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.

Prevalence of Medication Associated with QTc Prolongation Used Among Critically Ill Patients.

Background: Acquired prolonged corrected QT (QTc) interval can lead to life-threatening Torsade de Pointes (TdP) arrhythmia. Multiple risk factors including medications, comorbidities, and electrolyte imbalances contribute significantly to acquired manifestations of the QTc prolongation. Critically ill patients are particularly more vulnerable to TdP due to complex medical conditions, aging, and polypharmacy. Objective: This study aimed to assess the prevalence of TdP-associated medication prescribing, identify risk factors for QTc prolongation and TdP, and determine primary predictors of high TdP medication usage in critically ill patients in Jordan. Methods: We conducted a retrospective cross-sectional analysis of electronic medical records for patients from King Abdullah University Hospital who were admitted to Intensive Care Unit (ICU) between (July 2012-July 2022). We collected data on patients' demographics, clinical characteristics, comorbidities, laboratory results, and prescribed medications. Medications were categorized into three TdP risk levels according to CredibleMeds® assessment tool. Data were analyzed using descriptive statistics and a binary logistic regression model. Results: Of the 13,300 patients (58.2% male, median age 62 years). Prescribing prevalence for medications with known TdP risk was 19%, possible risk (24.7%), conditional risk (21.6%), and confirmed conditional risk (8.3%). Common comorbidities included hypertension (40.9%), diabetes (33.3%), and cancer (15.4%). Drugs with known TdP risk included citalopram, amiodarone, clarithromycin, and ciprofloxacin. A binary regression model revealed that as age increased, the odds of TdP associated medication prescribing decreased (OR = 0.989, p < 0.001), while patients on more than five medications had higher odds (OR = 4.281, p < 0.001). Conclusion: The study identified a notable prevalence of prescribing for medications with QTc prolongation/TdP risk in critically ill patients. Healthcare providers in the ICU should exercise caution to minimize the inadvertent prescription of TdP associated medications especially among older patients and those with polypharmacy.

Health literacy, knowledge, household disposal, and misuse practices of antibiotics among UAE residents: a nationwide cross-sectional study.

BACKGROUND: The study aimed to evaluate health literacy, knowledge, household disposal, and misuse practices of antibiotics among the United Arab Emirates (UAE) residents. RESEARCH DESIGN AND METHODS: An observational cross-sectional study was conducted between May 1st and August 31st, 2022. The study encompassed a sample of 1074 participants. RESULTS: Participants involved in a medical field (OR: 1.98, 95% CI: 1.45-2.69, p < 0.001) were more likely to have adequate health literacy. Most participants rarely (n = 315; 29.33%) or sometimes (n = 292; 27.19%) sought help from a doctor or pharmacist with reading the instructions and leaflets of antibiotics. A bachelor`s degree was associated with a reduced odds ratio of self-medication with antibiotics (OR: 0.46, 95% CI: 0.29-0.75, p = 0.002). Only 10.61% of unneeded antibiotics were returned to the pharmacy, 79.42% were disposed of at home and 10% were disposed of using other disposal practices. CONCLUSIONS: Higher levels of adequate health literacy were observed in those involved in the medical field and those with higher educational levels. The prevalence of self-medication with antibiotics among the UAE population was low. These findings highlight the importance of improving health literacy, promoting responsible antibiotic use, and encouraging proper disposal practices among the population.

Community pharmacists' knowledge and awareness about isotretinoin therapy and its dispensing practice in Jordan.

A validated self-reported questionnaire was used to evaluate pharmacists' knowledge about isotretinoin and their awareness of isotretinoin dispensing practice. The majority were not able to recognize the initial dose of isotretinoin, the potential side effects such as dyslipidemia and liver toxicity, the potential interaction with tetracycline and Vitamin A and the contraindications of isotretinoin. Around 41.3 % of the pharmacists dispensed isotretinoin without a prescription, and the majority did not recognize that isotretinoin should be dispensed for only 30 days, should not be dispensed without an emphasis on the appropriate indication, and did not know the appropriate duration of isotretinoin therapy. Male gender and postgraduate degree were associated with better awareness, while increased work experience and postgraduate degree were associated with better knowledge about isotretinoin therapy. Nevertheless, both male and female pharmacists demonstrated equivalent knowledge levels. The current study demonstrates the need to implement educational programs to improve pharmacists' knowledge and awareness about isotretinoin and its dispensing practice.

Lessons Learned from the Pandemic in the UAE: Children COVID-19 Vaccine Hesitancy and Its Impact on the Choice of Distance versus Face-to-Face Learning Modalities: An In-Depth Analysis of a National Study.

This study addresses the crucial aspect of childhood COVID-19 vaccination and its impact on parental decisions concerning learning modalities during the pandemic. This study aimed to gauge parental hesitancy towards vaccinating their children and its influence on choosing between distance and face-to-face learning options. Following STROBE guidelines for cross-sectional studies, this study surveyed 1973 parents in the United Arab Emirates using Google Forms during the COVID-19 pandemic. The results revealed that while more than half of the parents (51.6%) were willing to vaccinate their children if the COVID-19 vaccine was accessible and affordable, a significant majority (91.2%) expressed concerns about the rapid vaccine development process, which was the primary reason for vaccine rejection. Interestingly, a sizable portion (55.3%) had experienced online learning in the previous academic term, and, of those, 59.6% believed it negatively influenced their children's academic performance. Consequently, 66.4% expressed intent to shift their children back to face-to-face learning once feasible. Significantly, parents with medical backgrounds were more inclined (91.6%) to opt for face-to-face schooling compared to those without such backgrounds. Logistic regression analysis indicated associations between sociodemographic characteristics, educational level and background, and the decision to return children to face-to-face learning. Interestingly, when it comes to vaccine hesitancy, a noteworthy connection exists between the parents' reluctance to vaccinate their children and their preference for distance learning. In fact, parents who responded negatively to vaccinating their children against COVID-19, if the vaccine was available, showed a clear preference for the distance learning modality (p-value < 0.0001). This study underscores the complex interplay of factors and community perspectives shaping parental acceptance of childhood COVID-19 vaccination. The development pace of vaccines significantly influences parents' attitudes and beliefs about vaccination programs. Parents' medical backgrounds exhibit a clear correlation with their perceptions of sending children back to school safely. This highlights the potential impact of parental medical knowledge on decision making, emphasizing the need to consider parents' professional backgrounds when devising education- and vaccination-related policies.

Glycemic control and its associated factors among diabetic heart failure outpatients at two major hospitals in Jordan.

Patients with heart failure (HF) are generally at higher risk of developing type 2 diabetes and having uncontrolled blood glucose. Furthermore, the prevalence of uncontrolled blood glucose in patients with HF is largely unknown. Identifying the factors associated with poor blood glucose control is a preliminary step in the development of effective intervention programs. The current cross-sectional study was conducted at two major hospitals to explore the factors associated with blood glucose control among patients with heart failure and type 2 diabetes. In addition to sociodemographic, medical records were used to collect medical information and a validated questionnaire was used to evaluate medication adherence. Regression analysis showed that poor medication adherence (OR = 0.432; 95%CI 0.204-0.912; P<0.05) and increased white blood cells count (OR = 1.12; 95%CI 1.033-1.213; P<0.01) were associated with poor glycemic control. For enhancing blood glucose control among patients with HF and diabetes, future intervention programs should specifically target patients who have high WBC counts and poor medication.

Evaluating kidney function and the associated risk factors among patients with type 2 diabetes mellitus: a cross-sectional study at a tertiary hospital in Jordan.

BACKGROUND: The diabetes prevalence is escalating in Jordan; as a consequence, the risk of developing diabetic kidney diseases is also increasing. OBJECTIVE: This study evaluated the effect of risk factors and comorbidities on kidney function in patients with type 2 diabetes mellitus (T2DM). DESIGN: A cross-sectional, survey-based study. SETTING: Participants were recruited from the endocrinology and cardiology clinics of a tertiary hospital in Jordan. PARTICIPANTS: Patients with T2DM aged 18 years and more who had undergone a kidney function test within a year before data collection. OUTCOME MEASURES: The estimated GFR (eGFR) mean values and proteinuria presence were used to evaluate the impact of risk factors on kidney function. Descriptive and analytical statistical approaches were used to calculate mean, prevalence and correlations. The SPSS software was used with a p value<0.05 for significance. RESULTS: Of the total 331 study participants, 54.1% were men and 45.9% were women. The mean age was 60 years. The eGFR mean values were significantly reduced in patients with T2DM with hypertension, hyperlipidaemia and proteinuria (p<0.01). The correlation analysis results showed that the eGFR was positively correlated with hypertension and hyperlipidaemia presence (rs=0.253, 0.220), and negatively correlated with age, body mass index and diabetes duration (rs=-0.395, -0.151, -0.221), respectively. However, the eGFR did not corelate with income, sex, smoking and anaemia. Of note, about 68% of the patients with T2DM had uncontrolled diabetes. CONCLUSIONS: Kidney function were severely affected in patients with T2DM in the presence of risk factors and comorbidities. It is highly recommended to control diabetes through medications and life style, and to regularly check for kidney function to halt the deteriorations in kidney function.

Reported long-term effects of COVID-19 patients after hospital discharge in Jordan.

Coronavirus Disease 2019 (COVID-19) long-term effect is the new challenge facing healthcare providers that should be further assessed. We aim to describe the characteristics and patterns of long-term consequences of COVID-19 among recovered patients. COVID-19 patients baseline data was extracted from hospital records and alive patients filled self-reported symptoms questionnaires. A follow-up chest X-ray (CXR) was then scored based on lung abnormalities and compared with baseline CXR images. Six hundred ninety-four patients were included for the questionnaire and final analysis. Patients who were categorized as critical or severe were more prone to develop at least one symptom than those who were categorized as moderate. The most newly diagnosed comorbidities after discharge were diabetes (40.9%), cardiovascular diseases (18.6%), and hypertension (11.9%). Most patients with prolonged symptoms after discharge had a significant decrease in the quality of life. Small number of CXR showed persistent abnormalities in the middle right, the lower right, and lower left zones with an average overall score during admission 13.8 ± 4.9 and 0.3 ± 1.01 for the follow-up images. Effects of COVID-19 were found to persist even after the end of the infection. This would add on to the disease burden and would foster better management.

Factors contributing to poor COVID-19 outcomes in diabetic patients: Findings from a single-center cohort study.

Diabetes Mellitus (DM) is a frequent comorbidity in patients infected with the SARS-CoV-2 virus. The risk of developing severe or critical COVID-19 and higher mortality was observed to be increased in diabetic patients hospitalized due to COVID-19. In this study we aimed to find out the impact of clinical characteristics, comorbidities, laboratory results, and complications on the outcomes of diabetic patients hospitalized due to COVID-19. This article is a retrospective cohort study that include diabetic patients hospitalized with COVID-19 infection. A definition of diabetes was based on the past history of diabetes or if the HbA1c was 6.5% or higher. Demographics, clinical characteristics, comorbidities, laboratory results, and complications were extracted from the electronic medical records. The mortality rate increased with increasing age (from 5.56% in younger patients to 46% in the elderly) and with severity (from 25.71% in moderate cases to 43.77% in critical cases). We found that a critical severity on admission (OR: 5.26, 95% CI: 1.28-21.66, p = 0.0214), a history of stroke (OR: 8.37, 95% CI: 2.2-31.88, p = 0.0018), and low calcium levels on admission (OR: 2.23, 95% CI: 1.01-4.91, p = 0.0475) were significant risk factors predicting higher COVID-19 mortality in diabetic patients. The findings of this study suggest that reduced calcium levels could potentially indicate higher mortality due to COVID-19 in patients with DM. Furthermore, careful monitoring of diabetic patients hospitalized due to COVID-19 infection, especially those with critical disease severity or those with a history of stroke, may improve their outcome and lessen mortality.

A Jordanian Multidisciplinary Consensus Statement on the Management of Dyslipidemia.

Atherosclerotic cardiovascular disease (ASCVD) is the primary contributor to global mortality rates, which significantly escalates healthcare expenditures. Risk factors for ASCVD (including dyslipidemia) frequently present in clusters rather than separately. Addressing these risk factors is crucial in the early initiation of a comprehensive management plan that involves both lifestyle modifications and pharmacotherapy to reduce the impact of ASCVD. A team of Jordanian professionals from various medical organizations and institutes took the initiative to create a set of guidelines for dyslipidemia screening and therapy. A detailed, comprehensive literature review was undertaken utilizing several databases and keywords. This consensus statement provides recommendations for dyslipidemia management in Jordanians on several issues including cardiovascular risk estimation, screening eligibility, risk categories, treatment goals, lifestyle changes, and statin and non-statin therapies. It is recommended that all Jordanian individuals aged 20 years old or older undergo lipid profile testing. This should be followed by determining the level of cardiovascular risk depending on the presence or absence of ASCVD and cardiovascular risk factors, eligibility for lipid-lowering therapy, and the target low-density cholesterol serum level to be achieved. In conclusion, prioritizing the management of dyslipidemia is of the utmost importance in improving public health and reducing the burden of cardiovascular diseases.

An Evaluation of the Impact of Increasing the Awareness of the WHO Access, Watch, and Reserve (AWaRe) Antibiotics Classification on Knowledge, Attitudes, and Hospital Antibiotic Prescribing Practices.

The study aims to determine the effect of enhancing knowledge and awareness of the WHO Access, Watch, and Reserve (AWaRe) antibiotics classification on hospital clinical staff's knowledge, attitudes and antibiotic prescribing practices. A pre-post-intervention study design was employed. The intervention was an educational activity that involved teaching physicians and pharmacists about the AWaRe classification and the risk of antibiotic resistance. A questionnaire was administered to clinical staff pre-and post-intervention. In the pre-interventional stage, 78.5% of participants stated they had not heard about the AWaRe classification of antibiotics. After receiving the intervention: the knowledge regarding the meaning and purpose of AWaRe classification of antibiotics increased from 39.1% to 75.4%; the percentage of participants who agreed with following the AWaRe classification of antibiotics in their practice increased from 21.7% to 58.5%; and the percentage of participants who agreed that AWaRe classification of antibiotics can suggest safe choices of antibiotics increased from 56.5% to 90.8%. Hospital antibiotic use of the Access group increased by 6.6% from pre- to post-intervention. The use of the Watch group and Reserve group decreased post-intervention by 1.7%, and 43.1%, respectively. This study showed important gaps in knowledge and attitudes towards AWaRe, highlighting the need for increasing the awareness of the AWaRe tool amongst healthcare practitioners to ensure rational use of antibiotics.

The impact of the COVID-19 pandemic on antibiotic consumption and prevalence of pathogens in primary and secondary healthcare settings in Northern Ireland.

AIM: To evaluate the impact of the COVID-19 pandemic on the patterns of antimicrobial use and the incidence of pathogens in primary and secondary healthcare settings in Northern Ireland. METHODS: Data were collected on antibiotic use and Gram-positive and Gram-negative pathogens from primary and secondary healthcare settings in Northern Ireland for the period before (January 2015-March 2020) and during (April 2020-December 2021) the pandemic. Time series intervention analysis methods were utilized. RESULTS: In the hospital setting, the mean total hospital antibiotic consumption during the pandemic was 1864.5 defined daily doses (DDDs) per 1000 occupied-bed days (OBD), showing no significant change from pre-pandemic (P = .7365). During the pandemic, the use of second-generation cephalosporins, third-generation cephalosporins, co-amoxiclav and levofloxacin increased, there was a decrease in the percentage use of the hospital Access group (P = .0083) and an increase in the percentage use of Watch group (P = .0040), and the number of hospital Klebsiella oxytoca and methicillin-susceptible Staphylococcus aureus cases increased. In primary care, the mean total antibiotic consumption during the COVID-19 pandemic was 20.53 DDDs per 1000 inhabitants per day (DID), compared to 25.56 DID before the COVID-19 pandemic (P = .0071). During the pandemic, there was a decrease in the use of several antibiotic classes, an increase in the percentage use of the Reserve group (P = .0032) and an increase in the number of community-onset Pseudomonas aeruginosa cases. CONCLUSION: This study provides details of both changes in antibiotic consumption and the prevalence of infections in hospitals and primary care before and during the COVID-19 pandemic that emphasize the importance of antimicrobial stewardship in pandemic situations.

The Length of Hospital Stay of Patients with Venous Thromboembolism: A Cross-Sectional Study from Jordan.

Background and Objectives: Venous thromboembolism is one of the leading causes of mortality and disability worldwide. Treatment with anticoagulation therapy is essential and requires a delicate approach to select the most appropriate option to improve patient outcomes, including the length of hospital stay (LOS). The aim of this study was to determine the LOS among patients with acute onset of VTE in several public hospitals in Jordan. Materials and Methods: In this study, we recruited hospitalized patients with a confirmed diagnosis of VTE. We reviewed the electronic medical records and charts of VTE admitted patients in addition to a detailed survey to collect the patients' self-reported data. Hospital LOS was categorized into three levels: 1-3 days, 4-6 days, and ≥7 days. An ordered logistic regression model was used to study the significant predictors of LOS. Results: A total of 317 VTE patients were recruited, with 52.4% of them were male and 35.3% aged between 50 and 69 years. Most patients had a deep vein thrombosis (DVT) diagnosis (84.2%), and most of the VTE cases were admitted for the first-time (64.6%). The majority of the patients were smokers (57.2%), overweight/obese (66.3%), and hypertensive (59%). Most of the VTE patients received Warfarin overlapped with low molecular weight heparins as their treatment regimen (>70%). Almost half of the admitted VTE patients (45%) were hospitalized for at least 7 days. Longer LOS was significantly associated with hypertension. Conclusions: We recommend using therapies that have been proven to reduce hospital LOS, such as non-vitamin K antagonist oral anticoagulants or direct oral anticoagulants, to treat VTE patients in Jordan. Additionally, preventing and controlling comorbidities such as hypertension is essential.

Acid-base imbalance as a risk factor for mortality among COVID-19 hospitalized patients.

Severe coronavirus disease 2019 (COVID-19) infection can lead to extensive lung infiltrate, a significant increase in the respiratory rate, and respiratory failure, which can affect the acid-base balance. No research in the Middle East has previously examined acid-base imbalance in COVID-19 patients. The present study aimed to describe the acid-base imbalance in hospitalized COVID-19 patients, determine its causes, and assess its impact on mortality in a Jordanian hospital. The study divided patients into 11 groups based on arterial blood gas data. Patients in normal group were defined as having a pH of 7.35-7.45, PaCO2 of 35-45 mmHg, and HCO3- of 21-27 mEq/L. Other patients were divided into 10 additional groups: mixed acidosis and alkalosis, respiratory and metabolic acidosis with or without compensation, and respiratory and metabolic alkalosis with or without compensation. This is the first study to categorize patients in this way. The results showed that acid-base imbalance was a significant risk factor for mortality (P<0.0001). Mixed acidosis nearly quadruples the risk of death when compared with those with normal levels (OR = 3.61, P=0.05). Furthermore, the risk of death was twice as high (OR = 2) for metabolic acidosis with respiratory compensation (P=0.002), respiratory alkalosis with metabolic compensation (P=0.002), or respiratory acidosis with no compensation (P=0.002). In conclusion, acid-base abnormalities, particularly mixed metabolic and respiratory acidosis, were associated with increased mortality in hospitalized COVID-19 patients. Clinicians should be aware of the significance of these abnormalities and address their underlying causes.

Reporting Antimicrobial-Related Adverse Drug Events in Jordan: An Analysis from the VigiBase Database.

This study aims to assess the reporting of antimicrobial-related adverse drug events (ADEs) in Jordan between 2003 and 2022. Data regarding the antimicrobial-related ADEs were extracted from the WHO's global database (VigiBase) by the Rational Drug Use and Pharmacovigilance Department at the Jordan Food and Drug Administration (JFDA). A total of 279 Individual Case Safety Reports (ICSRs) were recorded. The number of ICSRs increased from 2019 onwards (219 out of 279 cases). This increase in the reported ADEs was influenced by the actions of the JFDA, including the introduction of electronic reporting forms, updating the national pharmacovigilance guidelines, which encouraged adverse drug reactions reporting, the implementation of the AMR-national action plan, the encouragement to report due to COVID-19 vaccine, and the continuous awareness campaigns and training programs. Skin and subcutaneous tissue disorders (n = 105; 19.48%) were the most reported antimicrobial-related ADEs. The highest number of ADEs was reported for tetracyclines (n = 101; 18.74%) followed by fluoroquinolones (n = 54; 10.02%), third-generation cephalosporines (n = 48; 8.9%), and carbapenems (n = 42; 7.79%). From the top 10 consumed antibiotics, the number of ADEs in patients who consumed Watch group antibiotics (97 ADEs) was higher than those who consumed Access group antibiotics (28 ADEs). The findings highlight the need to monitor and rationalize the use of Watch antibiotics. Enhanced reporting of antimicrobial-related adverse drug reactions is needed to inform antimicrobial stewardship and improve the pharmacovigilance system in Jordan.

The Impact of Multidrug-Resistant Acinetobacter baumannii Infection in Critically Ill Patients with or without COVID-19 Infection.

This is a single-center, retrospective, cohort study aimed to evaluate the clinical outcomes of multi-drug resistance in Acinetobacter baumannii infections (MDR-AB) in intensive care unit (ICU) patients with or without a COVID-19 infection and risk factors for blood stream infection. A total of 170 patients with MDR-AB were enrolled in the study. Of these, 118 (70%) patients were admitted to the ICU due to a COVID-19 infection. Comparing the COVID-19 and non-COVID-19 groups, the use of mechanical ventilation (98.31% vs. 76.92%, p = 0.000), the presence of septic shock (96.61% vs. 82.69%, p = 0.002), and the use of steroid (99.15% vs. 71.15%, p = 0.000) and tocilizumab therapies (33.05% vs. 0%, p = 0.000) were more prevalent and statistically more significant in patients with COVID-19 infections. The average length of the ICU stay (21.2 vs. 28.33, p = 0.0042) was significantly lower in patients with COVID-19 infections. Survival rate was 21.19% for the COVID-19 group and 28.85% for non-COVID-19 group with a p-value = 0.0361. COVID-19 status was associated with significantly higher hazards of death (HR 1.79, CI 95% 1.02-3.15, p = 0.043). Higher SOFAB (15.07 vs. 12.07, p = 0.0032) and the placement of an intravascular device (97.06% vs. 89.71%, p = 0.046) were significantly associated with the development of a bloodstream infection. Our study has shown that critically ill patients with an MDR-AB infection, who were admitted due to a COVID-19 infection, had a higher hazard for death compared to non-COVID-19 infected patients.

Public knowledge of antibiotics, self-medication, and household disposal practices in Jordan.

BACKGROUND: This study aimed to assess public understanding of antibiotics, self-medication, and drug disposal practices. METHODS: A cross-sectional self-administered online survey was undertaken in Jordan. RESULTS: The study was completed by 1,105 participants. When asked about their knowledge of antibiotics, rational antibiotic use, and disposal practices, 16% percent believed they should discontinue antibiotics once they felt better, and 12% agreed to take the same antibiotics prescribed to others for the same illness. Self-medication with antibiotics was practiced by 44% of the participants. Prior experience, healthcare costs, and pharmacy location were all major determinants of self-medication. Only 6.4% of unneeded antibiotics were returned to the pharmacy, 60% were kept at home, and 26.6% were disposed of at home. Almost half of those who kept the antibiotics said they would use them again, and one-third said they would give them to friends and family. Respondents who had used antibiotics within the previous 6 months (p = 0.052) and relied on medication leaflets (p = 0.031) and physician recommendations (p = 0.001) were less likely to self-medicate with antibiotics. CONCLUSIONS: The study highlighted areas of inappropriate use of antibiotics, self-medication and the improper antibiotic disposal that can inform antimicrobial stewardship.

Willingness to pay for COVID-19 vaccines: Applying the health belief model.

BACKGROUND: To date, there is no effective treatment for COVID-19. Vaccines are effective and safe strategies to control the pandemic. OBJECTIVE: To measure consumers' maximum willingness to pay (WTP) for COVID-19 vaccines in Jordan and to identify the predictors of WTP. METHOD: An online survey was used to collect data related to sociodemographic factors and constructs from the Health Belief Model (HBM). The contingent valuation method using the payment card approach was used, whereby the respondents were asked to choose their maximum WTP value from a range of 5-200 Jordanian Dinar (JOD). The maximum WTP values were then categorized into several groups, and an ordered logistic model was used to generate adjusted odds ratios and estimate the significant predictors of maximum WTP. RESULTS: A total of 3116 respondents completed the survey. More than half of the sample were not willing to pay out of pocket for the vaccine (57%). Among the respondents who were willing to pay any amount above zero, the mean maximum WTP was 28.1 JOD (39.63 USD), and the median WTP was 20 JOD (28.21 USD). The significant predictors of higher WTP values were being of younger age, higher income, being a healthcare provider, having one or more chronic diseases, previous history of receiving the seasonal influenza vaccine, having a family member/friend who has died from the COVID-19, lower perceived risk of the vaccine, higher perceived benefits of the vaccine, and having been recommended to get the vaccine. CONCLUSION: It is recommended to continue providing the vaccine free of charge to increase its uptake. Educational campaigns should focus on refuting myths related to the vaccine and promoting the benefits of receiving the vaccine in slowing the spread of the pandemic, and improving the economy. Healthcare providers' recommendations have the potential to increase WTP for the vaccine.

Antibiotic use and resistance: Information sources and application by dentists in Jordan.

INTRODUCTION: The availability of evidence-based information sources for dentists is essential to influence antibiotic prescribing practices and we need to understand how dentists interact with such sources and how this influences their practice. The present study aimed to evaluate dentists' preferred sources of information and their awareness of available information and initiatives on prudent antibiotic prescribing practices in Jordan. METHODOLOGY: An online cross-sectional questionnaire was administered to dentists between July to September 2021. It was an adapted version of the European Centre for Disease Prevention and Control (ECDC) survey for antibiotic use and resistance. RESULTS: A total of 204 dentists responded to the survey. The main sources of information regarding avoiding unnecessary antibiotic prescribing were published guidelines (35.5%), the dental professional body (20.0%), colleagues or peers (18.6%), and scientific organizations (17.2%), with the influence of these sources on changing prescribers' views being 40.7%, 9.8%, 10.3%, and 14.2%, respectively. Of the surveyed dentists, 9.3%, 33.8%, and 56.9% were aware, unaware, and unsure of the presence of national action plans on antimicrobial resistance, respectively. Dentists reported their desire to receive more information about resistance to antibiotics (57.8%), medical conditions for which antibiotics are used (52.9%), how to use antibiotics (41.2%), prescribing of antibiotics (39.7%), and links between the health of humans, animals, and the environment (26.0%). CONCLUSIONS: The study provided insights into the information available to and used by dentists, which can inform effective antimicrobial stewardship strategies for improving antibiotic prescribing.

Knowledge, Attitude, and Behavior about Antimicrobial Use and Resistance among Medical, Nursing and Pharmacy Students in Jordan: A Cross Sectional Study.

The present study aimed to survey medical, nursing and pharmacy students' knowledge, attitude and practice regarding antimicrobial use and resistance. Additionally, the study assessed the teaching and assessment activities received regarding antibiotic use. A cross sectional online survey was distributed to undergraduate students currently in clinical studies in their degree program. A total of 716 medicine, nursing and pharmacy undergraduate students were included. Respondents scored more than 76% on knowledge on effective use, unnecessary use and associated side effects of antibiotics, and 65.2% regarding knowledge on the spread of antibiotic resistance. Some participants (21.0%) agreed or strongly agreed that there has been good promotion of prudent antimicrobial use. Students were aware (13.1%), unaware (29.1%), or unsure (57.8%) that there is a national action plan relating to antimicrobial resistance. A total of 62.8% of the respondents strongly agreed or agreed that they have a key role in helping control antibiotic resistance. Participants reported that they require more information about resistance to antibiotics (53.9%), medical conditions for which antibiotics are used (51.7%) and how to use antibiotics (51.0%). Discussion of clinical cases and vignettes and small group teaching were reported as very useful or useful teaching strategies (79.9% and 74.2%, respectively). The findings from this study determined the current situation in relation to education on prudent antimicrobial use for undergraduates and highlighted areas for informing better curriculum design.