Background: Improved cancer survivorship has led to untoward effects of developing cardiovascular complications, mainly due to exposure to cardiotoxic cancer therapy. Cardiovascular screening can provide substantial benefits to patient care and outcomes, but successful implementation is challenging. This systematic review consolidates factors from existing literature and explores its relationships to highlight key domains that need to be addressed to implement these risk assessment programs in clinical practice. Methods: We searched PubMed, EMBASE, CINAHL, Web of Science and PsycINFO using search terms focused specifically on factors influencing the implementation of cardiovascular risk assessment among the cancer population. Two reviewers completed independently in study selection, data extraction, and quality assessment. To get meaningful insight of the findings, we thematically matched those factors into the domain of the Tailored Implementation for Chronic Diseases (TICD) framework and inductively identified its relationships. Results: Twelve studies met the inclusion criteria. Identified factors were grouped into six domains, of which the top three included factors related to individual health professionals, which were cited in 83% of studies, incentives and resources (75% of the studies), and professional interactions in 58% of studies. Within the domain of individual health professional, we include factors concerning cognitions and attitudes, knowledge and skills, and professional behaviour. The domain of incentives and resources highlighted the needs for availability of necessary resources, continuing education system, assistance for clinicians and financial related issues. Communication influence, team and referral processes were found to be the main barriers in the domain of professional interaction. Bi-directional associations were evident between these domains, which were categorised into macro and micro levels for better interpretation. Conclusion: This review identified key factors that could be leveraged to improve cardiovascular assessment reach and appeal. Future intervention efforts should first be targeted at the level of healthcare professionals, who are the key drivers of the entire process.

Background: Information on the extent of high-risk prescribing for nonsteroidal anti-infammatory drugs (NSAIDs) across developing countries is scarce. Objectives This study examines the prescribing pattern for NSAIDs in primary care, assesses the extent of high-risk NSAIDs prescribing and identifes associated factors. Setting 129 public and 416 private primary care clinics in Malaysia. Methods Data were derived from the National Medical Care Survey 2014, a cross-sectional survey on primary care morbidity patterns and clinical activities in Malaysia. Types of NSAIDs, indications for NSAIDs use and propor tion of high-risk NSAIDs prescribing were assessed. Factors associated with high-risk NSAIDs prescribing were identifed with a multivariable logistic regression. Weighted results, adjusted for sampling design and non-response were presented. Main outcome measures: Prescribing pattern of NSAIDs, proportion of high-risk NSAIDs prescribing and its associated factors. Results Among the 55,489 patients who received NSAIDs, diclofenac was the most frequently prescribed NSAID (40.5%, 95% CI 40.1–40.9%), followed by mefenamic acid (29.2%, 95% CI 28.8–29.6%). The commonest indications for NSAIDs use were musculoskeletal condition and respiratory tract infection, both at 17.8% (95% CI 17.4–18.1%). A total of 22.9% (95% CI 22.6–23.3%) patients received high-risk NSAID prescriptions. Of these, 47.8% (95% CI 46.9–48.7%) did not receive adequate gastroprotection despite being at risk, 24.8% (95% CI 24.0–25.5%) were prescribed NSAIDs despite having cardiovascular comorbidities and 22.4% (95% CI 21.7–23.2%) were prescribed high-dose NSAIDs. The odds of receiving high-risk NSAID prescriptions increased with the number of drugs prescribed (OR 1.23, 95% CI 1.06–1.43) and the number of diagnoses in one visit (OR 2.21,95% CI 1.71–2.86). The odds of being prescribed high-risk NSAID prescriptions were lower in patients with secondary (OR 0.52, 95% CI 0.35–0.77) and tertiary education (OR 0.39, 95% CI 0.22–0.68) compared to patients without formal education. Patients’ citizenship, indication for NSAID prescriptions and whether a medical certifcate was issued were also signifcantly associated with the likelihood of receiving high-risk NSAID prescriptions. Conclusions: A quarter of NSAIDs prescribed in Malaysian primary care setting is categorised as high-risk prescribing. Targeted strategies are necessary to improve patient safety.

Background: Translation into clinical practice for use of intravenous thrombolysis (IVT) for the management of ischemic stroke remains a challenge especially across low- and middle-income countries, with regional inconsistencies in its rate. This study aimed at identifying factors that infuenced the provision of IVT and the variation in its rates in Malaysia. Methods: A multiple case study underpinning the Tailored Implementation for Chronic Diseases framework was carried out in three public hospitals with difering rates of IVT using a multiple method design. Twenty-fve in-depth interviews and 12 focus groups discussions were conducted among 89 healthcare providers, along with a survey on hospital resources and a medical records review to identify reasons for not receiving IVT. Qualitative data were analysed using refective thematic method, before triangulated with quantitative fndings. Results: Of fve factors identifed, three factors that distinctively infuenced the variation of IVT across the hospitals were: 1) leadership through quality stroke champions, 2) team cohesiveness which entailed team dynamics and its degree of alignment and, 3) facilitative work process which included workfow simplifcation and familiarity with IVT. Two other factors that were consistently identifed as barriers in these hospitals included patient factors which largely encompassed delayed presentation, and resource constraints. About 50.0 – 67.6% of ischemic stroke patients missed the opportunity to receive IVT due to delayed presentation. Conclusions: In addition to the global efort to explore sustainable measures to improve patients’ emergency response for stroke, attempts to improve the provision of IVT for stroke care should also consider the inclusion of interventions targeting on health systems perspectives such as promoting quality leadership, team cohesiveness and workfow optimisation.

Background: Elective surgeries were suspended during the national lockdown in March 2020 to curb the spread of the COVID-19 pandemic in Malaysia. We sought to evaluate the impact of the lockdown on cataract surgeries and suggest lessons for future outbreaks. Study design: We conducted an interrupted time series analysis to examine rates of cataract surgery before and during the lockdown. Methods: We used national cataract surgical data between 2015 and 2021 from the Malaysian Cataract Surgery Registry. Segmented regression with a seasonally adjusted Poisson model was used for the analysis. Stratified analyses were performed to establish whether the effect of the lockdown on cataract surgeries varied by hospital designation, type of cataract service, sex, and age groups. Results: Cataract surgeries began falling in March 2020 at the onset of the lockdown, reached a trough in April 2020, and subsequently increased but never recovered to pre-lockdown levels. Cataract surgical rates in December 2021 were still 43 % below the expected surgical volume, equivalent to 2513 lost cataract surgeries. There was no evidence of a differential effect of the lockdown between COVID-19 designated and non-COVID-19 designated hospitals. The relative decrease in cataract surgical rates appears to have been greatest in outreach services and in people 40 years and older. Conclusions: The lockdown caused an immediate reduction in cataract surgical rates to nearly half of its baseline rate. Despite its gradual recovery, further delays remain to be expected should there be no redistribution or increase in resources to support backlogs and incoming new cases.