An Assessment of Knowledge, Attitude, and Practice (KAP) of Colorectal Cancer among Community Pharmacists in the Qassim Region of Saudi Arabia.

Background: The global burden of colorectal cancer remains a major public health issue and one of the leading causes of death worldwide. In Saudi Arabia, it continues to be a health concern. Any delays in diagnosis for any reason may contribute to advanced complications; therefore, pharmacists' knowledge and awareness of colorectal cancer are crucial for the welfare of society. Studies of colon cancer-related knowledge, attitude, and practice (KAP) among community pharmacists have not previously been conducted in the Al-Qassim region of Saudi Arabia. In the present study, therefore, we sought to investigate the KAP on colon cancer among pharmacists in Al-Qassim. Methods: This was a prospective, cross-sectional, observational study. A sample of 150 community pharmacists was recruited using a convenience sampling method. A self-administered questionnaire was used to evaluate levels of knowledge and practice. Results: Out of a total of 150 pharmacists, the majority of respondents (60.7%) possessed an adequate level of knowledge. About 50% of participants had heard of the early screening test, and 68.7% knew that colonoscopy is necessary in such scenarios. On the basis of their attitudes, 41.3% of study participants were aware of colon cancer symptoms and risk factors. In practice, however, the majority of pharmacists (81%) did not perform early cancer screenings, while 19% did screen when advised to do so by a physician. Conclusions: Our results indicate that pharmacists in Qassim have an adequate level of knowledge of colon cancer in terms of awareness, assessment, and screening. Since community pharmacists are among the most reliable members of the medical community, a greater awareness of colon cancer among pharmacists may improve public knowledge of the disease.

Pharmacy Students' Attitudes Toward Distance Learning After the COVID-19 Pandemic: Cross-Sectional Study From Saudi Arabia.

BACKGROUND: Electronic learning refers to the use of assistive tools in offline and distance learning environments. It allows students to access learning tools and materials anytime and anywhere. However, distance learning courses depend on several factors that affect the quality of learning, which consequently affect students' preferences in the settings and tools used to deliver educational materials. OBJECTIVE: This study aimed to evaluate students' preferences for continuing distance learning after the pandemic and to assess the distance educational environment after the pandemic. It also aimed to identify the factors affecting distance learning and evaluate students' preferences regarding modes of communication with instructors. METHODS: A web-based survey was used to conduct this cross-sectional study. The target participants of this study were students in the doctor of pharmacy program at Unaizah College of Pharmacy, Qassim, Saudi Arabia. All students enrolled from December 2022 to January 2023 received an invitation with a link to the web-based survey. RESULTS: The survey was completed by 141 students (58 female students and 83 male students). The research results showed that most students (102/141, 72.3%) did not wish to continue distance education for laboratory courses, and 60.3% (85/141) did not wish to continue taking distance team-based learning after the pandemic. Additionally, 83.7% (118/141) of the students indicated that distance courses were simple. More than half of the participants (79/141, 56%) stated that having a camera on during class negatively impacted their learning, and only 29.1% (41/141) of the students stated that nonvisual communication with their fellow students impacted their learning. A large proportion of students (83/141, 58.9%) reported impairment of social engagement on campus, 44% (62/141) in-person interactions during classes, and 73.7% (104/141) were relieved that their classes were not disrupted. CONCLUSIONS: Similar to all types of education, distance learning is characterized by advantages and disadvantages, as reported by students. Students felt that the course material was intelligible, and the distance course was uncomplicated. Moreover, they expressed relief that their studies were not disrupted. However, they also reported the loss of face-to-face contact during courses as the most significant drawback of distance learning versus face-to-face learning, followed by a lack of social connection on campus.

The Efficacy of Sodium Phytate as a Natural Chelating Agent in Reducing Elevated Calcium Levels in Nasal Mucus Among Individuals Experiencing Olfactory Dysfunction Following COVID-19: A Prospective Randomized Double-Controlled Clinical Trial.

BACKGROUND: COVID-19 has been associated with olfactory disturbances in many infected patients. The increase in calcium levels in nasal secretions plays an essential role in the olfactory process with a desensitizing effect on olfactory receptor neurons and negative effects on odor transmission. Calcium chelating agents have the ability to bind calcium in nasal mucus and prevent the negative effects associated with calcium increase. OBJECTIVES: The aim of this work is to demonstrate the intra-nasal topical application of sodium phytate, an environmentally friendly, non-harmful calcium chelating agent, to reduce the adverse effects of calcium on olfactory function and improve olfactory dysfunction according to COVID-19. METHODS: Fifty-two patients with a previous COVID-19 and olfactory dysfunction lasting longer than 90 days were enrolled in a prospective, randomized, blinded, controlled clinical trial. Patients were divided into two equal groups: 26 patients received nasal spray containing 0.9% sodium chloride and 26 patients received nasal spray containing 1% sodium phytate. Olfactory function was measured before treatment and 1 month later using the Sniffin' Sticks test. Calcium content of nasal secretions was determined before and after treatment with an ion-selective electrode. RESULTS: A significant improvement from anosmia to hyposmia was demonstrated after the use of sodium phytate compared with no improvement after the use of sodium chloride. In addition, a decrease in the level of calcium in nasal secretions was observed after the use of sodium phytate. CONCLUSION: Sodium phytate has benefit role on improving the olfactory function after COVID-19.

Perceptions of Community Pharmacists toward the National E-Prescribing Service (Wasfaty) and Exploring the Benefits and Challenges of the Service: A Descriptive Study from Qassim Region, Saudi Arabia.

BACKGROUND: Electronic prescribing systems (e-prescription) for medications have many benefits, including patient safety, increase in patient satisfaction, efficiency of pharmacy work, and quality of patient care. However, few studies have been conducted to evaluate the national e-prescription system "Wasfaty" service in Saudi Arabia, which was recently adopted. OBJECTIVE: The aims of this study were to explore the benefits observed through the use of the system and most frequent challenges experienced by community pharmacists in the Qassim region of Saudi Arabia. METHODS: This study was conducted using a descriptive survey on a web-based platform. The target population of the study included community pharmacists in the Qassim region of Saudi Arabia who worked in pharmacy chains utilizing the e-prescription service between September 2022 and November 2022. Descriptive statistics along with multiple ordinal regression were used for data analysis. RESULTS: The study population consisted of 124 pharmacists, of which 62.9% (78/124) were males and 37.1% (46/124) were females. Most of the participants had a positive perception of the e-prescription system with regard to medication safety, with 68.6% (85/124) indicating that e-prescriptions reduce the risk of dispensing errors. However, 81.5% (101/124) did not agree that the e-prescription system resulted in a reduction in workload, and 70.2% (87/124) disagreed that the service increased patient satisfaction. CONCLUSIONS: The results of this study indicated that the national e-prescription system has many benefits to healthcare employees and improves their work, particularly for patient safety, reducing medication errors, and improving the management of patient medications. The participants believe that there is a need to improve communication with prescribers, showing concern about the unavailability of some medications; thus, it is important for policymakers to encourage other pharmacy chains and suppliers to join the service to increase patient access to medications.

A Cross-Sectional Study to Investigate the Prevalence of Self-Medication of Non-Opioid Analgesics Among Medical Students at Qassim University, Saudi Arabia.

Purpose: Self-medication (SM) using non-opioid analgesics (NOA) is contentious and increasingly recognized as a major public health concern with severe consequences, including masking of malignant and fatal diseases, risk of misdiagnosis, problems relating to over- and under-dosing, drug interactions, incorrect dosage, and choice of therapy. Herein, we aim to determine the prevalence of SM with NOA among pharmacy and medical students at Unaizah College, Qassim University, Saudi Arabia. Patients and Methods: A cross-sectional study using a validated self-administered questionnaire was conducted on 709 pharmacy and medicine students belonging to an age group of 21-24 years from Unaizah Colleges. Data were statistically analyzed using SPSS version 21. Results: Of 709 participants, 635 responded to the questionnaire. Our results showed a prevalence percentage of 89.6% using self-medicated NOA for pain management. The most common factor leading to SM in NOA was the mild nature of the illness (50.6%), and headache/migraine (66.8%) was the dominant health problem. Paracetamol (acetaminophen, 73.7%) was the most commonly used analgesic, followed by ibuprofen (16.5%). The most common and reliable sources of drug information were pharmacists (51.5%). Conclusion: We observed a high rate of SM for NOA among undergraduate students. We believe that the adverse consequences of SM could be controlled through educational, regulatory, and administrative strategies by providing appropriate awareness sessions, and the role of pharmacists should be highlighted in preventing SM from NOA.

Impact of Vitamin D Supplementation on the Clinical Outcomes and Epigenetic Markers in Patients with Acute Coronary Syndrome.

Vitamin D has recently been found to influence the renin-angiotensin system (RAS); it can reduce the effects of renin-angiotensin system inhibitors (RASI) by decreasing plasma renin. This study examines the effect of vitamin D supplements on cardiac fibrosis markers, echocardiographic parameters, and epigenetic markers in patients with established acute coronary syndrome (ACS). It also looks at the incidence of vitamin D receptor (VDR) gene polymorphisms Apa I (rs7975232), Bsm I (rs1544410), Taq I (rs731236), and Fok I (rs2228570) and its association with the development of secondary major acute cardiovascular events (MACE) and heart failure (HF). A randomized controlled trial in which patients were divided into two groups was performed. Group 1 comprised of 125 ACS patients who received ACS standard therapy alone, while Group 2 consisted of 125 ACS patients who received ACS standard therapy plus vitamin D according to their vitamin D levels. Patients were monitored for 24 months to find subsequent MACE and HF. Vitamin D therapy for ACS patients resulted in a substantial decline in end systolic and end diastolic volumes (p = 0.0075 and 0.002, respectively), procollagen type III N-terminal peptide (PIIINP) and soluble ST2 levels (p = 0.007 and 0.001, respectively), as well as in ejection fraction and vitamin D level (p = 0.0001 and 0.008, respectively). In addition, vitamin D treatment was linked to a significant decline in the levels of noncoding RNA, such as mir361, lncRNA MEG3, and lncRNA Chaer (p = 2.9 × 10-4, 2.2 × 10-6, and 1.2 × 10-5, respectively). Furthermore, patients who suffered MACE had significantly higher levels of the Bsm I CC and Fok I GG genotypes (p = 4.8 × 10-4 and 0.003, respectively), while patients with HF had significantly higher levels of the Taq I AA genotype (p = 4.2 × 10-7). Supplementing ACS patients with vitamin D has been demonstrated to limit cardiac fibrosis and echocardiographic parameters, as well as epigenetic markers. Additionally, MACE and HF among ACS patients may be related to genetic variations among VDR gene polymorphisms.

Cost-Effectiveness of Dapagliflozin vs Empagliflozin for Treating Heart Failure With Reduced Ejection Fraction in the United States.

PURPOSE: Evidence suggests that adding dapagliflozin to the prior standard of care is cost-effective compared with the standard of care alone. The latest guideline by the American Heart Association/American College of Cardiology/Heart Failure Society of America now recommends the use of sodium-glucose cotransporter 2 (SGLT2) inhibitors for patients with heart failure with reduced ejection fraction (HFrEF). However, the relative cost-effectiveness of different SGLT2 inhibitors, including dapagliflozin and empagliflozin, has not been fully characterized. Therefore, we conducted a cost-effectiveness analysis to compare dapagliflozin and empagliflozin in patients with HFrEF from the US health care perspective. METHODS: To compare the cost-effectiveness of dapagliflozin and empagliflozin in treating HFrEF, we used a state-transition Markov model. This model was used to estimate the expected lifetime costs, quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER) for both medications. The model incorporated patients who were 65 years of age at entry and simulated their health outcomes over a lifetime horizon. The perspective of the analysis was based on the US health care system. To determine the health state transition probabilities, we used a network meta-analysis. All future costs and QALYs were discounted at an annual rate of 3%, and the costs were presented in 2022 US dollars. FINDINGS: The base case analysis found that the incremental expected lifetime cost of treating patients with dapagliflozin vs empagliflozin was $37,684, resulting in an ICER of $44,763 per QALY. A price threshold analysis indicated that for empagliflozin to be the most cost-effective SGLT2 inhibitor at a willingness-to-pay threshold of $50,000 per QALY, it may require a 12% discount on its current annual prices. IMPLICATIONS: The findings of this study indicate that dapagliflozin may offer greater lifetime economic value when compared with empagliflozin. Given that the current clinical practice guideline does not recommend one SGLT2 inhibitor over the other, it is essential to implement scalable strategies to ensure affordable access to both medications. By doing so, patients and health care practitioners can make informed decisions about their treatment options without being constrained by financial barriers.

Gender Differences in Knowledge, Attitudes, and Practices toward COVID-19 in Saudi Arabia: A Cross-Sectional Study.

Days after the World Health Organization (WHO) declared that COVID-19 was a pandemic, Saudi Arabia took preventative and precautionary measures to avoid its spread and to safeguard its citizens. In this study, we investigated the knowledge, attitudes, and practices (KAP) of both men and women toward COVID-19 as well as associated factors. A cross-sectional study was conducted using an online, self-report questionnaire distributed via Google Forms. The overall percentage of correct answers for the knowledge statements was 80.2%, with a higher rate among the female respondents (82.4% vs. 78.5%, p = 0.005). Slightly more than half (i.e., 165: 51.6%) of the participants showed that they did not go to crowded places during the pandemic; however, more female respondents recorded that they avoided crowded places than male respondents (57.7% vs. 46.2%, p = 0.04). Most participants (i.e., 272: 85.0%) reported that they had worn a mask in recent days, and more than two-thirds (84.4%) said that they still follow the strategies recommended by government authorities to prevent the spread of the virus. Again, more female respondents reported this than males (89.9% vs. 79.5%; p = 0.01). Significant correlations (p < 001) were noted between knowledge and practices (r = 0.31), knowledge and attitudes (r = 0.37), and attitudes and practices (r = 0.29). In the multivariate logistic regression analysis, occupation and education were independently associated with knowledge among both the male and female respondents (adjusted odds ratio [aOR]: 2.9; 95% confidence interval [CI]: 1.2-7.2; aOR: 5.9; 95% CI: 2.2-15.9). Residence was independently associated with attitudes, but only among the male respondents (aOR: 2.3; 95% CI: 1.1-4.9), and COVID-19 was independently associated with practices among both the male and female respondents (aOR: 4.5; 95% CI: 1.4-14.2; aOR: 9.8; 95% CI: 1.2-81.2). There were significant gender differences in both knowledge and practices toward COVID-19, with the female respondents achieving better scores than the male respondents. Thus, we recommend that health education campaigns are tailored to specifically target males.

Drug Information Sources for Patients with Chronic Conditions in the Qassim Region, Saudi Arabia.

Appropriate drug information is vital for the correct use of drugs in pharmaceutical practice. Providing patients with educational advice on prescribed medication and on proper medication administration has become an essential part of the pharmaceutical care process. The objectives of this study were to identify patients' knowledge of prescribed medications, their desire for more information, and the sources of medication information in a population from Qassim, Saudi Arabia, using a cross-sectional descriptive study. Our target population consisted of adult patients with chronic illnesses receiving drugs at outpatient pharmacies. Nineteen pharmacies were selected based on convenience. After collecting their prescriptions, patients were asked to take part in the study by interviewers as they were leaving the pharmacies. The questionnaire used was pretested on 18 patients and then modified accordingly. questions investigated participants' knowledge of drug information, their wish for more information, and their sources of drug information, other than clinicians. Descriptive analysis was used to describe patients' physical details. The effect of sex, education, diagnosis, number of drugs, and age on knowledge of the purpose of drugs and the need for additional information were tested using Chi-square test. A total of 270 patients were interviewed, of whom 29.7% reported not knowing the purpose of at least one of their medications, and only reading a portion of the PILs. Of the patients sampled, 56.7% said they read the side effects section of the PIL, 43.3% reported reading the uses, while 27% read the contraindications. The drug -interactions section was the least read, with only 18.9% reporting reading it. A total of 57% of the patients reported that they needed more information about their medications. Highly educated patients reported using the PIL, social media, family and friends, TV, and newspapers as sources of drug information at significantly higher rates than patients with lower levels of education. Healthcare professionals should assess patient comprehension and the need for additional drug information, especially among patients with low levels of education. Additionally, healthcare professionals should consider other information sources used by their patients.

Public Awareness Regarding Household Drug Storage, Qassim Region, Saudi Arabia: A Cross-Sectional Study.

Background: Little is known regarding the post-dispensing storage conditions for pharmaceuticals in Saudi Arabia (SA). Most parts of the region are usually hot and humid, which could result in the decline of crucial performance parameters. Objective: To determine the prevalence of household drug storage habits in the population of Qassim, and to investigate their storage behaviors as well as knowledge and awareness of factors that may affect drug stability. Methods: A cross-sectional study was conducted using a simple random sampling technique in the Qassim region. Data were collected over a period of 3 months using a well-structured self-administered questionnaire and analyzed using SPSS version 23. Results: More than six hundred households from all regions of Qassim in SA participated in this study. Approximately 95% of the participants stored 1-5 drugs at home. Analgesics and antipyretics were the highest household reported drugs (71.9%), with tablets and capsules dosage forms (72.3%). More than half of the participants (54.6%) stored drugs in their home refrigerators. Approximately 45% of the participants regularly checked the expiry dates of household drugs and immediately discarded them once their color changed. Only 11% of the participants shared drugs with others. We found that the number of drugs stored at home is heavily influenced by the number of family members in general and the number of members with medical issues in particular. Moreover, Saudi female participants with higher levels of education demonstrated better behaviors in terms of ensuring appropriate conditions for household drug storage. Conclusion: The majority of participants stored drugs in the home refrigerator or other easily accessible places, which may lead to toxicity or health risks, particularly for children. Therefore, population education and awareness programs should be implemented to raise awareness about the consequences of drug storage conditions in terms of the stability, efficacy, and safety of medications.

Knowledge, Attitude, and Acceptance of Sinopharm and AstraZeneca's COVID-19 Vaccines among Egyptian Population: A Cross-Sectional Study.

BACKGROUND: This study aimed to evaluate the Egyptian population's preference and awareness related to available COVID-19 vaccines and to determine different factors that can affect beliefs concerning these vaccines. METHODS: A cross-sectional web-based study was carried out among the general population in Egypt. Data collection was conducted via an online questionnaire. RESULTS: About 426 subjects participated in the survey. Vaccine preference is nearly equally even (50%) among all respondents. There was no significant difference in vaccine preference according to age, gender, residence, educational level, or social status. About 50% of public respondents mentioned that both AstraZeneca and Sinopharm vaccines do not offer protection against new variant COVID-19 strains. Healthcare workers are the lowest respondents to agree that vaccines offer protection against new COVID-19 variants (10.9%) compared to unemployed respondents (20.3%) and other professions (68.8%) with a statistically significant difference (p < 0.005). Safety of vaccine administration among children below 18 showed statistical differences for gender and educational level predictors. CONCLUSIONS: Most of the study population has satisfying knowledge about the COVID-19 vaccine. Continuous awareness campaigns must be carried out so that the people's background is updated with any new information that would help in raising the trust in vaccination.

Current state of career placement and employment opportunities for Doctor of Pharmacy graduates: A cross-sectional analysis from a college of pharmacy, Saudi Arabia.

Background: Traditionally, graduates from colleges of pharmacy in Saudi Arabia work mainly in hospital settings, and only a few graduates work in other practice settings. However, several initiatives and national plans have recently been introduced to facilitate employment in community pharmacies and the pharmaceutical industry/companies. Consequently, the objectives of this study were to explore the current state of career placement, type of employment sectors, and practice settings that Doctor of Pharmacy (PharmD) graduates join based on recent developments in the profession. Methods: This study is a cross-sectional, descriptive study. The target population was PharmD graduates from Unaizah College of Pharmacy, Qassim University, Saudi Arabia. Consequently, all 162 graduates from three recent cohorts (2018-2020) were contacted to participate in this survey. Results: A total of 157 graduates participated in this study, yielding a response rate of 96.91 %. Of the participants, 92 (58.6 %) were female graduates. The overall rate of employment was 84.7 %. Moreover, a higher proportion of male graduates than female graduates (97.1 % versus 73.7 %, P = 0.006) were employed. In this study, the three main sectors that the graduates joined were the pharmaceutical industry and companies (41.2 %), community pharmacies (29.4 %), and medical cities, hospitals and clinics (23.5 %). In addition, almost the same proportions of male and female graduates joined the pharmaceutical industry and companies (40.3 % versus 42.1 %). However, a higher proportion of male graduates than female graduates joined community pharmacies (32.3 % versus 26.3 %). Conversely, a higher proportion of female graduates joined medical cities, hospitals and clinics compared to male graduates (28.1 % versus 19.4 %). Conclusion: The current employment of PharmD graduates in the job market is generally high, but further improvement could be made, especially for female graduates. Moreover, the study findings showed that jobs are shifting toward community pharmacies and the pharmaceutical industry. Therefore, we believe that decision-makers in pharmacy education and curriculum developers must consider these trends and ensure that there is adequate preparation for careers in community pharmacy practice and other sectors of the profession in the curriculum.

Barriers and Facilitators of Pharmacoeconomic Studies: A Review of Evidence from the Middle Eastern Countries.

The world is facing a continuous increase in medical costs. Due to the surge in disease prevalence, medical science is becoming more sensitive to the economic impact of medications and drug therapies. This brings about the importance of pharmacoeconomics, which is concerned with the effective use of health resources to optimize the efficiency and costs of medications of treatment for the best outcomes. This review was conducted to find out the potential barriers and facilitators to implementing pharmacoeconomic studies in the Middle Eastern region having both high- and low-income countries. The varying economies in the region depict diverse healthcare systems where implementation of pharmacoeconomics faces a large number of challenges and is also aided by numerous facilitators that contribute to the growth of its implementation. In this context, we have reviewed the status of pharmacoeconomics in Middle Eastern countries in research databases (Google Scholar, MEDLINE, Science Direct and Scopus) using keywords ("pharmacoeconomics", "barriers", "facilitators", "Middle East"). The study reported that Yemen, Syria, Palestine, Iran, Iraq, Jordan and Lebanon are the lowest-income countries in the Middle East and the implementation of pharmacoeconomics is the poorest in these states. The UAE, Saudi Arabia and Israel are high-income rich states where economic aspects were comparatively better but still a large number of barriers hinder the way to its effective implementation. These include the absence of national governing bodies, the lack of data on the effectiveness of medications, the absence of sufficient pharmacoeconomic experts and the lack of awareness of the importance of pharmacoeconomics. The main facilitators were the availability of pharmacoeconomic guidelines, the encouragement of pharmacoeconomic experts and the promotion of group discussions and collaborations between researchers and policymakers. Cost-benefit analysis is still evolving in Middle Eastern countries, and there is a great need for improvement so that states can effectively benefit from cost analysis tools and utilize their health resources. In this regard, governments should develop national governing bodies to evaluate, implement pharmacoeconomics at the local and state levels and bring about innovation in the field through further research and development incorporating all sectors of pharmacy and pharmaceutics. The data presented in this research can further be extended in future studies to cover the various domains of pharmacoeconomics including cost-minimization analysis, cost-effectiveness analysis and cost-benefit analysis and their applications within the healthcare sectors of Middle Eastern countries.

Comparative Safety Signal Assessment of Hospitalization Associated With the Use of Atypical Antipsychotics.

Background: Persons with symptoms of psychosis receiving treatment with atypical antipsychotics (AAPs) can experience serious adverse events (AEs) requiring admission to the hospital. The comparative likelihood of AE-related hospitalization following the use of all AAPs has not been fully characterized. Therefore, we evaluated the safety signals of hospitalizations associated with the use of AAPs. Methods: We conducted a cross-sectional analysis using the FDA Adverse Event Reporting System (FAERS) database (from January 1, 2004, to December 31, 2021) to examine disproportionality in reporting hospitalizations suspected to be associated with 12 AAPs (aripiprazole, asenapine, brexpiprazole, clozapine, iloperidone, lurasidone, olanzapine, paliperidone, and pimavanserin, quetiapine, risperidone, and ziprasidone). Hospitalization in the FAERs database is an outcome that is recorded as a result of an AE occurring at any drug dose. We estimated reporting odds ratios (RORs) by comparing the odds of hospitalization occurring with a particular AAP to the odds of its occurrence with other drugs. In addition, we considered the presence of a significant safety signal when the lower limit of the 95% confidence interval (CI) of the ROR is >1. Results: A total of 204,287 cases of hospitalizations were reported to the FDA for individuals treated with AAPs. There were significant safety signals of hospitalization associated with using clozapine (ROR, 2.88; 95% CI, 2.84-2.92), olanzapine (ROR, 2.61; 95% CI, 2.57-2.64), quetiapine (ROR, 1.87; 95% CI, 1.85-1.89), risperidone (ROR, 1.41; 95% CI, 1.39-1.43), aripiprazole (ROR, 1.34; 95% CI, 1.32-1.35), and ziprasidone (ROR, 1.14; 95% CI, 1.10-1.18). However, no hospitalization-related safety signals were observed with the use of paliperidone, pimavanserin, iloperidone, asenapine, lurasidone, and brexpiprazole. The ROR estimates were numerically higher among older adults than younger adults. Conclusions: This cross-sectional assessment of data from FAERs (2004-2021) suggested that users of clozapine, olanzapine, quetiapine, risperidone, aripiprazole, and ziprasidone were more likely to report being hospitalized than users of other AAPs. Given that the FAERs database only contains spontaneous reports of AEs experienced by persons exposed to a drug but without information on exposed persons who did not have an event, a cohort study comparing hospitalizations among new users of individual AAPs against each other is needed to delineate these safety signals further.

Comparative Value of Cholinesterase Inhibitors and Memantine in Persons with Moderate-to-Severe Alzheimer's Disease in the United States: A Cost-Effectiveness Analysis.

BACKGROUND: Pharmacological treatment of Alzheimer's disease (AD) involves symptomatic improvement of cognition using cholinesterase inhibitors (ChEIs) and memantine. The cost-effectiveness of these medications will guide decision-makers in making judicious use of scarce healthcare resources, particularly during the advanced disease stages. OBJECTIVE: To evaluate the cost-effectiveness of ChEIs, memantine, and ChEI-memantine combinations in persons with moderate-to-severe AD from the US healthcare perspective. METHODS: This pharmacoeconomic evaluation study used a state-transition Markov cohort model to simulate the costs and effectiveness of ChEI-memantine combinations compared with monotherapies of ChEI (donepezil, galantamine and rivastigmine) and memantine in persons with moderate-to-severe AD over a lifetime horizon with a 1-year cycle length. We estimated expected quality-adjusted life-years (QALYs), costs (in 2020 $US), net monetary benefits, and incremental cost-effectiveness ratios (ICERs). We discounted future costs and QALYs at the rate of 3%. RESULTS: In this study, donepezil monotherapy, galantamine-memantine combination, and rivastigmine transdermal patch formed the cost-effectiveness frontier. Findings suggests that rivastigmine transdermal patch is the optimal treatment strategy at a willingness-to-pay (WTP) threshold of $150,000/QALY (ICER = $93,307/QALY [versus donepezil monotherapy]). Results across subgroups by age and sex also suggest that the rivastigmine transdermal patch is the optimal treatment strategy with the highest net benefit. CONCLUSION: From the US healthcare perspective, we found that, for persons with moderate-to-severe AD at a WTP threshold of $150,000/QALY, the rivastigmine transdermal patch is the most cost-effective pharmacological treatment option. Given that the transdermal patch is a preferred route of administration for persons with AD and their caregivers due to its convenience, our findings provide additional incentives for its use.

Steroid-induced psychosis in a child with croup: A case report.

Corticosteroids are effective for the treatment of many chronic and acute diseases but have many well-known adverse effects, which limit their use in some conditions. Steroid-induced psychosis is a rare side effect especially in the pediatric population. Although the estimated incidence of steroid-induced psychosis in adults is approximately 6%, it is rarely reported in the pediatric population. Moreover, it is poorly characterized and described in the literature. We report the case of a 4-year-old boy with no known medical or psychiatric history who presented to the emergency department with respiratory complaints. After observation and monitoring, the patient was diagnosed as having croup. A single dose of 8 mg dexamethasone was started intravenously. Within 3 h after the injection, the patient experienced psychiatric disturbances, including abnormal behaviors, anxiety, disorientation, decreased speech, and sleep disturbance. During the first 48 h of admission, the symptoms improved gradually, without using further medication during the rest of his hospital stay.

Awareness, Views, Perceptions, and Beliefs of Pharmacy Interns Regarding Digital Health in Saudi Arabia: Cross-sectional Study.

BACKGROUND: Digital health technologies and apps are rapidly advancing in recent years. It is expected to have more roles in transforming the health care system in this era of digital services. However, limited research is available regarding delivering digital health education in pharmacy and the pharmacy students' perspectives on digital health. OBJECTIVE: This study aims to assess pharmacy interns' awareness of digital health apps in Saudi Arabia and their views regarding the coverage of digital health in the education of pharmacists. In addition, we assessed the interns' perceptions and beliefs about the concepts, benefits, and implementation of digital health in practice settings. METHODS: A cross-sectional study using a web-based survey was conducted among pharmacy interns at Unaizah College of Pharmacy, Qassim University, Saudi Arabia. An invitation with a link to the web-based survey was sent to all interns registered at the college between January and March 2021. RESULTS: A total of 68 out of 77 interns registered in the internship year participated in this study, giving a response rate of 88%. The mean total score for pharmacy interns' awareness of digital health apps in Saudi Arabia was 5.66 (SD 1.74; maximum attainable score=7). The awareness with different apps ranged from 97% (66/68) for the Tawakkalna app to 65% (44/68) for the Ministry of Health 937 call center. The mean total score for attitude and beliefs toward concepts and benefits of telehealth and telemedicine apps was 58.25 (SD 10.44; maximum attainable score=75). In this regard, 84% (57/68) of the interns believed that telehealth could enhance the quality of care, 71% (48/68) believed that it could help effectively provide patient counseling, and 69% (47/68) believed it could improve patients' adherence to therapy. In this study, 41% (28/68) believed that the current coverage of digital health in the curriculum was average, whereas only 18% (12/68) believed it was high or very high coverage. Moreover, only 38% (26/68) attended additional educational activities related to digital health. Consequently, the majority (43/68, 63%) were of the opinion that there is a high or very high need to educate and train pharmacists in the field of digital health. CONCLUSIONS: Overall, the interns showed good awareness of common digital health apps in Saudi Arabia. Moreover, the majority of the interns had positive perceptions and beliefs about the concepts, benefits, and implementation of digital health. However, the findings showed that there is still scope for improvement in some areas. Moreover, most interns indicated that there is a need for more education and training in the field of digital health. Consequently, early exposure to content related to digital health and pharmacy informatics is an important step to help in the wide use of these technologies in the graduates' future careers.

Knowledge and Attitude of Pharmacy Students toward People with Mental Illnesses and Help-Seeking: A Cross-Sectional Study from Saudi Arabia.

People with mental illnesses (MIs) face several challenges in addition to their disease. People's negative views of those with MIs impact patients' decisions to seek professional help. The aims of this study were to assess pharmacy students' attitudes toward people with MIs and seeking help for mental health, as well as their knowledge about the causes of MIs. A cross-sectional survey was conducted on pharmacy students at Unaizah College of Pharmacy, Qassim University, Saudi Arabia. Out of the 460 distributed questionnaires, 330 complete questionnaires were received, giving a response rate of 71.7%. Overall, the mean total score for attitude towards people with MIs was 60.16 ± 10.48 (maximum attainable score: 105). In this study, 51.12% believed that people with MIs are more likely to harm others than a person without MIs and 66.9% mentioned that they did not trust the work of a mentally ill person as part of their work team. However, only 35.45% believed that it is difficult for mentally ill individuals to follow social rules. In terms of attitudes toward help-seeking, the mean total score of was 12.83 ± 3.16 out of the maximum score of 25. In addition, the mean total score for knowledge about causes of mental illness was 2.92 ± 1.76 out of the maximum score of 8. The participants reported that MIs could be due to genetic inheritance (56%), substance abuse (54.5%), or brain disease (66.1%). The findings showed that there are some negative attitudes toward people with MIs and negative attitudes towards seeking help for mental health. In addition, some misconceptions about the causes of MIs are prevalent. Consequently, the incorporation of more topics concerning mental health in pharmacy curricula could help improve the awareness of and knowledge about mental health.

Knowledge, Attitude and Practice About Coronavirus Disease (COVID-19) Pandemic and Its Psychological Impact on Students and Their Studies: A Cross-Sectional Study Among Pharmacy Students in Saudi Arabia.

BACKGROUND: Individuals' knowledge, attitude and practice towards preventive and precautionary measures of COVID-19 are essential to control the spread of the disease. Consequently, the aims of the study were to evaluate knowledge, attitude and practice of pharmacy students towards the pandemic and to assess its psychological impact on them to provide future guidance. METHODS: A cross-sectional, questionnaire-based study was conducted via a web-based survey in May 2020. All pharmacy students enrolled at Unaizah College of Pharmacy, Qassim University, were invited to take part in the study. RESULTS: A total of 232 out of 460 students took part in the study, giving a response rate of 50.43%. The mean total knowledge score was 9.87 ± 2.04 (maximum attainable score, 12). The majority of the participants (n=163; 70.3%) believed COVID-19 is a health threat to their community in the early months of the pandemic. Moreover, the majority (93%) also believed that the lockdown at the beginning of the pandemic was necessary to contain the pandemic. Encouragingly, 86.6% reported that they did not go to any crowded places during the pandemic with more female students avoiding crowded places compared to male students (91.6% versus 78.7%, respectively, P = 0.005). The majority (91%) also reported that they were following the strategies recommended by the authorities to prevent the spread of the virus. Encouragingly, 54.3% reported that the pandemic either had no effect or just a limited effect on their studies. However, 38.5% reported that they always felt or frequently felt nervous or anxious during the pandemic. CONCLUSION: The study showed that pharmacy students had good knowledge as well as positive attitudes and good practices towards COVID-19 and the preventive measures. However, during the early months, the pandemic did have a negative psychological impact on a number of students. Consequently, proactive psychological and social support services to the students should be considered during the current and future pandemics. In addition, it is important to consider and proactively address key issues that could cause stress and anxiety among students when shifting to distance learning and assessments.

Adoption of RTS, S malaria vaccine for children younger than 5 years in Rwanda: A budget impact analysis.

Background: In Rwanda, malaria affects one in six children under five years old. Despite being preventable and treatable, malaria causes substantial morbidity, mortality, and economic burden on the Rwandan government and healthcare donors. Recently, the World Health Organization (WHO) agreed to consider the new malaria vaccine (RTS, S) as an additional prevention strategy. The Global Fund, a healthcare donor, is committed to donating more than fifty million US dollars over four years (2018-2021) to fight malaria in Rwanda. We estimated the potential budget impact of the adoption of RTS, S, into the Global Fund budget (as a case study) for malaria prevention in Rwanda. Methods: We developed a static budget impact model based on clinical, epidemiological, and cost (in US dollars) data from the literature, to assess the financial consequences of adding RTS, S to existing prevention strategies. Cost of treatment and prevention for the first year (without vaccine) was estimated and compared to the total cost after the fifth year (with vaccine). A one-way sensitivity analysis evaluated the robustness of the model. Results: For the 283,931children under 5 years at risk of malaria in Rwanda every year, the expected budget for first year (without vaccine) was $1,328,377.71 and for the fifth year (with vaccine) was $3,837,804, yielding a potential budget impact of $2,509,427. The cost of treating un-prevented malaria for the first year was $736,959 and for the fifth year was $61,413. The annual number of malaria treatments avoided increased from 10,095 children in the first year after introduction of vaccine to 36,701 children at the fifth year. Conclusion: With a potential budget impact of $2,509,427, the introduction of malaria vaccine for children under 5 years by Global Fund in Rwanda may be affordable when compared to the amount spent on treating children with malaria. Given that Malaria causes more harm than most parasitic diseases and disproportionally affects low-income populations, it is ethical to deploy all measures to control or eliminate Malaria, including vaccination.