Physicians’ Perception on Prescribing Potentially Inappropriate Medications for Older Patients: A Qualitative Study from Malaysia

Introduction: Many quantitative studies reported that potentially inappropriate medication (PIM) is quite prevalent among older adult patients. However, the issue is less explored qualitatively from the perspective of physicians. Objective: To qualitatively explore hospital physicians’ perception regarding PIMs, associated factors and the possible interventions to control this phenomenon. Method: A qualitative study using individual semi-structured and in-depth interview research method was constructed on 15 physicians serving in a Malaysian hospital. The purposive sampling technique was used at the beginning followed by the snowball sampling process. Results: It was found that the physicians have inadequate knowledge about PIM and the published PIM criteria . Several factors were perceived as barriers of appropriate prescribing. Firstly, physicians’ lack of knowledge and training in geriatric medicine as well as lack of time. Secondly, some of the physicians were skeptical about the applicability of PIM criteria in daily practice due to limited alternative medications. Lastly, complexity of the cases due to multimorbidity, polypharmacy and patient’s poor knowledge about their medications. The proposed interventions to optimize prescribing for older patients were education (for patients and physicians), optimization of healthcare workforce and activation of deprescribing. Conclusions: Prescribing for older patients is a complex process that is affected by numerous patient-related and doctor-related factors. Improvement strategies should target the patient, physicians and the work environment activating a joined-up working between the physician and other healthcare providers

The use of antidepressants for physical and psychological symptoms in cancer

Cancer patients are commonly associated with various physical and psychological symptoms. In palliative setting, the aims are to relieve those symptoms, improve quality of life, and increase medication adherence among cancer patients. Antidepressants are generally accepted for the treatment of depression among patients with or without cancer. Some other potential benefits of the antidepressants have been reported in cancer patients. Objective: This study aims to review the use of antidepressants for physical and psychological symptoms in cancer patients. Results: Our findings showed the mixed result of positive and negative findings in various symptoms associated with cancer patients. These studies are categorised according to the hierarchy of evidence from high to low level, namely randomised controlled trials, cohort studies, case-control studies, case series, case reports, as well as other type of publications. The majority of antidepressants used in cancer patients seem to be beneficial for the treatment of depression, anxiety, hot flashes and other symptoms such as sexual dysfunction, fatigue, nicotine dependence, vasomotor symptoms, executive functions, sleep problems, pruritus, as well as for hypochondriasis. While fluoxetine was found to be associated with the reduction of antiemetic property in ondansetron, mirtazapine was identified to be a good alternative in treating nausea and cachexia among cancer patients. Conclusion: More research studies with adequate statistical power are warranted to validate the use of antidepressants among cancer patients in treating these physical and psychological symptoms

Validity Of Fisher Effect Theory: Evidence From The Conventional And Islamic Money Market In Malaysia

This study attempts to examine existence of Fisher Effect theory in Malaysia’s conventional and Islamic money markets. Time series data has been included for the years 2011 to 2018 and consists of two stages of data analysis. First stage analysis examines the existence of a Fisher Effect relationship by applying the Autoregressive Distributed Lag (ARDL) approach as an estimation method. Second stage analysis determines the strength of the Fisher Effect relationship by imposed restriction β=1 using standard asymptotic Chi-square in Wald test. The findings found that the Fisher Effect theory valid in Malaysia’s Islamic money market but there is no evidence for the conventional market. This outcome suggests that the Islamic money market can accurately predict inflation in the future. However, it appears in a weak form of relationship. Overall, outcomes of this study provide benefits for policy-makers since the existence of the Fisher relationship reflects an effective monetary policy for economic growth and sustainable developmen

Validity of fisher effect theory: Evidence from the conventional and Islamic money market in Malaysia

This study attempts to examine existence of Fisher Effect theory in Malaysia’s conventional and Islamic money markets. Time series data has been included for the years 2011 to 2018 and consists of two stages of data analysis. First stage analysis examines the existence of a Fisher Effect relationship by applying the Autoregressive Distributed Lag (ARDL) approach as an estimation method. Second stage analysis determines the strength of the Fisher Effect relationship by imposed restriction β=1 using standard asymptotic Chi-square in Wald test. The findings found that the Fisher Effect theory valid in Malaysia’s Islamic money market but there is no evidence for the conventional market. This outcome suggests that the Islamic money market can accurately predict inflation in the future. However, it appears in a weak form of relationship. Overall, outcomes of this study provide benefits for policy-makers since the existence of the Fisher relationship reflects an effective monetary policy for economic growth and sustainable developmen

The use of psychotropic substances among students: The prevalence, factor association, and abuse

This detailed review analyzed the previously published studies related to the prevalence of psychotropic substances use, associated factors, and the misuse of the psychotropics among students. A comprehensive literature search covering six databases was performed. References from published articles and reports were extracted. This helped in identifying the available information on the use of psychotropic drugs. A total of 16 articles were included in this review. There is an upsurge of using psychotropics with the preceding years. More students are exposed to the risk of using psychotropic substances due to the multiple factors like stress, increased academic workload, etc. The misuse is found to be common with prescribed psychotropic substances. Students need to be aware of the bad outcomes of using psychotropic substances. Participation of every stakeholder to curb this menace needs to be emphasized. More extensive studies are required to know about the increasing prevalence, factors, and misuse of psychotropics

Patient-centred communication in the use of antidepressants among people with depression: a scoping review

Antidepressants are the mainstay of depression treatment. However, little information is known about patient-centred communication related to the use of antidepressant among people with depression. This review aims to provide a comprehensive mapping of previously published studies on patient-centred communication in the use of antidepressants among patients with depression. A scoping review of the literature was conducted using PubMed, CINAHL, and Cochrane to answer the following questions: What is the nature of published scientific literature on this topic? and To what extent do the published articles address the six core components of patient-centred communication, which are: encouraging effective clinician-patient relationships, obtaining and providing information, responding to emotional states, handling uncertainty, achieving the best decision as well as advocating patient self-management? Out of 494 records identified, a total of 13 articles were included in the scoping review (2 randomised controlled trials, 1 observational cohort study, 5 cross-sectional studies, 4 qualitative studies, and 1 review article). All 6 core components of the patient-centred communication were discussed extensively in the literature except for 2 of them, which were handling uncertainty and patient self-management. Shared decision making (SDM) was found to be a critical feature in patient-centred communication. The six core components of patient-centred communication have been consistently recognized as vital for the process of achieving patient-centred care. SDM can be included as a tool to assist clinicians and patients in addressing effective clinician-patient relationships

Development of a Strategic Tool for Shared Decision-Making in the Use of Antidepressants among Patients with Major Depressive Disorder: A Focus Group Study

Shared decision-making (SDM) has been recognized as an important tool in the mental health field and considered as a crucial component of patient-centered care. Therefore, the purpose of this study was to develop a strategic tool towards the promotion and implementation of SDM in the use of antidepressants among patients with major depressive disorder. Nineteen doctors and 11 major depressive disorder patients who are involved in psychiatric outpatient clinic appointments were purposively selected and recruited to participate in one of six focus groups in a large teaching hospital in Malaysia. Focus groups were transcribed verbatim and analyzed using a thematic approach to identify current views on providing information needed for SDM practice towards its implementation in near future. Patients’ and doctors’ views were organized into six major themes, which are; summary of treatment options, correct ways of taking medication, potential side effects of treatments related to patients, sharing of case study related to the treatment options, cost of treatment options, and input from pharmacist. The information may be included in the SDM tool which can be useful to inform further research efforts and developments that contribute towards the successful implementation of SDM into clinical practice

QTc prolongation and antipsychotic medications in psychiatric patients – a review

Antipsychotic medications are the cornerstones of the acute and long-term treatment of schizophrenia. Despite their benefits in minimizing the schizophrenia symptoms, they have been associated with the risk of inducing QTc prolongation, which may lead to a serious life-threatening arrhythmia and cause sudden death. Objective: To review the QTc prolongation caused by antipsychotic medications used among psychiatric patients. Methods: Literature search was conducted using databases such as Scopus, Science Direct, Pubmed, and Springer link. The keywords used for the search were “QTc prolongation”, “antipsychotic medications” and “schizophrenia”. The inclusion criteria are articles from 2001 to 2014, articles written in English and articles related to the effects of antipsychotics in causing sudden cardiac death. The inclusion criteria are the articles written in other languages and the article about other adverse effect of antipsychotics. Results: Twenty-seven articles were found to be relevant to this study and twenty of them which discusses about antipsychotic-induced QT interval prolongation have been included in the table of evidence. Conclusion: Antipsychotics regardless of the generations have the potential of causing QT interval prolongation. The risk-to-benefit ratio that accounts for the danger of sudden cardiac death should be evaluated before prescribing an antipsychotic medicine and each individual patient should be assessed on the potential contributing factors to the prolongation of QTc