Comprehension of prescription orders with and without pictograms: tool validation and comparative assessment among a sample of participants from a developing country.

BACKGROUND: Medication errors can often occur due to the patient's inability to comprehend written or verbal medication orders. This study aimed to develop pictograms of selected medication orders and to validate the comprehension of prescription orders index and compare the comprehension scores with and without pictograms. In addition to determine the predictors that could be associated with a better or worse comprehension of prescription orders with pictograms versus that of their written counterparts. METHODS: A cross-sectional study was conducted using a snowball sampling technique. Six pictograms were developed to depict specific medication orders. The comprehension of prescription orders index was constructed and validated. The study then compared the comprehension scores of prescription orders with and without pictograms, and identified the predicting factors score difference. RESULTS: A total of 1848 participants were included in the study. The structure of the comprehension of prescription orders index was validated over a solution of four factors, with an adequate Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy of 0.711 and a significant Bartlett's test of sphericity (P < 0.001). The construct validity of the index was further confirmed by highly significant correlations between each item and the full index (P < 0.001). The study also found a significant association between the difference in comprehension scores for prescription orders with and without pictograms and several factors, including age, level of education, area of residence, number of children, and smoking status with the difference of comprehension scores (P < 0.001). CONCLUSION: Pictogram-based instructions of medication orders were better understood by the Lebanese population than written instructions, making the incorporation of pictograms in pharmacy practice paramount to optimize medication use by the patient and thus yielding better health outcomes.

Chronic kidney disease awareness among the general population: tool validation and knowledge assessment in a developing country.

INTRODUCTION: Good knowledge and early identification of chronic kidney disease (CKD) can help in preventing disease progression in its early stages and reducing undesired outcomes. The aim of the current study was to assess the level of public knowledge about CKD, determine predictors of better knowledge, and to construct and validate a CKD knowledge scale for public health assessment and research use. METHODS: A community-based cross-sectional study was conducted using an electronic self-administered questionnaire. All people living in Lebanon and being 18 years of age and above were considered eligible for recruitment. CKD knowledge was assessed by a 37-item scale that was constructed by principal component analysis and then validated. The score of the CKD knowledge scale was computed from the extracted factors. A multivariable binomial logistic regression model evaluated the sociodemographic and clinical predictors of the knowledge score. RESULTS: A total of 1308 participants were included. The scale items converged over 9 factors with Eigenvalue greater than 1 and explaining 53.26% of the total variance, and the total scale had a high Cronbach's alpha of 0.804. All items of the scale significantly correlated with the full scale with correlation coefficients ranging from 0.082 to 0.558. The ROC curve analysis determined an optimal cutoff point of better knowledge at 47.5 with 70.6% sensitivity and 44.2% specificity. The CKD knowledge score had a median of 51.00 (IQR 47.00-55.00). Higher knowledge score was significantly associated with old age (ORa = 1.018, 95% CI 1.006-1.030, P = 0.003),, occupation (ORa = 3.919, 95% CI 2.107-7.288, P <  0.001), and recent renal function assessment (ORa = 2.314, 95% CI 1.532-3.495, P <  0.001). However, a lower knowledge score was significantly associated with lower level of education (ORa = 0.462, 95% CI 0.327-0.653, P <  0.001). CONCLUSION: A reliable tool to assess public knowledge and awareness about CKD was developed and validated. The overall knowledge was good, however, important gaps in CKD awareness were detected in some areas and subpopulations. Therefore, public health stakeholders need to implement targeted CKD educational activities to minimize the disease burden.

Ensuring Doctor of Pharmacy Graduates Have the Essential Competencies for Innovative Practice.

As the pharmacy profession continues to evolve from product oriented to patient centered, pharmacy programs have been transitioning from a traditional pharmacy curriculum to a competency-based education pedagogy. Competency-based education has been developed to instill the required clinical competencies in graduates to better meet the contemporary role of pharmacists in accordance with the latest scientific knowledge and evidence-based practices in an ever-evolving health care landscape. While these ideas have helped shape the new Accreditation Council for Pharmacy Education (ACPE) Standards and Center for the Advancement of Pharmacy Education (CAPE) Educational Outcome domains, recent publications have indicated that it is integral for these Standards to include public health emergency preparedness and response. Updated Standards and Educational Outcomes must be integrated longitudinally in pharmacy curricula to ensure that graduates will be practice-ready health care professionals. This commentary highlights the strategic use of workforce development of population health based on two perspectives: emergency preparedness and response and digital health.

Potassium Ion Channels in Glioma: From Basic Knowledge into Therapeutic Applications.

Ion channels, specifically those controlling the flux of potassium across cell membranes, have recently been shown to exhibit an important role in the pathophysiology of glioma, the most common primary central nervous system tumor with a poor prognosis. Potassium channels are grouped into four subfamilies differing by their domain structure, gating mechanisms, and functions. Pertinent literature indicates the vital functions of potassium channels in many aspects of glioma carcinogenesis, including proliferation, migration, and apoptosis. The dysfunction of potassium channels can result in pro-proliferative signals that are highly related to calcium signaling as well. Moreover, this dysfunction can feed into migration and metastasis, most likely by increasing the osmotic pressure of cells allowing the cells to initiate the "escape" and "invasion" of capillaries. Reducing the expression or channel blockage has shown efficacy in reducing the proliferation and infiltration of glioma cells as well as inducing apoptosis, priming several approaches to target potassium channels in gliomas pharmacologically. This review summarizes the current knowledge on potassium channels, their contribution to oncogenic transformations in glioma, and the existing perspectives on utilizing them as potential targets for therapy.

Factors Affecting Influenza Vaccination Uptake and Attitudes among Lebanese University Students: The Impact of Vaccination Promotional Programs and COVID-19 Pandemic.

Vaccination is the most effective preventative strategy against influenza, yet university students' influenza vaccination uptake remains low. This study aimed firstly to determine the percentage of university students who were vaccinated for the 2015-2016 influenza season and to identify reasons for non-vaccination, and secondly to examine the impact of external factors (on-campus/online influenza awareness campaigns and COVID-19 pandemic) on their influenza vaccination uptake and attitudes for the 2017-2018 and 2021-2022 influenza seasons. A descriptive study was conducted over three phases for three influenza seasons at a Lebanese university in the Bekaa Region. Based on data collected in 2015-2016, promotional activities were developed and implemented for the other influenza seasons. This study was conducted using an anonymous, self-administered questionnaire by students. The majority of the respondents in the three studies did not receive the influenza vaccine (89.2% in the 2015-2016 study, 87.3% in the 2017-2018 study, and 84.7% in the 2021-2022 study). Among the unvaccinated respondents, the main reason for non-vaccination was that they thought that they did not need it. The primary reason for vaccination among those who were vaccinated was that they believed they were at risk of catching influenza in a 2017-2018 study and due to the COVID-19 pandemic in the 2021-2022 study. As for attitudes towards influenza vaccination post-COVID-19, significant differences were shown among the vaccinated and unvaccinated respondents. The vaccination rates among university students remained low despite of the awareness campaigns and COVID-19 pandemic.

The impact of COVID-19 on the mental health of Lebanese pharmacists: A national cross-sectional study.

Introduction: The COVID-19 pandemic has induced a global mental health crisis with variable consequences. This study aimed to assess the psychological impact of COVID-19 regarding anxiety, insomnia, depression, and response to trauma on pharmacists in Lebanon during COVID-19, and to identify factors contributing to psychological distress. Methods: This was a cross-sectional study among pharmacists that involved the use of the 7-item Generalized Anxiety Disorder (GAD-7), 7-item Insomnia Severity Index (ISI), Patient Health Questionnaire 9-item depression module (PHQ-9), and Impact of Event Scale revised (IES-R) subscales. Descriptive statistical analyses were performed to determine the study distribution. The associations between the scores and the participants' characteristics were assessed using the Chi-square test. Four binary logistic regression models were used to evaluate the association between the scores and the potential confounders, followed by four multivariable logistic regressions. An alpha of 0.05 was used to determine statistical significance. Results: Participants comprised 311 pharmacists from all Lebanese districts, of whom 251 (80.7%) were females and 181 (58.2%) aged between 26 and 35 years. The majority of the participants were community pharmacists (n = 178, 57.2%). A considerable proportion of participants had symptoms of anxiety (n = 128, 41.2%), insomnia (n = 64, 20.6%), depression (n = 157, 50.5%), and subjective stress (n = 227, 78.8%). Higher anxiety (aOR: 1.73, 95% CI: 1.08; 2.78, p-value: 0.02), higher depression (aOR: 3.06, 95% CI: 1.73; 5.39, p-value: 0.001), and higher stress (aOR: 1.86, 95 percent CI: 1.11; 3.14, p-value: 0.02) scores were significantly associated with pharmacists who reported that their work involves contact with infected/suspected COVID-19 patients. Interestingly, pharmacists who expressed concern about contracting COVID-19 infection had significantly higher anxiety (aOR: 2.35, 95% CI: 1.40; 3.94, p-value: 0.001) and higher depression scores (aOR: 2.64, 95% CI: 1.49; 4.67, p-value: 0.001) respectively. Conclusion: The preliminary results from pharmacists in Lebanon reflect increase in stress, burden, and frustration felt by pharmacists, creating a negative impact on their mental health and well-being during the global pandemic. As frontline healthcare workers, the role of pharmacists in the community should not be overlooked, and their mental health should be well investigated.

Allylamines, Benzylamines, and Fungal Cell Permeability: A Review of Mechanistic Effects and Usefulness against Fungal Pathogens.

Allylamines, naftifine and terbinafine, and the benzylamine, butenafine, are antifungal agents with activity on the fungal cell membrane. These synthetic compounds specifically inhibit squalene epoxidase, a key enzyme in fungal sterol biosynthesis. This results in a deficiency in ergosterol, a major fungal membrane sterol that regulates membrane fluidity, biogenesis, and functions, and whose damage results in increased membrane permeability and leakage of cellular components, ultimately leading to fungal cell death. With the fungal cell membrane being predominantly made up of lipids including sterols, these lipids have a vital role in the pathogenesis of fungal infections and the identification of improved therapies. This review will focus on the fungal cell membrane structure, activity of allylamines and benzylamines, and the mechanistic damage they cause to the membrane. Furthermore, pharmaceutical preparations and clinical uses of these drugs, mainly in dermatophyte infections, will be reviewed.

Motivation, satisfaction, and future career intentions of pharmacy students: A cross-sectional preliminary analysis.

INTRODUCTION: In recent years, the pharmacy profession has undergone many changes that impacted pharmacy educational programs and students' needs and experiences. In Lebanon, no previous studies have addressed students' perspectives of pharmacy studies and their future aspirations. METHODS: A cross-sectional survey was randomly sent to all pharmacy students at the main campus of the Lebanese International University. Questions included demographics, students' reasons for choosing pharmacy, satisfaction regarding choice of pharmacy, and future career plans. RESULTS: Pharmacy as a study major was the first choice for 61% of respondents, and reasons for this choice were family recommendations (87%), friends' encouragement (26%), and schoolteachers' endorsements (20%). Looking for a job with various career opportunities, flexible working hours, security, good salary, and wishing to provide public service and improve health were the main incentives to join the pharmacy program. Concerning their satisfaction, 88% were proud of studying pharmacy and 66% would choose to study pharmacy if they were to select their program of study again. As for career intentions, 68% were considering community pharmacy, 66% hospital pharmacy, and 60% academic pharmacy. CONCLUSIONS: While the attitudes, perceptions, and career intentions of the respondents were variable, the majority were aspired by family or societal factors to study pharmacy, were satisfied by their choice, and intended to work in the community pharmacy sector. Pharmacy curricula should be regularly assessed to meet students' expectations and society's needs.

Knowledge, Attitude, and Practice in a Sample of the Lebanese Population Regarding Cholera.

The evaluation of knowledge, attitude, and practices towards an emerging disease is an essential component of public health preventive measures during an outbreak. In October 2022, an outbreak of cholera was reported in Lebanon, which is the first to be reported in the Middle Eastern country for 30 years. This study aimed to explore the level of knowledge as well as attitude and practice of the general public in Lebanon towards cholera. A self-administered structured questionnaire was distributed via an online link to individuals living in Lebanon during October-November 2022. The survey instrument comprised items to assess the sociodemographic data; questions on knowledge about cholera symptoms, transmission, and prevention; as well as attitude and practice questions. Our study involved 553 participants, with a median age of 24 years and a majority of females (72.5%). The results showed that the majority of respondents correctly identified diarrhea as a symptom of cholera and recognized the spread via contaminated water and food. Having a university level education compared with secondary school or less (adjusted odds ratio (aOR) = 2.09), being married compared with single (aOR = 1.67), and working in the medical field compared with unemployed (aOR = 4.19) were significantly associated with higher odds of having good cholera knowledge. Having good knowledge compared with having a poor level of cholera knowledge (aOR = 1.83) and older age (aOR = 1.03) were significantly associated with higher odds of having a good attitude towards cholera. The current study showed an overall high knowledge score on cholera among the Lebanese population. Nevertheless, gaps in cholera knowledge were identified and should be addressed, particularly among workers in the medical field. Thus, we recommend targeted health education to the general population that aims to strengthen the health resilience in the community.

The psychological impact of the Syrian crisis on refugees living in Lebanon.

PURPOSE: This study aims to evaluate the impact of war on Syrian refugees' life in Bekaa/Lebanon, focusing on psychological and physical symptoms, and to assess the prevalence of the most common symptoms of posttraumatic stress disorder (PTSD) in affected patients recruited in the study. DESIGN AND METHODS: This observational study was conducted over a period of 1 month-June 2019-in three main camps in the Bekaa region. After taking approval, a total number of 108 Syrian refugees were interviewed and asked about their quality of life and health conditions in camps, after leaving their country. A validated questionnaire was filled by field researchers to gather information on refugees' psychological distresses, physical symptoms, and future perspective. FINDINGS: During the 4 weeks of study, 108 refugees completed the questionnaire; psychological assessment showed 73.8% of refugees who were exposed to the fighting atmosphere, suffered from one or more psychological symptoms related to PTSD. In addition, 50.5% of the refugees were <30 years old, and among those, 83.5% believed that they have no future for themselves and their families, while 15.4% lost hope in a better life. Seventy-four percent reported at least one physical symptom in the past 4 weeks that is related to PTSD. Furthermore, 64.3% strongly agreed that there is lack of awareness and medical care including psychological and mental health, while 56.1% strongly agreed on the important role of pharmacists and other healthcare professionals in providing advice to patients on their overall health and mental health. CONCLUSION: Syrian refugees at the assessed camps suffered from psychological distress that requires urgent attention. Current medical and psychological support is absent, and further assessment is needed.

Experiential Education in Pharmacy Curriculum: The Lebanese International University Model.

Experiential education is an essential component of pharmacy education in order to allow intern students to experience real conditions and training opportunities in different inpatient and outpatient settings. This paper provides a description of the pharmacy practice experiences (PPEs) in the Lebanese International University (LIU) 5-year bachelor of pharmacy (BPharm) and postgraduate doctor of pharmacy (PharmD) programs; focuses on the opportunities and challenges encountered; and presents a model for experiential education in Lebanon. Learning outcomes and thus students' acquisition of predefined competencies are evaluated in actual practice settings through assessment tools. Our experiential education program aligns with the accreditation/certification criteria set by the Accreditation Council for Pharmacy Education (ACPE) and equips future pharmacists with the knowledge and skills to become major components in the healthcare team.

The assessment of mentorship programs on pharmacy students’ leadership roles and performance in experiential education

Objective: The purpose of this study was to determine the perception and to assess the impact of mentorship programs on students’ performance and development in pharmacy education during experiential education. Methods: Students from all the schools of pharmacy and from different academic years across pharmacy programs in Lebanon were included. The study involved a survey that included a variety of questions and of different structures including the use of Likert-scale questions and multiple-choice grids that assessed the aim of this study. Results: Out of 260 students, the results indicated that 228, 227, and 219 students agreed/strongly agreed that clinical mentors in experiential education help students develop communication skills, promote their professional development, and develop leadership skills, respectively. In addition, 239, 224, 217, and 217 students agreed/strongly agreed that mentors influence students in advancing performance in experiential training, pursuing leadership positions, promoting general academic performance, and engaging in extracurricular activities, respectively. Conclusion: Mentorship is crucial for students’ performance in experiential education and supports them to take on leadership roles to become prospective pioneers of the pharmacy profession. Mentoring programs are perceived to have positive outcomes which supports the need to evaluate their impact on students. (AU)