The survival rate was lower as the stages increased, with the late stages were mostly seen among the Malays (46%), followed by Chinese (36%) and Indians (34%). Size of tumor>3.0cm; lymph node involvement, ERPR, and HER 2 status, delayed presentation and involvement of both breasts were among other factors that were associated with poor survival. Conclusions: The overall survival rate of Malaysian women with breast cancer was lower than the western figures with Malays having the lowest because they presented at late stage, after a long duration of symptoms, had larger tumor size, and had more lymph nodes affected. There is an urgent need to conduct studies on why there is delay in diagnosis and treatment of breast cancer women in Malaysia.

Drug therapies in the management of chronic kidney disease (CKD) are complex and specialised and have a high potential for drug-related problem (DRP). In adult CKD populations, the identification and resolution of DRP has been shown to have beneficial effects on disease management, adherence and knowledge of treatment, patient's quality of life, hospitalisation rate and length of stay and cost to the healthcare system. The focus of this article is the review of published studies on DRP in children with CKD. There is a lack of information on the epidemiology of DRP in this patient group, and research in this area is therefore needed to better understand and manage DRP in children with CKD.

BackgroundMedication-related problems (MRPs) are the undesirable effects of pharmacotherapy that can potentially lead to harm. The epidemiology of MRPs in paediatric renal patients is unknown. We aimed to characterise MRPs in this population at two tertiary care hospitals in the UK.MethodsPrescription charts for children (≤18 years) were reviewed to identify MRPs, and characterised using a specific proforma with a standard operational definition. MRP predictors were evaluated by logistic regression and severity was assessed using a validated scale.ResultsTwo hundred and sixty-seven MRPs were identified from 266 prescription chart reviews. The incidence was 51.2 % (203 MRPs, 166 charts; 95 % CI 43.2–60.6 %) of hospitalised patients and 32 % (64 MRPs, 100 charts; 95 % CI 22.9–41.1 %) in outpatients. The number of prescribed medications was the only independent predictor during inpatient treatment (OR 1.06, 95 % CI 1.02–1.10, p = 0.002) with no significant predictors identified at outpatient clinics. The severity level of the MRPs was minor: 53.9 %, (144 out of 267); or moderate: 46.1 %, (123 out of 267). Sub-optimal drug effect was the predominant MRP (inpatient: 68 %; outpatient: 39 %). Prescribing error and patients' medicine-taking behaviour were the main contributory factors. The majority of the MRPs in the inpatient setting were resolved.ConclusionMany factors are associated with MRPs in children; the associations are cumulative and interdependent. Investment in preventive strategies and extending the support from the acute health care setting into the community are invaluable for optimising pharmacotherapy.

Aims: This study aims to identify differences in outcomes of assessing overall versus individual adherence and factors associated with adherence to medication therapy in chronic kidney disease patients. Study Design:  This is a cross-sectional study. Place and Duration of Study: Nephrology Clinic, Universiti Kebangsaan Malaysia Medical Centre and Ministry of Health Hospitals between June 2018 and June 2019. Methodology: We included 491 patients (243 men, 248 women); average age of 54.5 (±14.6) years with chronic kidney disease and prescribed at least one medication, using a validated questionnaire. Results: Patients were prescribed an average of 7.0±2.4 medications. Majority were categorized as adherent (n=404, 82.3%) based on an overall assessment. In contrast, only 27.5% (n=135) were adherent when medications were assessed individually. Based on individual medication assessment, a multivariate logistic regression demonstrated patients aged >55 years were 2.3 times more likely to be adherent toward medicines (P=.001). Those with <3 comorbidities and <7 medications increased the odds of adherence by 2.1 (P=.002) and 2.2 (P=.001) times respectively. Having a drug knowledge score >80% increase the odds of adherence by 8.7 times compared to their counterparts (P<.01). Conclusion: Potential strategies for targeted management should be developed in order to remove barriers towards medication adherence in chronic kidney disease patients.

Background: Primary healthcare is the earliest gateway for patient care, and improvisations are often needed to accommodate the ever-increasing demand in public health. The Enhanced Primary Healthcare (EnPHC) initiative is aimed at improving such needs, and one core intervention is the introduction of a care coordinator (CC). The purpose of this study was to identify barriers and facilitators in implementing a new intervention in primary healthcare clinics. Methods: This qualitative exploration study. All healthcare providers who were involved in EnPHC at the intervention clinics were selected as participants. In-depth interviews and focus group discussions were carried out among healthcare providers working in the intervention clinic. Thematic analysis was used to categorize data, based on the consolidated framework for implementation research (CFIR) theoretical framework domains. Results: A total of 61 healthcare providers participated. All 5 domains with 19 CFIR constructs emerged from the analysis. Inner setting played a significant role in facilitating CC intervention, in which culture, networking, and collaboration and leadership engagement played an essential role in supporting CC activities. Although CC tasks are complex, concerns of losing clinical skill and resource constraints were identified as potential barriers in CC implementations. Criteria for appointing new CCs emerged from the characteristics of individual constructs, in which the individual must be familiar and interested in community health, have good communication skills, and at least 3 years’ experience in the primary healthcare setting. Conclusion: The implementation of the CC intervention faces varying challenges in different settings. This is partially resolved through teamwork, guidance from mentors, and support from superiors. The complexity of the responsibility of the CC intervention is perceived as both a validation and a burden. Above all, it is seen as paramount in EnPHC intervention.

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Inhaled corticosteroids (ICS) are a common pharmacotherapy option for chronic obstructive pulmonary disease (COPD) patients. However, previous reports showed that ICS have been overprescribed. This study aimed to identify the prevalence of and factors associated with the prescribing of ICS-containing and non-ICS therapy among a sample of COPD patients at a Malaysian hospital and to examine the patterns of COPD inhaled therapy prescriptions among the patients in the years 2017-2020. The study also aimed to determine the proportion of ICS-containing therapy users that were suitable for ICS withdrawal. In total, 153 COPD patients who were using an ICS-containing or a non-ICS therapy within the study period (2017-2020) were included. Most patients were male (91.5%) and Malays (96.1%). Overall, 45.1% of the patients had been prescribed an ICS-containing therapy. A history of moderate exacerbations, presence of concurrent asthma, and eosinophilia were significantly associated with ICS-containing therapy prescribing. A decreasing trend in ICS-containing therapy prescribing from 2017 to 2020 was observed. During the most recent clinic follow-up, 77 patients were ICS users and 26% of them could benefit from ICS withdrawal. Measures to improve ICS-containing therapy prescribing and de-prescribing are warranted.

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