The interviews were then transcribed and coded. Themes were developed from the codes using iterative thematic approach. Results The lived experiences and needs of nineteen patients converged into four major themes: disruption to daily lives, psychosocial and spiritual support system, information needs, and financial needs. This study described predominantly how cancer impacted patients’ lives and livelihood, how patients coped with their psychological conditions after diagnosis, the need for effective communication and trust in a multicultural society, and how finance affected access to and experience of cancer care. Conclusion Advanced cancer patients had different needs beyond receiving medical treatments. A concerted effort is required from clinicians, allied health professionals, social workers, support groups, and family members to understand and fulfil these needs.

Approximately 69 million people worldwide are annually affected by traumatic brain injury (TBI). In Malaysia, the traumatic injury was the leading cause of hospital admission and death, accounting for one in three emergency visits. Among the most recognised complication of TBI is post-traumatic epilepsy (PTE), which is an essential contributor to morbidity and mortality. However, there is a lack of local epidemiological data on PTE in Malaysia. This study aims to describe the incidence and predictors of PTE among TBI patients admitted to a tertiary healthcare centre in Kuala Lumpur, Malaysia. We hypothesised that increases in age, race, and severity of brain injury are among the main potential predictors of PTE. It will also provide evidence that patients with epilepsy following TBI are associated with significant impairment in cognitive performance than TBI patients without epilepsy. An analysis of a two years retrospective cohort will be employed, of which adults with a history of admission for TBI in 2019 and 2020 will be contacted, and the development of epilepsy will be ascertained using a validated tool and confirmed by our neurologists during visits. The patients will then be grouped into two, with PTE and without PTE, and assessed their cognitive performance by clinical psychologists. Given that the management of TBI and PTE patients involves a multidisciplinary team, the findings might be significant to many healthcare providers in determining policy and strategise a better treatment.

Background: Governments have an obligation to provide palliative care as a part of achieving Universal Health Coverage. This obligation to provide palliative care has grown significantly due to the immense suffering caused by the COVID-19 pandemic to patients and their carers. The successful delivery of palliative care, however, requires a healthcare workforce that is trained to provide palliative care at all levels. It is especially important to be able to train healthcare workers in basic-level palliative care to expand the health system’s capacity to provide palliative care. Objectives: The aim of this study is to evaluate the effectiveness of this training programme on the participants’ interest and knowledge in palliative care, and their preparedness to deliver basic-level palliative care. Methods: We developed a novel training programme for basic palliative care using didactic and participatory learning methods, along with a mentoring system. The programme was delivered over 6 months. 38 physicians were trained. A survey to evaluate the participants’ interest and knowledge of palliative care, as well as their preparedness to provide palliative care was conducted at 3 timepoints–pre-training, post-training, and 3 months post-training. Results: Improvements in the interest (4.05 vs 4.24, p

Background People with Parkinson’s are at higher risk of healthcare and pharmaceutical care issues. Objective To determine the healthcare challenges, pharmaceutical care needs, and perceived need of a pharmacist-run clinic by people with Parkinson’s and their caregivers. Setting Malaysian Parkinson’s Disease Association. Method A focus group discussion adopting a descriptive qualitative approach was conducted involving people with Parkinson’s and their caregivers. A semi-structured interview guide was used to determine the challenges they faced with their medications and healthcare system, their pharmaceutical care needs, and their views on a pharmacist-run clinic. Data was thematically analysed. Main outcome measure: Healthcare challenges faced by people with Parkinson’s and caregivers along with their pharmaceutical care needs and perceived need of a pharmacist-run clinic. Results Nine people with Parkinson’s and four caregivers participated. Six themes were developed: (1) “It’s very personalised”: the need for self-experimentation, (2) “Managing it is quite difficult”: challenges with medication, (3) “The doctor has no time for you”: challenges with healthcare providers, (4) “Nobody can do it except me”: challenges faced by caregivers, (5) “It becomes a burden”: impact on quality of life, and (6) “Lack of consistency could be counterproductive”: views on pharmacist-run clinic. Conclusion The provision of pharmaceutical care services by pharmacists could help overcome issues people with Parkinson’s face, however there is a need for them to first see pharmacists in their expanded roles and change their limited perception of pharmacists. This can be achieved through integration of pharmacists within multidisciplinary teams in specialist clinics which they frequent.

The prevalence of pre-diabetes is increasing globally, affecting an estimated 552 million people by 2030. While lifestyle interventions are the first line of defense against progression toward diabetes, information on barriers toward pre-diabetes management and how to overcome these barriers are scarce. This systematic review describes the publics’ and healthcare professionals’ knowledge, attitude and practice (KAP) toward pre-diabetes and determines the barriers toward pre-diabetes management. A systematic search for studies examining KAP towards pre-diabetes was conducted in six databases from inception to September 2022. Studies that quantitatively assessed at least two KAP elements using questionnaires were included. The quality of studies was assessed using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Barriers and enablers were identified and mapped onto the Capability, Motivation, and Behaviour model to identify factors that influence behavior change. Twenty-one articles that surveyed 8876 participants were included in this review. Most of the reviews (n=13) were directed to healthcare professionals. Overall, positive attitudes toward diabetes prevention efforts were observed, although there were still knowledge deficits and poor behavior toward pre-diabetes management. Barriers and enablers were detected at patients (eg, goals and intention), healthcare professionals (eg, clinical judgement) and system (eg, access and resources) levels. The use of different survey instruments to assess KAP prevented a head-to-head comparison between studies. Most studies conducted among patients were from middle-income countries, while among healthcare professionals (HCPs) were from high-income countries, which may produce some biasness. Nevertheless, the development of pre-diabetes intervention should focus on: (1) increasing knowledge on pre-diabetes and its management; (2) imparting practical skills to manage pre-diabetes; (3) providing resources for lifestyle management; (4) improving the accessibility of lifestyle management programs; and (5) other HCPs and human support to pre-diabetes management.

Background Despite the global consensus on the importance of palliative care for patients with multiple sclerosis (MS), many patients in developing countries do not receive palliative care. Improving access to palliative care for MS requires a contextual understanding of how palliative care is perceived by patients and health professionals, the existing care pathways, and barriers to the provision of palliative care. Objective This study aims to examine and contrast the perceptions of MS patients, neurologists, and palliative care physicians towards providing palliative care for patients with MS in Malaysia. Methods 12 MS patients, 5 neurologists, and 5 palliative care physicians participated in this qualitative study. Each participant took part in a semi-structured interview. The interviews were transcribed verbatim, and analysed using an iterative thematic analysis approach. Results Patients and neurologists mostly associated palliative care with the end-of-life and struggled to understand the need for palliative care in MS. Another barrier was the lack of understanding about the palliative care needs of MS patients. Palliative care physicians also identified the scarcity of resources and their lack of experience with MS as barriers. The current referral-based care pathway itself was found to be a barrier to the provision of palliative care. Conclusions MS patients in Malaysia face several barriers in accessing palliative care. Overcoming these barriers will require improving the shared understanding of palliative care and its role in MS. The existing care pathway also needs to be reformed to ensure that it improves access to palliative care for MS patients.

Background Understanding patient preferences in cancer management is essential for shared decision-making. Patient or societal willingness-to-pay (WTP) for desired outcomes in cancer management represents their preferences and values of these outcomes. Objective The aim of this systematic review is to critically evaluate how current literature has addressed WTP in relation to cancer treatment and achievement of outcomes. Methods Seven databases were searched from inception until 2 March 2021 to include studies with primary data of WTP values for cancer treatments or achievement of outcomes that were elicited using stated preference methods. Results Fifty-four studies were included in this review. All studies were published after year 2000 and more than 90% of the studies were conducted in high-income countries. Sample size of the studies ranged from 35 to 2040, with patient being the most studied population. There was a near even distribution between studies using contingent valuation and discrete choice experiment. Based on the included studies, the highest WTP values were for a quality-adjusted life year (QALY) ($11,498-$589,822), followed by 1-year survival ($3-$198,576), quality of life (QoL) improvement ($5531-$139,499), and pain reduction ($79-$94,662). Current empirical evidence suggested that improvement in QoL and pain reduction had comparable weights to survival in cancer management. Conclusion This systematic review provides a summary on stated preference studies that elicited patient preferences via WTP and summarised their respective values. Respondents in this review had comparable WTP for 1-year survival and QoL, suggesting that improvement in QoL should be emphasised together with survival in cancer management.

BACKGROUND Prediabetes, where an individual’s glycaemic variables are significantly higher than normal but lower than the threshold for diabetes, is a major health problem. People with prediabetes experience a higher risk of developing chronic kidney disease, neuropathy, diabetic retinopathy, cardiac events, and stroke. The implementation of lifestyle-changing interventions or programs designed to monitor and adjust a prediabetic person’s lifestyle, daily activities, and diet has been demonstrated to substantially reduce the risk of developing diabetes.[4] Implementing these interventions, however, is not without its challenges. One way to overcome these challenges would be the use of distal technologies such as telehealth, mobile health, game‐based support, social platforms, patient portals, as well as wearable devices. To the best of our knowledge, no reviews have attempted to summarise the published research related to the use of distal technologies for the prevention of diabetes. OBJECTIVE The aim of this systematic review is to critically appraise studies where distal technologies have been applied in a prediabetic population. The systematic review also aimed to synthesize the evidence to determine the effectiveness of lifestyle interventions utilizing distal technologies in people with prediabetes. METHODS The systematic review was conducted on articles from database inception till 31st December 2020 within the PubMed/MEDLINE, EMBASE, SCOPUS, and The Cochrane Library databases. The databases were searched for published articles describing the use of distal technologies in prediabetes. The search terms related to digital health and prediabetes were used. The reference lists of included articles were also reviewed to identify any relevant articles that may have been missed. This study was registered with PROSPERO: CRD42020188051. Articles which met the following inclusion criteria were included: 1) the study included prediabetic individuals, 2) was a randomised controlled trial, 3) the intervention included the use of any distal technology, and 4) published in peer-reviewed journals. RESULTS The initial search identified a total of 364 articles. After the removal of duplicates and ineligible articles, 29 articles were selected for inclusion in this review. Meta-analysis of 15 of the studies showed that distal technologies was effective in reducing participants’ body weight by 1.24 kg [95% CI: -1.92, -0.56], their BMIs (MD: -0.64; -0.93 to -0.35) and waist circumference (MD: -1.27; -2.22 to -0.32), when compared to usual care/control. HbA1c levels were lowered marginally by 0.05% (95% CI: -0.09% to -0.02%) in the intervention group compared to the control group. However, distal technologies had limited impact on FPG (-0.11 mmol/l; -0.25 to 0.02), total cholesterol (-0.06 mmol/l; 95% CI: -0.14 to 0.03), low density lipoprotein (-0.04; -0.09 to 0.02), high density lipoprotein (0.03; -0.01 to 0.07) and triglyceride levels (-0.05; -0.13 to 0.02) compared to control group. CONCLUSIONS The evidence reviewed suggests that lifestyle interventions incorporating distal technologies can be effective in helping prediabetics reduce their body weight, body mass index, waist circumference, and blood glucose. The effectiveness of these interventions in improving lipid profile, blood pressure, and quality of life remains unclear. While the results are encouraging, more work is required to improve the evaluation and implementation of these complex interventions.

Background One of the major challenges worldwide is the stigma associated with dementia. There is limited dementia awareness within Malaysian communities, including levels of confusion regarding the differences between dementia and the usual ageing progress, which can lead to delays in support seeking. The need for additional training and education for healthcare professionals has been highlighted. The present study aimed to evaluate the benefits of a one-hour dementia education session (Dementia Detectives workshop) for pharmacy and medicine undergraduate students at a Malaysian university. Methods Participants attended the workshop and completed pre- (Time 1) and post-workshop (Time 2) questionnaires consisting of validated measures exploring attitudes towards dementia and older people more broadly. Results A total of 97 students were recruited. Attitudes towards people with dementia showed significant positive changes between Time 1 and Time 2, whereas no differences were found for attitudes towards older people. Conclusions As medical and pharmacy students develop theoretical knowledge, practical skills and professional attitudes during their undergraduate studies, it is important for students to also learn about the humanistic side of diseases and conditions through workshops such as the one presented here. Further research should now be conducted to consider how Dementia Detectives can be delivered to non-healthcare students and what the barriers and facilitators to wider delivery are.

Multiple sclerosis is an incurable, degenerative disease that causes patients to suffer from physical and psychological suffering. Patients with multiple sclerosis often suffer as much from their symptoms as patients with cancer. Despite that, patients with multiple sclerosis in Malaysia often do not receive palliative care that could help them relieve their suffering and improve their quality of life. This thesis identified some of the factors preventing patients with multiple sclerosis in Malaysia from receiving palliative care. This includes the lack of awareness of multiple sclerosis in general and the needs of its patients, the lack of understanding of palliative care, and a healthcare model that makes it easy to deny rather than to provide palliative care to patients.

BACKGROUND The needs of patients with multiple sclerosis have been well-studied in high-income, high-prevalence countries but few studies have been based in low- and middle-income countries where resources are relatively scarce. As such, little is known about the needs of patients living in these countries. OBJECTIVE The study seeks to develop an understanding of the needs of patients with multiple sclerosis living in Malaysia in order to generate insights and contribute to a global database of patients' experience. METHOD 12 patients with multiple sclerosis participated in this qualitative study and took part in a semi-structured interview. The interviews were transcribed and analysed using an iterative thematic analysis approach. RESULTS The experiences, challenges and needs of the patients were reported. Five themes were developed (Daily living, Financial, Emotional and psychological, Healthcare, and Family). These predominantly revolved around the struggles of coping and adapting to the symptoms and disabilities imposed by multiple sclerosis, their heavy reliance on personal finances to cope with the increased costs of living for themselves and their families, as well as the limited healthcare services and treatments available to help them to manage the physical and emotional symptoms of multiple sclerosis. CONCLUSION Patients with multiple sclerosis in Malaysia have complex needs that are neglected due perceived lack of importance of the disease and the poor understanding of multiple sclerosis in general. Patients rely heavily on their finances to improve their quality of life. This perpetuates health inequities and reform of the national health financing system is needed to provide patients with the healthcare and support they need.Implications for rehabilitationPatients with multiple sclerosis in Malaysia prioritize being able to cope and adapt to their disabilities in order to continue performing their activities of daily living.There is a need to increase the availability and accessibility of healthcare professionals that are experienced with the management of multiple sclerosis.Healthcare professionals need to improve their understanding of the patients' needs and what they consider to be important in order to provide therapy that is effective and relevant.Patients also require financial support to help them with the increased costs of living associated with MS as well as the costs of healthcare services such as physiotherapy and rehabilitation.

Background: The state of palliative care research is closely linked to the development of palliative care services in a country or region. Objective: To systematically review the current s...

Background: Multiple sclerosis is thought to be relatively uncommon in the Asia Pacific region with prevalence estimated between 0 and 20 per 100,000. There is reason to doubt these estimates due to the lack of data from many countries and the growing evidence of variability in prevalence across small geographic areas. This study was conducted to systematically review the population prevalence, incidence, mortality and disability progression estimates of MS within the Asia Pacific region. Methods: The systematic review was conducted on articles from 1985 till 31st July 2017 within the PubMed/MEDLINE, EMBASE, SCOPUS, and The Cochrane Library databases. The review included articles that were population-based studies conducted on patients with MS in the Asia Pacific region that reported either incidence, prevalence, mortality, or disease progression. Hospital-based studies and non-research articles were excluded to ensure that only information representative of the population was included for analysis. Data appraisal and extraction was done by independent reviewers. This review was registered with PROSPERO (ID: CRD42017082760). Findings: Of the 2,757 articles found, 16 studies were included. Information on 6 (18.75%) of 32 Asia Pacific countries was found, with data representing 8% of the total population. Prevalence estimates were available for 6 countries while estimates for incidence (3 countries), mortality (4 countries), and disease progression (2 countries) were limited. Interpretation: The lack of epidemiological data available in the Asia Pacific region creates a blind spot in the surveillance of MS which obscures the true burden of MS, causing patients to struggle to receive the resources and funding that they need.

Approximately 69 million people worldwide are annually affected by traumatic brain injury (TBI). In Malaysia, the traumatic injury was the leading cause of hospital admission and death, accounting for one in three emergency visits. Among the most recognised complication of TBI is post-traumatic epilepsy (PTE), which is an essential contributor to morbidity and mortality. However, there is a lack of local epidemiological data on PTE in Malaysia. This study aims to describe the incidence and predictors of PTE among TBI patients admitted to a tertiary healthcare centre in Kuala Lumpur, Malaysia. We hypothesised that increases in age, race, and severity of brain injury are among the main potential predictors of PTE. It will also provide evidence that patients with epilepsy following TBI are associated with significant impairment in cognitive performance than TBI patients without epilepsy. An analysis of a two years retrospective cohort will be employed, of which adults with a history of admission for TBI in 2019 and 2020 will be contacted, and the development of epilepsy will be ascertained using a validated tool and confirmed by our neurologists during visits. The patients will then be grouped into two, with PTE and without PTE, and assessed their cognitive performance by clinical psychologists. Given that the management of TBI and PTE patients involves a multidisciplinary team, the findings might be significant to many healthcare providers in determining policy and strategise a better treatment.