Objectives The objective of this study was to assess the impact of the COVID-19 pandemic on healthcare providers (HCPs) at personal and professional levels. Methods This was a cross-sectional descriptive study. It was conducted using an electronic format survey through Qualtrics Survey Software in English. The target participants were HCPs working in any healthcare setting across Iraq. The survey was distributed via two professional Facebook groups between 7 April and 7 May 2020. The survey items were adopted with modifications from three previous studies of Severe Acute Respiratory Syndrome (SARS) and Avian Influenza Outbreak. Kruskal–Wallis test was conducted to determine the difference in the pandemic impact according to the dealing with COVID-19 cases. Key findings The authors received 430 surveys from HCPs representing 14 provinces. Approximately 60% of the participants were dealing with diagnosis or treatment of COVID-19 cases. More than 80% perceived high risk of infection and stress due to the COVID-19 pandemic. Additionally, 85.9% of the HCPs had concerns of putting family and close friends at risk due to their job during the COVID-19 crisis. HCPs working in a setting dealing with diagnosis/treatment of COVID-19 cases experienced significantly higher concerns about personal and family safety compared with other HCPs. Conclusions Working during COVID-19 pandemic has several negative impacts on HCPs including mental and physical health and an overwhelming work environment. Thus, social and emotional support is needed to help HCPs to cope with such stressful conditions. Finally, providing adequate PPE can help to minimise concerns of getting infected in the workplace.

Abstract Background: The novel coronavirus 2 (SARS?CoV?2) pandemic is a pulmonary disease, which leads to cardiac, hematologic, and renal complications. Anticoagulants are used for COVID-19 infected patients because the infection increases the risk of thrombosis. The world health organization (WHO), recommend prophylaxis dose of anticoagulants: (Enoxaparin or unfractionated Heparin for hospitalized patients with COVID-19 disease. This has created an urgent need to identify effective medications for COVID-19 prevention and treatment. The value of COVID-19 treatments is affected by cost-effectiveness analysis (CEA) to inform relative value and how to best maximize social welfare through evidence-based pricing decisions. Objective: compare the clinical outcome and the costs of two anticoagulants (heparin and (enoxaparin)) used to treat hospitalized patients with COVID-19 infection. Patients and method: The study was a retrospective review of medical records of adult, non-pregnant, COVID-19 infected hospitalized patients who had baseline and last outcome measurements at Alamal Epidemiology Center, Al-Najaf city from (Augast 2020 to June 2021). The outcome measures included D-dimer, length of stay (LOS), and mortality rate. Only the cost of the medical treatment was considered in the analysis. The pharmacoeconomics analysis was done in three different cost-effectiveness analysis methods. Microsoft Excel spreadsheet and Statistical Package for the Social Sciences software (SPSS), was used to conduct statistical analysis. Kaplan Meier test was used to compare the mortality rate. T-TEST was used to compare the outcomes of the two groups. Results and discussion: two groups were compared, the first group consists of 72 patients who received heparin, and the second group consists of 72 patients who received enoxaparin. COVID-19 infected patients had a higher abnormal average D-dimer (2534.675 ng/dl). No significant differences between both genders with regards to the basal average D-dimer (males= 2649.95 ng/dl, females= 2374.1mg/dl, P-value>0.05). There was a significant difference between patient's ages 60 years and patients <60. (3177.33 ng/dl, 1763.06 ng/dl, P-value <0.05). It seems that, higher D-dimer levels were associated with a higher mortality rate (died=3166.263 ng/dl, survived= 1729.94 ng/dl, P-value <0.05). Heparin was more effective in decreasing D-dimer levels than enoxaparin which inversely increased the D-dimer levels (-24.4 ng/dl/day, +154.701 ng/dl/day, P-value <0.05). Additionally, heparin was more effective in increasing the survival rate compared to enoxaparin (55% vs, 35%, P-value<0.05). Heparin was associated with a longer duration of stay in hospital than enoxaparin but with no significant difference (13.7 days, 12.3 days, P-value >0.05). Concerning the cost, treatment with heparin cost less than enoxaparin (2.08 U.S $, 9.44 U.S $)/per patient/per day. Conclusion: Originator heparin was a more cost-effective anticoagulant therapy compared to originator enoxaparin, it was associated with a lower cost and better effect, treatment with Heparin resulted in positive INB= 11.3, where a positive result means that heparin is more cost-effective than Enoxaparin. All three methods of pharmacoeconomic analysis decide that heparin was more cost-effective than enoxaparin in treating COVID-19 infected patients.

Objectives The objectives of this study were to review the literature covering the perceptions about influenza vaccines in the Middle East and to determine factors influencing the acceptance of vaccination using Health Belief Model (HBM). Methods A comprehensive literature search was performed utilizing PubMed and Google Scholar databases. Three keywords were used: Influenza vaccine, perceptions and Middle East. Empirical studies that dealt with people/healthcare worker (HCW) perceptions of influenza vaccine in the Middle East and written in English were included. The search covered articles published between January 2015 and November 2020. Key Findings A total of 34 cross-sectional studies covering a total of 35 518 participants from 22 countries were included in this review. The overall influenza vaccination rates were generally low (&lt;50%) among general population, particularly among pregnant women and children. HCWs had relatively higher vaccination rates compared with general population. Old age, health comorbidities or working in high-risk environments were noted as major motivators to receive the vaccine. Concerns about adverse reactions and the lack of vaccine efficacy were the most predominant reported barriers to receiving the vaccines. Lastly, cues to actions included receiving advice from HCWs, influence of institutional requirement, awareness/educational pamphlets and influence from the media. Summary The HBM can be helpful in identifying and analysing motivators and barriers to vaccination. Additionally, by looking at the root causation, this model can help plan campaigns to increase vaccination rates in the region. Finally, we recommend empowering HCWs to proactively advocate for vaccination as part of preventive care.

Background Seeking pharmacist advice about minor ailments is a common practice among Iraqi patients because such advice is free and quick. Unfortunately, the assessment and management of minor ailments by Iraqi pharmacists were inappropriate. Therefore, this study aimed to develop a model for a mobile application that can assist community pharmacists in the diagnosis and management of minor ailments. Methods The scientific content of the application was based on the information in the symptoms in the pharmacy and British National Formulary books. The design and content of the application were approved by two experts. Thereafter, the application was built for Android mobiles using flutter technology and dart language. A pre-post pilot study was conducted to assess outcomes associated with use of the application, including user acceptance and appropriateness of clinical recommendations. Fifteen students from the College of Pharmacy/University of Baghdad who had an Android mobile participated in this study. Two different scenarios about diarrhea were used during the pilot study, in which the researcher acted as a patient (SP) and the participant student as a pharmacist. Results After using the application, the number of questions asked by the participated student to the SP was significantly increased to about double. Additionally, providing the SP with appropriate non-pharmacological and pharmacological therapy along with optimum counseling and education were also significantly improved. All study participants agreed on the application’s ease of use and ability to reduce diagnosis and medication errors. Conclusions The implementation of the newly developed mobile application, diarrhea management step by step, was associated with improvements in assessment and recommended treatments for diarrhea cases with good acceptance by a pilot sample of pharmacy students at Baghdad University.

Background: Pharmacy internship programmes are driven by most developed countries to outweigh the ongoing growth in the pharmacy career which encourages pharmacists to play a significant role as healthcare providers.    Objectives: This study examines pharmacy students' perception, satisfaction, challenges, and limitations with the internship curriculum.    Method: A cross-sectional study was conducted using an online survey with different elements to examine students' perceptions of various aspects.    Result: Most students reported a positive impression regarding their internships, however, they were less satisfied with the allowance for filling prescriptions and compounding also, the college's follow-up was inadequate. Finding a pharmacy and devoted time for the training were the most reported challenges. Whether the preceptor is a pharmacist or not, the duration of the training and the pharmacy type have been demonstrated as important factors in the training outcomes.    Conclusion: Students have acquired experience and knowledge. However, there are still improvements needed in the interns' perception towards the programme.

Diarrhea is one of the most commonly encountered minor ailments in the community pharmacies. It is associated with significant morbidity and mortality. However, the majority of pharmacists in Iraq did not manage diarrheal cases in a proper way. Therefore, the current study aimed to evaluate the benefit of a new mobile application (diarrhea management step by step) to improve the pharmacist's role in the management of diarrhea. The study was conducted from 21th September to 21th October 2021 using a pre-post design via a simulated patient (SP) technique. A validated diarrhea scenario was presented to each pharmacist by the SP twice, once before and the other after giving the mobile application to the pharmacist. Furthermore, pharmacists were asked to rate the application in regard to its ease of use, reducing the time needed for management of diarrhea cases, reducing diagnostic errors, reducing  medication errors, and applicability in daily clinical practice. The study sample involved 50 community pharmacists. However, only 47 completed the study. After using the application, all questions necessary to assess diarrhea were significantly improved. Moreover, the average number of questions asked to the SP was significantly increased. On the other hand, providing the SP with an appropriate non-pharmacological and pharmacological treatment was also significantly improved. Additionally, counseling the SP with the necessary information about dispensed medication was improved; however, significant improvement was detected only in regard to information about the drug dose and dosing frequency. Most participated pharmacists strongly agreed with the application ease of use, its ability to reduce diagnosis and medication errors, and its applicability for use in daily clinical practice.  In conclusion the tested application is an effective method to improve the pharmacist's role in the assessment and management of diarrhea.