Background: Sodium–Glucose cotransporter 2 (SGLT-2) inhibitors, such as dapagliflozin and empagliflozin, are commonly used to treat type 2 diabetes mellitus, chronic kidney disease, and heart failure with reduced ejection fraction. Recent landmark trials, EMPEROR-Preserved and DELIVER, have demonstrated that both drugs can improve cardiovascular outcomes in heart failure patients with preserved ejection fraction (HFpEF). However, differences in the primary outcomes between these trials were observed when stratified by Asian subgroups.
Methods: This study analyzed data from 59 adults using empagliflozin and 26 using dapagliflozin at Princess Margaret Hospital between August 2016 and March 2022. The primary composite outcome was combined cardiovascular death and hospitalization due to heart failure. Results were stratified using a Cox proportional-hazards model. Furthermore, the occurrence of side effects was evaluated and reported as safety outcomes.
Results: The study found that the cardiovascular and mortality outcomes were higher than previously reported in the literature. The use of empagliflozin resulted in 24.9 composite outcome events per 100 patient years, whereas the use of dapagliflozin resulted in 29.9 events per 100 patient years. Patients taking empagliflozin without heart failure hospitalization in the past 12 months had significantly better composite outcomes than those taking dapagliflozin (hazard ratio, 0.30; 95% confidence interval, 0.12–0.76). However, no significant differences were observed in the composite outcome and all-cause mortality between the two drugs.
Conclusion: A substantial initial decrease in overall survival toward the primary composite outcome within the first year after the start of SGLT-2 inhibitor administration indicates the need for early intervention for this specific patient subgroup. Although constrained by a modest sample size obtained from a single center, the findings of this study highlight the importance of conducting additional research to explore the comparative efficacy of SGLT-2 inhibitors for HFpEF in a larger local population.

Background: Growing evidence demonstrates that emergency medicine pharmacists (EMPs) can positively improve patient care in the emergency department (ED). In Singapore, ED pharmacy is still generally limited to traditional roles, and EMPs are rarely included as part of the ED clinical team. We sought to investigate the impact of introducing an EMP into an ED.
Methods: From November 2019, we piloted a new, collaborative multidisciplinary model of care by introducing an EMP to provide clinical pharmacy services in the ED of our institution.
Results: The EMP’s roles and practices, as described in this report, included clinical and traditional non-clinical as well as administrative activities to support the multidisciplinary teams in the ED. On average, the EMP was involved in 1.2 documented pharmacist activities (involving medication-related enquiries or interventions) per hour spent in the ED.
Conclusion: Although our initial experience with introducing an EMP into our ED was mostly positive with tangible benefits in optimizing medication use and improving medication safety for ED patients, we also described the challenges that we faced in developing the service. Finally, the necessity of an EMP should be further examined, adapted to the local settings, and evaluated with respect to incorporation of this service into our local healthcare system by conducting further studies.

Background: Tuberculosis is a considerable hazard in Malaysia. According to the World Health Organization (WHO), the treatment success rate for newly diagnosed pulmonary tuberculosis patients (PTB) is lower than the global success target of 95%. Currently there are limited studies evaluating the predictors of treatment outcomes for newly diagnosed pulmonary tuberculosis patients. The current study aimed to determine the predictors for recently diagnosed PTB patients in Malaysia. The study also aimed to identify the effect of fixed-dose combinations (FDCs) and separate treatment regimens on PTB therapy.
Methods: In this retrospective cohort study, patients following up at the chest clinic at the Penang General Hospital were included. Convenient sampling was performed to collect data from patients who had been newly diagnosed from January 2014 to December 2017. SPSS version 23 was used for performing Cox regression analysis.
Results: Treating newly diagnosed PTB patients with FDCs in the intensive phase significantly reduced unfavorable outcomes (HR=0.266; 95% CI: 0.067–0.763). Age <60 years, drug abuse, and treatment interruption were the factors that considerably increased the hazards of unfavorable outcomes with HR=2.21 (95% CI: 1.05–4.65); 3.24 (95% CI: 1.24–8.49); and 2.702 (95% CI: 1.186–6.154) respectively.
Conclusion: The hazards of unfavorable outcomes in newly diagnosed PTB patients are significantly reduced by treating them with FDCs. However, treatment interruption adversely affects the outcome. Further studies investigating the effects of FDCs along with other factors influencing drug response relationships are paramount to improving treatment strategies.

Background: An Australian consensus statement on the pharmacological prevention and management of heart failure, released in August 2022, recommended initiation of four medications for treating heart failure with reduced ejection fraction (HFrEF): angiotensin- converting enzyme inhibitors or angiotensin receptor-neprilysin inhibitors, heart failure beta blockers, mineralocorticoid receptor antagonists and sodium glucose co-transporter 2 inhibitors. These four medications are classified as the guideline-directed medical therapy (GDMT). Intravenous administration of ferric carboxymaltose (IFC) in the hospital, following an episode of acute heart failure in patients with iron deficiency and an ejection fraction of less than 50% was also recommended to reduce heart failure related hospital admissions as demonstrated in the AFFIRM-AHF trial.
Methods: A study conducted a retrospective audit of patients with HFrEF discharged by the Cardiology and the General Medicine teams of a tertiary hospital between two time periods, October to December 2021, and October to December 2022. Information including patient demographics, medication allergies and iron studies was collected. Discharge medication lists were extracted, reviewed for GDMT prescription and audited to check the accuracy of heart failure medication documentation. SPSS v29 was used to perform the statistical analysis.
Results: A greater proportion of patients were discharged on optimal GDMT across both study periods by the Cardiology department compared with the General Medicine department (37% versus 4% respectively, p<0.001). More accurate recording of heart failure medications in discharge summaries was performed by the Cardiology department compared with the General Medicine department (82% versus 68% respectively, p=0.015). Lastly, eligible Cardiology patients were more likely to receive IFC compared with General Medicine patients (71% versus 28%, p=0.003).
Conclusion: Overall, the audits performed in this study demonstrated that improvements in HFrEF GDMT prescribing adherence, documentation accuracy and IFC administration are warranted since the current practice is suboptimal, particular in General Medicine teams. The barriers to GDMT adherence at the prescribers’ end will require further examination and the appropriate quality improvement tools need to be implemented to ensure that all patients with HFrEF have equal access to optimal healthcare.

The international practical training exchange program in clinical pharmacy at Chungnam National University equips pharmacy students and professionals with advanced clinical and research skills through immersive training in different healthcare environments. This program encompasses three core components—clinical pharmacy practice in hospital settings, clinical pharmacy practice in university settings, and research training within the College of Pharmacy—designed to develop clinical competencies, enhance patient-centered care, and foster interdisciplinary collaboration. Participants engage in clinical rotations, laboratory sessions, and active research projects, gaining insights to various international healthcare systems, including partnerships in Germany, Vietnam, Japan, and Malaysia. Based on student feedback and competency evaluations, the program assessment revealed significant improvement in patient assessment, medication management, interdisciplinary communication, and practical skills in pharmaceutical compounding, quality control, and analytical testing. Research training fosters a strong foundation in experimental design and scientific communication, and cross-cultural exposure enhances adaptability and global competence. This program offers a framework for comprehensive clinical pharmacy training aligned with international health standards, promoting cultural awareness, and preparing future pharmacists for the complexities of a globalized healthcare landscape. Future initiatives will include program expansion and evaluation of the long-term effects on participants’ professional growth.