Vitamin C supplements are widely used for their perceived benefits on immunity, collagen synthesis, and overall health. However, limited research has explored their usage prevalence and associated sociodemographic factors among the public. This study aims to examine the patterns of vitamin C supplement use, factors associated with its use, and the reasons for non-use among Malaysian adults. A cross-sectional survey was conducted from March to April 2024 among 408 Malaysian adults, recruited via convenience sampling. Data were collected through a self-administered online questionnaire, which captured demographic characteristics, vitamin C supplement usage patterns, reasons for use or non-use, sources of information and healthcare consultation behaviour. Descriptive statistics were used to summarize the data, and chi-square or Fisher’s exact tests were applied to identify associations between demographic variables and vitamin C supplement use. Vitamin C supplement use was reported by 79.2% of respondents, with higher prevalence among females, married individuals, and those aged ≥ 30 years. Key motivations included maintaining health (82.4%) and boosting immunity (84.8%). Pharmacies were the primary source (73.1%), while social media dominated as an information channel. Healthcare professional consultation was low, with only 26.9% consulting doctors and 47.7% consulting pharmacists. Non-users primarily cited preferences for natural sources (55.3%) and adequate dietary intake (29.4%) as reasons for non-use. Vitamin C supplement use is widespread in Malaysia, but low engagement with healthcare professionals and high reliance on non-professional sources suggest a need for targeted education and professional guidance to ensure safe and informed supplementation practices.

Optimal dosing of vancomycin in critically ill patients receiving renal replacement therapy (RRT) is uncertain due to high pharmacokinetic variability. We aimed to develop individualised vancomycin dosing recommendations that optimise efficacy while minimising toxicity. Prospective, international, pharmacokinetic study enrolling critically ill patients treated with vancomycin and various RRT modalities. A population pharmacokinetic model was developed, externally validated and applied to perform Monte Carlo dosing simulations. We calculated the probability of each dosing regimen to achieve the efficacy target against methicillin-resistant Staphylococcus aureus (ratio of the area under the concentration–time curve to the minimum inhibitory concentration (AUC0-24 h/MIC) ≥ 400) without exceeding the toxicity threshold (AUC0-24 h ≥ 700 mg.h/L). We enrolled 65 critically ill patients from 6 countries receiving continuous RRT (50.8

INTRODUCTION: Older adults often require multiple medications, increasing their risk of polypharmacy and drug-related problems (DRPs). Solid oral dosage forms (SODFs) are the most common medication formulation used by patients. However, administering SODFs to older adults can be challenging, especially for those with swallowing difficulties, leading to practices such as crushing, splitting tablets, or opening capsules. These modifications can affect medication efficacy and safety. This study aims to examine the prevalence of SODF modification among hospitalized older adults, the methods used, the reasons for modification, and the appropriateness of these practices. MATERIALS AND METHOD: This cross-sectional study included patients aged 60 years and above admitted to the general medical ward of a tertiary teaching hospital. Eligible participants were identified through the hospital's electronic registration system. Sociodemographic and clinical data were collected using a standardized form. Participants were interviewed about their SODF modification practices, and swallowing difficulties were assessed using the PILL-5 questionnaire. RESULTS: Of 122 participants, 54.1% were aged 60–69, and 9.8% reported dysphagia. SODF modification was practiced by 55.7%. Swallowing problems and pill dysphagia are significantly associated with SODF modification. Among those modifying SODFs, 47.1% incorrectly believed all medications could be safely altered. Splitting tablets was the most common practice (92.6%). CONCLUSION: Both dysphagia and pill dysphagia are significantly associated with SODF modification practices among older patients. Healthcare providers should be vigilant about these practices in older patients with swallowing difficulties. Proper education and assistance in medication handling are essential for this population.

Tele-pharmacy is an innovative approach to delivering pharmaceutical care at a distance. As this approach is increasingly being integrated into healthcare, pharmacy education providers are incorporating it into their curricula to prepare future pharmacists. This study investigates perceptions of pharmacy students regarding tele-pharmacy and examines how their views are influenced by factors such as their gender, educational background, and stage in their pharmacy programme. Using an online survey, a cross-sectional study was conducted over eight weeks (1st March to 30th April 2023) among undergraduate pharmacy students at a public university in Malaysia. The survey captured comprehensive data on students’ perspectives by asking closed-ended questions. Most participants were female (64.5%) and in their clinical semester (67.5%). Students expressed favourable views of tele-pharmacy, with 95.6% recognising its convenience, 98.0% highlighting time savings, and 97.5% acknowledging energy savings. However, concerns were raised about accessibility and pharmacists’ training. Optimism about and agreement on certain aspects of tele-pharmacy declined with study progression. However, 93.1% desired tele-pharmacy training, and 93.6% showed interest in providing such services, with enthusiasm growing among advanced students. These findings underscore the need for curricular enhancements, including hands-on simulations, structured patient follow-ups, and self-learning modules, to address the evident tele-pharmacy training gaps. Longitudinal research is needed to evaluate how students’ perceptions evolve with increased exposure to tele-pharmacy and its practical applications.

OBJECTIVES:Community pharmacists (CPs) can offer fall prevention services to minimize fall risks among older people. To effectively perform fall prevention activities, CPs need sufficient knowledge about fall prevention and fall-risk increasing drugs (FRIDs), as well as the confidence to execute fall prevention activities. This study aims to identify gaps in CPs' knowledge about fall prevention and FRIDs, as well as assess their confidence in implementing fall prevention activities and perceived-need for training. METHODS:A cross-sectional study using an online questionnaire was undertaken over 4 weeks from 21 June to 19 July 2023, among CPs in the state of Selangor, Malaysia. KEY FINDINGS:Overall, 369 attempted the survey (response rate: 99.5%). However, the completion rate was 79.9% (295/369). Most were female (67.8%, 200/295) and aged 25-30 (43%, 127/295). Many CPs were unaware that FRIDs such as antiepileptics, centrally acting antihypertensives, diuretics, and medications for overactive bladder and incontinence could increase fall risks. CPs had limited knowledge of resources for identifying FRIDs, with only 35.6% (105/295) of them aware of the Beers criteria. Furthermore, knowledge gaps were identified among CPs regarding fall prevention activities, particularly concerning the deprescribing of FRIDs. CPs had limited confidence in recommending deprescribing and offering advice to minimize medication-related fall risks. Most CPs believed that they received inadequate training in fall prevention and FRIDs and recognized the importance of such training. CONCLUSION:Knowledge and confidence gaps were identified among CPs regarding fall prevention and FRIDs. Enhanced education and training for CPs are essential for effective fall prevention.

Pharmacy students often struggle with fragmented learning about pharmacy professions due to the absence of a dedicated course. A survey at UiTM Malaysia revealed that 30% of students had only moderate or lower understanding, while 48% felt unprepared for their careers. A previous one-day program aimed at addressing this gap was costly and labour-intensive. To provide a more efficient solution, we developed PharmPathFinder, using the Plan, Do, Check, and Action (PDCA) tool with 21 steps. This mixed-method study incorporated surveys from alumni and students across four universities, alongside focus group discussions to refine the platform. After launching PharmPathFinder via TikTok, WhatsApp, and Facebook, 98.2% (275 students) expressed satisfaction, citing its usefulness and ease of use. Compared to the previous program, it reduced costs by 73%, time by 77%, and manpower by 75%. PharmPathFinder provides structured insights into four pharmacy specialisations and is accessible to students from their first year, regardless of location. Additionally, it is being promoted in secondary schools to introduce younger students to pharmacy careers.

Introduction: Dietary supplement (DS) use has increased across diverse populations. This study assessed prevalence and patterns of DS use among university students who engaged in physical activity and evaluated their perceptions and influencing factors. Methods: An online survey, based on content-validated questionnaire, was conducted over eight weeks targeting students at a Malaysian university. Participants were recruited using convenience sampling, with survey link distributed through widely used social media platforms, including Facebook, WhatsApp, and Telegram. Results: Out of 344 survey respondents, 77.6% were females, and 33.7% reported using DS in the past month. Users (n=116) generally had positive perceptions of DS, with vitamin C being the most commonly consumed (71.6%), followed by multivitamins (21.6%). Major sources of information for DS users included social media (52.6%) and pharmacists (43.1%). Most users obtained DS from pharmacies (69.8%), while 35.3% obtained from online platforms. Nonusers primarily cited high costs as the main reason for not using DS (90.8% of non-users). Multivariate analysis showed that individuals who exercised less frequently (aOR=0.540, 95% CI=0.324–0.901) were less likely to use DS, while those who believed in the health benefits of DS (aOR=4.287, 95% CI=2.055-8.942) were more likely to use DS. Conclusion: Overall, 33.7% reported using DS in the past month, primarily for health maintenance. Social media served as the main source of information. Reliance of over a third of participants on online platforms for purchasing DS warrants attention.

Introduction: Medicinal plant use among indigenous people in Malaysia is commonly influenced by cultural beliefs, accessibility to traditional plants, and modern medicine availability. This study explores the usage, knowledge, and perceptions of medicinal plants among the Bateq people in Taman Negara National Park, Pahang. Materials and methods: A qualitative study conducted in June 2022 interviewed 12 adult Orang Asli from the Bateq tribe in Kuala Sat, Taman Negara. The qualitative study using face-to-face semi-structured interviews was approved by the Research Ethics Committee of Universiti Teknologi MARA and explored medicinal plant knowledge and usage among the participants. Thematic content analysis was employed for data analysis. Results: All participants, aged 18-60, utilized medicinal plants for various health purposes, including chronic diseases and general health maintenance. Older individuals possessed more traditional knowledge, acquired from their elders. Accessibility to medicinal plants in the local environment was emphasized. Despite diverse applications, challenges in obtaining plants in remote areas and the convenience of modern medicine contributed to a decline in traditional plant use. Perceptions varied, with some favoring traditional plants, while others expressed skepticism. Conclusion: This study offers insights into medicinal plant use, knowledge, and perceptions among the Bateq community in Taman Negara National Park, Pahang. It emphasizes the importance of preserving traditional knowledge, understanding diverse perceptions, and promoting collaboration between traditional and modern healthcare systems. The findings contribute to a broader understanding of healthcare practices among indigenous communities in Malaysia.

Optimal dosing of meropenem and piperacillin/tazobactam in critically ill patients receiving renal replacement therapy (RRT) is uncertain due to variable pharmacokinetics. We aimed to develop generalisable optimised dosing recommendations for these antibiotics. Prospective, multinational pharmacokinetic study including patients requiring various forms of RRT. Independent population PK models were developed, externally validated and applied to perform Monte Carlo dosing simulations using Monolix and Simulx. We calculated the probability that these dosing regimens achieved standard and high therapeutic unbound antibiotic concentrations over 100

Introduction: The negative health consequences of overweight and obesity underscore the importance of weight loss in mitigating these issues. Weight-loss dietary supplements (DS) are highly sought-after by overweight or obese individuals, with widespread advertisements promoting their use. This study aimed to investigate the perceptions of overweight and obese individuals regarding weight-loss DS advertisements. Methods: Over a six-week period from 5th April to 17th May 2023, an online pilot cross-sectional study was conducted targeting overweight and obese individuals in Malaysia. The study utilized a convenience sampling method to recruit participants. Results: Of the 146 participants, most were female (82.9%), 53.4% were overweight, and 46.6% were obese. Most respondents believed that weight-loss DS advertisements often contained exaggerated, unverified, and misleading information. Nearly 90% acknowledged that exaggerated advertisement claims might influence consumers, and about 85% believed that people are influenced to buy frequently advertised weight-loss DS. Despite these perceptions, about 40% reported purchasing a weight-loss DS after seeing such a product in an advertisement, while less than 50% of those who purchased weight-loss DS sought information from healthcare professionals. Conclusion: The study found that almost 40% of the respondents had purchased a weight-loss DS after seeing such products being advertised. Individuals with higher income, married people, and older respondents appeared more likely to purchase a weight-loss DS. These findings underscore the necessity for stricter regulatory frameworks and comprehensive consumer education initiatives to protect consumers from misleading information and unethical marketing tactics within the weight-loss DS industry. Implementing targeted public health interventions could further safeguard consumers from the risks associated with exaggerated product claims.

Swallowing difficulty is prevalent among older people (OP). This study aims to identify the prevalence of swallowing difficulty and pill dysphagia among OP residing in nursing homes. It also aims to identify the factors associated with swallowing difficulty and explore the association between swallowing difficulty and pill dysphagia. The present study was a cross-sectional observational study conducted from June 20th to August 8th, 2022, in nursing homes in Selangor and Kuala Lumpur, Malaysia. Swallowing difficulty among eligible nursing home residents was identified using the Standardised Swallowing Assessment (SSA). The PILL-5 questionnaire was used to identify any indications of pill dysphagia. A total of 96 participants were recruited for the study. Of these, 50% were identified with swallowing difficulty. The use of medications with anticholinergic (AC) properties and an anticholinergic burden (ACB) score of ? 3 were significantly associated with swallowing difficulty. Approximately 11.5% (11/96) of all participants reported pills sticking in their throat, while a small minority (4.2%, 4/96) had a fear of swallowing pills. Additionally, 7.3% (7/96) mentioned the need to crush or coat their medication or use other forms of assistance to take their pills. Swallowing difficulties are common among OP residing in nursing homes, as well as being associated with the use of AC drugs and higher ACB scores. Some participants reported occasional problems with swallowing pills. These issues included pills getting stuck in the throat and the need for assistance and modifications in dosage forms.

Background: The safety and efficacy of COVID-19 vaccinations are crucial factors that parents consider when deciding whether to vaccinate their children. Aim: This study aimed to investigate parents' understanding of COVID-19 vaccines and its association with the degree of willingness to vaccinate their young children. Method: A cross-sectional survey was conducted among the public with children younger than 12 years old. Information on parents' demography, understanding of COVID-19 vaccines and their willingness to get their children vaccinated were collected. The association between the level of understanding and willingness was tested using the One-way analysis of variance (ANOVA) test. Predictors of good understanding and high willingness were investigated using multiple linear regression. Ethics approval was granted by the Research Ethics Committee of Universiti Teknologi MARA (Reference no: REC [PH]/012/2022) and the study conforms with the Declaration of Helsinki. Informed consent was obtained from all participants. A web-based survey link was distributed through social media platforms. The initial section of the survey included a project information sheet including the purpose of the study, length of questionnaire, identity of researchers and measures taken to ensure data confidentiality and anonymity of participants. Participants provided their consent electronically prior to being granted access to the questionnaire. Results: Of the 386 respondents, 53.4% had a good understanding, and 74.6% had a high willingness. Only 42.5% agreed that the vaccines are effective in protecting children from getting COVID-19, 79.5% and 73.3% misunderstood the severity and tendency to experience the side effects, respectively. A better understanding was associated with a higher willingness to vaccinate ([F(4381) = 54.417, p = 0.000). A higher understanding was significantly associated with higher educational status (postgraduate [beta = 0.297, p = 0.028] and bachelor [beta = 0.275, p = 0.034], work in a health-related field [beta = 0.300, p < 0.001]) and have received a COVID-19 booster (beta = 0.347, p < 0.001). A high willingness was prevalent among parents working in a health-related field, had received a COVID-19 booster and had medical condition. Low willingness was observed among parents aged above 30 years old and those who have used herbal medicines. Conclusion: It is of utmost importance to comprehend parents' understanding of this topic to minimise hesitancy toward COVID-19 vaccination in children.

Improper pharmaceutical waste disposal is a rising environmental pollutant around the world. Pharmaceutical waste disposal legislation and regulations are available to some extent but limited to industrial premises and health-care institutions. Information on the disposal of pharmaceutical waste in public hands, known as domestic pharmaceutical waste (DPW), is limited. This scoping review aims to comprehend the global practice of DPW disposal by following the PRISMA Extension for Scoping Reviews guideline. Three online databases were searched for eligible articles: peer-reviewed in English language, describing the methods that the public disposed of unwanted or expired pharmaceuticals at home (DPW Disposal) and the public’s participation in their local DPW programs (DPW Program). Search terms were derived from Medical Subject Headings (MeSH) and free text when applicable. One expert report and thirty research publications were analysed. The articles originated from Asia (n=13), the Middle East (n=6), Africa (n=4), Europe (n=3), the United States (n=3) and Australia (n=1). Most pharmaceuticals are disposed of as household garbage (58.8%), returned to health facilities (17.9%) and flushed down the toilet drain (8.1%). There is a large range of diversity in public awareness (range: 14% - 82%) and participation in DPW Programs (range: 8.3% to 64%) with higher percentages reported from European countries. Existing regulations and policies have modest to moderate impact on proper DPW disposal. Our findings provide new information that may be utilised by policymakers in the process of laying the groundwork for a national plan outlining the most effective methods for disposing of DPW.

BACKGROUND:The optimal dosing of antibiotics in critically ill patients receiving renal replacement therapy (RRT) remains unclear. In this study, we describe the variability in RRT techniques and antibiotic dosing in critically ill patients receiving RRT and relate observed trough antibiotic concentrations to optimal targets.METHODS:We performed a prospective, observational, multinational, pharmacokinetic study in 29 intensive care units from 14 countries. We collected demographic, clinical, and RRT data. We measured trough antibiotic concentrations of meropenem, piperacillin-tazobactam, and vancomycin and related them to high- and low-target trough concentrations.RESULTS:We studied 381 patients and obtained 508 trough antibiotic concentrations. There was wide variability (4-8-fold) in antibiotic dosing regimens, RRT prescription, and estimated endogenous renal function. The overall median estimated total renal clearance (eTRCL) was 50 mL/minute (interquartile range [IQR], 35-65) and higher eTRCL was associated with lower trough concentrations for all antibiotics (P < .05). The median (IQR) trough concentration for meropenem was 12.1 mg/L (7.9-18.8), piperacillin was 78.6 mg/L (49.5-127.3), tazobactam was 9.5 mg/L (6.3-14.2), and vancomycin was 14.3 mg/L (11.6-21.8). Trough concentrations failed to meet optimal higher limits in 26%, 36%, and 72% and optimal lower limits in 4%, 4%, and 55% of patients for meropenem, piperacillin, and vancomycin, respectively.CONCLUSIONS:In critically ill patients treated with RRT, antibiotic dosing regimens, RRT prescription, and eTRCL varied markedly and resulted in highly variable antibiotic concentrations that failed to meet therapeutic targets in many patients.

Critical illness leads to significant pathophysiological changes, particularly in the case of patients with sepsis or septic shock. Activation of systemic inflammatory mediators promotes endothelial leak, extravascular fluid shifts, and overall hemodynamic instability. As the critical illness progresses, redirection of blood flow occurs to the vital organs leading to poor peripheral perfusion. Aggressive critical care management to ensure hemodynamic stability by fluid resuscitation, administration of inotropes, and vasopressors, as well as commencement of artificial organ supports, all may complicate drug therapy in critically ill patients. Drug absorption, distribution, elimination, and/or metabolism may each be significantly affected in certain cute pathologies associated with critical illness. Changes in drug pharmacokinetics may lead to treatment failure. As such, drug-dosing adjustment is required through various approaches based on the clinical condition to ensure effective drug therapy. Applying the "best" approach to pharmacy practice in the intensive care unit (ICU) setting will enhance the delivery of optimal pharmaceutical care in critically ill patients.

Category: RRT Research Presenter: Dr FARIZ SAFHAN MOHAMAD NOR Keywords: vancomycin, continuous renal replacement therapy, pharmacokinetic

Here we describe the pharmacokinetics of piperacillin administered by continuous infusion (CI) versus intermittent bolus (IB) dosing in critically ill patients receiving continuous venovenous haemofiltration (CVVH) and compare the frequency of pharmacodynamic/pharmacokinetic (PK/PD) target attainment with each dosing strategy. This was a prospective pharmacokinetic trial in 16 critically ill patients with severe sepsis or septic shock undergoing CVVH and randomised to receive either CI or IB administration of a standard daily dose of piperacillin/tazobactam (11.25g/day on Day 1 followed by 9g/day). Serial blood samples were measured on two occasions. Piperacillin pharmacokinetics were calculated using a non-compartmental approach. Blood concentrations were compared with established PK/PD targets. On occasion 1 (Days 1–3 of therapy), IB administration resulted in significantly higher piperacillin peak concentrations (169 vs. 89mg/L; P=0.002), whereas significantly higher steady-state concentrations were observed in CI patients (83 vs. 57mg/L; P=0.04). Total clearance and clearance not mediated by CVVH were significantly higher with CI administration [median (interquartile range), 1.0 (0.7–1.1) and 0.8 (0.6–1.0)mL/kg/min; P=0.001 and 0.001, respectively]. The estimated unbound piperacillin concentrations were four times above the target susceptibility breakpoint (16mg/L) for the entire dosing interval (100%fT>4xMIC) in 87.5% of patients receiving CI administration (sampling occasion 1), compared with 62.5% of IB patients achieving the desired target (50%fT>4xMIC). Compared with IB dosing, and despite similar CVVH settings, CI administration of piperacillin results in a pharmacokinetic profile that may optimise outcomes for less susceptible pathogens.