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  1. Hiew SY, Low BY
    Int J Pharm Pract, 2024 Mar 06;32(2):120-132.
    PMID: 38300734 DOI: 10.1093/ijpp/riae001
    OBJECTIVE: The improper disposal of household pharmaceutical waste (HPW) is an emerging cause of environmental pollution. Behavioural practices are intricately linked to individuals' knowledge levels and attitudes. Thus, this systematic review aims to assess the knowledge, attitude, and practice (KAP) of HPW disposal among the public and to examine the interconnectedness of these KAP components.

    METHODS: A literature review for articles published from 2013 to 2023 was carried out in scientific databases PubMed, Scopus, and Web of Science, identifying quantitative studies involving the assessment of KAP of the public concerning HPW disposal.

    RESULTS: This review incorporated 12 studies conducted in Africa, South Asia, and Southeast Asia. Nine studies highlighted a consistent trend of limited to inadequate knowledge regarding safe medication disposal. Notwithstanding, respondents largely exhibited a positive attitude towards proper medication disposal. This encouraging disposition, unfortunately, stands in stark contrast to the reported practices, which appeared to be inadequate. This dissonance might be due to a deficit in accessible disposal facilities and information, compounded with insufficient guidance from healthcare professionals. Interestingly, the majority expressed support for take-back programs aimed at managing unused and expired medications.

    CONCLUSION: This review identified a need for a comprehensive understanding of the interconnected dynamics among KAP components regarding safe medication disposal. The exploration of theoretical behavioural frameworks could help predict public intentions to adopt safe medication disposal practices. Ultimately, a multi-faceted approach that addresses knowledge gaps, reinforces positive attitudes, and promotes accessible safe medication disposal services can collectively safeguard the environment and public health.

  2. Low BY, Ting KN, Lee MK
    Int J Pharm Pract, 2023 Apr 10;31(2):261-265.
    PMID: 36534990 DOI: 10.1093/ijpp/riac101
    OBJECTIVE: To assess the knowledge, attitude and practice of community pharmacists (CP) towards household pharmaceutical waste disposal.

    METHODS: All pharmacists attending the Malaysian Community Pharmacy Guild event held in-person were invited to self-administer a web-based survey.

    KEY FINDINGS: The response rate was 61% (168/276). Overall, community pharmacists have mixed knowledge (mean ± SD: 5.89 ± 1.38) and positive attitude (mean ± SD: 9.58 ± 0.81) towards household pharmaceutical waste disposal. However, few community pharmacists (18/168, 10.7%) have promotional materials encouraging safe medication disposal in their pharmacies.

    CONCLUSIONS: Community pharmacists do not proactively promote safe household pharmaceutical waste disposal to mitigate pharmaceutical pollutants entering the environment although they have satisfactory knowledge and attitude.

  3. Chanakit T, Low BY, Wongpoowarak P, Moolasarn S, Anderson C
    BMC Med Educ, 2015 Nov 19;15:205.
    PMID: 26585968 DOI: 10.1186/s12909-015-0473-4
    BACKGROUND: Pharmacy education and pharmacy practice are facing remarkable changes following new scientific discoveries, evolving patient needs and the requirements of advanced pharmacy competency for practices. Many countries are introducing or undertaking major transformations in pharmacy education. The Thai pharmacy curriculum has been changed from a 5-year BPharm and a 6-year PharmD to only a 6-year PharmD programme. Curriculum change processes usually involve stakeholders, including both internal and external educational institutions, at all levels. This study aims to understand the experiences and perceptions of stakeholders regarding the transition to an all-PharmD programme in Thailand.

    METHODS: Semi-structured interviews were conducted in Thailand with 130 stakeholders (e.g., policy makers, pharmacy experts, educators, health care providers, patients, students and parents) from August-October 2013. The interviews were audio recorded, transcribed verbatim and analysed using an inductive thematic analysis.

    RESULTS: Three main themes were derived from the findings: 1. influences on curriculum change (e.g., the needs of pharmacists to provide better patient care, the US-Thai consortium for the development of pharmacy education); 2. perceived benefits (e.g., improve pharmacy competencies from generalists to specialists, ready to work after graduation, providing a high quality of patient care); and 3. concerns (e.g., the higher costs of study for a longer period of time, the mismatch between the pharmacy graduates' competency and the job market's needs, insufficient preceptors and training sites, lack of practical experience of the faculty members and issues related to the separate licenses that are necessary due to the difference in the graduates' specialties).

    CONCLUSIONS: This is the first study to highlight the issues surrounding the transition to the 6-year PharmD programme in Thailand, which was initiated due to the need for higher levels of competency among the nation's pharmacists. The transition was influenced by many factors. Many participants perceived benefits from the new pharmacy curriculum. However, some participants were concerned about this transition. Although most of the respondents accepted the need to go forward to the 6-year PharmD programme, designing an effective curriculum, providing a sufficient number of qualified PharmD preceptors, determining certain competencies of pharmacists in different practices and monitoring the quality of pharmacy education still need to be addressed during this transitional stage of pharmacy education in Thailand.

  4. Chanakit T, Low BY, Wongpoowarak P, Moolasarn S, Anderson C
    BMC Med Educ, 2015;15:181.
    PMID: 26498661 DOI: 10.1186/s12909-015-0471-6
    Thai pharmacy education has moved to an all Doctor of Pharmacy (PharmD) programme. However, there has been no previous research about the perceptions regarding the suitability of PharmD graduates employed in hospital settings, which is the major pharmacy workforce in Thailand.
  5. Supapaan T, Low BY, Wongpoowarak P, Moolasarn S, Anderson C
    Pharm Pract (Granada), 2019 08 21;17(3):1611.
    PMID: 31592299 DOI: 10.18549/PharmPract.2019.3.1611
    This review focuses on the studies and opinions around issues of transition from the BPharm to the PharmD degree in the U.S., Japan, South Korea, Pakistan and Thailand. The transition to the clinically orientated PharmD degree in many countries was seen to be a means of developing the profession. However, some countries have both clinically-oriented and pharmaceutical sciences-oriented PharmD programme that are designed to meet the needs of their countries. Each country created a different process to handle the transition to an all-PharmD programme, but mostly had the process of school accreditation mandated by the regulatory bodies. The main barrier to the transition in most of the countries was the issue of educational quality. A set of indicators is needed to measure and monitor the impact/outcome of the PharmD degree. Each country has different needs due to the different contexts of health care systems and the scope of pharmacy practice. In order to increase their chances of benefiting from the new programme, academic leaders should critically assess their countries' needs before deciding to adopt a PharmD programme.
  6. Chanakit T, Low BY, Wongpoowarak P, Moolasarn S, Anderson C
    Am J Pharm Educ, 2014 Nov 15;78(9):161.
    PMID: 26056400 DOI: 10.5688/ajpe789161
    To explore the current status of pharmacy education in Thailand.
  7. Toh LS, Lai PS, Wu DB, Wong KT, Low BY, Anderson C
    PLoS One, 2015;10(5):e0124553.
    PMID: 25938494 DOI: 10.1371/journal.pone.0124553
    Objectives: To develop and validate Osteoporosis Prevention and Awareness Tool (OPAAT) in Malaysia.
    Methods: The OPAAT was modified from the Malaysian Osteoporosis Knowledge Tool and developed from an exploratory study on patients. Face and content validity was established by an expert panel. The OPAAT consists of 30 items, categorized into three domains. A higher score indicates higher knowledge level. English speaking non-osteoporotic postmenopausal women 50 years of age and pharmacists were included in the study.
    Results: A total of 203 patients and 31 pharmacists were recruited. Factor analysis extracted three domains. Flesch reading ease was 59.2. The mean±SD accuracy rate was 0.60±0.22 (range: 0.26-0.94). The Cronbach’s α for each domain ranged from 0.286-0.748. All items were highly correlated (Spearman’s rho: 0.761-0.990, p<0.05), with no significant change in the overall test-retest scores, indicating that OPAAT has achieved stable reliability. Pharmacists had higher knowledge score than patients (80.9±8.7vs63.6±17.4, p<0.001), indicating
    that the OPAAT was able to discriminate between the knowledge levels of pharmacists and patients.
    Conclusion: The OPAAT was found to be a valid and reliable instrument for assessing patient’s knowledge about osteoporosis and its prevention in Malaysia. The OPAAT can be used to identify individuals in need of osteoporosis educational intervention.
    Study site:: Primary care clinic, tertiary hospital, Malaysia
  8. Toh LS, Lai PSM, Low BY, Wong KT, Anderson C
    Int J Clin Pharm, 2020 Feb;42(1):11-17.
    PMID: 32221825 DOI: 10.1007/s11096-019-00960-x
    Background Population screening for osteoporosis using bone mineral density scan is not feasible in Malaysia as this test is costly. Hence, there is a need to develop a more efficient method to screen for osteoporosis.Objectives To determine the feasibility of an interprofessional collaborative osteoporosis screening programme (IPC-OSP). Methods Postmenopausal women aged ≥ 50 years, who had not been diagnosed with osteoporosis were recruited from a primary care clinic from June to August 2014. Patients were assessed for their osteoporosis risk and were counselled on prevention methods. Patients at risk were referred to the doctor with a recommendation for a bone mineral density (BMD) scan. Results Fifty out of 55 patients were recruited (response rate = 90.9%). A total 26/50 (52.0%) went for a bone mineral density scan, none were osteoporotic, 17/50 (34%) were osteopenic, 2/50 (4.0%), were started on osteoporosis medications and 14/50 (28%) modified their lifestyle to improve bone health or started on calcium supplements. Osteoporosis knowledge significantly increased from baseline to month two (46.3 ± 21.4 vs. 79.1 ± 14.3, p 
  9. Lee EL, Haseeb ASMA, Basirun WJ, Wong YH, Sabri MFM, Low BY
    Sci Rep, 2021 Aug 03;11(1):15768.
    PMID: 34344974 DOI: 10.1038/s41598-021-95276-0
    The miniaturization of electronic devices and the consequent decrease in the distance between conductive lines have increased the risk of short circuit failure due to electrochemical migration (ECM). The presence of ionic contaminants affects the ECM process. This work systematically investigates the ECM of tin (Sn) in the presence of bromide ions (Br-) in the range of 10-6 M to 1.0 M. Water drop test (WDT) was conducted in the two-probe semiconductor characterization system under an optical microscope as an in-situ observation. Polarization test was carried out to study the correlation between the corrosion properties of Sn and its ECM behaviour. The products of ECM were characterized by scanning electron microscope coupled with an energy dispersive X-rays spectrometer (SEM/EDX) and X-ray photoelectron spectrometer (XPS). The results confirm that the rate of anodic dissolution of Sn monotonously increases with the Br- concentration. However, the probability of ECM failure follows a normal distribution initially, but later increases with the Br- concentration. The main products of the ECM reactions are identified as Sn dendrites and tin hydroxide precipitates. The mechanisms of the ECM process of Sn in the presence of Br- are also suggested.
  10. Toh LS, Lai PSM, Othman S, Wong KT, Low BY, Anderson C
    Res Social Adm Pharm, 2017 11;13(6):1142-1150.
    PMID: 27780658 DOI: 10.1016/j.sapharm.2016.10.004
    OBJECTIVES: This study describes the perspective of patients, nurses, pharmacists, doctors and policy makers to identify the level of collaboration and the areas for improvement to achieve inter-professional collaboration between doctors, nurses, pharmacists and policy makers in a primary care clinic.

    METHODS: Patients (n = 20), Nurses (n = 10), pharmacists (n = 11), doctors (n = 10) and policy makers (n = 5) from a primary care were individually interviewed using a semi-structured topic guide. Purposive sampling was used. Interviews were transcribed verbatim and analysed using thematic analysis informed by constant comparison.

    RESULTS: Patients, doctors, nurses, pharmacists and policy makers were eager for pharmacists to be more proactive in creating health awareness and conducting osteoporosis screening at the primary care clinic via inter-professional collaboration. These findings were further examined using the D'Amour's structural model of collaboration which encompasses four main themes: shared goals and visions, internalization, formalization and governance. This model supports our data which highlights a lack of understanding of the pharmacists' role among the doctors, nurses, policy makers and pharmacists themselves. There is also a lack of governance and formalization, that fosters consensus, leadership, protocol and information exchange. Nonetheless, the stakeholders trust that pharmacists have sufficient knowledge to contribute to the screening of osteoporosis. Our primary care clinic can be described as developing towards an inter-professional collaboration in managing osteoporosis but is still in its early stages.

    CONCLUSIONS: Inter-professional collaboration in osteoporosis management at the primary care level is beginning to be practised. Efforts extending to awareness and acceptance towards the pharmacists' role will be crucial for a successful change.
  11. Toh LS, Lai PSM, Othman S, Shah A, Dang CPL, Low BY, et al.
    Int J Clin Pharm, 2018 Apr;40(2):450-457.
    PMID: 29380234 DOI: 10.1007/s11096-018-0597-9
    Background: Several studies have found that pharmacists can assist in screening and prevention of osteoporosis by referring patients for bone mineral density scans and counselling on lifestyle changes. In Malaysia, screening osteoporosis in all elderly women is not mandatory due to its cost. One approach to address this gap is to develop a pharmacist-led osteoporosis screening and prevention program. However, there is a paucity of data on the perspectives of Malaysian pharmacists in this area.
    Objective: To explore the perspective of stakeholders (policy makers, doctors, pharmacists, nurses and patients) towards the role of pharmacists in osteoporosis screening and management.
    Setting: A primary care clinic located within a teaching hospital in Kuala Lumpur, Malaysia.
    Method: Patients (n = 20), nurses (n = 10), pharmacists (n = 11), doctors (n = 10) and policy makers (n = 5) were individually interviewed using a semi-structured topic guide. Purposive sampling was used. Interviews were transcribed verbatim and analysed using thematic analysis. Main outcome measure Perspective of stakeholders on the current and future role of pharmacists.
    Results: All participants perceived pharmacists to be suppliers of medication, although there was some recognition of roles in providing medication advice. Nonetheless, these stakeholders were eager for pharmacists to expand their non-dispensing roles towards counselling, creating awareness and screening of osteoporosis. Interviewed pharmacists referred to their current role as 'robotic dispensers' and unanimously agreed to spread out to osteoporosis management role.
    Conclusion: Under stakeholders there is a willingness to expand the role of pharmacists in Malaysia to non-dispensing roles, particularly in osteoporosis screening and management.
    Study site: Primary care clinic, teaching hospital, Kuala Lumpur, Malaysia
  12. Toh LS, Lai PS, Wu DB, Wong KT, Low BY, Tan AT, et al.
    Patient Prefer Adherence, 2014;8:1365-81.
    PMID: 25328386 DOI: 10.2147/PPA.S65718
    Purpose: To develop and validate the English version of the Satisfaction Questionnaire for Osteoporosis Prevention (SQOP) in Malaysia.
    Methods: The SQOP was modified from the Osteoporosis Patient Satisfaction Questionnaire and developed based on literature review and patient interviews. Face and content validity were established via an expert panel. The SQOP consists of two sections: clinical services and types of counseling. There were 23 items in total, each with a five-point Likert-type response. Satisfaction score was calculated by converting the total score to a percentage. A higher score indicates higher satisfaction. English speaking, non-osteoporotic, postmenopausal women aged 50 years were included in the study. Participants were randomized to either the control or intervention group. Intervention participants were provided counseling, whereas control participants received none. Participants answered the SQOP at baseline and 2 weeks later.
    Results: A total of 140 participants were recruited (control group: n=70; intervention group: n=70). No significant differences were found in any demographic aspects. Exploratory factor analysis extracted seven domains. Cronbach’s α for the domains ranged from 0.531–0.812. All 23 items were highly correlated using Spearman’s correlation coefficient 0.469–0.996 (P<0.05), with no significant change in the control group’s overall test–retest scores, indicating that the
    SQOP achieved stable reliability. The intervention group had a higher score than the control group (87.91±5.99 versus 61.87±8.76; P<0.05), indicating that they were more satisfied than control participants. Flesch reading ease was 62.9.
    Conclusion: The SQOP was found to be a valid and reliable instrument for assessing patients’ satisfaction towards an osteoporosis screening and prevention service in Malaysia.
    Keywords: patient satisfaction, randomized controlled trial, postmenopausal women, screening
    Study site: primary care clinic, tertiary hospital, Malaysia
  13. Jamshed SQ, Ibrahim MI, Hassali MA, Masood I, Low BY, Shafie AA, et al.
    South Med Rev, 2012 Jul;5(1):22-30.
    PMID: 23093896
    OBJECTIVES: In developing countries out-of-pocket payments (OOP) are as high as 80% of healthcare spending. Generic medicines can be instrumental in reducing this expenditure. The current study is aimed to explore the knowledge, perception, and attitude of general practitioners towards generic medicines in Karachi, Pakistan.
    METHODS: This exploratory, descriptive study was conducted on a sample of 289 randomly selected general practitioners who were dispensing at their private clinics in Karachi, Pakistan. The questionnaires were distributed and collected by hand. Data was entered to SPSS version 17. Fischer's exact test was applied to see the association between variables.
    RESULTS: A total of 206 questionnaires were included in the study. A response rate of 71.3% was achieved. Out of 206 respondents, 139 (67.5%) were male while 67 (32.5%) respondents were female. Close to three quaters of the respondents (n= 148; 71.8%) showed correct knowledge about generic medicines being a 'copy of the brand name medicines' and 'interchangeable with brand name medicines' (n= 148; 71.8%). In terms of safety, the majority of respondents (n=85; 41.26%) incorrectly understood that the generic medicines are less safe than brand name medicines. The total percentage of correct responses was seen in 53% of the respondents. More than half of the respondents agreed that locally manufactured medicines are of the same effectiveness as brand name medicines (n=114; 55.4%). Male practitioners with practice experience of 11-15 years showed positive perception towards the quality of multinational products. The Majority of respondents believed that their prescribing decision is influenced by medical representatives (n=117; 56.8%). More than three-quarters of the respondents expressed their wish to prescribe low cost medicines in their practice (n=157; 76.2%). More than one third of the respondents expressed their uneasiness to prescribe products from all local manufacturers (n=72; 35%).
    CONCLUSION: There were gaps identified in the knowledge of respondents. Although good perception and attitude were noted among the respondents, dissemination of information regarding generic medicines may perhaps strengthen generic prescribing. There is a need to introduce 'Quality by Design' concept in local manufacturing units. This, in turn, can inculcate confidence in prescribers towards locally manufactured generic medicines.
    KEYWORDS: Karachi; Pakistan; attitude; dispensing doctor; general practitioner; generic medicines; perception
  14. Low BY, Liong ML, Yuen KH, Chee C, Leong WS, Chong WL, et al.
    J Urol, 2008 Apr;179(4):1461-9.
    PMID: 18295277 DOI: 10.1016/j.juro.2007.11.060
    PURPOSE: We determined the clinical efficacy and safety of terazosin in the treatment of patients with female lower urinary tract symptoms.
    MATERIALS AND METHODS: A total of 100 females 20 to 70 years old who met the inclusion criteria of total International Prostate Symptom Score 8 or greater, symptom duration 1 or more months, and did not meet any exclusion criteria were entered into the study. Subjects were randomized to receive terazosin or placebo in titrated dose from 1 mg od, 1 mg twice daily to 2 mg twice daily during 14 weeks. Successful treatment outcomes use primary end point of International Prostate Symptom Score quality of life 2 or less and secondary end point of total International Prostate Symptom Score 7 or less. Other outcome measures included International Prostate Symptom Score individual item scores, King's Health Questionnaire quality of life domains, objective assessment parameters of 24-hour frequency volume chart, maximum flow rate and post-void residual urine.
    RESULTS: Using a primary end point, 32 of 40 (80%) evaluable terazosin subjects responded in contrast to 22 of 40 (55%) evaluable placebo subjects (p <0.02). The secondary end point revealed a successful outcome in 85% of terazosin subjects vs 55% in placebo (p <0.01). Of the 7 International Prostate Symptom Score individual item scores, only item scores of frequency and straining showed statistically significant reductions with terazosin (p <0.01). All King's Health Questionnaire quality of life domains except domain of severity measures showed statistically significant improvement with terazosin (p <0.05). There were no differences between treatment groups in all objective assessment parameters. Of all evaluable subjects 23 of 40 (58%) on placebo experienced adverse events vs 16 of 40 (40%) on terazosin (p >0.05).
    CONCLUSIONS: Terazosin proved to be more effective and safe than placebo in patients with female lower urinary tract symptoms.
  15. Toh LS, Lai PSM, Wu DB, Bell BG, Dang CPL, Low BY, et al.
    Osteoporos Sarcopenia, 2019 Sep;5(3):87-93.
    PMID: 31728426 DOI: 10.1016/j.afos.2019.09.001
    Objectives: To compare and assess the performance of 6 osteoporosis risk assessment tools for screening osteoporosis in Malaysian postmenopausal women.

    Methods: Six osteoporosis risk assessments tools (the Simple Calculated Osteoporosis Risk Estimation [SCORE], the Osteoporosis Risk Assessment Instrument, the Age Bulk One or Never Estrogen, the body weight, the Malaysian Osteoporosis Screening Tool, and the Osteoporosis Self-Assessment Tool for Asians) were used to screen postmenopausal women who had not been previously diagnosed with osteoporosis/osteopenia. These women also underwent a dual-energy X-ray absorptiometry (DXA) scan to confirm the absence or presence of osteoporosis.

    Results: A total of 164/224 participants were recruited (response rate, 73.2%), of which only 150/164 (91.5%) completed their DXA scan. Sixteen participants (10.7%) were found to have osteoporosis, whilst 65/150 (43.3%) were found to have osteopenia. Using precision-recall curves, the recall of the tools ranged from 0.50 to 1.00, whilst precision ranged from 0.04 to 0.14. The area under the curve (AUC) ranged from 0.027 to 0.161. The SCORE had the best balance between recall (1.00), precision (0.04-0.12), and AUC (0.072-0.161).

    Conclusions: We found that the SCORE had the best balance between recall, precision, and AUC among the 6 screening tools that were compared among Malaysian postmenopausal women.

  16. Low BY, Liong ML, Yuen KH, Chong WL, Chee C, Leong WS, et al.
    Urology, 2006 Oct;68(4):751-8.
    PMID: 17070347
    To determine the prevalence, severity, and quality-of-life (QOL) impact of female lower urinary tract symptoms (FLUTS); to determine the patterns, reasons, and factors contributing to the women's treatment-seeking behavior; and to describe the relationship between the social demographic characteristics and FLUTS.
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