Browse publications by year: 2023

  1. ECG lead misplacement in the frontal and horizontal plane mimicking A myocardial infarction
    Kaisbain N, Khoo KKL, Lim WJ
    Am J Emerg Med, 2023 Dec;74:196.e1-196.e4.
    PMID: 37863804 DOI: 10.1016/j.ajem.2023.10.009
    BACKGROUND/AIMS: Electrocardiogram (ECG) is an inexpensive, fundamental screening tool used in daily clinical practice. It is essential in the diagnosis of life-threatening conditions, such as acute myocardial infarctions, ventricular arrhythmias etc. However, ECG lead misplacement is a common technical error, which may translate into wrong interpretations, unnecessary investigations, and improper treatments.

    METHODS/RESULTS: We report a case of a multiple ECG lead misplacement made across two different planes of the heart, resulting in a bizarre series of ECG, mimicking an acute high lateral myocardial infarction. Multiple ECGs were done as there were abrupt changes compared to previous ECGS. Patient was pain free and administration of potentially harmful procedures and treatments were prevented.

    CONCLUSION: Our case demonstrated the importance of high clinical suspicion in diagnosing ECG lead misplacement. It is the responsibility of both the healthcare workers who are performing and interpreting the ECG to be alert of a possible lead malposition, to prevent untoward consequences to the patient.

    MeSH terms: Arrhythmias, Cardiac/diagnosis; Electrocardiography/methods; Health Personnel; Humans
  2. A review of current antibiotic resistance and promising antibiotics with novel modes of action to combat antibiotic resistance
    Chen L, Kumar S, Wu H
    Arch Microbiol, 2023 Oct 20;205(11):356.
    PMID: 37863957 DOI: 10.1007/s00203-023-03699-2
    The emergence and transmission of antibiotic resistance is a global public health crisis with significant burden on healthcare systems, resulting in high mortality and economic costs. In 2019, almost five million deaths were associated with drug-resistant infections, and if left unchecked, the global economy could lose $100 trillion by 2050. To effectively combat this crisis, it is essential for all countries to understand the current situation of antibiotic resistance. In this review, we examine the current driving factors leading to the crisis, impact of critical superbugs in three regions, and identify novel mechanisms of antibiotic resistance. It is crucial to monitor the phenotypic characteristics of drug-resistant pathogens and describe the mechanisms involved in preventing the emergence of cross-resistance to novel antimicrobials. Additionally, maintaining an active pipeline of new antibiotics is essential for fighting against diverse antibiotic-resistant pathogens. Developing antibacterial agents with novel mechanisms of action is a promising way to combat increasing antibiotic-resistant pathogens.
    MeSH terms: Drug Resistance, Microbial
  3. The Impact of COVID-19 on Values and Religiosity in a Multi-Ethnic Population
    Koh MY, Lai ST, Lim KS, Lim SYH, Chin J, Chia ZJ, et al.
    Asia Pac J Public Health, 2023 Nov;35(8):524-528.
    PMID: 37864316 DOI: 10.1177/10105395231207238
    We investigated the COVID-19 pandemic's impact on values and religiosity in multi-ethnic Malaysia. Values were measured as changes in values, daily activities, and life priorities using a 5-point Likert scale (-2 to +2). Centrality of Religiosity Scale measured changes in religiosity. Around 176 predominantly female (66.5%), Chinese (68.2%) respondents, aged 35.5 ± 14.1 completed the survey. Most life values changed positively: a sense of security at home (2, interquartile range [IQR]: 1-2), connection with family (1, 1-2), and contribution to society (1, 1-2). Certain life priorities' importance increased: health (2, IQR 2-2), family (2, 2-2), and happiness (2, 1-2); except power and money. These significant positive changes in values and religiosity varied between genders and ethnicities.
    MeSH terms: Ethnic Groups; Female; Humans; Male; Surveys and Questionnaires; Religion; Pandemics*
  4. In Search for a Sustainable and Equitable Long-Term Care for Malaysia
    Yunus RM, Johar H, Katiman D
    J Aging Soc Policy, 2023 Nov 02;35(6):743-755.
    PMID: 35290173 DOI: 10.1080/08959420.2022.2049575
    Like many other countries across the globe, Malaysia is rapidly graying. It is projected that older adults will comprise 10-15% of the country's total population in the next decade. Despite the surge in chronic diseases and a rise in dependency in daily living activities among Malaysian elders, formal support and long-term care services (LTC) have not been adequately developed. The existing tax-funded health care system - currently under huge financial strain - has no systematic or comprehensive LTC provision in place. This paper highlights the need for sustainable and equitable LTC services in Malaysia while drawing insight from existing LTC provision and financing arrangements in neighboring countries. It offers several recommendations to move forward in LTC planning using an approach that is unique to the Malaysian context.
  5. Multi-air pollution risk assessment in Southeast Asia region using integrated remote sensing and socio-economic data products
    Sakti AD, Anggraini TS, Ihsan KTN, Misra P, Trang NTQ, Pradhan B, et al.
    Sci Total Environ, 2023 Jan 01;854:158825.
    PMID: 36116660 DOI: 10.1016/j.scitotenv.2022.158825
    Air pollution has massive impacts on human life and poor air quality results in three million deaths annually. Air pollution can result from natural causes, including volcanic eruptions and extreme droughts, or human activities, including motor vehicle emissions, industry, and the burning of farmland and forests. Emission sources emit multiple pollutant types with diverse characteristics and impacts. However, there has been little research on the risk of multiple air pollutants; thus, it is difficult to identify multi-pollutant mitigation processes, particularly in Southeast Asia, where air pollution moves dynamically across national borders. In this study, the main objective was to develop a multi-air pollution risk index product for CO, NO2, and SO2 based on Sentinel-5P remote sensing data from 2019 to 2020. The risk index was developed by integrating hazard, vulnerability, and exposure analyses. Hazard analysis considers air pollution data from remote sensing, vulnerability analysis considers the air pollution sources, and exposure analysis considers the population density. The novelty of this study lies in its development of a multi-risk model that considers the weights obtained from the relationship between the hazard and vulnerability parameters. The highest air pollution risk index values were observed in urban areas, with a high exposure index that originates from pollution caused by human activity. Multi-risk analysis of the three air pollutants revealed that Singapore, Vietnam, and the Philippines had the largest percentages of high-risk areas, while Indonesia had the largest total high-risk area (4361 km2). Using the findings of this study, the patterns and characteristics of the risk distribution of multiple air pollutants in Southeast Asia can be identified, which can be used to mitigate multi-pollutant sources, particularly with respect to supporting the clean air targets in the Sustainable Development Goals.
    MeSH terms: Asia, Southeastern; Environmental Pollutants*; Humans; Socioeconomic Factors; Risk Assessment; Particulate Matter/analysis; Remote Sensing Technology
  6. Predictors of maternal satisfaction with labor induction: A prospective observational cohort study
    Ramlee N, Azhary JMK, Hamdan M, Saaid R, Gan F, Tan PC
    Int J Gynaecol Obstet, 2023 Nov;163(2):547-554.
    PMID: 37177795 DOI: 10.1002/ijgo.14848
    OBJECTIVE: To identify independent predictors of maternal satisfaction with labor induction.

    METHOD: In this prospective observational cohort study, 769 women prior to their labor induction had sleep and psychological well-being assessed using Pittsburgh Sleep Quality Index and Depression, Anxiety and Stress Scales. Women were asked about the adequacy of labor induction information provided and their involvement and time pressure felt in the decision-making for their labor induction. Maternal characteristics, induction and intrapartum care measures, and labor and neonatal outcomes were also assessed. Prior to discharge, women rated their satisfaction with their birth experience.

    RESULTS: A total of 34 variables were considered for bivariate analysis, with 15 found to have P 

    MeSH terms: Cesarean Section; Female; Humans; Infant, Newborn; Labor, Obstetric*; Personal Satisfaction; Pregnancy; Prospective Studies
  7. Fulltext The evolutionary history of hepaciviruses
    Li YQ, Ghafari M, Holbrook AJ, Boonen I, Amor N, Catalano S, et al.
    bioRxiv, 2023 Jun 30.
    PMID: 37425679 DOI: 10.1101/2023.06.30.547218
    In the search for natural reservoirs of hepatitis C virus (HCV), a broad diversity of non-human viruses within the Hepacivirus genus has been uncovered. However, the evolutionary dynamics that shaped the diversity and timescale of hepaciviruses evolution remain elusive. To gain further insights into the origins and evolution of this genus, we screened a large dataset of wild mammal samples (n = 1,672) from Africa and Asia, and generated 34 full-length hepacivirus genomes. Phylogenetic analysis of these data together with publicly available genomes emphasizes the importance of rodents as hepacivirus hosts and we identify 13 rodent species and 3 rodent genera (in Cricetidae and Muridae families) as novel hosts of hepaciviruses. Through co-phylogenetic analyses, we demonstrate that hepacivirus diversity has been affected by cross-species transmission events against the backdrop of detectable signal of virus-host co-divergence in the deep evolutionary history. Using a Bayesian phylogenetic multidimensional scaling approach, we explore the extent to which host relatedness and geographic distances have structured present-day hepacivirus diversity. Our results provide evidence for a substantial structuring of mammalian hepacivirus diversity by host as well as geography, with a somewhat more irregular diffusion process in geographic space. Finally, using a mechanistic model that accounts for substitution saturation, we provide the first formal estimates of the timescale of hepacivirus evolution and estimate the origin of the genus to be about 22 million years ago. Our results offer a comprehensive overview of the micro- and macroevolutionary processes that have shaped hepacivirus diversity and enhance our understanding of the long-term evolution of the Hepacivirus genus.
  8. Fulltext Plasma CXCL8 and MCP-1 as biomarkers of latent tuberculosis infection
    Selvavinayagam ST, Aswathy B, Yong YK, Frederick A, Murali L, Kalaivani V, et al.
    medRxiv, 2023 Aug 09.
    PMID: 37609153 DOI: 10.1101/2023.08.07.23293767
    BACKGROUND: Early detection of latent tuberculosis infection (LTBI) is critical to TB elimination in the current WHO vision of End Tuberculosis Strategy.

    METHODS: We investigated whether detecting plasma cytokines could aid in diagnosing LTBI across household contacts (HHCs) positive for IGRA, HHCs negative for IGRA, and healthy controls. We also measured the plasma cytokines using a commercial Bio-Plex Pro Human Cytokine 17-plex assay.

    RESULTS: Increased plasma CXCL8 and decreased MCP-1, TNF-α, and IFN-γ were associated with LTBI. Regression analysis showed that a combination of CXCL8 and MCP-1 increased the risk of LTBI among HHCs to 14-fold.

    CONCLUSIONS: We postulated that CXCL8 and MCP-1 could be the surrogate biomarkers of LTBI, especially in resource-limited settings.

  9. Fulltext A search for decays of the Higgs boson to invisible particles in events with a top-antitop quark pair or a vector boson in proton-proton collisions at s=13TeV
    Tumasyan A, Adam W, Andrejkovic JW, Bergauer T, Chatterjee S, Damanakis K, et al.
    Eur Phys J C Part Fields, 2023;83(10):933.
    PMID: 37855556 DOI: 10.1140/epjc/s10052-023-11952-7
    A search for decays to invisible particles of Higgs bosons produced in association with a top-antitop quark pair or a vector boson, which both decay to a fully hadronic final state, has been performed using proton-proton collision data collected at s=13TeV by the CMS experiment at the LHC, corresponding to an integrated luminosity of 138fb-1. The 95% confidence level upper limit set on the branching fraction of the 125GeV Higgs boson to invisible particles, B(H→inv), is 0.54 (0.39 expected), assuming standard model production cross sections. The results of this analysis are combined with previous B(H→inv) searches carried out at s=7, 8, and 13TeV in complementary production modes. The combined upper limit at 95% confidence level on B(H→inv) is 0.15 (0.08 expected).
  10. Fulltext On the use of QDE-SVM for gene feature selection and cell type classification from scRNA-seq data
    Ng GYL, Tan SC, Ong CS
    PLoS One, 2023;18(10):e0292961.
    PMID: 37856458 DOI: 10.1371/journal.pone.0292961
    Cell type identification is one of the fundamental tasks in single-cell RNA sequencing (scRNA-seq) studies. It is a key step to facilitate downstream interpretations such as differential expression, trajectory inference, etc. scRNA-seq data contains technical variations that could affect the interpretation of the cell types. Therefore, gene selection, also known as feature selection in data science, plays an important role in selecting informative genes for scRNA-seq cell type identification. Generally speaking, feature selection methods are categorized into filter-, wrapper-, and embedded-based approaches. From the existing literature, methods from filter- and embedded-based approaches are widely applied in scRNA-seq gene selection tasks. The wrapper-based method that gives promising results in other fields has yet been extensively utilized for selecting gene features from scRNA-seq data; in addition, most of the existing wrapper methods used in this field are clustering instead of classification-based. With a large number of annotated data available today, this study applied a classification-based approach as an alternative to the clustering-based wrapper method. In our work, a quantum-inspired differential evolution (QDE) wrapped with a classification method was introduced to select a subset of genes from twelve well-known scRNA-seq transcriptomic datasets to identify cell types. In particular, the QDE was combined with different machine-learning (ML) classifiers namely logistic regression, decision tree, support vector machine (SVM) with linear and radial basis function kernels, as well as extreme learning machine. The linear SVM wrapped with QDE, namely QDE-SVM, was chosen by referring to the feature selection results from the experiment. QDE-SVM showed a superior cell type classification performance among QDE wrapping with other ML classifiers as well as the recent wrapper methods (i.e., FSCAM, SSD-LAHC, MA-HS, and BSF). QDE-SVM achieved an average accuracy of 0.9559, while the other wrapper methods achieved average accuracies in the range of 0.8292 to 0.8872.
    MeSH terms: Machine Learning; Algorithms; Cluster Analysis; Sequence Analysis, RNA/methods; Gene Expression Profiling/methods; Single-Cell Analysis/methods; Transcriptome; Support Vector Machine*
  11. Fulltext Spillover of volatility among financial instruments: ASEAN-5 and GCC market study
    Danila N
    PLoS One, 2023;18(10):e0292958.
    PMID: 37856501 DOI: 10.1371/journal.pone.0292958
    The research examines a comovement and spillover of volatility among foreign exchange, conventional and shariah stock markets in Association of South East Asian Nation-5 (ASEAN) countries and Gulf Cooperation Council (GCC) countries. Generalized Autoregressive Conditional Heteroskedasticity-Baba, Engle, Kraft and Kroner (GARCH-BEKK) and Dynamic Conditional Correlation (GARCH-DCC) models are used to capture the correlation and transmission volatility of the markets. The overall results show that both the Shariah and the conventional stock indices respond similarly to each country's currency. A bidirectional (two-way relationship) volatility spillover exists only in Malaysia and a unidirectional (one-way relationship) volatility is observed in Indonesia, Singapore, Thailand, and Bahrain. The rest of the markets-the Philippines, Saudi Arabia, and the United Arab Emirates (UAE)-do not have any volatility spillover evidence. Based on DCC outcomes, the conventional and Shariah stock in ASEAN-5 countries and GCC countries reveal the market efficiency, i.e., a positive high conditional correlation. Only Bahrain shows less efficiency than the other countries. It implies no portfolio diversification advantage in conventional and Shariah stock indices. Contrarily, currency and stock (conventional and Shariah) markets provide portfolio diversification benefits for all ASEAN-5 and GCC countries.
  12. Fulltext Measurement of radioactivity in soils of Karamjal and Harbaria mangrove forest of Sundarbans for establishment of radiological database
    Siraz MMM, A M J, Alam MS, Rashid MB, Hossain Z, Khandaker MU, et al.
    PLoS One, 2023;18(10):e0289113.
    PMID: 37856554 DOI: 10.1371/journal.pone.0289113
    This work presents the first in-depth study of soil radioactivity in the mangrove forest of Bangladesh part of the Sundarbans. It used HPGe gamma-ray spectrometry to measure the amount of natural radioactivity in soil samples from Karamjal and Harbaria sites of the world's largest mangrove forest. The activity concentrations of most of the 226Ra (14±2 Bqkg-1 to 35±4 Bqkg-1) and 232Th (30±5 Bqkg-1 to 50±9 Bqkg-1) lie within the world average values, but the 40K concentration (370± 44 Bqkg-1 to 660±72 Bqkg-1) was found to have exceeded the world average value. The evaluation of radiological hazard parameters revealed that the outdoor absorbed dose rate (maximum 73.25 nGyh-1) and outdoor annual effective dose (maximum 0.09 mSvy-1) for most samples exceeded the corresponding world average values. The elevated concentration of 40K is mainly due to the salinity intrusion, usage of fertilizers and agricultural runoff, and migration of waste effluents along the riverbanks. Being the pioneering comprehensive research on the Bangladesh side of the Sundarbans, this study forms a baseline radioactivity for the Sundarbans before the commissioning of the Rooppur Nuclear Power Plant in Bangladesh.
    MeSH terms: Potassium Radioisotopes/analysis; Radiation Dosage; Radiation Monitoring*; Radioactivity*; Radium*; Soil; Thorium/analysis; Wetlands
  13. Fulltext Simultaneous determination of tramadol and paracetamol in human plasma using LC-MS/MS and application in bioequivalence study of -fixed-dose combination
    Loh GOK, Wong EYL, Goh CZ, Tan YTF, Lee YL, Pang LH, et al.
    Ann Med, 2023;55(2):2270502.
    PMID: 37857359 DOI: 10.1080/07853890.2023.2270502
    The study aimed to develop a sensitive and high-throughput liquid chromatography coupled with tandem mass spectrometry method to quantify concentrations of tramadol and paracetamol simultaneously in human plasma. Sample preparation involved single-step protein precipitation using methanol and two deuterated internal standards, tramadol D6 and paracetamol D4. Agilent Poroshell 120 EC-C18 (100 × 2.1 mm, 2.1 µm) analytical column was employed to achieve chromatographic separation. Detection was in positive ion multiple reaction monitoring mode. A tailing factor (Tf) of <1.2, separation factor (K prime) of >1.5 from the column dead time and signal-to-noise (S/N) ratio >10, were obtained for analytes and internal standards. The standard curve was linear over the concentration range of 2.5-500.00 ng/mL for tramadol and 0.025-20.00 μg/mL for paracetamol. A small injection volume of 1 µL, low flow rate of 440 µL/min and short analysis time of 3.5 min reduced the solvent consumption, analysis cost and system contamination. The results of method validation parameters fulfilled the acceptance criteria of bioanalytical guidelines. The method was successfully applied to a bioequivalence study of fixed-dose combination products of tramadol and paracetamol in Malaysian healthy subjects.
    MeSH terms: Acetaminophen; Chromatography, High Pressure Liquid/methods; Chromatography, Liquid; Humans; Therapeutic Equivalency; Tandem Mass Spectrometry/methods
  14. 3D printing in surgery: revolutionizing trauma and fracture care in low and middle-income countries
    Awuah WA, Tenkorang PO, Adebusoye FT, Ng JC, Wellington J, Abdul-Rahman T, et al.
    Postgrad Med J, 2023 Dec 21;100(1179):1-3.
    PMID: 37857514 DOI: 10.1093/postmj/qgad100
    MeSH terms: Developing Countries*; Humans; Fractures, Bone*; Printing, Three-Dimensional
  15. Mycorrhizal feedbacks influence global forest structure and diversity
    Delavaux CS, LaManna JA, Myers JA, Phillips RP, Aguilar S, Allen D, et al.
    Commun Biol, 2023 Oct 19;6(1):1066.
    PMID: 37857800 DOI: 10.1038/s42003-023-05410-z
    One mechanism proposed to explain high species diversity in tropical systems is strong negative conspecific density dependence (CDD), which reduces recruitment of juveniles in proximity to conspecific adult plants. Although evidence shows that plant-specific soil pathogens can drive negative CDD, trees also form key mutualisms with mycorrhizal fungi, which may counteract these effects. Across 43 large-scale forest plots worldwide, we tested whether ectomycorrhizal tree species exhibit weaker negative CDD than arbuscular mycorrhizal tree species. We further tested for conmycorrhizal density dependence (CMDD) to test for benefit from shared mutualists. We found that the strength of CDD varies systematically with mycorrhizal type, with ectomycorrhizal tree species exhibiting higher sapling densities with increasing adult densities than arbuscular mycorrhizal tree species. Moreover, we found evidence of positive CMDD for tree species of both mycorrhizal types. Collectively, these findings indicate that mycorrhizal interactions likely play a foundational role in global forest diversity patterns and structure.
    MeSH terms: Feedback; Plants/microbiology; Soil; Symbiosis; Mycorrhizae*
  16. Ab initio insight into the physical properties of MgXH3 (X = Co, Cu, Ni) lead-free perovskite for hydrogen storage application
    Rehman ZU, Rehman MA, Rehman B, Sikiru S, Qureshi S, Ali EM, et al.
    Environ Sci Pollut Res Int, 2023 Nov;30(53):113889-113902.
    PMID: 37858013 DOI: 10.1007/s11356-023-30279-0
    Renewable energy systems are vital for a sustainable future, where solid-state hydrogen storage can play a crucial role. Perovskite hydride materials have attracted the scientific community for hydrogen storage applications. The current work focuses on the theoretical study using density functional theory (DFT) to evaluate the characteristics of MgXH3 (X = Co, Cu, Ni) hydrides. The structural, vibrational, electronic, mechanical, thermodynamic, and hydrogen storage properties of these hydrides were investigated. The equilibrium lattice parameters were calculated using the Birch-Murnaghan equation of state-to-energy volume curves. The elastic constants (Cij) and relevant parameters, such as Born criteria, were calculated to confirm the mechanical stability of the hydrides. The Cauchy pressure (Cp) revealed brittle or ductile behavior. The outcomes of the Pugh ratio, Poisson ratio, and anisotropy were also calculated and discussed. The absence of negative lattice vibrational frequencies in phonon dispersion confirmed the lattice's dynamic stability. The heat capacity curves of thermodynamic properties revealed that hydrides can conduct thermal energy. The metallic character and ample interatomic distances of hydrides were confirmed by the band structure and population analysis, which confirmed that hydrides can conduct electrical energy and adsorb hydrogen. The density of state (DOS) and partial DOS unveiled the role of specific atoms in the DOS of the crystal. The calculated gravimetric hydrogen storage capacity of MgCoH3, MgCuH3, and MgNiH3 hydrides was 3.64, 3.32, and 3.49wt%, respectively. Our results provide a deeper understanding of its potential for hydrogen storage applications through a detailed analysis of MgXH3 (X = Co, Cu, Ni) perovskite hydride material.
    MeSH terms: Hydrogen; Oxides*; Thermodynamics; Calcium Compounds*
  17. Sustainable energy for better social, environmental, and economic returns
    Jalil AA, Hamid MYS, Jusoh NWC, Hassan NS
    Environ Sci Pollut Res Int, 2023 Nov;30(55):116876-116877.
    PMID: 37858029 DOI: 10.1007/s11356-023-30429-4
    MeSH terms: Carbon Dioxide; Conservation of Natural Resources*; Economic Development; Renewable Energy*
  18. Fulltext Diabetic retinopathy: a comprehensive update on in vivo, in vitro and ex vivo experimental models
    Sadikan MZ, Abdul Nasir NA, Lambuk L, Mohamud R, Reshidan NH, Low E, et al.
    BMC Ophthalmol, 2023 Oct 19;23(1):421.
    PMID: 37858128 DOI: 10.1186/s12886-023-03155-1
    Diabetic retinopathy (DR), one of the leading causes of visual impairment and blindness worldwide, is one of the major microvascular complications in diabetes mellitus (DM). Globally, DR prevalence among DM patients is 25%, and 6% have vision-threatening problems among them. With the higher incidence of DM globally, more DR cases are expected to be seen in the future. In order to comprehend the pathophysiological mechanism of DR in humans and discover potential novel substances for the treatment of DR, investigations are typically conducted using various experimental models. Among the experimental models, in vivo models have contributed significantly to understanding DR pathogenesis. There are several types of in vivo models for DR research, which include chemical-induced, surgical-induced, diet-induced, and genetic models. Similarly, for the in vitro models, there are several cell types that are utilised in DR research, such as retinal endothelial cells, Müller cells, and glial cells. With the advancement of DR research, it is essential to have a comprehensive update on the various experimental models utilised to mimic DR environment. This review provides the update on the in vitro, in vivo, and ex vivo models used in DR research, focusing on their features, advantages, and limitations.
    MeSH terms: Blindness/etiology; Diabetes Mellitus*; Diabetic Retinopathy*; Humans; Retina/pathology; Prevalence; Endothelial Cells/pathology
  19. Correction: Plasmodium knowlesi: the game changer for malaria eradication
    Lee WC, Cheong FW, Amir A, Lai MY, Tan JH, Phang WK, et al.
    Malar J, 2023 Oct 19;22(1):316.
    PMID: 37858164 DOI: 10.1186/s12936-023-04732-x
  20. Development of a Malaysian potentially inappropriate prescribing screening tool in older adults (MALPIP): a Delphi study
    Chang CT, Chan HK, Cheah WK, Tan MP, Ch'ng ASH, Thiam CN, et al.
    J Pharm Policy Pract, 2023 Oct 19;16(1):122.
    PMID: 37858273 DOI: 10.1186/s40545-023-00630-4
    INTRODUCTION: Polypharmacy and potentially inappropriate medications (PIM) are common among older adults. To guide appropriate prescribing, healthcare professionals often rely on explicit criteria to identify and deprescribe inappropriate medications, or to start medications due to prescribing omission. However, most explicit PIM criteria were developed with inadequate guidance from quality metrics or integrating real-world data, which are rich and valuable data source.

    AIM: To develop a list of medications to facilitate appropriate prescribing among older adults.

    METHODS: A preliminary list of PIM and potential prescribing omission (PPO) were generated from systematic review, supplemented with local pharmacovigilance data of adverse reaction incidents among older people. Twenty-one experts from nine specialties participated in two Delphi to determine the list of PIM and PPO in February and March 2023. Items that did not reach consensus after the second Delphi round were adjudicated by six geriatricians.

    RESULTS: The preliminary list included 406 potential candidates, categorised into three sections: PIM independent of diseases, disease dependent PIM and omitted drugs that could be restarted. At the end of Delphi, 92 items were decided as PIM, including medication classes, such as antacids, laxatives, antithrombotics, antihypertensives, hormones, analgesics, antipsychotics, antidepressants, and antihistamines. Forty-two disease-specific PIM criteria were included, covering circulatory system, nervous system, gastrointestinal system, genitourinary system, and respiratory system. Consensus to start potentially omitted treatment was achieved in 35 statements across nine domains.

    CONCLUSIONS: The newly developed PIM criteria can serve as a useful tool to guide clinicians and pharmacists in identifying PIMs and PPOs during medication review and facilitating informed decision-making for appropriate prescribing.

External Links