Incidence, predictors, clinical outcomes, and economic burden of recurrent acute kidney injury: a retrospective cohort study.

OBJECTIVE: This study aimed to assess the incidence, predictors, mortality, and economic outcomes of recurrent Acute kidney injury (AKI) in Jordan. METHODS: This was a retrospective cohort study that included adult patients who were admitted with AKI to university hospitals in the country from 2010-2019. Recurrent episodes of AKI, laboratory data, baseline medication list, and death dates were retrieved from patient's medical records. The incidence rate of recurrent AKI was estimated. Predictors of recurrent AKI and mortality during the five years post-discharge was evaluated. Total admission charges were described and evaluated in total and by service provided. RESULTS: Among 1162 AKI patients, 57 patients (4.9%) died during the index admission (first admission during the study period), and among the survivors, 220 patients were re-hospitalized with a recurrent AKI during five years of follow-up. Patients with higher discharge serum creatinine level (SCr) at index admission had higher odds of AKI recurrence (OR = 1.001). Patients who were on respiratory, antineoplastic, or anticoagulant medications were also more susceptible to recurrence; ORs were 1.69, 2.77, and 4.16, respectively. Patients who were elderly, with recurrent AKI episodes, or with a more extended hospital stay at index admission were more likely to die during the five years post discharge. The median charge of recurrent admissions was higher than the median charge of the index admissions; 1519.17 JOD ($2142.7) versus 1362.85 JOD ($1922.2), respectively. CONCLUSIONS: Recurrent AKI is associated with increased mortality and health expenditures. Higher discharge SCr levels at index admission, and chronic comorbidities are associated with a higher likelihood of AKI recurrence.

Effect of strength and porosity of tablets on the magnitudes of subdivision forces.

In this study, a hardness tester was modified by attaching a metal blade to its testing area to obtain the minimum forces required to subdivide tablets along their diameters (F'). Moreover, the tensile strengths of subdividing tablets (TS') were calculated. Tablets of microcrystalline cellulose (MCC) weighing 0.5 g were produced at applied compression pressures of 21, 31, 41, 50, and 60 MPa. In addition, tablets of Ludipress®, and a 5:2 mixture of paracetamol to MCC weighing 0.7 g were produced at applied compression pressures of 77, 116, 154, 193, and 232 MPa. It was found that F' increased as the applied compression pressure used to produce the tablets increased until a maximum value was reached. This maximum value was at around 100 N for MCC and Ludipress® tablets and at around 76 N for paracetamol/MCC tablets. Moreover, a maximum value of TS' was reached at a porosity of 0.37 for MCC, 0.15 for Ludipress®, and 0.11 for paracetamol/MCC tablets. The maximum TS' values were at around 1.5 MPa for MCC and Ludipress® tablets and at around 0.9 MPa for paracetamol/MCC tablets. Therefore, both inter particulate bonding (tablet strength) and porosity (packing) affected the magnitudes of F' and TS'.

Organophosphate pesticide exposure prenatally influence on pregnancy outcomes.

BACKGROUND: Organophosphorus (OP) pesticides are widely used worldwide. The effect of OP exposure during pregnancy on the offspring is inconsistent in the current literature. Moreover, similar studies in the Middle East are lacking. PURPOSE: To examine the effects of OP exposure in utero on the outcome of pregnancies in an agricultural region in Jordan. METHOD: A prospective study, employing a questionnaire to collect women demographic data. Hospital records were collected for newborns' birth data. In addition, urine samples during the third trimester were collected from pregnant women and then analyzed for six OP metabolites to measure exposure. RESULTS: One of the metabolites, DEDTP, was negatively correlated with gestational age and Apgar scores 1 and 5. There were no other significant associations. CONCLUSIONS: Exposure to OP during pregnancy is not highly associated with any negative anthropometric characteristics of the newborns; it is probably offset by other factors.

Knowledge and Practice of Breast Cancer Screening Methods among Female Community Pharmacists in Jordan: A Cross-Sectional Study.

OBJECTIVES: Our study is aimed at exploring the knowledge and personal practice of breast cancer screening among female community pharmacists in Jordan. METHODS: A cross-sectional survey was carried out using a nonrandom sample selection method for pharmacists in community pharmacies. RESULTS: A total of 551 female pharmacists completed the questionnaire. The mean age of pharmacists was 29.1 ± 7.3 years (range 21-67), and most have bachelor degrees in pharmacy (89.1%). The mean score of knowledge of breast cancer signs and symptoms was 4.2 ± 1.5 out of 6 points (range 0-6). The mean score of knowledge of risk factors was 7.6 ± 1.9 out of 12 points (ranging from 2-12). The mean score for knowledge of screening guidelines was 2.8 ± 0.9 out of 4 points (range 0-4). Overall, 452 pharmacists (85.8%) had acceptable knowledge while 75 pharmacists (14.2%) had poor knowledge of breast cancer. Pharmacists surveyed were aware of the different screening methods of breast cancer. The percentage of pharmacists who has performed breast self-examination (BSE), clinical breast examination (CBE), and mammography was 46.6%, 16.5%, and 5.4%, respectively. The most common reason for the lack of BSE and CBE performance was the absence of breast symptoms. Not being at the age recommended for mammography was the most common reason for not undergoing this screening method. Knowledge and practice of screening methods were influenced by age, years of experience, geographic region, personal history of breast cancer, and educational level among community pharmacists. CONCLUSIONS: This study revealed some gaps in the knowledge of breast cancer among female community pharmacists. The practice of the different screening methods was suboptimal, and variable reasons were indicated for the low uptake of these screening methods. Community pharmacists need to practice preventive behaviors to a satisfactory level to encourage women in the community to adopt similar behavior.

Effect of different splitting techniques on the characteristics of divided tablets of five commonly split drug products in Jordan

OBJECTIVE: To determine the accuracy, variability, and weight uniformity of tablet subdivision techniques utilized to divide the tablets of five drug products that are commonly prescribed for use as half tablets in Jordan. METHODS: Ten random tablets of five commonly subdivided drug products were weighed and subdivided using three subdivision techniques: hand breaking, kitchen knife, and tablet cutter. The five commonly subdivided drug products (warfarin 5 mg, levothyroxine 50 μg, levothyroxine 100 μg, candesartan 16 mg, and carvedilol 25 mg) were weighed. The weights were analyzed for acceptance, accuracy, and variability. Weight variation acceptance criteria were adopted in this work as a tool to indicate the properness of the subdivision techniques used to produce acceptable half tablets. Other relevant physical characteristics of the five products such as tablet shape, dimensions, face curvature, score depth, and crushing strength were measured. RESULTS: All tablets were round in shape, had weights that ranged between 100.63 mg (standard deviation=0.99) and 379.04 mg (standard deviation=3.00), and had crushing strengths that ranged between 23.29 N (standard deviation=3.58)and 103.35 N (standard deviation=14.98). Both candesartan and carvedilol were bi-convex in shape with an extent of face curvature equal to about 33%. In addition, percentage score depth of the tablets had a range between 0% and 24%. The accuracy and variability of subdivision varied according to the subdivision technique used and tablet characteristics. Accuracy range was between 81% and 109.8%. Moreover, the relative standard deviation was between 1.5% and 17.4%. Warfarin 5 mg subdivided tablets failed the weight variation test regardless of the subdivision technique used. Subdivision by hand produced half tablets that were acceptable for levothyroxine 50 μg and levothyroxine 100 μg. Subdivision by knife produced half tablets that were acceptable only for candesartan tablets. However, the tablet cutter produced half tablets that passed the weight variation test for four out of the five drug products tested in this study. CONCLUSIONS: The tablet cutter performed better than the other subdivision techniques used. It produced half tablets that passed the weight uniformity test for four drug products out of the five

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Effect of different splitting techniques on the characteristics of divided tablets of five commonly split drug products in Jordan.

OBJECTIVE: To determine the accuracy, variability, and weight uniformity of tablet subdivision techniques utilized to divide the tablets of five drug products that are commonly prescribed for use as half tablets in Jordan. METHODS: Ten random tablets of five commonly subdivided drug products were weighed and subdivided using three subdivision techniques: hand breaking, kitchen knife, and tablet cutter. The five commonly subdivided drug products (warfarin 5 mg, levothyroxine 50 µg, levothyroxine 100 µg, candesartan 16 mg, and carvedilol 25 mg) were weighed. The weights were analyzed for acceptance, accuracy, and variability. Weight variation acceptance criteria were adopted in this work as a tool to indicate the properness of the subdivision techniques used to produce acceptable half tablets. Other relevant physical characteristics of the five products such as tablet shape, dimensions, face curvature, score depth, and crushing strength were measured. RESULTS: All tablets were round in shape, had weights that ranged between 100.63 mg (standard deviation=0.99) and 379.04 mg (standard deviation=3.00), and had crushing strengths that ranged between 23.29 N (standard deviation=3.58)and 103.35 N (standard deviation=14.98). Both candesartan and carvedilol were bi-convex in shape with an extent of face curvature equal to about 33%. In addition, percentage score depth of the tablets had a range between 0% and 24%. The accuracy and variability of subdivision varied according to the subdivision technique used and tablet characteristics. Accuracy range was between 81% and 109.8%. Moreover, the relative standard deviation was between 1.5% and 17.4%. Warfarin 5 mg subdivided tablets failed the weight variation test regardless of the subdivision technique used. Subdivision by hand produced half tablets that were acceptable for levothyroxine 50 µg and levothyroxine 100 µg. Subdivision by knife produced half tablets that were acceptable only for candesartan tablets. However, the tablet cutter produced half tablets that passed the weight variation test for four out of the five drug products tested in this study. CONCLUSIONS: The tablet cutter performed better than the other subdivision techniques used. It produced half tablets that passed the weight uniformity test for four drug products out of the five.

Glycosylated Hemoglobin A1c Is Associated with Anthropometric Measurements and Tumor Characteristics in Breast Cancer Patients.

PURPOSE: To investigate the association between glycosylated hemoglobin A1c (HbA1c) with anthropometric measurements and clinicopathologic characteristics of breast cancer patients. Such data are lacking in Arabian countries. PATIENTS AND METHODS: A cross-sectional study was conducted at the Outpatient Oncology Unit at King Hussein Medical Center at the Royal Medical Services (RMS) and 223 breast cancer patients were included. Blood levels of HbA1c were measured and patients were classified into normal/non-diabetic (HbA1c <5.7%), prediabetic (HbA1c 5.7-6.4%), and diabetic (HbA1c ≥6.5%). RESULTS: The average age of patients was 49.9±10.3 years. Most patients had waist circumference equal to or more than 80 cm (91.9%) and more than half (55.2%) had waist-hip ratio equal to or more than 0.85. Mean body mass index (BMI) was 29.9±5.7 kg/m2. The mean level of HbA1c was 6.2±1.4% (range 4.7% to 12.6%). HbA1c levels revealed that most patients in this study classified as prediabetics (44.4%). There was a significant positive correlation between HbA1c levels and each of patient's age (r=0.267, p<0.001), waist circumference (r=0.180, p=0.008), and waist-hip ratio (r=0.278, p<0.001). Compared with premenopausal breast cancer patients, postmenopausal patients had significantly higher HbA1c blood levels (t=-3.542, p=0.003). HbA1c was significantly associated with stage (p=0.044) and grade (p=0.016) of carcinoma in premenopausal breast cancer patients. Among postmenopausal cases, HbA1c was significantly associated with molecular subtype of the disease (p=0.039). CONCLUSION: The majority of Jordanian breast cancer patients in this study are prediabetic, obese, and had visceral obesity. HbA1c levels are increased among older patients and those who have greater waist circumference and waist-hip ratio. HbA1c is associated with advanced stage and grade of breast carcinoma in premenopausal patients and with molecular subtype in postmenopausal cases. These findings urge the need to screen breast cancer patients for glycemic status upon disease presentation and to further consider treatments to control hyperglycemia in order to reduce the impact of metabolic derangements on disease prognosis and outcomes.

Physicians' perceptions, expectations, and experiences of clinical pharmacists in Jordan-2017.

Background A decade ago, clinical pharmacy was a new concept in hospital settings in Jordan, as evidenced in our 2006/2007 study. Changes in the perceptions, expectations, and experiences of physicians regarding the role of clinical pharmacists need to be investigated. Objective To document physicians' perceptions and expectations of, and experiences with, clinical pharmacists in hospital settings in 2017, and to assess differences in these areas between the 2017 and the 2006/2007 samples. Setting: The study was conducted at four hospitals in the north of Jordan. Method Physicians completed a self-administered questionnaire similar to the one used in our 2006/2007 study, which recorded demographics and assessed physicians' perceptions, expectations, and experiences regarding clinical pharmacists. Data of the 2017 sample were analyzed and compared descriptively to those of the 2006/2007 sample. Main outcome measure Physicians' perceptions, expectations, and experiences of pharmacists in hospital settings in 2017. Results Two hundred and ninety-five physicians completed the questionnaire. Physicians in the 2017 sample were most comfortable with pharmacists suggesting the use of prescription medications such as antibiotics (53.6%). Physicians in the 2017 cohort agreed with the eight expectations stated in the questionnaire. Physicians' experiences with clinical pharmacists improved in 2017 from 2006/2007 in all eight areas evaluated. Conclusion Physicians' perceptions, expectations, and experiences towards the professional role of pharmacists have changed over the past 10 years in Jordan.

Evaluation of antibiotic dispensing practice in community pharmacies in Jordan: A cross sectional study.

It is well known that the emergence of antibiotic resistance is linked to the misuse and overuse of antibiotics. Misuse includes self-medication and the inappropriate use of antibiotics because of improper dosage or improper duration than recommended. This study investigated three patterns of dispensing antibiotics in a sample of community pharmacies in Jordan. This included dispensing antibiotics by prescription or over-the-counter either by direct request or upon a pharmacist's recommendation. The antibiotics dispensed were evaluated in terms of indication, appropriateness of dose, and duration of treatment based on the empirical treatment suggested by selected references: Lexicomp (2017) and UptoDate (2017) and the manufacturer's recommendations. Of the 457 antibiotics dispensed, almost one third were without prescription. Of the antibiotics dispensed with prescription or without prescription, 31.5% and 24.6% respectively were appropriate dosage and duration (p = 0.002). In the three patterns of dispensing, beta lactam antibiotics were the most commonly dispensed. In addition, it was noticed that there was a tendency to prescribe or dispense higher generations of antibiotics to cases that could have been treated with lower generation or safer antibiotics. Furthermore, 12.2% of the antibiotics were dispensed to treat infections that are not indicated for them. In conclusion, a significant proportion of antibiotics are dispensed without prescription in Jordan. Moreover, a considerable proportion of prescribed antibiotics were inappropriate for the conditions concerned. This indicates the importance of enforcing the Jordanian regulations prohibiting the dispensing of nonprescription antibiotics and the implementation of continuous education to physicians and pharmacists to increase awareness about the emergence of antibiotic resistance.

Anti-factor Xa levels in obese patients receiving enoxaparin for treatment and prophylaxis indications.

OBJECTIVES: To evaluate the degree of anticoagulation achieved with different enoxaparin dosing regimens used in obese and morbidly obese patients in a hospital setting in Jordan. METHODS: All obese adult patients who were prescribed enoxaparin for various indications were invited to participate in the study. The anti-factor Xa (anti-Xa) level was checked once after 4-6 hours of the third or fourth dose of enoxaparin (at steady state). Patients were followed daily to evaluate drug efficacy and safety through their hospital course. RESULTS: Enoxaparin daily dose used for prophylaxis indications ranged from 0.3 to 0.85 mg/kg and from 0.31 to 2.25 mg/kg in case of certain treatment indications. Most participants who received enoxaparin for treatment indications (76.9%) were on capping dosing regimens, which was <1 mg/kg twice daily. On the other hand, most patients (88.5%) who received enoxaparin for prophylaxis indications were on a fixed 40 mg/d dose. Among the 52 patients who completed the study, 19 patients (36.5%) had therapeutic anti-Xa levels. The results showed no statistically significant associations between regimens that were used and achieving therapeutic anti-Xa level (p>0.05). No bleeding events or thrombocytopenia were noticed, and there was one case of recurrent thrombosis. CONCLUSION: Enoxaparin dosing regimens that were used for obese patients varied based on prescribing physicians. Regardless of the regimen used, the majority of participants had nontherapeutic anti-Xa. Individualized dosing regimens based on anti-Xa levels are warranted for obese patients on enoxaparin.

Healthcare providers' attitude and knowledge regarding medication use in breastfeeding women: a Jordanian national questionnaire study.

Medication use among women who have recently given birth is unavoidable in some situations. The aim of this study was to assess the attitude and knowledge of healthcare providers (HCPs) in Jordan about the safe use of medications during breastfeeding. The data were collected from HCPs in maternal and children care centres and hospitals from April 2015 to January 2016, using a self-administered questionnaire. A total of 904 HCPs (79.3%) were enrolled in the study. Half of the participants followed the World Health Organisation's and American Academy of Pediatrics' recommendations. The awareness of HCPs regarding these recommendations was lower among nurses (OR 0.212, 95%CI 0.132-0.338, p < .001) and pharmacists (OR 0.476, 95%CI 0.297-0.763, p = .002) than physicians. The majority of participants (80%) had low level of knowledge and nurses were more likely to have low knowledge than physicians (OR 0.099, 95%CI 0.050-0.197, p < .001). Professional continuous education programmes were highly encouraged. Impact statement What is already known on this subject: Use of medications among women who have recently given birth is unavoidable in some situations and most of them are safe to be given during breastfeeding. What the results of this study add: Healthcare providers in Jordan have variable attitudes regarding the safety of medication use during breastfeeding. The majority of healthcare providers have a low level of knowledge regarding the safe use of medication during breastfeeding. Nurses are more likely to have low knowledge as compared to physicians. IMPLICATIONS FOR CLINICAL PRACTICE: Healthcare providers should be encouraged to seek information regarding compatibility of medication use during breastfeeding from reliable sources. Professional continuing education programmes concerning the safety of medication use during breastfeeding period are needed to target all involved HCPs. More attention should be directed toward medical schools' curricula to widen the knowledge of medication use and focus on practice-based clinical experience.

A randomised control trial to evaluate the clinical pharmacist's role in managing iron deficiency anaemia patients.

OBJECTIVE: To investigate the role of clinical pharmacists in managing iron deficiency anaemia patients. METHODS: A prospective parallel randomised controlled trial conducted in an outpatient clinic enrolled adult iron deficiency anaemia patients. Patients were randomised into either an intervention or a control group. Patients in the intervention group were followed closely by a clinical pharmacist who offered pharmaceutical care services and worked closely with physicians to manage iron deficiency anaemia. Patients in the control group received the usual medical care. KEY FINDINGS: One hundred and four patients were enrolled in the study. Eighty-two patients completed the 4-6 week study, with 43 patients in the intervention group and 39 patients in the control group. By the end of the study, 86% of intervention group patients and 59% of control group patients reached their haemoglobin goal values, with statistically significant improvement in intervention group patients versus control group patients (P value = 0.006). Most of the clinical pharmacist's recommendations were adopted by physicians (83.9%). CONCLUSION: Clinical pharmacist interventions improved iron deficiency anaemia patients' outcomes.

Difficulties in swallowing oral medications in Jordan.

Background Difficulties swallowing oral medications can affect patient compliance and consequently can compromise patient health. Objective To investigate the prevalence of difficulties in swallowing oral medications among a sample of the Jordanian population and the techniques used to overcome such difficulties. Setting The study was carried out in outpatient pharmacies in the north of Jordan. Method Adult patients who were taking at least one solid oral dosage form for at least 1 month were interviewed using a questionnaire. The questionnaire included demographic details, current medication use, questions about swallowing difficulties, and patient strategies to overcome such difficulties. Main outcome measure The study measured the number of patients reporting difficulties in swallowing oral medications and the techniques used to overcome swallowing difficulties. Results In this study 1250 patients were interviewed and 130 patients reported that they experienced or were currently experiencing difficulties in swallowing oral medications (10.4%). In order to overcome swallowing difficulties, 112 patients (86.2%) stated that they drink more water while 22 patients (16.9%) stated that they cut or crush their solid dosage forms, and 13 patients stated that they open their capsules. Forty-five patients (34.6%) stated that they sometimes skip their doses due to swallowing difficulties. The majority of participants with swallowing difficulties did not discuss their difficulties with their physicians or pharmacists (85.4%). Conclusion Difficulties in swallowing oral medications is a problem that is encountered in Jordan. Techniques used to overcome swallowing difficulties such as crushing or opening capsules can compromise medication efficacy and negatively impact patient health outcomes. Non-compliance due to swallowing difficulties raises a major concern.

Medication Use in Breastfeeding Women: A National Study.

INTRODUCTION: A wealth of evidence reveals the benefits of breastfeeding. During the breastfeeding period, nursing mothers may face many medical conditions that require medical management. The medication use among breastfeeding women in Jordan is largely unknown. OBJECTIVE: This study assessed the beliefs and attitudes of breastfeeding women in Jordan toward medication use. METHODS: The data were collected from breastfeeding women in hospitals and maternal and children care centers from north, middle, and south Jordan by semistructured interviews using a self-administered questionnaire from February 2015 to November 2015. RESULTS: Of the 903 participants (96% response rate), 17% used over-the-counter medications and 33% took prescribed medications. Of these, 7% (n = 64) used both over-the-counter and prescribed medications. Analgesics followed by antibiotics were the most commonly used medications among breastfeeding women in Jordan. The majority of breastfeeding women consulted with their physician or pharmacist before initiating or changing any medication. Product Information was the most commonly used drug information resource utilized by breastfeeding women to inquire about safety of medication use during breastfeeding. CONCLUSION: Breastfeeding women should be educated about the reliable sources of medication information and the importance of physician consultation before initiation or modification of medication therapy. Physicians and pharmacists should be encouraged to be actively involved in detailed discussion with breastfeeding women regarding medication use.

Primary prevention of cardiovascular disease in a primary care setting.

AIM: This study was designed to investigate primary prevention of cardiovascular disease in a primary care setting in Jordan. METHODS: Adult patients without clinical cardiovascular disease who attended a primary care setting were interviewed and their medical files were reviewed. Data collected to assess primary prevention of cardiovascular disease included lifestyle/risk factor screening, weight assessment, blood pressure measurement and control, and blood lipid measurement and control. RESULTS: A total of 224 patients were interviewed. The proportions of patients' files with risk factors documentation were 37.9% for smoking status, 30.4% for physical activity assessment and 72.8% for blood pressure assessment. The majority of hypertensive patients (95.9%) had a blood pressure reading at their most recent visit of ⩽ 140/90 or was prescribed ⩾ 2 antihypertensive medications. CONCLUSION: Documentation of cardiovascular disease risk factors was suboptimal. Healthcare providers should be encouraged to document and assess cardiovascular risk factors to improve primary prevention.

Evaluating unfractionated heparin fixed dosing protocol and establishing an institutional therapeutic range for UFH in hospital setting in Jordan.

This study was conducted to evaluate current unfractionated heparin (UFH) dosing regimen and establish an institutional therapeutic range for UFH in a public hospital in Jordan. In the first part, medical records of 241 patients who received UFH were reviewed retrospectively. In the second part, blood samples were withdrawn from 60 patients on UFH, and activated partial thromboplastin time and anti-Xa assay were measured. Most activated partial thromboplastin time readings were not therapeutic (91.4%) and recurrence of thrombosis was reported in 35.3% of patients. In the second part, therapeutic activated partial thromboplastin time range corresponding to the UFH concentration of 0.3 to 0.7 anti-factor Xa unit/mL was 56 to 95 seconds, which corresponds to an activated partial thromboplastin time range of 1.5 of 2.8 times the mean control value. The traditional activated partial thromboplastin time range ratio of 1.5 to 2.5 times the control value can result in subtherapeutic UFH levels.

Tablet splitting and weight uniformity of half-tablets of 4 medications in pharmacy practice.

BACKGROUND: Tablet splitting is a common practice for multiple reasons including cost savings; however, it does not necessarily result in weight-uniform half-tablets. OBJECTIVES: To determine weight uniformity of half-tablets resulting from splitting 4 products available in the Jordanian market and investigate the effect of tablet characteristics on weight uniformity of half-tablets. METHODS: Ten random tablets each of warfarin 5 mg, digoxin 0.25 mg, phenobarbital 30 mg, and prednisolone 5 mg were weighed and split by 6 PharmD students using a knife. The resulting half-tablets were weighed and evaluated for weight uniformity. Other relevant physical characteristics of the 4 products were measured. RESULTS: The average tablet hardness of the sampled tablets ranged from 40.3 N to 68.9 N. Digoxin, phenobarbital, and prednisolone half-tablets failed the weight uniformity test; however, warfarin half-tablets passed. Digoxin, warfarin, and phenobarbital tablets had a score line and warfarin tablets had the deepest score line of 0.81 mm. CONCLUSION: Splitting warfarin tablets produces weight-uniform half-tablets that may possibly be attributed to the hardness and the presence of a deep score line. Digoxin, phenobarbital, and prednisolone tablet splitting produces highly weight variable half-tablets. This can be of clinical significance in the case of the narrow therapeutic index medication digoxin.

The role of clinical pharmacist on lipid control in dyslipidemic patients in North of Jordan.

OBJECTIVE: The purpose of this study is to investigate the effectiveness of introducing clinical pharmacy services in achieving goal lipid profile in dyslipidemia patients in North of Jordan. Setting the study was carried out in a primary care facility in North of Jordan. METHODS: One hundred fifty two dyslipidemia patients were randomized into intervention and control groups and followed for 6 months period. Intervention group patients were followed intensively by a clinical pharmacist who worked closely with physicians in controlling lipid profiles according to the third edition of recommendations by The National Cholesterol Education Program Adult Treatment Panel, control group patients were provided with standard medical care. Main outcome measure percent of patients at their low density lipoprotein cholesterol target in the intervention group compared to percent of patients at their low density lipoprotein cholesterol target in the control group by the end of the study. RESULTS: One hundred twenty five patients completed the study duration. After 6 months, 94.5% of intervention group patients and 71.2 % of control group patients reached their goal low density lipoprotein cholesterol levels (P value < 0.001, Pearson Chi-Square test) compared to 24.7 and 28.8% respectively at baseline. Majority of pharmacist recommendations (90.4%) were followed by physicians and overall lipid lowering agents use was increased to 91.8% in intervention group patients and 86.5% in control group patients compared to 69.9 and 78.8% respectively at baseline. CONCLUSION: Implementing clinical pharmacy services in Jordan has improved the lipid profiles of dyslipidemic patients.

Physicians' perceptions, expectations, and experience with pharmacists at Hamad Medical Corporation in Qatar.

OBJECTIVES: The purpose of this study was to investigate the physicians' perceptions, and expectations of their experiences with the pharmacists at Hamad Medical Corporation (HMC) in Qatar. METHOD: A cross-sectional study was conducted at HMC between January and March 2006 using a validated questionnaire. The self-administered questionnaire was distributed to 500 physicians who were working at HMC comprising Hamad General Hospital, Women's Hospital, Rumaila Hospital, Al-Amal Hospital, Al Khor Hospital, and primary health centers. The questionnaire was composed of four parts, investigating the physicians' expectations, experiences, and perceptions of the pharmacists. RESULTS: A total of 205 questionnaires were completed (response rate 41%). A total of 183 physicians (89%) expected the pharmacist to educate patients about safe and appropriate use of drugs, whereas 118 (57%) expected the pharmacist to be available for health-care team consultation during bedside rounds. The indices of physicians showing how comfortable they were with pharmacists, and their expectations of pharmacists, were 61% and 65%, respectively, whereas the index on experience of physicians with pharmacists was lower (15%). CONCLUSIONS: Physicians were comfortable with pharmacists and had high expectations of pharmacists in performing their duties. However, physicians reported a poor experience with pharmacists, who infrequently informed them about the effectiveness of alternative drugs, patients experiencing problems with prescribed medications, and who took personal responsibility to resolve any drug-related problem.

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.