Pharmacy Students' Perception of the Content and Delivery of Drug Information Training: A Mixed-Methods Study.

OBJECTIVE: To explore the pharmacy students' perception of the content and pedagogical strategies used for the delivery of drug information (DI) training. METHODS: An explanatory sequential mixed-methods study was conducted among BSc Pharmacy and PharmD students at the College of Pharmacy, Qatar University. The first phase consisted of a quantitative cross-sectional survey using a 34-item pretested questionnaire. The Donabedian framework guided the development of the questionnaire. This was followed by a phenomenological qualitative phase that was conducted based on the result of the first phase. Descriptive statistics and thematic content analysis were used for data analyses. RESULTS: The completion and usable rates were 88.7% (102 of 115) and 91.2% (93 of 102) respectively. The online resources used for the delivery of DI and the progressive structuring from year 1 to 4 were reported to be adequate by a majority of the respondents (93.55%). Ninety percent of the students opined that the use of simulation-based assessments improved their integration of the theoretical and practical aspects, and their preparedness to apply the DI concepts in practice. However, 20% of the participants reported inconsistency of the DI curricular content with some practices encountered during their experiential learning exposures. The themes identified from the focus group discussion included the perceived value and skills acquired from the DI content, availability and currency of DI resources, students' preparedness, curricular structuring of DI content, and reflection on and recommendations to improve DI coverage and delivery. CONCLUSION: The curricular structuring of the DI content across varieties of relevant undergraduate pharmacy courses from the lower to higher professional years and its focus on the progressive development of DI-related competencies appeared to have enhanced the students' perception of the relevance, appropriateness, and utility of the content, resources, and pedagogical strategies used for the delivery of DI education at the undergraduate level.

Determinants of caregiver's knowledge and practices regarding childhood fever management in a developing setting: a multi-centre cross-sectional assessment.

Introduction: Fever is both a sign of various diseases (chief of which are infectious in nature) and an adverse effect of certain interventions (e.g. vaccines, drugs) in the pediatric population. It elicits anxiety among caregivers and healthcare professionals alike resulting in non-evidence based practices, adverse medication administration events, waste of scarce resources and overutilization of health facilities. The determinants of these practices among caregivers in the domiciliary contexts have not been well characterized in developing settings. Methods: We assessed the knowledge and practices of childhood fever and their determinants among caregivers in domiciliary settings in Northern Nigeria using a 41-item questionnaire between August 2020 and February 2021. Results: The questionnaire is reliable (knowledge: Cronbach's Alpha = 0.689; practice: Cronbach's Alpha = 0.814) and collected data on a total of 2,400 caregiver-child pairs, who participated in the study. Over two-third (68.3%; 1,640) of the caregivers expressed fever phobic tendencies. Paracetamol was the most commonly used medication and constituted 31.3% of medication administration adverse events reported by the caregivers. Only one out of every six knowledgeable caregivers engaged in evidence-based home childhood fever management practices (7% vs. 41.6%) with being a primary caregiver [Knowledge: odd ratio (OR): 2.81, 95% CI: 0.38; 5.68; p value: 0.04; Practice: OR: 1.65, 95% CI: 0.09; 7.33; 0.02] and having a child/children aged ≤3 years (knowledge: OR: 7.03, 95% CI: 4.89; 9.67, p value: 0.003; practice OR: 3.11, 95% CI: 1.27; 8.59, 0.007) determining both the knowledge and practices of childhood fever management in a household. Conclusions: The knowledge and practice of childhood fever management among caregivers were sub-optimal with being a primary caregiver and having a child/children aged ≤3 years being the significant determinants of each domain. These gaps underscore the dire need for targeted strategies aimed at improving childhood fever management by educating caregivers.

Predictors of community pharmacists' readiness to manage the effective and safe use of oral anticancer medicines in a developing setting.

BACKGROUND: There is a paucity of studies about the readiness of community pharmacists to manage the safe and effective use of oral anticancer medicines (OAMs) in developing settings. OBJECTIVES: Using the readiness component (knowledge and willingness) of the situational theory of leadership, the study assessed community pharmacists' readiness to manage the safe and effective use of OAMs in Qatar, and also identified its significant predictors. METHODS: A cross-sectional assessment of 252 community pharmacists was conducted with a pre-tested 48-item questionnaire. Readiness was assessed with a 5-point Likert-type scale and the maximum obtainable score was 70. The mean was used as the cut-off point to categorize willingness and knowledge as either high (≥ mean) or low (< mean). Independent t-test, one-way analysis of variance and multiple linear regression was used for data analyses. RESULTS: The mean SD score for the readiness of community pharmacists was 39.3 ± 11.2 (min = 11, max = 70). Only a minority of the respondents expressed an excellent understanding of the chemotherapy cycles (19.6%; 45/230), and familiarity with targeted anticancer therapy (14.3%; 33/230), side effects (22.2%; 51/230), and dosing of OAMs (14.4%; 33/230). Employment status, number of OAMs prescriptions dispensed per month and adequacy of the contents related to OAMs in undergraduate training were the significant predictors of readiness (R2 = 0.558, (F (11, 209) = 3.559, p = 0.0001). CONCLUSIONS: Community pharmacists' readiness appear inadequate especially regarding its dosing, side effects, handling, and disposal of OAMs. These inadequacies probably underline community pharmacists' low familiarity and comfortability with dispensing and educating patients on the effective and safe use of OAMs.

Predictors of enablers and barriers to community pharmacists' management of minor ailments in a developing setting: A theory-driven assessment.

BACKGROUND: The clinical and financial burdens associated with minor ailments are well documented, but published evidence suggests that minor ailment services led by community pharmacists have a remarkable positive impact, mainly in developed settings. There is a paucity of evidence on community pharmacists' self-perceived enablers and barriers to the effective management of minor ailments. OBJECTIVES: The objective of the study was to identify community pharmacists' self-perceived enablers and barriers to the effective management of minor ailments as well as their significant predictors. METHODS: A Kurt Lewin's theory-driven cross-sectional survey of 305 community pharmacists was conducted in Qatar using a pretested 25-item structured questionnaire developed with an adapted conceptual framework focused on 4 key areas: education, regulation, practice, and research. Bivariate logistic regression was used to identify significant predictors of community pharmacists' self-perceived enablers and barriers. RESULTS: The response rate was 92.5% (282/305). Most of the respondents (68.1%) were males, who were 31-40 years of age (55.3%) and worked for pharmacy chains (77.3%). Community pharmacists identified a higher proportion of enablers (positive force) (82.4%) relative to only 3 barriers (negative force) (17.6%). The barriers identified included insufficient private or semiprivate space for patient counseling, the paucity of invitations to participate in practice-based research, and lack of feedback regarding the results and recommendations of previous research in which they were participants. The significant predictors of self-perceived enablers and barriers were female gender (odds ratio [OR], 2.21; 95% CI, 1.25-3.91; P = 0.007) and age group of ≤40 years (OR, 4.74; 95% CI, 3.50-7.16; P = 0.006). CONCLUSION: Community pharmacists' perceptions of the factors that enhance their effective management of minor ailments were overwhelmingly positive, as 14 enablers were identified relative to only 3 barriers. Female and young community pharmacists were significantly more likely to perceive enablers than barriers. The insights provided are potentially useful in developing pharmacy-based schemes to improve the effective management of minor ailments.

Knowledge of Lassa fever, its prevention and control practices and their predictors among healthcare workers during an outbreak in Northern Nigeria: A multi-centre cross-sectional assessment.

BACKGROUND: The year 2020 Lassa fever (LF) outbreak had the greatest disease burden and this can place an enormous strain on the already overstretched healthcare system and can potentially increase morbidity and mortality due to infectious diseases. Therefore, having a knowledgeable healthcare workforce with appropriate skills and competencies to prevent and manage outbreaks of a neglected infectious disease such as LF in Nigeria will potentially enhance public health. Thus, this survey assessed the level of knowledge of LF and its prevention and control (PC) measures amongst the healthcare workers (HCWs) during a LF outbreak in Katsina state, Nigeria. METHODOLOGY/PRINCIPAL FINDINGS: During this cross-sectional survey, HCWs complete a validated 29-item questionnaire comprising 18 items on the knowledge of LF and its PC measures and an item on global self-evaluation of their LF knowledge. Psychometric properties of the questionnaire were evaluated. Chi-square and binary logistic regression analyses were conducted. Out of 435 HCWs invited, a total of 400 participated in the study (92% response rate). The majority of participants (51.8%) demonstrated inadequate LF knowledge, with 62.9% of those scoring low having a high self-perception of their LF knowledge with the global scale. This LF knowledge over-estimation was predicted by LF training status (odds ratio (OR) 2.53; 95% CI: 1.49-4.30; p = 0.001). The level of LF knowledge and its PC measures among the study participants was low (11.60±8.14, 64.4%) and predicted by participants' LF training status (OR 2.06; 95% CI: 1.19-3.57; p = 0.009), place of work (OR 1.82; 95% CI: 1.07-3.08; p = 0.03) and their designations (OR 2.40; 95% CI: 1.10-5.22; p = 0.03). CONCLUSION: The level of knowledge of LF and its PC measures among the HCWs surveyed was suboptimal and participants' LF training status, place of work and occupational category were the significant predictors. In addition, LF knowledge overestimation on a global scale was observed among a majority of HCWs and this was also predicted by LF training status. Therefore, there is a critical need for health authorities in Nigeria to prioritize continuous on-the-job training of HCWs on priority neglected tropical diseases such as Lassa fever.

Prevalence, types and severity of medication errors associated with the use of automated medication use systems in ambulatory and institutionalized care settings: A systematic review protocol.

The use of automated systems within the medication use process has significantly reduce the occurrence of medication errors and the associated clinical and financial burden. However, automated systems lull into a false sense of security and increase the risk of medication errors that are often associated with socio-technical interactions, automation bias, workarounds and overrides. The objective of the systematic review is to determine the prevalence, types and severity of medication errors that are associated the use of automated systems in ambulatory and institutionalized care settings. The search strategy will be guided by PRISMA framework. Selected databases and relevant gray literature were searched and screening was done independently by two researchers between 01 April and 29 June 2021. These covered all relevant articles published from the inception of the use of automation in the medication use process (2000) until 2020. De-duplication and screening of all studies were done independently by two researchers with a clear inclusion / exclusion criteria. Data extraction and synthesis are currently on going (started on 06 July 2021) and being conducted independently but the validity and completeness of the processes will be confirmed by the third researcher. The Cochrane Risk of Bias tool and the Hoy et al's quality assessment checklist will be used for the assessment of methodological bias while the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system will be used for the quality of evidence assessment. Detailed qualitative synthesis of key findings will be done with thematic and descriptive analyses. If the number and types of included studies permit, fixed or random effect model meta-analysis will be conducted based on the degree of homogeneity in the sampling frame used in the included studies. Heterogeneity will be assessed with I2 statistics and I2 > 50% will be considered a high statistical heterogeneity. The systematic review may provide new perspective especially from developing settings about the prevalence, types and severity of medication errors associated with the use of automated systems at all the stages of medication use process, and in all categories of patients. This may add to global knowledge in the research area. Systematic review registration: The systematic review was registered and published by PROSPERO (CRD42020212900).

Community Pharmacists' Knowledge and Attitudes Towards Pediatric Pain Management in Nigeria.

PURPOSE: Community pharmacists (CPs) frequently attend to pediatric patients with pain but limited data exist regarding their knowledge of and attitude to effective management of pediatric pain in Nigeria. Thus, this study aimed to evaluate the knowledge of and attitude to pediatric pain management among CPs in Nigeria. PATIENTS AND METHODS: A validated and pilot-tested questionnaire, the Community Pharmacists Survey on Pediatric Pain, was administered to 517 eligible participants at the 38th Annual National Conference of the Association of Community Pharmacists of Nigeria. Independent samples t-test and one-way analysis of variance were used for inferential statistical analyses. RESULTS: CPs with additional higher academic qualifications and clinically related additional academic degrees had significantly higher mean knowledge scores relative to first degree only holder counterpart (t= 4.33, p< 0.05, Eta2=0.05) and those without clinically related second degrees (t= 6.34, p< 0.05, Eta2=0.27). Pain knowledge among the study cohort also varied significantly by age group, years of practicing community pharmacy, ownership structure of premises, geographical location of practice and previous exposure to pain management training (F(4370)=2.858, p=0.025, Eta2=0.03; F(3371)=3.985, p=0.008, Eta2=0.03; F(2372)=3.643, p=0.027, Eta2=0.02; F(5369)=4.497, p=0.01, Eta2=0.06; F(2372)=3.587, p=0.029, Eta2=0.02), respectively. CONCLUSION: Community pharmacists' knowledge of and attitude to pediatric pain management in Nigeria appeared sub-optimal, and requires regular targeted educational intervention to fill the identified gaps, improve service delivery and patient outcomes.

Determinants of community pharmacists' information gathering and counseling practices during the management of minor ailments.

OBJECTIVE: To assess the determinants of community pharmacists' information gathering and counseling practices during the management of minor ailments in Qatar. METHOD: A cross-sectional study of 305 community pharmacists was conducted with a pre-tested 27-item questionnaire. Bivariate logistic regression was used to identify the determinants of information gathering and counseling practices. RESULTS: The response rate was 92.5% (282/305). A majority of the respondents (68.1%) were males, within the age range of 31-40 years (55.3%), work for chains pharmacies (77.3%), and were predominantly of foreign nationalities (94.7%). Patients' identity (91.1%), age (92.2%), symptoms (92.6%) and duration of symptoms (89.3%) were most frequent information gathered, while dose (99%), frequency (97.8%), route of administration (95.7%), and duration of use (92.9%) were the most frequent counseling information. Median information gathering score was significantly higher in females and among community pharmacists in chain pharmacies (p < 0.05), while median counseling practice scores were significantly higher among in chain pharmacies (p < 0.05). Consultation time of 6-10 min (OR = 1.75, 95% CI: 1.02-3.0, p = 0.04) and female gender (OR = 2.10, 95% CI: 1.16-3.79, p = 0.01) were significant determinants of information gathering, while age group (31-40 years) (OR = 1.84, 95% CI: 1.05-3.22, p = 0.03) and consultation time (6-10 min) (OR = 2.24, 95% CI: 1.31-3.86, p = 0.003) were significant determinants of counseling practices. CONCLUSION: The significant determinants of community pharmacists' Information gathering and counseling practices during the management of minor ailments were female gender and consultation time (6-10 min), and age group (31-40 years) and consultation time (6-10 min) respectively.

Management of common minor ailments in Qatar: Community pharmacists' self-perceived competency and its predictors.

Studies focused on comprehensive assessment of self-perceived competency of community pharmacists to manage minor ailments are scanty despite that self-perceived competency is a valid determinant of task performance. The objectives of the study were to assess community pharmacists' self-perceived competency to manage fourteen common minor ailments in Qatar, and identify its significant predictors. A cross-sectional assessment of 307 community pharmacists was conducted with a pre-tested 20-item questionnaire. Self-perceived competency was assessed with nine elements on a scale of 1-10 (Maximum obtainable score: Each minor ailment = 90; each element = 140). Mann-Whitney U and bivariate logistic regression were used for data analyses. The response rate was 91.9% (282/307). The majority of the respondents were males (68.1%; 192/282), within the age range of 31-40 years (55.3%; 156/282). The minor ailments with the highest median competency score were constipation (76), and cold/catarrh (75) while travel sickness (69), and ringworm (69) had the lowest. The two condition-specific competency elements with the highest median score were recommendation of over-the-counter (OTC) medicines (115), and provision of instructions to guide its use (115). Ability to differentiate minor ailments from other medical conditions had the lowest median competency score (109). The significant predictors self-perceived competency were female gender (OR = 2.39, 95%CI: 1.34-4.25, p = 0.003), and working for chain pharmacies (OR = 2.54, 95%CI: 1.30-4.96, p = 0.006). Overall, Community pharmacists' self-perceived competency was adequate for majority of the common minor ailments, and it was highest for constipation and cold/catarrh, and specifically for the recommendation of OTC medicines and provision of instructions to guide its use. However, diagnostic ability to differentiate minor ailments from other medical conditions with similar features had the lowest median competency score. Female gender and working in chain pharmacies were the significant predictors of self-perceived competency to manage minor ailments.

Community pharmacists' management of minor ailments in developing countries: A systematic review of types, recommendations, information gathering and counselling practices.

AIMS: To conduct a systematic review of the management of minor ailments by community pharmacists in developing countries, and to identify the specific minor ailments encountered, the medications recommended or requested and the information gathering and counselling practices. METHOD: Observational studies from developing countries published in English language from inception to 2019 and report the management of minor ailments by community pharmacists were systematically searched in PubMed, ScienceDirect and Cochrane Library. RESULTS: Thirty full-text studies, out of 7876 retrieved and screened, were included in the systematic review. Minor ailment-induced encounters by patients with community pharmacists are generally pervasive and involve mainly verbal request for specific medicines by name (60%). The most frequent minor ailments reported were respiratory, gastrointestinal and musculoskeletal conditions, and the most common medicines recommended or requested for were cough/cold preparations, antimotility and oral rehydration preparation, and analgesic/antipyretic. Inappropriate recommendation of antibiotics were reported for acute diarrhoea and cough/colds (40%) (10/25). Community pharmacists encountered 11-30 customers with minor ailments per day, with an average of about 4.8 (1.3-20.5) minutes per encounter. None of the studies reported the availability and/or use of a specific protocol to guide the management of minor ailments. There was wide variation in the type and depth of information gathered and used for the management of minor ailments; and the counselling information provided by community pharmacists, and there was no evidence of the documentation activities related to the management of minor ailments. CONCLUSIONS: Community pharmacists' encounter with and management of minor ailments appear extensive in developing countries and probably present an opportunity to contribute significantly to reduce disease burden and enhance public health. However, the management process is currently unstructured, unguided by a specific protocol and vary in the quality of recommendations, information gathering and counselling practices.

Healthcare professionals' knowledge, attitude and acceptance of influenza vaccination in Saudi Arabia: a multicenter cross-sectional study.

BACKGROUND: All healthcare professionals (HCPs) are at high risk of influenza infection. Therefore, immunization is recommended for all HCPs. Due to safety and effectiveness concerns, HCPs have a low vaccination rate. This study was designed to explore the attitude, awareness and knowledge of HCPs toward vaccination for influenza. METHOD: A cross-sectional study was performed during October-November 2016. A total of 405 questionnaires were distributed in 8 major hospitals in Saudi Arabia. A validated questionnaire consisting of 31 questions and 5 sections was administered. Statistical Analysis Software (SAS®) version 9.2 was used to analyze the data. RESULTS: A total of 364 HCPs responded to the study survey, which is a response rate of 90%. A large proportion (61.8%) of participants were female. The majority of the participants were nurses (60.4%). More than half of the respondents (57.7%) were working in government-run hospitals. Among all the participants, approximately 67.6% of HCPs were vaccinated. The majority (84.1%) of HCPs believed that influenza vaccine prevents the flu. Furthermore, approximately 75% of participants believed that HCPs can be more susceptible to influenza infections than other people. The majority of participants (89.6%) knew the proper signs and symptoms of influenza. HCPs' belief that vaccination prevents influenza infection (OR = 3.93, 95% CI = 1.97-7.82), their awareness of the Scientific Committee for Influenza and Pneumococcal Vaccination (SCIPV)'s guidelines (OR = 2. 13, 95% CI = 1.16-3.90) and the presence of the standing orders regarding influenza vaccine (OR = 1.57, 95% CI = 1.01-3.21), were the predictors for receipt of influenza vaccine by HCPs. Many (58.0%) respondents believed that vaccine safety concerns is a major barrier to the vaccination of HCPs. Some misconceptions, such as influenza infection due to vaccination (42.3%) and incorrect perceptions about the symptoms of influenza in adults (50.5%), were found. CONCLUSION: The acceptance of and participation in influenza vaccination by HCPs in Saudi Arabia appears to have markedly increased in the 2016 season. Continuing evaluation of vaccination practices is necessary, and more training programs are needed in the future.

Does personalized goal setting and study planning improve academic performance and perception of learning experience in a developing setting?

OBJECTIVE: The learning process for pharmacists must enable the skillful harnessing of metacognition, critical thinking, and effective application of specialized skills. This study assessed the impact of self-developed academic goals and study plans on pharmacy students' academic performance and perception of learning experience in a developing setting. METHODS: A prospective cohort study was conducted at the College of Clinical Pharmacy, King Faisal University, KSA, in a compulsory 4th year course (Pharmacy management). The study group was exposed to goal setting and study planning while the control group had only routine teaching and learning activities planned for the course. Academic performance was determined with quizzes, midterm, and final exams, and the percentage achievement for the course objectives. An end-of-course evaluation, with a pre-tested questionnaire, was used to assess the perception of learning experience. RESULTS: The study group constituted 41.4% (29), while 58.6% (41) were in the control group, with a mean ± SD age of 22.9 (SD = 3.2) and 21.6 (SD = 6.1) years, respectively. The mean ± SD scores for quizzes (8.4 (SD = 2.2), mid-term (21.9 (SD = 3.7), and final exams (42.8 (SD = 5.3), and the percentage achievement for the course objectives A (77%) and B (78%) were significantly higher in the study group (P < 0.001). The end-of-course feedbacks showed key differences in the perception of learning experience between the study and control groups. CONCLUSION: Personalized goal setting and study planning appeared to significantly improve continuous engagement with learning, focus on academic goals, and academic performance.

Parental perceptions, attitudes and acceptance of childhood immunization in Saudi Arabia: A cross sectional study.

OBJECTIVES: The widespread availability and use of vaccines have tremendously reduced morbidity, mortality and health care costs associated with infectious diseases. However, parental beliefs about vaccination are one of the major factors in achieving high vaccination rates. Thus, this study aims to assess the perceptions and attitudes regarding routine childhood immunization among Saudi parents. METHODS: A cross sectional study with a pre-tested 18-item questionnaire was conducted using 467 randomly selected parents from the Hail region of Saudi Arabia in the period between February 1st, 2016, and February 1st, 2017. The validated questionnaire consisted of three sections that collected information on participants' demographics, parents' awareness of vaccine benefits, and parents' practices regarding the immunization of their children. RESULTS: Female and male parents comprised 54.5% (255) and 45.5% (212) of the sample, respectively, and the response and completion rates were 97%. The majority of the respondents had received a formal education (94.1%, 439), were gainfully employed (62.9%, 294) and had a regular monthly income (73.3%). The majority of the respondents were aware of childhood vaccinations (78.9%), completed vaccinations mandated for children up to 5 years (86.2%), encouraged other parents to do so (89.9%), and had easy access to vaccines (90.5%). Sixty to ninety percent of the respondents were knowledgeable regarding the health benefits of vaccinations in children, even though 18.4% of their children had experienced vaccination-related minor adverse effects during or after vaccination of which 23.2% required doctor's visits. Health care professionals were the most frequent source of parents' vaccine-related information (65.2%), and vaccination reminder services provided by the Ministry of Health (MOH) via mobile phones were cited by 57.5% of respondents. CONCLUSIONS: Confidence in and acceptance of childhood vaccinations, perceptions of vaccine-related health benefits and ease of access to immunizations appeared to be quite good among Saudi parents.

Does self-reflection and peer-assessment improve Saudi pharmacy students' academic performance and metacognitive skills?

BACKGROUND: The patient-centered focus of clinical pharmacy practice which demands nuanced application of specialized knowledge and skills targeted to meeting patient-specific therapeutic needs warrant that the training strategy used for PharmD graduates must empower with the ability to use the higher level cognitive processes and critical thinking effectively in service delivery. However, the historical disposition to learning in the Middle East and among Saudi students appeared heavily focused on rote memorization and recall of memorized facts. OBJECTIVES: To assess the impact of active pedagogic strategies such as self-reflection and peer assessment on pharmacy students' academic performance and metacognitive skills, and evaluate students' feedback on the impact of these active pedagogic strategies on their overall learning experience. METHOD: An exploratory prospective cohort study was conducted among 4th year students at the College of Clinical Pharmacy, King Faisal University, Saudi Arabia to assess the impact of self-reflection and peer-assessment in a semester-wide assessment tasks in two compulsory first semester 4th year courses (Therapeutics-3 and Pharmacoeconomics). An end-of-course evaluation survey with a pre-tested 5-item open-ended questionnaire was also conducted to evaluate students' feedback on the impact of active pedagogic strategies on their overall learning experience. RESULT: Male students (study group) constituted 40.7% of the cohort while 59.3% were females (control group) with mean ± SD age of 23.2 ± 5.6 and 22.1 ± 4.9 years respectively. The mean ± SD scores for quizzes, mid-term and final exams, and the overall percentage pass were significantly higher in the study group for both courses (P < 0.001). The majority of the students in the study group opined that the exposure to active pedagogic strategies enabled them to improve their use of critical thinking, facilitated deeper engagement with their learning and improved their clinical decision-making and discussion skills. CONCLUSION: The use of active pedagogic strategies such as self-reflection and peer-assessment appeared to significantly improve examination performance, facilitate deep and constructive engagement with learning and fostered students' confidence in the use of critical thinking and clinical decision-making.

Frequency, types and factors associated with potentially harmful drug interactions in ambulatory elderly patients in Nigeria.

OBJECTIVE: To determine the frequency, types and factors associated with potentially harmful drug interactions among ambulatory elderly (≥65 years) patients in Ibadan, Nigeria. METHODS: A 4-week cross-sectional study was conducted among 229 elderly patients who consented and were prescribed two or more medicines within a 4-week study period at a major 256-bed secondary care facility in Ibadan, Nigeria. Chi-square and risk ratio were used to identify the factors associated with the potentially harmful drug-drug interactions. KEY FINDINGS: Potentially harmful drug-drug interactions were identified in about two-thirds (65%, 149/229) of the patients. The risk of occurrence drug interactions was significantly higher among patients who had at least six prescribed medicines (relative risk: 7.8 (95% confidence interval, 6.9 to 9.5) (P < 0.001)), and a significant majority were also females (73.8%) (110) (P < 0.001). The most frequent interacting drug combination was angiotensin-converting enzyme inhibitors and amiloride + hydrochlorothiazide (34.7%). CONCLUSION: Potentially harmful drug interactions that are significantly associated with high multiple prescribing are considerable among elderly patients in Nigeria.

Anti-hypertensive medicines prescribing for medical outpatients in a premier teaching hospital in Nigeria: a probable shift of paradigm.

BACKGROUND: Previous studies of anti-hypertensive medicines utilization pattern in Nigeria showed that Angiotensin converting enzyme inhibitors (ACEIs) were often the least prescribed. However, the appropriate use of ACEIs in the black population achieves good blood pressure control and provides additional long term cardio- and renovascular protection benefits. OBJECTIVE: To assess the current utilization pattern of antihypertensive medicines with specific emphasis on identifying possible shift in the frequency of use of ACEIs. METHODS: A prospective cross-sectional assessment of the current utilization pattern of anti-hypertensive medicines was conducted among 300 randomly selected cohort at a 900-bed premier Teaching Hospital located in Ibadan, Southwestern Nigeria. The current utilization pattern was compared with the results of a study conducted at the same site and published 10 years ago. RESULTS: Of the 300 random cohorts, a majority (79%) were females (237) with mean age 58.7 years (SD=2.81 years. Stage 2 hypertension was the most frequent diagnosis (54.3%). The utilization of ACEIs and long acting CCB (amlodipine) significantly increased from 8.6% and 21% (Ten years ago) to 29.93% and 36.68% respectively (p < 0.0001). The use of thiazide diuretic and methyldopa declined significantly from 39.4% and 23.3% (Ten years ago) to 16.12% and 9.7% respectively (p < 0.0001). Adverse drug reactions due to ACEIs were documented in 1.5% (3), while laboratory monitoring of serum potassium, urea and creatinine was conducted in only 37% (111) of cohort. Potentially harmful drug-drug interactions were identified in 25% (75) of cohorts, and the most frequent were ACEIs + NSAIDs (53.3%), ACEIs + amiloride / hydrochlorothiazide (22.6%). CONCLUSIONS: Anti-hypertensive medicines utilization has significantly shifted towards the increased use of ACEIs and long acting dihydropyridine CCBs. The use of thiazides and methyldopa has declined significantly. Physicians appeared more cognizant of the long term cardio- and renovascular benefits inherent in using ACEIs in a high cardiovascular risk group such as black hypertensive.

Anti-hypertensive medicines prescribing for medical outpatients in a premier teaching hospital in Nigeria: a probable shift of paradigm / Prescripción de antihipertensivos para pacientes médicos ambulatorios de un hospital universitario en Nigeria: probable cambio de paradigma

Background: Previous studies of anti-hypertensive medicines utilization pattern in Nigeria showed that Angiotensin converting enzyme inhibitors (ACEIs) were often the least prescribed. However, the appropriate use of ACEIs in the black population achieves good blood pressure control and provides additional long term cardioand renovascular protection benefits. Objective: To assess the current utilization pattern of antihypertensive medicines with specific emphasis on identifying possible shift in the frequency of use of ACEIs. Methods: A prospective cross-sectional assessment of the current utilization pattern of anti-hypertensive medicines was conducted among 300 randomly selected cohort at a 900-bed premier Teaching Hospital located in Ibadan, Southwestern Nigeria. The current utilization pattern was compared with the results of a study conducted at the same site and published 10 years ago. Results: Of the 300 random cohorts, a majority (79%) were females (237) with mean age 58.7 years (SD=2.81 years. Stage 2 hypertension was the most frequent diagnosis (54.3%). The utilization of ACEIs and long acting CCB (amlodipine) significantly increased from 8.6% and 21% (Ten years ago) to 29.93% and 36.68% respectively (p ˂ 0.0001). The use of thiazide diuretic and methyldopa declined significantly from 39.4% and 23.3% (Ten years ago) to 16.12% and 9.7% respectively (p ˂ 0.0001). Adverse drug reactions due to ACEIs were documented in 1.5% (3), while laboratory monitoring of serum potassium, urea and creatinine was conducted in only 37% (111) of cohort. Potentially harmful drug-drug interactions were identified in 25% (75) of cohorts, and the most frequent were ACEIs + NSAIDs (53.3%), ACEIs + amiloride / hydrochlorothiazide (22.6%). Conclusions: Anti-hypertensive medicines utilization has significantly shifted towards the increased use of ACEIs and long acting dihydropyridine CCBs. The use of thiazides and methyldopa has declined significantly. Physicians appeared more cognizant of the long term cardio- and renovascular benefits inherent in using ACEIs in a high cardiovascular risk group such as black hypertensive (AU)

Antecedentes: anteriores estudios de patrones de utilización de antihipertensivos en Nigeria mostraron que los inhibidores de la enzima convertidora de angiotensina (IECA) eran a menudo los menos prescritos. Sin embargo, el uso apropiado de IECA en la población negra alcanza buen control de presión arterial y proporciona protección adicional cardio y renovascular a largo plazo. Objetivo: Evaluar el patrón actual de utilización de antihipertensivos con especial énfasis en identificar potenciales cambios de frecuencia de uso de IECA. Métodos: Se realizó una evaluación transversal prospectiva de la actual utilización de antihipertensivos entre una cohorte de 300 individuos aleatoriamente seleccionados en un hospital universitario localizado en Ibadan, Sur-Oeste de Nigeria. Se comparó el patrón actual de utilización de resultados con un estudio realizado en la misma localización hace 10 años. Resultados: De los 300 individuos aleatorizados, la mayoría (79%) eran mujeres (237) con una edad media de 58,7 años (DE=2,81). El diagnóstico más frecuente era la hipertensión en Estado 2 (54,3%). La utilización de IECA y bloqueantes de canales de calcio (BCC) de larga acción (amlodipina) se aumentó significativamente de 8,6% y 21% (hace 10 años) a 29,93% y 36,68% respectivamente (p<0.0001). El uso de diuréticos tiazídicos y metildopa se redujo significativamente de 39,4% y 23,3% (hace 10 años) a 16,12% y 9,7% respectivamente (p < 0.0001). Se documentaron reacciones adversas debidas a IECA en el 1,5% (3) de los casos, mientras que se realizaron solo un 37% (111) de monitorizaciones laboratoriales de potasio sérico, urea y creatinina. Se identificaron interacciones medicamentosas potencialmente dañinas en el 25% (75) siendo las más frecuentes las de IECA + AINE (53,3%), IECA + amilorida / hidroclorotiazina (22,6%). Conclusiones: El uso de antihipertensivos ha cambiado significativamente hacia los IECA y los BCC dihidropiridínicos de larga acción. El uso de tiazidas y metildopa ha disminuido significativamente. Parece que los médicos están más concienciados de los beneficios a largo plazo cardio y renovasculares asociados al uso de IECA en un grupo de alto riesgo cardiovascular como los hipertensos negros (AU)

Perceived medication use challenges and coping strategies among medical outpatients in Nigeria.

BACKGROUND: The use of medicines is an action that involves a change in behaviour and it is a complex construct involving reciprocal interactions between social, environmental and cognitive factors. This is particularly true when a patient uses medicines for asymptomatic chronic conditions, requiring life-long use. OBJECTIVE: To identify patient-perceived medication use challenges, determine the coping strategies used and investigate the relationship between patient-perceived challenges and self-initiation of coping strategies. SETTING: A premier 900-bed tertiary/teaching hospital located in Ibadan, Nigeria. METHOD: Ten pharmacists conducted cross-sectional medication use interviews for a random sample of 324 medical outpatients in 4 weeks (25th October-19th November 2006). MAIN OUTCOME MEASURE: Patient-perceived challenges with prescribed medications, self-initiated coping strategies used and relationship between patient-perceived challenges and self-initiation of coping strategies RESULTS: Eighty-one percent (324) of the random sample of 400 patients consented and completed the interview. Of these, 50.3 % were males while 49.7 % were females with mean age (SD) of 51.5 (17.6) and 52.1 (17.4) years respectively. The most frequent diagnoses were hypertension (53 %) and type-2 diabetes + hypertension (14.5 %). Two hundred and twenty-four patients reported one or more perceived challenges. Of these, 43.8 % were 65 years or older and about half reported at least 3 challenges. The majority (95.6 %) of patients who reported perceived challenges initiated one or more coping strategies without the knowledge of their physicians or pharmacists. Of 100 patients who did not report any perceived challenge, 43 % admitted initiating strategies to maintain perceived "cure" of their medical conditions. Self-initiation and use of coping strategies was far more likely among patients who reported perceived challenges (OR: 28.4, 95 % CI 26.1-30.5). The number of coping strategies reported appeared strongly related to the number of perceived challenges (r = 0.91, p < 0.001). CONCLUSION: Perceived challenges associated with the use of prescribed medications and self-initiation of coping strategies appeared considerable among medical outpatients at a major teaching hospital in Nigeria. The risk of unauthorised initiation and use of varieties of coping strategies without the knowledge of clinicians was very high among patients who reported at least one perceived challenge.

Determinants of self medication practices among pregnant women in Ibadan, Nigeria.

OBJECTIVE: To assess the frequency and evaluate the factors underlining self-medication with orthodox and herbal medicines among pregnant women in Ibadan, Nigeria. Setting Antenatal clinics at the major antenatal care facility in Ibadan, south-western Nigeria. METHODS: A prospective cross-sectional study with a pre-tested 15-item structured questionnaire over a 12 week period among 1,650 pregnant women who attended antenatal clinics at a major antenatal care facility in Ibadan, south-western Nigeria. Data analysis was done with Chi-square, multivariate logistic regression and summary statistics. MAIN OUTCOME MEASURE: Frequency and major factors associated with self-medication in pregnancy. RESULTS: The response and completion rate was 96.6% (1,594) [mean age ± SD 27 ± 5.3 years]. The majority of the respondents were literate (92.6%), self-employed (61.5%) and in the third trimester (49.5%). A significant majority (63.8%) used self-medication (orthodox and herbal medicines) as their first response to perceived ill-health (P < 0.001). Self-medication in pregnancy was strongly associated with self-employment (OR: 3.8 (2.6-4.7), unemployment (OR: 2.6 (1.4-4.2) and third trimester of pregnancy (OR: 4.2 (3.1-5.6). The major over-the-counter medicines and potentially harmful prescription medicines kept at home for self-medication were Paracetamol, vitamins and haematinics; and piroxicam, dipyrone, chloramphenicol and Diazepam respectively. About one-third of the respondents who self-medicated (1,017) used local herbs (31.2%). The most frequent source of the medicines purchased during self-medication was patent medicine stores (55%). Mothers-in-law and relatives (41.3%) were the most frequently cited sources of advice during self-medication. Miscarriage/bleeding (44.3%) was the most frequently cited potential adverse effect that could occur with the use of certain medicines during pregnancy. Only 32% of respondents could identify medicines that are potentially harmful in pregnancy. CONCLUSION: Poorly guided self-medication with prescription, over-the-counter and herbal medicines is pervasive and significantly associated with gestational age and occupational pattern among pregnant women in Ibadan, south-western. A majority lacked the knowledge of potential adverse outcomes associated with the use of certain medicines, and the potentially harmful medicines to avoid during pregnancy.

Itinerant vending of medicines inside buses in Nigeria: vending strategies, dominant themes and medicine-related information provided / Venta itinerante de medicamentos en autobuses en Nigeria: estrategias de venta, temas dominantes e información sobre medicamentos proporcionada

Objective: To determine vending strategies and marketing themes employed by itinerant bus vendors, and assess the accuracy and completeness of information provided on medicines being sold in an urban setting in Nigeria Methods: Cross-sectional study and content analysis of itinerant vending of medicines inside buses recorded with a mobile telephone on purposively selected routes in a mega city with an estimated 18 million residents in southwestern Nigeria over a 2-month period. Two coders independently assessed 192 vending episodes by 56 vendors for 147 OTC and prescription medicines. Inter-rater reliability (Gwet AC1 =0.924; p<0.0001). Results: Fourteen thousands and four hundred potential consumers encountered 192 recorded episodes of vending of medicines inside 192 buses within the study periods. Forty-four (78•5%) of the 56 vendors were females in the 30-45 years age bracket, were mostly (75%) attired in the local ‘Iro and Buba’ Ankara fabric and showed laminated identity cards (97.5%) issued by the local association for ‘marketers’ of medicines inside buses, markets, and motor parks. Of the 14400 consumers encountered inside buses during the study period, between 6.7% and 48.3% purchased the medicines promoted. Prayers against death from road traffic accidents and diseases of physical and / or meta-physical origins were the most frequently used (76•8%) ice-breaking opening statement / strategy to gain consumers’ attention. Hematinics, multi-vitamins, simple analgesic, NSAIDs and corticosteroids were the most frequently vended medicines. Consumers’ enquiries were related to dosing for children (51.8%), elderly (28.6%), and pregnancy (52.7%); and contraindications during pregnancy (8.9%). Factual medicines information such as dose, frequency, potential side effects and contra-indications were not provided in majority of vending episodes. Conclusion: Itinerant vending of medicines and the use of misleading and melodramatic themes to secure high consumer patronage appear considerable in Nigeria. Majority of the vendors did not correctly respond to consumers medicine- related enquiries, or provide detailed factual medicines information to guide appropriate use. These misleading promotional activities could potentially encourage inappropriate purchase and probable self-medication by consumers (AU)

Objetivo: Determinar las estrategias de venta y los temas de marketing empleados por los vendedores en autobuses itinerantes y evaluar la precisión y compleción de la información sobre medicamentos proporcionada durante la venta en un área urbana de Nigeria. Métodos: Estudio transversal y análisis de contenido de la venta itinerante de medicamentos en autobuses grabadas con un teléfono móvil en rutas seleccionadas a propósito en una mega-ciudad de 18 millones de habitantes en el suroeste de Nigeria durante un periodo de dos meses. Dos codificadores evaluaron independientemente 192 episodios de venta de 56 vendedores para 147 medicamentos OTC y de prescripción. Fiabilidad inter-evaluador (K de Cohen)=0.89 [IC95% 0.76- 0.92]. Resultados: 14.400 potenciales consumidores visitaron los 192 episodios grabados de venta de medicamentos en el interior de 192 autobuses en el periodo de estudio. 44 (78.5%) de los 56 vendedores eran mujeres entre los 30-45 años, estaban mayoritariamente (75%) con tejidos tradicionales ‘Iro and Buba’ Ankara y mostraban tarjetas identificativas plastificadas (97.5%) emitidas por las autoridades locales para ‘vendedores’ de medicamentos en autobuses, mercados y aparcamientos. De los 14.400 consumidores que visitaron el interior de los buses durante el periodo de estudio, el 6.7% y el 48.3% compró los medicamentos promocionados. Oraciones contra la muerte en accidentes de tráfico y enfermedades de orígenes físicos o metafísicos eran los mensajes para romper el hielo / estrategias para ganar la atención de los clientes más frecuentemente utilizados (76.8%). Los medicamentos más frecuentemente vendidos eran los hematínicos, multivitamínicos, analgésicos simples, AINE y corticoides. Las preguntas de los consumidores estaban relacionadas con las dosis para niños (51.8%), ancianos (28.6%) y embarazo (52.7%); y contraindicaciones durante el embarazo (8.9%). En la mayoría de los episodios de venta no se proporcionaba informaciones objetivas sobre los medicamentos, como dosis, frecuencia, efectos adversos potenciales y contraindicaciones. Conclusión: La venta itinerante de medicamentos y el uso de temas engañosos y melodramáticos para asegurar el elevado consumo aparecen frecuentemente en Nigeria. La mayoría de los vendedores no respondió correctamente a las preguntas sobre medicamentos de los consumidores, ni proporcionó información objetiva detallada para guiar en el uso adecuado. Estas actividades promocionales engañosas probablemente podrían animar a la compra y a la automedicación de los consumidores (AU)