Trust in pharmaceuticals and vaccine hesitancy: exploring factors influencing COVID-19 immunization among Lebanese children aged 1 to 11 years.

INTRODUCTION: The COVID-19 pandemic is a serious threat to everyone's health. Numerous studies have demonstrated that vaccines are very effective in preventing COVID-19-related severe illness, hospitalization, and death. Children's vaccination exerts its protecting effect by preventing the spread of the virus. The purpose of this study was to analyze the rate of COVID-19 immunization among Lebanese children aged 1 to 11 years and assess parental factors that affect immunization rates. METHODS: An online cross-sectional study was conducted between January and March 2023. The online survey was distributed across all social media channels, including the Ministry of Public Health website. RESULTS: A total of 390 parents filled the survey (mean age = 37.48 ± 8.39 years; 50.5% mothers; 70% with a university level of education). Mothers compared to fathers, having a history of bad reaction to a vaccine vs. not, and higher vaccine hesitancy were significantly associated with less willingness to administer the vaccine to the child. Trusting pharmaceutical companies was significantly associated with more willingness to administer the vaccine to the child. CONCLUSION: The results of this study show that the factors associated with parents' decisions to vaccinate their children may vary. Our findings conclude that vaccine acceptance is being highly associated with parental concerns, trust, and information regarding the vaccine safety and efficacy.

A 1-year analysis of adverse events following COVID-19 vaccination in Lebanon: a retrospective study.

BACKGROUND: Since the deployment of Coronavirus Disease 2019 (COVID-19) vaccines, skepticism about the safety, incidence, and severity of Adverse Events Following Immunization (AEFI) was a concern. The study has two main objectives. First, to analyze AEFIs following COVID-19 vaccines (Pfizer-BioNTech, AstraZeneca, Sputnik, and Sinopharm) during the vaccination campaign in Lebanon and correlate them with age and gender. Second, to correlate Pfizer-BioNTech and AstraZeneca vaccines' AEFI with the dose administered. METHODS: A retrospective study was carried out between February 14th, 2021, and February 14th, 2022. AEFI case reports received to the Lebanese Pharmacovigilance (PV) Program were cleaned, validated, and analyzed using SPSS software. RESULTS: A total of 6808 AEFI case reports were received to the Lebanese PV Program during the period of this study. Case reports were mostly received from females (60.7%) and from vaccine recipients aged 18-44 years. As for the vaccine type, AEFIs occurred more frequently with the AstraZeneca vaccine compared to the Pfizer-BioNTech vaccine. The latter had AEFIs mainly following dose 2, whereas AEFIs with the AstraZeneca vaccine were more frequently reported after dose 1, with general body pain being the most reported systemic AEFI with PZ (34.6%), while fatigue was the most reported AEFI with AZ vaccine (56.5%). CONCLUSIONS: The AEFI reported with COVID-19 vaccines in Lebanon were aligned with those reported worldwide. The incidence of rare serious AEFIs should not discourage the public from getting vaccinated. Further studies are needed to evaluate their long-term potential risk.

Implementation of a Pharmacovigilance System in a Resources-Limited Country in the Context of COVID-19: Lebanon's Success Story.

Implementation of Pharmacovigilance (PV) systems in resource-limited countries is a real challenge. The objective of this paper is to describe the implementation of an effective national PV system in Lebanon in the context of COVID-19, within a limited resources setting and with the absence of a guaranteed funding. In 2018, the PV center hosted at the Lebanese University, Faculty of Pharmacy under the supervision of the Quality Assurance of Pharmaceutical Products Program within the Lebanese Ministry of Public Health became an associate member of the World Health Organization (WHO) Program of International Drug Monitoring and recognized as Full member in 2021.This analysis highlights the requirements of the WHO that were met in Lebanon to create an effective PV system. The Lebanese experience shows that it is not only possible, but also crucial to implement a PV system in low to middle-income countries with limited resources and with the absence of a guaranteed funding in order to be able to promote patients' safety. Support from organizations like WHO and World Bank, skilled leadership, hard work and dedicated staff with efficient training, and finally mass awareness initiatives were all considered as key elements to implement a successful PV System. In the midst of a turbulent political, economic and health context, Lebanon has been able to develop one of the most active and rapidly evolving PV systems in the Middle East.

Vaccination process evaluation at COVID-19 vaccination centers in Lebanon: a national study.

BACKGROUND: Upon the authorization of COVID-19 vaccines worldwide, national and international standards were developed to help integrate mass COVID-19 immunization campaigns into the healthcare network. The primary objective is to evaluate the overall COVID-19 vaccination process through on-site visits to vaccination centers all over Lebanon to assess whether these are abiding by the national and international requirements for both Pfizer-BioNTech and AstraZeneca vaccines. The secondary objective is to explore whether the type of the facility, private versus governmental, and educational versus non-education, affects the vaccination process in these centers. METHODS: A convenient sample of 33 vaccination centers was selected from a list of all COVID-19 vaccination centers operating in Lebanon. Data were collected using a structured checklist developed following an extensive literature review of the national and international standards for Pfizer-BioNTech and AstraZeneca COVID-19 vaccines. A scoring system for the overall vaccination process was developed. RESULTS: Quality deficiencies were identified in several steps of the immunization process; however, the international standards were followed in most vaccination centers visited despite their limited resources. It was noticed that there were no significant differences between private and governmental, between educational and non-educational, and between Pfizer and AstraZeneca vaccination centers; the 33 vaccination centers visited have scored above 75 on the entire process immunization against COVID-19 with P-values above 0.05 in all steps evaluated. CONCLUSION: An optimization of the immunization process should be performed to ensure that the practice is within international standards. This can be done by conducting periodic vaccination center visits, implementing clear guidelines, training staff involved in the vaccination process, and ensuring continuous support of the Lebanese Ministry of Public Health.

Presence of a psychiatric patient at home and work fatigue in family caregivers: The moderating effect of spirituality.

OBJECTIVES: To assess the association between the mental health of caregivers having a psychiatric patient at home and work fatigue, and if this association is moderated by spirituality. METHODS: This case-control study enrolled 600 caregivers (July-September 2019). RESULTS: Stress, anxiety, insomnia and the presence of a psychiatric patient at home were associated with higher levels of physical, mental, and emotional work fatigue. In the case of caregivers who have a psychiatric patient at home, those with low spirituality had more mental and emotional work fatigue. PRACTICAL IMPLICATIONS: Healthcare professionals should enlighten caregivers more on the risks and the consequences of their job, assist them with information on what to expect, and teach them how to normalize feelings that they may face.

Clinical preceptor competencies for a better pharmacy education: a suggested framework for Lebanon.

BACKGROUND: Experiential education is a core element in developing the ability of pharmacy students to apply theory to practice, solve problems, and acquire standard pharmacist competencies. To achieve this goal, preceptors play a crucial role as teachers, mentors, and evaluators. The study objective was to identify and describe the core competencies and skills considered essential to the success of clinical preceptor pharmacists in the training of future care providers, in a steadily changing environment. METHODS: A task force was formed within the Scientific Committee of the Lebanese Order of Pharmacists to map, sort, select, and adapt international competencies to the current Lebanese context. RESULTS: Seven roles were identified: Role model/Practitioner/Mentor, Supervisor/Facilitator/Coach/Teacher, Manager, Collaborator/Communicator, Leader, Clinical expert, and Researcher. Related competencies were also defined. CONCLUSION: all aforementioned competencies are expected to improve the acquisition of learning by pharmacy trainees in Lebanon. This framework can be used by pharmacy program directors and preceptors for developmental purposes through self- or peer-evaluation processes, identifying gaps, and helping to fill the needs for a better workforce in academic and experiential pharmacy education.

Effect of pharmacy practice program on pharmacy student learning, satisfaction, and efficiency: assessment of introductory pharmacy practice course.

INTRODUCTION: The Lebanese American University (LAU) offers first-year pharmacy students with Introductory Pharmacy Practice Experience (IPPE) courses comprising various activities that provide students with direct patient contact so that they can be geared up for "real-world" pharmacy practice. Routine assessment and improvement in these courses are imperative to ensure efficiency of these courses. This study was conducted to evaluate the quality of our IPPEs courses, determine its impact on student learning and satisfaction, and identify shortcomings in the program for quality improvement purposes. METHODS: A literature review-based questionnaire, consisting of 76 questions with a response options following a 4-point scale (strongly agree = 4 to strongly disagree = 1), was completed by 92 first professional year pharmacy students who finished their hospital and community IPPE at LAU. RESULTS: The students reported a high degree of satisfaction in community and hospital sites in terms of site selection, program schedule, site and school preceptors, and overall satisfaction with the experience. Compared to the hospital setting, students practicing in the community reported significantly higher scores in overall satisfaction. Besides the high satisfaction rate, our results identified improvement measures in some aspects of the program. CONCLUSION: Our IPPE program serves as a successful experiential learning for pharmacy students.

Evaluation of anti-emetic use in chemotherapy-induced nausea and vomiting in a third-world country (Lebanon).

RATIONALE: In Lebanon, the appropriateness of anti-emetic use is questionable in large measure because of the absence of published multicentre trials. AIM AND OBJECTIVES: To evaluate the extent of appropriateness of anti-emetic use in patients on chemotherapy among several Lebanese hospitals. Appropriateness of chemotherapy-induced nausea and vomiting (CINV) prophylaxis was determined as per National Comprehensive Cancer Network guidelines. METHODS: A multicentre, cross-sectional study was conducted over a 3-month period. Data were collected from medical charts of cancer patients. The main outcome measure was to evaluate the appropriateness of prophylactic use of anti-emetics in CINV in terms of selected drug regimen, dosage and route of administration, and to investigate the role of several pre-specified variables (including hospital type and size, type of insurance coverage and patient-related factors) in influencing the appropriateness of anti-emetic practice. RESULTS: A total of 493 patients' forms were analysed. The median age was 58.8 ± 13.9 years, 290 (58.8%) patients were female. Around 211 (42.8%) patients received inappropriate anti-emetic regimen, and only 17 (6%) patients of those receiving appropriate regimen received the appropriate dose, and just 55 (19.5%) patients were treated for the appropriate duration. Factors that may affect the relative effectiveness of treatment were identified. CONCLUSION: This study reflected substantial flaws in CINV prophylaxis practice in Lebanon which should alert health care professionals of the adverse consequences resulting from non-adherence to guidelines. Our study also highlighted areas for improvement and suggested recommendations in order to minimize patient risk and optimize safe and effective CINV management.

Acute pain management and assessment: are guidelines being implemented in developing countries (Lebanon).

RATIONALE: Pain assessment and treatment is influenced by subjective perception of pain. Despite the international efforts to implement guidelines and protocols for pain management, pain continues to be regarded as a complication rather than a primary problem. The literature pertaining to the adequacy of pain management in the Middle East is frail. This study focuses on revealing the implemented practices of initial pain assessment, follow-up and re-evaluation of pain treatment in Lebanese hospitals. AIM AND OBJECTIVES: The objective of this study is to evaluate the presence and effectiveness of acute pain management and its impact on the quality of life in hospitals throughout Lebanon, in both cancer and non-cancer populations. METHODS: A Lebanese multi-centre, prospective, chart review study was conducted over a period of 3 months. Data on demographics, pain medication, dose, route, duration and adjunct pain management were collected. Appropriateness of pain management was determined as per World Health Organization guidelines. Institutional Review Board approvals were obtained from each hospital. RESULTS: Results from 582 participants revealed that 50% of initial pain assessment intensity scores were based on the assumptions of health care professionals. Furthermore, as pain severity scores increased, the adequacy of pain management decreased. Only 22% of the patients had a daily follow-up, and the majority of those continued to receive inappropriate therapy. CONCLUSION: This study reflects the lack of a well-structured system for pain management in Lebanese hospitals. It underlines the need for pain research in the region. It also highlights the need for implementing the recommendations discussed to minimize risk and optimize pain management.

Stress ulcer prophylaxis guidelines: Are they being implemented in Lebanese health care centers?

AIM: To evaluate the current practice of stress ulcer prophylaxis (SUP) in Lebanese Health care centers. METHODS: A multi-center prospective chart review study was conducted over 8 mo. A questionnaire was distributed to pharmacy students who collected data on demographics, SUP medications, dose, route, duration and associated risk factors. The appropriateness of SUP use was determined as per American Society of Health-System Pharmacists guidelines. Institutional review board approval was obtained from each hospital center. RESULTS: A total of 1004 patients were included. 67% of the patients who received prophylaxis did not have an indication for SUP. The majority (71.6%) of the patients who were administered parenteral drugs can tolerate oral medications. Overall, the regimen of acid-suppressant drugs was suboptimal in 87.6% of the sample. This misuse was mainly observed in non-teaching hospitals. CONCLUSION: This study highlighted the need, in Lebanese hospitals, to establish clinical practice guidelines for the use of SUP; mainly in non-critical care settings.

An evaluation of practice pattern for venous thromboembolism prevention in Lebanese hospitals.

BACKGROUND: Venous thromboembolism (VTE) is a major cause of death among hospitalized patients. Many VTE prophylaxis guidelines have been developed, including the American College of Chest Physicians (ACCP). VTE prophylaxis is required in specific patients; however, its practice is not always optimal, and often depends on the hospitals' protocols. In Lebanon, information about the appropriateness of VTE prophylaxis in health care centers is lacking. OBJECTIVE: The primary objective of this study was to evaluate the pattern of VTE prophylaxis application, including agents, doses, duration of treatment, and route of administration, in Lebanese health care centers. METHODS: A Lebanese multi-center, prospective, chart review study was conducted over 4 months. Data on demographics, VTE prophylaxis medication, dose, route, duration, and associated risk factors were collected by pharmacy students. The appropriateness of VTE prophylaxis was determined as per ACCP guidelines. Patients receiving VTE treatment were excluded from the study. Institutional review board (IRB) approval was obtained from each hospital center. RESULTS: A total of 840 patients were included. Both gender groups were equally represented in the sample and the mean age was 59 +/- 19.53 years. The majority (639/840, 76.1%) of the sample were at high risk for deep venous thrombosis (DVT), and inappropriate VTE prophylaxis was reported in 35% of the low-risk group, in 70% of the moderate-risk group, and in 39% of the high-risk group (P < 0.0001). Comparing proper VTE prophylaxis practice between intensive care unit (ICU) and non-ICU patients, there was no statistical difference observed in teaching hospitals (67.2% vs. 65.5%, P = 0.312). However, in non-teaching hospitals, appropriate VTE prophylaxis practice was more prevalent in ICU than non-ICU patients (65.9% vs. 51.2%, P = 0.004). The average duration of VTE prophylaxis was less than 10 days. Missing data was a major limitation for this study, where, for instance, the duration of prophylaxis could not be accurately abstracted in half of the sample. Another limitation was the absence of laboratory results needed for clinical assessment of the regimen used. CONCLUSION: This study reflected the importance of assessing VTE prophylaxis in Lebanese hospitals, thus, the need for implementing established guidelines to improve the overall patient safety.