Objective: (1) To report the awareness on MRP and its utilization rate. (2) To assess environment awareness with regards to improper disposal. (3) To explore practices toward unused medication. Methods: A cross-sectional study was conducted in 33 out-patient pharmacies in Sabah healthcare facilities. Quota sampling was used to recruit 244 subjects. Data collector from each facility was identified and trained prior to data collection. Self-reporting questionnaire captured data of socio-demographic, awareness on MRP and patient's knowledge and practice towards unused medication. Independent t-test and chi square test were performed to detect differences and association. Result: Subject mean (SD) age was 45.1(15.5) years and almost two-third (60%) of the subjects were female. Majority (73%, 95%CI 67-78%) knew that inappropriate disposal of medication will cause environmental hazard. Only 54% (95% CI 47-60%) had heard of MRP, 26% (95%CI 21-32%) had utilized MRP to return unused medication.Subject's awareness on environmental hazard and MRP were associated with their practice to return unused medication (p=0.001 and p<0.001 respectively). Mean years of education and median family income were significantly different between the aware and unaware group respectively [11.3(6.0) vs 8.9(4.5) yrs, p=0.003; RM2000 vs RM1260, p<0.001]. The most common unused medication were analgesics (27.1%), antihypertensive (24.4%), antiglycemic (14.7%) and supplements (12%). The two predominant methods to "dispose" unused medication at home were through garbage (47.8%) and return to healthcare facilities (30.0%). Conclusion: This study has established the evidence for public awareness on MRP, environment awareness and disposal practice of Malaysian citizen. Creative and innovative recommendations have been made for MRP promotion and to improve public knowledge on safety disposal of unused medication.

Background The role of pharmacists in the healthcare system has evolved towards facilitating and providing patient‐centred care. Involving pharmacists in research is essential to the advancement of practice; however, at present, the level of involvement of pharmacists in research in Sabah, Malaysia, is low. Aim The aims of this study were to explore the attitudes, perceptions and barriers faced by pharmacists in Sabah and to identify potential strategies to increase the involvement of pharmacists in research. Method The present qualitative study comprised a series of in‐depth, face‐to‐face interviews. Pharmacists from public services in Kota Kinabalu, Sabah, were selected using purposive sampling and were interviewed until saturation of themes was reached. All interview sessions were audio recorded and transcribed, with additional notes recorded by a member of the research team. Data were analysed thematically. Results Nine pharmacists participated in the interviews. Two themes emerged around pharmacists’ attitudes towards research: (1) perspectives regarding willingness; and (2) perceptions of research participation. Some interviewees expressed limited interest in research participation because they underestimated or undervalued the importance of undertaking research. Barriers to research participation were grouped into five themes: perception; communication; resources; skill and knowledge; and recognition and rewards. Strategies such as proper time management and providing adequate staffing in research were suggested to overcome the barriers to participation. Conclusion Most interviewees were not aware of the importance of participating in research in improving health care. Practical strategies were suggested to overcome the barriers to participation, and these strategies should be considered when promoting research participation.

Background Anticoagulants are the cornerstone therapy for the management of venous thromboembolism (VTE) and atrial fibrillation (AF). Pharmacists should be confident and equipped with the skill and updated knowledge in managing anticoagulation therapy. Objective To explore self-reported confidence level of pharmacists, perceived reasons influencing their confidence and socio-demographic associated with high confidence level in the area of anticoagulation. Methods A cross-sectional, self-administered questionnaire survey was carried out among fully registered pharmacists who work in selected government hospitals and clinics in Borneo, Malaysia, from January 2019 to February 2020. Results Overall, responses from 542 fully registered pharmacists were obtained. Proportion of respondents who claimed confident in providing necessary information to patient receiving warfarin (n = 479, 88.3%) was significantly higher (p < 0.001) compared to low molecular weight heparins (n = 317, 58.5%) and direct oral anticoagulants (n = 211, 38.9%). Respondents’ perceived reasons that may influence their confidence level include experience in dealing with anticoagulants’ cases (n = 469, 86.5%), knowledge on anticoagulants (n = 394, 72.7%) and knowledge on diseases needing anticoagulation therapy (n = 311, 57.4%). Practising as ward pharmacist and “always” dealing with anticoagulants during their practice were the socio-demographic that significantly associated with high confidence level of pharmacist in providing pharmaceutical care on all types of anticoagulants (p < 0.05). Conclusion Pharmacists were found more confident in providing pharmaceutical care on warfarin compared to low molecular weight heparins and direct oral anticoagulants. Continuous educational and training programmes on the use of anticoagulants should be carried out to enhance pharmacists’ confidence in supporting patients’ care.

It is commonly held that a normal electrocardiography (ECG) rules out heart failure (HF). In older populations with HF, 98% of patients have been reported to have major ECG abnormalities. Anecdotally, young patients with HF have been noted to have ECGs without major abnormalities. The aim of this study was to determine the proportion of patients aged under 65 years with HF lacking major ECG abnormalities. Data were collected for 100 consecutive admissions with HF (aged ,65 years) with echocardiogram and ECG available. ECGs were independently assessed by two cardiologists; disagreements were resolved by a third. Ejection fraction was quantified using the biplane Simpson's. Majorly abnormal ECGs contained !1 of Q waves, left ventricular hypertrophy, bundle branch block or atrial fibrillation. Minor abnormalities of ECG also recorded; these included atrial enlargement, bradycardia, tachycardia, broadening of QRS complex, poor R wave progression, left/right axis deviation, first-degree atrioventricular block and non-specific ST-T wave changes. The mean age was 50.0 years. Seventy-six had major abnormalities on ECG, 22 had minor abnormalities and two showed no abnormalities. Ejection fractions were similar across all groups (28.6 + 2.8%, 28.4 + 3.4% and 25.5 + 6.9%, respectively). Twenty-four percent of patients with HF (aged ,65 years) do not have major ECG abnormalities. Patients aged ,65 years with a clinical suspicion of HF but without major ECG abnormalities should undergo further investigation.

Introduction: Enteral feeding is a type of nutritional support for critically ill patients who are unable to tolerate oral feeding. It is vital to ensure that nurses practise proper administration techniques via enteral feeding tubes (EFT) to ensure that medications can be delivered safely and effectively.Objective: This study aims to assess the knowledge and practice of nurses on medication administration through EFT. The association between demographics and knowledge was also explored. Method: This study is a cross-sectional, self-administered, content-validated, pre-tested questionnaire survey involving all nurses who worked in the ward setting at Hospital Queen Elizabeth II from August to December 2020. Result: A total of 409 questionnaires were sent out with 252 responses received. The majority of respondents were female (n = 240, 95.6%) with a median working experience of 84 months (interquartile range of 44 months). Most nurses knew that the immediate-release dosage forms (n = 237, 94.4%) may be crushed and administered through EFT. Similarly, most nurses were aware that sublingual nitroglycerin (GTN) tablets should not be crushed (n = 232, 92.8%) and that nystatin suspension should not be administered via EFT (n = 212, 85.1%). However, about half of the nurses responded incorrectly when questioned about the particulars of EFT involving the administration of sustained-release medications (n = 152, 60.6%), soft gelatin capsules (n = 111, 44.4%) and hard gelatin capsules (n = 102, 40.6%). Meanwhile, in terms of practice, a majority of the nurses would correctly routinely flush the EFT before (n = 226, 90.4%) and after (n = 245, 98.8%) the administration of medications. However, only a small proportion of nurses (n = 43, 17.3%) demonstrated the appropriate practice of administering all medications separately all the time. Furthermore, it was also worth noting that for some specific knowledge-based questions, nurses from the intensive care setting had more correct responses when compared to those from the general ward setting (p < 0.05). Conclusion: The knowledge gap and inconsistencies in practices amongst nurses related to the use of EFT may lead to suboptimal delivery of medications, whilst potentially compromising patient outcomes. Hence, continuous educational programs should be carried out to ensure safe and effective drug administration through EFT.