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  1. Nguyen TA, Hassali MAA, McLachlan A
    WHO South East Asia J Public Health, 2013 Jan-Mar;2(1):72-74.
    PMID: 28612828 DOI: 10.4103/2224-3151.115849
    Generic medicines are a key strategy used by governments and third-party payers to contain medicines costs and improve the access to essential medicines. This strategy represents an important opportunity provided by the global intellectual property regimes to discover and develop copies of original products marketed by innovator companies once the patent protection term is over. While there is an extensive experience regarding generic medicines policies in developed countries, this evidence may not translate to developing countries. The generic medicines policies workshop at the Asia Pacific Conference on National Medicines Policies 2012 provided an important opportunity to discuss and document country-specific initiatives for improving access to and the rational of use of generic medicines in the Asia Pacific region. Based on the identified barriers and enablers to implementation of generic medicines policies in the region, a set of future action plans and recommendations has been made.
  2. Ha MT, Ho TAT, Nguyen AN, Nguyen TA
    Trop Biomed, 2021 Sep 01;38(3):371-376.
    PMID: 34508346 DOI: 10.47665/tb.38.3.082
    In Vietnam, severe malaria is currently rare but is a life-threatening disease. It may be misdiagnosed with other common diseases. This descriptive study aimed to characterize severe malaria and its clinical aspects, as well as outcomes of infected pediatric patients to improve case management. The case-series study was carried out based on medical records of children aged between one month and 15 years with malaria diagnosed by blood smear or rapid diagnostic test. Chi-squared test with the p values less than 0.05 were considered statistically significant. There were 47 cases enrolled in the study. The prevalence of severe malaria was 29.8% (57.1% in children under five). The morbidity was 71.4% in male and 28.6% in female. Common clinical signs of severe malaria were fever (100%), severe anemia (21.4%), hepatomegaly (85.7%), and splenomegaly (71.4%). Common biological abnormalities in severe malaria were anemia, thrombocytopenia, increased liver enzymes, and high CRP level. The severe malaria was mainly caused by P. falciparum (100%). The age range for those infected with P. falciparum was 6.5 ± 4.5 years (min 0.3; max 14.9). The successful rate of treatment was 92.9% with artesunate. Antimalarial treatment time was 9.0 (6 - 12) days for severe malaria, which was twice as many as that for non-severe malaria (p = 0.067). The current clinical and biological findings of severe malaria are different from those in previous times, which make it easy to be overlooked. Therefore, it's important to perform malaria diagnostic tests when there're clinical suggestions of severe malaria, including fever, hepatomegaly or splenomegaly.
  3. Hassali MA, Alrasheedy AA, McLachlan A, Nguyen TA, Al-Tamimi SK, Ibrahim MI, et al.
    Saudi Pharm J, 2014 Dec;22(6):491-503.
    PMID: 25561861 DOI: 10.1016/j.jsps.2013.12.017
    Generic medicines are clinically interchangeable with original brand medicines and have the same quality, efficacy and safety profiles. They are, nevertheless, much cheaper in price. Thus, while providing the same therapeutic outcomes, generic medicines lead to substantial savings for healthcare systems. Therefore, the quality use of generic medicines is promoted in many countries. In this paper, we reviewed the role of generic medicines in healthcare systems and the experiences of promoting the use of generic medicines in eight selected countries, namely the United States (US), the United Kingdom (UK), Sweden, Finland, Australia, Japan, Malaysia and Thailand. The review showed that there are different main policies adopted to promote generic medicines such as generic substitution in the US, generic prescribing in the UK and mandatory generic substitution in Sweden and Finland. To effectively and successfully implement the main policy, different complementary policies and initiatives were necessarily introduced. Barriers to generic medicine use varied between countries from negative perceptions about generic medicines to lack of a coherent generic medicine policy, while facilitators included availability of information about generic medicines to both healthcare professionals and patients, brand interchangeability guidelines, regulations that support generic substitution by pharmacists, and incentives to both healthcare professionals and patients.
  4. Nguyen TA, Kirubakaran R, Schultz HB, Wong S, Reuter SE, McMullan B, et al.
    Clin Chem, 2023 Jun 01;69(6):637-648.
    PMID: 37116191 DOI: 10.1093/clinchem/hvad036
    BACKGROUND: Therapeutic drug monitoring (TDM) of aminoglycosides and vancomycin is used to prevent oto- and nephrotoxicity in neonates. Analytical and nonanalytical factors potentially influence dosing recommendations. This study aimed to determine the impact of analytical variation (imprecision and bias) and nonanalytical factors (accuracy of drug administration time, use of non-trough concentrations, biological variation, and dosing errors) on neonatal antimicrobial dosing recommendations.

    METHODS: Published population pharmacokinetic models and the Australasian Neonatal Medicines Formulary were used to simulate antimicrobial concentration-time profiles in a virtual neonate population. Laboratory quality assurance data were used to quantify analytical variation in antimicrobial measurement methods used in clinical practice. Guideline-informed dosing recommendations based on drug concentrations were applied to compare the impact of analytical variation and nonanalytical factors on antimicrobial dosing.

    RESULTS: Analytical variation caused differences in subsequent guideline-informed dosing recommendations in 9.3-12.1% (amikacin), 16.2-19.0% (tobramycin), 12.2-45.8% (gentamicin), and 9.6-19.5% (vancomycin) of neonates. For vancomycin, inaccuracies in drug administration time (45.6%), use of non-trough concentrations (44.7%), within-subject biological variation (38.2%), and dosing errors (27.5%) were predicted to result in more dosing discrepancies than analytical variation (12.5%). Using current analytical performance specifications, tolerated dosing discrepancies would be up to 14.8% (aminoglycosides) and 23.7% (vancomycin).

    CONCLUSIONS: Although analytical variation can influence neonatal antimicrobial dosing recommendations, nonanalytical factors are more influential. These result in substantial variation in subsequent dosing of antimicrobials, risking inadvertent under- or overexposure. Harmonization of measurement methods and improved patient management systems may reduce the impact of analytical and nonanalytical factors on neonatal antimicrobial dosing.

  5. Mattap SM, Mohan D, Xi HJ, Ramachandram DS, Turana Y, Tan MP, et al.
    Alzheimers Dement, 2024 Dec;20 Suppl 7(Suppl 7):e086022.
    PMID: 39784941 DOI: 10.1002/alz.086022
    BACKGROUND: Dementia is a global public health concern, that poses daily challenges to the individuals, families, and healthcare systems worldwide. Sixty percent of those affected reside in low- and middle-income countries (LMICs), where 71% of new cases are anticipated by 2025. Most dementia studies focus on high-income countries, emphasizing the need for region-specific investigations in areas like Southeast Asia, where diverse cultural, economic, and healthcare settings present unique complexities. Addressing specific challenges and priorities in Southeast Asia will facilitate tailored interventions and effective strategies. We aim to map dementia research priorities in Southeast Asian LMICs and align them with stakeholder-identified priorities through a consultation process using the nominal group technique.

    METHOD: A scoping review was conducted utilizing the Joanna Briggs Institute guidance. Four databases (OvidMedline, Scopus, PsycINFO, and CINAHL) were searched for eligible studies reporting dementia research priorities in LMICs in Southeast Asian. Comparisons were made to a stakeholders' consultation during a two-day workshop from the 9th to 10th February 2023 in Kuala Lumpur, Malaysia. Participants included the Southeast Asia-Dementia (SEA-Dem) Research Network members key stakeholders from Malaysia, Indonesia, Vietnam, Philippines, Singapore, and Hong Kong (n = 20). Research priorities from each participating country were generated and ranked, harmonized with those from the nominal group technique into tiers of priorities.

    RESULT: Only two studies from Malaysia and Vietnam were eligible, reporting unranked research priorities. Nominal group technique ranked outcomes from Malaysia, Vietnam, Indonesia, and the Philippines were included. Top dementia research priorities were (1) local research and data collection capacity, (2) community awareness and engagement, and (3) health policy. Second-tier research priorities included harmonizing guidelines and tools standardization, health inequalities, and availability of carer support. The third tier comprised multisectoral collaboration, integration of care, telemedicine, digital approaches, dementia risk reduction, health economics, and sustainable interventions.

    CONCLUSION: Our ranked and harmonized latest dementia research priorities list can serve as a more nuanced and contextually informed dementia research directional guide for countries with similar backgrounds. Collaborative efforts to increase high-quality dementia research capacity in Southeast Asian LMICs should be intensified for better dementia care in the region.

  6. O'Callaghan C, Michaelian JC, Aihara Y, Anlacan VM, Chen C, Cheung G, et al.
    Lancet Reg Health West Pac, 2024 Sep;50:101183.
    PMID: 39399864 DOI: 10.1016/j.lanwpc.2024.101183
    Here we first review the limited available literature addressing the current landscape of specialist assessment services for dementia and cognitive decline and the preparedness for new amyloid-targeting therapies for Alzheimer's disease across the Western Pacific region. Considering the scarcity of literature, as national representatives of Western Pacific nations we were then guided by the World Health Organization's Global Action Plan on Dementia to provide country-specific reviews. As a whole, we highlight that the existing diverse socioeconomic and cultural landscape across the region poses unique challenges, including varying access to services and marked differences among countries in their preparedness for upcoming amyloid-targeting therapies for Alzheimer's disease. Therefore, there is an urgent call for intergovernmental collaboration and investment across the Western Pacific to ensure that for all nations, citizens living with dementia and cognitive decline have access to effective and equitable methods of diagnosis, treatment and care.
  7. Hughes A, Ragonnet R, Jayasundara P, Ngo HA, de Lara-Tuprio E, Estuar MRJ, et al.
    Lancet Reg Health West Pac, 2022 Dec;29:100563.
    PMID: 35974800 DOI: 10.1016/j.lanwpc.2022.100563
  8. Nguyen TA, Pham T, Vu HTT, Nguyen TX, Vu TT, Nguyen BTT, et al.
    Am J Alzheimers Dis Other Demen, 2018 Nov;33(7):423-432.
    PMID: 29642720 DOI: 10.1177/1533317518768999
    This study examined the use of potentially inappropriate medicines that may affect cognition (PIMcog) in people with dementia and its associated factors. Medical records of all outpatients with dementia attending a tertiary hospital in Vietnam between January 1, 2015, and December 31, 2016, were examined. Medicine use was assessed against a list of PIMcog. Variables associated with having a PIMcog were assessed using a multiple logistic regression. Of the 128 patients, 41% used a PIMcog, 39.1% used cholinesterase inhibitors (CEIs) concomitantly with anticholinergics, and 18% used antipsychotics. The number of hospital visits (adjusted odds ratio [OR]: 1.08; 95% confidence interval [CI]: 1.02-1.16) and number of treating specialists (adjusted OR: 0.61; 95% CI: 0.45-0.83) were associated with PIMcog use. This study highlights a high-level use of medicines that can further impair cognition or reduce the effectiveness of CEIs in people with dementia. Efforts to improve quality use of medicines for this population are warranted.
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