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RATIONALE: Approximately 8,000 new cases of pediatric cancer arise annually in Pakistan. However, there is a dire survival rate of 30–35% due to various factors, especially a lack of competent nurses in pediatric oncology care. Public-private partnerships (PPP) supported by a My Child Matters (MCM) Grant from Sanofi Espoir Foundation was granted to Indus Hospital & Health Network (IH&HN) to improve pediatric nursing standards. METHODS: Starting in 2016, nurses from hospitals across Pakistan were enrolled in a continuing education program, which included a comprehensive, hands-on training component. A group chat was created following the training for communication and mentorship regarding challenges faced locally. RESULTS: Seventy-seven pediatric oncology nurses were successfully trained by IH&HN over three years. DISCUSSION: Challenges included lack of government funding, shortage of specialist nurses, frequent shifting of nurses away from pediatric care, and indifferent attitudes. Success of the project could have been maximized if trained nurses were motivated and retained by hospitals. CONCLUSION: Development and maintenance of PPP in national healthcare systems is essential to improve pediatric oncology nursing care.

AbstractWe examined the impact of attributed responsibility and crisis communication for a terrorism crisis on brand image. This crisis scenario involved the loss of life. Using an experimental design methodology and based on the response of 209 respondents, we find that brand image, as expected decreases post‐terrorism. Various types of communication responses were ranked as appropriate and assessed as to impact on the brand. We found that during an event involving the loss of life, the public wanted the brand to apologize and compensate for the grief and loss, irrespective of attribution. The least appropriate communication strategies were justification and excuse and inappropriate communication decreased brand image more than after the attack. This could be because there was insufficient information at that moment to prove guilt or innocence, and the public wanted some form of retribution, perhaps as a method of dealing with the shock and grief. The communications perceived as more appropriate, for example, apology and compensation, were shown to increase the brand image to a higher level immediately after the attack than before the attack. This paper adds to our knowledge of situational crisis communication theory and extends the theory on definition of terrorism, complation of communication strategies, and on suggests how to prevent brand image loss or brand burn during a terrorism crisis.

Since the early 1950s, for medication management, the hospital formulary system subsisted as a list of drugs into the supply chain management process in hospitals. With the advent of pharmacy practice services, the system now is more oriented towards the rational use of drugs taking into account the safety of therapy, cost-effectiveness, and uninterrupted availability of drugs to improve and reflect upon the clinical judgment of healthcare professionals. Though very few hospitals in Nepal have adopted hospital formulary system, the perfect practice is still skimpy. The formation of drug and therapeutic committee along with the establishment of hospital pharmacy services is a growing trend with the arrival of hospital pharmacy guidelines 2072, thus, a positive spill-over of the hospital formulary system to each hospital in Nepal would be valuable in promoting rational drug therapy.Keywords: Cost-effectiveness; hospital formulary system, rational drug therapy.

Background: The inappropriate use of antibiotics in hospitals increases resistance, morbidity, and mortality. Little is currently known about appropriate antibiotic use among hospitals in Lahore, the capital city of Pakistan. Methods: Longitudinal surveillance was conducted over a period of two months among hospitals in Lahore, Pakistan. Antibiotic treatment was considered inappropriate on the basis of a wrong dosage regimen, wrong indication, or both based on the British National Formulary. Results: A total of 2022 antibiotics were given to 1185 patients. Out of the total prescribed, approximately two-thirds of the study population (70.3%) had at least one inappropriate antimicrobial. Overall, 27.2% of patients had respiratory tract infections, and out of these, 62.8% were considered as having inappropriate therapy. Cephalosporins were extensively prescribed among patients, and in many cases, this was inappropriate (67.2%). Penicillins were given to 283 patients, out of which 201 (71.0%) were prescribed for either the wrong indication or dosage or both. Significant variations were also observed regarding inappropriate prescribing for several antimicrobials including the carbapenems (70.9%), aminoglycosides (35.8%), fluoroquinolones (64.2%), macrolides (74.6%) and other antibacterials (73.1%). Conclusion: Educational interventions, institutional guidelines, and antimicrobial stewardship programs need to be developed to enhance future appropriate antimicrobial use in hospitals in Pakistan. Policies by healthcare and Government officials are also needed to minimize inappropriate antibiotic use.

Abstract Background Infections with hepatitis B virus (HBV) and hepatitis C virus (HCV) can lead to chronic liver disease and hepato-cellular carcinoma (HCC). This cross-sectional study estimated the prevalence and identified risk factors associated with Hepatitis B surface antigen (HBsAg) and HCV antibody (anti-HCV) sero-positivity among children 1 to 15 years of age. Methods The study targeted the low to middle socioeconomic population that comprises 80% to 85% of the population. Consent was obtained from parents of the eligible children before administering questionnaire and collected a blood sample for anti-HCV and HBsAg serology. Results 3533 children were screened for HBsAg and anti-HCV. 1826 (52 %) were males. 65 (1.8 %) were positive for HBsAg, male to female ratio 38:27; mean age 10 ± 4 years. 55 (1.6 %) were positive for anti-HCV with a mean age 9 ± 4 years. 3 (0.11%) boys were positive for both HBsAg and anti-HCV. The overall infection rate was 3.3 % in the studied population. Hepatitis BsAg was more prevalent in subjects who received therapeutic injections 45 (69.2%) positive [Odd Ratio OR = 2.2; 95% Confidence interval CI: 1.3–3.6] inspite of using new needle and syringe 44 (67.7%) positive [OR = 2.2; 95% CI: 1.3–3.7] and vaccination in the government healthcare facilities 46 (70.7 %) positive with [OR = 3.0; 95% CI: 1.4–6.4]. These factors were not significant in anti-HCV positive cases. Conclusion There is a need to educate general population regarding HBV and HCV infection and risks associated with inappropriate therapeutic injections. Hepatitis B vaccine should be administered to all newborns regardless of maternal HBsAg status.

Background Infections with hepatitis B virus (HBV) and hepatitis C virus (HCV) can lead to chronic liver disease and hepato-cellular carcinoma (HCC). This cross-sectional study estimated the prevalence and identified risk factors associated with Hepatitis B surface antigen (HBsAg) and HCV antibody (anti-HCV) sero-positivity among children 1 to 15 years of age. Methods The study targeted the low to middle socioeconomic population that comprises 80% to 85% of the population. Consent was obtained from parents of the eligible children before administering questionnaire and collected a blood sample for anti-HCV and HBsAg serology. Results 3533 children were screened for HBsAg and anti-HCV. 1826 (52 %) were males. 65 (1.8 %) were positive for HBsAg, male to female ratio 38:27; mean age 10 ± 4 years. 55 (1.6 %) were positive for anti-HCV with a mean age 9 ± 4 years. 3 (0.11%) boys were positive for both HBsAg and anti-HCV. The overall infection rate was 3.3 % in the studied population. Hepatitis BsAg was more prevalent in subjects who received therapeutic injections 45 (69.2%) positive [Odd Ratio OR = 2.2; 95% Confidence interval CI: 1.3–3.6] inspite of using new needle and syringe 44 (67.7%) positive [OR = 2.2; 95% CI: 1.3–3.7] and vaccination in the government healthcare facilities 46 (70.7 %) positive with [OR = 3.0; 95% CI: 1.4–6.4]. These factors were not significant in anti-HCV positive cases. Conclusion There is a need to educate general population regarding HBV and HCV infection and risks associated with inappropriate therapeutic injections. Hepatitis B vaccine should be administered to all newborns regardless of maternal HBsAg status.

BACKGROUND: Poor availability and unaffordability of key access antibiotics may increase antimicrobial resistance in the community by promoting inappropriate antibiotic selection and abridged therapy compliance. OBJECTIVE: To check the prices, availability, and affordability of the World Health Organization (WHO) key access antibiotics in private sector pharmacies of Lahore, Pakistan. METHODOLOGY: A survey of WHO key access antibiotics from WHO essential medicine list 2017 was conducted in private sector pharmacies of 4 different regions of Lahore employing adapted WHO/HAI methodology. The comparison of prices and availability between originator brands (OB) and lowest price generics (LPG) were conducted followed by the effect of medicine price differences on patient's affordability. The data were analyzed using a preprogrammed WHO Microsoft excel workbook. RESULTS: The mean availability of OB products was 45.20% and the availability of LPGs was 40.40%. The OBs of co-amoxiclav, clarithromycin and metronidazole and LPGs of azithromycin and ciprofloxacin were easily available (100%) in all private sector pharmacies. Whereas, antibiotics like chloramphenicol, cloxacillin, nitrofurantoin, spectinomycin, and cefazolin were totally unavailable in all the surveyed pharmacies. The OBs and LPGs with high MPRs were ceftriaxone (OB; 15.31, LPG; 6.38) and ciprofloxacin (OB; 12.42, LPG; 5.77). The median of brand premium obtained was 38.7%, which varied between the lowest brand premium of 3.97% for metronidazole and highest for ceftriaxone i.e. 140%. The cost of standard treatment was 0.5 day's wage (median) if using OB and 0.4 day's wage (median) for LPG, for a lowest paid unskilled government worker. Treatment with OB and LPG was unaffordable for ciprofloxacin (OB; 2.4, LPG; 1.1) & cefotaxime (OB; 12.7, LPG; 8.1). CONCLUSION: There is dire need to properly implement price control policies to better regulate fragile antibiotic supply system so that the availability of both OB and LPG of key access antibiotics should be ...

Iltaf Hussain,1 Muhammad Fawad Rasool,1 Imran Imran,2 Hamid Saeed,3 Furqan Hashmi,3 Muqarrab Akbar,4 Muhammad Asad Abrar,1 Basit Ramzan,5 Muhammad Omer Chaudhry,6 Muhammad Islam,3 Areeba Usman,7 Naveed Nisar,8 Abdul Majeed1 1Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan; 2Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan; 3University College of Pharmacy, University of the Punjab, Allama Iqbal Campus, Lahore 54000, Pakistan; 4Department of Political Science, Bahauddin Zakariya University, Multan 60800, Pakistan; 5Al Shifa Pharmacy, Multan, Pakistan; 6School of Economics, Bahauddin Zakariya University, Multan 60800, Pakistan; 7Nishter Medical Hospital, Multan, Pakistan; 8Department of Pharmaceutics, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, PakistanCorrespondence: Abdul MajeedDepartment of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, PakistanTel +92 3336139819Email abdulmajeed@bzu.edu.pkBackground and Purpose: Over the past few decades, the focus of pharmacy practice has been shifted from the classical role of drug dispenser to pharmacotherapy expert. Pharmacists now are more often involved in the patient care process by addressing the drug-related needs of the patients and this patient-centered approach is known as pharmaceutical care (PC). The present study was conducted to assess the attitude of pharmacy undergraduate students toward PC and various contributing factors that influence their preference towards it.Method and Instrument: A descriptive cross-sectional study was conducted in 422 undergraduate pharmacy students by using a simple random sampling method. A pre-validated and self-reported Pharmaceutical Care Attitude Scale (PCAS) was used for assessing a student's attitude towards PC.Results: Amongst the 422 undergraduate students, the majority were males (68.2%) and 70.4% were between the age group of 20 and 25 years. The students studying in third, fourth, and fifth year (final year) were 140 (33.2%), 142 (33.6%), and 140 (33.2%), respectively. Overall participant showed a positive attitude toward the PC. Professional year showed significant influence on professional duties (PD) (p< 0.001) and age was significantly associated with return on efforts (ROE) (p< 0.001) and professional benefits (PB) (p< 0.001).Conclusion: Most of the participants showed a positive attitude toward PC and showed motivation to practice it. To promote PC practice in Pakistan, the government along with other professional bodies like Pakistan Pharmacists Association (PPA) should work together in collaboration with global health agencies to develop a well-structured advanced healthcare system in which there is a defined role of PC practice.Keywords: attitude, clinical pharmacy, pharmaceutical care, pharmacy practice

BACKGROUND AND PURPOSE: Over the past few decades, the focus of pharmacy practice has been shifted from the classical role of drug dispenser to pharmacotherapy expert. Pharmacists now are more often involved in the patient care process by addressing the drug-related needs of the patients and this patient-centered approach is known as pharmaceutical care (PC). The present study was conducted to assess the attitude of pharmacy undergraduate students toward PC and various contributing factors that influence their preference towards it. METHOD AND INSTRUMENT: A descriptive cross-sectional study was conducted in 422 undergraduate pharmacy students by using a simple random sampling method. A pre-validated and self-reported Pharmaceutical Care Attitude Scale (PCAS) was used for assessing a student's attitude towards PC. RESULTS: Amongst the 422 undergraduate students, the majority were males (68.2%) and 70.4% were between the age group of 20 and 25 years. The students studying in third, fourth, and fifth year (final year) were 140 (33.2%), 142 (33.6%), and 140 (33.2%), respectively. Overall participant showed a positive attitude toward the PC. Professional year showed significant influence on professional duties (PD) (p<0.001) and age was significantly associated with return on efforts (ROE) (p<0.001) and professional benefits (PB) (p<0.001). CONCLUSION: Most of the participants showed a positive attitude toward PC and showed motivation to practice it. To promote PC practice in Pakistan, the government along with other professional bodies like Pakistan Pharmacists Association (PPA) should work together in collaboration with global health agencies to develop a well-structured advanced healthcare system in which there is a defined role of PC practice.

Abdul Majeed,1 Iltaf Hussain,1 Imran Imran,2 Muhammad Usman Saleem,3 Hamid Saeed,4 Muhammad Asad Abrar,1 Muhammad Islam,4 Furqan K Hashmi,4 Muqarrab Akbar,5 Basit Ramzan,6 Muhammad Omer Chaudhry,7 Waseem Ashraf,2 Muhammad F Rasool1 1Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan; 2Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan; 3Department of Biosciences, Faculty of Veterinary Sciences, Bahauddin Zakariya University, Multan, Pakistan; 4University College of Pharmacy, University of the Punjab, Allama Iqbal Campus, Lahore, Pakistan; 5Department of Political Science, Bahauddin Zakariya University, Multan, Pakistan; 6Al Shifa Pharmacy, Multan, Pakistan; 7School of Economics, Bahauddin Zakariya University, Multan, PakistanCorrespondence: Muhammad F RasoolDepartment of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, 60800, PakistanTel +92 3008639046Email fawadrasool@bzu.edu.pkBackground: The COVID-19 pandemic is not only affecting public health, but it is also impairing the specialized surgical care services in the hospitals. The present study aimed to assess the barriers faced by the surgeons while performing surgical procedures during the COVID-19 pandemic.Methods: A cross-sectional, web-based survey was conducted from September 10 to October 14, 2020. The study population consisted of surgeons practicing in Kpk, Pakistan. Descriptive statistics and binary logistic regression analysis were used to analyze the data.Results: A total of 292, out of 543, surgeons participated in the study (response rate: 59.6%). The younger surgeons (25– 30 years) considered the lack of policies and practices regarding exposure to COVID-19 patients as a significant barrier to their practice. The surgeons practicing in private hospitals considered themselves at a higher risk while providing surgical care to the COVID-19 patients. The non-cooperation of the patients was the main barrier in delivering surgical care services.Conclusion and Recommendation: The current study highlighted the barriers to the surgeons while providing surgical care to patients in the current pandemic. The most pronounced barriers to the surgeons were the lack of policies regarding exposure to COVID-19 and practice and non-cooperation of the patient. To address these barriers, it is recommended that health regulatory agencies of Pakistan should implement strict infection control practices to ensure the safety of surgeons and allied healthcare staff during the COVID-19 pandemic.Keywords: COVID-19, nCoV-2, surgeons, barriers

Muhammad Fawad Rasool,1 Rimsha Sarwar,1 Muhammad Subhan Arshad,1,2 Imran Imran,3 Hamid Saeed,4 Abdul Majeed,1 Muqarrab Akbar,5 Muhammad Omer Chaudhry,6 Anees ur Rehman,1 Waseem Ashraf,3 Tanveer Ahmad,7 Waleed Badoghaish,8 Faleh Alqahtani9 1Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, 60800, Pakistan; 2Department of Pharmacy, Southern Punjab Institute of Health Sciences, Multan, 60000, Pakistan; 3Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, 60800, Pakistan; 4University College of Pharmacy, Allama Iqbal Campus, University of the Punjab, Lahore, 54000, Pakistan; 5Department of Political Science, Bahauddin Zakariya University, Multan, 60800, Pakistan; 6School of Economics, Bahauddin Zakariya University, Multan, 60800, Pakistan; 7Institute for Advanced Biosciences (Iab), CNRS UMR5309, INSERM U1209, Grenoble Alpes University, La Tronche, 38700, France; 8Department of Internal Medicine, College of Medicine, University of Tabuk, Tabuk, 71411, Saudi Arabia; 9Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh, 11451, Saudi ArabiaCorrespondence: Muhammad Fawad Rasool; Faleh Alqahtani Email fawadrasool@bzu.edu.pk; afaleh@ksu.edu.saPurpose: Gastroesophageal reflux disease (GERD) is a highly prevalent gastrointestinal disorder with modifiable risk factors and it is associated with considerable health and economic burden. The current study was conducted to assess the frequency and risk factors related to GERD in the previously unstudied population of Southern Punjab, Pakistan.Methods: A cross-sectional study was conducted for assessing the frequency and risk factors of GERD by using a self-administered questionnaire. The gastroesophageal reflux disease questionnaire (GerdQ) was utilized to detect the presence of the disease.Results: The study included 308 participants; among them, 55.2% were female and 44.8% were male. The participants diagnosed with GERD (GerdQ score ≥ 8) were 26.6%. The various risk factors like higher BMI, past disease and smoking history, frequent use of NSAIDs, soft drinks, pickles, and spicy foods were significantly associated with GERD.Conclusion: The present study showed that GERD is prevalent in Southern Punjab and is associated with various modifiable risk factors. The ascendance of GERD can be prevented by public health education and awareness campaigns.Keywords: gastroesophageal reflux, GERD, risk factors, Southern Punjab

OBJECTIVE: To evaluate the impact of new National Drug Pricing Policy (NDPP) 2018 on access to medicines in terms of prices, availability and affordability. DESIGN: Two cross-sectional surveys were undertaken before and after the launch of NDPP 2018, using a modified WHO/Health Action International (WHO/HAI) methodology. SETTING: Four districts of Lahore division, Pakistan. PARTICIPANTS: 16 public sector hospitals and 16 private sector retail pharmacies. MEASURES: The pre and post survey data on prices and availability of lowest price generics (LPGs) and originator brands (OBs) of 50 medicines were obtained by visiting the same public and private sector health facilities (n=32). Out of 50, 46 surveyed medicines were from the National Essential Medicines List. Inflation-adjusted median unit prices (MUPs) and median price ratios (MPRs) from 2019 were used for price comparison. Affordability was calculated in terms of number of days' wages required to get a standard treatment by the lowest paid unskilled government worker. RESULTS: The overall mean percent availabilities remained poor in both years, that is, far less than 80%. In the public sector, the mean percent availability of OBs improved from 6.8% to 33.1%, whereas, in the case of LPGs, it was reduced from 35.1% to 9%. In the private sector, the mean percent availability of both OBs and LPGs demonstrated slight improvements in 2019, that is, 55.0%–58.3% and 20.3%–32.3%. The adjusted MUPs and MPRs of OBs significantly increased by a median of 4.29% (Wilcoxon test p=0.001, p=0.0001), whereas the adjusted MUPs and MPRs of LPGs increased by a median of 15.7% (p=0.002, p=0.0002). Overall, the affordability of many medicines for common ailments was reduced significantly in 2019. CONCLUSIONS: The availability of medicines slightly improved, except in the case of LPGs, which was reduced in the public sector. The implementation of NDPP 2018 led to increase in drug prices, making the standard treatment for some of the most prevalent ailments unaffordable. So verily, ...