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.

Monkeypox virus: An emerging epidemic.

INTRODUCTION: A monkeypox outbreak is spreading in territories where the virus is not generally prevalent. The rapid and sudden emergence of monkeypox in numerous nations at the same time means that unreported transmission may have persisted. The number of reported cases is on a constant increase worldwide. At least 20 non-African countries, like Canada, Portugal, Spain, and the United Kingdom, have reported more than 57662 as of September 9th suspected or confirmed cases. This is the largest epidemic seen outside of Africa. Scientists are struggling to determine the responsible genes for the higher virulence and transmissibility of the virus. Because the viruses are related, several countries have begun acquiring smallpox vaccinations, which are believed to be very effective against monkeypox. METHODS: Bibliographic databases and web-search engines were used to retrieve studies that assessed monkeypox basic biology, life cycle, and transmission. Data were evaluated and used to explain the therapeutics that are under use or have potential. Finally, here is a comparison between how vaccines are being made now and how they were made in the past to stop the spread of new viruses. CONCLUSIONS: Available vaccines are believed to be effective if administered within four days of viral exposure, as the virus has a long incubation period. As the virus is zoonotic, there is still a great deal of concern about the viral genetic shift and the risk of spreading to humans. This review will discuss the virus's biology and how dangerous it is. It will also look at how it spreads, what vaccines and treatments are available, and what technologies could be used to make vaccines quickly using mRNA technologies.

The Association Between e-Health Literacy and Willingness to Deprescribe Among Patients with Chronic Diseases: A Cross-Sectional Study from Jordan.

Background: Deprescribing refers to the partnered discontinuation of chronic medications to limit the negative impacts of polypharmacy. Polymedicated patients play a key role in the success of deprescribing efforts. eHealth literacy reflects patients' ability to appraise electronically available health-related information to make informed health care decisions, which partly reflect their desire to deprescribe. Objectives: The current study aimed to explore the relationship between eHealth literacy and willingness to deprescribe among patients with chronic diseases. Additionally, the predictors of willingness to deprescribe were examined. Materials and Methods: This cross-sectional study was conducted among adult patients with chronic diseases in Jordan. An online questionnaire comprising two validated tools, namely the Electronic Health Literacy Scale (eHEALS) and the Revised Patients' Attitudes Toward Deprescribing (rPATD) Questionnaire, was used for data collection. The questionnaire targeted adult patients with chronic medical conditions in Jordan and was posted to social media portals, following a convenience sampling technique. Results: A total of 719 responses were recorded and included in the final analysis. Participants with higher levels of eHealth literacy were more willing to get their medications deprescribed, as indicated by the perceived use of unneeded medications (p = 0.042). Meanwhile, participants with low levels of eHealth literacy were more likely to report fear of missing out on the potential benefits of deprescribed medications (p = 0.003). Other items that were commonly agreed upon by both the low and high eHealth literacy groups, respectively, included desire for dose reduction (p < 0.001, p < 0.001), belief in the lack of effectiveness of some prescribed medications (p < 0.001, p < 0.001), and fear of precipitating side effects (p = 0.001, p = 0.007). Conclusions: The present study highlighted the relationship between eHealth literacy and a number of items reflecting willingness to deprescribe, and these indicators can be used to guide future deprescribing efforts among eligible patients.

Synergistic Beneficial Effects of Resveratrol and Diet on High-Fat Diet-Induced Obesity.

Introduction: Despite decades of research, obesity and its related medical complications remain a major health concern globally. Therefore, novel therapeutic strategies are needed to combat obesity and its numerous debilitating complications. Resveratrol (RES) has a potential therapeutic effect in obesity and diabetes by improving oxidative metabolism and insulin signaling. Background and Objectives: The aim of this study was to investigate the effect of RES treatment on weight loss and glucose and fatty acid metabolism. Methods: Obesity was induced in 24 mice by exposure to a high-fat diet (HFD) for 8 weeks. Mice were randomly assigned to one group of either: group 1: control, non-treated low-fat diet (LFD) for 12 weeks (n = 8), group 2: non-treated high-fat diet (HFD) for 12 weeks (n = 8), group 3: RES-treated HFD (HFD + RES) (n = 8), or group 4: RES-treated and switched to LFD (HFD-LFD + RES) (n = 8). HFD + RES mice were first fed an HFD for 8 weeks followed by 4 weeks of RES. The HFD-LFD + RES group was first fed an HFD for 8 weeks and then treated with RES and switched to an LFD for 4 weeks. Results: After 12 weeks, group 2 mice had significantly higher body weights compared to group 1 (23.71 ± 1.95 vs. 47.83 ± 2.27; p < 0.05). Group 4 had a significant decrease in body weight and improvement in glucose tolerance compared to mice in group 2 (71.3 ± 1.17 vs. 46.1 ± 1.82 and 40.9 ± 1.75, respectively; p < 0.05). Skeletal muscles expression of SIRT1, SIRT3, and PGC1α were induced in group 3 and 4 mice compared to group 2 (p < 0.01), with no changes in AMP-activated protein kinase expression levels. Furthermore, combination of RES and diet ameliorated skeletal muscle intermediate lipid accumulation and significantly improved insulin sensitivity and secretion. Conclusions: The results of this study suggest a synergistic beneficial effect of LFD and RES to lower body weight and enhance glucose and fatty acid metabolism.

Obesity Paradox among Heart Failure with Reduced Ejection Fraction Patients: A Retrospective Cohort Study.

Background and Objectives: There is consensus on the negative effects of obesity on the development of heart failure. However, several studies have suggested that obesity may have paradoxical survival benefits in heart failure patients. Therefore, the aim of this study is to investigate whether the obesity paradox exists in heart failure with reduced ejection fraction (HFrEF) patients in Jordan. Materials and Methods: In this retrospective cohort study, data were retrieved from electronic hospital records of heart failure patients admitted to King Abdullah University Hospital between January 2010 and January 2020. Patients were divided into five BMI (kg/m2) subgroups: (1) Less than 25.0, (2) Overweight 25.0−29.9, (3) Obese Class I 30.0−34.9, (4) Obese Class II 35.0−39.9, and (5) Obese Class III ≥40.0. Changes in patients' clinical and echocardiographic parameters over one year were analyzed. Results: Data of a total of 297 patients were analyzed to determine the effect of obesity on heart failure. The mean age was 64.6 ± 12.4 years, and most patients (65.7%) were male. Among several co-morbidities, diabetes mellitus and hypertension were the most common and were present in 81.8% and 81.1% of patients, respectively. Over all patients, there was no significant change in EF after 1 year compared to baseline. However, only patients in the Obese Class I group had a statistically significant improvement in EF of 38.0 ± 9.81% vs. 34.8 ± 6.35% (p = 0.004) after 1 year. Importantly, among non-diabetic individuals, only Obese Class I patients had a significant (p < 0.001) increase in EF after 1 year compared to other BMI subgroups, a feature that was not observed among patients with diabetes. On the other hand, only Obese Class I patients with hypertension had a significant improvement (p < 0.05) in EF after 1 year compared to other BMI subgroups, a feature that was not observed among patients without hypertension. Conclusions: Our study demonstrates an inverted U-shaped relationship between BMI and EF such that patients with mild obesity (i.e., Obese Class I) had significant improvement in EF compared to those having a lower and higher BMI. We, therefore, suggest the existence of the obesity paradox among HFrEF patients in Jordan.

The prevalence and patterns of self-medication with antibiotics in Jordan: A community-based study.

BACKGROUND: Self-medication with antibiotics is one of the leading causes of antibiotic resistance and drug therapy problems, making antibiotic self-medication practices a global concern. Despite global efforts to limit these practices, self-medication with antibiotics remains prevalent in developing countries. This study aimed to investigate the prevalence and patterns of self-medication with antibiotics in Jordan and to compare the findings of self-medication practices with antibiotics with results from 2006. METHOD: A cross-sectional community-based study used a convenient sampling technique and recruited a large sample from all over Jordan. Between February and April 2019 trained 5th-year pharmacy students recruited participants (eg, door to door) who had taken antibiotics in the preceding month. The questionnaire consisted of 14 questions that aimed to describe the patterns of self-medication with antibiotics. RESULTS: A total of 1928 participants took part in this study. Of the 1928 respondents, 40.4% reported having used an antibiotic without a prescription in the previous month. Participants who had self-medicated with antibiotics had primarily used them for sore throat and influenza. Self-medicated participants had obtained antibiotics primarily from pharmacies (57.2%) and relied primarily on pharmacists (34.8%) and their own previous experience (35.2%) for information on the proper use of antibiotics. The rate of self-medication with antibiotics in Jordan in 2019 (40.4%) had not changed significantly since 2006 (39.5%, P = .295). However, self-medication practices (eg, source of antibiotic supply and information) have changed over the year. CONCLUSION: The findings of this study revealed that the prevalence of self-medication with antibiotics in Jordan remains high. This is a significant concern that requires a quick response from the government authorities to develop a collaborative approach to stop the dispensing of antibiotics without a prescription.

Management of urinary tract infections and antibiotic susceptibility patterns of bacterial isolates.

AIM OF STUDY: Urinary tract infections (UTIs) are among the most common infections affecting individuals of different ages worldwide. Antimicrobial agents are usually the first-line treatment for UTIs, and the use of the prescribed antibiotic is escalating, resulting in increased rates of bacterial resistance and UTI recurrence. The current study aimed to identify the causative bacteria in Jordan, to explore their resistance pattern to antibiotics and to describe drug-related problems (DRPs) associated with UTI management. METHODS: This prospective, descriptive study was conducted in two major health institutions in two cities in Jordan over a period of six months. The study population included inpatients and outpatients diagnosed with UTIs. Patients' data were collected directly from patients using data collection sheet and from patients' charts. RESULTS: A total of 273 patients were included, of whom 56.4% were women. Urine cultures were obtained from 81% of the patients. Escherichia coli was the most common causative pathogen (50.6%), followed by Klebsiella pneumonia (10.8%). Extended spectrum beta-lactamase (ESBL) producing E. coli was the most commonly detected organism across all types of UTIs. Ceftriaxone and imipenem/cilastatin were most commonly administered to hospitalised patients, whilst ciprofloxacin and co-triamzaxole were the most commonly prescribed in outpatient clinics. The susceptibility results for parenteral antibiotics showed high rates of resistance to cefazolin and ticarcillin. Additionally, high rates of resistance to fluoroquinolones were identified. Further, several DRPs were identified. High rates of resistance to commonly prescribed antibiotics were detected. DRPs (ie, inappropriate antibiotic dosage, unnecessary antibiotic prescribing, inappropriate duration of therapy and prescribing of ineffective antibiotics) were relatively common. CONCLUSION: The present study highlights the need for clinical pharmacists to manage the high level of drug related problems by providing updated information about proper drug selection, rational drug use and patient education and counselling.

Caesarean section delivery from maternal perspective: An exploratory study in Jordan.

AIMS OF THE STUDY: This study aims to determine females' views, experiences and attitudes regarding the caesarean section (CS) and to explore the factors that increase the prevalence of CS in Jordan. DESIGN: This is a cross-sectional study using a questionnaire that was distributed electronically through social media websites. Study participants included 1005 females with a history of at least one CS. Awareness, experiences about CS, complications and reasons for performing CS were investigated. SETTINGS: The participants were recruited from all Jordan cities by social media and emails. FINDINGS: Most of the respondents stated that the source of their knowledge about CS was from the internet (36.2%) followed by family and friends (31.6%). The majority of respondents were satisfied with their CS experience (72.8%). More than half of the participants (56.9%) reported that CS carries no risk for infants. About 53% of respondents stated that the most common reason leading women to choose to give birth via CS is the fear of labour pain. However, the majority of the respondents disagree with performing CS under maternal request (59.2%). CONCLUSIONS AND IMPLICATIONS: This study indicated that Jordanian females do not have reliable sources of information about CS. This leads to lower awareness of CS and its complications, and, as expected, CS is more likely to be performed by privately insured women.

Patterns and Predictors of Internet Gaming Disorder: An Observational Study from Jordan.

OBJECTIVE: Internet Gaming Disorder (IGD) is a rapidly growing public health problem that may have detrimental effects. The purpose of this study is to identify factors associated with IGD status. METHODS: In this cross-sectional observational study, a convenient sample of gamers in Jordan was recruited and asked to participate in an online survey based on the nine criteria of the 20-item Internet Gaming Disorder (IGD-20) used to assess gaming disorder. Sociodemographic and psychosocial data were also obtained. RESULTS: A total of 504 gamers participated in this study. The mean age of respondents was 21.6 ± 3.90 years. Using the standard IGD-20 scale, 96 participants (19%) were classified as potential IGD cases, compared to 408 (80.9%) non-disordered gamers. Males were dominant among the population, constituting 348 (69%) of gamers. Males also played significantly more hours per week [17.8 ±16.75] compared to females [13 ± 17.65]. The majority of gamers (411 (81.5%)) were students, although unemployed adults played for the highest total time [23.9 ± 30.84 hours/week]. Device type used for gaming also significantly (p <0.05) affected the time spent playing. Predictors of IGD included educational level (p< 0.05) and playing hours/week (p< 005). Conversely, no significant associations were found between IGD and gender, age, employment, or sleeping hours. IGD is increasingly being diagnosed among both genders and presents a health challenge for internet users. CONCLUSION: Establishing gamer profiles and recognizing predictors of IGD is therefore vital for guiding clinical classification and diagnosis of the disease.

An assessment of HIV patient's adherence to treatment and need for pharmaceutical care in Jordan.

OBJECTIVE: The objective of the present study was to explore the barriers and supporting factors for adherence among HIV patients and to explore their needs for pharmaceutical care services. METHODS: This study utilizes in-depth interviews with HIV patients. Out of 50 patients approached, a total of 30 patients agreed to participate in the study. The researchers used a predesigned topic guide. The interview guide included two parts; the first one focused on the assessment of HIV patients' adherence to their treatment. The second part focused on patients' need for pharmaceutical care services. RESULTS: Three main themes emerged from the interviews. Those included patient-related factors, medication-related factors and Healthcare professional related factors. This study found that a number of barriers that decreased adherence in HIV patients included stigmatisation, fear from disclosure, dosage form of the drug, adverse events and poor cooperation from healthcare professionals. On the other side supporting factors included family and friends support, electronic mobile reminders, feeling responsible to raising children, religious beliefs and feeling improvement while using therapy. Furthermore, the study illustrated that HIV patients need to have a specialist pharmacist in their healthcare team who delivers specialised pharmaceutical care services which may increase patients' adherence. CONCLUSIONS: The current study reveals a margin for medication adherence improvement in HIV patients. Patients in this study demonstrated the need for a pharmaceutical care. Future disease management and clinical pharmacy services programs should address the current study findings in order to improve the health service for HIV patients.

Willingness and readiness to test for COVID-19; A qualitative exploration of community pharmacists.

OBJECTIVES: The present study aimed to exploring community pharmacists' willingness and readiness to test for COVID-19 in Jordan. METHODS: Purposeful sampling was used to identify a list of 30 community pharmacies, which were approached to participate in the study. Twenty interviews were needed to reach data saturation. In-depth interviews were conducted, recorded, transcribed, and analysed using NVivo 11 Software. Interviews followed a previously prepared and validated 10-item interview guide. The interview guide discussed pharmacists' willingness and readiness to test for COVID-19. RESULTS: Twenty community pharmacists were interviewed for the purpose of the present study. Interviews took place during April 2020 and the mean interview duration was 23.30 minutes. Respondents had a mean age of 36.4 years and a mean experience of 8.8 years. The majority were female (70%) and 50% held a BSc in Pharmacy. Regarding respondents' willingness to test for COVID-19 emerging themes were helping other healthcare professional, willingness to contribute to official efforts in fighting COVID-19, acting as an accessible testing cite, willingness to carry out home testing. Regarding respondents' readiness to test for COVID-19 emerging themes were Pharmacists lack basic testing skills, pharmacies are not ready to preform tests and the need for training and certifying. CONCLUSION: Jordanian pharmacists are willing to test patients for COVID-19 in community pharmacies, however, they thought they are not ready enough to undergo such tests and needed extra training and better safety precautions.

The prevalence and severity of potential drug-drug interactions among adult polypharmacy patients at outpatient clinics in Jordan.

OBJECTIVE: To assess the prevalence of potential drug-drug interactions (pDDIs) among polypharmacy patients in Jordan using Lexicomp®. Additionally, this study aims to categorize and rate the identified pDDIs according to interaction risk, severity, and reliability. METHODS: A descriptive cross-sectional study was conducted at six different hospitals representing different public health sectors in Jordan (ministry of health, royal medical services, and university-affiliated hospitals). Polypharmacy patients from outpatient clinics (e.g., cardiology,& and internal medicine) were identified, recruited, and interviewed by clinical pharmacists. pDDIs were assessed using the Lexicomp® mobile application and classified according to interaction risk rating, severity, and reliability rating. Furthermore, the prevalence of pDDIs across chronic medical conditions was assessed. P-value <0.05 was considered as significant. RESULTS: A total of 801 patients with polypharmacy were identified. The average number of drugs per patient was 6.6 ± 1.96, with an average of 4.2 ± 3.0 pDDIs per patient. Potential drug-drug interactions were detected in 769 patients (96%), with a total of 3359 interactions. Blood pressure lowering agents were involved in 39.9% of the pDDIs. Cardiovascular system drugs contributed to the largest share of pDDIs (46.6%). While diuretics had the major share of interactions among cardiovascular system drugs (16.2%), drugs used in diabetes had the highest share across all groups (17.1%). The majority of pDDIs were of "C" risk rating with a moderate interaction severity, whilst 1.6% of pDDIs could have been avoided in the first place as the concurrent administration of these agents is contraindicated (i.e., risk rating X). Patients with cardiovascular diseases, diabetes, chronic obstructive pulmonary disease, gout, and chronic kidney disease were associated with the highest number of potential drug-drug interactions. CONCLUSION: Our study showed that 96% of polypharmacy patients at outpatient clinics have at least one pDDI. Almost half of the detected interactions involved cardiovascular medications. The majority of these pDDIs had moderate severity, with no more than 10% of the interactions requiring therapy modification.

The Effect of Long-Term Second-Generation Antipsychotics Use on the Metabolic Syndrome Parameters in Jordanian Population.

Objectives: The aim of this study was to determine the incidence of metabolic syndrome in patients treated with second-generation antipsychotics (SGAs). Methods: In this retrospective study, we reviewed patients' electronic medical records (EMRs) of all patients who received one SGA for at least six months, excluding patients who were taking other medications that are associated with significant effect on metabolic syndrome. Relevant clinical information was collected prior to starting the SGA and after six months of continuous use of the same SGA. Results: A total of 91 patients were included in the study. The majority of patients (72%) were diagnosed with schizophrenia. After six months of taking the SGA, 44% of patients experienced elevated systolic pressure, 54.9% had elevated triglyceride, and 31.9% had impaired glucose levels (p value < 0.05). Prior to initiating SGA therapy, 14.3% of patients had metabolic syndrome, while 37.4% had metabolic syndrome after six months of therapy, and it was more prominent in males compared to female patients (p value < 0.05). Conclusion: This study found a strong correlation between SGA use and the appearance of metabolic alterations, such as weight gain, glucose intolerance, and increased triglyceride levels. These findings highlight the importance of assessing metabolic deregulations to minimize SGA associated metabolic abnormalities.

Investigating the Effect of Demographics, Clinical Characteristics, and Polymorphism of MDR-1, CYP1A2, CYP3A4, and CYP3A5 on Clopidogrel Resistance.

Clopidogrel is an antiplatelet agent that is indicated for cardiovascular emergencies and procedures. The drug, however, is subject to response variability leading to therapy resistance. In this research, we explored the demographic, clinical, and genetic factors associated with clopidogrel resistance. Data analysis among our 280 subjects receiving clopidogrel showed some risk factors that are significantly associated with clopidogrel resistance compared with responders. Those were: female sex (P = 0.021), advanced age (P = 0.011), obesity (P = 0.002), and higher body mass index (P = 0.008) and higher platelets count (P = 0.002). However, known polymorphisms of MDR-1, CYP1A2, CYP3A4, and CYP3A5 were not associated with treatment resistance when compared to responders to clopidogrel therapy. Knowledge about such risk factors might provide recommendation in the future about starting doses or monitoring recommendations.

Perceptions and attitudes towards off-label dispensing for pediatric patients, a study of hospital based pharmacists in Jordan.

BACKGROUND: With growing responsibility of the pharmacists in ensuring public health and safe medicine use, an understanding of the issues surrounding off-label prescribing is crucial to allow pharmacists to make informed decisions about such practice. The aim of this study is to assess the perceptions and attitudes of hospital based pharmacists toward off-label medicine dispensing to children. METHODS: After obtaining the required approvals, a validated questionnaire about off-label dispensing to pediatric patients was administered to 250 randomly selected hospital pharmacists. RESULTS: One hundred and fifty (150) completed questionnaires were returned. Less than half of the respondents (44%, n = 66) admitted to being familiar with the concept of off-label dispensing, claiming to have obtained this knowledge basically through their dispensing experience rather than education. A minority of respondents (36%, n = 54) reported dispensing off-label medicines within their practice knowingly. The majority of respondents had concerns regarding the efficacy (82%, n = 123) and safety (98%, n = 147) of off-label medicines. The most common reasons given by respondents for a dispensed prescription being off label were younger age than recommended (88%, n = 132). Most of respondents (94%, n = 141) claimed to double check the calculations of doses of medicines before dispensing off-label medicines and 60% (n = 90) of them felt that parents and guardians should be told when an off-label medicine has been prescribed for their children. CONCLUSION: The majority of respondents were not familiar with the concept of offlabel medicines. While reporting to have gained their knowledge from their professional experience, only a minority of respondents reported knowingly dispensing off-label medicines for pediatric patients. Respondents indicated that manufacturing more appropriate formulations for pediatric patients would reduce such practices in this population. Having concerns regarding the efficacy and safety of off-label medicines used for pediatric patients, respondents felt that the use of off-label medicines would increase the likelihood of adverse drug reactions (ADRs). Finally, respondents felt that such practice of prescribing and dispensing should receive parental consent.

Standardized patients' preferences for pharmacist interactive communication style: A mixed method approach.

BACKGROUND: Interactive communication approaches may help to shift pharmacy practice toward more patient-centered care. One example of such an approach is the 3 prime questions (3PQs). Patients' preferences for pharmacists' interactive communication styles were not identified in the literature. OBJECTIVE: The purpose of this paper was to explore standardized patient (SP) preferences, satisfaction, and perceptions of pharmacists' communication style and changes in pharmacist to standardized patient talk-time ratio. DESIGN: Mixed methods, before and after evaluation. SETTING: SPs were hired from the University of Alberta's Standardized Patient Program, Canada. PARTICIPANTS: Twelve SPs and 10 pharmacists. INTERVENTION: SPs were video recorded interacting with the same pharmacists before and after pharmacist training on the 3PQs. SPs participated in an open-ended interview using stimulated recall on videos of their pharmacist encounters. MAIN OUTCOME MEASURES: Explore SP preferences, satisfaction, and perceptions of pharmacists' communication style, in addition to changes in pharmacist to standardized patient talk-time ratio before and after the intervention RESULTS: Generally SPs were satisfied with pharmacists' interactive communication style post training. Qualitative themes varied with SPs' preference for an interactive approach (58%, i.e., Conversation with Equals, Double Check, and Manageable Information) or traditional approach (33%, i.e., Expected Information, Shouldn't the Pharmacist Know, and Feels Uncomfortable) and improvements in item scores varied by type of prescription. Pharmacists' use of the 3PQs increased patient talk time for scenarios with new chronic and acute medication, though pharmacists still dominated the conversation. CONCLUSION: Just over half of SPs preferred an interactive communication style, although a third of SPs preferred a communication style that focused on information provision. Patients had more time to talk in some interactive encounters. Pharmacists may need to be aware of patient expectations when using the 3PQs.

Factors that contribute to clopidogrel resistance in cardiovascular disease patients: environmental and genetic approach.

BACKGROUND AND OBJECTIVE: Clopidogrel is a potent antiplatelet drug that reduces the risk of vascular events in patients with cardiovascular disease. However, several studies have shown that about a quarter of patients showed low or no response to clopidogrel therapy. In this study, factors that contribute to clopidogrel resistance were investigated in 270 cardiovascular disease patients from Jordan. PATIENTS AND METHODS: Clopidogrel resistance was determined through platelet aggregation analysis using the Multiplate analyzer®. Genetic factors (CYP2C19*2 and PON1 Q192R) were examined using polymerase chain reaction-restriction fragment length polymorphism analysis. RESULTS: The incidence of clopidogrel resistance among Jordanians is about 32%. Significant association between clopidogrel resistance and female gender, concomitant use of calcium channel blockers, and low HDL was found (p < 0.05). In addition, presence of CYP2C19*2 allele is strongly related to clopidogrel resistance (p < 0.001). However, lack of contribution to clipidogrel resistance was found for PON1 Q192R polymorphism, age, diabetes, hypertension, smoking and aspirin use (p > 0.05). CONCLUSION: Several factors might contribute to clopidogrel resistance including gender, concomitant use of calcium channel blockers, HDL and CYP2C19*2 polymorphism.

Impact of the Novel CoronaviruS (COVID-19) on Frontline PharmacIsts Roles and ServicEs: INSPIRE Worldwide Survey.

BACKGROUND: Pharmacy has been recognized as a vital healthcare profession during the COVID-19 pandemic. The primary objective of the INSPIRE Worldwide survey was to determine the impact of COVID-19 on pharmacy practice and pharmacists' roles around the world. METHODS: A cross-sectional online questionnaire with pharmacists who provided direct patient care during the pandemic. Participants were recruited through social media, with assistance from national and international pharmacy organizations between March 2021-May 2022. The questionnaire was divided into (1) demographics, (2) pharmacists' roles, (3) communication strategies, and (4) practice challenges. The data were analyzed using SPSS 28, and descriptive statistics were used to report frequencies and percentages. RESULTS: A total of 505 pharmacists practicing in 25 countries participated. The most common role that pharmacists undertook was responding to drug information requests (90%), followed by allaying patients' fears and anxieties about COVID-19 (82.6%), and addressing misinformation about COVID-19 treatments and vaccinations (80.4%). The most common challenges were increased stress levels (84.7%), followed by medication shortages (73.8%), general supply shortages (71.8%), and inadequate staffing (69.2%). CONCLUSIONS: Pharmacists within this study were significantly impacted by the COVID-19 pandemic and took on new or adapted roles (e.g., providing COVID-specific information, managing patients' emotions, and educating on public health measures) to meet the needs of their communities. Despite, the significant challenges (e.g., increased stress, supply chain challenges, addressing misinformation, and staffing shortages) faced by pharmacists, they continued to put their patients' needs first and to provide pharmacy services.

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.

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.