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1.  Awareness, use, attitude and perceived need for Complementary and Alternative Medicine (CAM) education among undergraduate pharmacy students in Sierra Leone: a descriptive cross-sectional survey 
The widespread use of CAM around the world requires health professionals including pharmacists to have the required knowledge to better advise their patients. This has lead to an increased need for the inclusion of CAM instruction into the mainstream undergraduate Pharmacy education. This study was designed to describe pharmacy students awareness, use, attitude and perceived need for CAM education at COMAHS-USL and at the same time, determine how these descriptive outcomes are influenced by the socio-demographic variables considered in this study.
A descriptive cross-sectional survey was conducted among undergraduate pharmacy students (n = 90) at the College of Medicine and Allied Health Sciences, University of Sierra Leone using a structured questionnaire. Chi square, fisher exact test, and general linear model univariate analysis were used to compare data between independent cohorts.
All 90 (100%) of the students were aware and have used (except Ayurveda) at least one of the listed CAM modalities. Herbal/Botanical/Supplements followed by Spirituality/Prayer were the most commonly known and used CAM modalities. Almost two thirds of students considered the CAM modalities they have used to be effective and not harmful. Overall, pharmacy students had a positive attitude towards CAM (Mean attitudinal score = 34.9 ± 4. 5 (range 19–43)) with fourth and fifth year students showing a significantly less positive attitude as compared to the first, second and third year (B = −3.203 p = 0.001, 95% confidence interval - 5.093 to −1.314). The media [53 (58.9%)] was the most frequent source of information about CAM. Nearly all students [89 (98.9%)] agreed that CAM knowledge is important to them as future pharmacist and that CAM should be included into the Pharmacy curriculum at COMAHS-USL [81 (90.0%)].
Pharmacy students in Sierra Leone are aware of and have used at least one of the CAM modalities and do show a positive attitude towards CAM. This was demonstrated by their overwhelming endorsement for CAM course to be part of the undergraduate pharmacy training at COMAHS-USL. This study among others will inform and guide the development and implementation of CAM instruction at COMAHS-USL.
Electronic supplementary material
The online version of this article (doi:10.1186/1472-6882-14-438) contains supplementary material, which is available to authorized users.
PMCID: PMC4236455  PMID: 25380656
Complementary and alternative medicine; Pharmacy students; Awareness; Attitude; Use; Education; Sierra Leone
2.  Pharmacists’ attitude, perceptions and knowledge towards the use of herbal products in Abu Dhabi, United Arab Emirates 
Pharmacy Practice  2010;8(2):109-115.
The purpose of the study was to assess pharmacists’ current practice, perception and knowledge towards the use of herbal products in Abu Dhabi, United Arab Emirates (UAE). The study assessed the need for incorporating herbal medicine as a separate topic in under- graduate pharmacy student curricula.
The study was done on 600 pharmacists employed in Abu Dhabi, who were contacted electronically, out of which 271 had completed the survey. The data was collected using a structured questionnaire.
Pharmacists’ use of herbal products is high in the UAE, as they have a high belief on the effectiveness of herbal products, and only age was found to be the most predominant variable that was influencing pharmacists’ personal use of herbal products (p-value=0.0171). Pharmacists were more knowledgeable on the uses/indications of herbal products (47%) rather than on other areas. Knowledge of the dispensing mode (prescription only or over the counter medicines) mandated by the Ministry of Health was quite good, however, it is to be noted that the source of information on the dispensing mode was provided by medical representatives (48%). Knowledge of dispensing mode of herbal products was found to be significantly influenced by the place of work with more knowledge of the dispensing mode by pharmacists working in the private sector (p-value 0.0007). The results from the study also underscores the need for including herbal medicine as a separate topic in pharmacy college curriculum and to provide for more seminars and continuing pharmacy education programs targeting pharmacists in the Emirate of Abu Dhabi.
Pharmacists need to be informed on indications, drug interactions, adverse events and precautions of herbal products. Concerned bodies must also provide them with regular continuing education programs apart from putting their efforts to incorporate relevant topics on herbal medicine in the pharmacy students’ curriculum.
PMCID: PMC4133064  PMID: 25132878
Herbal Medicine; Education; Pharmacy; United Arab Emirates
3.  Herbal medicine use in pregnancy: results of a multinational study 
The use of complementary and alternative medicines (CAM) is growing in the general population. Herbal medicines are used in all countries of the world and are included in the top CAM therapies used.
A multinational study on how women treat disease and pregnancy-related health ailments was conducted between October 2011 and February 2012 in Europe, North and South America and Australia. In this study, the primary aim was to determine the prevalence of herbal medicine use in pregnancy and factors related to such use across participating countries and regions. The secondary aim was to investigate who recommended the use of herbal medication in pregnancy.
There were 9,459 women from 23 countries participating in the study. Of these, 28.9% reported the use of herbal medicines in pregnancy. Most herbal medicines were used for pregnancy-related health ailments such as cold and nausea. Ginger, cranberry, valerian and raspberry were the most commonly used herbs in pregnancy. The highest reported rate of herbal use medicines was in Russia (69%). Women from Eastern Europe (51.8%) and Australia (43.8%) were twice as likely to use an herbal medicine versus other regions. Women using herbal medicines were characteristically having their first child, non-smokers, using folic acid and consuming some alcohol in pregnancy. Also, women who were currently students and women with an education other than a high school degree were more likely to use herbal medicines than other women. Although 1 out of 5 women stated that a physician had recommended the herbal use, most women used herbal medicine in pregnancy on their own initiative.
In this multinational study herbal medicine use in pregnancy was high although there were distinct differences in the herbs and users of herbal medicines across regions. Most commonly the women self-medicated with herbal medicine to treat pregnancy-related health ailments. More knowledge regarding the efficacy and safety of herbal medicines in pregnancy is warranted.
PMCID: PMC4029224  PMID: 24330413
Herbal medicine; CAM; Complementary and alternative medicine; Pregnancy; Information sources
4.  Evaluation of knowledge base of hospital pharmacists and physicians on herbal medicines in Southwestern Nigeria 
Pharmacy Practice  2008;6(2):88-92.
The use of herbal medicines among Nigerian patients and the tendency to combine this class of medicines with allopathic drugs while on hospital admission have been on the increase. Earlier studies show that community pharmacists from Nigeria believe that they need more training to counsel patients on their use of herbal medications.
To evaluate knowledge base, use, acceptability, attitudes and beliefs of hospital pharmacists and physicians in South-western Nigeria on herbal products / phytopharmaceuticals /dietary supplements (HP/PP/DS).
A 20-odd questionnaire including an 8- item herbal medicine question was used to assess the knowledge of the physicians and pharmacists in the area of pharmacology of HP/PP/DS. Effects of demographic information such as age, sex, year post graduation, years of experience and area of specialization on the scores obtained were evaluated using Fisher’s exact tests. Level of significance was set at p<0.05.
Pharmacists (51.4%) believed that the training they had was not adequate while physicians (44.6%) believed HP/PP/DS are not safe and 18.5% believed they are not effective. Pharmacovigilance centres were not significantly used for adverse reactions reported by patients. Pharmacists (67.6%) and physicians (29.3%) believed phytopharmaceuticals interact with other drugs. Year of graduation had a significant effect on the perception of the possibilities of interaction for pharmacists. 5.6% of the physicians and 62.4% of the pharmacists scored ≥50% with the questions on use and interaction potentials of HP/PP/DS, with cadre and years of practice having significant effects.
There is a deficiency in the knowledge base of physicians, especially on the pharmacology and potential interaction of herbal medicines. There is an urgent need for the inclusion of pharmacology of common herbal medicines in the curriculum of Nigerian medical degree and an improvement in the pharmacy curriculum in this area.
PMCID: PMC4141870  PMID: 25157286
Medicine; Herbal; Herb-Drug Interactions; Pharmacists; Physicians; Nigeria
5.  Attitudes and perceptions of Australian pharmacy students towards Complementary and Alternative Medicine – a pilot study 
With the increased usage of CAM worldwide comes the demand for its integration into health professional education. However, the incorporation of CAM into health professional curricula is handled quite differently by different institutions and countries. Furthermore, the evaluation of CAM curricula is complicated because students' ability to learn about CAM may be influenced by factors such as student's prior knowledge and motivation, together with the perceptions and attitudes of clinical preceptors.
The study aimed to describe the attitudes, perceptions and beliefs of second, third and fourth year pharmacy students towards complementary and alternative medicine (CAM) and to explore factors that might affect attitudes such as learning, preceptors and placements.
Pharmacy students from a University in South East Queensland, Australia participated in the study. The study consisted of a cross-sectional survey (n = 110) and semi-structured interviews (n = 9).
The overall response rate for the survey was 75%, namely 50% (36/72) for second year, 77.3% (34/44) for third year and 97.6% (40/41) for fourth year students. Overall, 95.5% of pharmacy students believe that pharmacists should be able to advise patients about CAM and most (93.7%) have used CAM prior to course enrolment. Students' attitudes to CAM are influenced by the use of CAM by family, friends and self, CAM training, lecturers and to a lesser degree by preceptors. The majority of pharmacy students (89.2%) perceive education about CAM as a core and integral part of their professional degree and favour it over an additional postgraduate degree. However, they see a greater need for education in complementary medicines (such as herbal medicines, vitamins and minerals) than for education in complementary therapies (such as acupuncture, meditation and bio-magnetism). Knowledge and educational input rationalised rather than marginalised students' attitudes towards CAM.
Pharmacy students perceive education about CAM as a core and integral part of their professional degree. Students' attitudes towards CAM can be influenced by learning, lecturers, preceptors and practice experience. The content and focus of CAM education has to be further investigated and tailored to meet the professional needs of our future health professionals.
PMCID: PMC2267156  PMID: 18221569
6.  Use of herbal medicine during pregnancy among women with access to public healthcare in Nairobi, Kenya: a cross-sectional survey 
Maternal health is a public health priority in many African countries, but little is known about herbal medicine use in pregnancy. This study aimed to determine the pattern of use of herbal medicine in an urban setting, where women have relatively high access to public healthcare.
This cross-sectional study included 333 women attending a childcare clinic in a district public health hospital in Nairobi, Kenya, during January and February, 2012, and who had delivered a baby within the past 9 months. Qualitative and quantitative data on herbal medicine use during their latest pregnancy were collected through an interviewer-administered questionnaire. Data was analysed descriptively and the Chi square test and Fishers’ exact test used to analyse relationships among variables.
About 12% of women used herbal medicine during their most recent pregnancy. The use of herbal medicine was associated with a lower level of education (p = 0.007) and use before the index pregnancy (p <0.001). Only 12.5% of users disclosed such use to healthcare professionals, and about 20% used herbal medicine concomitantly with Western medicine for the same illness/condition. Women used herbal medicine for back pain, toothache, indigestion and infectious diseases, such as respiratory tract infections and malaria. A proportion of users took herbal medicine only to boost or maintain health. There were high rates of self-prescribing, as well as sourcing from family and friends. Beliefs about safety and efficacy were consistent with patterns of use or non-use, although both users and non-users were unsure about the safety and contraindications of Western medicine during pregnancy compared with that of herbal medicine.
Herbal medicine is used by 12% of pregnant women with access to healthcare in an urban context in Kenya, and often occurs without the knowledge of healthcare practitioners. Healthcare professionals should play a role in rational use of both herbal and Western medicine, by discussing contraindications and the potential for drug-herb interactions with patients. More studies are needed into the use of herbal medicines during pregnancy, labour and the postpartum period in different geographical areas, and into the health outcomes associated with their use.
PMCID: PMC4230355  PMID: 25370478
Herbal medicine; Pregnancy; Maternal health; Concomitant medication; Kenya
7.  Prevalence of hazardous alcohol use among pharmacy students at nine U.S. schools of pharmacy 
Pharmacy Practice  2011;9(3):162-168.
Hazardous use of alcohol continues to be recognized as a problem at the university level. Knowledge regarding alcohol consumption in healthcare professional students is limited, especially in regards to pharmacy students. Much of the information available focuses on pharmacy student drinking patterns in specific geographic regions or is simply outdated.
This study was designed to assess levels of alcohol consumption and estimate the level of hazardous drinking among pharmacy students in a larger sample size that is representative of US pharmacy schools.
An anonymous survey regarding alcohol usage was offered to students at nine schools of pharmacy across the United States. The survey consisted of demographic questions, the World Health Organization Alcohol Use Disorders Identification Test (AUDIT), and questions that assess particular alcohol-induced behaviors.
More than 25% of 1161 respondents had a total AUDIT score ≥ 8, which indicates a risk of alcohol-related problems. Students that were male, in their first or second professional year of school, not married, and without children were statistically more likely to have AUDIT scores in the hazardous drinking range. Grade point average and student housing did not statistically affect student’s AUDIT scores.
These results indicate that over one-fourth of pharmacy students surveyed have indicators of harmful alcohol use. Pharmacy schools should continue to address and confront hazardous alcohol use on campuses in order to curtail heavy alcohol consumption and reduce the risk of alcohol-related problems in pharmacy students.
PMCID: PMC3870176  PMID: 24367471
Alcohol Drinking; Students, Pharmacy; United States
8.  Attitude and use of herbal medicines among pregnant women in Nigeria 
The use of herbal medicines among pregnant women in Nigeria has not been widely studied.
Opinion of 595 pregnant women in three geopolitical zones in Nigeria on the use of herbal medicines, safety on usage, knowledge of potential effects of herbal remedies on the fetus and potential benefits or harms that may be derived from combining herbal remedies with conventional therapies were obtained using a structured questionnaire between September 2007 and March 2008. Descriptive statistics and Fisher's exact tests were used at 95% confidence level to evaluate the data obtained. Level of significance was set at p < 0.05.
More than two-third of respondents [67.5%] had used herbal medicines in crude forms or as pharmaceutical prepackaged dosage forms, with 74.3% preferring self-prepared formulations. Almost 30% who were using herbal medicine at the time of the study believed that the use of herbal medicines during pregnancy is safe. Respondents' reasons for taking herbal medications were varied and included reasons such as herbs having better efficacy than conventional medicines [22.4%], herbs being natural, are safer to use during pregnancy than conventional medicines [21.1%], low efficacy of conventional medicines [19.7%], easier access to herbal medicines [11.2%], traditional and cultural belief in herbal medicines to cure many illnesses [12.5%], and comparatively low cost of herbal medicines [5.9%].
Over half the respondents, 56.6% did not support combining herbal medicines with conventional drugs to forestall drug-herb interaction. About 33.4% respondents believed herbal medicines possess no adverse effects while 181 [30.4%] were of the opinion that adverse/side effects of some herbal medicines could be dangerous. Marital status, geopolitical zones, and educational qualification of respondents had statistically significant effects on respondents views on side effects of herbal medicines [p < 0.05)] while only geopolitical zones and educational qualifications seemed to have influence on respondents' opinion on the harmful effects of herbal medicines to the fetus [p < 0.05].
The study emphasized the wide spread use of herbal medicines by pregnant women in Nigeria highlighting an urgent need for health care practitioners and other health care givers to be aware of this practice and make efforts in obtaining information about herb use during ante-natal care. This will help forestall possible interaction between herbal and conventional medicines.
PMCID: PMC2808296  PMID: 20043858
9.  Herbal medicines supplied by community pharmacies in Lagos, Nigeria: pharmacists’ knowledge 
Pharmacy Practice  2013;11(4):219-227.
The use of herbal medicines is on the increase globally and they are usually supplied in pharmacies as non-prescription medicines. Pharmacists are, therefore, responsible for educating and informing the consumers about rational use of herbal medicines.
To evaluate the knowledge of pharmacists in Lagos, Nigeria with regards to the herbal medicines they supplied by their pharmacies.
Pharmacists in charge of randomly selected 140 community pharmacies from 20 Local Government Areas in Lagos were required to fill out a self-administered questionnaire. We gathered information on their knowledge of the indications, adverse effects, potential drug-herb interactions and contraindications of the herbal medicines they supply in their pharmacies.
Of the 140 questionnaires distributed, 103 (72.9%) participants completed the questionnaire appropriately. The majority (74; 71.8%) of the participants were males and 36-50 years (56; 54.4%). The pharmacies supplied mostly Yoyo cleanser bitters® (101; 98.5%), ginseng (97; 98.5%), Jobelyn® (91; 88.3%), Ciklavit® (68; 66.6%), gingko (66; 64.1%), herbal tea (66; 64.1%), and Aloe vera (57; 55.3%). The pharmacists self-rated their knowledge of herbal medicines mostly as fair (39%) and good (42%), but they exhibited poor knowledge with regards to the indications, contraindications and safety profiles. Seventy participants consulted reference materials such as leaflet insert in the herbal medicines (56%) and internet (20%) before supplying herbal medicines. The information most frequently sought was herb-drug interactions (85%), contraindications (75%) and adverse effects (70%).
Community pharmacists need to be informed about the indications and safety profiles of herbal medicines.
PMCID: PMC3869638  PMID: 24367462
Phytotherapy; Herbal Medicine; Herb-Drug Interactions; Pharmacies; Pharmacists; Health Knowledge, Attitudes, Practice; Nigeria
10.  Effects and treatment methods of acupuncture and herbal medicine for premenstrual syndrome/premenstrual dysphoric disorder: systematic review 
During their reproductive years about 10% of women experience some kind of symptoms before menstruation (PMS) in a degree that affects their quality of life (QOL). Acupuncture and herbal medicine has been a recent favorable therapeutic approach. Thus we aimed to review the effects of acupuncture and herbal medicine in the past decade as a preceding research in order to further investigate the most effective Korean Medicine treatment for PMS/PMDD.
A systematic literature search was conducted using electronic databases on studies published between 2002 and 2012. Our review included randomized controlled clinical trials (RCTs) of acupuncture and herbal medicine for PMS/PMDD. Interventions include acupuncture or herbal medicine. Clinical information including statistical tests was extracted from the articles and summarized in tabular form or in the text. Study outcomes were presented as the rate of improvement (%) and/or end-of-treatment scores.
The search yielded 19 studies. In screening the RCTs, 8 studies in acupuncture and 11 studies in herbal medicine that matched the criteria were identified. Different acupuncture techniques including traditional acupuncture, hand acupuncture and moxibustion, and traditional acupuncture technique with auricular points, have been selected for analysis. In herbal medicine, studies on Vitex Agnus castus, Hypericum perforatum, Xiao yao san, Elsholtzia splendens, Cirsium japonicum, and Gingko biloba L. were identified. Experimental groups with Acupuncture and herbal medicine treatment (all herbal medicine except Cirsium japonicum) had significantly improved results regarding PMS/PMDD.
Limited evidence supports the efficacy of alternative medicinal interventions such as acupuncture and herbal medicine in controlling premenstrual syndrome and premenstrual dysphoric disorder. Acupuncture and herbal medicine treatments for premenstrual syndrome and premenstrual dysphoric disorder showed a 50% or better reduction of symptoms compared to the initial state. In both acupuncture and herbal medical interventions, there have been no serious adverse events reported, proving the safety of the interventions while most of the interventions provided over 50% relief of symptoms associated with PMS/PMDD. Stricter diagnostic criteria may have excluded many participants from some studies. Also, depending on the severity of symptoms, the rate of improvement in the outcomes of the studies may have greatly differed.
PMCID: PMC3898234  PMID: 24410911
Premenstrual syndrome; Premenstrual dysphoric disorder; Acupuncture; Herbal medicine; TCM; CAM; PMS; PMDD
11.  Pharmacists’ attitudes and awareness towards the use and safety of herbs in Kuwait 
Pharmacy Practice  2007;5(3):125-129.
The purpose of this study was to investigate the knowledge and attitudes among pharmacists in Kuwait towards the use of herbs.
Self-administered questionnaire was designed as the study instrument and distributed among 100 qualified pharmacists working in government and private pharmacies in Kuwait.
The mean age was 34.2 (SD=7.5) years. About 51% of pharmacists reported they had used herbal therapy in their lifetime. The majority were interested in herbal information, and their herbal information came mainly from their previous classes during college. Although the pharmacists’ knowledge about uses of selected herbs was good, their awareness about side effects of those herbs was modest. About 31% of the pharmacists did not have enough information about potential interactions between herbs and conventional medicines.
Herbal information is needed for pharmacy students as part of the Pharmacy College curriculum. Continuing education programs for practising pharmacists about the safety of different herbal products should be established in Kuwait.
PMCID: PMC4154746  PMID: 25214928
Herbal Medicine; Pharmacy Continuing Education; Pharmacy Graduate Education; Attitude of Health Personnel; Kuwait
12.  THE VAXED PROJECT: An Assessment of Immunization Education in Canadian Health Professional Programs 
BMC Medical Education  2010;10:86.
Knowledge & attitudes of healthcare providers (HCP) have significant impact on frequency with which vaccines are offered & accepted but many HCP are ill equipped to make informed recommendations about vaccine merits & risks. We performed an assessment of the educational needs of trainees regarding immunization and used the information thus ascertained to develop multi-faceted, evaluable, educational tools which can be integrated into formal education curricula.
(i) A questionnaire was sent to all Canadian nursing, medical & pharmacy schools to assess immunization-related curriculum content (ii) A 77-item web-based, validated questionnaire was emailed to final-year students in medicine, nursing, & pharmacy at two universities in Nova Scotia, Canada to assess knowledge, attitudes, & behaviors reflecting current immunization curriculum.
The curriculum review yielded responses from 18%, 48%, & 56% of medical, nursing, & pharmacy schools, respectively. Time spent on immunization content varied substantially between & within disciplines from <1 to >50 hrs. Most schools reported some content regarding vaccine preventable diseases, immunization practice & clinical skills but there was considerable variability and fewer schools had learning objectives or formal evaluation in these areas. 74% of respondents didn't feel comfortable discussing vaccine side effects with parents/patients & only 21% felt they received adequate teaching regarding immunization during training.
Important gaps were identified in the knowledge of graduating nursing, medical, & pharmacy trainees regarding vaccine indications/contraindications, adverse events & safety. The national curriculum review revealed wide variability in immunization curriculum content & evaluation. There is clearly a need for educators to assess current curricula and adapt existing educational resources such as the Immunization Competencies for Health Professionals in Canada.
PMCID: PMC3002370  PMID: 21110845
13.  Basic life support knowledge of healthcare students and professionals in the Qassim University 
To evaluate the knowledge of basic life support (BLS) among students and health providers in Medicine, Pharmacy, Dentistry, and Allied Health Science Colleges at Qassim University.
A cross sectional study was performed using an online BLS survey that was completed by 139 individuals.
Ninety-three responders were medical students, 7 were medical interns, 6 were dental students, 7 were pharmacy students, 11 were medical science students and 15 were clinical practitioners. No responder scored 100% on the BLS survey. Only two out of the 139 responders (1.4%) scored 90–99%. Both of these individuals were fifth year medical students. Six responders (4.3%) scored 80–89%. Of these, 5 were fifth year medical students, and one was fourth-year medical student. Eleven responders (7.9%) scored 70–79%. Of these, eight were fifth year medical students, two were medical interns and one was a pharmacist. Twenty-three responders (16.5%) scored 60–69%. Of these, 11 were fifth year medical students, 1 was a fourth-year medical student, 3 were medical interns, 2 were medical science students, 1 was a dentistry student, and 5 were pharmacists. Twenty-eight responders (20.1%) scored 50–59%. Of these, 11 were fifth year medical students, 3 were fourth-year medical students, 1 was a third-year medical student, 1 was a second-year medical student, 2 were first-year medical students, 1 was a pharmacy student, 3 were dental students, 1 was a allied health science student, 2 were doctors, and 3 were pharmacists. The remaining 69 responders (49.6%) scored less than 50%.
Knowledge of BLS among medicine, pharmacy, dentistry, and allied health science students and health providers at Qassim University is poor and needs to be improved. We suggest that inclusion of a BLS course in the undergraduate curriculum with regular reassessment would increase awareness and application of this valuable life-saving skill set.
PMCID: PMC4166986  PMID: 25246881
14.  Comparison of self-reported professional competency across pharmacy education programs: a survey of Thai pharmacy graduates enrolled in the public service program 
Thai pharmacy education consists of two undergraduate programs, a 5-year Bachelor of Science in Pharmacy (BScPsci and BScPcare) degree and a 6-year Doctor of Pharmacy (Pharm D). Pharmacy students who wish to serve in the public sector need to enroll in the public service program. This study aims to compare the perception of professional competency among new pharmacy graduates from the three different pharmacy programs available in 2013 who enrolled in the public service program.
A cross-sectional survey was conducted among new pharmacy graduates in 2013 using a self-administered, structured, close-ended questionnaire. The questionnaire consisted of respondents’ characteristics and perception of professional competencies. The competency questions consisted of 13 items with a 5-point scale. Data collection was conducted during Thailand’s annual health professional meeting on April 2, 2013 for workplace selection of pharmacy graduates.
A total of 266 new pharmacy graduates responded to the questionnaire (response rate 49.6%). There were no significant differences in sex and admission modes across the three pharmacy programs. Pharm D graduates reported highest competency in acute care services, medication reconciliation services, and primary care services among the other two programs. BScPsci graduates reported more competence in consumer health protection and herbal and alternative medicines than BScPcare graduates. There were significant differences in three competency domains: patient care, consumer protection and community health services, and drug review and information, but no significant differences in the health administration and communication domain among three pharmacy programs.
Despite a complete change into a 6-year Pharm D program in 2014, pharmacy education in Thailand should continue evolving to be responsive to the needs of the health system. An annual survey of new pharmacy graduates should be continued, to monitor changes of professional competency across different program tracks and other factors which may influence their contribution to the health service system. Likewise, a longitudinal monitoring of their competencies in the graduate cohort should be conducted.
PMCID: PMC4199843  PMID: 25337000
pharmacy education; professional competency; pharmacy graduate; Doctor of Pharmacy; Thailand
15.  Development and implementation of an herbal and natural product elective in undergraduate medical education 
Medical students have consistently expressed interest in learning about alternative healing modalities, especially herbal and natural products. To fill this void in medical education at our institution, a novel elective was developed and implemented for fourth year medical students. This herbal/natural product course uses guest lecturers, classroom presentations, and active learning mechanisms that include experiential rotations, case-based learning, and team-based learning to increase student knowledge of herbal/natural product safety and efficacy.
Knowledge outcomes were evaluated via administration of a pre- and post-course test (paired student t-test). End-of-course evaluations (Likert-type questions and narrative responses) were used to assess student opinion of knowledge and skills imparted by the elective and overall course content (mean, standard deviation).
Over three academic years, 23 students have enrolled in this elective. More than 60% of participants have been female and nearly half of the students (43%) have pursued residencies in primary care. Completion of the course significantly increased student knowledge of common herbal/natural product mechanisms, uses, adverse effects, and drug-interactions as determined by a pre- and post-course knowledge assessment (45% ± 10% versus 78% ± 6%; p < 0.0001). The course was highly rated by enrollees (overall course quality, 4.6 of 5.0 ± 0.48) who appreciated the variety of activities to which they were exposed and the open classroom discussions that resulted. While students tended to view some alternative medical systems with skepticism, they still believed it was valuable to learn what these modalities encompass.
Development and implementation of a herbal/natural product elective that engages undergraduate medical students through active learning mechanisms and critical analysis of the literature has proven effective in increasing knowledge outcomes and is deemed to be a valuable curricular addition by student participants. In the future, it will be of interest to explore mechanisms for expanding the course to reach a larger number of students within the time, financial, and logistical constraints that currently exist.
PMCID: PMC3358235  PMID: 22540850
Complementary and alternative medicine; Dietary supplements; Herbal; Integrated therapy; Natural product; Undergraduate medical education
16.  A gap between acceptance and knowledge of herbal remedies by physicians: The need for educational intervention 
The unprecedented global increase in the use of herbal remedies is set to continue apace well into the foreseeable future. This raises important public health concerns, especially as it relates to safety issues including adverse effects and herb-drug interactions. Most Western-trained physicians are ignorant of the risks and benefits of this healthcare modality and assessment of acceptance and knowledge would identify appropriate intervention strategies to improve physician-patient communication in this area.
A cross-sectional survey was done using an interviewer-administered pilot tested de novo questionnaire at six public hospitals in Trinidad between May–July 2004. The questionnaire utilized weighed questions to quantify acceptance (maximum score = 14 points) and knowledge (maximum score = 52 points). Acceptance and knowledge scores were analyzed using the ANOVA and Tukey's tests.
Of 192 physicians interviewed, most (60.4%) believed that herbal remedies were beneficial to health. Respondents had relatively high acceptance levels (mean = 5.69 ± 0.29 points or 40% of total possible score) and poor knowledge (mean = 7.77 ± 0.56 points or 15% of total possible score). Seventy-eight physicians (40.6%) admitted having used herbs in the past, and 60 of these (76.9%) were satisfied with the outcome. Although 52 physicians (27.1%) recommended the use of herbs to their patients only 29 (15.1%) were able to identify at least one known herb-drug interaction.
The use of herbal remedies is relatively high in Trinidad, as throughout the world, and most patients self-medicate with or without the knowledge of their attending physician. Surprisingly, we demonstrated relatively high acceptance levels and use of herbs among physicians in Trinidad. This interesting scenario of high acceptance levels and poor knowledge creates a situation that demands urgent intervention. We recommend educational intervention to narrow the gap between acceptance and knowledge so that physicians would be adequately equipped to communicate with their patients on this modality. The integration of herbal medicine into the curriculum of medical schools, continuing education programs and the availability of reputable pharmacopoeias for referencing at public health institutions are useful instruments that can be used to close this gap and promote improved physician-patient communication.
PMCID: PMC1310610  PMID: 16297236
17.  Pharmacy Students’ Retention of Knowledge of Drug-Drug Interactions 
Objectives. To evaluate pharmacy students' drug-drug interaction (DDI) knowledge retention over 1 year and to determine whether presenting DDI vignettes increased knowledge retention.
Methods. A knowledge assessment tool was distributed to fourth-year pharmacy students before and after completing a DDI educational session. The questionnaire was re-administered after 1 year to assess knowledge retention. During the intervening year, students had the option of presenting DDI case vignettes to preceptors and other health professionals as part of their advanced pharmacy practice experiences (APPEs).
Results. Thirty-four of 78 pharmacy students completed both the post-intervention and 1-year follow-up assessments. Students’ knowledge of 4 DDI pairs improved, knowledge of 3 DDI pairs did not change, and knowledge of the remainder of DDI pairs decreased. Average scores of the 18 students who completed all tests and presented at least 1 vignette during their APPEs were higher on the 1-year follow-up assessment than students who did not, suggesting greater DDI knowledge retention (p = 0.04).
Conclusion. Although pharmacy students’ overall DDI knowledge decreased in the year following an educational session, those who presented vignettes to health professionals retained more DDI knowledge, particularly on those DDIs for which they gave presentations. Other methods to enhance pharmacy students’ retention of DDI knowledge of clinically important DDIs are needed.
PMCID: PMC3175677  PMID: 21931448
drug-drug interaction; assessment
18.  Attitudes and knowledge regarding health care policy and systems: a survey of medical students in Ontario and California 
CMAJ Open  2014;2(4):E288-E294.
Canada and the United States have similar medical education systems, but different health care systems. We surveyed medical students in Ontario and California to assess their knowledge and views about health care policy and systems, with an emphasis on attitudes toward universal care.
A web-based survey was administered during the 2010–2011 academic year to students in 5 medical schools in Ontario and 4 in California. The survey collected demographic data and evaluated attitudes and knowledge regarding broad health care policy issues and health care systems. An index of support for universal health care was created, and logistic regression models were used to examine potential determinants of such support.
Responses were received from 2241 students: 1354 from Ontario and 887 from California, representing 42.9% of eligible respondents. Support for universal health care coverage was higher in Ontario (86.8%) than in California (51.1%), p < 0.001. In California, females, self-described nonconservatives, students with the intent to be involved in health care policy as physicians and students with a primary care orientation were associated with support for universal coverage. In Ontario, self-described liberals and accurate knowledge of the Canadian system were associated with support. A single-payer system for practice was preferred by 35.6% and 67.4% of students in California and Ontario, respectively. The quantity of instruction on health care policy in the curriculum was judged too little by 73.1% and 57.5% of students in California and Ontario, respectively.
Medical students in Ontario are substantially more supportive of universal access to health care than their California counterparts. A majority of students in both regions identified substantial curricular deficiencies in health care policy instruction.
PMCID: PMC4251516  PMID: 25485256
19.  Evaluation of attitude to, knowledge of and barriers toward research among medical science students 
Plans to increase the role of students in health research require data on students’ knowledge and views of research. The aim of the study was to evaluate these factors toward research among medical science students.
Undergraduate and postgraduate students of three medicine, dentistry and pharmacy schools in Shiraz were enrolled in a cross-sectional descriptive study using questionnaires to provide details of the parameters of attitude to, knowledge of and barriers toward research for each individual. All data was coded for each of the parameters. Data analyses were performed by one-way ANOVA/Tukey and Student’s t, Pearson’s correlation and Chi-squared tests.
A total of 384 questionnaires were returned complete. Mean student scores for attitude, knowledge and barriers were 68.97 ± 12.56, 70.99 ± 20.97 and 75.27 ± 15.38, respectively. On the knowledge parameter, 77.8% of students’ scores fell above the middle of the possible attainable score, but 90% of attitude scores came in at below the middle of the possible attainable score. Undergraduate students (70.27 ± 12.00) showed a more positive attitude to research than postgraduate students (65.57 ± 13.06) (p = 0.001). Female students (72.97 ± 20.54) had greater knowledge than males (67.09 ± 21.56) (p = 0.010). Many barriers were highlighted by students such as lack of funding support and lack of time for research.
Students showed favorable knowledge of research, but their attitude to the field was inadequate. More attention must be placed on these parameters in the curriculum to improve student interest in health research. The impact of barrier factors on research demonstrates that there is a need for greater availability of information in order to solve the problems and change strategies for research.
Electronic supplementary material
The online version of this article (doi:10.1186/s12930-015-0019-2) contains supplementary material, which is available to authorized users.
PMCID: PMC4336721
Approach; Awareness; Medical students; Investigate; Research
20.  Self-medication and related health complaints among expatriate high school students in the United Arab Emirates 
Pharmacy Practice  2013;11(4):211-218.
Self-medication, often without adult guidance, has been reported to be a common practice during adolescence. Similar to other preventable health-risk behaviors initiated in early adolescence, it has become a cause for concern universally.
This study examines the prevalence of self-medication with both prescribed and non-prescribed (OTC) medications, related health complaints, sources of drugs, and sources of drug recommendation, and gender differences related to self-medication among expatriate high school students in the United Arab Emirates (UAE).
A cross-sectional survey was conducted among 324 expatriate students through a validated, self-administered questionnaire and data was analyzed using SPSS 19 version. Means and proportions were calculated and Pearson Chi-square test of significance was used to analyze association among variables.
Majority of the participating students, almost equally distributed by gender, was aged 16 to 17 years. The period prevalence rate of self-medication with prescribed and OTC medications were 89.2%, which did not vary with age, gender, ethnicity or parents’ educational level. The most common sources of drug and drug recommendation were community pharmacies and parents respectively. Headache and fever were the common self-medicated conditions and consequently, analgesics and antipyretics were most commonly used both in the previous two weeks and the previous year prior to the survey. A high prevalence of self-medication with antibiotics (53%) and sedative/hypnotics (27%) was also observed. A female excess emerged for certain health complaints and use of medicines except for the use of anti-allergic and herbal/homeopathic drugs.
This is the first study to explore self-medication practices among high school students in UAE and provides baseline data critical in creating awareness about the risks and benefits of self-medication. Health care providers, educators and parents should be actively involved in health education strategies for inculcating responsible self-medication practices in the adolescent population of UAE.
PMCID: PMC3869637  PMID: 24367461
Self Medication; Adolescent; Prevalence; Patient Medication Knowledge; Patient Education as Topic; United Arab Emirates
21.  Availability and needs of herbal medicinal information resources at community pharmacy, Riyadh region, Saudi Arabia 
A cross-sectional survey of community pharmacists in Riyadh region, Saudi Arabia was conducted over a period of 6 months from July through December 2011. Data collection was carried out using a structured self-administered questionnaire. The survey questionnaire consisted of a brief introduction to the study and eleven questions. The questions consisted of close ended, multiple-choice, and fill-in short answers. A stratified random sample of one thousand and seven hundred registered pharmacy practitioners all over Saudi Arabia were randomly chosen to respond to the survey. The data from each of the returned questionnaire were coded and entered into Statistical Package for the Social Sciences (SPSS) version 19 software (SPSS Inc., Chicago, IL, USA) which was used for statistical analysis. Only one thousand four hundred one pharmacists responded to the survey (response rate is 82.4%) with a completely answered questionnaire. The study results show that 59.7% of the participants sometimes discuss herbal medicine use with their patients, while only 4.25% never discuss it. The study shows 48.5% of participated pharmacists record herbal medicine use sometimes where only 9.4% of them never did so. However, with regard to initiation of the discussion, the study shows that 44.3% of the respondents reported that patients initiate herbal issue discussion while 20.8% reported that pharmacists initiate the discussion. This discussion was reported to be a one time discussion or an ongoing discussion by 14.3% or 9.9% of the respondents respectively. According to the study results, respondents reported that the most common barriers that limit discussing herbal medicines’ use with their patients were lack of time due to other obligations assigned to the community pharmacist (46%), lack of reliable resources (30.3%), lack of scientific evidence that support herbal medicine use (15.2%), or lack of knowledge of herbal medicines (13.4%). Yet, a small number of respondents was concerned about interest in herbal medicines (9.1%) and other reasons (2.4%). So it is urgent to ensure that pharmacists are appropriately educated and trained. Extra efforts are needed to increase the awareness of pharmacists to adverse drug reactions reporting system at Saudi Food and Drug Authority. Finally, more consideration to herbal issues should be addressed in both pharmacy colleges’ curricula and continuous education program..
PMCID: PMC3824944  PMID: 24227954
Recourse; Medicinal; Herbal; Availability
22.  A meta-analysis of Chinese herbal medicines for vascular dementia☆ 
Neural Regeneration Research  2013;8(18):1685-1692.
To investigate the efficacy and safety of Chinese herbal medicines in the treatment of patients with vascular dementia.
We retrieved publications from Cochrane Library (2004 to July 2011), PubMed (1966 to July 2011), the Chinese Science and Technique Journals Database (1977 to July 2011), the China National Knowledge Infrastructure (1979 to July 2011), Google Scholar (July 2011), and the Chinese Biomedical Database (1977 to July 2011) using the key words “Chinese medicine OR Chinese herbal medicine” and “vascular dementia OR mild cognition impair OR multi-infarct dementia OR small-vessel dementia OR strategic infarct dementia OR hypoperfusion dementia OR hemorrhagic dementia OR hereditary vascular dementia“.
Randomized controlled trials comparing Chinese herbal medicines with placebo/western medicine in the treatment of patients with vascular dementia were included. Diagnostic standards included Diagnostic and Statistical Manual of Mental Disorders-IV, and National Institute of Neurological Disorders and Stroke and Association Internationale pour la Recherché et l’Enseignement en Neurosciences. Two participants independently conducted literature screening, quality evaluation and data extraction. The quality of each trial was assessed according to the Cochrane Reviewers’ Handbook 5.0.
Effective rate, Mini-Mental State Examination scores, Hasegawa Dementia Scale scores, and incidence of adverse reactions.
We identified 1 143 articles discussing the effects of Chinese medicine on vascular dementia. Thirty-one of these were included in the analysis. These studies involved a total of 2 868 participants (1 605 patients took Chinese medicine decoctions (treatment group); 1 263 patients took western medicine or placebo). The results of our meta-analysis revealed that Chinese herbal remedies in the treatment group were more efficacious than the control intervention (relative risk (RR) = 1.27; 95% confidence interval (CI): 1.18–1.38, P < 0.01). Mini-Mental State Examination scores were higher in patients taking Chinese herbal medicines than in those in the control group (weighted mean difference (WMD) = 2.83; 95%CI: 2.55–3.12, P < 0.01). Patients in the treatment group showed better disease amelioration than those in the control group (Hasegawa Dementia Scale scores; WMD = 2.41, 95%CI: 1.48–3.34, P < 0.01). There were also considerably fewer adverse reactions among those in the treatment group compared with those in the control group (RR = 0.20, 95%CI: 0.08–0.47, P < 0.01).
Chinese herbal medicine appears to be safer and more effective than control measures in the treatment of vascular dementia. However, the included trials were generally low in quality. More well-designed, high-quality trials are needed to provide better evidence for the assessment of the efficacy and safety of Chinese medicines for vascular dementia.
PMCID: PMC4145917  PMID: 25206465
neural regeneration; Chinese herbal medicine; meta-analysis; vascular dementia; mild cognitive impairment; decoction; efficacy; Mini-Mental State Examination; Hasegawa Dementia Scale; adverse reaction; neurodegenerative disease; grants-supported paper; neuroregeneration
23.  Pharmacists and Natural Health Products: A systematic analysis of professional responsibilities in Canada 
Pharmacy practice  2008;6(1):33-42.
Natural health products (natural health products) such as herbs, vitamins and homeopathic medicines are widely available in Canadian pharmacies. The purpose of this paper was to conduct a systematic analysis of Canadian pharmacy policies and guidelines to explore pharmacists’ professional responsibilities with respect to natural health products.
Legislation, codes of ethics, standards of practice and guidance documents that apply to the practice of pharmacy in each Canadian jurisdiction were systematically collected and examined to identify if, and how, these instruments establish professional duties in regard to natural health products.
The majority of Canadian jurisdictions now include some explicit reference to natural health products in standards of practice policy or guideline documents. Often natural health products are simply assumed to be included in the over-the-counter (OTC) product category and thus professional responsibilities for OTCs are relevant for natural health products. A minority of provinces have specific policies on natural health products, herbals or homeopathy. In addition, the National Association of Pharmacy Regulatory Authorities’ Model Standards of Practice specifically refers to natural health products. Most policy documents indicate that pharmacists should inquire about natural health product use when counselling patients and, when asked, should provide accurate information regarding the efficacy, toxicity, side effects or interactions of natural health products. Public messaging also indicates that pharmacists are knowledgeable professionals who can provide evidence-based information about natural health products.
Explicit policies or guidelines regarding pharmacists’ professional responsibilities with respect to natural health products currently exist in the majority of Canadian jurisdictions.
PMCID: PMC3265537  PMID: 22282720 CAMSID: cams1356
pharmacist; legal responsibilities; natural health products; dietary supplements
24.  Pharmacists and Natural Health Products: A systematic analysis of professional responsibilities in Canada 
Pharmacy Practice  2008;6(1):33-42.
Natural health products such as herbs, vitamins and homeopathic medicines are widely available in Canadian pharmacies.
to conduct a systematic analysis of Canadian pharmacy policies and guidelines to explore pharmacists’ professional responsibilities with respect to natural health products.
Legislation, codes of ethics, standards of practice and guidance documents that apply to the practice of pharmacy in each Canadian jurisdiction were systematically collected and examined to identify if, and how, these instruments establish professional duties in regard to natural health products.
The majority of Canadian jurisdictions now include some explicit reference to natural health products in standards of practice policy or guideline documents. Often natural health products are simply assumed to be included in the over-the-counter (OTC) product category and thus professional responsibilities for OTCs are relevant for natural health products. A minority of provinces have specific policies on natural health products, herbals or homeopathy. In addition, the National Association of Pharmacy Regulatory Authorities’ Model Standards of Practice specifically refers to natural health products. Most policy documents indicate that pharmacists should inquire about natural health product use when counselling patients and, when asked, should provide accurate information regarding the efficacy, toxicity, side effects or interactions of natural health products. Public messaging also indicates that pharmacists are knowledgeable professionals who can provide evidence-based information about natural health products.
Explicit policies or guidelines regarding pharmacists’ professional responsibilities with respect to natural health products currently exist in the majority of Canadian jurisdictions.
PMCID: PMC3265537  PMID: 22282720
Natural health products; Practice Guidelines as Topic; Pharmacists; Canada
25.  Medicinal herb use among asthmatic patients attending a specialty care facility in Trinidad 
There is an increasing prevalence of asthma in the Caribbean and patients remain non-compliant to therapy despite the development of guidelines for management and prevention. Some patients may self-medicate with medicinal herbs for symptomatic relief, as there is a long tradition of use for a variety of ailments. The study assessed the prevalence of use and the factors affecting the decision to use herbs in asthmatic patients attending a public specialty care clinic in Trinidad.
A descriptive, cross-sectional study was conducted at the Chest Clinic in Trinidad using a de novo, pilot-tested, researcher-administered questionnaire between June and July 2003.
Fifty-eight out of 191 patients (30.4%) reported using herbal remedies for symptomatic relief. Gender, age, ethnicity, and asthma severity did not influence the decision to use herbs; however, 62.5% of patients with tertiary level schooling used herbs, p = 0.025. Thirty-four of these 58 patients (58.6%) obtained herbs from their backyards or the supermarket; only 14 patients (24.1%) obtained herbs from an herbalist, herbal shop or pharmacy. Relatives and friends were the sole source of information for most patients (70.7%), and only 10.3% consulted an herbalist. Ginger, garlic, aloes, shandileer, wild onion, pepper and black sage were the most commonly used herbs.
Among patients attending the Chest Clinic in Trinidad the use of herbal remedies in asthma is relatively common on the advice of relatives and friends. It is therefore becoming imperative for healthcare providers to become more knowledgeable on this modality and to keep abreast with the latest developments.
PMCID: PMC553979  PMID: 15713232

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