Background Increased harmful effects of medication resulting from polypharmacy, especially among older patients, is a significant concern globally. Hence, continuous medication review and withdrawal of inappropriate medications are essential to improve patient safety. Objective To explore physicians' perceived barriers and enablers of deprescribing among older patients in the public primary healthcare setting. Setting Public primary care clinics in the northern states of Malaysia. Methods A semi-structured, face-to-face interview was conducted among physicians working in eight primary care clinics in northern Malaysia using a purposive sampling approach. Interviews were conducted using validated topic guides. All the responses were recorded, transcribed verbatim, validated, and analysed for the emerging themes using thematic analysis. Main outcome measure Physicians perceived barriers and enablers of deprescribing among geriatric patients. Results A total of eleven physicians were interviewed. Seven emerging themes were identified, which are categorised under barriers and enablers of deprescribing. The barriers were patient-specific, prescriber-specific, and healthcare provision and system. Prescriber deprescribing competencies, medication-specific outcomes, availability of empirical evidence, and pharmacist's role were the enablers identified. Conclusion Patient-specific barriers were identified as a significant challenge for deprescribing. Improving competencies on deprescribing was the repeatedly adduced enabler by physicians. The development of targeted educational training can help to reduce the obstacles faced by prescribers.
In this study, the authors investigated the effects of a single layer graphene as a coating layer on top of metal thin films such as silver, gold, aluminum and copper using finite-difference time domain method. To enhance the resolution of surface plasmon resonance (SPR) sensor, it is necessary to increase the SPR reflectivity and decrease the full-width-half maximum (FWHM) of the SPR curve so that there is minimum uncertainty in the determination of the resonance dip. Numerical data was verified with analytical and experimental data where all the data were in good agreement with resonance angle differing in <10% due to noise present in components such as humidity and temperature. In further analysis, reflectivity and FWHM were compared among four types of metal with various thin film thicknesses where graphene was applied on top of the metal layers, and data was compared against pure conventional metal thin films. A 60 nm-thick Au thin film results in higher performance with reflectivity of 92.4% and FWHM of 0.88° whereas single layer graphene-on-60 nm-thick Au gave reflectivity of 91.7% and FWHM of 1.32°. However, a graphene-on-40 nm-thick Ag also gave good performance with narrower FWHM of 0.88° and reflection spectra of 89.2%.