Evaluation of pharmaceutical care services in the Middle East Countries: a review of studies of 2013–2020

Abstract Introduction Pharmaceutical care services (PCs) have evolved significantly over the last few decades, with a greater focus on patient’s safety and proven effectiveness in a wide range of contexts. Many of the evidence supporting this technique comes from the United States, the evaluation and adoption of (PCs) which differ greatly across the globe. Objective The goal of this study was to identify and assess the efficacy of pharmaceutical care services in various pharmaceutical aspects throughout seventeen Middle Eastern nations. Method The Arkesy and O’Malley technique was used to conduct a scoping review. It was conducted using PubMed/Medline, Scopus, Cochrane Library, Springer Link, Clinical Trials, and Web of Science etc. The Van Tulder Scale was utilized in randomized trials research, whereas the dawn and black checklists were used in non-randomized trials research. A descriptive and numerical analysis of selected research was done. The scope of eligible PCs, pharmaceutical implementers, study outcomes, and quality were all identified by a thematic review of research. Results There were about 431,753 citations found in this study, and 129 publications were found to be eligible for inclusion after analysing more than 271 full-text papers. The study design was varied, with 43 (33.3%) RCTs and 86 (66.7%) n-RCTs. Thirty-three (25.6%) of the studies were published in 2020. Jordan, Saudi Arabia, and Turkey were home to the majority of the studies (25.6%, 16.3%, and 11.6%) respectively. Thirty-seven studies (19.7%) were concerned with resolving drug related problems (DRPs), whereas 27 (14.4%) were concerned with increasing quality of life (QOL) and 23 (12.2%) with improving drug adherence. Additionally, the research revealed that the average ratings of the activities provided to patients improved every year. Conclusion Studies in the Middle East continue to provide evidence supporting the positive impact of pharmaceutical care services on both hard and soft outcomes measured in most studies. Yet there was rare focus on the value of the implemented services. Thus, rigorous evaluation of the economic impact of implemented pharmaceutical care services in the Middle East and assessment of their sustainability is must

Ameliorative Effect of Olea europaea Leaf Extract on Cisplatin-Induced Nephrotoxicity in the Rat Model

Background. Olea europaea leaf extract (OELE) has potential health benefits and protects against cytotoxicity. This study investigated the possible ameliorative effect of OELE on cisplatin-induced nephrotoxicity in rats. Methods. Rats were assigned into six groups; two groups received 150 mg/kg or 300 mg/kg of OELE, one group received a single dose of cisplatin (6 mg/kg) IP on the first day of the experiment, two groups received a single dose of cisplatin 150 mg/kg or 300 mg/kg of OELE on the first day then starting from the fifth day for 10 consecutive days, and one group acted as a control. Results and Conclusion. The findings showed that cisplatin-induced nephrotoxicity was evidenced by a significant increase in serum creatinine blood urea nitrogen (BUN) and a significant decrease in estimated creatinine clearance and potassium level, which corresponded with the alterations in the histopathology of the renal tissue. OELE significantly ameliorated the nephrotoxic effects of cisplatin as dose-dependent

Sweat metabolome and proteome: Recent trends in analytical advances and potential biological functions

Metabolome and proteome profiling of biofluids, e.g., urine, plasma, has generated vast and ever-increasing amounts of knowledge over the last few decades. Paradoxically, omics analyses of sweat, one of the most readily available human biofluids, have lagged behind. This review capitalizes on the current knowledge and state of the art analytical advances of sweat metabolomics and proteomics. Moreover, current applications of sweat omics such as the discovery of disease biomarkers and monitoring athletic performance are also presented in this review. Another area of emerging knowledge that has been highlighted herein lies in the role of skin host-microbiome interactions in shaping the sweat metabolite-protein profiles. Discussion of future research directions describes the need to have a better grasp of sweat chemicals and to better understand how they function as aided by advances in omics tools. Overall, the role of sweat as an information-rich biofluid that could complement the exploration of the skin metabolome/proteome is emphasized

A Multi-Institutional Study of Yemeni Final Year Undergraduate Pharmacy Students’ Understanding, Attitudes, and Perceived Barriers Toward Provision of Pharmaceutical Care: A Cross-Sectional Study

Introduction: Pharmaceutical care (PC) is the philosophy of the pharmacist’s practice to achieve a better health-related outcome by designing, implementing and monitoring the therapeutic plans. It is in its infancy in Yemen. Hence, the study objectives were to examine the barriers to PC provision as perceived by Yemen pharmacy students and to assess their level of understanding of PC and their attitudes toward PC. Methodology: A cross-sectional study was conducted among ten pharmacy colleges in Yemen, offering undergraduate pharmacy programs. A stratified sample of 518 students from the included universities were surveyed using a well-structured, validated and selfadministered questionnaire. Chi-square, Mann–Whitney U, and Kruskal–Wallis tests were conducted at an alpha level of 0.05. Results: Four hundred and seventy-five (475) participants were included (92.9% response rate). More than 17% (n=84) of participants were involved in Pharm.D program, and nearly 29.9% (n=142) preferred pharmaceutical marketing as a career after graduation. About 65% of participants recognized the purpose of PC, and pharmacists’ role within PC. However, only 43.8% (n=208) knew the difference between clinical pharmacy and PC. About 82% of respondents showed very good attitudes toward PC. Pharm.D students showed higher attitudes’ total scores, median (IQR): 4.3 (4.1–4.4), 4.2 (4–4.2) and 4 (3.9–4.2) for Pharm.D, bachelor of pharmacy and bachelor of clinical pharmacy respectively, (p-value = 0.032). Moreover, students who currently employed in pharmacy-related job during their study were also associated with high attitudes scores compared to unemployed students, median (IQR): 4.2 (4–4.4) and 4(3.9–4.1) respectively (p-value = 0.023). “Lack of access to the patient medical record in the pharmacy” and “inadequate (hospital and community pharmacy) internship period” were the top reported barriers with 81.5% (n=387) agreement. Conclusion: Although PC is in its infancy in Yemen, pharmacy students showed positive attitudes toward practicing PC. Educational institutions should exert efforts for curricular revision to improve understanding, and overcome the reported barriers in the future

COMPARATIVE STUDY OF SEVEN BRANDS OF LEVOFLOXACIN 500 MG FILM-COATED TABLET MARKETED IN YEMEN

Objective: The objective of the current study was to evaluate the quality control parameters of seven brands of levofloxacin 500 mg film-coated tablet available in the Yemeni market. Methods: Physicochemical parameters assay was performed for seven brands of levofloxacin 500 mg film-coated tablet. Each brand was subjected to official and unofficial in vitro quality control tests, including weight variation, thickness, hardness, friability, disintegration, dissolution, and content uniformity assay by High-Performance Liquid Chromatography (HPLC). Results: Out of seven, six brands of levofloxacin 500 mg film-coated tablet passed official specified assay tests according to the United States Pharmacopeia (USP) specifications. They showed a similar profile of thickness ranged between±0.01 and 0.10%, friability ranged between 0.01% and 0.34%, disintegration time ranged between 3.00 and 15.00 min, dissolution percentage ranged between 90.650 and 103.05 and content uniformity ranged between 93.62 and 107.12%. Regarding weight variation and hardness, six brands passed the weight variation test and only three brands showed optimum range (10-20 kg) of hardness test. Only one brand failed to pass the weight variation test, and four brands failed to pass the optimum range (10-20 kg) of hardness. Conclusion: There are no remarkable differences between the seven brands regarding in vitro quality control tests of content uniformity, thickness, friability, disintegration, and dissolution. Even though four brands were above the optimum range of hardiness, they showed complete disintegration and dissolution within the acceptable limit. Regular assessment of marketed drugs is required to ensure bioequivalent to their innovators

Community pharmacists' attitudes, prior experience, and perceived barriers to informatics: A cross-sectional study from a developing country

Background: Patient-centered care and integrating health informatics are essential to delivering high-quality healthcare services and improving patient outcomes. Despite their crucial role, research on health informatics in community settings is limited in Jordan, emphasizing the necessity for evaluating the state of pharmacy informatics. Purpose: The study aimed to evaluate community pharmacists' prior experience, attitudes, and perceived barriers to adopting information technology in their practice. Methods: An online cross-sectional survey was conducted from August to November 2020 to assess community pharmacists' prior experience, attitudes, and perceived barriers to using information technology to enhance their daily practice. Results: A total of 431 Community pharmacists participated in the study. Most of the participants were female (68.7%), aged 25 to 35 (53.8%), and having 5–10 years of professional experience (47.1%). Only 12.8% had prior experience with health informatics. The majority agreed that health informatics systems would be clear and understandable to use (84 %), limit drug addiction (82.1%), facilitate data exchange between physicians and pharmacists (81.7%), and enhance medication safety (82.1%). However, over two-thirds of participants agreed on potential barriers to implementing health information technology in their daily practice, such as technology difficulties (71.2%), resistance to change (73.8%), and a lack of competencies (77.5%). Statistically significant relationships were found between positive attitudes and age (p = 0.001), gender (0.004), experience duration (p = 0.001), and education level (p = 0.001). Apart from the workplace, sociodemographic characteristics were significantly associated with perceived barriers to implementing health informatics (p < 0.05). Pharmacists' positive attitudes and full-time work schedule were significantly associated with the adoption of health informatics. Conclusion: Pharmacists' positive attitudes in this study encourage the adoption of pharmacy informatics systems and the integration of technology in pharmacy practice in developing countries for better patient care. Addressing identified barriers will require research and effective regulations directed to stakeholders

Risk assessment of atherosclerotic cardiovascular diseases before statin therapy initiation: Knowledge, attitude, and practice of physicians in Yemen.

BackgroundRisk evaluation of atherosclerotic cardiovascular disease (ASCVD) remains the cornerstone of primary prevention. The cardiovascular risk assessment can guide the decision-making on various preventive measures such as initiating or deferring statin therapy. Thus, our study aimed to assess the physicians' knowledge, attitude, and practices regarding atherosclerotic cardiovascular diseases risk assessment. Also, we evaluated the physician-patient discussion and counseling practices before statin therapy initiation in concordance with recommendations from the latest clinical practice guideline.MethodsA cross-sectional study was conducted between November 2020 and January 2021. A self-administered questionnaire was distributed to 350 physicians (GPs, residents, specialists, and consultants). Two trained pharmacists distributed the questionnaires in 5 major tertiary governmental hospitals and more than ten private hospitals. Also, private clinics were targeted so that we get a representative sample of physicians at different workplaces.ResultsA total of 270 physicians filled the questionnaire out of 350 physicians approached, with 14 being excluded due to high missing data, giving a final response rate of 73%. Participants had suboptimal knowledge and practices with a high positive attitude toward atherosclerotic cardiovascular diseases risk assessment. The knowledge and practices were higher among consultants, participants from the cardiology department, those with experience years of more than nine years, and those who reported following a specific guideline for cholesterol management or using a risk calculator in their practice. Notably, the risk assessment and counseling practices were lower among physicians who reported seeing more patients per day.ConclusionPhysicians had overall low knowledge, suboptimal practices, and a high positive attitude toward cardiovascular risk assessment. Therefore, physicians' training and continuing medical education regarding cholesterol management and primary prevention clinical practice guidelines are recommended. Also, the importance of adherence to clinical practice guidelines and their impact on clinical outcomes should be emphasized

Knowledge and perception about pharmacovigilance among pharmacy students of universities in Sana'a Yemen

Introduction: Pharmacists in community or hospital setting play a key role in reporting Adverse Drug Reaction (ADRs) during practice. Under reporting is considered as a profession malpractice worldwide. Aim: To determine the level of knowledge and perception about phramacovigilance and ADRs reporting among final year pharmacy students of Universities in Sana'a Yemen. Materials and Methods: A cross-sectional study design was conducted among 385 final year pharmacy students. One public and four private universities were selected randomly using a validated self-administered questionnaire. The questionnaire contained data about student demographic data, knowledge and perception about the ADRs. The data was analysed by SPSS program and Chi-square tests were used to assess the significance of association. Results: The male students were more knowledgeable than female (p=0.035), as well as private university students had better ideas on how to report ADRs than public university students (p=0.009). Private university students reported that pharmacovigilance topic is well covered in their curriculum compared to public university students (p0.001). A significant difference was seen amongst the students of public and private universities when asked about reporting ADRs in future, former found more confident (p0.001). Furthermore, the private university students also had more command on the concept of post-marketing surveillance than public university students (p0.001). The private university students in Yemen were more known to causality assessment of ADRs as compared to the students of public universities (p0.001). The results of perception revealed regarding perception toward ADRs and pharmacovigilance. Female students (p0.018) and private universities students (p0.001) had positive perception than male and public university students respectively. Conclusion: The findings showed poor knowledge among students in Sana'a Universities and positive perception towards pharmacovigilance and ADRs reporting. A poor knowledge among the future pharmacists suggests need for educational interventions and improvement of strategies to ease the reporting mechanisms. Steps can be taken to improve pharmacovigilance tools and methods in Yemen as well as incorporating subjects of pharmacovigilance in the health faculty's curriculum in Yemen.Scopu

Awareness and Perception of Hospitalized Patients on Thromboembolism and Thromboprophylaxis: A Cross-Sectional Study in Sana’a-Yemen

Purpose: Patients’ awareness toward VTE and thromboprophylaxis is critical for medication adherence. This study aimed to evaluate the patient’s awareness and perception towards VTE and its prophylaxis and to assess patient’s satisfaction towards the information given by the medical staff. Participants and Methods: A cross-sectional survey was conducted among hospitalized patients who received VTE prophylaxis in public and private hospitals in Sana’a, Yemen. Besides sociodemographic variables, participants’ awareness and perception of VTE and its prophylaxis were evaluated. Variables’ association with VTE awareness were analyzed using univariable and multivariable logistic regression using SPSS. Results: A total of 396 of the hospitalized patients agreed to participate in the study, with 31% (n = 121) have ever heard about VTE. The multivariable logistic regression findings revealed that the participants who did not have a profession had OR = 17.182 (P < 0.001) of being unaware of VTE compared with those who had one. Participants who did not have a personal history of VTE had OR = 7.580 (P < 0.001) of being unaware of DVT/PE compared with the participants who had a personal history of VTE. Male participants had OR = 2.839 (P < 0.005) of being unaware of DVT/PE compared with female participants. Participants who were illiterate had OR = 2.832 (P < 0.022) of being unaware of DVT/PE compared with participants with a higher level of education. Conclusion: The study revealed lack of awareness and perception of VTE and its prophylaxis among hospitalized patients in Yemen. The patients who are unaware of the disease have wrong perception about their role in DVT prophylaxis. Patient’s education must be considered in healthcare setting to improve patient’s health outcomes