Pharmacy faculty experiences with student academic entitlement: a multinational study from the Arab world.

Academic Entitlement (AE) is the expectation by students to receive high grades or preferential treatment without significant effort. Exploring AE from faculty perspective has not been investigated in Arab colleges of pharmacy. The aim of this study was to explore experiences and perceptions towards student AE among pharmacy faculty in the Arab World. A cross-sectional, self-administered, anonymous, electronic survey was sent to pharmacy faculty across pharmacy colleges in Arab countries. The survey collected demographic data, an AE measure including 17 items reflecting seven AE components, and faculty perceptions and perceived reasons for AE. A total of 345 responses were collected. The AE level was moderate (46.05 ±7.29), and the highest scores among its components were for customer service expectation (62%) and responsibility avoidance (59%). In multiple linear regression, AE showed positive significant association with faculty in clinical pharmacy departments and those having fewer years of experience. Most common complaints heard by faculty from students were requests to turn in assignments late (90%), while the most common communication issues faculty faced with students were unprofessional verbal communication (58%) and unprofessional messages on social media (57%). Poor admission criteria (40%) and existence of multiple private colleges of pharmacy (37%) were the most common perceived reasons for AE by participating faculty. This study reveals moderate AE experienced by pharmacy faculty in the Arab World, as well as common complaints, communication issues, and AE reasons. In collaboration with other stakeholders, faculty play an important role in indicating expectations from students regarding AE, and research is warranted to check if such interventions reduce AE among pharmacy students.

Risk factors for severe dysmenorrhea in Arab women: A focus on war displacement and mental health outcomes.

Background: Dysmenorrhea is wide spread gynecological disorder among that affect the quality of life of women world wide. The current study aims to examine whether war displacement, mental health symptoms, and other clinical factors are associated with dysmenorrhea severity. Methods: This is a cross-sectional case-control study recruiting two groups: displaced Syrian women and un-displaced local Jordanian women. Demographics and clinical details were recorded. The severity of dysmenorrhea was assessed using WaLIDD scale, the PHQ-9 scale was emplyed to assess depressive symptoms, anxiety was assessed using the GAD-7 scale, and insomnia was assessed using the ISI-A scale. Predictors of severe dysmenorrhea in females using multivariate binary logistic regression. Results: Out of 808 of the total participants, 396 (49%) were Syrian displaced war refugees, 424 (42.5%) reported using paracetamol, 232 (23.2%) were using NSAIDs, and 257 (25.9%) using herbal remedies. Severe dysmenorrhea was associated with war displacement (OR = 2.14, 95% CI = 1.49-3.08, p < 0.001), not using NSAIDs (OR = 2.75, 95% CI = 1.91-3.95, p < 0.001), not using herbal remedies (OR = 2.01, 95% CI = 1.13-3.60, p = 0.01), depression (OR = 2.14, 95% CI = 1.40-3.29, p < 0.001), and insomnia (OR = 1.66, 95% CI = 1.14-2.42, p = 0.009). Conclusions: War displacement, type of analgesic, depression, and insomnia are risk factors for severe dysmenorrhea.

Assessment of adherence to carbamazepine using plasma and saliva samples, a study from Jordan.

Background: The measurement of carbamazepine levels in a biological sample is required to guide dosing, and prevent toxicity, and can be useful to assess medication adherence. Aim: The primary aim of the presented study is to analyze carbamazepine levels in saliva and plasma samples of outpatients and to assess adherence to carbamazepine using saliva and plasma levels. Methods: Adults who used carbamazepine for at least one month were recruited from the outpatient clinic department of Princess Basma Hospital, a public hospital in Irbid. Saliva and blood samples (1 ml) were collected simultaneously from subjects, and using a microanalytical method with high-performance liquid chromatography coupled with an ultraviolet detector, the level of carbamazepine (in micrograms per milliliter) was ascertained. Analysis of adherence to carbamazepine was carried out using plasma and saliva levels. Results: A total of 69 consecutive patients attending the neurology clinic were recruited, of whom 85.5% had epilepsy. Approximately one-third (34.8%) used carbamazepine as monotherapy, whereas the remainder used a combination of antiepileptic drugs to control seizures. Overall, about two-thirds (71.9%) of the studied samples were non-adherent in either plasma or saliva samples. By referring to the plasma sample carbamazepine concentration, 75.4% of the respondents were adherents, 15.9% had under-adherence, and 8.7% had over-adherence. A total of 85.9% of the responders were adherent using the carbamazepine level in saliva samples. Plasma and saliva carbamazepine levels were linearly correlated to one another. Polypharmacy was commonly utilized with the patients, as 42% of the patients used two medications, with a range of 1-7 drugs used concomitantly. The predictor associated with higher plasma and saliva carbamazepine levels, as determined by multiple linear regression analysis, was the occurrence of seizures less than once a month, as compared to seizures with higher frequencies. Conclusion: Saliva carbamazepine levels show the potential to be used as an alternative matrix to assess medication adherence, with a considerable correlation with the plasma carbamazepine level. Healthcare professionals can address routine care non-adherence through such measures.

Academic Entitlement Among Pharmacy Students in the Arab World: A Multi-National Exploratory Study.

OBJECTIVE: The study's aim was to explore academic entitlement among pharmacy students in different pharmacy colleges in the Arab World and assess associated factors. METHODS: This study design was a cross-sectional survey. Data were collected using a self-administered electronic questionnaire posted across pharmacy college networks in 10 Arab countries (Egypt, Iraq, Jordan, Lebanon, Libya, Oman, Palestine, Qatar, Saudi Arabia, and United Arab Emirates). The electronic survey was administered through Qualtrics Survey Software, and its link was open from January 23, 2022 to May 13, 2022. The multiple linear regression measured the association between different predictors and the academic entitlement. RESULTS: A total of 2386 surveys were received from students studying in 10 different Arab countries. The majority of responding students were male and studying in a Bachelor of pharmacy program. Students reported an agreeable attitude in 4 areas: rewards for efforts, customer orientation, customer service expectation, and general academic entitlement. In accommodation, a neutral attitude was reported, while they reported a disagreeing attitude in the responsibility avoidance domain. In grade haggling, the 3 items of the domain had different attitudes. Only 3 factors had a significant negative association with student entitlement (professionalism, GPA, and year in the study program). CONCLUSION: The academic entitlement scores among pharmacy students in the Arab World were high and had a negative association with professionalism perceptions. This study finding is a call for pharmacy programs to consider the effect of academic entitlement on pharmacy education and to obtain in-depth evidence on its magnitude and associated factors.

The relationship between psychiatric symptoms and the use of levetiracetam in people with epilepsy.

Background: Mental health in people with epilepsy (PWE) is often overlooked, especially in developing countries.Purpose: Consequently, the current work had two objectives: (1) to estimate the burden of depression, anxiety, insomnia, and stress, and (2) to examine the association of these psychiatric/psychological symptoms with levetiracetam and other relevant clinical factors in a cohort of Jordanian PWE.Research Design: This is a cross-sectional study. The demographic and clinical data were recorded. Depression was measured by the Patient Health Questionnaire-9 (PHQ-9, Arabic-validated version) and anxiety by the General Anxiety Disorder-7 (GAD-7, Arabic-validated version). The insomnia severity index (ISI-A, Arabic version) was used to assess sleep quality, and the Perceived Stress Scale (PSS-A, Arabic version) was used to measure perceived stress.Study Sample: Data were analyzed from 280 patients, of which 178 (63.6%) received levetiracetam as monotherapy or as adjuvant.Results: Depression was reported in 150 (53.6%), anxiety in 110 (39.3%), insomnia in 131 (46.8%), and clinically significant stress in 211 (75.4%). At univariate analysis, levetiracetam was not associated with psychiatric symptoms. Multivariate logistic regression revealed that severe depressive symptoms were associated with family history (OR = 2.47, 95% CI = 1.42-4.33, P = .001) and seizure type (OR = 1.69, 95% CI = 1.01-2.80, P = .04), severe anxiety symptoms were associated with family history (OR = 1.90, 95% CI = 1.12-3.23, P = .01), severe insomnia was associated with seizure type (OR = 2.16, 95% CI = 1.33-3.5, P = .002) and severe stress was associated with marital status (OR = 2.37, 95% CI = 1.31-4.29, P = .004).Conclusions: The high psychological burden of PWE is a challenging issue that requires attention and prompt action to control its risk factors.

Vancomycin audit in the paediatric population: Patterns of use and appropriateness of therapeutic drug monitoring.

AIMS: This study aims to investigate prescribing and therapeutic drug monitoring (TDM) practices for vancomycin in paediatrics at the Jordan University Hospital and to determine the impact of inaccuracies in TDM data on dosing decisions. METHODS: Patterns of vancomycin prescriptions, appropriateness of vancomycin dosing, duration, TDM, and the accuracy of the recorded dosing/sampling times were determined prospectively based on prespecified criteria. Finally, Monte Carlo simulations were undertaken using the mrgsolve-package in R to assess the effect of inaccuracies in recording dosing/sampling times on subsequent dose adjustments. RESULTS: Four hundred forty-two vancomycin courses were analysed. Vancomycin prescriptions were mainly empirical (77.4%). Initial vancomycin doses were appropriate in 73.1% of vancomycin courses. Prolonged use (>5 days) was found in 45.7% of admissions with negative cultures; this was related to the diagnosis of suspected sepsis unadjusted-OR: 1.8 (1.1-2.9). TDM was appropriately ordered in 90.7% of concentrations. Discrepancies between the recorded and actual times were noted in 83.9% and 82.7% of audited times of dose administration and sample collection, respectively. Based on simulations, these discrepancies were predicted to result in inappropriate dose adjustment in 37.9% of patients. CONCLUSIONS: Inappropriate empirical and prolonged vancomycin use and inaccuracies in recording dosing/sampling times are important areas of improvement in the current clinical practice.

Perceived Public Stress Among Jordanians During the COVID-19 Outbreak.

OBJECTIVES: Outbreaks and containment measures implemented to control them can increase stress in affected populations. The impact of the coronavirus disease 2019 (COVID-19) outbreak on perceived stress levels in the Jordanian population is unknown. The aim of the study was to determine the perceived stress level and factors associated with it in the Jordanian population during the COVID-19 outbreak. METHODS: Required data, such as those from the Perceived Stress Scale (PSS-10) and possible predictors of perceived stress, were collected through a Web-based survey. Statistical analysis was conducted through SPSS. RESULTS: The mean (SD) of perceived stress score was 19.8 (6.7). Regression analysis revealed that stress was increased in females, young adults, usually being stressed more than others by a health problem, increased perceived severity of the disease, increased overall worry score, and student's worry regarding their studies/graduation. Perceived stress was decreased if participants' self-rated health status score increased. CONCLUSIONS: In the context of increasing public health preparedness, the results of this study can be used in designing interventions to alleviate stress in susceptible segments of the Jordanian community.

Remote learning during Covid-19 lockdown: A study on anatomy and histology education for pharmacy students in Jordan.

The Covid-19 pandemic has changed almost all aspects of education. The anatomy and histology courses for pharmacy students focus heavily on the face-to-face communication of theory and practical knowledge, and due to the pandemic, only theory content was delivered in an online format. This brought up many concerns about pharmacy student preparedness. This work explores the effectiveness and student perspective of remote teaching of the theoretical anatomy and histology course in Jordanian universities from the perspective of pharmacy students. The objectives are to determine the strengths, challenges, and the effectiveness of remote delivery on student learning. An online-based validated questionnaire was distributed to students majoring in Pharmacy and enrolled in the course during the second semester of 2019-2020 at 11 universities in Jordan. A total of 442 students participated in the study. Results showed that there were significant differences in perceptions of the social media platforms used in distance learning and remote delivery of the course. Most participants had positive perceptions of the educational process and studying via distance learning. There were many strengths noted including time flexibility and several challenges such as the lack of face-to-face interaction with instructors, inadequate internet connectivity, and technical issues. In conclusion, online-taught anatomy and histology course during the Covid-19 lockdown in Jordan was a success as perceived by students, but the course still possessed challenges need to be overcome in the future.

Knowledge about cervical cancer and awareness about human papillomavirus vaccination among medical students in Jordan.

OBJECTIVES: To assess the knowledge about cervical cancer and HPV infection and the awareness towards and perceived barriers of HPV vaccination amid medical students in Jordan. METHODS: The present study is a cross-sectional survey that was conducted for a period of three months in the College of Medicine at six different universities in Jordan. Third-year to sixth-year students from these medical colleges in Jordan were invited to participate in the study. RESULTS: There were 504 students that took part in the study with 42.3% being males and 57.7% females. The mean knowledge score of students in our survey was 21.4 ± 4.4 out of 34, which was categorized as a moderate level of knowledge regarding cervical cancer and HPV. Only 40.5% knew about the availability of the HPV vaccine in Jordan, and 65.9% accepted the idea that it is necessary to introduce the HPV vaccine for school girls in Jordan. CONCLUSIONS: This study highlights that there is inadequate knowledge about cervical cancer and its screening among medical students in Jordan. Despite the limited awareness about the HPV vaccine among the study's participants, there is a favorable opinion towards the introduction of the vaccine for school girls in Jordan. The data provide a benchmark on the level of knowledge about cervical cancer and awareness about HPV, which can be used to formulate an effective awareness program.

Use of complementary and alternative therapies in infants under 3 months in Jordan.

BACKGROUND: The use of complementary and alternative medicine in infants to maintain health and treat illnesses is popular in Jordan. No guidelines or regulations govern their use. AIMS: This study explored mothers' knowledge and use of complementary and alternative therapies for infants younger than 3 months in Jordan and their reasons for using these remedies. METHODS: This was a cross-sectional study of a convenience sample of mothers of babies born in 2015 in Jordan. Data were collected using a questionnaire posted on six Facebook groups that target mothers in Jordan. Mothers were asked about their use of several complementary and alternative therapies for different conditions. RESULTS: Of 1028 questionnaires received, 520 were included in the analysis. Most mothers (81.3%) were 18-29 years old and had a university degree (78.3%). Most knew about the use of the complementary and alternative medicines for bloating/ colic but had never used them. Of the medicines used for bloating/colic, aniseed was most often used (by 70.2% of mothers). Aniseed was also used by 60.8% of mothers to help their baby sleep and by 48.1% for constipation. The main reasons for using these remedies were availability at home (60.4%) and social acceptability of their use (55.4%). The main sources of information about these medicines were older female relatives (78.1%) and social media (56.0%). CONCLUSIONS: The use of complementary and alternative medicines for babies is common in Jordan. Efforts are needed to increase awareness among mothers of the risks, side-effects and efficacy of complementary and alternative therapies in infants.

Population Pharmacokinetic Studies of Digoxin in Adult Patients: A Systematic Review.

BACKGROUND: Digoxin is a cardiac glycoside that was introduced to cardiovascular medicine more than 200 years ago. Its use is associated with large variability, which complicates achieving the desired therapeutic outcomes. OBJECTIVES: To present a synthesis of the available literature on the population pharmacokinetics of digoxin in adults and to identify the sources of variability in its pharmacokinetics. METHODS: This is a PROSPERO registered systematic review (CRD42018105300). A literature search was conducted using the ISI Web of Science, Science Direct, PubMed, and SCOPUS databases to identify digoxin population pharmacokinetic studies of adults that utilized the nonlinear mixed-effect modeling approach. RESULTS: Sixteen articles were included in the present analysis. Only two studies were conducted in elderly subjects as a separate population. Both the pharmacokinetics and pharmacodynamics of digoxin were investigated in one study. Furthermore, the reviewed studies were mostly conducted in East Asian populations (68.8%). Digoxin's pharmacokinetics were usually described by a one-compartment model because of the nature of the collected data. Weight, age, kidney function, presence of heart failure, and co-administered medications such as calcium channel blockers were the most commonly identified predictors of digoxin clearance. The value of apparent clearance in a typical study individual ranged from 0.005 to 0.2 l/h/kg, while the value of the apparent volume of distribution ranged from 3.14 to 15.2 l/kg. The quality of model evaluation was deemed excellent only in 31.3% of the studies. CONCLUSION: This review provides information about variables that need to be considered when prescribing digoxin. The results highlight the need for prospective studies that allow two-compartment pharmacokinetic/pharmacodynamic models to be established, with a special focus on the elderly subpopulation.

Self-medication among pregnant women attending outpatients' clinics in northern Jordan-a cross-sectional study.

Self-medication can facilitate patients' access to medicinal products, save time, and reduce financial and health-care service use burden. On the other hand, irresponsible use of self-medications can result in adverse consequences. Self-medication is common among different demographic groups including pregnant women. In general, medicinal products might have harmful effects on mothers and baby. This study aimed to assess self-medication practices among pregnant women in the northern region of Jordan. A cross-sectional study was conducted on pregnant women attending outpatient clinics in the northern region of Jordan. Self-medication practices among the target population were assessed using a survey questionnaire that was administered through interviewer-assisted mode. Data were collected between December 2019 and September 2020, and descriptive statistics and inferential analysis were applied. A total of 1,313 pregnant women were surveyed (response rate = 95.50%). Self-medication and the use of herbal remedies were practiced by 33.10% and 32.14% of the participant, respectively. Headaches and general pains were the most frequently reported conditions treated by self-medication practice with either conventional medicinal products or herbal remedies. The gravidity (≥4) and the gestational stage (≥28 weeks) were the predictors of self-medication practice. This study showed that self-medication was not widely practiced by pregnant women in the northern region of Jordan. Disease simplicity and previous history were the main motives for self-medicating. Efforts should be made by health-care providers to address pregnant women and educate them to increase their awareness about the unsafe use of medicines and the harmful effects on fetus.

Knowledge and awareness about human papillomavirus infection and its vaccination among women in Arab communities.

Cervical cancer (CC) is one of the most common types of cancer that affect females worldwide with hundreds of thousands of women dying annually due to this disease, mainly in developing countries. Infection with human papillomavirus (HPV) is the main risk factor for this cancer. There are no public awareness and national immunization programs in most Arab countries. This study aimed to investigate the knowledge and awareness about the HPV vaccine among females in four Arab countries and their acceptance to receive the vaccine. A cross-sectional study was conducted in several Arab countries: Jordan, Qatar, the United Arab Emirates (UAE), and Iraq. Respondents that fulfilled the desired criteria and were willing to participate in the study were asked to fill out the survey. Knowledge and awareness were assessed using 13 questions. Ethical approvals were given from the four countries. A total of 3658 individuals participated in the study; however, 2804 responses were included in the analysis and more than one third of participants (n = 1007) were aged between 18 and 25 years old. This study revealed poor awareness and knowledge of the participants about HPV and its vaccine among all four countries' participants with relatively better knowledge among participants from the UAE. Participants who are younger (18-25 years old), have a postgraduate education, have an education or career related to the medical field, or had a Pap smear in the last three years tend to have higher knowledge about the HPV vaccine compared to others. Poor knowledge and awareness findings in this study were expected, considering the lack of public education campaigns regarding the HPV virus coupled with the absence of the HPV vaccination from the national immunization schedule in three participating countries (Jordan, Qatar, and Iraq). It is recommended that there is a need to provide national educational campaigns about the HPV vaccine to the public in all Arab populations.

Knowledge about Medicine Use in Pregnancy: A National Study among Pharmacy Students in Jordan.

BACKGROUND: Knowledge of medication use during pregnancy presents a concern to pharmacists upon graduation since they will be responsible for drug-related inquiries and counselling pregnant women about their medications. The present study aimed to assess undergraduate senior pharmacy students' knowledge about medication use during pregnancy in Jordan. METHODS: A cross-sectional survey was conducted in Jordanian universities. A total of 409 senior pharmacy students participated in the study. RESULTS: The results found that the majority of the students (60.6%) did not have enough instruction on medications during pregnancy through their undergraduate study. Overall, only 2.5% of the participating students were considered to have good knowledge about medicine use during pregnancy and accordingly, the majority (52.6%) were not confident to recommend medicines for pregnant women in the future. In view of that, participating students suggested the addition of an obligatory course to the current curriculum. Students in public universities, Pharm.D. students, and those in their sixth year of study were more knowledgeable than others (P > 0.05). CONCLUSION: It was concluded that pharmacy students have low knowledge regarding medication use in pregnancy. The results call for a reassessment of the current pharmacy curriculum.

Role of Pharmacists in COVID-19 Disease: A Jordanian Perspective.

OBJECTIVES: The novel 2019 coronavirus outbreak that first appeared in Wuhan has quickly gained global attention, due to its high transmissibility and devastating clinical and economic outcomes. The aim of this study was to assess the possible roles of Jordanian pharmacists in minimizing the stage of community transmission. METHODS: A cross-sectional survey using Google forms targeting Jordanian pharmacists was conducted during March 2020 and distributed electronically by means of social media. Using the survey tool, we measured the pharmacists' knowledge, the educative activities they perform, and their perceptions regarding undertaking traditional and untraditional roles during the COVID-19 outbreak, as specified by the International Pharmaceutical Federation (FIP). Collected data were analyzed using SPSS version-19. RESULTS: Jordanian pharmacists (n = 449) reported performing various educative activities, and in general, they were knowledgeable about various aspects of the COVID-19 disease (median knowledge score: 20 [range, 13-25]), but certain gaps in knowledge were detected that must be addressed. Pharmacists had positive perceptions about both their traditional and untraditional roles specified by the FIP, the median perceptions score was 4 (range, 1-5). CONCLUSIONS: Jordanian pharmacists can be used to reduce community transmission of the outbreak. However, more actions are required to keep pharmacists knowledgeable with recent disease updates to enable them to perform their tasks effectively during times of crisis.

Effect of an educational intervention on public knowledge, attitudes, and intended practices towards diabetes mellitus: A quasi-experimental study.

AIM: To assess the impact of educational workshops on the knowledge, attitudes, and intended practices (KAP) of the general public towards diabetes in Jordan in terms of symptoms, risk factors, complications, and prevention. METHODS: A pharmacist led educational intervention and Propensity score matching was carried out for a convenience sample to assess Jordanians pre- and post-knowledge, attitudes, and practices towards diabetes mellitus (DM) using a validated questionnaire. RESULTS: Among the 357 invited participants, 335 attended the educational workshops (response rate 93.8%). Prior to intervention, participants showed an overall knowledge score of 16.03 ± 4.88. About half of the participants knew that a sedentary lifestyle is a risk factor for getting DM (n = 172, 51.3%). Following educational intervention, knowledge scores significantly improved to be 21.36 ± 2.11 (P value < .001). A similar finding was obtained for attitude scores, where mean attitude scores significantly improved from 2.74 ± 1.94 before intervention to 4.40 ± 1.87 following the workshop (P value < .001). As for the intended practices, the educational intervention improved the participants' intent to exercise, eat healthy foods, and do annual screening. CONCLUSIONS: Participants' knowledge, attitudes, and intended practices improved following a trained pharmacy led educational intervention. These encouraging results highlight the need for continuous national educational interventions about diabetes provided by trained health care professionals such as pharmacists. Future studies are needed to evaluate the impact of improved knowledge and perceptions on actual long-term practice.

Adherence to Azathioprine/6-Mercaptopurine in Children and Adolescents with Inflammatory Bowel Diseases: A Multimethod Study.

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 (p=0.013). 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.

A systematic review of population pharmacokinetic analyses of digoxin in the paediatric population.

This is a PROSPERO registered systematic review (CRD42018105207), conducted to summarize the available knowledge regarding the population pharmacokinetics of digoxin in paediatrics and to identify the sources of variability in its disposition. PubMed, ISI Web of Science, SCOPUS and Science Direct databases were searched from inception to January 2019. All paediatric population pharmacokinetic studies of digoxin that utilized the nonlinear mixed-effect modelling approach were incorporated in this review, and data were synthesized descriptively. After application of the inclusion-exclusion criteria 8 studies were included. Most studies described digoxin pharmacokinetics as a 1-compartment model with only 1 study describing its pharmacokinetics as 2-compartments. Age was an important predictor of clearance in studies involving neonates or infants, other predictors of clearance were weight, height, serum creatinine, coadministration of spironolactone and presence of congestive heart failure. Congestive heart failure was also associated with an increased volume of distribution in 1 study. The estimated value of apparent clearance in a typical individual standardized by mean weight ranged between 0.24 and 0.56 L/h/kg, the interindividual variability in clearance ranged between 7.0 and 35.1%. Half of the studies evaluated the performance of their developed models via external evaluation. In conclusion, substantial predictors of digoxin pharmacokinetics in the paediatric population in addition to model characteristics and evaluation techniques are presented. For clinicians, clearance could be predicted using age especially in neonates or infants, weight, height, serum creatinine, coadministration of medications and disease status. For future researchers, designing pharmacokinetic studies that allow 2-compartment modelling and linking pharmacokinetics with pharmacodynamics is recommended.

Hematocrit, blood volume, and surface area of dried blood spots - a quantitative model.

The use of the dried blood spot (DBS) sampling technique has extended the scope of clinical research, particularly in children. The effects of different hematocrit levels (25-55%) and different blood volumes (7.5-30 µL) on the surface area of the blood spots were investigated using ImageJ® software. Variation in hematocrit levels between patients and inaccuracies in blood volumes applied to Guthrie cards can have a marked effect on analyte concentrations measured in DBS samples. The current study presents a validated model that links blood volume and hematocrit to the surface area of the blood spot. The final model showed that both factors affect the blood spot surface area, however, the positive effect of blood volume is higher than the negative effect of hematocrit. The measurement of surface area could be added as an additional quality control step in clinical studies that have adopted fixed volume DBS sampling for the quantification of the analytes. This approach can be used in estimating the hematocrit if this is not known for a patient or estimating the volume in spots that are visually different in size from the norm, i.e. technical error.

The awareness of the Jordanian population about OTC medications: A cross-sectional study.

Due to the shortage of literature related to the safe use of over-the-counter (OTC) products by patients worldwide, the aim of this study was to evaluate people's knowledge and attitudes regarding the use of OTC products in Jordan. Using an internet-based questionnaire mainly spread through social media platforms, a descriptive cross-sectional study was conducted with Jordanian candidates who consume OTC products. A total of 274 OTC product users answered the survey questions. The results showed that analgesics were the most commonly used OTC products among the participants (50.4%). The majority used the OTC products only as needed rather than on a regular basis. Only 42.4% of the participants sought a pharmacist's help in determining the dose of the OTC medicine. Most of the participants were very interested in reading a patient information leaflet (80.3%) and the side effects and contraindications (89.5%). The majority of participants agreed that antibiotics have to be prescribed (68.5%), and anti-allergy medications should not be used as sleep aid medications (75.0%). About 53.4% thought that OTCs are sometimes enough to treat their health conditions without the need to follow-up with a physician. A chi-square analysis showed an association between gender, age, educational level and having a family member in the medical field and OTC products knowledge among Jordanians. Females, for example, were more interested in reading leaflet, checking production and expiry dates, knowing adverse effects, and appropriate storage conditions (P < .001, 0.022, 0.003, 0.007, respectively). We concluded that a good level of knowledge on the use of OTC products among the study population was identified in the present study.