Costs saved and avoided from pharmacist interventions to address drug-related problems identified from outpatient clinics in Jordan.

BACKGROUND: The pharmacist plays an essential role in identifying and managing drug-related problems. The aim of this research was to assess the costs avoided by clinical pharmacist interventions to resolve drug-related problems. RESEARCH DESIGN AND METHODS: Clinical pharmacists identified drug-related problems and interventions to address them in consecutive outpatients visiting internal medicine clinics at major teaching and public hospitals in Jordan from September 2012 to December 2013. The costs avoided by each intervention to address drug-related problems were collected from the literature. The collected data were used to calculate the overall cost saved and avoided by the interventions implemented to address the identified drug-related problems, adopting a Jordanian healthcare system perspective. RESULTS: A total of 2747 patients were enrolled in the study. Diagnostic interventions, such as the need for additional diagnostic testing, were employed in 95.07% of the 13935 intervention to address the drug-related problem "Miscellaneous" which was the most frequent drug-related problems. Other common drug-related problems categories included inappropriate knowledge (n = 6972), inappropriate adherence (4447), efficacy-related drug-related problem (3395) and unnecessary drug therapy (1082). The total cost avoided over the research period was JOD 1418720 per month and total cost saved over the study period was JOD 17250.204. Drug-related problems were associated the number of prescription medications (odds ratio = 1.105; 95% confidence interval = 1.069-1.142), prescribed gastrointestinal drugs (3.485; 2.86-4.247), prescribed antimicrobials (3.326; 1.084-10.205), and prescribed musculoskeletal drugs (1.385; 1.011-1.852). CONCLUSIONS: The study revealed that pharmacists have provided cognitive input to rationalize and optimize the medication use and prevent errors, that led to the reported projected avoided and saved expenditures via various interventions to address drug-related problems. This highlights the added economic impact to the clinical impact of drug-related problems on patients and the healthcare system. The high prevalence and cost of drug-related problems offer strong rationale for pharmacists to provide more vigilant intervention to improve patient outcomes while maintaining cost effectiveness.

The rise of telepharmacy services during the COVID-19 pandemic: A comprehensive assessment of services in the United Arab Emirates.

Objective: The study aimed to explore changes in community pharmacies' processes in response to the pandemic in the United Arab Emirates (UAE) and factors affecting the adoption of these changes. Method: A cross-sectional study was conducted using a self-administered questionnaire that was distributed to licensed community pharmacists in the UAE. The survey used to collect information on the type of telepharmacy services and related topics such as constraints and supports. The evaluation of services was done for three periods: before, during and after lockdown. Results: The number of completed surveys was 391. The majority of the participants were under 35 years old (79.5%), female (65.0%), with a bachelor's degree (82.6%), and working in a pharmacy group (70.6%). Pharmacies provided the services by phone (95.6%) and/or messaging applications (80.0%) such as WhatsApp and Messenger. The community pharmacies provided a variety of services using telepharmacy tools such as managing of mild diseases, dispensing and delivering prescribed and OTC medications, general health information, and services for patients with chronic disease. The main factors that had significant effects on several telepharmacy services were pharmacies' type (group/chain vs. individual) and the number of pharmacists in the pharmacy (p < 0.05). Lack of time, training and financial support were the main barriers associated with telepharmacy services among individual pharmacies. Conclusion: Telepharmacy supported the work of community pharmacies during the COVID-19 pandemic by facilitating the provision of pharmaceutical services. Although the occurrence of several financial and technical problems, it appeared less frequently in pharmacy chains with a large number of pharmacists.

A Comprehensive Assessment of Knowledge, Attitudes, and Practicalities Related to Doping Agents use among Jordanians.

Background: People perform sports for better health and wellbeing. However, the use of doping agents is emerging among young adults. This study investigated aspects related to doping agents. Methods: A reliable self-administered questionnaire (Cronbach's alpha =0.72, Pearson's r = 0.89) was used to assess knowledge, attitudes, and practicalities related to the use of doping agents. Results for pharmacists as health care providers (HCP, n=550) were compared with non-healthcare providers (Non-HCP, n=319). Results: Among pharmacists, 82.9% knew the definition of doping agents vs. 72.4% of non-HCP (P<0.001). However, 36.7% of pharmacists vs. 39.6% of non-HCP incorrectly classified doping agents (P=0.02). The majority of responders (89.8%) supported having an anti-doping authority, yet, only 15% were aware of the anti-doping organizations. The majority of responders (83%) did not receive an official education related to doping agents. Enhancing physical performance was perceived as a leading driver (82.1%) to use doping agents. More than 90% of responders supported awareness in the community. The perceived best tool for awareness was social media and TV sites, as suggested by pharmacists (95.0%) and non-HCP (92.1%, P=0.312). A total of 6.1% had ever used doping agents (3.6% pharmacist vs. 9.8% non-HCP, P<0.001). Almost half of the users utilized a diet or medication to counteract the side effects of doping agents. Within pharmacists, males received more requests to provide doping agents (41.9%) compared with females (23.8%, P<0.001). Conclusion: It is crucial to enhance professional and legal knowledge and public awareness about doping agents, not only for non-HCP but also for HCPs. Applying more restrictions on doping agents is strongly recommended.

Awareness about nanotechnology and its applications in drug industry among pharmacy students.

INTRODUCTION: Given the multiple nanotechnology-based pharmaceutical products that are available on the drug market, nanotechnology education has to be offered within pharmacy undergraduate curricula. METHODS: A cross-sectional study was carried out to assess the level of nanotechnology awareness among pharmacy students using two questionnaires. The study targeted 500 students and the deans of the faculties of pharmacy in Jordan. RESULTS: Results show that most of the students had poor knowledge about nanotechnology and that academic courses are the leading source of information. <10% of students attended experiments related to nanotechnology. About 50% of students did not have any knowledge about the safety of nanotechnology. All the deans stated that there is no specific practical or theoretical course to teach nanotechnology, but the concepts are taught within other courses. CONCLUSIONS: Pharmacy students' knowledge about nanotechnology is poor, and courses within pharmacy curricula need to be dedicated to teaching nanotechnology and its applications.

Assessment of Pathogenic Potential, Virulent Genes Profile, and Antibiotic Susceptibility of Proteus mirabilis from Urinary Tract Infection.

Proteus mirabilis is the third most common bacterium that can cause complicated UTI, especially in catheterized patients. Urovirulence genes of P. mirabilis strains are poorly identified among UTI patients. The aims of the present study were to determine the prevalence of the uropathogenic P. mirabilis strains isolated from UTI patients by the detection of several P. mirabilis virulence genes and to characterize the antibiotic susceptibility profile of P. mirabilis isolates. P. mirabilis isolates were collected from urine specimens of patients suffering from UTI. Virulence genes in P. mirabilis, namely, hpmA, hpmB, rsbA, luxS, ureC1, hlyA, rpoA, atfA, atfC, mrpA, and pm1 were detected in the isolates via PCR detection method. All P. mirabilis virulence genes were detected in more than 90% of the isolates except hlyA gene, which was detected in only 23.8% of the isolates. The rate of susceptibility for ceftriaxone was 96.8%, followed by norfloxacin (82.5%), gentamicin (71.4%), ciprofloxacin (69.8%), cephalexin (52.4%), nalidixic acid (42.9%), sulfamethoxazole (39.7%), ampicillin (36.5%), and nitrofurantoin (3.2%). Significant associations (P < 0.05) were detected between antimicrobial susceptibility of each of the following antibiotics and the presence virulence genes. Cephalexin antimicrobial susceptibility was significantly associated with the presence each of ureC1 and atfC. Sulfamethoxazole antimicrobial susceptibility was significantly associated with the presence atfA. Ceftriaxone antimicrobial susceptibility was significantly associated with the presence each of hpmA, ureC1, rpoA, atfC, mrpA, and pm1. Nitrofurantoin antimicrobial susceptibility was significantly associated with the presence each of hpmA, ureC1, rpoA, atfA, atfC, mrpA, and pm1. In conclusion, an association between the presence of urovirulence genes of P. mirabilis and increasing P. mirabilis resistance to antimicrobials has been demonstrated.

Analysis of prevalence, risk factors, and potential costs of unnecessary drug therapy in patients with chronic diseases at the outpatient setting.

Background: Patients with chronic diseases require long-term use of medications and are at risk for prescription of unnecessary drugs.Objective: To determine the prevalence, risk factors, and costs associated with unnecessary drugs in patients with chronic diseases at outpatient settings.Methods: Clinical and demographic data, unnecessary drug therapy and prices of drugs were obtained from 2,677 patients from the outpatient setting of six major hospitals in Jordan. Multivariate logistic regression was used to determine risk factors associated with unnecessary drug therapy.Results: A total of 936 unncessary medications were identified with an average of one unnecessary medication per every three patients. Monthly costs of unnecessary medications, at the national level, were estimated to range between JD 438,930.24 [(618,821.41 USD) (payer's perspective)] and JD 744,765.5 [(1,050,000.19 USD) (patient's perspective)]. Unnecessary drug was associated with cardiac catheterization (adjusted odds ratio [AOR] = 1.29, 95% CI: 1.01-1.71, p = 0.041), increased number of medications (AOR = 3.11, 95% CI: 2.51-3.86, p < 0.001), and inadequate knowledge/understanding of drug use (AOR = 2.4, 95% CI: 1.24-4.64, p = 0.009).Conclusion: Unnecessary drug therapy is common in the outpatient setting. Identified risk factors should be specifically targeted to reduce its burden.

Synthesis, Characterization, Antimicrobial Activity, and Genotoxicity Assessment of Two Heterocyclic Compounds Containing 1,2,3-Selena- or 1,2,3-Thiadiazole Rings.

New 1,2,3-thiadiazole and 1,2,3-selenadiazole derivatives, (4-[4-((4-bromobenzyl)oxy)-phenyl]-1,2,3-thiadiazole (5a), 4-[4-((4-chlorobenzyl)oxy)-phenyl]-1,2,3-thiadiazole (5b)), (4-[4-((4-bromobenzyl)oxy)-phenyl]-1,2,3-selenadiazole (6a), and 4-[4-((4-chlorobenzyl)oxy)-phenyl]-1,2,3-selenadiazole (6b)), were prepared and screened in vitro for their antimicrobial activity against various pathogenic microbes. In addition, two compounds (5a and 6a) were examined for their in vivo genotoxicity using rats and an 8-hydroxy-2'-deoxyguanosine (8-OHdG) assay. Compounds 5a and 5b were found to be highly active against Gram-positive and Gram-negative bacteria. In addition, a significant inhibition of urinary 8-OHdG level (50.2%) was observed upon treatment of animals with 500 mg/kg body weight (b.w.) of compound 6a (p < 0.0001). However, compound 5a increased urinary 8-OHdG levels. The lethal dose (LD50) values for compounds 5a and 6a were determined by an up-and-down procedure (OECD 425; OECD 1998), which showed that these compounds are safe, since the LD50 was >5000 mg/kg b.w. Thus, the tested compounds might have the potential for use as antibiotics, since they have low genotoxicity and strong antimicrobial activity.

Association of smoking with direct medical expenditures of chronic diseases in north of Jordan: a retrospective cohort study.

OBJECTIVE: This study aimed to estimate the association of smoking with the direct medical expenditures for chronic disease management in north of Jordan. DESIGN, SETTING AND PARTICIPANTS: Retrospective cohort study using hospital database. Patients who were diagnosed with at least one chronic disease,were aged 18 years or older and had attended King Abdullah University Hospital for disease management and procedures from 1 July 2015 through 30 June 2016 were included in the study. MAIN OUTCOME MEASURES: The outcome of interest was the direct medical expenditures for chronic disease management according to smoking status. RESULTS: Data were collected from 845 patients having at least one chronic disease (mean age of 61±10.7 years). Smokers formed 22% of total patients. The back transformed mean total expenditure per patient of smokers, former smokers and non-smokers was 875 JD, 928 JD and 774 JD, respectively. Drugs were the most expensive healthcare resource used, accounting for 43% of total expenditure, followed by inpatient-related and outpatient-related services (19%). Smokers and former smokers were associated with the highest inpatient expenditures and inpatient-related and outpatient-related services expenditures. However, smokers were associated with the lowest outpatient and medication expenditures. CONCLUSIONS: Smokers and former smokers presented with higher statistically significant inpatient-related and outpatient-related services expenditures and higher transformed mean total expenditures compared to non-smokers; highlighting this economic burden is useful for promoting tobacco control policies.

Assessment of Genotoxicity of Levosimendan in Human Cultured Lymphocytes.

BACKGROUND AND OBJECTIVE: Levosimendan is a positive inotropic and a vasodilator agent with pleotropic characteristics that include antioxidation, anti-inflammation and smooth muscle vasodilation. METHODS: In this study, the effects of levosimendan (0, 0.1, 1, 10, and 20 µg/ml) on oxidative DNA damage and sister-chromatid exchanges (SCEs) were evaluated in human cultured lymphocytes. RESULTS: The results showed that levosimendan increased the frequency of SCEs in all examined concentrations (P<0.01) except for 0.1 µg/ml. On the other hand, levosimendan did not induce oxidative DNA damage as measured by the 8-OHdG biomarker (P > 0.05). In addition, neither mitotic arrest nor proliferation index was affected by levosimendan at all examined doses (P > 0.05). CONCLUSION: In conclusion, levosimendan might be associated with increases in sister-chromatid exchanges in cultured human lymphocytes. In vivo studies are required to confirm the present findings.

Evaluation of drug-prescribing patterns based on the WHO prescribing indicators at outpatient clinics of five hospitals in Jordan: a cross-sectional study
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BACKGROUND: Irrational drug prescribing is considered one of the major challenges for the healthcare sectors worldwide, leading to negative outcomes in patients including various drug-related problems, such as polypharmacy, adverse drug events, more demands on drug monitoring, and unwanted increase in treatment cost. OBJECTIVE: The main objective of this study was to evaluate the trends and issues related to prescription at outpatient hospital pharmacies in Jordan and to contrast that to the WHO rational medication list and WHO drug use indicators. METHOD: This study was a cross-sectional study, conducted between January 2014 and May 2014. It involved a total number of 24,089 patient encounters from five teaching and referral hospitals in Jordan. The encounters included patients who were prescribed at least one medication during their visit to outpatient clinics in those hospitals. RESULTS: The average number of drugs per prescription was 2.93. The percentage of encounters which had antibiotics or injections in the prescription was 17.7% and 8.1%, respectively. The top three most common prescribed antibiotics were amoxicillin (n = 2,129, 49.9%), ciprofloxacin (n = 609, 14.3%), and clarithromycin (n = 267, 6.3%), while the most common prescribed injections were insulin and insulin analogs (n = 766, 39.2%), cyanocobalamin (Vitamin B12) (n = 612, 31.3%), and erythropoietin (n = 80, 4.1%). The percentage of prescriptions by generic was 57.6%, whereas the prescribing from the essentials drug list (formulary) was close to optimal (99.8%). CONCLUSION: The average number of prescribed drugs per encounter was higher than what was considered ideal according to WHO standards; the other issue found was a lower percentage of generic prescribing compared to WHO ideal value. The rest of prescribing indicators including the injections prescribing, antibiotics prescribing, and prescribing from the essential drug list were within the optimal range of values recommended by the WHO.
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Assessment of genotoxicity of pyrethrin in cultured human lymphocytes.

Pyrethrin is an insecticide that is obtained from the Chrysanthemum flower (Pyrethrum). In this study, we examined the genotoxic effects of pyrethrin on cultured human lymphocytes using sister chromatid exchanges (SCEs) and 8-hydroxy deoxyguanosine (8-OHdG) assays. Cultures were treated with different concentrations of pyrethrin (25, 50, and 100 µg/mL), which was dissolved in in dimethyl sulfoxide (DMSO). The results showed that treatment of cultured lymphocytes with pyrethrin at 50 µg/mL and 100 µg/mL induced significant elevation in SCEs (p < 0.05). In addition, the 100 µg/mL concentration significantly affected both mitotic and proliferative indices (p < 0.05). Finally, pyrethrin induced significant elevation in the oxidative stress marker 8-OHdG in a dose-dependent manner (p < 0.001). In conclusion, the results suggest that pyrethrin is genotoxic as measured by two independent assays on genetic toxicity.

Evaluation of the types and frequency of drug-related problems and the association with gender in patients with chronic diseases attending a primary health care center in Jordan.

BACKGROUND: Drug-related problems (DRPs) can be defined as any event that is drug related that results in harm or in providing less than optimum medical care to patients. The aim of this study is to determine the types and frequency of each type of DRP in selected outpatient settings in Jordan, with emphasis on gender as a grouping variable. METHODS: This study was a non-randomized controlled trial, carried out over 3 days, at Alsarih Medical Health Center in the north of Jordan. Clinical pharmacists conducting the research interviewed a randomly selected population, assessed their DRPs, proposed appropriate clinical interventions to physicians and provided appropriate patient counseling. RESULTS: The study included a total of 258 patients (mean age 54.4±12.1; male ratio 37.6%). The most frequently encountered DRPs in our study were patients' need for counseling and education (83.8%), and life style modifications (80%). This study also revealed that 71.8% of patients required additional and/or more frequent monitoring, and 53% of patients had untreated conditions that required pharmacological and/or non-pharmacological interventions. Gender did not affect the frequency of DRPs among patients. CONCLUSION: Certain types of DRPs are the most common among outpatient settings. Therefore, measures should be taken to specifically tackle these types of DRPs.

Exposure of pregnant women to waterpipe and cigarette smoke.

INTRODUCTION: Throughout the Eastern Mediterranean region, tobacco is used primarily in 2 forms: cigarette smoking and waterpipe smoking. Despite the fact that tobacco use is considered as a global public health threat, waterpipe smoking is reported to be growing in popularity, particularly among women. The objectives of this study are to determine the prevalence and patterns of cigarette, waterpipe, and passive smoking among pregnant women in Jordan, and to assess their perception of harmful effects of cigarette and waterpipe smoking. METHODS: A total of 500 pregnant women were randomly recruited from maternity clinics in North and Middle of Jordan and surveyed regarding exposure to waterpipe tobacco and cigarette smoking. RESULTS: The results showed that 7.9% of women were current cigarette smokers and 8.7% were current waterpipe smokers. About 82.4% of all women reported that they are exposed to cigarette smoke and 32.8% reported that they are exposed to waterpipe smoke. The most common place where women are exposed to cigarette and waterpipe smoke was their house (50.4% and 48.7%, respectively) followed by public places (31.4% and 21.4%, respectively). In addition, the husband was the main source for exposure to cigarette and waterpipe smoke (48.5% and 42.7%, respectively). Approximately, 74% of women believed that cigarette smoking is addictive, whereas only 55.1% reported that waterpipe smoking leads to addiction. CONCLUSIONS: Exposure of pregnant women to tobacco smoke is a public health problem in Jordan that requires immediate action.

Assessment of DNA damage using chromosomal aberrations assay in lymphocytes of waterpipe smokers.

OBJECTIVES: The aim of this study was to investigate the genotoxicity of waterpipe smoking in the lymphocytes of waterpipe smokers using chromosomal aberrations (CAs) assay. MATERIALS AND METHODS: Fifty waterpipe smokers and 18 healthy non-smokers volunteered to participate in the study. Additionally, 18 heavy cigarette smokers were recruited for comparison. Chromosomal aberrations (CAs) assay was used to evaluate DNA damage in the lymphocytes. RESULTS: The results showed that similarly to cigarette smoking, waterpipe smoking significantly increased the frequencies of CAs (p < 0.01). In addition, the frequencies of CAs increased with more waterpipe use. CONCLUSIONS: Waterpipe smoking causes DNA damage to lymphocytes and the damage increases with more waterpipe use.

Assessment of Cardiovascular Risk Factors Among University Students: The Gender Factor.

BACKGROUND: Evidence indicates that the pathophysiological process of cardiovascular (CV) disease begins at early age, though the manifestations of the disease do not appear until middle age adulthood. Risk factors for CV disease, particularly lipoprotein profiles, are affected by physiological abnormalities, and lifestyle related issues. To evaluate prevalence of CV diseases risk factors among university students and to investigate relation between number of risk factors and body anthropometric, hematological and biochemical indices parameters. METHODS: In this cross sectional study, 348 students were randomly recruited. Blood glucose, cholesterol profile (total, HDL, and LDL cholesterol), and triglyceride were measured using standard protocols. Physical activity (PA) level was assessed using the short-form Arabic version of the International Physical Activity Questionnaires (IPAQ). RESULTS: The most commonly encountered CV disease risk factor was low levels of HDL-C, followed by physical inactivity, high levels TG, and obese BMI. When stratified by gender, females were less likely to have low HDL-C, and high TG, whereas, males were more likely to have overweight or obese BMI (P < 0.001). About 49% of the participants had at least one CV disease risk factor, where as the prevalence of having one, two and three or more CV disease risk factors were 35.7%, 9.3% and 4%, respectively. Additionally, the number of CV disease risk factors showed strong positive correlation with increases in body fat and bone percentages, glucose, total cholesterol, TG, LDL-C, BMI, and WHR (range of R2: 0.17 to 0.603). On the other hand, physical activity, percentages of body water and muscle, HDL-C showed inverse strong correlation with cardiovascular risk factors (range of R2: -0.239 to -0.412). CONCLUSIONS: Results indicate the high prevalence of CV disease risk factors among university students, and stress the need for early intervention programs to counteract these risks.

Assessment of genotoxicity of waterpipe and cigarette smoking in lymphocytes using the sister-chromatid exchange assay: a comparative study.

Tobacco smoking is a major world health problem. Recently, waterpipe smoking has become more popular in many countries. Although the genotoxicity associated with cigarette smoking has been extensively investigated, studies evaluating such toxicity in waterpipe users are still lacking. In this study, we examined the genotoxicity of waterpipe smoking in lymphocytes compared with the genotoxicity of cigarette smoking. Genotoxicity was evaluated using the sister chromatid exchanges (SCEs) assay. Fifty waterpipe smokers and 18 healthy nonsmokers participated in this study. Additionally, 18 heavy cigarette smokers (CS) were recruited for comparison. The results show that waterpipe smoking and cigarette smoking significantly increase the frequencies of SCEs (P < 0.01) compared with those of nonsmokers, indicating the genotoxic effect of tobacco smoking. In addition, frequencies of SCEs were significantly higher among waterpipe smokers compared with CS (P < 0.01), indicating that waterpipe smoking is more genotoxic than cigarette smoking. Moreover, the frequency of SCEs increased with the extent of waterpipe use. In conclusion, waterpipe smoking is genotoxic to lymphocytes and the magnitude of its genotoxicity is higher than that induced by regular cigarette smoking.

Smoking-cessation practice guidelines: awareness and implementation among medical teams.

OBJECTIVES: The aim was to evaluate the awareness and implementation of the Smoking Cessation Clinical Practice (SCCP) guidelines. METHODS: A self-reported questionnaire based on the updated version of the SCCP guidelines was completed by 422 healthcare providers (HCPs) including physicians, dentists, dental hygienists and pharmacists recruited from both public and private sectors in Jordan. KEY FINDINGS: The majority of HCPs reported good smoking-cessation practices. However, their awareness about the SCCP guidelines was inadequate. Approximately 68% of HCPs lacked knowledge of the 5As; about 74% lacked knowledge of the 5Rs of the clinical guidelines for smoking cessation, which are the principal guidelines for smoking intervention and motivation to quit smoking. Fortunately, about 70% of participants from all groups examined and applied most of the steps in the guideline spontaneously without previous knowledge of the guideline. This spontaneous practice could be due to their vast practical experience, and the use of logic and/or basic knowledge about smoking cessation. Compared to physicians, pharmacists and dental hygienists showed significantly more frequent practice of most steps with patients willing to quit smoking. CONCLUSIONS: Jordanian HCPs showed good, spontaneous smoking-cessation practice. However, this practice could have been better if HCPs had adequate awareness of the SCCP guidelines.