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  1. Hatem NAH, Mohamed Ibrahim MI, Halboup A, Kubas M
    Adv Med Educ Pract, 2023;14:109-121.
    PMID: 36816050 DOI: 10.2147/AMEP.S392886
    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 self-administered 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.

  2. Ibrahim D, Halboup A, Al Ashwal M, Shamsher A
    Int J Nephrol, 2023;2023:2074498.
    PMID: 37497380 DOI: 10.1155/2023/2074498
    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.

  3. Al-Ashwal FY, Sulaiman SAS, Sheikh Ghadzi SM, Kubas MA, Halboup A
    Curr Med Res Opin, 2022 Mar;38(3):451-459.
    PMID: 34657524 DOI: 10.1080/03007995.2021.1994380
    BACKGROUND: Risk evaluation of atherosclerotic cardiovascular diseases can guide the decision-making on various preventive measures, such as initiating or deferring statin therapy. Pharmacists can play an active part in the risk evaluation and primary prevention of atherosclerotic cardiovascular diseases. Thus, our study aimed to assess the pharmacists' knowledge, attitude, perceived barriers, and practices regarding risk assessment of atherosclerotic cardiovascular disease.

    MATERIALS AND METHODS: A cross-sectional study was conducted among 500 pharmacists using a structured validated questionnaire between November 2020 and February 2021. The Mann-Whitney and Kruskal-Wallis tests were used to analyze the data.

    RESULTS: A total of 456 pharmacists completed the questionnaire out of 500 distributed (91.2% response rate). Over 60% of participants responded with never or rarely for two out of five cardiovascular diseases (CVD) prevention practices. The lowest pharmacist-patient counseling practices were for side effects of statin medication (14.5%) and reviewing the patient's medications to avoid potential statin-drug interactions (31.8%). Participants had a high positive attitude (median = 34 out of 40). The three major barriers for risk assessment were the lack of support (74.8%), the lack of resources (70.6%), and inadequate training (48.7%). Interestingly, having ≤75 customers a day, community pharmacies, PharmD degree, age ≥30 years, and experience ≥6 years were significantly associated (p < .05) with higher CVD prevention activities and counseling practices.

    CONCLUSION: Pharmacists have a high positive attitude toward CVD risk assessment. However, they had insufficient knowledge and only provided limited activities and counseling services for CVD prevention and statin therapy. Participants perceived several barriers to CVD risk assessment services in pharmacies. Therefore, it is necessary to remove these impediments for pharmacists to be more involved in CVD risk assessment and prevention. Also, continuing medical education and adequate training for pharmacists are required.

  4. Al-Ashwal FY, Sulaiman SAS, Sheikh Ghadzi SM, Kubas MA, Halboup A
    PLoS One, 2023;18(1):e0280432.
    PMID: 36662695 DOI: 10.1371/journal.pone.0280432
    BACKGROUND: Millions of individuals worldwide use statins, and their significant impact on cardiovascular disease (CVD) has been well-established. However, a lack of knowledge about the up-to-date guideline recommendations regarding statin therapy is a common barrier to implementation in clinical practice. Therefore, the present study aimed to assess the current clinical knowledge about statin therapy and its monitoring parameters. Also, we evaluated the barriers to cholesterol management guideline implementation in Yemen.

    METHODS: This observational cross-sectional study was conducted over four months, from June/2021 to September/2021, in Sana'a, Yemen. A validated questionnaire was distributed face-to-face to 650 participants (350 physicians and 300 pharmacists). Physicians and pharmacists from governmental and private hospitals and those working in private clinics or community pharmacies were included in the study.

    RESULTS: A total of 496 participants filled out the survey, with 22 being excluded due to incomplete data. So, the study has an overall response rate of 72.9% (474). The majority of pharmacists (81.8%) and physicians (78.7%) could not identify the patient group that needed ASCVD risk assessment before statin therapy initiation. Although a significant proportion of respondents knew of the fact that high-intensity statins are recommended for patients with ASCVD (65.4%) and primary hypercholesterolemia (58.4%), the majority of physicians and pharmacists could not identify the high (61.6% and 66.7.3%, respectively) and moderate statin-intensity doses (72.2% and 68.6%, respectively). Only 21.9% of all respondents knew that atorvastatin and rosuvastatin can be administered at any time of the day. Similarly, a low overall rate of respondents (19.6%) knew that atorvastatin does not need dose adjustment in chronic kidney diseases, with a statistically significant difference in knowledge between physicians and pharmacists (12.5% vs. 25.6%, p <0.001, respectively). Notably, only 39.2% of participants were aware that statins are not safe to use during breastfeeding. Around half of respondents (52.3%) correctly identify the duration (4 to 12 weeks) at which LD-C measuring is recommended after therapy initiation or dose change. The lowest knowledge scores for respondents were related to statin-drug interactions. Age, experience, degree, and previous guideline exposure were all significantly associated with the knowledge scores (p <0.05). The four most perceived barriers to implementing cholesterol management guidelines were no audit on adherence to the guidelines in the workplace (73.4%), insufficient resources to adequately implement and follow up on the guideline's recommendations (73.6%), patient's financial status (75.7%), and lack of familiarity about the guideline's latest recommendations (63.3%).

    CONCLUSION: Physicians and pharmacists had suboptimal clinical knowledge regarding statin therapy, dose intensities, drug-drug interaction, contraindications, and monitoring parameters. Therefore, physicians' and pharmacists' educational interventions regarding the up-to-date recommendation about statins are recommended.

  5. Abu Hammour K, Alhamad H, Al-Ashwal FY, Halboup A, Abu Farha R, Abu Hammour A
    J Pharm Policy Pract, 2023 Oct 03;16(1):115.
    PMID: 37789443 DOI: 10.1186/s40545-023-00624-2
    OBJECTIVES: The purpose of this study is to find out how much pharmacists know and have used ChatGPT in their practice. We investigated the advantages and disadvantages of utilizing ChatGPT in a pharmacy context, the amount of training necessary to use it proficiently, and the influence on patient care using a survey.

    METHODS: This cross-sectional study was carried out between May and June 2023 to assess the potential and problems that pharmacists observed while integrating chatbots powered by AI (ChatGPT) in pharmacy practice. The correlation between perceived benefits and concerns was evaluated using Spearman's rho correlation due to the data's non-normal distribution.Any pharmacists licensed by the Jordanian Pharmacists Association were included in the study. A convenient sampling technique was used to choose the participants, and the study questionnaire was distributed utilizing an online medium (Facebook and WhatsApp). Anyone who expressed interest in taking part was given a link to the study's instructions so they may read them before giving their electronic consent and accessing the survey.

    RESULTS: The potential advantages of ChatGPT in the pharmacy practice were widely acknowledged by the participants. The majority of participants (69.9%) concurred that educational material about pharmacy items or therapeutic areas can be provided using ChatGPT, with 66.9% of respondents believing that ChatGPT is a machine learning algorithm. Concerns about the accuracy of AI-generated responses were also prevalent. More than half of the participants (55.7%) raised the possibility that AI systems such as ChatGPT could pick up on and replicate prejudices and discriminatory patterns from the data they were trained on. Analysis shows a statistically significant positive link, albeit a minor one, between the perceived advantages of ChatGPT and its drawbacks (r = 0.255, p 

  6. Al-Ashwal FY, Sulaiman SAS, Sheikh Ghadzi SM, Kubas MA, Halboup A
    PLoS One, 2022;17(5):e0269002.
    PMID: 35617266 DOI: 10.1371/journal.pone.0269002
    BACKGROUND: Risk 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.

    METHODS: A 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.

    RESULTS: A 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.

    CONCLUSION: Physicians 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.

  7. Al-Ashwal FY, Syed Sulaiman SA, Sheikh Ghadzi SM, Harun SN, Halboup A, Kubas MA
    Adv Med Educ Pract, 2024;15:357-368.
    PMID: 38707544 DOI: 10.2147/AMEP.S445610
    INTRODUCTION: Understanding the latest guideline recommendations is crucial for healthcare professionals to apply statin therapy effectively. Thus, the purpose of this study was to evaluate the efficacy of an educational intervention in enhancing the awareness and understanding of physicians and pharmacists concerning risk assessment of Atherosclerotic cardiovascular disease (ASCVD) and the role of statin therapy.

    METHODS: This pre- and post-intervention study was conducted in Sana'a, Yemen's capital city, at the University of Science and Technology Hospital. The study was done between 11/2021-12/2021, and two separate educational sessions were ‎held. The McNemar's test and Wilcoxon signed-rank test were employed as necessary.

    RESULTS: Participants' awareness of the Framingham CVD risk calculator improved significantly from 40.4% pre-intervention to 78.7% post-intervention. Similarly, understanding of the parameters used in the 10-year ASCVD Risk calculator rose from 46.8% pre-intervention to 76.6% post-intervention. The ability to identify high, moderate, and low-intensity statin therapy, for instance, increased from 34% to 63.8% post-intervention. Regarding statins' contraindications, safety, and efficacy monitoring parameters, pre-intervention knowledge was unsatisfactory, and the educational intervention improved it significantly (p <0.05). For physicians, the median ASCVD risk assessment knowledge score was significantly improved from ‎‎4 (IQR = 3-5) pre-intervention to 7 (6.25-8) immediately post-intervention, while the statin therapy clinical knowledge median score ‎significantly improved from 3 (1.25-6.5) to 9 (7.25-14.75) post-education intervention, p-values were 0.002 and 0.003; respectively. For pharmacists, a similar significant improvement (p <0.05) in the overall knowledge scores for both ASCVD risk ‎assessment and statin therapy was noted.

    CONCLUSION: The educational intervention improved participants' knowledge of statin therapy and ASCVD risk assessment. Therefore, further education lectures and training programs through continuing ‎medical ‎education on the up-to-date guidelines' recommendations should be regularly implemented to raise ‎awareness and improve ‎the clinical knowledge and appropriateness of statins use in clinical settings.‎.

  8. Mohammed M, Kumar N, Zawiah M, Al-Ashwal FY, Bala AA, Lawal BK, et al.
    J Racial Ethn Health Disparities, 2024 Aug;11(4):2284-2293.
    PMID: 37428357 DOI: 10.1007/s40615-023-01696-1
    ChatGPT represents an advanced conversational artificial intelligence (AI), providing a powerful tool for generating human-like responses that could change pharmacy prospects. This protocol aims to describe the development, validation, and utilization of a tool to assess the knowledge, attitude, and practice towards ChatGPT (KAP-C) in pharmacy practice and education. The development and validation process of the KAP-C tool will include a comprehensive literature search to identify relevant constructs, content validation by a panel of experts for items relevancy using content validity index (CVI) and face validation by sample participants for items clarity using face validity index (FVI), readability and difficulty index using the Flesch-Kincaid Readability Test, Gunning Fog Index, or Simple Measure of Gobbledygook (SMOG), assessment of reliability using internal consistency (Cronbach's alpha), and exploratory factor analysis (EFA) to determine the underlying factor structures (eigenvalues, scree plot analysis, factor loadings, and varimax). The second phase will utilize the validated KAP-C tool to conduct KAP surveys among pharmacists and pharmacy students in selected low- and middle-income countries (LMICs) (Nigeria, Pakistan, and Yemen). The final data will be analyzed descriptively using frequencies, percentages, mean (standard deviation) or median (interquartile range), and inferential statistics like Chi-square or regression analyses using IBM SPSS version 28. A p<0.05 will be considered statistically significant. ChatGPT holds the potential to revolutionize pharmacy practice and education. This study will highlight the psychometric properties of the KAP-C tool that assesses the knowledge, attitude, and practice towards ChatGPT in pharmacy practice and education. The findings will contribute to the potential ethical integration of ChatGPT into pharmacy practice and education in LMICs, serve as a reference to other economies, and provide valuable evidence for leveraging AI advancements in pharmacy.
  9. Abu Hammour A, Hammour KA, Alhamad H, Nassar R, El-Dahiyat F, Sawaqed M, et al.
    J Pharm Policy Pract, 2024;17(1):2429000.
    PMID: 39600801 DOI: 10.1080/20523211.2024.2429000
    BACKGROUND: The integration of Artificial Intelligence (AI) tools like ChatGPT into medical education is expanding, offering benefits such as efficient information synthesis. However, concerns about the accuracy, reliability, and proper use of these tools persist. Understanding medical students' perceptions of ChatGPT is crucial for optimising its use in educational settings.

    OBJECTIVES: To evaluate how medical students perceive ChatGPT for educational purposes and to assess its perceived advantages and disadvantages.

    METHODS: A cross-sectional study was carried out using a questionnaire with five main domains to explore Jordanian medical students' perceptions, practices, and concerns regarding the ChatGPT. This study was conducted from May to July, 2023, and the data were collected using the convenience sampling technique through Google Forms shared within medical students' Facebook groups. Descriptive statistics summarised participant demographics, while logistic regression identified factors influencing ChatGPT usage. Variables with a P-value ≤ 0.05 in multiple regression were considered statistically significant.

    RESULTS: Nearly two-thirds (N = 136, 61.5%) claimed to have knowledge of AI but not in clinical settings. Most participants (88.5%, N = 216) were aware of ChatGPT, with 86.9% (N = 212) agreeing that 'Medical students can benefit from using ChatGPT.' Additionally, 83.2% (N = 203) felt that 'ChatGPT helps students quickly and easily summarize complex information.' Conversely, 78.3% (N = 191) expressed concerns about ChatGPT's potential inaccuracies, with accuracy and reliability cited as primary concerns. Multiple logistic regression showed that younger students (OR = 0.902, P = 0.025) and those with lower proficiency (OR = 0.487, P = 0.007) used ChatGPT more frequently than others.

    CONCLUSION: Although the use of the ChatGPT could be more beneficial for aiding students in developing medical knowledge, evidence-based academic regulations should guide its use. Future research should be conducted to examine the enablers and barriers to ChatGPT use in medical education.

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