The potential counter effect of COVID-19 outbreak on an antimicrobial agents prescribing educational intervention.

INTRODUCTION: Educational interventions targeting health care professionals can contribute to improving knowledge and behaviors of antimicrobial agents prescribing. However, the unprecedented COVID-19 outbreak caused a disruption of the current practices and treatment guidelines. Therefore, it is highly likely that the pandemic had its disruptive effect on any educational interventions that were going on during the outbreak. This study aims to evaluate the effectiveness of an educational intervention in improving antimicrobial agents prescribing. METHODOLOGY: This was a randomized controlled study that included 69 resident physicians in a teaching hospital. The intervention group received an educational intervention focusing on antimicrobial agents prescribing and resistance. Before and after the intervention, outpatient antimicrobial agents prescribing rates for the two study arms were compared for the pre- and post-intervention periods. Additionally, all participants were asked to complete an online questionnaire that measured their knowledge, attitudes and behavioral intention towards antimicrobial agents resistance and prescription. The post-intervention period included the months of February, March, and June 2020. April and May were excluded from the study period since clinics were closed due to the COVID -19 pandemic. RESULTS: Post-intervention, the rate of antimicrobial agents prescribing by the intervention group was significantly higher than that of the control group (p < 0.001). Mean fear score for the intervention group was significantly lower than that for the control group after the intervention. CONCLUSIONS: Findings indicate failure of the educational intervention in improving antimicrobial agents prescribing. However, an unexpected counter effect of the COVID-19 outbreak is highly likely.

A survey on the knowledge, attitudes and practices of physicians towards pharmacovigilance in Jordanian health centres.

Background: Knowledge, attitudes and practices of health care professionals towards pharmacovigilance are strongly associated with reporting adverse drug reactions, as proven by a number of studies. This study aims to evaluate the levels of knowledge, attitudes and practices towards pharmacovigilance among physicians working at health centres of the Jordanian Ministry of Health. Methods: This took the form of a cross-sectional survey. Questionnaires were distributed by the researcher and research assistant to the physicians. Twenty primary and comprehensive health centres were covered. Results: The study included 106 physicians. Poor knowledge and practices were observed (mean knowledge score of 1.5±1.2 out of five, and mean practice score of 5.5±1.8 out of 15), while a high level of positive attitudes was observed (mean attitude score of 9.3±1.3 out of 10). Half of the physicians were aware that monitoring adverse drug reactions in Jordan is carried out by the Jordan Pharmacovigilance Centre. The majority of physicians (95.2%) mentioned that they rarely or never used the adverse drug reactions reporting form in Jordan. Conclusions: It is clear that there is a need to initiate educational activities and intervention programmes to raise the awareness of health care providers in Jordan regarding pharmacovigilance.

Serum vitamin D and the metabolic syndrome among osteoporotic postmenopausal female patients of a family practice clinic in Jordan.

BACKGROUND: Vitamin D deficiency and insufficiency and the metabolic syndrome are two common health issues worldwide. The association between these two health problems is subject to debate. OBJECTIVES: This study aims to investigate the association between vitamin D deficiency or insufficiency and the metabolic syndrome in a sample of osteoporotic postmenopausal women attending a family practice clinic in Amman-Jordan. MATERIAL AND METHODS: This was an observational cross sectional study. It was carried out in the family practice clinic in Jordan University Hospital. The study included all postmenopausal osteoporotic women attending the clinic between June 2011 and May 2012, yielding a total of 326 subjects. The association between metabolic syndrome and serum vitamin D levels was investigated. RESULTS: Waist circumference, body mass index, triglycerides and fasting blood sugar were significantly higher among postmenopausal women with metabolic syndrome, but HDL cholesterol was significantly lower (p<0.05). The prevalence of metabolic syndrome among all study participants was 42.9%. Triglycerides and LDL cholesterol were significantly higher among women deficiency or insufficiency (p<0.05). The prevalence of vitamin D deficiency or insufficiency was 45.7%. Among patients with metabolic syndrome, the prevalence of vitamin D deficiency or insufficiency was 50.7%. CONCLUSIONS: Findings of the current study suggest a lack of relationship between serum vitamin D and metabolic syndrome. However, a significant inverse relationship was found between serum vitamin D levels and both serum triglycerides and LDL levels.

Complementary and alternative medicine (CAM) use among Jordanian patients with chronic diseases.

PURPOSE: This study explores the prevalence of herbal medicine use in a cohort of patients with chronic kidney disease (CKD), dyslipidemia and hypertension (HTN) in Jordan. METHODS: The study took the form of a cross-sectional survey of patients attending the outpatient departments at The Jordan University Hospital (JUH), in Amman. The method was based on semi-structured questionnaire. RESULTS: A total of 700 CKD, dyslipidemia and hypertension patients were interviewed. Of the participants, 7.6% (n = 53) reported using herbs. Most of complementary and alternative medicine (CAM) users were older than 50 years of age (n = 42; 79.3%) and predominantly female (54.1%, n = 29). The majority of patients in this group had hypertension (n = 44, 83.0%), followed by dyslipidemia (n = 32, 60.4%). The most common herbal product to be used was Hibiscus sabdariffa (22.5%). CONCLUSION: This study confirmed that there is an appreciable prevalence of herbal use among patients with CKD, dyslipidemia and hypertension in Jordan.

Prevalence and risk factors of urinary incontinence among Jordanian women: impact on their life.

We estimate the prevalence and type of urinary incontinence (UI), possible associated risk factors, and the impact of UI on women's social and psychological well-being. The sample consisted of women attending a family medicine clinic at Jordan University Hospital (JUH) who answered a self-administered questionnaire. More than one-third of the sample reported the presence of UI. Stress type was the most frequently reported risk factor, followed by mixed incontinence, then urge. Age, diabetes, chronic cough, parity, and hysterectomy were positively associated with the presence of UI. Incontinence caused low self-esteem in more than half of the women who experienced it.

Discrepancies between elderly patient's self-reported and prescribed medications: a social investigation.

AIMS: To study some characteristics of the elderly people attending the family practice clinic at the Jordan University Hospital (JUH) and to evaluate their knowledge of the prescribed drugs. METHODS: A total of 400 elderly people (180 men and 220 women) aged 71 ± 5.8 years were studied regarding sociodemographic characteristics and the use of medicinal and nonmedicinal remedies. In addition, agreement between self-reported drug information and information taken from the medical records was also evaluated. FINDINGS: Almost one-third of the patients had full agreement between their knowledge of total number of drugs they take and the numbers found in the medical records, whereas 43.4% underestimated and 21.8% overestimated these numbers. Five drugs/classes were accurately estimated by the patient (methyldopa, ezetimibe, warfarin, statins and antigout drugs). Underestimation was noticed in 17 drugs/classes and overestimation in 14. The significantly underestimated drug classes were biphoshponates, proton pump inhibitors, sulfonylureas and antiepileptic drugs. CONCLUSION: Some aspects of elderly people were evaluated regarding their medication knowledge. Almost two-third of the patients did not take their drugs in the proper way. The results of the study highlight the importance of taking several actions by all healthcare workers and by the community to optimise health care provided for elderly people.

A randomized controlled trial to assess pharmacist- physician collaborative practice in the management of metabolic syndrome in a university medical clinic in Jordan.

BACKGROUND: The prevalence of metabolic syndrome is increasing worldwide, and patients with metabolic syndrome have increased risk of developing cardiovascular disease and type 2 diabetes. Although specific criteria vary, the National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP III) criteria (2002) defined metabolic syndrome as the presence of 3 or more of the following 5 components: waist circumference more than 102 centimeters (cm) for men or more than 88 cm for women; triglycerides 150 milligrams per deciliter (mg per dL) or more; high-density lipoprotein cholesterol (HDL-C) less than 40 mg per dL for men or less than 50 mg per dL for women; blood pressure (BP) 130/85 millimeters mercury (mm Hg) or more; and fasting blood glucose 110 mg per dL or more. OBJECTIVE: To evaluate the effect of a pharmacist-physician collaborative practice compared with usual care in the management of patients with metabolic syndrome as defined by the NCEP/ATP III criteria. METHODS: A prospective, randomized controlled trial conducted in family medicine outpatient clinics in Jordan enrolled 199 patients who met the NCEP/ATP III criteria for metabolic syndrome during an enrollment period from March 15, 2009, through May 10, 2009. Patients were randomized into 2 groups, with 110 in the intervention group (pharmacist-physician collaborative practice) and 89 in usual care (physician only). The patients in the intervention group were provided with pharmacist recommendations and pharmaceutical care counseling. Outcome measures included metabolic syndrome status (binomial) and changes in mean values for each metabolic syndrome component (waist circumference, triglycerides, HDL-C, fasting blood glucose, and systolic and diastolic BP) and for body weight. A 2 ￗ 2 contingency table with a Pearson chi-square test was used to assess bygroup differences in metabolic syndrome status after 6 months of followup. In difference-in-difference analyses, t-tests (Mann-Whitney U tests when appropriate) were used to assess by-group differences in changes in the individual metabolic syndrome components and body weight. RESULTS: From baseline to follow-up, 39.1% (n = 43) of intervention group patients versus 24.7% (n = 22) of usual care patients were successfully shifted from a status of metabolic syndrome to no metabolic syndrome (P = 0.032). Three of 7 outcome measures were improved more in the intervention group compared with the usual care group. Mean (SD) triglyceride (mg per dL) declined by 30.9 (54.4) from 189.3 (79.6) to 158.4 (77.3) in the intervention group and by 14.5 (50.7) from 202.5 (88.0) to 188.5 (89.0) in the usual care group (P = 0.029). For the intervention and usual care groups, mean baseline systolic BPs were 134.7 (16.2) mm Hg and 134.6 (12.2) mm Hg, respectively, declining after 6 months follow-up by 12.1 (20.1) mm Hg in the intervention group versus 6.9 (14.6) mm Hg in the usual care group (P = 0.018). Mean baseline diastolic BPs were 83.6 (10.7) mm Hg and 83.6 (7.9) mm Hg, respectively, declining by 7.2 (12.6) mm Hg in the intervention group versus 4.9 (8.1) mm Hg in the usual care group (P = 0.049). CONCLUSIONS: Compared with usual care provided by physicians only, pharmacist involvement in the clinical management of patients with metabolic syndrome increased the proportion of patients who no longer met criteria for the syndrome after 6 months follow-up and improved control of BP and triglycerides.

Pharmacist-physician collaboration improves blood pressure control.

OBJECTIVE: To evaluate the effect of teamwork (physician and pharmacist) on the management of uncontrolled hypertensive patients. METHODS: This is a randomized controlled clinical trial conducted from March to November 2009. Patients attending the Family Medicine Clinic at Jordan University Hospital, Amman, Jordan with uncontrolled hypertension were invited to participate in the study. A total of 253 patients were randomly allocated to an intervention (n=130) or control group. In the intervention group, patients were managed by a physician-pharmacist team. In the control group, patients were managed by physician(s) only. RESULTS: In the intervention group, 79.4% of patients achieved blood pressure (BP) goals specified by the Joint National Committee on Prevention and Management, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VII) compared to 65.6% in the control group (p=0.01). Decline in systolic BP was 16.1 +/- 14.6 mm Hg in the intervention group, and 10.6 +/- 13.5 mm Hg in the control group (p=0.002). Reduction in diastolic BP was 10.5 +/- 12.9 mm Hg in the intervention group, and 7.17 +/- 13.11 mm Hg in the control group, (p=0.04). Data were presented as mean +/- standard deviation. CONCLUSION: This study found that the physician-pharmacist collaborative approach to uncontrolled hypertension in Jordan improved the rate of BP control in hypertensive patients, and resulted in more profound decline in both systolic and diastolic BP, and this will probably reflect on better outcomes in cardiovascular diseases. Establishing pharmaceutical care managed clinic in the setting of outpatient-clinics is possible, and provides better management of patients.

Prevalence of vitamin-mineral supplement use among Jordan University students.

OBJECTIVE: To determine the prevalence, reasons, source of information of vitamin-mineral supplement uses, and their relationship with selected demographic and lifestyle characteristics among Jordan University students. METHODS: A cross-sectional survey was carried out at Jordan University, Amman, Jordan from March to September 2005. The survey included 1,187 students aged 17-28 years. A multistage stratified sampling technique was used to recruit the participants from different majors at Jordan University. A self-administered questionnaire containing questions on use of vitamin-mineral supplement during the last year, demographic, and lifestyle characteristics was completed. RESULTS: The overall prevalence of vitamin-mineral supplement use during the last year reported by students was 27.4% (males 22%, and females 30.2%). Vitamin-mineral supplement use among university students was significantly (p<0.05) associated with age, gender, family monthly income, smoking status, physical activity, vegetarian status, and body mass index. The most frequently used supplements were multivitamins (10.4%) and multivitamins-multi minerals (10%). The most frequently given reason for supplement use was for treatment. The main frequently reported source of information was a physician (45.8%). CONCLUSION: The overall prevalence rate of vitamin-mineral supplement use is very low. Supplement users are more likely to be: females, nonsmokers, of higher income, physically active, vegetarians, and of normal body mass index. The main reason for supplement use is for treatment, and the major source of information on supplements is by physicians and pharmacists.

Familiarity, knowledge, and attitudes towards epilepsy among attendees of a family clinic in Amman, Jordan.

OBJECTIVE: To investigate the present familiarity, knowledge, and attitudes of Jordanians towards epilepsy. METHODS: This is a cross-sectional study that was conducted over a 6-month period, from April 2006 to October 2006 at the family clinic of Jordan University Hospital, Amman, Jordan. A face-to-face questionnaire interview was conducted with 600 non-epileptic adults who visited the clinic during the study period. RESULTS: The sample matched the overall Jordanian population for literacy rate, however, included a higher proportion of females, and consequently findings may be taken as being only moderately representative of the Jordanian population. Ninety-eight percent of the respondents had heard about epilepsy, 47.3% knew someone with epilepsy, and 39.7% had witnessed a seizure. The major source of knowledge was word of mouth; knowledge about causes and treatment were far below the results reported in western countries. In addition, negative attitudes were present with regard to marriage and employment of epileptic patients (86.8% objected to marriage and 50.8% objected to employment). Eighty-three percent of respondents admitted that their knowledge of epilepsy was not satisfactory and were willing to learn more about epilepsy. The television was believed to be the most efficient and preferred way to disseminate knowledge about epilepsy. CONCLUSION: Although this study does not represent the whole Jordanian population, however, it demonstrated lack of knowledge and emphasized the extent of negative as well as positive attitudes towards epilepsy in Jordan.