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لين فينو

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​​​​​​​Exploring pharmacy ethics in developing countries: a scoping review

Authors : ​Leen B. Fino, Iman A. Basheti, Bandana Sai​​ni, Rebekah Moles & Betty B. Chaar

Abstract : Background Healthcare ethics have been profound​​ly influenced by principles of bioethics that emerged post-World War II in the Declaration of Geneva 1948. ‘Beneficence’ (to do good), ‘Non-Maleficence’ (to do no harm), ‘Justice’ (fairness and justice in access) and ‘Respect for Autonomy’ (respect for patient individuality, including decision making, privacy, and right to refuse), have become foundational principles of contemporary medical codes of ethics. These principles are well reflected in most professional pharmacy code of ethics globally. This domain remains relatively unexplored in most developing countries and the majority of what has been published in this area relates to western cultures. There have been no attempts to pool findings from a similar scope of research emanating in developing countries. Aim of the review This study aims to explore the scope of pharmacy ethics in the literature pertaining to developing countries. Methods An extensive search of three relevant (Scopus, CINAHL, IPA) databases was conducted from Jan 2000 to Feb 2020, in order to identify relevant studies conducted in or focussed on ethics in pharmacy in developing countries. A separate Google Scholar search was carried out in an effort to locate supplementary articles, hand-searched articles were also included to achieve an exhaustive investigation of all current relevant studies. Results The full text of 20 relevant articles that met inclusion criteria were critically analysed and qualitatively categorised into three emerging themes; Ethical challenges in pharmacy practice, Approaches used in teaching pharmacy ethics, and Code of ethics analysis and implementation. Conclusions: Findings of this literature review illuminated a gap in pharmacy ethics literacy in developing countries and variances in pharmacists’ ethical attitudes in handling ethical dilemmas, as well as a lack of familiarity with ethical principles and codes of ethics. Pharmacists’ lack of respect for patients’ autonomy and pharmacists being prone to financial pressure were found to have a significant impact on pharmacy practice in most of developing countries. However, attempts are being made to rectify this gap by efforts to incorporate ethical and professional education in undergraduate curricula, and by studies in which new codes of ethics are being implemented.

Keywords : Developing countries, Literature review, Pharmacy ethics Pharmacy ethics teaching

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​​​​​Exploring Ethical Pharmacy Practice in Jordan

Authors : ​Leen B. Fino, Iman A. Basheti & Betty B. Chaar

Abstract : Patient-centered pharmacy practice involves increased pharmacist engagement inpatient care. This increased involvement can sometimes require diverse decision-making when handling various situations, ranging from simple matters to major ethical dilemmas. There is literature about pharmacy ethics in developed Western countries. However, little is known about pharmacists’ practices in many developing countries. For example, there is a paucity of research conducted in the area of pharmacy ethics in Jordan. This study aimed to explore the manner in which ethical dilemmas were handled by Jordanian pharmacists, the resources used and their attitudes towards them. Semi-structured, face to face interviews were carried out with30 Jordanian registered pharmacists. The transcribed interviews were thematically analyzed for emerging themes. Four major themes were identified: legal practice; familiarity with the code of ethics; personal judgement, cultural and religious value​s; and Experience. Findings showed that ethical decision-making in pharmacy practice in Jordan was decisively influenced by pharmacists’ personal moral values, legal requirements and managed by exercising common sense and experience. This pointed to gaps in Jordanian pharmacists’ understanding and application of basic principles of pharmacy ethics and highlighted the need for professional ethics training, incorporating pharmacy ethics courses in pharmacy undergraduate curricula, as well as professional development courses. This study highlighted that paternal-ism, personal values and legal obligations were major drivers influencing decision-making processes of Jordanian pharmacists. Findings also highlighted an inclination towards lack of respect for patient autonomy. This illuminated the need for increasing pharmacists’ literacy in professional ethics.

Keywords : Ethical dilemmas · Pharmacy practice · Pharmacy ethics · Jordan

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​​​​​Exploring and evaluating Vertically Integrated Teaching in Ethical Decision-Making (VIT-EDM) in pharmacy

Authors : ​Leen Fino, Iman A. Basheti, Bandana Saini, Rebekah Moles, Betty B. Chaar

Abstract : Background: With increased patient-centred care, pharmacists are often faced with ethical dilemmas and expected to provide solutions for practice dilemmas, relying on ethical judgment, principles of professional ethics, standards of practice, and moral reasoning capabilities. Pharmacists need to be competent in ethical decision-making which will enable them to act in a morally preferable and justifiable manner with patients. Literature has shown that moral reasoning skills are teachable and measurable competencies in healthcare. Objective: To evaluate the impact of implementing a vertically integrated teaching approach in ethical decision-making (VIT-EDM), on moral reasoning capabilities of pharmacy students as they progressed from year-one (pre-exposure to teaching intervention) to final year (post-intervention) of pharmacy studies, using the Professional Ethics in Pharmacy test (PEP) as a surrogate measure of moral reasoning capabilities. Methods: Cross-sectional, parallel cohort, comparison study, using PEP. A de-identified electronic survey link was emailed to enrolled students in each targeted cohort. Descriptive and inferential statistics were conducted using SPSS. Results: Fourth-year students’ confidence measures were significantly higher in decision-making. Furthermore, students’ decision-making and moral reasoning measures were higher in fourth-year students. They generally demonstrated moral reasoning capabilities belonging to stage four of moral reasoning levels, which is related to benefitting patients while respecting authorities and legal requirements. However, the difference in the P-scores (fourth-year and first-year) was not found statistically significant. Conclusion: Findings of this study underlined the positive impact of the (VIT-EDM) approach, a relatively novel mixed-method pedagogy in teaching pharmacy ethics. It highlighted the enhanced confidence of students in ethical decision-making when facing an ethical dilemma.

Keywords : Education. Ethical dilemma. Ethics Moral-reasoning. PEP. Pharmacy Ethics Teaching

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​​​​​Implementing and evaluating a course in professional ethics for an undergraduate pharmacy curriculum: A feasibility study

Authors : ​Leen B. Fino, Ahmad R. Alsayed, Iman A. Basheti, Banda​na Saini, Rebekah Moles, Betty B. Chaar

Abstract : Background Pharmacy practice today mandates “patient-centred care”, thereby assigning higher levels of professional responsibility for pharmacists leading to ethical challenges. These challenges often involve ethical principles, institutional, personal, or other constraints that can pull practitioners in incompatible opposite directions, creating “ethical dilemmas” in many circumstances. Pharmacists are expected to handle challenges competently and in the best interest of patients. Literature underlines the positive impact of educational interventions focusing on ethical awareness and competence, and that “gaps” existed in pharmacy training/curricula for Jordanian pharmacists. The objective of this study was to develop, implement, and evaluate the utility of a tailored ethics education component in the pharmacy curriculum for students enrolled at a well-ranked Jordanian university. Educational activity and setting Fifth-year pharmacy students attending summer school at a university in Jordan from July to September 2020 were invited to participate in an educational intervention (suite of didactic online lectures and skills-based workshops). This study was delivered in four parts, with a pre-test administered immediately before and a post-test survey immediately after the educational intervention, the educational intervention (three phases), and focus-group discussions to elicit students' feedback. Findings: Findings indicated enhanced levels of confidence in students' decision-making. The development of students' moral reasoning and decision-making skills were also observed to be improved. Summary This study highlighted the importance of the implementation of an ethics course in pharmacy undergraduate curricula. It emphasized the positive impact this course made on the students' learning experiences and provided a strong environment for discussion and group learning.

Keywords : Ethics Ethical decision-making Moral dilemmas Online Teaching Pharmacy ethics

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Skin-lightening products and Jordanian women: Beliefs and practice. A cross-sectional study

Authors : Manal Ayyash, Kamel Jaber, Razan I. Nassar, Leen Fino, Lana Mango, Alaa Abuodeh​

Abstract : The use of skin-lightening products (SLPs) among Jordanian women has immensely increased and healthcare professionals have a vital role in raising public awareness of SLPs. The aim of this study is to identify SLPs practices among Jordanian women and their basic knowledge of the agents and the side effects associated with using these products. Methods A cross-sectional study conducted during October to December of 2022. Jordanian women above 18 years of age were invited to participate via a survey link. Descriptive statistics were used, and logistic regression was applied to screen for variables affecting the knowledge score of the participants. Results The mean age of the study participants (n = 384) was 32.04 (SD = 12.678). Results demonstrated that more than half of the participants (n = 193) reported current or past use of SLPs. Additionally, less than one-fifth (18.2%) of the participants (n = 70) reported previously experiencing some side-effects after using SLPs. About 90% of participants thought that these side-effects were caused by the active ingredients in SLPs. Most of the participants were able to identify some of the active ingredients used in SLPs such as Vitamin C (87.8%) and Hydroquinone (62.0%). It was also found that young participants, and those employed, or university students had higher knowledge scores of SLPs’ active ingredients, and of their side-effects. Conclusion This study demonstrated that Jordanian women are adequately informed about skin-lightening products. Moreover, the practices revealed an educated pattern of action when obtaining information regarding SLPs. Fundamentally, healthcare providers should be influential in educating consumers on the proper use. Strict guidelines and policies should target the practices concerned with these products.

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​​​​​Evaluation of community pharmacists' perceptions and willingness to integrate ChatGPT into their pharmacy practice: A study from Jordan

Authors : Rana Abu-Farha, Leen Fino, Fahmi Y. Al-Ashwal, Mohammed Zawiah, Lobna Gharaibeh, Mea’ad M. Harahsheh, Feras Darwish Elhajji ​

Abstract :Objectives: The aim of this study is to examine the extent of community pharmacists' awareness of ChatGPT, their willingness to embark on this new development of AI development, and barriers that face the incorporation of this non-conventional source of information into pharmacy practice METHODS: A cross-sectional study was conducted among community pharmacists in Jordanian cities between April 26, 2023, and May 10, 2023. Convenience and snowball sampling techniques were utilized to select study participants due to resource and time constraints. The questionnaire was distributed by research assistants through popular social media platforms. Logistic regression analysis was employed to assess predictors affecting their willingness to use this service in the future. Results: A total of 221 community pharmacists participated in the current study (response rate was not calculated since opt in recruitment strategies were used). Remarkably, nearly half of the pharmacists (n= 107, 48.4%) indicated a willingness to incorporate the ChatGPT into their pharmacy practice. Nearly half of the pharmacists (n=105, 47.5%) demonstrated a high perceived benefit score for ChatGPT, while around 37% of pharmacists (n= 81) expressed a high concern score about ChatGPT. More than 70% of pharmacists believed that ChatGPT lacked the ability to utilize human judgment and make complicated ethical judgements in its responses (n= 168). Finally, logistics regression analysis showed that pharmacists who had previous experience in using ChatGPT were more willing to integrate ChatGPT in their pharmacy practice than those with no previous experience in using ChatGPT (OR= 2.312, p= 0.035). Conclusion: While pharmacists show a willingness to incorporate ChatGPT into their practice, especially those with prior experience, there are significant concerns. These mainly revolve around the tool's ability to make human-like judgments and ethical decisions. These findings are crucial for the future development and integration of AI tools in pharmacy practice.

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​​​​​Medicinal plants of Jordan: A scoping review

Authors : Ala’ Abu-Odeh, Leen Fino, Ghadeer Al-Absi, Dalal Alnatour ,Mohanad Al-Darraji, Mayadah Shehadeh, Ghadeer Suaifan ​

Abstract :Jordan is rich in the flora of ethnobotanical importance. This scoping review aims to highlight the ethnopharmacological value of Jordanian medicinal plants using the Preferred Reporting Items of Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A total of one hundred twenty-four articles published between 2000 and 2022 obtained from PubMed, EBSCO, and Google Scholar databases were included in this review. These plants own several classes of secondary bioactive metabolites, including alkaloids, flavonoids, phenolics, and terpenes. Jordanian plants exhibited potential therapeutic activity against various tumors, bacterial infections, elevated blood glucose levels, hyperlipidemia, platelets aggregation disorders, and gastrointestinal disorders. Phytochemicals’ biological activities depend on their structures, parts used, methods of extraction, and evaluation model. In conclusion, this review highlights the need of researching Jordan's abundant naturally occurring medicinal plants and their phytochemicals as novel lead molecules in drug discovery and development. Studying active phytochemicals for disease treatment will help develop drugs for safe treatment and cure in the future

Keywords : Jordan Medical plants Phytochemicals Cancer Diabetes Antimicrobial

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The era of E-learning from the perspectives of Jordanian medical students: A cross-sectional study

Authors :Muna Barakat, Rana Abu Farha, Suhaib Muflih, Ala’a B. Al-Tammemi, Bayan Othman,Yasmin Allozi, Leen Fino ​

Abstract :Introduction: Online learning is becoming a crucial part of the educational process worldwide, especially after the recent COVID-19 pandemic. This study was designed to assess medical students’ perception toward online learning and their perceived preparedness and barriers during the COVID-19 pandemic. Methods: An electronic-based, cross-sectional survey was used to recruit eligible students in Pharmacy, Doctor of Pharmacy, Medicine, Nursing, Dentistry, and Veterinary Medicine programs at various Jordanian universities (public and private). Descriptive and linear regression analysis were conducted using S.P.S.S. software. The perception score was calculated based on a 5-point Likert scale. Results: A total of 939 students agreed to participate in this study. The prominent category was females (n = 691, 73.6%), the median age of students was 22.0 years (IQR = 2.0), and around 56% of the students study in private universities (n = 520, 55.6%). More than half of the students reported that their experiences were unsatisfactory or very unsatisfactory (n = 510, 54.3%). The majority of students preferred face-to-face communication with their professors and colleagues and considered it more effective (n = 682, 72.6%). The median of the mean perception score was 2.4 (IQR = 1.1). Regarding challenges and barriers, more than 70% reported weak internet connection, E-learning boredom, and lack of motivation (n = 723, 77.0%). Conclusion: This study reported inadequate satisfaction and perception towards the current experience in E-learning during the COVID-19 pandemic. It also discussed the barriers and challenges hindering this transition, such as weak internet connection and the lack of motivation, indicating a need for implementing new pedagogies to enhance students’ experiences regarding online education.

Keywords : E-learning Medical Students Perception Jordan COVID-19

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