The presence of synchronous primary tumors in head and neck cancers poses complex challenges for clinical management, requiring careful decision-making by surgical teams. Research suggests that such tumors occur in 1.3–5.8
Malaysia's rapid population aging has intensified the need for dementia care systems that extend beyond hospital-based services. This qualitative study explored the experiences and support needs of family caregivers of persons living with dementia (PLWD) in Malaysia, with the aim of informing dementia workforce development and para-professional training. Semi-structured interviews were conducted with 67 caregivers attending the geriatric unit of a public hospital in Selangor. Responses to open-ended questions on social support, emotional impact, communication with health professionals, economic consequences, and unmet needs were analyzed using structured qualitative content analysis, supported by a human-large language model (LLM) parallel coding approach. Caregivers described substantial emotional burden, including exhaustion, anxiety, social isolation, and feelings of being trapped in a continuous caregiving role. Many reported fragmented information from healthcare professionals, limited awareness of available welfare schemes, and inadequate access to respite, home-based support, and caregiver education. Caregiving also produced major financial strain through lost employment, reduced working hours, depleted savings, and recurring out-of-pocket costs. Across domains, caregivers expressed a strong need for affordable day care, home-based therapy, psychological support, financial assistance, and practical training. These findings indicate that dementia care in Malaysia remains heavily dependent on family caregivers who are expected to absorb unmet system demands with limited formal support. Strengthening the dementia care workforce through structured para-professional roles may help bridge gaps in caregiver education, welfare navigation, post-discharge support, and community-based care. The study underscores the need to align national aging and dementia policies with workforce development strategies that better support both persons living with dementia and the families who care for them.
OBJECTIVES:Although new molecular entity (NME) antibacterials active against multidrug-resistant organisms have been introduced, their availability remains limited even in developed countries. This study aimed to examine the current availability of NME antibacterial agents in Asia. METHODS:NME antibacterials approved by the US FDA from 2010 to 2024 were included. Approval status in ten Asian countries was collected as of June 2025. Population and economic status were sourced from the United Nations and World Bank databases. Investigators reported approval, withdrawal, and unit prices of study drugs as well as the type of healthcare systems using a standardised report form. RESULTS:Among 22 NME antimicrobials included in this study, thirteen were approved in the surveyed countries. Beta-lactam/beta-lactamase inhibitors such as ceftazidime/avibactam and ceftolozane/tazobactam were the most approved class, each available in nine and eight countries, respectively. Agents active against carbapenem-resistant Acinetobacter spp. were available in three countries: cefiderocol (Japan, Singapore, Taiwan) and eravacycline (Singapore). The median number of available NME antibacterials per country was 3.5, ranging from one to six. For most NME antibacterials, a delay of three to five years existed between US FDA approval and approval in study countries. The number of available NME antibacterials showed no significant correlation with gross domestic product, relative drug price, or healthcare delivery system, except for approval lag. CONCLUSIONS:Access to NME antibacterials in Asia remains markedly limited, with substantial approval delays. Considering the severity of antimicrobial resistance in the region, concerted efforts are warranted to improve access to crucial antibiotics in Asia.
Background:Outpatient parenteral antimicrobial therapy (OPAT) is practised worldwide due to the benefits it provides to patients and healthcare systems. However, its full potential remains unrealized due to different implementation challenges. This study aims to identify barriers and facilitators that influence the routine implementation of current practices in the OPAT programme. Methods:An international, multi-centre electronic survey was conducted among healthcare facilities providing OPAT services in Australia, Malaysia, the UK, Spain, Turkey and Middle East countries. The survey instrument was developed based on the Consolidated Framework for Implementation Research and guideline recommendations for OPAT. Statistical analyses were performed using SPSS version 30. Results:The survey received responses from 150 healthcare facilities across 10 countries offering OPAT services. The majority (11 879.7%) of healthcare facilities implement OPAT through a formal structure. The majority (92.2%) had a designated team lead. Most facilities (12 685.7%) reported the implementation of antimicrobial toxicity monitoring. Only 58 facilities (39.5%) reported implementation of regular audits of their OPAT programmes. The most reported barriers to OPAT implementation included wide geographic distribution of patients (50.7%), lack of financial support (42.7%) and the dosing frequency of antimicrobials (40.6%). Facilitators to OPAT implementation include hospital bed savings, clinical safety and efficacy, cost-effectiveness and patient satisfaction. Conclusions:The majority of healthcare facilities implement OPAT through a formal structure. However, several challenges continue to hinder its routine implementation. Ongoing efforts to address implementation barriers are crucial for strengthening existing services and supporting the expansion of new services.
BACKGROUND:Streptococcus pneumoniae remains a major global health threat, causing diseases ranging from mild respiratory infections to severe conditions like pneumonia, sepsis, and meningitis. Although pneumococcal conjugate vaccines (PCVs), including PCV7, PCV10, and PCV13 have significantly reduced disease burden, especially in children, S. pneumoniae continues to exhibit high serotype and genetic diversity. Whole-genome sequencing (WGS) analysis offers high-resolution insights into clonal lineages and multidrug-resistant strains. However, genomic data on Malaysian isolates remain limited. METHODS:This study characterized the whole genome features and comparative profiles of seven invasive S. pneumoniae isolates from two tertiary hospitals in Malaysia. WGS analyses described serotype, sequence type (ST), antimicrobial resistance determinant genes, pan-genome structure, and recombination events. RESULTS:The average genome size was ∼2.12 Mbp, with 1 988-2 205 coding sequences. WGS-based MLST identified five sequence types (ST236, ST320, ST386, ST671, ST695), with ST236 linked to serotypes 19A and 19F related to PMEN clones Taiwan19F-14 and CC271. Core genome analysis with 35 global reference strains revealed three major clades. Notably, isolates TSP95, SSP45, and SSP46 clustered closely with strains from South Korea, suggesting a long-term persistence of ST320 over a decade. Recombination analysis identified both shared and isolate-specific events, forming distinct phylogenetic clusters. Extensive shared recombination was observed in several isolates, while others displayed isolate-specific events, indicating ongoing genetic diversification. CONCLUSION:These findings underscore the critical role of recombination in shaping pneumococcal population structure, evolution, and adaptation.
