Increasing prescription drug pricing often reflects additional work stress on medical professionals because they function as financial advisors for patients and help them manage out-of-pocket expenses. Providers or prescribers wish to help patients with prescription costs but often lack related information. Healthcare plan providers try to display prescription and drug cost information on their websites, but such data may not be linked to electronic prescription software. A mark-up is defined as the additional charges and costs that are applied to the price of a product for the purpose of covering overhead costs, distribution charges, and profit. Therefore, the policies implemented in the pharmaceutical distribution chain might include the regulation of wholesale and retails mark-ups and pharmaceutical remuneration. If mark-ups are regulated, countries are highly recommended to use regressive mark-ups rather than fixed percentage mark-ups. This narrative review provides insights into the framework of pharmaceutical mark-up systems by describing different factors impacting pharmaceutical prices and affordability. These include the interplay of medicine pricing and the supply chain, the impact of pertinent laws and regulation and out-of-pocket expenditure.

Antibiotic use and its linked to antibiotic resistance has become a great public concern. Antibiotic-resistant infections resulted from abuse of antibiotics have causedsubstantial morbidity and mortality worldwide. This problem is so serious that it threatens the achievements of modern medicines. Poor knowledge and attitude amonggeneral public has served as a barrier to appropriate antibiotics utilisation. This study aimed to determine public's knowledge, attitude towards antibiotic use and pattern of self-medication with antibiotic's (SMA) practice in AlorSetar, Kedah. This study also aimed to determine the correlation between knowledge and attitude as well as to study the level of knowledge and attitude among different demographic background. A guided self-administered questionnaire was used in this study. The questionnaire composed of 4 parts; demographic data, knowledge about antibiotic, attitude towards antibiotics use and SMA practice. This cross-sectional study in AlorSetar, Kedah, included 394 respondents sampled via convenient sampling method. The proportions of male and female respondents in this study were 47.2% and 52.8% respectively. More than half of the respondents were of Malay ethnic background (59.4%). Half of the respondents were found to practice SMA and it was found that major source of antibiotics supply intended for SMA was generally obtained from communitypharmacies. This study showedthat the respondents had an overall poor knowledge towards antibiotics (mean score = 42.22 ± 20.48). The level of knowledge among different education level, monthly income and healthcare related work were statistically significant (p<0.001). Respondents also have poor to moderate attitude towards antibiotics use (mean score = 61.44 ± 14.02). There was a notable difference in the attitude score between different education level, employment status, monthly income and healthcare related work (p < 0.001). Moreover, a positive correlation was also observed between knowledge on antibiotics and attitude towards antibiotic use (r =0.532, p < 0.001). This study concluded that overall public in AlorSetar was prevalent in SMA practice. Generally, public in AlorSetar had poor knowledge and moderate attitude towards antibiotics use. Further similar study can be done by involving relatively a larger population to provide a better picture of knowledge and attitude of Malaysian public towards antibiotics use.

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Objectives: To investigate and compare the views of undergraduate pharmacy students in two Malaysian pharmacy schools (one private and one public) regarding the organization, quality, and objectivity of OSCE. Methods: A cross-sectional study was undertaken among penultimate and final year students in two Malaysian pharmacy schools between October and December 2019. A questionnaire was developed, tested, and validated and then distributed to study participants through online Google forms. Results: A total of 221 undergraduate pharmacy students participated in the study. Regarding the adequacy of the time allocated per OSCE station, students of the public university expressed a relatively higher level of disagreement (IIUM 63.9% & 48.7% vs. UoC 11.6% & 14.3%). Relatively few students agreed that OSCE is a less stressful type of assessment compared to other traditional methods (IIUM 7.2% & 10.3% vs. UoC 39.5% & 23.8%). Regarding the OSCE scores as valid indicators of student’s skills, private university students had more agreement than their counterparts in a public university (UoC 79% & 64.3% vs. IIUM 39.2% 30.8%). In addition, both student groups disagreed that OSCE marks were likely to be affected by the student’s gender (IIUM 73.2% & 66.7% vs. UoC 67.4% & 78.6%). Conclusion: Overall, most of the participants had overall good views regarding the organization, quality, and objectivity of OSCE, with several differences between students in public and private universities. There are few areas to be further considered to ensure more positive students’ OSCE experience such as revision on the time allocation for every station and on the provision of timely constructive feedback.

Background Studies have shown that the use of medicines with anti-cholinergic (Ach) properties can increase elderly patients’ risk of experiencing falls, confusion, and longer hospital stays (LOS). These adverse effects are preventable with appropriate intervention. Little is known about the use of medicines with Ach properties and their impact on Malaysian elderly patients. This study aimed to investigate the use of medicines with Ach properties and their impact on fall risk, confusion, and longer LOS among hospitalised elderly patients. Methods This study utilised a cross-sectional design and was conducted at a single centre where convenience sampling was employed to collect data from elderly patients (> 60 years) admitted to geriatric and medical wards at Hospital Tuanku Ja’afar during a 2-month period (July 2017–August 2017). Patients were excluded from this study if their hospital admission was planned for an elective procedure or if neurocognitive and hepatic impairment were diagnosed prior to the hospital admission. Medicines with Ach properties were identified and classified according to the anti-cholinergic drug scale (ADS). Univariate and multiple logistic regression statistical analyses were performed to assess its impacts on falls, confusion, and LOS. Results A total of 145 elderly patients with a mean age of 71.59 years old (SD = 8.02) were included in the study. Fifty-two percent of the participants were female, and the average hospital stay was 6 days (SD = 2.09). Medicines with Ach properties were administered in 62% ( n = 90) of the cases. The most commonly prescribed medicine with Ach properties was furosemide ( n = 59), followed by ranitidine ( n = 44), warfarin ( n = 23), and methylprednisolone ( n = 22). Compared to patients who did not receive medicines with Ach properties, patients who received them had a significantly higher risk of falls [odds ratios (OR) = 2.61; 95%CI: 1.18, 5.78; P = 0.018], confusion (OR = 3.60; 95%CI: 1.55, 8.36; P = 0.003), and LOS (OR = 4.83; 95%CI: 2.13, 10.94; P < 0.001). Multiple comorbidities also showed a significantly increased risk of falls (OR = 3.03; 95%CI: 1.29, 7.07; P = 0.010). Conclusion Medicines with Ach properties had a significant impact on elderly patients’ health. Strategies for rationally prescribing medicines with Ach properties to Malaysian elderly patients need to be improved and be recognised as an important public health priority.