An evaluation of pharmacists' general attitudes, knowledge, and phobias regarding medications that include corticosteroids: a cross-sectional study.

BACKGROUND: Corticosteroid-containing medications are widely accessible in various forms, including topical, injectable, and inhaled formulations. Due to uncertain safety profiles, healthcare providers, including pharmacists, often express apprehension when dispensing these drugs. This cross-sectional study assesses the knowledge, attitudes, and phobia of Jordanian pharmacists regarding corticosteroid-containing medications. METHODS: Conducted through a self-administered online questionnaire. RESULTS: the study reveals that dermatological conditions and respiratory disorders are the primary indications for prescribing corticosteroid-containing drugs. The most reported side effects among pharmacists' patients include increased appetite, diabetes, and skin thinning. Pharmacists generally exhibit acceptable knowledge, with a median score of 9.0 out of 11.0 (IQR = 3.0). Over two-thirds of pharmacists (69.9%) achieve a high knowledge score (Bloom's cut-off point ≥ 8.8). However, only 55.7% are aware that corticosteroids may induce mood changes. High phobia scores, particularly concerning increased blood pressure and osteoporosis risks, indicate pharmacist reservations in corticosteroid dispensing. Interestingly, pharmacists in rural areas display lower knowledge scores, while those working outside community pharmacies exhibit lower phobia scores compared to their counterparts in urban areas and community pharmacies, respectively. CONCLUSION: Despite generally good knowledge levels, the study underscores high phobia scores among Jordanian pharmacists regarding corticosteroid dispensing, particularly due to concerns about blood pressure elevation and osteoporosis risks. This suggests a potential need for targeted educational interventions and support systems to enhance pharmacist confidence and optimize corticosteroid usage while minimizing associated risks.

Assessing the predictive value of neutrophil percentage to albumin ratio for ICU admission in ischemic stroke patients.

Background: Acute ischemic stroke (AIS) remains a substantial global health challenge, contributing to increased morbidity, disability, and mortality. This study aimed at investigating the predictive value of the neutrophil percentage to albumin ratio (NPAR) in determining intensive care unit (ICU) admission among AIS patients. Methods: A retrospective observational study was conducted, involving AIS cases admitted to a tertiary hospital in Jordan between 2015 and 2020. Lab data were collected upon admission, and the primary outcome was ICU admission during hospitalization. Descriptive and inferential analyses were performed using SPSS version 29. Results: In this study involving 364 AIS patients, a subset of 77 (21.2%) required admission to the ICU during their hospital stay, most frequently within the first week of admission. Univariable analysis revealed significantly higher NPAR levels in ICU-admitted ischemic stroke patients compared to those who were not admitted (23.3 vs. 15.7, p < 0.001), and multivariable regression models confirmed that higher NPAR (≥19.107) independently predicted ICU admission in ischemic stroke patients (adjusted odds ratio [aOR] = 4.85, 95% CI: 1.83-12.83). Additionally, lower GCS scores and higher neutrophil-to-lymphocyte ratio (NLR) were also associated with increased likelihood of ICU admission. In terms of predictive performance, NPAR showed the highest accuracy with an AUC of 0.885, sensitivity of 0.805, and specificity of 0.854, using a cutoff value of 19.107. NPAR exhibits an AUC of 0.058, significantly outperforming NLR (Z = 2.782, p = 0.005). Conclusion: NPAR emerged as a robust independent predictor of ICU admission in ischemic stroke patients, surpassing the predictive performance of the NLR.

Assessment of Jordanian pharmacists' knowledge and perception regarding sexual and reproductive health and their practice in providing sexual counseling to patients.

Objective: In this quantitative study, we intended to explore sexual/ reproductive counseling between Jordanian pharmacists by addressing pharmacists' knowledge regarding sexual/ reproductive health and their perception and practice in providing counseling to patients. Method: This study adopted a survey methodology using a self-completed validated and administered unnamed survey. Participants were asked to fill-out the electronic survey after providing their electronic consent. Social media was utilized to extend the survey to facilitate contact multiple parts of pharmacists' community. Results: In this study, 200 pharmacists agreed to participate in this study. Most of the pharmacists knew that depression (n= 182, 91%) and alcohol (n=171, 85.5%) were among the main factors that my decrease sexual performance. Also, only 38.5% of the pharmacists (n= 77) agreed that discussing sexual issues is the responsibility pf pharmacists, and only 55% of them (n= 110) felt comfortable discussing patients' sexual matters as any medical issue. Moreover, more than two-third of the pharmacist (n= 146, 73%) reported that if they were consulted about sexual problem, they may explore patients' problem. On the other side, only half of pharmacists (n= 102, 51%) revealed that they may discuss the side effects of prescribed drug if it might affect sexual performance. Conclusion: Education on sexuality/ reproduction is the key to help Jordanian pharmacists to advance patients' sexual/ reproductive health. In general, research on sexual/ reproductive health in conservative societies is limited. Therefore, additional surveys that include the perspectives of both patients and pharmacists on sexuality/ reproduction to augment this normally ignored aspect of health are necessary.

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

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

Medication discrepancies in hospitalized cancer patients: Do we need medication reconciliation?

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.

Pharmacists' perceived barriers towards delivering their emergency roles during the COVID-19 pandemic and perceived policymakers' responsibilities.

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.

Pharmacists' perception of their role during COVID-19: a qualitative content analysis of posts on Facebook pharmacy groups in Jordan.

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 20th and April 3rd. 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.

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.

Health-related quality of life and its associated factors among patients with angina in Jordan.

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.

Patterns of antibiotic use and administration in hospitalized patients in Jordan.

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.

Premenstrual syndrome and premenstrual dysphoric disorders among Jordanian women.

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.

The impact of drug related problems on health-related quality of life among hypertensive patients in Jordan.

BACKGROUND: Hypertension is a major cause of cardiovascular diseases with a high prevalence in Jordan. No previous studies have been carried out to determine the effect of the presence of drug-related problems (DRPs) on the health-related quality of life (HRQOL) among hypertensive patients. OBJECTIVES: The purpose of this study was to identify the influence of different types of DRPs on the HRQOL of hypertensive patients. METHODS: A total of 200 hypertensive patients were recruited in this cross-sectional correlation study that was conducted across the cardiac outpatient clinic at Jordan University Hospital. Ethical approval was obtained and patients were recruited using convenience sampling technique. During the study period, patients' data was used to evaluate their quality of life using RAND-12 scale and to identify DRPs utilizing a systematic evidence based approach. RESULTS: 200 hypertensive patients (mean age 59.7 years (SD=10.2)) were recruited in this study. Patients showed a poor quality of life on both the physical and mental domains of the RAND-12 scale. The average number of DRPs was 5.1 (SD=2.3). Multiple linear regression analysis showed that among DRPs categories, non-adherence to medications, non-adherence to non-pharmacological therapies and inadequate knowledge about medications were among the main predictors of the poor physical domain of the RAND-12 (Beta= -0.149, -0.226 and -0.230 respectively, p-value < 0.05 for all). On the other hand, only non-adherence to medication and non-adherence to non-pharmacological therapies were significantly associated with poor mental domain of the RAND-12 (Beta= -0.208 and -0.191 respectively, p-value < 0.05 for both). CONCLUSION: Prevalence of DRPs among hypertensive patients is a concern that needs attention. These DRPs were associated with poor HRQOL on both the physical and mental domain of the RAND-12 scale. The pharmaceutical care service delivered by pharmacists is needed to identify, prevent and resolve DRPs, which may improve patients HRQOL.

Hospital pharmacy medication reconciliation practice in Jordan: perceptions and barriers.

RATIONALE, AIMS AND OBJECTIVES: The primary aim of this study is to gain an insight into hospital pharmacists' current practice and perceptions towards medicine reconciliation and to identify common challenges preventing pharmacists from providing this service. METHODS: A cross-sectional study was conducted over 2 months (September-October 2015) at four Jordanian hospitals accredited by the Joint International Commission. A total of 76 pharmacists were recruited. Each pharmacist completed a validated structured questionnaire evaluating (1) pharmacist's current practice of medication reconciliation, (2) pharmacist's perceptions towards practicing medication reconciliation and (3) pharmacist's perceived barriers towards implementing medication reconciliation. RESULTS: There was relatively low awareness of the presence of current medication reconciliation policy in the hospitals. The majority of recruited pharmacists believed that pharmacists must have an integral role in providing such services to patients. They were also willing and able to provide help and support to all healthcare providers regarding the appropriateness of prescribed medications. It was evident that the greater the practice of medication reconciliation services and the higher the educational level, the better the overall perception score (r = 0.416 and r = 0.366, respectively; P-value = 0.000 for both). 'Time constraint' was the primary barrier discouraging pharmacists from practicing such service. CONCLUSION: This study demonstrates a relatively low awareness of the concept and policy of medication reconciliation process among Jordanian pharmacists. This suggests that educational programs are urgently needed to increase pharmacists' role and responsibilities in implementing and practicing reconciliation services with expected positive impact on patient care.