Comprehension of prescription orders with and without pictograms: tool validation and comparative assessment among a sample of participants from a developing country.

BACKGROUND: Medication errors can often occur due to the patient's inability to comprehend written or verbal medication orders. This study aimed to develop pictograms of selected medication orders and to validate the comprehension of prescription orders index and compare the comprehension scores with and without pictograms. In addition to determine the predictors that could be associated with a better or worse comprehension of prescription orders with pictograms versus that of their written counterparts. METHODS: A cross-sectional study was conducted using a snowball sampling technique. Six pictograms were developed to depict specific medication orders. The comprehension of prescription orders index was constructed and validated. The study then compared the comprehension scores of prescription orders with and without pictograms, and identified the predicting factors score difference. RESULTS: A total of 1848 participants were included in the study. The structure of the comprehension of prescription orders index was validated over a solution of four factors, with an adequate Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy of 0.711 and a significant Bartlett's test of sphericity (P < 0.001). The construct validity of the index was further confirmed by highly significant correlations between each item and the full index (P < 0.001). The study also found a significant association between the difference in comprehension scores for prescription orders with and without pictograms and several factors, including age, level of education, area of residence, number of children, and smoking status with the difference of comprehension scores (P < 0.001). CONCLUSION: Pictogram-based instructions of medication orders were better understood by the Lebanese population than written instructions, making the incorporation of pictograms in pharmacy practice paramount to optimize medication use by the patient and thus yielding better health outcomes.

Assessment of Antimicrobial Utilization among Cancer Patients with Febrile Neutropenia at the Lebanese Hospitals.

BACKGROUND: Febrile neutropenia is a prevalent oncologic complication. Initiating rapid treatment with empirical antimicrobials in febrile neutropenia patients reduces mortality due to infections. OBJECTIVES: The study aims to evaluate antimicrobial utilization among FN patients in Lebanon in terms of drug choice, dose, and duration of the treatment. This is a retrospective, multicenter, observational study conducted at three different Lebanese university hospitals (in which the Infectious Diseases Society of America (IDSA) guidelines are adopted), between February 2014 and May 2017. METHODS: Adult cancer patients aged 18 years and older with febrile neutropenia were included in the study. Using the IDSA guidelines as a reference, patients were assessed whether they received the antimicrobial regimen inconsistent with the IDSA reference or not. Statistical analysis was performed using the Statistical Package for the Social Science software (SPSS version 22.0). The adherence to guidelines for the indication and doses of antibiotics and anti-fungal in patients with febrile neutropenia. RESULTS: A total of 124 patients with a mean age of 54.43 ± 17.86 years were enrolled in the study. Leukemia (29.7%) was the most prevalent cancer and the most common infection was sepsis (20.2%). Combination antibiotic lactams are the most prescribed antibiotics (86.8%). Only 94 (86.23%) patients were given the antibiotic therapy appropriate for choice, dose, and duration. Empirical antifungal therapy was initiated in 63.7% of the patients and fluconazole was the most used antifungal (36.3%). In contrast to antibiotics, the majority of antifungal choices were not selected according to the recommendations and they were considered inappropriate for doses and the required treatment duration as proposed by (IDSA). Fifty-eight percent of patients received antivirals, even though it is not recommended as empirical treatment. CONCLUSION: In conclusion, this study reveals a non-consistent antimicrobial utilization practice at the involved sites concerning FN treatment. Inappropriateness was encountered in drug selection, dose, and duration of treatment with antifungals and antivirals.

Management of Acute Stroke Among Lebanese Patients: Assessing Adherence to International Guidelines.

BACKGROUND: Ischemic stroke accounts for around 87% of all strokes worldwide and is the second leading cause of mortality and a significant factor of disability in adults. The objective of this study was to assess the adherence to international treatment guidelines for ischemic stroke in Lebanese hospitals and evaluate factors associated with in-hospital mortality. METHODS: This retrospective observational study was conducted in three Lebanese hospitals between January 2018 and December 2019. All adult patients diagnosed with ischemic stroke and who were subsequently admitted and treated in the internal medicine department, intensive care unit, or coronary care units were included in the study. RESULTS: Out of 292 patients with stroke, 56.8% were females with hypertension being the most common previous disease (38.4%). Concerning acute management, 94.5% had an early brain imaging performed upon hospital presentation, 14.4% were eligible for emergency reperfusion, 2.1% were prescribed fibrinolytic therapy, 50% were adherent with acute hypertension treatment, and 6.2% were adherent with the antiplatelet regimen recommendation. The results highlight that right sided hemiparesis, decreased level of consciousness, and hyperthermia (T > 38°C) were significantly associated with in-hospital death. Guideline adherence for all the acute treatment measures and management strategies was 90.2%. CONCLUSION: The study highlights that guideline recommendations were not uniformly applied among all patients, and those recommendation standards set by the guidelines were not applied among all hospitals.

Association Between Different Attachment Styles and Trends of Engagement in Violent Video Games: A Study Among Lebanese Male Adolescents.

Objective: To evaluate the association of different attachment styles with the exposure of Lebanese male adolescents to violent video games.Methods: This cross-sectional survey study was conducted between October and December 2019 among 388 Lebanese male adolescents (aged 13-17 years) from 5 Lebanese schools. Participants answered questions regarding the 4 attachment styles (secure, preoccupied, fearful, and dismissing) and violent video game engagement.Results: Dismissing attachment style (ß = -1.389) was significantly associated with less violent video gaming. Higher fearful attachment style (ß = 2.981) was significantly associated with more violent video gaming.Conclusions: Adolescents with more insecure attachment styles were found to be more engaged in violent video games. Further research is needed on stress and empathy in association with these attachment styles to investigate whether they have an impact on violent gaming exposure. Future studies should focus on the type of video games and whether they require interaction with others.

Association of violent video games with alcohol use disorder and smoking dependence among male adolescents in Lebanon.

BACKGROUND: With the well-known serious effects of alcohol and nicotine dependence on adolescents' well-being, and knowing that males are more exposed to violent video gaming, this study was conducted to examine the association between exposure to violent video gaming and alcohol, cigarette, and waterpipe dependence among male Lebanese adolescents. METHODS: This was a cross-sectional observational study conducted with Lebanese male students (13-17 years old) between October and December 2019. The Video Game Questionnaire was utilized to assess the content of violence in video games. For the assessment of alcohol, cigarette, and waterpipe dependence, the Alcohol Use Disorders Identification Test scale (AUDIT), Fagerström Test for Nicotine Dependence (FTND), and Lebanese Waterpipe Dependence Scale (LWDS) were used, respectively. Log transformation was used for the three addiction scores. Four linear regressions were performed taking the AUDIT, FTND, LWDS, and violent video gaming scores as dependent variables. RESULTS: From the 388 students enroled (mean age= 15.83 ± 1.93 years), 190 (48.8%) were classified as having violent video gaming. Older age (beta=0.049) and more violent video gaming (beta=0.006) were significantly associated with more cigarette dependence. More violent video gaming (beta=0.003) was significantly associated with more waterpipe dependence. Older age (beta=-0.090) was significantly associated with lower alcohol use disorder, whereas more violent video gaming (beta=0.005) was significantly associated with more alcohol use disorder. CONCLUSION: The study supports an association between higher exposure to violent video game and higher alcohol and smoking dependence among male teenagers in Lebanon. Hence, support and guidance should be implemented to raise awareness and protect teenagers.

Smoking Behavior among Adolescents: The Lebanese Experience with Cigarette Smoking and Waterpipe Use.

(1) Background: The study aims to assess cigarette smoking and waterpipe experimentation among Lebanese adolescent school students with respect to their gender, region, age, and socioeconomic status. (2) Methods: This is a cross-sectional study, where students between 11 to 18 years of age were included from all over Lebanon. (3) Results: A total of 1133 students were interviewed. The total proportion of adolescents who ever experimented with cigarette smoking was 24.5%. Males experimented with cigarette smoking more commonly than females (31.9% vs. 19.1%; p < 0.001). Cigarette smoking experimentation was higher among students from the Beirut area (33.6%; p < 0.001) in comparison to other regions, and among those with poor health perception (29.1% vs. 19.8%; p < 0.001) compared to students with excellent health perception. The total proportion of adolescents who ever used a waterpipe was 33.9%. Waterpipes were significantly more experimented with among males than females (40.3% vs. 29.8%; p < 0.001), and among students with bad perception about their health (39.4% vs. 28.9%; p < 0.001). Adolescents who experimented with both cigarettes and waterpipes constitute 22.2% of the studied sample. (4) Conclusions: The rate of tobacco product use is alarming and constitutes a major public health issue for adolescents that urgently needs intervention. The findings raise important policy implications for the development of cigarette smoking prevention programs for youth.

Knowledge of Antibiotics Use among Lebanese Adults: A study on the influence of sociodemographic characteristics.

OBJECTIVES: This study aimed to evaluate the association between sociodemographic characteristics and antibiotic knowledge in the Lebanese population. METHODS: A questionnaire-based survey was conducted in community pharmacies across all Lebanese governorates. Data were collected by well-trained pharmacists through face-to-face interviews from January until March 2017. The survey tool was adapted from a questionnaire developed by the World Health Organization. A knowledge index was computed for comparative purposes and a linear regression model was performed to assess factors associated with knowledge. RESULTS: A total of 623 participants were included in the analysis of this study (response rate: 90.6%). The mean antibiotic knowledge index was 12.5 ± 3.2 (minimum score: 3 and maximum score: 19). Higher knowledge score was inversely correlated with age (r = -0.118; P = 0.003), but no gender differences were reported (females: 12.6 versus males: 12.3; P = 0.191). However, statistically significant differences were found for residence type (P = 0.002), educational level (P <0.001) and total household income categories (P <0.001). The linear regression model showed a significant association between residence type and knowledge (urban versus rural: ß = 0.793; P = 0.011). Furthermore, a higher knowledge index was significantly associated with a higher income combined with higher education (additive scale/ß = 1.590; P = 0.025). Finally, interactions between income and age, gender and residence type were not significant. CONCLUSION: Individuals residing in urban areas, with combined high income and educational levels, are more knowledgeable about antibiotics use and resistance compared to other groups. More studies are needed to assess the interaction of sociodemographic interactions with health literacy.

Assessment of vancomycin utilization among Lebanese hospitals.

OBJECTIVES: To assess the appropriateness of vancomycin dosing and monitoring at Lebanese hospitals. METHODS: This was a multicenter retrospective study conducted at 3 Lebanese hospitals between January and March 2018. Patients 18 years of age and older treated with vancomycin for a systemic infection or prophylaxis were eligible for study enrollment. Consistency with the Infectious Diseases Society of America guidelines was evaluated to determine whether the dose of vancomycin was appropriate, as well as for the time of trough measurement, and the target concentration obtained. RESULTS: From a total of 120 patients who met the inclusion criteria, only 11 (12%) were given the appropriate maintenance dose of vancomycin with respect to actual body weight. The trough levels were monitored for 67 (55.8%) patients, with 20 (29.9%) of these patients achieving appropriate therapeutic trough levels of 15-20 mg/l. The trough concentration time measurement before the fourth dose was only carried out in 28 (41.8%) of the 67 patients. CONCLUSION: This study reveals a gap between the appropriate utilization of vancomycin with respect to the international guidelines in the studied Lebanese hospitals. It highlights the need for dosing and monitoring protocols suitable for vancomycin utilization in these hospitals.

The Community Pharmacist's Role in Reducing Cardiovascular Risk Factors in Lebanon: A Longitudinal Study.

OBJECTIVE: To assess the role of the pharmacist in modifying risk factors for cardiovascular disease (CVD) among Lebanese adults in urban and rural areas. METHODS: In a prospective survey, 865 out of 1,000 participants aged ≥45 years, previously interviewed, agreed to be followed at 1 and 2 years time points. Parameters including blood pressure, lipid profile, blood glucose, average number of risk factors, and atherosclerotic CVD (ASCVD) risk were assessed and evaluated at the beginning of the study, then after 1 and 2 years. RESULTS: During both follow-ups, the mean average body mass index and systolic blood pressure decreased significantly and the lipid profile improved significantly. Further significant improvements in ASCVD risk occurred during the second follow-up. Monitoring parameters revealed significant improvements as well. CONCLUSION: This study showed that a plan that includes pharmacists, who regularly monitor and follow-up patients, could improve CVD prevention through the reduction of risk factors.

Professional practice evaluation of emergency department prescriptions for community-acquired infections in Lebanon.

BACKGROUND: Selecting the appropriate antibiotic regimen is extremely important in improving patient outcomes, minimizing antimicrobial resistance, and reducing costs. This study was conducted to evaluate current prescribing practices for empiric antibiotics at the time of admission to the emergency department (ED) and to assess their appropriateness in Lebanon. METHODS: A retrospective observational study was conducted at three different Lebanese hospitals between June and December 2016. Adult patients who received antibiotics in the ED during the study period were included. The assessment of antibiotic therapy based on adherence to international guidelines, including the choice of antibiotic, dosing, or both, was considered for analysis. RESULTS: A total of 258 patients who had a single diagnosis of an infectious disease were included. Adherence to international guidelines was noted in only 32.6% of cases; the frequency was highest for skin and soft tissue infections (50.0%), followed by urinary tract infections (40%). Among the different antibiotic classes, the highest percentage of drug incompatibility was for ß-lactam prescriptions (70.8%). The percentage of incompatibility with guidelines for administered regimens on the basis of drug selection, dosing, or both was 53.4%, 10.3%, and 36.2%, respectively. CONCLUSIONS: Inappropriate antibiotic use in the ED is prevalent, and physician adherence to international guidelines for empiric antibiotic prescriptions in the ED remains low. This emphasizes the importance of monitoring the use of antibiotics in the ED, as there is growing concern for antibiotic resistance and healthcare safety.

The Prevalence and Awareness of Cardiovascular Diseases Risk Factors among the Lebanese Population: A Prospective Study Comparing Urban to Rural Populations.

Introduction. CVDs are largely driven by modifiable risk factors. This study sought to determine the awareness and prevalence of the modifiable CVDs risk factors among the Lebanese population. Methods. In a cross-sectional survey, 1000 participants aged ≥ 45 years were randomly selected from pharmacies and interviewed. The data was analyzed with SPSS version 21.0 software. Results. Differences between urban and rural areas include alcohol consumption (2.8% versus 1.7%; p = 0.0001), cardioprotective vegetable servings (6.1% versus 2.3%; p = 0.016), sedentary hours per day (18.6% versus 15.1%; p = 0.002), and hypertension (38.5% versus 25.4%; p = 0.001). The prevalence of overweight and obesity (77.3% versus 75.2%; p = 0.468), smoking (39.3% versus 43.3%; p = 0.232), diabetes (25.4% versus 21.4%; p = 0.173), and dyslipidemia (25 versus 21.2%) was reported. Measurements revealed 19.3% of undiagnosed hypertension (12.4% versus 22.4%, p = 0.001), 61.7% of hypertension (59.8% versus 62.6%; p = 0.203), and 7.9% of undiagnosed diabetes (6.6% versus 8.6%; p = 0.323). The declared awareness of CVDs risk factors was highest for smoking (91.5% versus 89.7%; p = 0.339) and lowest for diabetes (54.4 versus 55.7%; p = 0.692). Conclusion. This study has shown a high prevalence of modifiable CVDs risk factors in the Lebanese population ≥ 45 years, among which hypertension is the most prominent.