Pandemic preparedness of community pharmacies for COVID-19

© 2020 Elsevier Inc. Background: Community pharmacies provide an important healthcare service, which is broadly established, and constitutes the preferred and initial contact for members of the community. The significant value of community pharmacies was further highlighted during the COVID-19 pandemic crisis. Objective: The assessment of community pharmacies preparedness for the COVID-19 pandemic. Methods: A cross-sectional interview survey of 1018 community pharmacies working in four regions of Egypt (South, East, Centre, and North). Data collection was conducted from 8–19 April 2020. Results: Availability of personal protective equipment (PPE) and medication was better than alcohol (70% conc.). Home delivery services were available in 49.1% of pharmacies. Infection control measures covering interactions between staff were in place in up to 99.5% of pharmacies. Conversely, there was less frequent availability of contactless payment (29.1%), hand sanitizers (62.1%) or masks (86.5%) for customer use, or a separate area for patients with suspected COVID-19 (64%). Verbal customer education (90.4%) was used preferably to written (81.3%). Despite high clinical knowledge and awareness (97.6%–99.2%), only 8.8% of pharmacists had reported suspected COVID-19 cases, however this varied significantly with pharmacist demographics (geographic region P < 0.001; pandemic training p < 0.001; position p = 0.019; age p = 0.046). Conclusions: Government and policymakers strive to mitigate the shortage of PPE and medication. More attention should be given to infection control measures around interactions between staff and customers to ensure community pharmacists are fit and able to provide continuity in their important role. Educating customers using regularly-updated posters, banners or signs will contribute to decreasing contact with patients, and reducing the number and duration of visits to the pharmacy. Pandemic preparedness of community pharmacists must also extend to reporting procedures. By avoiding under-reporting or over-reporting, community pharmacists will contribute to accurate monitoring of the national spread of infection

Barriers to Community Pharmacists Referring Patients With Suspected COVID-19 Symptoms

Background: With the necessary skills available to community pharmacists, they are well equipped to relieve pressure on hospitals and general practices by providing referral services for symptomatic patients for COVID-19 testing. Objective: The assessment of potential barriers that limit the successful implementation of a community pharmacy referral service for patients with suspected COVID-19 symptoms. Methods: A questionnaire comprising of 100 questions was administered to one pharmacist by interview in 1023 working community pharmacies in 4 regions of Egypt between May 17 and May 30th 2020. Results: Forty-five barriers were identified. Respondents (79%, n = 803) had difficulty obtaining an accurate patient history. Patient data confidentiality was a significant issue for pharmacists who had not received referral training, with these respondents being significantly (P =.010) less able to differentiate between COVID-19 and similar conditions. Respondents (68.8%, n = 698) were not confident in determining whether COVID-19 was the cause of the patient’s presenting symptoms. A large majority (73.7%, n = 747) of respondents were worried about referring misdiagnosed patients and were concerned about the negative implications of proceeding with such a referral, including legal consequences. Of Respondents (71.7%, n = 727) reported that online referral was not easy, and 71.6% (n = 722) were unable to locate paper referral forms. Only a small number of pharmacists (11%, n = 112) preferred to report a referral in their own name. Conclusions: This study has demonstrated the potential of the community pharmacist’s role as a point of referral for COVID-19 testing, and identified some major barriers to implementation of this. The lack of pharmacists’ education, legal support, availability of referral forms, clarity of responsibility and unsupportive management teams are key obstacles that must be overcome for the successful implementation of a COVID-19 referral service

Spontaneous adverse drug reaction reporting by community pharmacists: preparedness and barriers

Background: Adverse drug reactions (ADRs) are undesired, unintended responses to drugs, and are significantly underreported. Pharmacists are drug experts recognized as custodians of drug safety, who are expected to be prepared for and knowledgeable about ADR reporting. Objectives: To identify Egyptian community pharmacists’ preparedness for and perceived barriers to spontaneous ADR reporting. Methods: This cross-sectional study recruited a sample of community pharmacists across Egypt, who were invited to complete a self-administrated questionnaire during April 2020. Results: A total of 923 pharmacists across Egypt responded to the questionnaire. Most pharmacists were knowledgeable about the definition of ADRs (93.9 %) and indicated they felt reporting ADRs benefits the patients (82.2%). Despite recognizing their public health value, only a small percentage of participants conveyed familiarity with the reporting process for both paper (19.2%) and electronic (30.4%) forms, indeed 56.6% of participants did not remember what the ADR report form looked like. Moreover, 75.4% of respondents said they felt that community pharmacies are not the right place for reporting, with 49% suggesting that reporting was the responsibility of physicians. However, only 32.1% reported having insufficient time being a barrier to ADR reporting. Conclusions: Community pharmacists in Egypt are not well prepared for spontaneous ADR reporting due to a lack of knowledge about the formal process and not acknowledging their responsibility, although time was not a major barrier. Therefore, this highlights a clear opportunity for improvement likely involving targeted education

Community pharmacy practice related to the COVID-19 pandemic: barriers and facilitators

BACKGROUND: Community pharmacies provide an important healthcare service. Their significant value has been further highlighted during the COVID-19 pandemic crisis. OBJECTIVES: To identify and categorize potential barriers and facilitators to the role of community pharmacists during the pandemic and their association with demographic factors. METHODS: A cross-sectional survey of community pharmacists was conducted using a self-administered questionnaire during April 2020 across all regions of Egypt. KEY FINDINGS: Respondents (n = 1018; 98.4% response rate) revealed practical and psychological barriers, including inadequate levels of pandemic preparedness (mean 61.43%; ±SD 0.47), inadequate working environments (mean 56.23%; ±SD 0.49) and uncooperative behaviour from stakeholders (mean 65.3%; ±SD 0.47).The majority of respondents emphasized the universal, region-independent necessity for facilitators, including the availability of timely (94.9%) guidance (97.4%) published by the Egyptian healthcare authority (94.6%), in electronic format (82.1%), through smartphone application (80.0%) and the provision of a dedicated telephone hotline (89.5%). Furthermore, authorities must use the media to manage public perceptions (97.2%) and increase public trust (94.8%) towards the pharmacist. CONCLUSIONS: The barriers and facilitators identified herein could improve service provision in an integrated manner by overcoming the reported inadequate level of preparedness (barrier) through the provision of electronic guidance (facilitator), and the use of the media in managing public perceptions and trust (facilitators) to reduce the panic that negatively affects the working environment (barrier) for pharmacy staff. The varied level of healthcare authority cooperation reported in many regions requires further investigation

Spontaneous adverse drug reaction reporting by community pharmacists: preparedness and barriers

Background: Adverse drug reactions (ADRs) are undesired, unintended responses to drugs, and are significantly underreported. Pharmacists are drug experts recognized as custodians of drug safety, who are expected to be prepared for and knowledgeable about ADR reporting. Objectives: To identify Egyptian community pharmacists’ preparedness for and perceived barriers to spontaneous ADR reporting. Methods: This cross-sectional study recruited a sample of community pharmacists across Egypt, who were invited to complete a self-administrated questionnaire during April 2020. Results: A total of 923 pharmacists across Egypt responded to the questionnaire. Most pharmacists were knowledgeable about the definition of ADRs (93.9 %) and indicated they felt reporting ADRs benefits the patients (82.2%). Despite recognizing their public health value, only a small percentage of participants conveyed familiarity with the reporting process for both paper (19.2%) and electronic (30.4%) forms, indeed 56.6% of participants did not remember what the ADR report form looked like. Moreover, 75.4% of respondents said they felt that community pharmacies are not the right place for reporting, with 49% suggesting that reporting was the responsibility of physicians. However, only 32.1% reported having insufficient time being a barrier to ADR reporting. Conclusions: Community pharmacists in Egypt are not well prepared for spontaneous ADR reporting due to a lack of knowledge about the formal process and not acknowledging their responsibility, although time was not a major barrier. Therefore, this highlights a clear opportunity for improvement likely involving targeted education

Robust Synthesis of Size-Dispersal Triangular Silver Nanoprisms via Chemical Reduction Route and Their Cytotoxicity

Triangular silver nanocrystals, well-known as nanoprisms (Ag-NPrs), were successfully developed via a robust and straightforward direct chemical reduction synthetic approach, producing desirable tiny and well-controlled Ag-NPrs. This procedure was accomplished by fabricating a mixture of di-sodium succinate hexa-hydrate (DSSH) and tri-sodium citrate di-hydrate (TSCD) as capping agents at optimal synthetic conditions and under an open-air condition, which proved to be an enormous challenge. Additionally, the Ag-NPrs were fully characterized by UV-vis spectra, X-ray diffraction (XRD), scanning electron microscope (SEM), and dynamic light scattering (DLS). Likewise, the formation stages from spherical silver nanoparticles (Ag-NPs) to triangular Ag-NPrs were also captured simultaneously via transmission electron microscope (TEM) and high-resolution transmission electron microscope (HR-TEM) images. More interestingly, an active thin silica-shell was efficiently applied on the Ag-NPrs outer-layer to increase their functionality. Furthermore, to confirm their biocompatibility, we also carried out cell viability assays for the Ag-NPs, Ag-NPrs, and Ag-NPrs@SiO2 with different concentrations at 62.5, 125, and 250 &#181;g/mL after 12, 24, and 48 h of exposure time, respectively, on a regular African green monkey kidney cell line. The cell viability test results exemplified that the three silver nanostructures were toxic-free and suitable for further potential biological applications in the near future

Predictors of ectopic pregnancy in nulliparous women: A case-control stud

Objective: To investigate risk factors of ectopic pregnancy (EP) in nulliparous women and the main lines of treatment offered. Methods: A case-control study was conducted from January 2013 to December 2014 at Mansoura University Hospitals, Egypt. A total of 36 cases of EP in nulliparous women were included. Each case was matched to 2 healthy subsequent pregnant nulliparous women. Data were gathered by using a questionnaire. Odds ratios were adjusted for the confounding factors using multiple logistic regression models. The main outcome measures were predictors of EP. Results: There were no significant differences in age and gravidity between cases and controls (p > 0.05). The main predictors of EP were history of pelvic inflammatory diseases (PID) (OR = 10.14, 95% CI = 3.382–30.435, p < 0.001), infertility treatment (OR = 8.7, 95% CI = 1.4–55.3, p = 0.021), and past pelvi-abdominal surgery (OR = 4.1, 95% CI = 1.3–13.3, p = 0.017). The primary treatment involved laparoscopic salpingectomy in 86.1% (n = 31 cases), and 8.3% (n = 3 cases) were offered methotrexate treatment meanwhile 2 cases (5.6%) were treated by laparotomy. Conclusion: The study concluded that common risk factors for EP in nulliparous women were PID followed by infertility treatment and past pelvi-abdominal surgery. The main line of treatment was laparoscopic salpingectomy followed by methotrexate and laparotomy

Effect of Ramadan fasting on amniotic fluid index in last month of pregnancy

Objective: To assess the effect of fasting in Ramadan on amniotic fluid index (AFI). Design: A cross sectional observational study. Methods: This study was conducted between July 21, 2012 and August 17, 2012, which corresponded to the 3rd and 27th days of the month of Ramadan 1433 and from July 12, 2013 and August 6, 2013, which corresponded to the 3rd and 27th days of the month of Ramadan 1434. Pregnant women attending the antenatal care clinic at Assiut and Qena University Hospitals were included in this study. The study groups included fasting and non fasting women beyond 36 weeks of gestation. The study took place at the same time of day (i.e., between 9 and 12 AM). Results: A total of 221 pregnant women were studied, 97 fasting and 124 non fasting. As regards age, parity and the gestational age no significant differences were reported. The AFI was less affected by fasting, also there was a significant difference in the AFI between fasting and non fasting pregnant women with oligohydramnios (4.00 ± 0.82 and 2.64 ± 1.12 respectively). A positive relationship with gravidity was observed as AFI increased with the increase of gravidity in pregnant fasting women, on the other hand there was variable non significant relation between AFI and gravidity in pregnant non fasting women. Conclusion: We conclude that the fasting in Ramadan has no effect on or may improve the AFI in the last month, while gravidity plays a role in the AFI in fasting group