Diverging levels of COVID-19 governmental response satisfaction across middle eastern Arab countries: a multinational study
Authors : Rania Itani, Samar Karout, Hani MJ Khojah, Makram Rabah, Mohamad B Kassab, Francine K Welty, Mazen AlBaghdadi, Haitham Khraishah, Faris El-Dahiyat, Salman Alzayani, Yousef S Khader, Mohammad S Alyahya, Danah Alsane, Rana Abu-Farha, Tareq L Mukattash, Tarek Soukarieh, Mohamad Fawzi Awad, Reem Awad, Abir Wehbi, Fatima Abbas, Hadi El Mais, Huda El Mais, Lina Karout
Abstract : Background: Public acceptance of governmental measures are key to controlling the spread of infectious diseases. The COVID-19 pandemic has placed a significant burden on healthcare systems for high-income countries as well as low- and middle-income countries (LMICs). The ability of LMICs to respond to the challenge of the COVID-19 pandemic has been limited and may have affected the impact of governmental strategies to control the spread of COVID-19. This study aimed to evaluate and compare public opinion on the governmental COVID-19 response of high and LMICs in the Middle East and benchmark it to international countries.
Methods: An online, self-administered questionnaire was distributed among different Middle Eastern Arab countries. Participants’ demographics and level of satisfaction with governmental responses to COVID-19 were analyzed and reported. Scores were benchmarked against 19 international values.
Results: A total of 7395 responses were included. Bahrain scored highest for satisfaction with the governmental response with 38.29 ± 2.93 on a scale of 40, followed by the Kingdom of Saudi Arabia (37.13 ± 3.27), United Arab Emirates (36.56 ± 3.44), Kuwait (35.74 ± 4.85), Jordan (23.08 ± 6.41), and Lebanon (15.39 ± 5.28). Participants’ country of residence was a significant predictor of the satisfaction score (P < 0.001), and participants who suffered income reduction due to the pandemic, had a history of SARS-CoV-2 infection, and held higher educational degrees had significantly lower satisfaction scores (P < 0.001). When benchmarked with other international publics, countries from the Gulf Cooperation Council had the highest satisfaction level, Jordan had an average score, and Lebanon had one of the lowest satisfaction scores.
Conclusion: The political crisis in Lebanon merged with the existing corruption were associated with the lowest public satisfaction score whereas the economical instability of Jordan placed the country just before the lowest position. On the other hand, the solid economy plus good planning and public trust in the government placed the other countries of the Gulf Cooperation Council on top of the scale. Further investigation is necessary to find out how the governments of other low-income countries may have handled the situation wisely and gained the trust of their publics. This may help convey a clearer picture to Arab governments that have suffered during the pandemic.
Keywords : Government, Perception, Middle East, Arab countries, COVID-19, Level of satisfaction
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Impact of Pharmacist-Directed Medication Reconciliation in Reducing Medication Discrepancies: A Randomized Controlled Trial
Authors : Impact of Pharmacist-Directed Medication Reconciliation in Reducing Medication Discrepancies: A Randomized Controlled Trial
Abstract : Background: In hospital surgical wards, patients are at higher risk for medication errors, in part because physicians may not consider themselves sufficiently trained to prescribe medications. Hence, collaborative teamwork involving the pharmacist is needed.
Objectives: To assess the impact of medication reconciliation directed by pharmacists on decreasing medication discrepancies after discharge from the surgical ward.
Methods: Patients admitted to the surgical unit at a tertiary teaching hospital in Amman, Jordan, between July 2017 and July 2018 were selected and randomly assigned to either the control or the intervention group. Upon admission, the number and kinds of unintentional medication discrepancies were determined for both groups. Medication reconciliation was then provided to patients in the intervention group. The number of unintentional discrepancies was re-evaluated upon discharge for both groups. To assess differences between the control and intervention groups, the χ2 or Fisher exact test was used for categorical variables and an independent-sample t test for continuous data. A paired t test was conducted to determine whether the number of medication discrepancies was reduced as a result of pharmacists’ recommendations.
Results: A total of 123 patients met the inclusion criteria, 61 in the intervention group and 62 in the control group. Discrepancies of omission and wrong dose constituted 41 (77%) of the 53 discrepancies in the intervention group and 25 (76%) of the 33 discrepancies in the control group. The number of unintentional discrepancies was significantly reduced from admission to discharge in both the intervention group (p = 0.002) and the control group (p = 0.007). Of 53 recommendations made by pharmacists, 20 (38%) were accepted by the treating physician, and all of these discrepancies were resolved.
Conclusions: This study sheds light on the existence of unintentional medication discrepancies upon admission for surgical patients, which may expose the patients to potential harm upon discharge from hospital. Additional studies with a larger sample size are needed to gain further insights on pharmacists’ role in implementing medication reconciliation for surgical patients.
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The Appropriateness of Empiric Treatment of Urinary Tract Infections in a Tertiary Teaching Hospital in Joran: A Cross-Sectional Study
Authors : Rama Alkhawaldeh, Rana Abu Farha, Khawla Abu Hammour, Eman Alefishat
Abstract : This is a cross-sectional study that was conducted at Jordan University Hospital (JUH) to evaluate the appropriateness of Urinary Tract Infection (UTI) empiric treatment based on microbial culture data and susceptibility testing. All urine cultures requested for adult patients (≥18 years) admitted to JUH within the period from January 2019–July 2021 were reviewed and only those cultures with positive episodes of infection were considered. In this study, 6950 urine culture episodes were screened; among them, 34.5% (n = 2400) revealed positive results. Among those patients with positive culture episodes, 1600 patients (66.7%) were discharged before the availability of culture results and were excluded. Of the remaining eligible 800 patients, 701 (87.6%) received empiric treatment. In 26.8% of the eligible cases (n = 214), the prescribed empiric agents failed to have appropriate coverage of the identified pathogens, and in 14.6% of the cases (n = 117) the identified microorganisms were reported as resistant to the prescribed empiric agents. Furthermore, only 13.4% of the patients (n = 107) were appropriately treated for their UTI with empiric antibacterial agents. We were not able to judge the appropriateness of UTI treatment for one third (n = 263, 32.9%) of the patients, because they did not have susceptibility reports performed. This study revealed an alarmingly high rate of inappropriate treatment of UTIs, which encourages the emergence of bacterial resistance and affects health-related outcomes negatively. Therefore, antimicrobial stewardship programs must be applied to optimize antibiotic consumption in hospital settings.
Keywords : antibiotic resistance; empiric antibiotic; urine culture; susceptibility test; Jordan
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The effect of the emerging omicron variant on the willingness to take or continue with COVID-19 vaccination in the Middle East
Authors : Tareq L Mukattash, Anan S Jarab, Rana K Abu-Farha, Rania Itani, Samar Karout, Razan Z Mansour, Shorouq Abuhishmah
Abstract : The present study aimed to explore the willingness of the general public in the Middle East area to take or continue with the available COVID-19 vaccine in light of the emergence of the new omicron variant. This study is a web-based questionnaire distributed in Lebanon, Jordan, and Kuwait during the omicron variant outbreak. The questionnaire consisted of 15 close-ended questions with predefined options, divided into four sections preceded. The total included responses were 812 that were recruited from Lebanon (n= 427, 52.6%), Jordan (n = 279, 34.4%), and Kuwait (n = 106, 13.1%). Almost two-thirds of the participants (77%) received two doses of the COVID-19 vaccine, while only 7.9% received the booster shot (third dose). On the other hand, 90 participants (11%) did not receive any COVID-19 vaccine yet. The reported willingness among the unvaccinated individuals to receive the COVID-19 vaccine was only 22.4% (20/90). However, higher acceptability of fully vaccinated individuals to receive the booster shot was reported after the surge of the omicron variant (49.2%). The findings of the present study have important implications on COVID-19 vaccination decision. As the pandemic evolves, the public’s opinions with the surge of different variants are changing. Therefore, there is an urgent need to raise awareness about omicron severity, and that the rapidly spreading strain puts the unvaccinated particularly at risk. Vaccine campaigns should elevate the voices of influencing messengers caring for severe COVID-19 cases.
Keywords : COVID-19; vaccine; omicron; willingness; Middle east
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Early Detection of Prostate Cancer: Self-Reported Knowledge and Attitude of Physicians in Jordan
Authors : Mohammad AY Alqudah, Raneem Al-Samman, Obada Matalgah, Rana Abu Farhah
Abstract : Prostate cancer (PC) screening aims to detect PC in early stages, amenable to curative treatment and reduction in disease morbidity and mortality. However, PC screening may be associated with overdiagnosis and complications of unnecessary treatment for indolent disease. Therefore, careful patient selection for PC screening is critical to avoid overestimation and missed diagnosis. The aim of this study was to assess physicians’ knowledge and attitude towards early detection of PC in Jordan and whether their knowledge is an important predictor of their attitude. An electronic, self-reported questionnaire was used to collect data on demographics, knowledge, and attitude of physicians regarding early detection of PC. The participants’ responses were analyzed using descriptive statistics and multiple linear regression. Around 296 physicians agreed to participate in this study. Most respondents were males (75.7%), residents (34%), practiced medicine more than 15 years (29%) and graduated (81.4%) from local universities. Surprisingly, only 28.4% recognized PC as a non-self-detected disease and less than one-half (48.6%) were aware that PC screening tests are not enough to exclude a diagnosis of PC. The median knowledge Percent of Maximum Possible (POMP) score was 59%. Around two-thirds of participants showed a positive attitude towards early detection of PC (median attitude POMP score was 66%). Higher attitude scores were significantly associated with younger age, those working in private hospitals, and those having higher knowledge POMP score (P < .05). This study highlighted that most physicians demonstrated a positive attitude towards PC screening but with moderate level of knowledge that is considered an important predictor of their attitude towards PC early detection. Thus, improving knowledge and awareness of physicians should be considered as a strategy to improve their attitude towards prostate screening practices and informing men of the importance of regular screening.
Keywords : prostate cancer, physicians, knowledge, attitude, early-detection
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Jordanian views regarding sharing of medical data for research: A cross-sectional study during COVID-19 pandemic
Authors : Moawiah Khatatbeh, Lobna F Gharaibeh, Omar F Khabour, Rana K Abu-Farha, Karem H Alzoubi
Abstract : Purpose: In the current study, the views of Jordanian regarding sharing medical reports for research purposes were investigated during the COVID-19 pandemic. In addition, motivators and barriers regarding sharing of medical records were examined.
Methods: This observational survey-based cross-sectional study was conducted using an electronic questionnaire during the COVID-19 pandemic (second half of 2020). The questionnaire link was disseminated through two social media platforms (WhatsApp and Facebook), targeting Jordanian adults (age >18 years).
Results: In this study, 1,194 participants agreed to complete the study survey. Results showed that 58.3% of them (n = 696) reported to be willing to share their medical data. while 17.6% of the participants (n = 210) showed hesitancy to share their medical information. The most important motivators as perceived by the study participants were helping other patients who have similar health conditions (n = 995, 83.3%). Moreover, fearing from stigma (n = 753, 63.1%), and the lack of confidence in data security and privacy (n = 728, 61.0%) were among the main barriers preventing participants from sharing their information. Finally, results showed that participants with higher educational level (bachelor or higher) (OR = 0.299, P<0.001), or those living in center of Jordan (OR = 0.270, P<0.001) showed a lower tendency to share their medical data. While participants those who have shared data before showed a higher tendency to share their medical data (OR = 2.524, P<0.001).
Conclusion: In this study, many of the participants had a positive attitude towards sharing biomedical data for scientific research during the COVID-19 pandemic, many had doubts in the control over their data. Thus, policymakers and data users should address the concerns and values of patients and understand their preferences in favor of an ethically scrupulous use of data in research.
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Electronic Prescribing System and electronic health record priorities for antimicrobial stewardship
Authors : Fares Albahar, Hamza Alhamad, Rana K Abu-Farha, Husam Alsalamat, Deema Jaber, Abla M Albsoul-Younes
Abstract : Rationale, aims, and objectives: This study provided a platform for electronic prescribing design features that may facilitate antimicrobial stewardship. This study aimed to identify software features within electronic prescribing systems and to assign priorities to these software features according to the opinions of the infection specialist health care professionals. Also, to identify any differences in priorities according to a professional group and experience in using electronic prescribing and communicate research findings to policy-makers and electronic prescribing manufacturers. Methods: The study was conducted in a large (600-bed) governmental tertiary and teaching hospital in Amman, Jordan. The survey was delivered by hand to antimicrobial prescribers (internists, surgeons, paediatricians, infectious diseases specialists, and critical care specialists) and non-prescribers (medical interns, clinical pharmacists, nurses, and other allied health care professionals) who filled out the survey face to face. The delivery of the survey started on March 15, 2020, and was closed on April 7, 2020. Results: Responses were received from 210 individuals. Interns represented more than one-third of respondents (n= 79, 37.6%), with 15.7% were internal medicine physicians. Among the healthcare professionals, around 44.7% (n= 94) are considered prescribers to antimicrobials, while others are considered non-prescribers (n= 116, 55.2%). The majority of respondents (n= 205, 97.6%) reported using an electronic prescribing and electronic health record system for part or all in their hospital, with 35.7% (n= 75) of them reported using these systems for more than one year. The prompt prescribing feature having the highest assigned priority was the allergy checker (n= 193, 91.9%) followed by the dose checker (n= 192, 91.4%). Conclusion: This study demonstrates the first attempt to describe views of healthcare professionals in Jordan about the potential significance of prescribing prompt and active prescription surveillance software features on clinical, microbiological and process outcomes to support antimicrobial stewardship. Findings from this study reveal considerable demand for additional software features expressed by the healthcare professionals charged with promoting rational use of antimicrobials and a consensus of anticipated positive impact on patient safety and efficiency outcomes.
Keywords : antimicrobial stewardship, electronic prescribing, electronic health record, antimicrobial resistance, hospital software design features
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Knowledge, practices, and patterns of data confidentiality among pharmacists in a developing country
Authors : Lobna Gharaibeh, Sayer I Al-Azzam, Karem H Alzoubi, Reema A Karasneh, Rana Abu-Farha
Abstract : Background: Increased application of electronic health information systems led to the buildup of patient information and facilitated access to this data. Consequently, the confidentiality of this information became an ethical challenge to medical teams' members including pharmacists. However, no study has been conducted to assess pharmacists’ knowledge or practices of data confidentiality. Thus, the aim of this study was to assess the current practices and knowledge of pharmacists concerning data confidentiality.
Methods: This was a cross sectional study that included clinical pharmacists in tertiary hospitals and health care centers in Jordan. Data was collected through phone or face to face interviews using a data collection sheet. All continuous data was presented as median ± interquartile range (IQR) and categorical data as frequency (%). One way Chi square was used to check significant differences among categorical groups. Predictors that may affect knowledge and behavior scores were screened using simple linear regression.
Results: A total of 388 pharmacists were interviewed with a mean age of 39.59 ± 8.32 years, with an average experience of 12.55 ± 7.30 years. Pharmacists relied on their personal experience to resolve ethical dilemmas (n = 274, 70.3%), and when they seek advice, their work colleagues (n = 180, 46.4%) %), followed by the head of departments (144 n; 37.1%), were the main source of advice on ethical issues. The overall median knowledge score of pharmacists about data confidentiality was 2.0 out of 5.0 (IQR = 2.0). A considerable percentage of the pharmacists was willing to share information with family members without asking for permission from the patient (n = 98, 25.3%). Pharmacists had a median behavior score of 3.5 out of 4.0 (IQR = 0.4) regarding practices related to data confidentiality, where the majority of them handled medical information from the patient with great confidentiality (304 n, 78.4%), and 85.8% of them (n = 333) gave patient's sexual diseases-related medical information the highest confidentiality. However, based on univariate and multivariate linear regression analysis, none of the examined sociodemographic variables significantly predicted pharmacists’ knowledge or behaviors (P > 0.05).
Conclusion: Pharmacists are aware of the importance of confidentiality issues of their patients. However, a number of gaps in their knowledge and practices of data confidentiality were identified. Training that targets these gaps in their knowledge, and rectifies incorrect practices is needed during university education and as part of their continuous medical education.
Keywords : Jordan, Pharmacy, Confidentiality, Clinical ethics
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Dietary supplements intake during the second wave of COVID-19 pandemic: A multinational Middle Eastern study
Authors : Tareq L Mukattash, Hana Alkhalidy, Buthaina Alzu'bi, Rana Abu Farha, Rania Itani, Samar Karout, Hani MJ Khojah, Maher Khdour, Faris El-Dahiyat, Anan Jarab
Abstract : Introduction: Despite the controversy about the benefits of dietary supplements in treating or preventing COVID-19, their use has increased worldwide even with the introduction of relevant vaccines. Thus, this study aimed to investigate the perception of the Middle Eastern Arab public of dietary supplements as prophylactic or therapeutic agents against COVID-19, and their consumption during the second wave of the COVID-19 pandemic.
Methods: A validated, pilot tested online survey was distributed through social networking platforms in Lebanon, the Kingdom of Saudi Arabia, Palestine, Jordan, and the United Arab Emirates. Responses underwent various statistical analyses.
Results: A total of 2,100 responses were included. Around 44% of participants reported changes in their dietary behavior during COVID-19, and 70% believed that healthy habits may prevent the infection. Moreover, 21% believed that dietary supplements surely protect against COVID-19 and 45% thought they aid in treating it. Users of supplements during the second wave of the pandemic counted for 47%, who declared they were influenced by the media, healthcare providers, or close contacts. Most used supplements included Vitamins C and D and zinc. Only 34% of participants read supplement leaflets. The use of supplements was significantly correlated with being female and exercising, as revealed by the odds ratio and logistic regression analysis.
Conclusions: In line with other areas of the world, the use of dietary supplements in the Middle East against COVID-19 is not evidence-based. Competent health authorities should play their role in spreading sound awareness among the public regarding this issue.
Keywords : COVID-19; Dietary supplements; Vitamins; Prophylaxis; Middle East
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Evaluation of Drug Use Pattern in Pediatric Outpatient Clinics in a Tertiary Teaching Hospital Using WHO Drug-Prescribing Indicators
Authors : Aya Aldabagh, Rana Abu Farha, Samar Karout, Rania Itani, Khawla Abu Hammour, Eman Alefishat
Abstract : Purpose: The main aim of the study is to assess physicians’ prescribing patterns using the World Health Organization (WHO) prescribing indicators among pediatric outpatient clinics, and to identify areas in need of intervention regarding the rational use of medicines among pediatric outpatients in Jordan.
Methods: This is a descriptive observational cross-sectional study that was conducted at the outpatient pediatric clinics at Jordan University Hospital (JUH). During the study period, prescriptions were collected over a period of two months. Prescribing patterns were assessed using the five WHO drug prescribing indicators.
Results: A total of 1011 prescriptions/encounters were assessed. More than half of the encounters were for male patients (n= 595, 58.9%), and the median age of patients was eight years (IQR = 7.9). The average number of drugs prescribed per encounter was 1.8 ± 1.3; however, a specific individual clinic, the respiratory clinic, witnessed an average of 2.1 drugs prescribed per encounter. All of the prescribed drugs were prescribed by generic name (100%). Only 47.7% of the drugs were from the essential drug list of the JUH. Overall, antibiotics were prescribed in 19.5% of the encounters, but at higher rates in some clinics such as respiratory clinics (50.8%). Injectables were prescribed in 9.5% of the 1011 encounters; however, they were prescribed at higher rates in endocrinology and neurology clinics, in 44.8% and 31.3% of encounters, respectively.
Conclusion: This study revealed some adequate prescribing habits with an optimal prescribing pattern of generics and number of drugs per encounter among pediatric patients. However, the prescribing patterns of the essential drug list, antibiotics, and injectables, in specific clinics, failed to meet WHO standards. The findings of this study shed light on the need to establish national strategies to improve prescribing practices among the pediatric population.
Keywords : World Health Organization, irrational drug use, pediatrics, drug prescribing indicators, outpatient, Jordan
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Factors affecting the public’s knowledge about COVID-19 vaccines and the influence of knowledge on their decision to get vaccinated
Authors : Khawla Abu Hammour, Rana Abu Farha, Qusai Manaseer, Bayan Al-Manaseer
Abstract : Objective: An analysis was conducted to assess the factors affecting the public’s knowledge about coronavirus disease (COVID-19) vaccines and the influence of that knowledge on their decision to get vaccinated.
Study Design: Cross-sectional survey.
Methods: An online, self-administered questionnaire was instrumentalized to assess the factors affecting the Jordanian public’s knowledge about COVID-19 vaccines and the influence of that knowledge on their decision to get vaccinated. A multiple linear regression analysis was carried out to determine the variables that affected the participants’ knowledge score regarding COVID-19 vaccines. The Mann–Whitney U test was used to evaluate the differences in knowledge scores among different groups. P < 0.05 was considered statistically significant.
Results: Only 45.9% of the 468 participants reported being willing to receive the vaccine, and only 38.5% (n = 180) had registered on the Ministry of Health platform to get vaccinated. Moreover, very few of them (26/468, 5.6%) had received the vaccine. The participants showed inadequate knowledge, with a median knowledge score of 4 out of 8 (interquartile range = 4). The linear regression analysis showed that participants aged above 45 years, those with bachelor’s or graduate degrees, and those with medical-related degrees had higher knowledge scores regarding COVID-19 vaccines than the others (P < 0.001). Participants who were willing to receive the vaccine, those who had registered to receive the vaccine, and those who had got vaccinated had higher knowledge scores than the others (P < 0.001 for all).
Conclusion: This cross-sectional analysis indicated that urgent education is needed to improve the public’s knowledge and awareness about the COVID-19 vaccine to reduce the adverse impact of lack of knowledge on decision making for the COVID-19 vaccination.
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An Audit on Pharmacists' Knowledge and Experience in Pediatric Care
Authors : Mohammad AY Alqudah, Tareq L Mukattash, Esra'a Al-Shammari, Anan S Jarab, Walid Al-Qerem, Rana K Abu-Farha
Abstract : Objective: The aim of this study was to determine pharmacists' perceived knowledge and expertise required to deliver pharmaceutical care services to pediatric patients.
Methods: Once ethical approval was obtained, a questionnaire was posted on local pharmacy groups. The questionnaire is composed of 4 domains: 1) Demographics, 2) Perceived knowledge of pediatric treatment and dosing, 3) Real-life pediatric cases, and 4) Future aspirations to enhance pediatric pharmacy.
Results: A total of 200 questionnaires were completed and submitted online. Most participants (62.5%) practiced in a community setting. Most respondents (40%) reported that 41% to 60% of their patients were pediatrics. In general, respondents had a good perception of their knowledge and expertise to deliver pharmaceutical care services to pediatric patients. However, most respondents had a low knowledge score when faced with real-life pediatric cases. On a scale of 7 most respondents obtained the score of 2 (32%).
Conclusion: The present study sheds light on an alarming lack of knowledge in pediatric pharmaceutics among pharmacies in Jordan. Further training and educational programs should be put in place to address this gap in knowledge.
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Antimicrobial Stewardship from Health Professionals’ Perspective: Awareness, Barriers, and Level of Implementation of the Program
Authors : Haya Nassar, Rana Abu-Farha, Muna Barakat, Eman Alefishat
Abstract : This study aimed to evaluate health professionals’ perceptions regarding the level of implementation of the Antimicrobials Stewardship (AMS) programs in Jordanian tertiary hospitals and to assess the perceived barriers to its implementation. During this cross-sectional study, a total of 157 healthcare providers agreed to participate (response rate 96.3%). Participants were asked to complete an electronic survey after meeting them at their working sites. Only 43.9% of the healthcare providers (n = 69) reported having an AMS committee in their hospital settings. The results suggested that private hospitals have significantly better AMS implementation compared to public hospitals among four areas (p ≤ 0.05). Moreover, the results showed that the most widely available strategies to implement AMS were infectious disease/microbiology advice (n = 112, 71.3%), and treatment guidelines (n = 111, 70.7%). Additionally, the study revealed that the main barrier to AMS implementation was the lack of information technology support (n = 125, 79.6%). These findings could draw managers’ attention to the importance of AMS and support the health care provider’s practice of AMS in Jordanian tertiary hospitals by making the right decisions and the required modifications regarding the strategies needed for the implementation of AMS programs.
Keywords : antimicrobial stewardship; perception; practice; tertiary hospitals; Jordan
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Is COVID-19 multisystem inflammatory syndrome a new variant of Kawasaki Disease?
Authors : Khawla Abu Hammour, Rana Abu Farha, Qusai Manaseer, Tasnim Dawoud, Walid Abu Hammour
Abstract : Objectives: In this systematic review, we aimed to evaluate the clinical features, therapeutic options, and outcomes of children with multisystem inflammatory syndrome in children (MIS-C) and to investigate whether MIS-C is a new variant of Kawasaki disease. Materials and methods: Adhering to PRISMA principles, we searched for eligible studies between December 2019 and June 2020 through the following databases: PubMed, ISI Web of Science, SCOPUS, and Science Direct. Studies including original data of patients aged 4 days. Mucocutaneous manifestations are similar to Kawasaki disease presented in up to 64% in some studies. Almost all patients had significant elevations in inflammatory markers, and up to 50 to 100% had elevated troponin suggesting myocardial damage. Intravenous immunoglobulin (IVIG) was administered to 60% of patients in 12 studies and 80 to 100% in five studies. Steroids were administered to 10 to 95% of patients. The overall mortality rate was 0.9%. Conclusion: The temporal association between novel coronavirus disease 2019 (COVID-19) onset and Kawasaki-like disease and MIS-C suggests a causal link. Both syndromes have similar cascades of symptoms and hyperinflammation, which likely explain their response to the same immunomodulatory agents. However, it is unclear yet why some children appear more susceptible to develop MIS-C.
Keywords : Children, COVID-19, Kawasaki disease, multisystem inflammatory syndrome in children, SARS-CoV-2
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Coronavirus disease patients’ views and experiences of pharmaceutical care services in Lebanon
Authors : Tareq L Mukattash, Anan S Jarab, Walid Al-Qerem, Rana K Abu Farha, Rania Itani, Samar Karout, Ibrahim L Mukattash
Abstract : Objectives: This study aimed to explore the experiences and views of domiciliary coronavirus disease (COVID-19) patients towards pharmaceutical care services provided during their infection.
Methods: This was a single-centred observational study conducted among home-treated COVID-19 patients (n = 500), who were tested positive for COVID-19 in a medical centre in Lebanon.
Key findings: Out of the 500 home-treated COVID-19 patients invited to participate in the study, 279 patients completed the questionnaire. Although the participants had a good view of pharmacists caring for COVID-19 patients (mean view score: 17.79/25), their treatment experiences were unsatisfactory (mean experience score: 1.51/4).
Conclusions: COVID-19 patients reported minimal involvement of pharmacists in their treatment. Therefore, in response to the COVID-19 pandemic, healthcare authorities should intervene in restructuring, guiding and reviewing unrealized new pharmaceutical services to COVID-19 outpatients.
Keywords : COVID-19, pharmaceutical care, perception, community pharmacists
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Medication discrepancies among hospitalized patients with hypertension: assessment of prevalence and risk factors
Authors : Rana Abu Farha, Alaa Yousef, Lobna Gharaibeh, Waed Alkhalaileh, Tareq Mukattash, Eman Alefishat
Abstract : Background: Medication errors remained among the top 10 leading causes of death worldwide. Furthermore, a high percentage of medication errors are classified as medication discrepancies. This study aimed to identify and quantify the different types of unintentional medication discrepancies among hospitalized hypertensive patients; it also explored the predictors of unintentional medication discrepancies among this cohort of patients.
Methods: This was a prospective observational study undertaken in a large teaching hospital. A convenience sample of adult patients, taking ≥4 regular medications, with a prior history of treated hypertension admitted to a medical or surgical ward were recruited. The best possible medication histories were obtained by hospital pharmacists using at least two information sources. These histories were compared to the admission medication orders to identify any possible unintentional discrepancies. These discrepancies were classified based on their severity. Finally, the different predictors affecting unintentional discrepancies occurrence were recognized.
Results: A high rate of unintentional medication discrepancies has been found, with approximately 46.7% of the patients had at least one unintentional discrepancy. Regression analysis showed that for every one year of increased age, the number of unintentional discrepancies per patient increased by 0.172 (P = 0.007), and for every additional medication taken prior to hospital admission, the number of discrepancies increased by 0.258 (P= 0.003). While for every additional medication at hospital admission, the number of discrepancies decreased by 0.288 (P < 0.001). Cardiovascular medications, such as diuretics and beta-blockers, were associated with the highest rates of unintentional discrepancies in our study. Medication omission was the most common type of the identified discrepancies, with approximately 46.1% of the identified discrepancies were related to omission. Regarding the clinical significance of the identified discrepancies, around two-third of them were of moderate to high significance (n= 124, 64.2%), which had the potential to cause moderate or severe worsening of the patient´s medical condition.
Conclusions: Unintentional medication discrepancies are highly prevalent among hypertensive patients. Medication omission was the most commonly encountered discrepancy type. Health institutions should implement appropriate and effective tools and strategies to reduce these medication discrepancies and enhance patient safety at different care transitions. Further studies are needed to assess whether such discrepancies might affect blood pressure control in hypertensive patients.
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Assessment of public knowledge and perception about the use of probiotics
Authors : Manal Ayyash, Mohammad AA Al-Najjar, Kamel Jaber, Layal Ayyash, Rana Abu-Farha
Abstract : Introduction: In Jordan, there is a remarkable lack of public awareness about probiotics and available guidance on their use. This study was designed to evaluate Jordanians’ awareness and perception about probiotics and their willingness to use these nutritional supplements as a part of their daily diet.
Methods: This cross-sectional survey was conducted among the Jordanian public. During the study period, participants were invited to fill out an electronic-based questionnaire.
Results: A total of 508 people agreed to participate in the study. Among them, 64.0% (n = 325) reported that they were willing to take probiotics. Only 17.1% of the surveyed participants (n = 90) knew that probiotics were not dead microorganisms. Only 55.0% of participants (n = 279) believed that probiotics were safe to consume. In addition, 75.0% (n = 381) believed that community pharmacists had a limited role in improving public knowledge about probiotics. Regression analysis showed that participants with higher income (>500 JD/month) and those who had medical degrees had greater knowledge about probiotics compared to others (P <0.001).
Conclusion: This study demonstrated that there is inadequate knowledge about probiotics and their potential use. More effort is needed to provide more information about the benefits of probiotics. Greater knowledge could be achieved by encouraging medical doctors and pharmacists to inform the public about probiotics.
Keywords : Probiotics, Knowledge, Perception, Jordan, Willingness
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Exposure of community pharmacists to COVID-19: a multinational cross-sectional study
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Authors : Hani MJ Khojah, Rania Itani, Tareq L Mukattash, Samar Karout, Fatima Jaffal, Rana Abu-Farha
Abstract : Objectives: Community pharmacists (CPs) are among the frontline healthcare providers who have been exposed to a high risk of being infected with SARS-CoV-2 during the pandemic. Unfortunately, there have been limited studies in the Middle East that provide an occupational risk analysis among CPs. Therefore, this study aims to evaluate the risk of COVID-19 exposure among Middle Eastern CPs and to identify the infection predictors.
Methods: A cross-sectional survey was conducted using an online, self-administered questionnaire that was distributed to CPs across KSA, Lebanon, and Jordan between November and December 2020. The bivariate logistic regression test was used to analyse the predictors associated with COVID-19.
Results: CPs were more susceptible to acquiring SARS-CoV-2 than the general public (12.9% vs. 1.5%). The significant predictors of infection included a family member with confirmed COVID-19 infection, age <40 years, encountering patients in pharmacy without a protective glass-barrier, and contact with confirmed COVID-19 patients or colleagues with confirmed COVID-19 during practice. Additionally, the mean level of the respondents’ expected rate of infection was 3.27 ± 1.04 (out of 5). This level was significantly higher among female pharmacists and Lebanese pharmacists.
Conclusions: This study demonstrates that CPs are at a higher risk of acquiring COVID-19 compared with the general public. This is attributed to several occupational factors that increase the risk of exposure to COVID-19. Therefore, healthcare authorities are advised to enforce strict occupational guidelines for CPs.
Keywords : Community pharmacists, COVID-19 exposure, Jordan, Lebanon, KSA
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Predictors of Plagiarism Research Misconduct: A Study of Postgraduate Pharmacy Students in Jordan
Authors : Rana Abu Farha, Tareq Mukattash, Wael Al-Delaimy
Abstract : This study aimed to evaluate Jordanian pharmacy postgraduate students’ knowledge, behavior and perception about plagiarism and why do they commit such research misconduct.
This is a cross-sectional survey that was conducted in Jordan during the period between June-July 2019. The study targeted postgraduate pharmacy students from all Jordanian universities. Recruited students were asked to fill out the study questionnaire to evaluate their knowledge, behavior, and perception about plagiarism.
A total of 103 postgraduate students participated in this survey, most of them (n = 93, 90.3%) were enrolled in masters programs. Most of them (n = 72, 69.9%) reported that they have committed plagiarism during their studies, but this work was unintended for about 76.4% (n = 55) of the plagiarist.
Students were asked about 12 items that represented plagiarism actions and most of postgraduate students were able to identify most of the actions as plagiarism (> 60% for most items). Overall, the mean knowledge score for students about plagiarism was 8.6 ± 2.6 (out of 12).
Regarding students’ perceptions towards plagiarism, many students (n = 99, 96.1%) believed that plagiarizing is as bad as to steal from someone and 92.2% (n = 95) reported that plagiarism is considered against their ethical values.
This study found a high rate of plagiarism among postgraduate pharmacy students in Jordan despite their awareness and understanding of the concept and its different forms. Academic institutions must establish formal policies to raise awareness about plagiarism, enforce and implement penalties for those who commit plagiarism.
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Detection of medication administration errors at a tertiary hospital using a direct observation approach
Authors : Alaa M Yousef, Rana K Abu-Farha, Khawla M Abu-Hammour
Abstract : Objectives: Medication administration errors (MAEs) are the most common and significant type of medication errors worldwide. This study aims to assess the prevalence, types, and severity of MAEs. Furthermore, this study attempts to determine the factors associated with the occurrence of MAEs.
Method: This cross-sectional study was conducted over a three-month interval in the internal medicine ward of a tertiary teaching hospital in Jordan. During the study period, 13 nurses were observed while they were preparing and administering medications using a direct disguised observation method. All the recorded observations about the preparation and administration were compared with the physician's orders in the medications' records to identify any possible MAEs.
Results: Having observed a total of 1,012 opportunities for errors, 910 MAEs were identified. Among these 910 errors, adherence errors were found to be the most frequent type (n = 364, 35.9%), followed by incorrect drug preparation (n = 247, 24.4%). None of the MAEs revealed any serious harm to patients or contributed to prolonged hospitalization. Antimicrobial drugs (n = 210, 23.0%) was the most common class associated with MAEs, followed by the class of cardiovascular (n = 157, 17.2%) medicines. Results have shown that the occurrence of MAEs was significantly higher in the non-intravenous medications in comparison to the intravenous medications (p-value < 0.001).
Conclusion: While this study revealed a high rate of MAEs, all the identified errors did not cause harm to the patients. Continuous awareness and education campaigns targeting the nurses about the importance of proper and safe drug administration are highly recommended.
Keywords : Direct observation, Internal medicine, Jordan, Medication administration errors, Tertiary hospital
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Potential prescribing omissions of medications in older adults based on START version 2 criteria in a tertiary Jordanian teaching hospital
Authors : Khawla Abu Hammour, Mariam Abdeljalil, Rana Abu Farha, Sara Alhabeis, Qusai Manaseer, Samah AbuMoghli
Abstract : Potential prescribing omission (PPO) represents a failure in prescribing drugs when indicated due to lack of the evidence base. Published data are scarce on the prevalence of prescribing omissions in Jordan. This study aimed to assess the prevalence of prescribing omissions in elderly patients in a Jordanian teaching hospital. Screening Tool to Alert doctors to the Right Treatment (START) version 2 was used to identify the prescribing omissions in older adults admitted to a tertiary hospital in Jordan for 18 months. During the study period, data relating to the patients’ medical problems and prescribed medicines were collected by two clinical pharmacists via reviewing the clinical and prescription records of the included patients. Data were collected using a predefined data collection form and statistical analysis was conducted using Statistical Package of Social Sciences (SPPSS). One or more prescribing omissions were found in 40.5%, 41.0%, and 39.5% of the patients upon admission, during hospitalization, and on discharge, respectively. The most common prescribing omission was about START criterion I1 which was “seasonal trivalent influenza vaccine annually” in 54.8% upon admission, 51.5% during hospitalization, and 51.9% on discharge. Logistic regression found that the higher number of medical conditions was associated with an increased risk of PPO occurrence upon admission, during hospitalization, and on discharge (p value < 0.05). Acts of omission of appropriate medications were highly prevalent among older patients in our hospital setting. A validated screening tool (START) is one method of systematically identifying appropriate omitted medicines in clinical practice. Application of validated START criteria can help detect and prevent PPO occurrence among older patients.
Keywords : Prescribing omission, older adults, acute illness, START screening tool.
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Medication administration errors: Causes and reporting behaviours from nurses perspectives
Authors : Alaa Yousef, Rana Abu Farha, Khaled Da’meh
Abstract : Evaluation of nurses’ perceptions towards medication administration errors (MAEs) reporting is a key aspect for improving patient safety, and prevention of errors repetition. Thus, this study has evaluated nurses’ behaviour towards MAEs reporting practice, and factors contributing to their under-reporting of errors.
This is a cross-sectional survey-based study that was conducted during February 2021. During the study period, a convenience sample of nurses working at Jordan university hospital was invited to voluntarily participate in the study and to fill an online questionnaire uploaded on an electronic data collection platform. The questionnaire assessed nurses MAEs reporting practice, their perception towards factors contributing to MAEs, factors associated with under-reporting of MAEs, and their perception towards MAEs preventive measures.
A total of 150 nurses responded to the electronic questionnaire, with 54.0% of them (n = 81) were males and the majority had a bachelor's degree in nursing (n = 138, 92.0%). Regarding MAE reporting's practice, 78% of them (n = 117) indicated that they are always/often report MAEs even if it is not possible to improve the patient's health status. With regard to factors contributing to MAEs, results showed that “insufficient staffing” was the most common reason contributing to MAEs occurrence reported by nurses (n = 114, 94.0%). Personal fear from nursing administration was the primary cause of MAEs under-reporting (n = 98, 65.3%), while 94.0% of nurses (n = 141) agreed/strongly agreed that following the six rights is a way to prevent MAEs occurrence.
This study indicates a positive reporting attitude towards MAEs. Nursing administration concerns were considered the main reason associated with the under-reporting of MAEs. This study shed the light on the deep need for continuous education programmes about the importance of the right MAEs reporting. As well, the need for effective and restricted rules in a non-punitive environment to prevent MAEs incidences.
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Awareness and Perception of Healthcare Providers about Proxy Consent in Critical Care Research
Authors : Rania Mahafzah, Karem H Alzoubi, Omar F Khabour, Rana Abu-Farha
Abstract : Objective. Proxy consent respects patients’ autonomy when they are incapable of providing consent for research participation. Healthcare providers need to understand the ethical regulations and practices relevant to the proxy consent process. +us, this study aimed to assess the knowledge and attitudes of healthcare providers about research proxy consent in the ICU setting. Methods. A cross-sectional survey-based design was used in the study. Study participants were resident and specialist physicians, registered nurses, and registered pharmacists from ICU units in Jordan. Participants were asked to fill out a questionnaire developed to assess their knowledge and attitudes towards informed proxy consent for research studies conducted at the ICU. Results. In this study, 145 healthcare providers completed the study questionnaire. +e healthcare providers agreed that the purpose of the proxy consent is to inform the participants about the potential benefits (66.9%) and risks (66.9%) related to the research to study and respect patient’s autonomy (44%), to discuss alternative options (62.1%), and to protect the researchers from any litigation (84.1%). Regarding the assessment of proxy consent, 65.5% of respondents believed that relatives are considered as an authorized legal representative for an informed consent decision on behalf of their ICU patients (65.5%) as they are knowledgeable about patients’ values and preferences and have the desire to provide the necessary help. Respondents also agreed that the informed consent process should explain research protocols and procedures (76.6%), therapeutic alternatives (84.1%), potential benefits (41.4%), and potential risks (44.1%) and that participation in the research is voluntary (66.9%). No significant differences in the responses were found among different groups of healthcare providers. Conclusion. +e majority of healthcare providers had inadequate awareness about the ethical aspects regarding the informed proxy consent process. Providing training regarding the informed consent process can improve the quality of the proxy consent process in clinical research studies in the ICU setting.
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Community pharmacists' preparedness and responses to COVID‐19 pandemic: A multinational study
Authors : Rania Itani, Samar Karout, Hani MJ Khojah, Fatima Jaffal, Fatme Abbas, Reem Awad, Lina Karout, Rana K Abu‐Farha, Mohamad B Kassab, Tareq L Mukattash
Abstract : Background: Community pharmacists play a pivotal role in healthcare worldwide. Their role became more critical during the COVID-19 pandemic. This study aims to investigate the community pharmacists' preparedness and responses to the COVID-19 pandemic and how efficiently they were prepared to contain and prevent the spread of infection.
Methods: An online questionnaire was distributed to community pharmacists in Saudi Arabia, Lebanon, and Jordan through social media platforms. A scoring system was developed to measure their level of adherence to the preventive measures of the global infection.
Results: The total included responses were 800. Around 44% of the pharmacists reported spending less than 15 min/d reading about COVID-19 updates. Although more than half of them were reviewing official sites, 73% of them were also retrieving information through non-official channels. Additionally, almost 35% of them were directly contacting customers without physical barriers, 81% reported encountering infected customers, and 12% wore the same facial masks for more than a day. Moreover, 58% of the pharmacies reported the absence of door signs requesting infected customers to declare the infection, 43% of the pharmacies were not limiting the number of simultaneous customers, and 70% were not measuring customers' temperatures prior to entry. Collectively, the mean total score of applied protective measures was 10.12 ± 2.77 (out of 17).
Conclusion: The level of preparedness of the community pharmacies in these three Middle Eastern countries was not adequate for facing the COVID-19 pandemic. Health authorities in these countries should closely monitor their adherence to the protective guidelines.
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Pharmacists’ perceptions of the use of internet-based medication information by patients: A cross-sectional survey
Authors : Eman Alefishat, Rana Abu Farha, Mohammed Zawiah
Abstract : Purpose: The credibility and the reliability of Internet webpages to seek medication-related information is questionable. The main objective of the current study was to evaluate perception and experience of pharmacists with the use of Internet-based medication information by their patients.
Methods: This is a cross-sectional descriptive study that was conducted to evaluate perception and experience of pharmacists with the use of Internet-based medication information by their patients. During the study period, 200 pharmacists were approached to participate in the study using a paper-based survey to assess their perceptions and current experience with the use of Internet-based medication information by their patients. Data were analyzed using descriptive statistics (mean/standard deviation for continuous variables, and frequency/percentages for qualitative variables). Also, simple linear regression was utilized to screen factors affecting pharmacists’ perception scores of the use of Internet-based medication information.
Results: Among 161 recruited pharmacists, the majority (n = 129, 80.1%) reported receiving inquiries from patients about Internet-based medication information within the last year. Among them, only 22.6% (n = 29) of pharmacists believed that Internet-based medication information is somewhat or very accurate. Unfortunately, only 24.2% (n = 31) of them stated that they always had enough time for their patient to discuss their Internet-based medication information.
Regarding pharmacists’ perception of the use of Internet-based medication information by their patients, more than half of the pharmacists (>50%) believe that Internet-based medication information could increase the patient’s role in taking responsibility. On the other hand, 54.7% (n = 88) of the pharmacists believed that Internet-based medication information would contribute to rising the healthcare cost by obtaining unnecessary medications by patients. Finally, pharmacists’ educational level was found to significantly affect their perception scores toward patient use of Internet-based medication information where those with higher educational level showed lower perception score (r = -0.200, P-value = 0.011).
Conclusion: Although pharmacists felt that usage of Internet-based data by patients is beneficial, they also have believed that it has a negative impact in terms of rising the healthcare cost, and it promotes unnecessary fear or concern about medications. We suggest that pharmacists be trained on principles of critical appraisal to become professional in retrieval information on the Internet that might improve their delivery of healthcare information and their recommendations to patients.
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Pharmacists’ knowledge and perceptions regarding wound management at the community pharmacies in Jordan
Authors : Manal Ayyash, Kamel Jaber, Maram Abu Moghli, Tareq L Mukattash, Rana Abu Farha
Abstract : Community pharmacists play an important role by being a valuable resource in the management of the wound. In this descriptive cross-sectional survey-based study conducted during October 2020, we aimed to assess community pharmacists’ knowledge and perception regarding wound management at the community pharmacies in Jordan. Thus, community pharmacists in Jordan have been invited to fill out an electronic-based survey. During the study period, 152 community pharmacists participated in this study. Regarding participants’ knowledge about wound management, pharmacists showed good knowledge regarding the medications and conditions known to delay wound healing. On the other hand, 82.2% reported a lack of adequate knowledge and adequate skills to deal with wounds. Finally, results showed that male pharmacists showed a higher knowledge score about wound management compared to females (p = 0.001). Those pharmacists who attended a course/workshop about wounds showed a significantly higher knowledge score than those who did not (p < 0.001). In conclusion, our findings revealed that awareness campaigns and educational workshops are needed to enhance pharmacists’ knowledge and skills in this area.
Keywords : Wound care, community pharmacy, knowledge, perception, pharmacists, Jordan
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Caesarean section delivery from maternal perspective: An exploratory study in Jordan
Authors : Sawsan Abuhammad, Tareq L Mukattash, Sayer I Alazzam, Reham Yafawi, Anan S Jarab, Mohammad B Nusair, Rana K Abu‐Farha, Nasr N Alrabadi
Abstract : Aims of the Study: This study aims to determine females' views, experiences and attitudes regarding the caesarean section (CS) and to explore the factors that increase the prevalence of CS in Jordan.
Design: This is a cross-sectional study using a questionnaire that was distributed electronically through social media websites. Study participants included 1005 females with a history of at least one CS. Awareness, experiences about CS, complications and reasons for performing CS were investigated.
Settings: The participants were recruited from all Jordan cities by social media and emails.
Findings: Most of the respondents stated that the source of their knowledge about CS was from the internet (36.2%) followed by family and friends (31.6%). The majority of respondents were satisfied with their CS experience (72.8%). More than half of the participants (56.9%) reported that CS carries no risk for infants. About 53% of respondents stated that the most common reason leading women to choose to give birth via CS is the fear of labour pain. However, the majority of the respondents disagree with performing CS under maternal request (59.2%).
Conclusions and Implications: his study indicated that Jordanian females do not have reliable sources of information about CS. This leads to lower awareness of CS and its complications, and, as expected, CS is more likely to be performed by privately insured women.
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Ophthalmic Drug Abuse: Knowledge, Attitude, and Practice of Ophthalmologists in Jordan
Authors : Waed Al-Khalaileh, Rana Abu-Farha, Marie Claire Van Hout, Mayyada Wazaify
Abstract : This study was conducted to provide background regarding knowledge, attitude, and practice (KAP) of ophthalmologists in Jordan regarding ophthalmic product abuse and misuse. A cross-sectional self-reported survey was conducted among a sample of ophthalmologists of all ranks who were working at different hospitals, centers, and clinics in Jordan. A total of 137 valid questionnaires were returned (response rate = 69.1%). The majority of respondents were male (73.7%) and between 20 and 40 years old. Only 47.4% of our sample knew the correct difference between the definitions “abuse” and “misuse.” The majority of participating ophthalmologists (87.6%) reported that ophthalmic drugs were liable to abuse. Ophthalmologists 40 years or younger had more knowledge about ophthalmic products abuse than their older counterparts (p < 0.05). Most ophthalmologists (67.2%) reported Pentolate® eye drop (cyclopentolate) as the top ophthalmic product liable to abuse. This study provided, for the first time, background regarding the knowledge, attitude, and practice of ophthalmologists about this relatively uncommon and alerting type of drug abuse. Moreover, it highlighted the importance of increasing awareness of ophthalmologists and community pharmacists who dispense such drugs about the issue.
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Willingness of Middle Eastern public to receive COVID-19 vaccines
Authors : Rana Abu-Farha, Tareq Mukattash, Rania Itani, Samar Karout, Hani MJ Khojah, Asia Abed Al-Mahmood, Karem H Alzoubi
Abstract : Background: COVID-19 is a pacing pandemic that affected health systems, economy, and social life in the whole world. Currently, there is no treatment for it, but the world is in a race that yielded, in a relatively short time than usual, several approved, promising vaccines in the middle of a storm of debates because of the speed of their production and approval.
Objective: This study assessed the willingness of Middle Eastern Arab publics to receive COVID-19 vaccines and investigated the factors behind any reluctance to receive them.
Methods: A self-administered questionnaire was distributed through social media applications in four Arab countries (Jordan, Saudi Arabia, Lebanon, and Iraq). Participants’ demographics, medical history, their experience with COVID-19, and their willingness to receive the available vaccines were obtained and analyzed.
Results: A total of 2,925 completed forms were included. Only 25% of the participants were willing to receive a vaccine while 33% were hesitant. Iraqis were the most willing to receive it while Jordanians were the least (35% and 17% of each country, respectively). Interestingly, 60% of the acceptors were ready to pay for the vaccine if not covered by governments. It was also found that American vaccines were preffered by 50% of the acceptors. However, 30% of acceptors were unsure of which vaccine is the best and 11% stated that any vaccine is good. Social media were the major source of information about COVID-19 and its vaccines. Finally, predictors of acceptance of the vaccines included living in Saudi Arabia and Iraq, being unmarried, having monthly income > $1,000, holding a medical degree, having high fear from COVID-19, feeling of being at risk of getting infected with COVID-19, and previous reception of influenza vaccine, whereas predictors of refusal included female sex and previous infection with COVID-19.
Conclusion: Middle Eastern Arabs are less likely to accept receiving the COVID-19 vaccines compared with non-Arabs. Health authorities in these countries are advised to intensify their awareness-raising activities about the vaccines while ensuring fair distribution of them.
Keywords : Willingness, COVID-19 vaccine, Hesitancy, Predictors, Middle East
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Medication discrepancies in hospitalized cancer patients: Do we need medication reconciliation?
Authors : Maram Abu Moghli, Rana Abu Farha, Khawla Abu Hammour
Abstract : Objective: This study aimed to identify and point out the number and types of medication discrepancies among cancer patients admitted to Jordan University Hospital.
Method: This is a cross-sectional observational study that was conducted on cancer patients in the internal medicine department at Jordan University Hospital, Amman, Jordan. During a period of six months, a convenience sample of cancer patients was recruited, and their medical records were reviewed to collect information regarding their demographics, clinical, and medication information. Also, patients’ Best Possible Medication History (BPMH) was collected using different methods, and a comparison between patients’ BPMH and their current medications was conducted where discrepancies were recognized.
Results: Seventy-eight medical records were reviewed, with a total of 166 discrepancies identified. Of these, 110 discrepancies (66.3%) were unintentional. Exactly 67.9% of the study participants (n = 53) were found to have at least one unintentional discrepancy, with the most common type being omissions (n = 71, 65.1%,) and the second most common type being additions (n = 16, 14.7%). Most of the discrepancies ranged between low to moderate in severity. Fifty-six (33.7%) intentional undocumented discrepancies (documentation errors) were also identified.
Conclusion: This study revealed a high rate of medication discrepancies among hospitalized cancer patients, most commonly unintentional omissions. Nevertheless, undocumented intentional discrepancies can equally harm this critically ill population. So, do we need medication reconciliation in cancer patients? Yes. Cancer patients are critically ill, and therefore more effort should be paid towards implementing medication reconciliation services in their treatment plan.
Keywords : Medication discrepancies, medication reconciliation, cancer
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Awareness of pharmacy researchers about the national research code of ethics: A study from Jordan
Authors : Nasr N Alrabadi, Tareq L Mukattash, Karem H Alzoubi, Rana K Abu-Farha, Omar F Khabour, Nizar M Mhaidat
Abstract : Objective: In Jordan, research ethics have been subject to increasingly formal regulations and structuring. Recently the Ministry of Higher Education and Research Published the National Research Code of Ethics. However, little is known about the awareness of pharmacology researchers of this code and the extent of its applicability to their research.
Methods: Purposeful sampling through institutions’ websites was used to identify staff members with excellent profiles from 20 Faculties of Pharmacy in Jordan. After obtaining the required approvals, in-depth interviews were conducted, recorded, transcribed, and analyzed using NVivo 11 Software. The interviews followed a previously prepared and validated interview guide that covered various aspects of education, research, and training.
Key findings: Eighteen members of staff agreed to take part in the study. Qualitative analysis revealed three main themes each concerning respondents’ awareness of the National Code of Research Ethics in Jordan. The emerging themes were: the lack of awareness regarding the code of ethics, the need for clear guidelines for pharmacology research in Jordan, and the need for further workshops and training courses for pharmacology researchers.
Conclusion: This study highlights a lack of awareness regarding the presence of the National Research Ethics Code among pharmacology researchers in Jordan. This might have negative implications on medical research. It was thought that the code of ethics should be incorporated in postgraduate pharmacy education, training courses for pharmacy researchers, and workshops for pharmacy academic staff.
Keywords : Awareness, National research ethics code, Qualitative study, Pharmacology, Pharmacy researchers
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Providing pharmaceutical care during the COVID-19 pandemic: attitudes and experiences of home-treated patients in Jordan
Authors : Tareq L Mukattash, Anan S Jarab, Walid Al-Qerem, Rana K Abu Farha, Rania Itani, Samar Karout, Ibrahim L Mukattash, Iman Basheti
Abstract : Objectives: This study aims to explore home-treated COVID-19 patients’ experiences and perceptions of pharmaceutical care services offered during their sickness.
Methods: This is a cross-sectional online questionnaire study, where a 30-item questionnaire was texted via a link to COVID-19 patients who were tested positive previously. A list of anonymised numbers was obtained from different COVID-19 testing centres. The study received ethical approval from the Institutional Review Board at the King Abdulla University Hospital/Jordan University of Science and Technology.
Key findings: A total of 268 patients who were previously diagnosed with COVID-19 agreed to participate in this study. Only 22.9% of patients reported taking medications regularly. Almost one-third of respondents (28.7%) indicated that pharmacists were involved in prescribing medicine to patients. Almost half the respondents (49.6%) stated that they or their caregivers obtained information and advice about their medicine from the pharmacists. Only 54.9% of the respondents agreed/strongly agreed that pharmacists have enough scientific information to provide the necessary medical assistance to COVID
Keywords : health services research, managed care, international, pharmaceutical HSR
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Exploring perception and hesitancy toward COVID-19 vaccine: A study from Jordan
Authors : Rana Abu Farha, Karem Alzoubi, Omar Khabour, Mahmoud Alfaqih
Abstract : Vaccination against COVID-19 may present the most effective strategy to control current viral pandemic. The success of delivering mass vaccination, on the scale of what would be applied to contain COVID-19, largely depends on the compliance of the public to programs mandated by public health officials. This study was aimed to evaluate the perception and possible hesitance of people in Jordan toward a tentative COVID-19 vaccine using self-administrated online survey. During the study period, a total of 1287 agreed to participate in the study. More than half of the participants (n = 734, 57%) were females and the majority (n = 893, 69%) had a University degree. Most of the participants (n = 871, 68%) believed that scientists have adequate tools to develop a safe and efficacious COVID-19 vaccine and two-third of them (n = 861, 67%) believed that developing vaccines would end the pandemic. However, around half of them (n = 665, 52%) reported not having adequate information on the benefits of COVID-19 vaccination. Preference of study participants to achieve immunity against COVID-19 using natural way was the most commonly reported reason to refuse vaccination (n = 826, 64%), followed by their concern about adverse effects associated with the vaccine (n = 781, 61%). In conclusion, the sampled participants showed an overall positive attitude toward receiving a COVID-19 vaccine. Educational campaigns using television and social media are recommended to better inform the public of the benefits of COVID-19 vaccine in reaching a “herd immunity” based strategy to control the current pandemic.
Keywords : COVID-19, vaccine, perception, public hesitancy, Jordan
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Psychometric properties of Arabic translated temperament instrument
Authors : Sawsan Abuhammad, Manar Al-Azzam, Nasr Alrabadi, Kimberly Howard, Rana AbuFarha
Abstract : Background: Investigating temperament has been a multi-subject exercise that attempts to determine the contribution of temperament to additional measurable phenomena like behavior. The existing research not only evaluates temperament as a variable with the ability to influence additional characteristics but has included interventions that can result in adapted outcomes. Develop an Arabic translation of the Infant Characteristics Questionnaire (ICQ).
Purpose: Examine the psychometric properties of the translation and establish modified criteria for evaluating the questionnaire.
Methods: Cross sectional design was used. Translation of the ICQ was achieved through translation/back translation. The population that used the ICQ translation on convenience sample of 40 Arabic-speaking women with children between the ages of 3–12‐months old; this same group also completed a demographic survey.
Results: The internal consistency of the translated instrument was almost equivalent to or higher than the reported from the United States (US) review. The alpha coefficients calculated from subscales varied between .47 and .87.
Conclusion: This research study described the translation of the ICQ into the Arabic language for use in the research and clinical setting. The ICQ is a useful tool for evaluating infant difficulty by describing and summarizing parents’ ratings.
Keywords : Infant temperament, Secure attachment, Translation, Jordan
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Evaluation of Community Pharmacists’ Professional Practice and Management of Patient's Respiratory Conditions
Authors : A Raja’a, Rana Abu Farha, Maram M Al Ali, Nour S Jaradaneh, Mohamed Izham Mohamed Ibrahim
Abstract : Objectives: We assessed the extent of community pharmacists managing respiratory conditions and their ability to make differential diagnoses between the common cold and allergic rhinitis.
Methods: A simulated patient technique was used to achieve the study objectives. Thirty community pharmacies were randomized to be visited by a patient with allergic rhinitis symptoms, followed by a patient with common cold symptoms, and vice versa. One simulated patient visited the 15 pharmacies assigned to allergic rhinitis. Then, after 3–4 days, the pharmacies were revisited by a second simulated patient using the same symptoms; likewise, a simulated patient visited the other 15 pharmacies with common cold symptoms. Then, these pharmacies were revisited by the other simulated patient with the common cold symptoms. Descriptive statistics and correlation analyses were carried out using SPSS at alpha 0.05.
Results: Fifteen pharmacies were used for the common cold scenario and 15 for the allergic rhinitis scenario (a total of 30 visits per scenario). Pharmacists showed overall poor skills in asking questions for differential diagnosis between the two conditions. No significant difference was found in the overall differential diagnosis score between the two groups (P = 0.744). The overall adherence to the labeling standard score was low, with an average of 2.38 (standard deviation [SD] = 2.50) out of 11, with no significant difference between the two scenarios (P = 0.332). The overall adherence score to the counseling standard was low, with an average of 2.93 (SD = 3.74) out of 15, with no significant difference between the two scenarios (P = 0.586).
Conclusion: The simulated patient technique approach revealed a lack of ability of pharmacists in Amman, Jordan, to make differential diagnoses between the common cold and allergic rhinitis. In addition, pharmacists lacked the ability to carry out their role with respect to the management of the common cold and allergic rhinitis, including treatment recommendations, adherence to medicine labeling standards, and adherence to the counseling standard.
Keywords : Allergic rhinitis, common cold, community pharmacists, Jordan, simulated patient
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Pharmacists' perspectives on providing the COVID-19 vaccine in community pharmacies
Authors : Tareq Mukattash, Anan Jarab, Rana Abu Farha, Saqer Nusair, Mohammad, Al Muqatash
Abstract : Objectives: The objective of this study was to explore community pharmacists’ perspectives on administering COVID-19 vaccine in community pharmacies in Jordan.
Methods: Purposeful sampling was used to identify a list of 100 community pharmacies which were approached to participate in the study. Twenty-three interviews were needed to reach data saturation. In-depth interviews were conducted, recorded, transcribed and analysed using NVivo 11 software. Interviews followed a previously prepared and validated 12-item interview guide. The interview guide discussed pharmacists’ perspectives on providing the COVID-19 vaccine in community pharmacies.
Key findings: The three overarching themes which described the participating pharmacists’ views towards administrating the COVID-19 vaccine in community pharmacies were advantage, support and barriers. The reported advantages included expediting the COVID-19 vaccination process, convince people to take the vaccine, increased patient accessibility to vaccines and aiding the healthcare system in the vaccination process. Respondents indicated that they would be more willing to administer the COVID-19 vaccine if they received the needed support from the Ministry of Health and the Pharmacists Association. Furthermore, from the respondents’ perspectives, the main barriers to this practice were having no confidence in the vaccine, risk of adverse effects and lack of training and expertise.
Conclusions: Respondents reported a positive attitude towards administering the COVID-19 vaccine in community pharmacies. Respondents highlighted that they could help fighting the pandemic through administering the vaccine and expedite the vaccination process.
Keywords : health services research, international, pharmaceutical HSR, qualitative research
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Prevalence and predictors of polypharmacy in Jordanian hospitalised patients: A cross‐sectional Study
Authors : Rana K Abu Farha, Tareq L Mukattash, Lina Al‐Sakran, Khawla Abu Hammour, Mohammed Zawiah
Abstract : Objectives: This study aimed to evaluate the prevalence and predictors of polypharmacy in hospitalised patients in Jordan to help guide healthcare efforts in decreasing the burden on the healthcare system.
Methods: This cross-sectional study was conducted at the University of Jordan Hospital in Amman, Jordan. During the study period, a convenience sample of patients admitted to the internal medicine and surgical wards were approached to take part in this study. Following patients’ recruitments, patients were interviewed and their medical files were reviewed to obtain demographic and clinical information regarding their medical conditions and their regular use of medicines. Then, the prevalence of patients with polypharmacy were identified, and factors predicting polypharmacy among them were determined.
Results: Among the 300 participants who agreed to participate in this study, females represented 45.3% of the recruited sample (n = 139), and around 48.0% (n = 144) of the study sample were elderly people (≥65 years old).
Most of the recruited patients (n = 248, 82.7%) were found to use polypharmacy (≥ 5 medications). Hypertension was the most frequent medical condition among study participants (n = 240, 80.0%) followed by diabetes (n = 185, 61.7%). Results of logistic regression analysis showed that polypharmacy was only significantly affected by patients’ age (OR = 2.149, P-value = .024) and monthly income (OR = 0.336, P-value = .009), while other factors were not associated with polypharmacy. Elderly patients (≥65 years) were found to have polypharmacy more significantly than non-elderly patients. Also, those with lower monthly income (<500 JD) were found to use lower polypharmacy compared with those with higher monthly income (>500 JD).
Conclusion: The present study showed that polypharmacy is prevalent among patients in Jordan. While polypharmacy was not affected by smoking status, gender, BMI and educational level, it was significantly affected by monthly income and age. Further plans should be put in place to reduce polypharmacy, starting with effective pharmaceutical care services leading to treatment optimisation and ensuring desired treatment outcomes
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Antimicrobial stewardship in community pharmacies in Jordan: assessing current status
Authors : Doaa Saleh, Rana Abu Farha, Feras Darwish El-Hajji
Abstract : Objectives: The aim of this study was to assess knowledge and perceptions of the Jordanian community pharmacists towards antimicrobial resistance and antimicrobial stewardship programmes (ASPs).
Methods: A descriptive cross-sectional questionnaire-based study was conducted between August and September 2020. The validated questionnaire consisted of sections that measure participants’ demographics, knowledge and perceptions towards ASPs, and assess antibiotic prescribing practice. Questionnaires were distributed via social media to be filled by community pharmacists in Jordan. For knowledge questions, participants gained one point for each correct answer and zero point for each incorrect answer. Then, a knowledge score was calculated out of 10.
Key findings: During the study period, a convenience sample of 200 pharmacists were recruited and were asked to fill out the study questionnaire, with a majority claimed attending ASPs workshops previously (n = 162, 81.0%). The main sources of knowledge about antimicrobial resistance were university courses and books. With a median knowledge score of 6/10, participants knew that antimicrobials are not always safe. Although only less than 25% knew that ASPs does not necessarily increase treatment duration, most of the pharmacists had positive perceptions towards ASPs. Barriers against application of ASPs were mainly lack of training and lack of physicians’ cooperation (89.0% and 87.5%, respectively). It was agreed by 90.0% of the respondents that ASPs would boost public health confidence in community pharmacists, and 86.0% believed that ASPs would enhance their job satisfaction. Multivariate linear regression showed that female gender of pharmacist was significantly associated with higher knowledge score (P-value = 0.045).
Conclusions: This study highlighted that community pharmacists have a good knowledge in antibiotics and a positive perception regarding ASPs. Despite not being highly familiar with ASPs concept, pharmacists showed great support for involvement in ASPs. They also encouraged incorporating ASPs within community pharmacy level which is considered crucial to control antimicrobial resistance throughout the world.
Keywords : antimicrobial stewardship, knowledge, perception, community pharmacists, Jordan
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Perception of pharmacy students towards their community pharmacy training experience: a cross-sectional study from Jordan
Authors : Rana Abu Farha, Eman Elayeh, Needa Zalloum, Tareq Mukattash, Eman Alefishat, Maysa Suyagh, Iman Basheti
Abstract : Background: The fact that pharmacists are in the front line of patients’ care gives a great responsibility to focus on education and training of pharmacy students to build a ‘patient-centered’ clinicians. Unfortunately, pharmacy education in the developing countries, have been lagging behind actual practice delivered by pharmacists. This highlighted the need to evaluate the perceptions of undergraduate pharmacy students regarding their current pharmacy training practices and experiences.
Methods: This is a cross-sectional study that was conducted in Jordan during the period from August 2018 to October 2018. During the study period, a questionnaire was distributed to pharmacy students to collect information regarding 1) pharmaceutical care services provided by them during their experiential training, 2) their perceptions towards training sites, 3) their perceptions of the outcomes of their training experience, 4) information about their training site and 5) their demographics characteristics.
Results: A total of 202 pharmacy students responded to the questionnaire. The majority of them reported having the opportunity to dispense refill or new prescriptions (73.8%, n = 149), and conduct patient interviews (69.8%, n = 141, but they were not provided good opportunities to create electronic patient profiles using the information obtained (53.0%, n = 107), perform required dose calculations based on patient information (37.6%, n = 76), and interact with other healthcare professionals (34.6%, n = 70). In addition, students showed positive attitudes toward training sites, positive feedback about the outcomes of their training experience (median scores range between 4 and 5 for all statements (IQR = 1 for all)).
Conclusion: Students showed positive feedback about the outcomes of their training experience, but they felt that the selected training sites do not have adequate resources to meet their training competencies. Memorandums of understanding development is needed to specify the purpose of training and define the responsibility for both parties of the training process.
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Views of Community Pharmacists on Antimicrobial Resistance and Antimicrobial Stewardship in Jordan: A Qualitative Study
Authors : Doaa Saleh, Rana Abu-Farha, Tareq Mukattash, Muna Barakat, Eman Alefishat
Abstract : The Center for Disease Control and Prevention and the World Health Organization issued a practical approach and Global Action Plan to control the threatening emerging antibacterial resistance. One of the main bases of this plan is the Antimicrobial Stewardship Program (ASPs). This study aimed to evaluate community pharmacists’ awareness and perception towards antimicrobial resistance and ASPs in Jordan. Thus, a qualitative study was conducted through in-depth interviews with twenty community pharmacists. Convenience sampling was used in the study. Qualitative analysis of the data yielded four themes and eleven sub-themes. All the respondents showed a good understanding of the causes of antimicrobial resistance. The most important cause reported by them was the non-restricted prescription of antimicrobials. Most of the pharmacists believed that they are competent to provide ASPs, however, they believed that there are several barriers against the implementation of ASPs in community pharmacies in Jordan. Barriers demonstrated by the pharmacists, included organizational obstacles, resources obstacles, and personal obstacles. In conclusion, this study revealed several barriers against the implementation of ASPs in community pharmacies in Jordan. Incorporating ASPs in the community pharmacy settings requires proper pharmacist training, several academic disciplines team efforts, and good pharmacy practice of antimicrobial guidelines.
Keywords : antimicrobial stewardship; antimicrobial resistance; community pharmacist; qualitative research; Jordan
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Pharmacy students’ knowledge and perception about the implementation of pharmaceutical care services in Jordan
Authors : Rana Abu Farha, Mohammad Saadeh, Tareq L Mukattash, Anan S Jarab, Mohammad B Nusair, Waleed Al-Qirim
Abstract : Background: The concept of pharmaceutical care was introduced to the literature by helper and strand before around thirty years, they defined it as "the provision of drug therapy for the purpose of achieving definite outcomes that improve a patient's quality of life". Jordan is still moving slowly toward implementing this service which showed numerous health and economic benefits since its implementation. Objectives: This study aimed to measure pharmacy the knowledge and perception of pharmacy students approaching the completion of their studies towards pharmaceutical care and their readiness to implement it in their practice after graduation. Methods: An electronic questionnaire was distributed via the internet to pharmacy and doctor of pharmacy students in public and private universities in Jordan. The questionnaire was composed of 35 question and was divided into three sections. Section one measured knowledge, while section two explored respondents' perceptions of pharmaceutical care. The final section collected respondents’ demographic details. Results: A total of 215 respondent took part in the study. The knowledge score of pharmaceutical care among respondents was 45%, although the vast majority of them stated that they completed at least one module regarding pharmaceutical care during their studies. On the other hand, almost 75% of respondents had a positive perception of pharmaceutical care in Jordan. Results showed statically significant differences among students regarding university type and academic year. Conclusion: Though respondents completed pharmaceutical care courses during their studies, they had low knowledge regarding the term and its implementation. Combining didactic and experiential education in crucial to build proper practice capacities among future pharmacists
Keywords : Pharmaceutical care; students; pharmacy; knowledge; perception
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Medication errors: a focus on nursing practice
Authors : Nasr Alrabadi, Shaima Shawagfeh, Razan Haddad, Tareq Mukattash, Sawsan Abuhammad, Daher Al-rabadi, Rana Abu Farha, Suzan AlRabadi, Ibrahim Al-Faouri
Abstract : Objectives: Health departments endeavor to give care to individuals to remain in healthy conditions. Medications errors (MEs), one of the most types of medical errors, could be venomous in clinical settings. Patients will be harmed physically and psychologically, in addition to adverse economic consequences. Reviewing and understanding the topic of medication error especially by nurses can help in advancing the medical services to patients.
Methods: A search using search engines such as PubMed and Google scholar were used in finding articles related to the review topic.
Key findings: This review highlighted the classifications of MEs, their types, outcomes, reporting process, and the strategies of error avoidance. This summary can bridge and open gates of awareness on how to deal with and prevent error occurrences. It highlights the importance of reporting strategies as mainstay prevention methods for medication errors.
Conclusions: Medication errors are classified based on multifaceted criteria and there is a need to standardize the recommendations and make them a central goal all over the globe for the best practice. Nurses are the frontlines of clinical settings, encouraged to be one integrated body to prevent the occurrence of medication errors. Thus, systemizing the guidelines are required such as education and training, independent double checks, standardized procedures, follow the five rights, documentation, keep lines of communication open, inform patients of drug they receive, follow strict guidelines, improve labeling and package format, focus on the work environment, reduce workload, ways to avoid distraction, fix the faulty system, enhancing job security for nurses, create a cultural blame-free workspace, as well as hospital administration, should support and revise processes of error reporting, and spread the awareness of the importance of reporting.
Keywords : health policy, pharmaco-economics, quality of care, management, epidemiology
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Infant temperament as a predictor of maternal attachment: a Jordanian study
Authors : Sawsan Abuhammad, Manar AlAzzam, Rana AbuFarha
Abstract : Aim: To investigate the relationship between maternal bonding and infant temperament during the first year of infant's life. Moreover, it also wanted to explore which perinatal factors could influence the quality of maternal attachment.
Method: A cross-sectional study design was used to collect data from a sample of 277 mothers during the period of May–October 2018. The participants were asked to complete a three-part survey that was developed to collect data on maternal attachment and infant temperament. Data was collected between March 2019–June 2019.
Results: The analysis of the data revealed that there was a significant relationship between infant temperament and maternal attachment [F(2, 95) = 6.783, p-value = .001]. It also revealed that the factors that most influenced maternal attachment were infant temperament and planned pregnancy, which together explained 54% of the variance in maternal attachment (R2 = 7.5).
Conclusion: Maternal attachment in Jordanian mothers can be explained by two significant factors: infant temperament and planning for pregnancy.
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Pharmacists’ readiness to deal with the coronavirus pandemic: Assessing awareness and perception of roles
Authors : Iman A Basheti, Razan Nassar, Muna Barakat, Rajaa Alqudah, Rana Abufarha, Tareq L Mukattash, Bandana Saini
Abstract : Background: The 2019 Coronavirus infection (COVID-19) caused by a novel strain of coronavirus was detected in China in December 2019, and declared a public health emergency of international concern on January 30, 2020. Community pharmacists have an important role in supporting the local health emergency preparedness and response arrangements.
Objectives: To investigate pharmacists and pharmacy students’ awareness and source of their information regard the management of the coronavirus pandemic, and their perspective of their role during this emergent situation.
Methods: This descriptive cross-sectional online survey study was conducted in Jordan during the COVID-19 outbreak (from 15 to 30 March 2020). A validated online questionnaire addressing participants' current awareness about epidemics/pandemics and COVID-19, source of information and their perspectives of their role. Data were analyzed using statistical package for social science (SPSS).
Results: Participants (n = 726) had a mean age of 26.9 (8.0) years with 71.9% females. Pharmacy students made 35.3% of the sample while the rest were pharmacists. Only 54.3% of participants believed that they got enough education about epidemics/pandemics, and 94.6% of them follow on the latest coronavirus updates on treatments, and that is mainly from the media (59.5%) followed by the World Health Organization reports (58.7%) and then the published researches (57%). Awareness score (out of 20) of pharmacists (n = 470) was significantly higher (p < 0.001) than that of students (n = 256). Better Awareness scores were also associated with higher age of participants, graduating from a public versus a private university, and attending more educational workshops.
Conclusion:The majority of pharmacists and pharmacy students reported that they have a major role in the management of epidemics/pandemics through the community pharmacies but the majority follow on the latest coronavirus updates from the media. This fact rings bills considering the numerous conflicting messages publicized during the pandemic through the media.
Keywords : Coronavirus, Pandemics, Pharmacists, Faculty of pharmacy, Pharmaceutical association, Jordan
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Evaluation of the potential anticancer activity of different vitamin D metabolites on colorectal and breast cancer cell lines
Authors : Abeer Khriesha, Yasser Bustanji, Rana Abu Farha, R Al-Abbasi, B Abu-Irmaileh
Abstract : Objectives: Vitamin D is very important for calcium and mineral metabolism, and many hypotheses appear to link sunlight exposure with cancer risk and prognosis. As many studies supported the antitumor effect of vitamin D we wanted to investigate the potential effect of multiple vitamin D metabolites.
Methods: This study compared the anticancer effect of three inactive forms of vitamin D3 which are; cholecalciferol, alfacalcidol, and calcifediol on two human cancer cell lines colorectal cancer (CaCo II) and breast cancer (MCF-7). All were examined after 24, 48, and 72 h continuous exposure using a colorimetric assay (MTT) seeded in 96-multiwell plates. Doxorubicin anticancer used as a standard agent for comparison, while normal skin fibroblast cells (HDFa) was used as our negative control. IC50 values were calculated as indication of antitumor effect.
Results: Broad-spectrum of cytotoxicity with IC50 values ranging from 4 to 200 μM were found. Alfacalcidol was the most potent cytotoxic agents on colorectal cancer (CaCo II) and breast cancer (MCF-7) compared to cholecalciferol, and calcifediol. Both, alfacalcidol and calcifediol were more cytotoxic than cholecalciferol on the tested cell lines as they are partially active metabolites. Breast cancer (MCF-7) was the most sensitive to all metabolites at all-time intervals with the best IC50 values of 4.35 μM ± 1.06 after 72 h continuous exposure of alfacalcidol.
Conclusions: Vitamin D metabolites are a potential option for cancer treatment along with or an alternative to chemo-therapeutics although extensive preclinical studies are required to prove this effect.
Keywords : breast cancer; cell line; colorectal cancer; cytotoxic; vitamin D
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Impact of Educational Intervention to Promote Jordanian Community Pharmacists’ Knowledge and Perception Towards Antimicrobial Stewardship: Pre-Post Interventional Study
Authors : Doaa Saleh, Rana Abu Farha, Eman Alefishat
Abstract : Objective: The aim of this study was to assess the impact of an online educational workshop on improving the knowledge, and perception of community pharmacists in Jordan towards the antimicrobial stewardship (AMS) and enhancing their ability to appropriately select correct antibiotic therapy.
Methods: This is a pre-post study that was conducted in Jordan in December 2020. An electronic questionnaire was used to assess the awareness, perception of community pharmacists towards AMS, and their ability to appropriately select correct antibiotic before and after the educational workshop. The two-days’ workshop was conducted on Zoom application. Analysis was conducted using Wilcoxon signed-rank test, McNemar’s test using SPSS version 22.
Results: During the study period, 100 community pharmacists attended the educational workshop. Pharmacists’ knowledge was assessed prior to their participation which revealed a relatively good knowledge score with a median score of 6/10 (IQR = 4); their scores have improved significantly following the educational workshop with a median score of 7/10 (IOR = 2), p-value<0.001. Although one-third of the participants knew the definition of AMS prior to the workshop, almost half of the respondents (n = 56, 56%) knew the definition after the educational workshop. Regarding community pharmacist’s ability to appropriately select correct antibiotic therapy, they showed a significant improvement in selecting the optimal antimicrobial for the virtual cases following the workshop (p-value < 0.05). Perceptions towards AMS were consistently positive before and after the workshop.
Conclusion: This study revealed the benefit of AMS-focused workshops for improving community pharmacists’ knowledge and appropriate antibiotic prescribing. Thus, efforts are required to implement more AMS educational workshops for community pharmacists.
Keywords : stewardship program, antimicrobial resistance, community pharmacist, workshop, knowledge, perception
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Knowledge and attitudes of pharmacists towards colorectal cancer health education in Jordan: A cross‐sectional study
Authors : Mohammad AY Alqudah, Raneem M Al‐Samman, Tareq L Mukattash, Rana K Abu‐Farha
Abstract : Aims of the study: The purpose of this study was to assess pharmacists’ knowledge and attitude towards early detection of colorectal cancer (CRC) in Jordan and to explore potential predictor variables of such knowledge and attitude.
Methods used to conduct the study: An electronic, self-reported questionnaire was used to collect data about demographics, knowledge and attitude regarding early detection of CRC. Both content and face validity were tested in a panel of experts. The participants’ responses were analysed using descriptive statistics and multiple linear regressions.
Results of the study: The 352 pharmacists (78% females, 94% Jordanian) had a median age of 28 years and graduated mostly (83%) from public universities. Surprisingly, 90% were not able to identify carcinoembryonic antigen (CEA) as a non-accurate diagnostic method and almost one-third did not identify the correct screening tests. On a scale of 5, the majority of participants (59%) had moderate knowledge scores (3 or 4) in case scenarios. The median knowledge Percent of Maximum Possible (POMP) score was 67% and higher scores were associated with more years since graduation, pharmacists with MSc degree and higher, working in urban areas, studying oncology course and received oncology training (P < .05). Most participants showed a positive attitude towards early detection of CRC (median attitude POMP score was 78%). However, none of the analysed variables predicted their level of attitude.
Conclusions drawn from the study and clinical implications: Although the majority of pharmacists demonstrated a positive attitude towards early detection of CRC, their knowledge was inadequate. The study highlighted the importance of optimising the education programmes to improve the pharmacists’ knowledge about CRC early detection and preparing the pharmacists for participating in future national screening initiatives.
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Pharmacists’ perceived barriers towards delivering their emergency roles during the COVID-19 pandemic and perceived policymakers’ responsibilities
Authors : Iman A Basheti, Razan Nassar, Muna Barakat, Rajaa Alqudah, Rana Abu Farha, Tareq Muqatash, Samar Thiab, Bandana Saini
Abstract : Rational: In March 2020, the World Health Organization (WHO) declared the coronavirus infectious disease as a pandemic referred to as COVID-19. As an essential service, community pharmacists have been enacting a key role in patient counseling and supply of essential medicines and protective equipment.
Objectives: To investigate pharmacists’ perspectives of the role of educational institutes and professional pharmacy organizations in supporting them to take on roles during COVID-19 pandemic and to identify barriers to be able to support themselves and their patients.
Methods: This descriptive mixed-method study was conducted via a cross-sectional online survey distributed to pharmacists/pharmacy students in Jordan during the COVID-19 outbreak (15–30 March 2020) using an online questionnaire, followed by an online focus group. Questionnaire items related to participants’ perspectives in being prepared for and supported in their roles during the COVID-19 pandemic, and items were tested for face validity. Data were descriptively analyzed using the Statistical Package for the Social Sciences and triangulated with focus group findings.
Results: Considering that fear and anxiety are a consequence of mass social distancing/quarantine, study participants (n = 726, age = 26.9 (SD = 8.0) years, 71.9% females), reported needing training on mental healthcare to be able to support themselves and people during pandemics (90.2%). Most respondents agreed/strongly agreed (59.7%) with the statement around pharmacy educators/educational institutes having a key role in preparing pharmacists for practice during epidemics/pandemics and agreed that their faculties should add a course regarding pandemic preparedness in their curriculum (89.9%). Results were similar regarding roles for the pharmaceutical associations. Focus group findings (n = 7) mirrored the survey findings to a large extent.
Conclusions: Most participants believed that pharmacy educators and pharmaceutical associations have a role in preparing them to deal with the COVID-19 pandemic through online educational workshops/webinars. Online education on mental healthcare is specifically needed.
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Willingness and readiness to test for COVID‐19; A qualitative exploration of community pharmacists
Authors : Tareq L Mukattash, Anan S Jarab, Rana K Abu‐Farha, Mohammad Nusair, Ibrahim L Mukattash, Rana M Obaidat, Maher Khdour, Iman Basheti
Abstract : Objectives: The present study aimed to exploring community pharmacists’ willingness and readiness to test for COVID-19 in Jordan.
Methods: Purposeful sampling was used to identify a list of 30 community pharmacies, which were approached to participate in the study. Twenty interviews were needed to reach data saturation. In-depth interviews were conducted, recorded, transcribed, and analysed using NVivo 11 Software. Interviews followed a previously prepared and validated 10-item interview guide. The interview guide discussed pharmacists’ willingness and readiness to test for COVID-19.
Results: Twenty community pharmacists were interviewed for the purpose of the present study. Interviews took place during April 2020 and the mean interview duration was 23.30 minutes. Respondents had a mean age of 36.4 years and a mean experience of 8.8 years. The majority were female (70%) and 50% held a BSc in Pharmacy. Regarding respondents’ willingness to test for COVID-19 emerging themes were helping other healthcare professional, willingness to contribute to official efforts in fighting COVID-19, acting as an accessible testing cite, willingness to carry out home testing. Regarding respondents’ readiness to test for COVID-19 emerging themes were Pharmacists lack basic testing skills, pharmacies are not ready to preform tests and the need for training and certifying.
Conclusion: Jordanian pharmacists are willing to test patients for COVID-19 in community pharmacies, however, they thought they are not ready enough to undergo such tests and needed extra training and better safety precautions.
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Herbal medicines: a cross-sectional study to evaluate the prevalence and predictors of use among Jordanian adults
Authors : Faris El-Dahiyat, Mohamed Rashrash, Sawsan Abuhamdah, Rana Abu Farha, Zaheer-Ud-Din Babar
Abstract : Introduction: Understanding why adults resort to herbal medicine can help in planning interventions aimed at increasing awareness regarding herbal use. This study sought to investigate the prevalence and to determine factors for predicting the use of herbal medicine among Jordanian adults.
Methods: A cross-sectional study was conducted involving 378 older adults who were randomly selected from two different areas of Jordan. A questionnaire was used to gather data and validation criteria for validity and reliability of the content were tested by content and face validity in a panel of experts.
Results: From a total of 500 invited participants, 378 completed the questionnaire. The prevalence of the use of of herbal products in this study was high at 80.2%. Herbal medicines use was not associated with any demographic factors other than age (p < 0.05). Moreover, the only associated health-related characteristic was the patient’s disease state including, notably, hypertension (p < 0.05). Reasons for not using herbal medicines as reported by nonusers included mainly a lack of belief in their efficacy (52.2%). Another two important reasons were that the individuals believed themselves to healthy and have no need for their use (31.3%) and the unavailability of enough information about the herbal medicines (29.7%). Finally, the most common side effects as reported by patients in this study were nausea and vomiting (9.3%), and, to a lesser extent, skin rash (2.1%).
Conclusion: There is a high rate of use of herbal medicines in Jordan, especially among hypertensive patients. Therefore, there is a need to establish effective herbal medicine policies and health education programs to discuss the benefits and risks of herbal medicine use, with the aim of maximizing patient-desired therapeutic outcomes.
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Evaluation of women knowledge and perception about polycystic ovary syndrome and its management in Jordan: A survey‐based study
Authors : May Abu‐Taha, Aya Daghash, Rajaa Daghash, Rana Abu Farha
Abstract : Objectives: Polycystic ovary syndrome (PCOS) is a common metabolic and endocrine disorder in females in their reproductive-age and is associated with clinical complications. The aim of this study was to evaluate the knowledge and perception of women in Jordan about PCOS, its symptoms, diagnosis and treatment.
Methods: A descriptive, cross-sectional study that was designed in order to assess female knowledge, and perceptions about PCOS in Jordan. The study was carried out through a validated questionnaire and 227 was the number of recruited female participants.
Results: The result showed that the participants had inadequate knowledge about PCOS. The major sources of information were physician and family (n = 77, 34%), 205 participants were aware that irregular or absence of menstrual cycle is a symptom of PCOS (90.3%). More than half of participants (55.9%) believe that PCOS patients have low body image. The educational level and marital status factors were significantly associated with participants’ knowledge about PCOS (P-value = .008 and .004, respectively).
Conclusion: The result of this study concluded that women have insufficient knowledge about PCOS and its complication. There is a need to enhance the knowledge and perception in female population in Jordan by developing education using different sources.
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Pharmacists’ perception of their role during COVID-19: a qualitative content analysis of posts on Facebook pharmacy groups in Jordan
Authors : Tareq L Mukattash, Anan S Jarab, Ibrahim Mukattash, Mohammad B Nusair, Rana Abu Farha, May Bisharat, Iman A Basheti
Abstract : Objective: This study aimed to evaluate the content available on Facebook pharmacy groups in Jordan regarding the perception of the pharmacists’ role during the coronavirus pandemic in Jordan.
Methods: Researchers identified Facebook pharmacy groups through the search engine on the Facebook website. The main search keywords were pharmacy, pharmacist, pharmacists, and Jordan using both Arabic and English. Two researchers analyzed the posts and discussion threads on local pharmacy Facebook groups in a period between March 20 th and April 3 rd. A total of 184 posts and threads were identified for the purpose of the study.
Results: Identified threads and responses resulted in three overarching themes: pharmacists having a positive role during the pandemic, taking additional responsibilities and services, and having passive or negative roles. A positive role was seen in pharmacists acting as first-line healthcare providers, creating public’s awareness regarding COVID-19, and being responsible for chronic medication refill during the pandemic. Taking additional responsibilities was summarized in home deliveries and involvement in industrial and corporate efforts to deal with the pandemic. A passive/negative role was seen mostly among hospital pharmacists not being proactive during the pandemic and by pharmacists trying to maximize profits during pandemic time.
Conclusions: Pharmacists perceived their role as a positive role during the coronavirus pandemic. Not only they took responsibilities for their daily services during the crises, but they took additional responsibilities to assure patient safety and satisfaction.
Keywords : Pharmacists; Pharmaceutical Services; Pharmacies; Severe Acute Respiratory Syndrome; Coronavirus; Pandemics; Professional Role; Self Concept; Personal Satisfaction; Social Media; Qualitative Research; Jordan
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Factors affecting health‐related quality of life among hypertensive patients using the EQ‐5D tool
Authors : Eman Alefishat, Anan S. Jarab, Rana Abu Farha
Abstract : Objectives: Hypertension (HTN) is a major risk factor for cardiovascular disease, it is an epidemic health problem with 1 billion people affected worldwide. Limited studies have examined the impact of HTN on physical, psychological and social functioning of HTN patients. Furthermore, little is known about factors that impair these domains among these patients. Thus, the aim of the present study is to assess health-related quality of life (HRQoL) and to explore predictors of poor HRQoL in patients with HTN in Jordan.
Methods: Hypertensive patients visiting cardiology and internal medicine departments were recruited from three major hospitals in Jordan. Patients’ Socio-demographics and medical data were collected via direct patient encounters and medical records. The validated Arabic version of EQ-5D tool was used to assess HRQoL. Simple linear regression was performed to explore the factors associated with poor HRQoL.
Results: The mean score of the EQ-5D index of the 300 participants was 0.732 (SD = 0.29, range from −0.594 to 1.0). While extreme problems were only reported by 10% of the participants, most of them reported “some problems” through the five dimensions with the highest percentage (43.3%) for mobility dimension. Gender, monthly income, number of medical conditions, number of medications, number of HTN medications, duration of HTN and the presence of any atherosclerotic cardiovascular diseases were significantly associated with the EQ-5D index value (P-value <.05).
Conclusions: The current study highlights factors that negatively impact HRQoL in patients with HTN. Such findings should provide useful information for future pharmaceutical care intervention programmes aimed at improving HRQoL and other health outcomes in patients with HTN.
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Pharmaceutical care in children, an exploratory study of parental experiences in Jordan
Authors : Tareq L Mukattash, Anan S Jarab, Walaa H Gharaibeh, Rana K Abu-Farha, Mohammad B Nusair, Rajaa Daghash
Abstract : Background Pediatric pharmaceutical care is a new concept in the pharmacy profession. In Jordan, the knowledge of pediatric pharmaceutical care is limited, which may have negative consequences on pediatric pharmaceutical care and treatment efficacy and safety. Objectives The main objective of the present study is to assess parental needs for pediatric pharmaceutical care services and explore their current experiences of pharmaceutical services provided to their children. Setting Parental Facebook Groups in Jordan. Methods A descriptive, cross-sectional survey was designed and distributed online via Social Media networks, mainly Facebook. The validated survey contained 4 main sections addressing different themes related to pediatric pharmaceutical care services including: (1) parental perception of pediatric pharmaceutical care services. (2) Parental needs, wants, and expectations from the pharmacist when providing care to their children. (3) Parental awareness about pediatric pharmaceutical care, and parental satisfaction with current pediatric pharmaceutical care. Respondents who agreed to complete the survey signed and electronic informed consent form to access it. Main outcome measure The main outcomes measure was parental need for pediatric pharmaceutical care services. Results A total of 1104 respondents took part in the study. Of those 71% were female and 44% were 31–40 years old. The majority of respondents (78%) were not familiar with the pediatric pharmaceutical care term. The calculated overall mean perception score was 63.4%. The majority of respondents (89%) reported to need pediatric pharmaceutical care and the mean need score was 71.7%. Only 10.5% agreed/strongly agreed that their children were offered good pediatric pharmaceutical care services and respondents has a total mean satisfaction score of 65.7%. Conclusion The majority of the respondents reported that they need pharmaceutical care services for their children. Pharmacists in Jordan have to develop their role to incorporate pediatric pharmaceutical care services in their practice.
Keywords : https://link.springer.com/article/10.1007/s11096-020-01095-0
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An assessment of HIV patient's adherence to treatment and need for pharmaceutical care in Jordan
Authors : Yara R Al Tall, Tareq L Mukattash, Huda Sheikha, Anan S Jarab, Mohammad B Nusair, Rana K Abu‐Farha
Abstract : Objective: The objective of the present study was to explore the barriers and supporting factors for adherence among HIV patients and to explore their needs for pharmaceutical care services.
Methods: This study utilizes in-depth interviews with HIV patients. Out of 50 patients approached, a total of 30 patients agreed to participate in the study. The researchers used a predesigned topic guide. The interview guide included two parts; the first one focused on the assessment of HIV patients' adherence to their treatment. The second part focused on patients' need for pharmaceutical care services.
Results: Three main themes emerged from the interviews. Those included patient-related factors, medication-related factors and Healthcare professional related factors. This study found that a number of barriers that decreased adherence in HIV patients included stigmatisation, fear from disclosure, dosage form of the drug, adverse events and poor cooperation from healthcare professionals. On the other side supporting factors included family and friends support, electronic mobile reminders, feeling responsible to raising children, religious beliefs and feeling improvement while using therapy. Furthermore, the study illustrated that HIV patients need to have a specialist pharmacist in their healthcare team who delivers specialised pharmaceutical care services which may increase patients' adherence.
Conclusions: The current study reveals a margin for medication adherence improvement in HIV patients. Patients in this study demonstrated the need for a pharmaceutical care. Future disease management and clinical pharmacy services programs should address the current study findings in order to improve the health service for HIV patients.
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Health-related quality of life and its associated factors among patients with angina in Jordan
Authors : Anan S Jarab, Abdullah Almousa, Abeer M Rababa’h, Tareq L Mukattash, Rana Abu Farha
Abstract : Background: Despite the negative impact of angina and its worsening symptoms on the quality of life of the affected patients, little research has evaluated the factors associated with poor health-related quality of life (HRQOL) among patients with angina.
Objective: The study aim was to evaluate HRQOL and to explore factors associated with poor HRQOL in patients with angina in Jordan.
Setting: The present study used data collected for patients attending the cardiology clinic at the Royal Medical Services (RMS) Hospital in Amman.
Methods: In addition to collecting sociodemographic and clinical data, the EQ-5D questionnaire was used to assess HRQOL in outpatients with angina in the present study. Multiple linear regression analysis was conducted to build a model with variables that are significantly and independently associated with poor HRQOL.
Main outcome measure: HRQOL quantified using the EQ-5D.
Results: The mean of the total EQ-5D score of the 500 participants was 0.392. Most of the patients reported ‘some problems’ through the five dimensions, with the highest percentage (66.6%) related to mobility domain. Regression analysis identified female gender (B = − 0.232; P < 0.05) elevated fasting blood sugar (FBS) (P < 0.05; B = − 0.219), and low high density lipoprotein (HDL) (B = − 0.183; P < 0.05) as being significantly associated with poor HRQOL.
Conclusions: The HRQOL has considerable scope for improvement for patients with angina in Jordan. Female gender, elevated FBS, and decreased HDL levels were significantly associated with poor HRQoL in the present study.
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Evaluation of the effect of video tutorial training on improving pharmacy students' knowledge and skills about medication reconciliation
Authors : Rana K Abu Farha, Mays Rashad, Eliza Hasen, Tareq L Mukattash, Amna Al-Hashar, Iman A Basheti
Abstract : Objectives: This study aimed to describe the effect of using an innovative teaching strategy using a video tutorial on enhancing students’ knowledge about medication reconciliation, and skills in identifying medication discrepancies.
Methods: This is a one group pre-post interventional study that was conducted at the School of Pharmacy at Applied Science Private University. Sixty pharmacy students were invited to attend an educational sessions that involve watching a 6-minutes video tutorial. The first two levels of the Kirkpatrick’s Model were used to evaluate the effectiveness of this training tool. Level 1 (Reaction) was assessed using a satisfaction questionnaire, while level 2 (Learning) was assessed using two criteria: 1) student acquired knowledge about medication reconciliation using a questionnaire and a knowledge score out of 13 was calculated for each student, and 2) student acquired skills in identifying medication discrepancies using a virtual case scenario. If the student was able to identify any of the four impeded discrepancies he/she rewarded 1 point for each identified discrepancy, but if they identified any incorrect discrepancy they scored a negative point.
Results: Among the 60 students who registered to participate in the study, 49 attended the educational training (response rate 81.6%). The majority of them (n=44, 89.8%) were satisfied with the training process. Before the video tutorial, students showed an overall low knowledge score [4.08/13.0, SD 1.81], and low ability to identify discrepancies [0.72 identified discrepancies out of 4.0, SD 1.1]. Following the video tutorial, the overall knowledge score was improved (p<0.001), and students were able to identify more discrepancies after watching the video (p<0.001).
Conclusion: In conclusion, video education has shown itself to be an effective method to educate pharmacy students. This visualized method can be applied to other areas within pharmacy education. We encourage the integration of videos within the learning process to enhance students’ learning experience and to support the traditional learning provided by the teaching staff.
Keywords : Students Pharmacy; Education Pharmacy; Videotape Recording; Teaching; Medication Reconciliation; Educational Measurement; Controlled Before-After Studies; Jordan
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Adherence to azathioprine/6-mercaptopurine in children and adolescents with inflammatory bowel diseases: a multimethod study
Authors : Mervat M Alsous, Ahmed F Hawwa, Cameron Imrie, Andras Szabo, Eman Alefishat, Rana Abu Farha, Mohammad Rwalah, Rob Horne, James C McElnay
Abstract : Background. Measurement of the degree of adherence is a key element for the evaluation of treatment efficacy and safety; thus, adherence plays an important role in clinical research and practice. The aim of this study was to investigate medication adherence in children with inflammatory bowel disease (IBD) utilizing a multimethod assessment approach. A further aim was to examine factors that can influence adherence within this population. Methods. Medication adherence in 47 children (age range 3 to 17 years) with IBD in three centers in Northern Ireland and Jordan was assessed via subjective (parent and child versions of the Medication Adherence Report Scale (MARS) specific questionnaire) and objective methods, that is, high-performance liquid chromatography (HPLC) determination of the 6-mercaptopurine (6-MP) and azathioprine (AZA) metabolites in packed red blood cell samples taken during a clinic visit. Beliefs about prescribed medicines were also assessed in parents/guardians using the Beliefs about Medicines Questionnaire (BMQ). Results. An overall nonadherence to AZA/6-MP therapy in children with IBD was found to be 36.17% (17 out of 47 patients were classified as nonadherent using at least one of the assessment methods). A total of 41 patients (91.1%) were classified as adherent to AZA or 6-MP using the blood sampling, while adherence rates using the MARS questionnaire completed by children and parents/guardians were 60.6% and 72.7%, respectively. The latter provides a more longitudinal measure of adherence. Child self-reported nonadherence rates were significantly higher than parent/guardian reported rates (). Binary logistic regression analysis identified age to be independently predictive of adherence, with adolescents (children aged ≥ 13 years old) more likely to be classified as nonadherent. Regarding the BMQ, when parental/guardian necessity beliefs outweighed concerns, that is, higher scores in the necessity-concern differential (NCD), adolescents were more likely to be classified as adherent. Conclusion. Results provide evidence for ongoing adherence challenges in the paediatric population with IBD. It is recommended that parents/guardians (particularly of older children) and older children themselves, should receive enhanced counselling and education about their prescribed medicines.
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Public willingness to participate in COVID-19 vaccine clinical trials: a study from Jordan
Authors : Rana K Abu-Farha, Karem H Alzoubi, Omar F Khabour
Abstract : Purpose: The development and production of novel vaccine to prevent COVID-19 is an international imperative to human lives. For that purpose, clinical trials have to be carried out as per international ethical standards. The current study was undertaken to examine the willingness to participate in COVID-19 vaccine clinical trials and to determine factors that might affect their decision to participate.
Patients and Methods: A cross-sectional survey study was carried out among the public in Jordan. During the study period, a convenience sample of adults (aged 18 years or above) were asked to participate via an online self-administered survey that was designed to evaluate the willingness to participate in COVID-19 vaccine clinical trials and to determine factors affecting their decision to participate.
Results: Results showed that, among participants (n=1,287), 36.1% reported to be willing to participate in clinical trials of the vaccine. Additionally, a lower percentage (18.1%) were willing to allow their children to participate. Motivators that encourage participation were the desire to return to normal life (73.2%), followed by the desire to help in finding a treatment for COVID-19 infection (68.1%). Barriers towards the participation were not wanting to be challenged by the virus (54.7%), fear (40.7%), lack of time (40.4%), and mistrust in pharmaceutical companies (38.9%). Finally, results showed that higher educational level was associated with lower willingness to participate (P=0.001), whereas having a previous participation in clinical studies is associated with a significantly higher willingness to participate in COVID-19 vaccine clinical trials (P<0.001).
Conclusion: A good portion of Jordanians are positive regarding participation in clinical studies of COVID-19 vaccine. Educational level and previous participation in clinical studies were among the determinants of such willingness. In addition, fear and lack of time were among the barriers of participation.
Keywords : willingness, COVID-19, clinical trials, participation, Jordan
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Public Perceptions about Pharmacists’ Role in Prescribing, Providing Education and Delivering Medications during COVID‐19 Pandemic Era
Authors : Hamza Alhamad, Rana K Abu‐Farha, Fares Albahar, Deema Jaber
Abstract : COVID-19 is a pandemic disease with a significant threat to public health. Public knowledge and perception significance in tackling pandemics have been evidenced in the previous research. This study aimed to explore public perceptions about pharmacists’ educational and prescribing role, and the medication delivery service provided during COVID-19 outbreak.
A cross-sectional study was conducted among the general population of Jordan using a convenient sampling technique for 10 days (15-25 May 2020). Data were collected from 578 participants who agreed to fill the questionnaire, which was distributed online. The questionnaire items were piloted using face validity and reliability.
Participants showed a positive perception about the impact of pharmacists and pharmacy services provided during COVID-19 outbreak. More than half of the participants (61.1%) believed that pharmacists could prescribe over-the-counter medications, and only 15.7% believed that pharmacists could prescribe both over-the-counter and prescribed medications. Linear regression was performed to assess the factors that affect the participants’ perception of pharmacists’ prescribing and educational role and delivering medication during COVID-19. Females have lower perception scores towards medication delivery services compared with males (P value = .008). However, male participants, those aged less than 50 years, those with postgraduate degrees and those from non-medical profession showed a significantly higher perception score towards the impact of pharmacists and pharmacy services provided during COVID-19 outbreak compared with others (P value < .05 for all).
This study indicates that the public positively endorsed the impact of the educational role of the pharmacist, medication delivery services and extending pharmacists’ prescribing authority during COVID-19 pandemic. Also, findings from this study provide a platform to examine the perception of the public towards pandemic diseases and inform policy decision-makers to react by updating their regulation to allow extending pharmacy services and prescribing role during COVID-19 pandemic.
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Perceptions Towards Medical Research Participation: A Study from Jordan
Authors : Rana Abu Farha, Karem Alzoubi, Omar Khabour, Tareq Mukattash
Abstract : Purpose: Progress and development in medical researches require the participation of volunteers in such research, but unfortunately, the participation rate is low. This study aimed to assess Jordanian public perceptions towards participation in medical research and to understand motivators and barriers that may affect their participation.
Patients and Methods: This is a cross-sectional study that was conducted from December 2019 to February 2020. Adults from the public were invited to participate in this paper-based survey. The survey assessed public perception (values, trust and ethics), motivators, and barriers towards participation in medical research.
Results: During the study period, 2000 subjects were recruited. Around 82.3% (n = 1643) strongly agreed/agreed that medical research is important for the advancement of science. Helping the society was found to be the main motivators to participate in medical research (n = 1708, 85.4%), while time constrains (n = 1400, 70.0%), lack of opportunity (n = 1278, 63.9%), and the lack of knowledge and awareness about these researches (n = 1152, 57.6%) were among the top barriers towards the participation in medical research. Finally, results showed that previous participation in medical research was correlated with lower overall perception of values and ethics of research, and higher trust in research (p-value <0.001).
Conclusion: Jordanians have positive perception toward participation in medical research, which could be improved by increasing awareness, trust, and training of researchers on responsible conduct of research(RCR) in the country.
Keywords : medical research, perception, value, trust, ethics, Jordan
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Factors Influencing Public Knowledge and Willingness to Participate in Biomedical Research in Jordan: A National Survey
Authors : Rana Abu Farha, Karem H Alzoubi, Omar F Khabour, Tareq L Mukattash
Abstract : Purpose: Recruitment of adequate numbers of research participants is important for advancement in biomedical fields. Awareness and knowledge of the population about biomedical research are expected to enhance willingness to participate in such research. Therefore, in the current study, participants’ awareness, knowledge, and willingness to participate in scientific research in Jordan were examined.
Methods: This was a survey-based, cross-sectional study conducted from December 2019 to February 2020 among the public in Jordan. After written informed consent had been obtained from study participants, a structured questionnaire was used to survey research participants. The final questionnaire contained three parts: part I was about demographics and general information, part II assessed participants’ awareness and willingness to participate in biomedical research, and part III assessed participants’ knowledge about biomedical research studies.
Results: A total of 2,000 subjects agreed to participate, of which 67.4% were female (n=1339). More than half the respondents were aware of biomedical research (58.6%), of which 18.1% had previously participated in biomedical research. In addition, 55.5% reported that they were willing to participate in biomedical research, while a lower proportion (31.1%) were willing to volunteer in a clinical trial. The overall knowledge of participants about biomedical research was deemed moderate (total score 12.9 out of 20). Finally, willingness to participate in biomedical research was associated with being male, being married, having a biomedicine-related degree, and higher knowledge score.
Conclusion: A majority of Jordanians had moderate levels of awareness and knowledge about biomedical research. Such factors as sex, type of education, and knowledge contribute to willingness to participate in biomedical research.
Keywords : willingness, knowledge, biomedical research, public, Jordan
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Evaluation of the completeness of information sources used to prepare the best possible medication histories at a tertiary teaching hospital in Jordan
Authors : Nadeen Asakrh, Rana Abu Farha, Khawla Abu Hammour, Amna Al‐Hashar
Abstract : Objectives: In this study we aimed to evaluate the completeness of three different medication information sources that are commonly used to collect and obtain the Best Possible Medication History (BPMH).
Methods: This is an observational study which was held at Jordan University Hospital. After identifying eligible patients, the BPMH was obtained from three different sources separately. These sources include medical file, pharmacy database, and patients’ interview. Information from all of these sources was compiled to create the BPMH. The BPMH was used as the standard against which every other information source was compared and given a “completeness score” according to a systematic scoring system.
Results: Among the 196 participating patients who were included in the study, 113 (57.7%) were recruited from internal medicine and 83 (42.3%) from surgical department. Patients’ interview showed the highest median completeness score (71.4%) among the three used sources followed by pharmacy database (35.3%), and medical files (28.2%). The median completeness score for the compiled BPMH obtained by the pharmacist was 93.0%. The compiled BPMH completeness score was inversely proportional to the numbers of medications in the compiled BPMH (R = −.392, P value < .001). Moreover, patients with lower income showed better median BPMH completeness score compared with those with higher income (95.2% (IQR = 16.7%) vs 88.9% (IQR = 15.7%), respectively, P value = .042).
Conclusion: The results show that pharmacist’s interview with the patients scored the highest percentage of completeness compared with hospital pharmacy database and medical file and is, therefore, considered more comprehensive in obtaining the BPMH.
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Drug abuse in Syria: pattern of use, causes and perception as perceived by Syrian addicts
Authors : usam Abazid, Samir Abou‐Isba, Rana Abu Farha, Esraa E Al‐Jomaa
Abstract : Objectives: We aimed to evaluate the current pattern, causes and attitude towards drug use amongst Syrian prisoners who were incarcerated due to their using drugs.
Methods: This is a descriptive cross-sectional survey-based study that was conducted over a period of six months. Prisoners were recruited from two main civil prisons in Syria. The data collected in this study were through the use of a self-administered survey. The prisoners were met in a separate room away from their dormitories and they were asked to fill out the survey after obtaining their verbal consent.
Keyfindings: A total of 50 participants were recruited (response rate = 66.7%). Most of the prisoners (n = 29, 58.0%) started to use drugs at a friend's home, and the most commonly used drug was Hashish (weed and cannabis) (n = 22, 44.0%). Two-thirds of the participants (n = 34, 68.0%) said that they returned to drugs after quitting. The most common reason was using drugs for euphoria (n = 12, 24.0%). Regarding prisoners’ beliefs about different causes of drug use, curiosity was found to be the most common cause of drug use (n = 19, 38.0%). Surprisingly, prisoners incorrectly believed that they can take drugs and they can stop them whenever they want (n = 34, 68.0%) and that drug use does not lead to addiction (n = 30, 60.0%).
Conclusions: The findings of this study indicate the need to devote more attention to family and peer influences on an individual's behaviour by policymakers, in developing preventive strategies. As well as, the need to raise the awareness of individuals in the society about drug use, subsequently, changes their incorrect perceptions towards drugs through several strategies including educational programmes as well as workshops whether in school, universities or social media.
Keywords : causes, drug abuse, perception, prisoners, Syria
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Parental self-medication of antibiotics for children in Jordan
Authors : Tareq Mukattash, Mohammad Alkhatatbeh, Shireen Andrawos, Anan Jarab, Rana AbuFarha, Nusair Nusair
Abstract : Objectives: This study aims to describe the prevalence and predictors for parental antibiotics self-medication of their children and to characterize their knowledge, practice and attitude within this area.
Methods: This is a cross-sectional study which targeted parents of children between the ages of 1–12 years. Parents were asked to fill out an online validated questionnaire that aimed to assess their knowledge, practice and attitude to self-medication of children with antibiotics.
Key findings: In this study, 332/855 (39.2%) participants had previously self-medicated their child(ren) with antibiotics. The overall score in the knowledge section was satisfactory (mean = 3.48 out of five); however, the majority of participants (72.1%) did not have the knowledge that antibiotics are solely indicated for bacterial infections. Parents with older age, lower education, not working in a medical field, families with low-income and lived away from the capital were found to have higher rates of self-medication (P-value <0.05).
Conclusion: The findings of this study show that there is a high prevalence of parental self-medication practice of antibiotics in Jordan that should be considered as alarming problem. The lack of adequate parental knowledge about the use of antibiotics may be a major cause of the increased self-medication among them.
Keywords : international, patient satisfaction, quality of life, regulatory
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Medication histories documentation at the community pharmacy setting: A study from Jordan
Authors : Rana Abu Farha, Khawla Abu Hammour, Tareq Mukattash, Raja Alqudah, Rand Aljanabi
Abstract : Objectives: The main objective of this study was to evaluate community pharmacists’ awareness and perception about medication reconciliation service and to assess the completeness of collecting patients’ medication histories in the community pharmacy setting.
Methods: A cross-sectional study was conducted between February to March 2018 in Amman-Jordan. During the study period, 150 community pharmacists were invited to participate in the study. Each pharmacist completed a validated structured questionnaire evaluating their awareness, current practice, perceived attitude and perceived barriers towards the implementation of medication reconciliation and the collection of medication histories at the community pharmacy setting.
Results: A total of 121 pharmacists agreed to participate and filled the questionnaire. Our results showed that only 13.2% of the pharmacists were able to define “medication reconciliation” correctly, and around 31% have a misconception that the medication reconciliation process should be performed only at the inpatient setting.
Only 19.8% (n = 24) of the participating pharmacists stated that they ask all patients for a complete current medication list of medications when they arrive at the pharmacy site. Medication histories for most patients were lacking information about the dosage, route, frequency, and time of the last refill for each medication listed. “Patients lack of awareness about all the medications they are receiving” was the main barrier discouraging community pharmacists from collecting medication histories and participating in reconciliation service.
Conclusion: Community pharmacists in Jordan showed a low awareness about the medication reconciliation concept and demonstrated a modest role in obtaining medication histories in community pharmacies. But still, they showed a positive attitude towards their role in implementing the different steps of medication reconciliation. This suggests that educational workshops to increase pharmacists’ awareness about their role and responsibilities in collecting a complete and accurate medication history are warrented.
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Drug-related problems and health-related quality of life in outpatients with type 2 diabetes: a cross-sectional study from Jordanbr/>
Authors : Rana K Abu Farha, Tareq L Mukattash, Rajaa Qudah, Waed Alkhalaileh, Sama Alsaffar
Abstract : Objectives: This study aimed to assess the different types of drug-related problems (DRPs) among diabetic patients and to study the effect of those DRPs on health-related quality of life (HRQoL) of this population.
Methods: The current retrospective cross-sectional study was conducted at outpatients’ clinics at the Jordan University Hospital. During the study period, a total of 91 patients with type 2 diabetes were recruited. Patients’ medical information was used to assess the different DRPs and to evaluate their impact on the HRQoL evaluated using the Arabic EQ-5D tool.
Key findings: The mean age of study participants was 61.1 (SD = 8.8). Females represented 60.4% (n = 55) of them. A total of 571 DRPs were identified among the study participants (average 6.27, SD: 2.08; range 0–14). Lack of appropriate monitoring was the most common type of DRPs identified (30.6%, n = 175), followed by safety DRPs (22.1%, n = 126). The EQ-5D average score in this study was 0.6124 (SD: 0.3133). Regression statistical analysis indicated that non-adherence to non-pharmacological therapy was associated with poor EQ-5D scores (P-value <0.05), while indication DRPs were associated with better EQ-5D scores (P-value <0.05).
Conclusions: The number of DRPs among diabetic patients is high, and this represents a major concern that needs attention. Some of these DRPs were associated with poor HRQoL. Engaging pharmacists through pharmaceutical care service is needed to prevent those DRPs, which may ultimately improve patients HRQoL.
Keywords : diabetes mellitus, drug-related problem, health-related quality of life, Jordan
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Ophthalmic drug abuse: An observational study from community pharmacies
Authors : Waed Al-Khalaileh, Rana Abu-Farha, Mayyada Wazaify, Marie Claire Van Hout
Abstract : Background: There has been a trend in the past five years in Jordan for ophthalmic anticholinergic preparations to be misused or abused. This is done mainly to experience mental altering effects such as mood changes, euphoria or hallucinations. Such products are mostly obtained from community pharmacies without a prescription.
Objectives: This study aimed to observe the requests of ophthalmic preparations in community pharmacies in Amman, Jordan, and evaluating the most popular and frequently requested ophthalmic drops suspected of abuse. Also, it aimed to describe the current methods that Jordanian community pharmacists use to manage such requests.
Methods: A prospective cross-sectional observational study was conducted between November 2016 and January 2017 at sixteen different community pharmacies in Amman. All ophthalmic products requested were observed during this period.
Results: A total of 140 ophthalmic product requests for 130 customers were observed. Dry eye was the most common complaint for which the customer requested the medication (n = 30, 23.1%) and direct self-medication (ie-requesting the product by name), was the most frequent method of purchase (n = 63, 48.5%). In 19 cases (14.6%), product requests were suspected to be for non-medical (ie-abuse) purposes. Most of the suspected cases were for Pentolate® (n = 11, 57.9%), whereas 7 were for Prisoline® (36.8%) and 1 for Naphcon-A® (5.3%). The majority of observed cases were for products requested without a prescription (n = 16, 84.2%), and in 12 cases out of which, sale was refused (63.2%).
Conclusion: More effort and enforcement of pharmacy regulation for safe dispensing is needed to reduce the abuse of ophthalmic products. Educating pharmacists and ophthalmologists would help raise awareness and control the type of drug abuse.
Keywords : Abuse, Community pharmacy, Eye drops, Jordan, Misuse, Ophthalmic
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Perceptions, knowledge, and perceived barriers of Yemeni pharmacists and pharmacy technicians towards evidence‐based practice
Authors : Sayida Al‐Jamei, Rana Abu Farha, Mohammed Zawiah, Taha Kadi, Afnan Al‐Sonidar
Abstract : Rational, aims, and objective: The aim of this study was to assess the knowledge and perception towards evidence-based practice (EBP) and identify the perceived barriers to practicing EBP among Yemeni pharmacists and pharmacy technicians.
Methods: A cross-sectional survey study was carried out among 153 Yemeni pharmacists and pharmacy technicians who are working in hospitals or community pharmacies. This study took place between the 15th of August and the 8th of November 2017 using a self-administered validated questionnaire. The study was approved by the ethics committee/scientific research center of Yemen University, Yemen (Reference number: ERC/2017/103).
Results: Completed questionnaires were received from 153 (46.6% response rate). Most of the respondents showed a positive attitude towards EBP; however, their understanding of the basic terms used in EBP was poor (34.6%). The types of source that the respondent used in high percentage to make their decisions were own judgement and consulting the colleagues that can no longer be accurate and evidence based. The barriers to practicing EBP identified by most respondents were the limited access to EBP sources and lack of personal time.
Conclusion: These results reveal strong support for EBP among pharmacists and pharmacy technicians in Yemen but only a minority indicated that they understood the technical terms of EBP. Training and continuing education programs on EBP and guidelines for pharmacists are strongly needed. These findings may help in planning the use and the application of EBP process in pharmacy practice.
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Exploring variables associated with poor health-related quality of life in patients with type 2 diabetes in Jordan
Authors : Anan S Jarab, Eman Alefishat, Tareq L Mukattash, Abdel Qader Albawab, Rana K Abu-Farha, James C McElnay
Abstract : Objective: The study aim was to evaluate health-related quality of life (HRQoL) and to explore factors associated with poor HRQoL in patients with type 2 diabetes in Jordan.
Methods: The EQ-5D questionnaire was used to assess HRQoL in outpatients (n = 196) with type 2 diabetic during their clinic appointment at three major Hospitals in Jordan. Sociodemographic and medical data were collected from patient interviews and medical files. Multiple linear regression was performed to build a model with variables associated with poor HRQoL.
Key findings: The mean score of the total EQ-5D index of the 196 participants was 0.724. Most of the patients reported ‘some problems’ through the five dimensions, with the highest percentage (46.1%) related to mobility domain. Regression analysis identified women gender (β = −0.252; P < 0.01), duration of diabetes (β = −0.344; P < 0.01) number of medications (β = −0.423; P < 0.01), and insulin therapy (β = −0.205; P < 0.05) as being significantly associated with poor HRQoL.
Conclusions: The quality of life for patients with type 2 diabetes in Jordan has considerable scope for improvement. Future diabetes management programs should focus on improving HRQoL, with specific attention to be given for women patients, those who have long duration of diabetes, and patients receiving multiple medications or insulin therapy.
Keywords : EuroQol 5D, health-related quality of life, Jordan, type 2 diabetes
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Community pharmacists experience of pregabalin abuse and misuse: A quantitative study from Jordan
Authors : Amneh Al-Husseini, Rana Abu-Farha, Marie Claire Van Hout, Mayyada Wazaify
Abstract : Pregabalin is an anticonvulsant that has an abuse potential. The aim of this study was to investigate abuse/misuse of pregabalin in Jordan from the perspective of community pharmacists. A cross-sectional survey using a structured questionnaire was delivered to a sample of community pharmacies. Self-reported method was used to fill the surveys. A total of 151/205 questionnaires were completed (response rate = 74.1%). A total of 132 respondents (87.4%) reported cases of pregabalin abuse in their pharmacies. Less than half of the respondents (n = 69; 45.7%) indicated that pregabalin requests were, in most of the cases, not accompanied by prescriptions. More than half of the sample (55.8%) noticed an increased pattern of pregabalin abuse/misuse during the last 6 months. The study underscored the need for regulatory efforts and pharmacovigilance to manage pregabalin abuse, along with a pharmacist and patient education at a community pharmacy level.
Keywords : Abuse, Community pharmacy, Jordan, Pregabalin, Survey
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A qualitative assessment of the pediatric content in pharmacy curricula adopted by pharmacy schools in Jordan
Authors : Tareq L Mukattash, Anan S Jarab, Rana K Abu-Farha, Mohammad B Nusair
Abstract : Objective: The present study aimed to explore faculty (i.e., professors of various ranks) opinions and views regarding the pediatric content in courses taught to pharmacy students in Jordan.
Methods: Purposeful sampling was used to identify faculty from ten pharmacy schools. Participants were identified through their institutions’ websites. After obtaining required approvals, twelve in-depth interviews were conducted, recorded, transcribed and analyzed using NVivo 11 Software. Interviews followed a previously prepared and validated interview guide. The interview guide covered various aspects of pediatric undergraduate education and training.
Results: Twelve professors (eight assistants and four associate professors) agreed to take part in the study. Qualitative analysis revealed four themes each with regard to respondents’ knowledge of the pediatric content and their students’ competency in dealing with pediatric patients. The emerging themes were: the lack of pediatric content in their current curriculum, the need for exposing students to more courses teaching pediatrics, and future aspirations to deal with this, and implications on practice.
Conclusions: This study highlights the deficiency of pediatric courses in pharmacy curriculum in Jordan. Respondent believed that this will have negative implications on pediatric pharmaceutical care and treatment efficacy and safety. It was thought that adding more pediatrics topics to undergraduate curricula, offering pediatric specialized postgraduate education, and implementing pre-registration training could alleviate the current situation.
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Keywords : Child; Education; Pharmacy Students; Pharmacy Schools; Pharmacy Faculty; Curriculum; Pharmaceutical Services; Qualitative Research; Jordan
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Impact of pharmacist's directed medication reconciliation on reducing medication discrepancies during transition of care in hospital setting
Authors : Lana K Salameh, Rana K Abu Farha, Khawla M Abu Hammour, Iman A Basheti
Abstract : Objectives: To evaluate the effect of pharmacist's directed services (reconciliation plus counselling) on reducing medication discrepancies and improving patient's outcomes at discharge from hospital.
Methods: During the 3-month study period, 200 patients were randomly selected from internal medicine department from Jordan University Hospital (JUH) and allocated into two groups (intervention and control groups). The number and types of medication discrepancies were identified at admission. Then, pharmacist implemented medication reconciliation and medication counselling services to the intervention group patients. At discharge, the number of unintentional discrepancies was evaluated for both groups. Patients were assessed at 1 month following their discharge for any subsequent hospital readmissions, emergency department visits or side effects of medication therapy.
Key findings: The total number of identified unintentional discrepancies was 84 for the intervention group compared with 60 discrepancies for the control group. Omission and addition represented the most common types of discrepancies for both groups. Of the 84 recommendations submitted by pharmacists, clinicians accepted 78 cases (92.8%), and implemented only 46 recommendations (54.7%). At discharge, a significant reduction in the number of unintentional discrepancies was achieved for the intervention group, P-value (0.014), while no significant change was found for the control group, P-value = 0.508. One month postdischarge, a significantly higher number of patients in the control group reported experiencing side effects compared with the intervention group, P-value = 0.020.
Conclusion: The presence of clinical pharmacists in hospital wards had a promising effect on decreasing the number of medication errors and improving health outcomes.
Keywords : discrepancies, hospital, Jordan, pharmacists, reconciliation
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Pharmacists' knowledge and perceptions about pharmacovigilance and barriers towards adverse drug reactions reporting in Yemen
Authors : Mohammed Zawiah, Ramzi Mukred, Sayida Al-Jamei, Taha Kadi, Abdulrhman Al-Baidani, Rana Abu Farha
Abstract : Objective: The current study aims to assess Yemeni pharmacists’ knowledge, attitude and practice of adverse drug reactions (ADRs) reporting systems and to determine barriers hindering them from reporting.
Methods: A cross-sectional descriptive study was conducted between August and October 2017. One hundred sixty-two pharmacists practicing in both community and hospital settings were recruited from five governorates using a convenient sampling technique. A validated self-administered questionnaire was used to collect data and to achieve the study objectives. Descriptive analysis was done using Statistical Package for Social Science version 20.
Key findings: Out of 260 questionnaires distributed, 162 pharmacists responded (Response rate of 62.3%). In terms of knowledge, 156 (96.3%) were not aware of the existence of ADRs reporting system in Yemen. The overall average knowledge score among pharmacists was 1.2 (SD = 1.2) out of 7. Concerning practice, about (140, 87.0%) of pharmacists disclosed that patients reported at least one ADRs annually. Insufficient clinical knowledge of pharmacist, unavailability of ADRs reporting form and unawareness of existence of the national ADRs reporting system were noticed to be the main barriers towards ADRs reporting.
Conclusions: Most of pharmacists were unaware of the ADRs reporting system in Yemen. However, advertising, education and intensive training are needed to improve awareness and to ensure an effective ADRs reporting process.
Keywords : adverse drug reactions, barriers, knowledge, pharmacists, pharmacovigilance
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Pharmacy drive-thru service in Jordan: assessing customers' awareness, perceptions and factors affecting the use of this service
Authors : Khawla Abu Hammour, Rana Abu Farha, Mai Rizik, Tareq Mukattash, Murhaf Alnan, Ahmad Alkhader, Rand Aljanabi, Iman Basheti
Abstract : Objectives: In Jordan, drive-thru pharmacy service has recently been introduced representing a new trend in community pharmacy services. This study aimed to evaluate pharmacy customers' awareness and perceptions towards the drive-thru service to unveil important information regarding such service.
Methods: A Self-administered questionnaire was used in this cross-sectional study which was conducted in Amman-Jordan between April and August 2017. A Self-administered questionnaire was used to evaluate pharmacy customers' awareness and perceptions towards pharmacy drive-thru services. Factors affecting customers' use of this service was also investigated.
Key findings: A total of 789 pharmacy customers participated in the current study. Mean age of study participants was 27.7 years (SD = 10.6) and half of them were men (n = 397, 50.4%). Although 26.8% (n = 212) of the customers knew that the drive-thru pharmacy service was newly implemented in Jordanian pharmacies, only 10.9% (n = 86) reported to have used this service. Customers (59.1%) expressed their support for the introduction of this service to pharmacy practice in the country. Certain factors affected customers' use of the drive-thru pharmacy service positively, including male gender, Jordanian nationality, non-single marital status and having children (P-value <0.05).
Conclusions: This study demonstrated positive customer awareness and perceptions towards the drive-thru pharmacy service. Busy customers seem to use this service more (men being married and having children). Hence, this service seems to be most beneficial to a certain type of customers. However, concerns about poor communication between the pharmacist and the patient represented the main disadvantage of the drive-thru service.
Keywords : awareness, customers, drive-thru pharmacy service, perception, pharmacy
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Branched amino acids as potential biomarkers in metabolic syndrome patients and as hypolipidemic compounds
Authors : Moath Alqaraleh, Violet Kasabri, Rana Abu Farha, Randa G Naffa, Israa Yousef, Ahmad Aljaafreh
Abstract : Background and aims: Metabolic syndrome (MetS) and lipid abnormalities can increase the risk of type 2 diabetes mellitus (T2DM) and cardiovascular disease. The aims of this study were to assess branched-chain amino acids (BCAAs) levels in MetS patients and to evaluate the effects of these acids on lipid profile abnormalities. Material and Methods: A cross-sectional study design comprising 30 normoglycemic lean subjects, 30 MetS patients, and 30 MetS-pre/T2DM patients was conducted to measure the BCAA levels for each of these groups. Then, an in vivo evaluation of BCAA hypolipidemic activity using Triton WR1339-induced hyperlipidemia was conducted in rats. Results: The BCAAs plasma levels showed a substantially significant increase in both MetS and MetS-pre/T2DM groups compared with lean normoglycemic controls. Furthermore, BCAAs in Triton WR-1339 treated rats could exert fenofibrate-like pronounced TC, TG, and LDL-C reductions but marked the HDL-C enhancements significantly. Conclusion: MetS is associated with the high plasma level of BCAAs, indicative of a putative predictive/prognostic value with respect to MetS patients. Moreover, BCAAs supplementation may serve as a potential novel therapeutic agent for the treatment of hyperlipidemia.
Keywords : BCAA, biomarker, metabolic syndrome, hyperlipidemia, type 2 diabetes mellitus
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Parental views and attitudes towards use of unlicensed and off‐label medicines in children and paediatric clinical trials: an online cross‐sectional study in the Arab world
Authors : Tareq L Mukattash, Anan S Jarab, Aseel Daradkeh, Rana Abufarha, Sawsan H AbuHammad, Nasr N AlRabadi
Abstract : Objectives: The present study aimed to explore views and attitudes of parents towards the use of unlicensed and off-label medicines in children, paediatric clinical trials, and the role of pharmacists in the safety and effectiveness of medicines.
Methods: A cross-sectional electronic survey was conducted over social media networks in the Arab world to assess parents’ views and attitude towards use of unlicensed/off-label medicines and clinical trials in children. Validated questionnaire was adopted to achieve the study goals.
Key findings: A total of 4740 respondents completed the online questionnaire. 55.2% have no previous knowledge of use of unlicensed medicines in children. Most of parents thought that they should be told about the use of such medicines, with the doctor (55.0%) selected as the person who should tell parents. Respondents thought that the use of medicines in children was extremely safe or safe. However, this proportion is decreased dramatically (P < 0.001; McNemar test). Views of parents towards clinical trials vary according to child health (child in good health 14.8% versus child suffering of life-threatening condition 50.4%). The majority of respondents thought that pharmacist has a significant role in assuring the safety and efficacy of medicines.
Conclusions: Limited parents’ knowledge about the use of medicines in children and the importance of clinical trials. General consensus about pharmacists’ role in ensuring medicines’ safety and efficacy.
Keywords : Arab, children, clinical trials, off-label medicines, parents, unlicensed medicines
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The prevalence and clinical seriousness of medication discrepancies identified upon hospital admission of pediatric patients
Authors : Rana Abu Farha, Khawla Abu Hammour, Sayida Al-Jamei, Raja AlQudah, Mohammed Zawiah
Abstract : Background: Medication discrepancies are seen frequently in hospital setting upon admission or discharge. Medication Reconciliation service is a practice designed to ensure that patients’ medications are ordered in a correct manner upon hospital admission, thus reducing the risk of having medication discrepancies. This study aimed to determine the prevalence of medication discrepancies and their clinical seriousness in pediatric patients at the time of hospital admission.
Methods: A prevalence cross-sectional study was conducted at the pediatric departement at the Jordan University hospital between March–May 2018. During the study period, 100 pediatric patients were enrolled using a convenience sampling method. Patients’ medical records were reviewed by two clinical pharmacist-reserachers to obtain patients' demographic, medical, and admission medication information. All parents were interviewed to obtain information regarding their children’s Best Possible Medication History (BPMH). Following data collection, differences between patient’s current admission medications and the BPMH were identified as medication discrepancies, and then they were classified into either undocumented intentional or unintentional discrepancies.
Results: Among the 100 medication records reviewed, 13.0% (13 out of 100) contained at least one unintentional discrepancy, with the majority (n = 11, 84.6%) being classified to be associated with mild potential harm to patients. Of those discrepancies, 8 were omission of medications (61.5%) and 5 were addition of unnecessary medication (38.5%). On the other hand, 35.0% (35 out of 100) of medication records contained at least one intentional undocumented discrepancy.
Conclusions: This study revealed that unintentional medication discrepancies exist at the time of hospital admission for pediatric patients but with low proportion. The low proportion of medication discrepancies might be explained by the recent implementation of medication reconciliation service at the studied hospital. Also, intentional undocumented discrepancies were common, which may carry a potential harm to such vulnerable population at discharge. These data may inform the need for a strict policies to regulate medication documentation, thus decreasing the possibilities of medication errors.
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Off-label medicine use in children, a study of community pharmacists in Jordan
Authors : Tareq L Mukattash, Shada Alkhaldi, Qais Alefan, Anan S Jarab, Rana K Abu Farha, Ahmad Al-Azayzih
Abstract : Objectives: The aim of this study was to explore self-reported experiences of community pharmacists towards off-label prescribing.
Methods: A questionnaire survey was handed directly to pharmacists working in a group of randomly chosen community pharmacies in Jordan. Complete questionnaires were collected 1 week after the questionnaires were distributed.
Key findings: Only a minority of respondents (15%) admitted to being familiar with the concept of off-label prescribing. When asked how they became familiar, 56% reported they had gained their knowledge through dispensing experience rather than undergraduate (14.7%) or postgraduate education (29.3%). The majority of respondents had concerns regarding the efficacy (98%) and safety (95%) of off-label medicines used in children.
Conclusions: The majority of respondents were not familiar with the concept of off-label medicines. While reporting to have gained their knowledge from their professional experience, only a minority of respondents reported knowingly dispensing off-label medicines for children
Keywords : children, community pharmacy, dispensing, jordan, off-label medicines, paediatrics, prescribing
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Administration of off-label medicines to paediatrics, self-reported experiences and perceptions of nurses working in paediatric wards in Jordan
Authors : Tareq L Mukattash, Anan S Jarab, Jamal Nabrawi, Rana K Abu-Farha, Wafa'a Ta'an
Abstract : Objectives: The purpose of this study was to explore perceptions and experiences of nurses working in paediatric wards in Jordan towards the off-label administration of medicines in children.
Methods: This is a prospective cross-sectional questionnaire-based study. A validated questionnaire was administered to 200 paediatric nurses in different hospitals in Jordan. The questionnaire was obtained from a previous study conducted to assess the perceptions and attitudes of paediatricians towards off-label medicine use. The questionnaire consisted of 27 questions and was divided into four parts.
Key findings: Only 25.6% of respondents were familiar with the concept of off-label medicine use, primarily through work experience. The most common reasons for that were younger age than recommended (86.6%), and higher than (64%) or lower than (38%) recommended dose. Furthermore, lack of dosage data, risk of side effect and lack of clinical trials data were recognized as major areas of concern for paediatric nurses when handling paediatric off-label medicines. More than half of respondents (55%) believed that the lack of appropriate formulations or the lack of efficacy data were of concern.
Conclusions: The study revealed low levels of knowledge of off-label medicine use in children among nurses. The majority of respondents admitted to unknowingly administer medicines in an off-label manner to paediatrics. The implementation of training programmes and workshops is very important to increase nurses’ awareness of the use of off-label medicine in children. Further development of the educational curriculum for nurses should cover such use of medicine in children. Multidisciplinary paediatric care should be encouraged, specifically the collaboration between nurses and clinical pharmacists.
Keywords : children, Jordan, medicines, nurses, off-label, paediatrics
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Pharmaceutical Care in Children: Self-reported knowledge, attitudes and competency of final-year pharmacy students in Jordan
Authors : Tareq L Mukattash, Anan S Jarab, Rana K Abu-Farha, Eman Alefishat, James C McElnay
Abstract : Objectives: Pharmacists require a baseline level of knowledge in paediatric pharmaceutical care in order to be able to adequately care for paediatric patients and counsel their families. This study aimed to explore the self-reported knowledge, attitudes and competency of final-year pharmacy students in Jordan regarding paediatric pharmaceutical care.
Methods: This study took place in Jordan between November 2016 and May 2017. A 28-item questionnaire was designed and administered to 400 students from all pharmacy programmes in Jordan during their final year of training.
Results: A total of 354 students agreed to take part in the study (response rate: 88.5%). Most respondents (95.2%) were aware of the term ‘paediatrics’. However, almost one-third of the respondents (30.5%) reported never having taken paediatric dose calculation courses and more than half (55.6%) were unfamiliar with the term ‘off-label medicines’. Moreover, most respondents (65.1%) had low knowledge scores (≤2 out of 5) when presented with realistic paediatric case scenarios. There were no significant differences in knowledge and attitudes between undergraduate and doctoral students or between those from public or private universities (P >0.05).
Conclusion: The findings of this study highlight an alarming deficiency in paediatric pharmaceutical knowledge among final-year pharmacy students in Jordan. As such, paediatric-related content should be emphasised in the pharmacy curricula of Jordanian universities so that pharmacy students receive more formalised education and more extensive training in this area.
Keywords : Pharmaceutical Care, Pediatrics, Pharmacy Students, Knowledge, Attitudes, Competency-Based Education, Jordan
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Patterns of antibiotic use and administration in hospitalized patients in Jordan
Authors : Anan S Jarab, Tareq L Mukattash, Buthaina Nusairat, Mohammad Shawaqfeh, Rana Abu Farha
Abstract : Background: Inappropriate use of antibiotics is the leading cause of emergence of resistance. It has been estimated that two million people in the United States had infection with resistant bacteria, resulting in 23,000 deaths annually. In Jordan, more than 50% of physicians prescribe antibiotics for inappropriate indication such as common cold, and approximately 67% of adult Jordanians believe that antibiotics should be used for this purpose. It is essential to follow antibiotics prescription guidelines in order to maximize effectiveness and enhance patient safety.
Objective: The study aim was to describe patterns of antibiotics prescription and adherence to guidelines of IV to oral antibiotic conversion in elderly patients visiting King Abdullah University Hospital (KAUH).
Methods: A retrospective cross sectional study was conducted on hospitalized patients who were prescribed IV antibiotics. Sociodemographic and clinical data in addition to a list of IV prescribed antibiotics was collected by referring to information technology department at KAUH. Patients' eligibility for antibiotic conversion from IV to oral route was then evaluated based on Society for Healthcare Epidemiology of America criteria.
Results: A total of 110 antibiotics were dispensed for 80 patients, imipenem/cilastatin was the most prescribed antibiotic (41.25%), followed by cephalosporines which were prescribed for 27.5% of the participants. Approximately half of the study patients (47.5%) were prescribed IV antibiotics despite their eligibility for oral conversion.
Conclusion: This study shows a shortage in the implementation of guidelines which are important to decrease antibiotic resistance and improving clinical outcomes. The clinical Pharmacist needs to be more involved in antibiotics prescription with the aim of improving effectiveness and decreasing potential antimicrobial resistance in hospital settings.
Keywords : IV antibiotics, Oral antibiotics, Clinical pharmacy, Hospitals, Jordan
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Premenstrual syndrome and premenstrual dysphoric disorders among Jordanian women
Authors : Abla Albsoul‐Younes, Eman Alefishat, Rana Abu Farha, Lina Tashman, Enas Hijjih, Rasha AlKhatib
Abstract : Purpose: The aim of this study was to investigate the frequency, associated factors, and management approaches of premenstrual dysphoric disorder (PMDD) and premenstrual syndrome (PMS) in Jordanian women.
Design and Methods: Three hundred premenopausal women completed a self-administered questionnaire.
Findings: Moderate–severe PMS was reported by 29% of women, while 14% had PMDD. Younger unmarried women had the more severe condition. Herbal remedies and no medication were the most common approaches used to manage PMS/PMDD.
Implications for Nursing Practice: High rates of PMS and PMDD found in this study highlight the need to increase awareness to this condition among health providers in order to facilitate its identification, diagnosis, and management.
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Effect of educational intervention on healthcare providers knowledge and perception towards pharmacovigilance: A tertiary teaching hospital experience
Authors : Rana Abu Farha, Khawla Abu Hammour, Mai Rizik, Rand Aljanabi, Lina Alsakran
Abstract : Objective: Based on the theory on planned behavior, perception or attitude is found to be a well-established predictor of healthcare providers’ intentions to perform different behaviors. Also, improving knowledge was proposed to affect their practice as well. In Jordan, many studies have been conducted to evaluate healthcare providers’ knowledge and perception towards pharmacovigilance but no intervention or training was provided. Thus, the aim of this study was to evaluate the impact of an educational workshop on the knowledge and perception of healthcare providers towards pharmacovigilance in a Jordanian tertiary teaching hospital.
Methods: An interventional study conducted in Jordan University Hospital on various healthcare providers to assess their pre- and post-knowledge and perception towards pharmacovigilance and adverse drug reactions (ADRs) reporting via questionnaire before and after an educational workshop.
Results: Among the 200 invited healthcare providers, 150 attended the educational workshop (response rate 75.0%). Pre-workshop, healthcare providers showed an overall low knowledge score (7.8/19), where only 8.7% could define pharmacovigilance correctly. On the other hand, they showed a favorable perception score (33.6/39).
Following educational workshop, knowledge scores significantly improved by 67.9% (P-value <0.05). A similar finding was obtained for perception scores, where perception scores significantly improved by 10.1% following workshop (P-value <0.05).
Conclusion: Continuous efforts are needed to implement different strategies including education modules and the provision of appropriate training programs to increase awareness and improve perception towards pharmacovigilance among healthcare providers. Future study is needed to evaluate the impact of improving knowledge and perception on ADRs reporting practice.
Keywords : Educational workshop, Pharmacovigilance, Adverse drug reactions, Healthcare providers, Jordan
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The Impact of Shift Work-Related Circadian Rhythm Disruption on Inflammatory Biomarkers
Authors : Maysa Suyagh, Eman Alefishat, Rana Abu Farha, Amal Akour, Violet Kasabri, Nailya Bulatova
Abstract : OBJECTIVE: This study aimed to examine the effect of circadian rhythm disruption in night-shift workers on systemic biomarkers of inflammation. METHODS Demographic data, clinical parameters and data on working patterns of 126 adult employees were documented. Serum levels of biomarkers were measured by enzymatic assay procedures. RESULTS: Night-shift workers had markedly lower anti-inflammatory IL-10 and cardioprotective adiponectin and MCP-1 compared to daytime workers. Night-shift workers’ MIF, LAR, TNF-α and TNF-α/IL-10 ratio were significantly higher than those in day shift workers. Spearman's correlation showed that MIF, TNF-α, LAR and TNF-α/IL-10 ratios were positively and significantly correlated with both the duration of the night shift and total number of shifts (p < 0.05). Meanwhile, IL-10, adiponectin and MCP-1 were negatively and significantly correlated with both variables (p < 0.05). CONCLUSION: Night shift work may be closely associated with a higher propensity of cardiometabolic risk factors clustering. Therefore, close monitoring of shift workers’ clinical status and lifestyle is warranted.
Keywords : Night shift work, MIF, TNF-α/IL-10 ratio, IL-6, MCP-1, Leptin/Adiponectin ratio
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Pharmaceutical care in community pharmacies in Jordan: a public survey
Authors : Tareq L Mukattash, Nour H Bazzi, Khawla Q Nuseir, Anan S Jarab, Rana K Abu-Farha, Maher R Khdour
Abstract : Objective: This study aims to assess the views and attitudes of the general public towards the current role of pharmacists in Jordan.
Methods: This study is a cross-sectional quantitative questionnaire-based study. After a thorough literature review on public perspectives of pharmaceutical care services, a draft questionnaire was designed. This questionnaire was examined and discussed in a focus group of invited public members and was amended accordingly to reach the final draft. The questionnaire was administered using a structured interview technique in which members of the public were asked a series of questions by a trained pharmacist. The study took a place over a period of six months, from January to June 2013. Individuals were recruited from urban and rural areas of Jordan.
Results: A total of 1214 respondents were interviewed during the study. Of the respondents, 67.8% were female. Most of the respondent were married (64%) and had a university degree (88.5%). Approximately half of the respondents (55.1%) had no previous knowledge of pharmaceutical care. A relative majority of respondents considered the most important activity performed by pharmacists to be dispensing medications (46.2%), followed by patient counseling (34.6%). The majority of respondents (86.4%) believed that pharmacists have a role in providing healthcare services, and 68% of respondents reported that in order to serve their needs, a pharmacist must consider the patient’s needs and engage patients in determining medication timing and options.
Conclusions: The plurality of respondents believed in the importance of pharmacists in providing pharmaceutical care services. However, respondents expected much from pharmacists and felt that their current role was unsatisfying.
Keywords : Pharmacies; Community Pharmacy Services; Pharmacists; Professional Role; Professional Practice; Health Knowledge; Attitudes; Practice; Surveys and Questionnaires; Jordan
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Shift work and the risk of cardiovascular diseases and metabolic syndrome among Jordanian employees
Authors : Rana Abu Farha, Eman Alefishat
Abstract : Objectives: We sought to evaluate the effect of night shift working on increasing the risk of developing cardiovascular disease (CVD) using three different predictors.
Methods: One hundred and forty adult Jordanian employees were recruited in this cross-sectional study. Demographic data, anthropometric parameters, and working patterns information were documented. Metabolic syndrome (MetS) was diagnosed, and atherogenic index of the plasma (AIP) and Framingham risk score were calculated.
Results: Night shift workers had a significantly higher AIP ratio compared to daytime workers (p = 0.024). No significant association was observed between the two groups in term of 30-year Framingham risk score (p = 0.115). However, the duration of night shifts and the number of night shifts per months were found to significantly increase the 30-year Framingham risk (p = 0.000 and 0.012, respectively). Furthermore, the incidence of MetS among night shift workers was 15.9% (13/82) compared to 10.3% (6/58) among daytime workers (p = 0.484).
Conclusions: This is the first study to assess the association between night shift work and AIP as well as the 30-year Framingham risk score as predictors of CVDs. Night shift work was associated with an increase in AIP score compared to daytime work. Also, the duration of night shifts and the number of night shifts per month significantly increased the 30-year Framingham risk among night shift workers. These findings suggest an association between night shift work and the risk of CVD and atherosclerosis. Our results highlight the need for interventional strategies to diminish the risk of CVD in night shift workers.
Keywords : Night Shift Work, Cardiovascular Diseases, Metabolic Syndrome, Risk, Jordan
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Pregabalin dispensing patterns in Amman-Jordan: An observational study from community pharmacies
Authors : Amneh Al-Husseini, Rana Abu-Farha, Mayyada Wazaify, Marie Claire Van Hout
Abstract : Objectives: Pregabalin is currently approved for the treatment of epilepsy, generalized anxiety disorder, neuropathic pain and fibromyalgia. Rising attention to the abuse liability of pregabalin causing addictive behaviors is partially based on case reports and published literature of pregabalin used in dosages that override the approved therapeutic range. This study was conducted to provide background data regarding the abuse/misuse of pregabalin from community pharmacy in Jordan.
Methods: A prospective cross-sectional observational study design was used, which was conducted at different community pharmacies in Amman-Jordan. During the study period (November 2016–January 2017), a total 77 requests for pregabalin were observed from 14 pharmacies. A structured interview was conducted with all customers to gather information regarding their demographic and their request of pregabalin.
Results: A total of 77 pregabalin requests form 77 customers in a community pharmacy setting were observed in this study. Spinal disc herniation was the most common complaint for which the customer asked for the medication (n = 27, 35.1%). Self-medication was the most frequent method of requesting pregabalin (n = 44, 57.1%), while a total of 33 customers (42.9%) asked for the product using a prescription. During the observation period the number of customers suspected of abusing pregabalin for non-medical reason was 35 (45.5%). A total of 33 out of the 35 suspected customers (94.3%) asked for the product without a prescription, and 19/35 weren‘t sold due to suspicion of abuse (54.3%).
Conclusion: The study underscores the need for regulatory efforts to manage pregabalin abuse, through the addition of pregabalin containing products to the controlled drug list which can’t be purchased without a prescription. Also, pharmacists and customers must be educated at a community pharmacy level regarding potential hazards of pregabalin abuse.
Keywords : Pregabalin, Abuse, Observational study, Community pharmacy, Jordan
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Knowledge, attitudes, and practices of pharmacovigilance and ADRs spontaneous reporting among pediatricians and pediatric residents in Jordan
Authors : Tareq L Mukattash, Maysaa W Alwadi, Rana K Abu-Farha, Anan S Jarab, Sameh A Al-Zubiedi, Tareq Alwedyan
Abstract : Introduction: Pharmacovigilance (PV) is the science responsible for ADRs reporting and accordingly medication safety. Pediatrics age group is a special concern as they have a higher risk of developing ADRs; this put more burden on pediatricians for early detection and reporting of ADRs. The present study aims to explore pediatricians' knowledge, attitude, and practices of pharmacovigilance.
Method: A structured validated questionnaire was designed to achieve the study goals. A convenient sample of 142 pediatricians took part in the study.
Results: The majority of pediatricians had a poor knowledge score about pharmacovigiliance and ADRs reporting. On the other hand, 71% of respondents had a good attitude score towards reporting ADRs. When exploring their own practice, pediatricians have a low reporting rate.
Conclusion: The results of the present study reveal that pediatricians lack knowledge of PV and ADRs reporting. However, they have a good attitude towards ADRs reporting and enhancing their PV practice. This is still not reflected in their own practice. Further training and education about ADRs reporting are very important to move toward safer medications in children.
Keywords : ADRs; Jordan; hospital; pediatricians; pharmacovigilance; pharmacovigiliance
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An audit on parental attitudes towards medicines used in children
Authors : Tareq L Mukattash, Nuha Y ALGhzawi, Rana K Abu Farha, Anan S Jarab, Katri Hämeen-Anttila, Kristi Vainio, Omar S Gammoh
Abstract : Introduction: There is growing concerns regarding the use of medicines in children. Therefore, many strategies were implemented to improve such use and make safe and effective medicines more available for children. Enhancing interaction between parents and health care providers plays an important role in insuring the proper use of medicines. In order to optimize such interaction, the attitudes, beliefs and practices of parents toward medicine use in children need to be explored.
Methods: A validated questionnaire was administered via face to face interviews to 1000 parents attending pediatric outpatient clinics with their children in order to investigate their attitudes toward children's medicines.
Results: The majority of respondents (83.2%) were mothers. The majority participants (84.4%) agreed that medicines are necessary in treating illnesses, 80% of the parents had worries about the side effects and interactions of medicines, and 60% of the parents said they try to avoid giving medicines to their children. Moreover, parents in this study varied considerably in their views toward prescription and over-the- counter medicines. More than half of the participants (55.2%) declared that doctors in Jordan prescribe antibiotics to children too easily.
Conclusion: Participants had positive attitudes toward the necessity of medicines for ill children. However, a considerable proportion of the parents had negative attitudes toward children's medicines with respect to their side effects and interactions, their capability of disturbing the body's own capability of healing illnesses, their unnatural characteristic and other aspects related to medicines.
Keywords : Parents, Attitudes, Medicines, Children, Jordan
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