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Sustainability in healthcare has gained increasing attention globally, yet limited research has explored its application within community pharmacy practice, particularly in the Malaysian context. Community pharmacies play a dual role as healthcare providers and small-to-medium business entities, positioning them uniquely to contribute to sustainability initiatives. This study aimed to explore community pharmacists’ perceptions of sustainability, guided by the three dimensions of sustainability - environmental, social, and economic. A qualitative design was employed using semi-structured interviews with practising community pharmacists across Malaysia. Recruitment considered diversity in years of experience, position, seniority, practice setting, and ethnicity. Interviews were transcribed, verified by participants, and analysed thematically through an iterative process involving two coders to enhance rigour and credibility. A total of 15 community pharmacists (6 men and 9 women) initially consented to take part in the study. Two participants did not attend the scheduled interviews, resulting in a final sample of 13 participants. Findings indicated that environmental sustainability practices such as medicine disposal programmes and plastic reduction initiatives were recognised but inconsistently implemented, with barriers including customer attitudes, workload, and lack of enforcement. Social sustainability was reflected in pharmacists’ emphasis on equitable access to care, patient trust, and professional reputation, although challenges such as workforce stress and limited engagement in wider health equity initiatives were noted. Economic sustainability was strongly linked to business viability, service diversification, and reputation as drivers for long-term resilience. The study highlights uneven adoption of sustainability practices, with stronger visibility in areas supported by public awareness and regulatory measures, such as plastic reduction, compared to less enforced domains like medicine disposal and energy conservation. These findings underscore the need for integrated policies, professional guidance, and educational support to embed sustainability more consistently in community pharmacy practice. This research contributes context-specific insights into how Malaysian community pharmacists conceptualise and enact sustainability, offering implications for policy development, professional training, and future research.

Introduction Accurate risk stratification is crucial in the management of acute coronary syndrome (ACS) to guide clinical decision-making. The Thrombolysis in Myocardial Infarction (TIMI) and Global registry of Acute Coronary events (GRACE) risk scores are widely recommended for risk stratification. However, comparative evidence supporting their predictive performance within the Malaysian public healthcare setting remains limited. This study aimed to evaluate and compare the ability of GRACE and TIMI risk scores to predict in-hospital outcome and major adverse cardiac events (MACE) among patients with ST-elevation myocardial infarction (STEMI, non-ST- elevation myocardial infarction (NSTEMI) and unstable angina (UA). Methods This study was a retrospective observational study conducted at Shah Alam Hospital in Selangor, Malaysia. All consecutive patients admitted with ACS between 1 January 2024 and 31 December 2024 were included. GRACE and TIMI risk scores were retrospectively calculated using admission data. The primary outcome was in-hospital mortality and the secondary outcome was MACE. Predictive performance was evaluated using logistic regression, receiver operating characteristics (ROC) curve analysis, calibration testing and net reclassification improvement (NRI). Results A total of 873 patients with ACS were included, comprising of 193 STEMI and 680 NSTE-ACS patients. In STEMI patients, GRACE demonstrated superior discrimination for in-hospital mortality prediction (AUC 0.843 vs 0.798), while both scores showed comparable performance for MACE prediction (GRACE AUC 0.837; TIMI AUC 0.847). In multivariable analysis, GRACE remained an independent predictor of mortality (OR 1.021, 95% CI 1.008–1.034, p = 0.001), whereas TIMI was not statistically significant (p = 0.415). In contrast, among NSTE-ACS patients, GRACE consistently outperformed TIMI for prediction of both in-hospital mortality (AUC 0.750 vs 0.617) and MACE (AUC 0.634 vs 0.568). GRACE retained statistical significance in combined regression models for mortality (OR 1.028, 95% CI 1.014–1.042, p < 0.001) and MACE (OR 1.014, 95% CI 1.008–1.020, p < 0.001), while TIMI lost independent predictive significance. Conclusion While both scores are clinically useful, in STEMI, both scores performed relatively comparably, although GRACE demonstrated superior performance for prediction of in-hospital mortality. In NSTE-ACS, GRACE consistently demonstrated better discriminatory ability, retained independent predictive value, and showed more favourable risk classification compared with TIMI. Keywords: Acute coronary syndrome; GRACE risk score; TIMI risk score; in-hospital mortality; major adverse cardiac events

Background Nasopharyngeal Carcinoma (NPC) is an endemic cancer in Malaysia, yet public awareness regarding its risk factors, signs, and symptoms remains insufficient, contributing to late-stage diagnosis. To address this issue, a pharmacist-led educational approach was conducted to evaluate the effectiveness of a pharmacist-led educational intervention on the Knowledge and risk factors of NPC among the general public in Klang Valley, Malaysia. Method A quasi-experimental, single-group pre-test and post-test design was employed among a sample of the general public. The intervention consisted of a standardized, pharmacist delivered 7 days online educational session, during which images and videos related were shared and discussed, focusing on NPC risk factors (e.g., smoking, alcohol, ethnicity) and symptoms. Data on knowledge and risk factors were collected immediately before and after the intervention using a validated questionnaire. Results The study included a total of 400 participants in the pre-intervention phase and 193 participants in the post-intervention phase, with ages ranging from 18 to 80 years. Knowledge about the prevalence of NPC among the population increased significantly from 36.8% before the intervention to 99.5% after the intervention (p = 0.001). In the post-intervention phase, 99.45% of participants correctly identified the throat, and 1.55% identified the nose as the organ affected by NPC. Before the intervention, only 13.3% of participants rated their knowledge as “good,” while 43.8% described it as “medium” and 43.0% as “poor.” Post-intervention results showed a dramatic improvement, with 96.4% of participants rating their knowledge as “good,” 3.6% as “medium,” and none as “poor.” Similarly, before the intervention, only 26.25% (n =105) reported being familiar with treatment approaches, while 57.0% (n = 228) were unfamiliar and 16.75% (n = 67) were unsure. After the intervention, 99.48% (n = 192) indicated familiarity with treatment options, 0.52% (n = 1) remained unfamiliar, and no participants expressed uncertainty. Conclusion Knowledge of nasopharyngeal carcinoma (NPC), including its signs, symptoms, and risk factors, was very limited among participants at baseline. However, it improved significantly following the pharmacist-led educational intervention. This intervention proved effective in establishing a general knowledge baseline and reducing disparities related to participants’ prior educational backgrounds. Future public health programs should be tailored to address the unique cognitive and behavioural determinants associated with high-risk groups. Keywords: Nasopharyngeal Carcinoma, NPC, cancer, risk factors, knowledge, general public, public awareness, EBV virus

Introduction Accurate patient identification is foundational to patient safety, yet there are many organisational and human obstacles to good patient identification practices. The purpose of this study was to evaluate the levels of awareness, practice, and attitude of healthcare providers (HCPs) with regard to patient identification and to determine the perceived barriers at a tertiary care hospital. Methods This quantitative, cross-sectional study implemented a questionnaire to survey 804 HCPs, including doctors, nursing staff, allied health professionals, and clinical support staff at a private hospital in Malaysia. Patient identification practices, including awareness and attitude, were assessed via self-reported 4-point Likert scale ratings and multiple-choice questions. Perceived barriers were examined using descriptive statistics and the Human Factors Analysis and Classification System (HFACS) to classify system-level shortcomings. Results Overall, HCPs demonstrated good awareness, positive attitudes, and satisfactory compliance with patient identification practices. However, gaps were identified, particularly in the standardization of patient identifiers. The study found that higher qualifications, longer work experience, and greater job role weightage for patient identification were positively associated with better awareness, attitude, and practice compliance. The top consensus barriers were patients’ physical communication barriers (n=431, 53.7%), language barriers (n=407, 50.6%), and fear of annoying patients (n=379, 47.0%). Moreover, clinical support staff were identified as a vulnerable subgroup with lower self-confidence in their knowledge, suggesting systemic failures in Unsafe Supervision and Preconditions for Unsafe Acts. Conclusion Although the HCPs demonstrated generally good awareness, practice, and attitude, systemic limitations remain as a vulnerability. Recommended next steps include implementing non-verbal verification technologies, encouraging patient and carer engagement to reduce social pressure, and providing role-specific, targeted training for clinical support staff. These interventions will strengthen the foundation for accurate patient identification and enhance safety at the organisational level. Keywords: Patient, Identification, Hospital, Patient Safety, Healthcare, Practices.

The COVID-19 pandemic created widespread uncertainty, leading many people to stockpile medications out of fear and misinformation. This study explores how pharmacists in Klang Valley, Malaysia, experienced and managed public behavior during various situations that are not pandemic-related. Using a qualitative approach, twelve pharmacists from retail and government settings were interviewed to understand their perspectives and strategies. Thematic analysis revealed five key themes: the reasons behind medication stockpiling, how pharmacists responded to it, the emotional and operational challenges they faced, their efforts to educate patients, and the broader systemic factors that influenced their work. Pharmacists reported that stockpiling was often driven by fear of price increases, the desire for preventive medication, and misleading information shared on social media. In response, they implemented measures such as limiting purchases, counseling patients, forecasting inventory needs, and sourcing alternative brands. Despite their efforts, pharmacists faced significant stress, multitasking demands, and financial strain. The study highlights the vital role pharmacists play during health crises—not only in dispensing medications but also in educating the public and managing supply challenges. These findings point to the need for better support systems, flexible policies, and stronger public education to promote safe and responsible medication use in future emergencies.