The digital transformation in pharmacy: embracing online platforms and the cosmeceutical paradigm shift.

In the face of rapid technological advancement, the pharmacy sector is undergoing a significant digital transformation. This review explores the transformative impact of digitalization in the global pharmacy sector. We illustrated how advancements in technologies like artificial intelligence, blockchain, and online platforms are reshaping pharmacy services and education. The paper provides a comprehensive overview of the growth of online pharmacy platforms and the pivotal role of telepharmacy and telehealth during the COVID-19 pandemic. Additionally, it discusses the burgeoning cosmeceutical market within online pharmacies, the regulatory challenges faced globally, and the private sector's influence on healthcare technology. Conclusively, the paper highlights future trends and technological innovations, underscoring the dynamic evolution of the pharmacy landscape in response to digital transformation.

Assessment of Adherence to Cardiovascular Medicines in Saudi Population: An Observational Study in Patients Attending a Tertiary Care Hospital.

BACKGROUND: Drug adherence has been extensively evaluated in many developed countries in the West using different methods of medication adherence measurement; however, there are relatively few reports studying the adherence levels among Saudi patients. Thus, this study will evaluate the adherence to cardiovascular medicines in Saudi patients visiting (PSCC) in Al-Qassim, Saudi Arabia. METHODS: This cross-sectional observational study relied on self-administered questionnaires. This study used the Morisky, Green, and Levine (MGL) Adherence Scale, also known as the MAQ (Medication Adherence Questionnaire), in PSCC's pharmacy waiting room in Qassim, Saudi Arabia. RESULTS: This study included 993 PSCC pharmacy waiting room patients. The patients were between 11 and 50 years old, and 52.7 percent were male. Most participants (71.2%) were above 50, while 16.3% were 41-50. Non-adherent patients cited traveling or being busy (28.6%), forgetting (18.7%), daily multi-medications (7.1%), being sleepy or sleeping (6.6%), and not repeating the prescription (6.6%). The Medicine Adherence Questionnaire indicated that 62.6 percent of patients fully adhered to their medications, and 21.6 percent usually adhered. Only drug adverse effects affected adherence (p =0.0001). CONCLUSION: The current study showed that there is a good level of adherence among patients with cardiovascular diseases toward their diseases. The most common reasons for neglecting medications include traveling or being busy, forgetting multiple medications, and being tired or sleeping. Having experience with side effects was the only significant factor affecting adherence to medications.

Comparison between the ECG Outcomes of Metoprolol and Bisoprolol.

BACKGROUND: Beta-blockers are essential agents in the management of cardiovascular diseases, such as heart failure, acute myocardial infarction (MI), and cardiac arrhythmias. However, there are diurnal variations in the cardioprotective effects of the subgroups as a result of their different pharmacokinetic, pharmacodynamic, and pharmacogenetic profiles. OBJECTIVE: We aimed to compare metoprolol and bisoprolol in terms of electrocardiogram (ECG) outcomes. METHODS: A retrospective cross-sectional study was conducted at Prince Sultan Cardiac Center. The trial included 404 patients who met the inclusion criteria (204 in the metoprolol arm and 200 in the bisoprolol arm). Using case record forms that had already been created, information, such as patient demographics, medical histories, and treatment histories, was taken from their medical files. The most recent ECG records were also gathered. The ethical approval for this study was obtained from Qassim ethical committee (approval number: 45-44-902). RESULTS: There was no significant difference found between the patients in both arms in terms of baseline characteristics, age, or sex. CONCLUSION: In this retrospective cross-sectional study, we have compared the effects of metoprolol and bisoprolol beta blockers on ECG changes. The findings have indicated no difference between metoprolol and bisoprolol groups in terms of all ECG readings, particularly PR/ms, QTC-ms, and ventricular rate. Further studies are required to confirm these findings.

Decentralization and Virtualization of INR-based Anticoagulation Control During the COVID-19 Pandemic.

OBJECTIVE: To investigate the effectiveness of the decentralization and virtualization of anticoagulation clinics just before and during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: We conducted a cohort study investigation at Prince Sultan Cardiac Clinics PSCC Qassim region, Saudi Arabia. To evaluate the effectiveness of the virtual coagulation clinic, we calculated the time in therapeutic range (TTR), Morisky score for adherence, and satisfaction. Demographics of the patients were analyzed to group patients based on their regions or districts to facilitate the visits. Thirteen different PHCs/Hospitals were allocated for decentralization based on patient density in that region. Intensive courses were provided for all general practitioners (GPs) regarding warfarin anticoagulation and point of care testing (POCT) using iSTAT. All appointments were scheduled by WhatsApp, with no more actual visits to the main center. RESULTS: Among the included participants (n = 5616), 61.1% were females, 38.9% were males, and the mean age was 60.5 (18-85) years. The total number of clinic visits was 7303 per month, with an average of 1.3 visits per patient. Approximately 95% of the participants had a valvular indication to receive anticoagulation; of them, 55% underwent mitral valve replacement. Moreover, after the virtualization of the INR clinic, keeping INR levels within a therapeutic range was reported in 80% of patients. Regarding patient satisfaction, 90% of the total population was satisfied by the new experience. CONCLUSION: Decentralization and virtualization of the INR clinic have similar TTR results if conducted properly.

Management of COVID-19 vaccines cold chain logistics: a scoping review.

BACKGROUND: Successful mass vaccination programmes are public health achievements of the contemporary world. While pharmaceutical companies are actively developing new vaccines, and demonstrating results of effectiveness and safety profiles, concerns on COVID-19 vaccine management are under-reported. We aimed to synthesise the evidence for efficient cold chain management of COVID vaccines. METHODS: The scoping review's conduct and reporting were based on the PRISMA-ScR 2018 checklist. We searched from April 2020 to January 2022 for publications in PubMed (LitCovid), Scopus and ScienceDirect. All review stages were pilot-tested to calibrate 2 reviewers. Articles on cold chain logistics and management were included, while publications solely describing COVID vaccines, their development and clinical aspects of the vaccine, were excluded. To capture relevant data, charting was conducted by one reviewer and verified by another. Results were analysed thematically and summarised descriptively in a table and in-text. RESULTS AND DISCUSSION: We assessed 6984 potentially relevant citations. We included 14 publications originating from USA (n = 6), India (n = 2), Finland, Spain, Bangladesh, Netherlands, Switzerland and Ethiopia. They were reported as reviews (4), policy or guidance documents (3), experimental studies (2), case reports (2), expert commentary (1), phenomenological study (1), and decision-making trial and evaluation laboratory trial (1). The findings were presented in three themes: (i) regulatory requirements for cold-chain logistics, (ii) packaging and storage, and (iii) transportation and distribution. A conceptual framework emerged linking regulatory requirements, optimal logistics operation and formulation stability as the key to efficient cold chain management. Recommendations were made for improving formulation stability, end-product storage conditions, and incorporating monitoring technologies. CONCLUSION: COVID-19 vaccines require special end-to-end supply cold chain requirements, from manufacture, and transportation to warehouses and healthcare facilities. To sustain production, minimise wastage, and for vaccines to reach target populations, an efficient and resilient vaccine supply chain which is assisted by temperature monitoring technologies is imperative.

Severe Ludwig's angina caused by an unknown insect bite.

Hereby, we report a case of a 75-year-old man who presented with a 3-day history of facial swelling and choking sensation. The only history of note was an insect bite on the left parotid gland area 3 days prior. The patient was later diagnosed with insect-bite-induced Ludwig's angina. Enterococcus faecalis was detected on blood cultures and was presumed the source of infection. Intravenous antibiotics and corticosteroids were initiated. The patient was intubated and was subsequently made to undergo a tracheostomy insertion to establish a definitive airway. He was admitted to the intensive care unit and when his condition improved, he was transferred to the ward for full recovery. The patient spent a total of 66 days in hospital before being discharged. This case suggests that Ludwig's angina can be caused by insect bites. However, further similar cases are needed to be documented to explore this theory.

Pharmacokinetics Parameters of Diagoxin among Saudi Patients in Qassim Region, Saudi Arabia.

BACKGROUND: The pharmacodynamic effects of digoxin are susceptible to multiple factors, most notably, heart uptake of the digoxin dose and its concentration in the serum. Another important factor to mention is the renal function state of an individual. OBJECTIVE: In this study, we aimed to develop a simple algorithm based on subsets of clinically relevant information, which will help to personalize digoxin based on pharmacokinetic (PK) approach which can help in marketing the appropriate utilization of this medication. METHODS: This was a retrospective chart review and analysis of 48 patients who were admitted to the Drug and Poison Information center in Buraidah, Saudi Arabia, between January 2016 and April 2019. All pharmacokinetic parameters were added according to the C-peaks and C-troughs. MONOLiX® was used for data pharmacokinetic analysis. RESULTS: Twenty-seven (56%) were males and twenty-one (44%) were females with an average age of 63.6 years across both genders. The mean volume of distribution was 496.6 litres with an average clearance of 6.6 L/h. For females, their average volume of distribution was slightly higher than that for males (526 litres compared to 473 litres). In addition, the clearance rate between both genders showed a 2.1 litre/hour discrepancy (7.8 L/h for females compared to 5.7 L/h for males). CONCLUSION: In order to individualize the digoxin dosage regimens, this model can be used to predict digoxin serum concentration. Further studies are needed to clarify the effects of nutritional status and co-administration of medications on digoxin pharmacokinetics.

Major CYP450 Polymorphism among Saudi Patients.

BACKGROUND: Cytochrome P450 (CYP) contributes to a huge collection of medicinal products' Phase I metabolization. We aimed to summarize and investigate the current evidence regarding the frequency of CYP2D6, CYP2C9, CYP2C19, and MDR1 in Saudi Arabia. METHODS: A computerized search in four databases was done using the relevant keywords. The screening process was done in two steps; title and abstract screening and full-text screening. Data of demographic and characteristics of included studies and patients were extracted and tabulated. RESULTS: Ten studies were eligible for our criteria and were included in this systematic review. The age of participants ranged between 17-65 years. Only two subjects showed PM phenotype of CYP2C19 in the Saudi population. The most frequent alleles were CYP2C19*1 (62.9%), CYP2C19*2 (11.2%-32%), and CYP2C19*17 (25.7%). The CYP2C19m1 was observed in 97 cases of extensive metabolizing (EM) phenotype CYP2C19. Concerning the CYP2C9, the most frequent alleles were CYP2C9*1 and CYP2C9*2, and the most frequent genotype was CYP2C9*1*1. The CYP2D6*41 allele and C1236T MDR1 were the most frequent allele in this population. CONCLUSION: The current evidence suggests that Saudi resembled European in the frequency of CYP2C19, Caucasians in both the incidence of CYP2C9 and CYP2C19m1, and the absence of CYP2C19m2. The CYP2D6*41 allele frequency in Saudi is relatively high. We recommend further research to evaluate the basic and clinical relevance of gene polymorphism in such ethnicity.

Knowledge about and attitude toward cosmeceuticals among pharmacists in Saudi Arabia.

BACKGROUND: Whitening cosmeceuticals are commonly used for beauty purposes and managing pigmentation disorders. There is significant variability across the world with regard to knowledge as well as legislation of cosmeceuticals. AIM: To evaluate the knowledge of and attitude toward whitening cosmeceuticals among pharmacists in Saudi Arabia. METHODS: This was a descriptive cross-sectional observational study based on an online survey conducted between February and August 2019. The participants were registered pharmacists in different sectors in Saudi Arabia. The study was approved by the Ethics Committee of Qassim, Ministry of Health. The pharmacists' response to questions on demographic characteristics, occupation, knowledge, and attitude toward whitening cosmeceuticals were collected in an online sheet. RESULTS: In all, 584 pharmacists completed the survey; of these, 5.49%, 24.82%, and 70% were consultants, pharmacists I, and pharmacists, respectively. The male-to-female ratio was 1.6:1. The most common response in the survey is "I don't know." Interestingly, 324 (59.12%) of the participants could define whitening cosmeceuticals, but 520 (90%) did not identify the term's source. Regarding practice, 196 (35.77%) participants had never used a whitening cosmetic, whereas 72 (13.14%) had but could not identify the agent. Forty percent of the participants were unaware of the possibility of combining two or more whitening cosmeceuticals and 13.14% thought that such combinations are contraindicated. CONCLUSION: There is significant variability among pharmacists in Saudi Arabia regarding the understanding and practice of whitening cosmeceuticals. Our results indicate that further measures are essential for increasing the awareness of pharmacists in Saudi Arabia.

Detection and Extraction of Heparin from Camel Lungs.

BACKGROUND: Heparin is an essential drug used as an anticoagulant. Access to raw material suitable for heparin extraction is critical for creating a viable business opportunity. In Saudi Arabia, large amounts of raw material with potential for heparin extraction are wasted. OBJECTIVE: To extract heparin and low-molecular-weight heparin (LMWH) from the camel lung, and measure its potency and activity. METHODS: Heparin preparation included three steps: extraction, electrophoretic identification, and activity measurement. Fresh lung tissue (100 g) was minced and homogenized in a blender. Crude heparin extracts were prepared using Charles's or Volpi's method with slight modifications. Heparin was purified by electrophoresis using high-purity agarose gels in barium acetate buffer. The heparin activity of purified samples was assayed spectrophotometrically using commercial heparin kits. RESULTS: Charles's and Volpi's extraction methods were simple and easy to establish. The yield was 90 mg crude heparin per 100 g of camel lung tissue following Volpi's extraction protocol, whereas Charles's method did not yield any heparin. The separation of heparin and LMWH by gel electrophoresis resulted in sharp and clear product bands using material prepared according to Volpi's method. The heparin preparation had an anti-factor Xa activity of 37 IU/mg, indicating weak potency. CONCLUSION: Preparation of active heparin from camel lung tissue is a technology applicable in manufacturing. Further method development is needed to increase heparin purity and potency.

Predictive and prognostic value of 256-slice computed tomography angiography in patients with suspected coronary artery diseases.

BACKGROUND: Coronary computed tomography angiography (CCTA) is commonly used to diagnose coronary artery diseases (CADs). We aimed to determine the utility of CCTA among patients suspected with CAD at the Prince Sultan Cardiac Center Qassim. MATERIALS AND METHODS: CCTA results of 425 cardiac patients, complaining of chest pain with suspected CAD, were used to classify coronary artery stenosis into two types: obstructive if the luminal stenosis was ≥50% or nonobstructive if it was <50%. Follow-ups were conducted through clinic or phone-based interviews to document any of the following endpoints: nonfatal myocardial infarctions (MIs) or cardiac deaths (CDs), representing the major cardiac events. All other cardiac cases, including hospitalization with unstable angina, and/or late coronary revascularization, were documented. RESULTS: Patients with a normal coronary artery were 278 (65.5%). The number of patients with nonobstructive and obstructive diseases was 85 (20%) and 62 (14.5%), respectively. After 19.6 ± 7 months of follow-up, 21 cardiac events occurred in twenty patients: five major adverse events (two CDs and three nonfatal MIs), ten hospitalizations due to unstable angina, and six late coronary revascularizations. Furthermore, the cumulative all-cardiac-event rates in patients with normal coronary arteries, nonobstructive CAD, and obstructive CAD were 3 (1%), 7 (8.2%), and 11 (17.7%), respectively. However, patients with normal CCTA had no major cardiac events during the follow-up. CONCLUSION: CCTA can provide valuable prognostic information on patients with suspected CAD. Patients are likely to have excellent intermediate outcomes if the coronary arteries are confirmed to be normal by CCTA.

Awareness of fitness to drive among cardiologists in Saudi Arabia.

OBJECTIVES: To assess the perception and awareness of cardiologists in Saudi Arabia about medical fitness to drive in different cardiovascular diseases. Methods: The study is a cross-sectional survey-based study between June 2018 and July 2018. Cardiologists were asked to complete a self-administered questionnaire inquiring about awareness of driving fitness and educating patients regarding driving risks in specific cardiovascular conditions. Results: A total of 194 cardiologists completed the study survey; there were 30.4% consultants, 59.3% specialists, and 10.3% residents. Out of 195, 72% were aware of the existence of particular international driving regulations for cardiovascular diseases, whereas 28% were not aware. Although, no Saudi guidelines assessing fitness-to-drive are available, 11% of the participants claimed awareness of such regulations. Interestingly, we found that cardiologists had never or rarely educated their patients regarding the potential risks of driving: 49% in symptomatic angina, 47% when ejection fraction is ≤35%, 39% in symptomatic valvular diseases, 26% after cardioverter defibrillators implantation, and 23% after non-elective percutaneous coronary interventions. Conclusion: There is a lack of awareness among cardiologists in Saudi Arabia about international guidelines regarding medical driving fitness. This study highlights the necessity of formulating appropriate national driving regulations for cardiovascular diseases.

Comparison of the Effects of Metoprolol and Bisoprolol on Lipid and Glucose Profiles in Cardiovascular Patients.

BACKGROUND: Cardioselective beta-blockers may affect glucose or lipid profiles. OBJECTIVE: We sought to compare the effects of two beta-blockers, metoprolol and bisoprolol, as the most commonly used drugs in cardiology, on glucose and lipid profiles in patients with cardiovascular diseases. METHODS: We conducted a retrospective cross-sectional matched study at Prince Sultan Cardiac Center in Burydah in August 2017. Patient records were screened, and adult patients with cardiovascular disorders who were treated with a stable dose of metoprolol or bisoprolol were included. Parameters related to glucose and lipid metabolism were compared using the Student's t-test between the two groups. RESULTS AND CONCLUSION: The metoprolol and bisoprolol arms included 204 and 200 patients, respectively.

Fat volume measurements as a predictor of image noise in coronary computed tomography angiography.

INTRODUCTION: Image noise can negatively affect the overall quality of coronary computed tomography angiography (CCTA). OBJECTIVES: The purpose of this study was to evaluate the relationship between image noise and fat volumes in the chest wall. We also aimed to compare these with other patient-specific predictors of image noise, such as body weight (BW) and body mass index (BMI). METHODS: We undertook a cross-sectional, single-center study. A tube voltage of 100 kV was used for patients with BW <85 kg and 120 kV for BW ≥85 kg. The image noise in the aortic root, single-slice fat volume (SFV) at the level of the left main coronary artery and the total fat volume of the chest (TFV) were analyzed. RESULTS: A total of 132 consecutive patients were enrolled (mean age ±â€¯standard deviation, 51 ±â€¯11 years; 64% male). The mean image noise was 30.5 ±â€¯11 Hounsfield units (HU). We found that patients with image noise >30 HU had significantly higher SFV (75 ±â€¯33 vs. 51 ±â€¯24, p < 0.0001) and TFV (2206 ±â€¯927 vs. 1815 ±â€¯737, p < 0.01) compared with patients having noise ≤30 HU, whereas BW and BMI showed no significant difference (78 ±â€¯13 vs. 81 ±â€¯14, p < 0.34) and (28.7 ±â€¯4.7 vs. 26.8 ±â€¯3.8, p < 0.19), respectively. Linear regression analysis showed that image noise has better correlation with SFV (R = 0.399; p < 0.0001); and TFV (R = 0, p < 0.009) than BMI (R = 0.154, p < 0.039) and BW (R = -0.102, p = 0.12). CONCLUSIONS: Fat volume measurements of the chest wall can predict CCTA image noise better than other patient-specific predictors, such as BW and BMI.

Are cardiac patients in Saudi Arabia provided adequate instructions when they should not drive?

OBJECTIVE: Driving capability can be significantly affected by different heath disorders; cardiovascular diseases (CVDs) should be considered when assessing patients for medical fitness to drive (MFTD). The aim of this study was to evaluate the awareness of Saudi patients about driving recommendations and to assess the incidence of motor vehicle accidents (MVAs) among cardiac patients. MATERIALS AND METHODS: We conducted a cross-sectional survey-based study. Male patients diagnosed with CVDs and who were visiting outpatient departments were invited to complete a questionnaire regarding their awareness of driving recommendations. Patients' demographics, clinical diagnosis, echocardiography parameters, and time-to-CVD diagnosis were all obtained from the patients' medical records. Women were excluded because it was illegal for women to drive in Saudi Arabia during the study period. RESULTS: In total, 800 men were included, with a mean age of 54 ± 12 years. Driving counseling had been provided to 241 participants (30%). Of these, 207 (25%) were advised not to drive for a period of between one week and six months. Five percent of the patients had a history of MVAs during the follow-up period of 6.2 ± 4 years. We found that the presence of a dyspnea ≥2, according to the New York Heart Association (NYHA), and a history of loss of consciousness (syncope/pre-syncope) were significantly associated with accidents (46% vs. 20%, P < 0.0001 and 41% vs. 10%, P < 0.0001, respectively). CONCLUSION: Patient-physician discussion about MFTD was only performed with 30% of the patients with CVDs in Saudi Arabia. Dyspnea NYHA class ≥2 or a prior history of syncope were significantly associated with the incidence of MVAs.

CYP2B6 and OPRM1 Receptor Polymorphisms at Methadone Clinics And Novel OPRM1 Haplotypes: A Cross-Sectional Study.

INTRODUCTION: Methadone is accepted as an alternative therapy in opioid use disorders worldwide. Methadone responsiveness, however, is affected by a range of CYP450 enzymes and OPRM1 polymorphisms. OBJECTIVE: This study sought to detect CYP2B6 and OPRM1 variants and their genotypes, as major contributors to inter-variability in methadone responsiveness and methadone dose requirements. METHODS: We carried out a prospective experimental one-phase pharmacogenetic study in four addiction clinics in Malaysia. Patients on stable methadone maintenance therapy were recruited. The prevalence of the CYP2B6 and OPRM1 polymorphisms was determined using a nested polymerase chain reaction (PCR), followed by genotyping. A two-step multiplex PCR method was developed to simultaneously detect the 26 SNPs in these two genes. RESULTS: 120 males were recruited for this study. The patients were between 21and 59 years old, although the majority of the patients were in their 30s. C64T and G15631T in CYP2B6and G31A, G691C, and A118G in OPRM1 were found to be polymorphic, and the allelic frequencies of each were calculated. We further detected eight new haplotypes. CONCLUSION: C64T and G15631T in CYP2B6and G31A, G691C, and A118G in OPRM1were found to be polymorphic. The new haplotypes may give a new insight on methadone clinics.

Assessment of steady-state clopidogrel reactivity by using platelet reactivity units.

Platelet function testing is an important laboratory measure in clopidogrel treatment. We sought to investigate the stability of the reactivity of clopidogrel after 1 month of treatment. A prospective analysis was carried out using a matched study design to compare platelet reactivity units (PRUs) and platelet inhibition in clopidogrel-treated patients. Patients with various cardiac diseases were divided into 2 matched groups. The first group was treated on an inpatient acute basis, and the other group was treated on an outpatient chronic basis. PRU was measured 5 days after clopidogrel administration in the acute group and 1 month after chronic use for several cardiac indications in the second group. VerifyNow (Accumetrics) was used to detect platelet reactivity and calculate inhibition rates in response to clopidogrel. A total of 260 Saudi patients were enrolled, including 90 inpatients and 170 outpatients. A significant difference was observed in PRU (173.69 vs. 195) and percent inhibition (24.05% vs. 16.13%) between the outpatient and inpatient groups. Platelet function evolves over time and initial readings may not be constant.

Basic life support knowledge of healthcare students and professionals in the Qassim University.

OBJECTIVE: To evaluate the knowledge of basic life support (BLS) among students and health providers in Medicine, Pharmacy, Dentistry, and Allied Health Science Colleges at Qassim University. METHODOLOGY: A cross sectional study was performed using an online BLS survey that was completed by 139 individuals. RESULTS: Ninety-three responders were medical students, 7 were medical interns, 6 were dental students, 7 were pharmacy students, 11 were medical science students and 15 were clinical practitioners. No responder scored 100% on the BLS survey. Only two out of the 139 responders (1.4%) scored 90-99%. Both of these individuals were fifth year medical students. Six responders (4.3%) scored 80-89%. Of these, 5 were fifth year medical students, and one was fourth-year medical student. Eleven responders (7.9%) scored 70-79%. Of these, eight were fifth year medical students, two were medical interns and one was a pharmacist. Twenty-three responders (16.5%) scored 60-69%. Of these, 11 were fifth year medical students, 1 was a fourth-year medical student, 3 were medical interns, 2 were medical science students, 1 was a dentistry student, and 5 were pharmacists. Twenty-eight responders (20.1%) scored 50-59%. Of these, 11 were fifth year medical students, 3 were fourth-year medical students, 1 was a third-year medical student, 1 was a second-year medical student, 2 were first-year medical students, 1 was a pharmacy student, 3 were dental students, 1 was a allied health science student, 2 were doctors, and 3 were pharmacists. The remaining 69 responders (49.6%) scored less than 50%. CONCLUSION: Knowledge of BLS among medicine, pharmacy, dentistry, and allied health science students and health providers at Qassim University is poor and needs to be improved. We suggest that inclusion of a BLS course in the undergraduate curriculum with regular reassessment would increase awareness and application of this valuable life-saving skill set.