Investigation of community pharmacists' knowledge and attitudes of pharmacogenomics testing: implication for improved pharmacogenomic testing practice.

BACKGROUND: Community pharmacists must be well-equipped to advance pharmacogenomics services. Nevertheless, limited data is available regarding pharmacists' knowledge and attitudes toward pharmacogenomics testing. The present study aimed to evaluate community pharmacists' knowledge and attitudes toward pharmacogenomics testing in the UAE. METHODS: In this cross-sectional study, a validated, online, self-administered survey, was randomly distributed to community pharmacists across the United Arab Emirates (UAE). RESULTS: The participants demonstrated poor knowledge about pharmacogenomic testing (median score < 8). Having 10-29 (Adjusted odds ration [AOR]: 0.038; 95% CI: 0.01-0.146, p = 0.001) and 30-49 (AOR: 0.097; 95% CI: 0.04-0.237, p = 0.001) patients per day was associated with poorer knowledge. Also, receiving 10-29 (AOR: 0.046; 95% CI: 0.005-0.401, p = 0.005), 30-49 (AOR: 0.025; 95% CI: 0.003-0.211, p = 0.001), and > 50 (AOR: 0.049; 95% CI: 0.005-0.458, p = 0.008) prescriptions decreased the odds of having good knowledge. Around half (43.9%) of the participants did not show a positive attitude toward pharmacogenomic testing (median score < 11). Having 30-49 patients per day (AOR: 5.351; 95% CI: 2.414-11.860, p = 0.001) increased the odds of good knowledge while receiving 10-29 (AOR: 0.133; 95% CI: 0.056-0.315, p = 0.001) and 30-49 (AOR: 0.111; 95% CI: 0.049-0.252, p = 0.001) prescriptions a day were associated with decreased odds of positive attitude toward the pharmacogenomics testing. CONCLUSIONS: The findings indicate a lack of knowledge and less-than-ideal attitudes among community pharmacists regarding pharmacogenomics testing. Enhanced efforts focused on educational initiatives and training activities related to pharmacogenomics testing is needed. Additionally, reducing workload can facilitate better knowledge acquisition and help mitigate unfavorable attitudes.

Correlation of vitamin D receptor genotypes, specific IgE levels and other variables with asthma control in children.

INTRODUCTION: Asthma is a common condition affecting millions of children globally. The main goal of this study is to assess factors related to asthma management, particularly atopy level and the impact of genetic variants of the vitamin D receptor (VDR) gene. METHODS: Asthmatic children were enrolled in an outpatient respiratory clinic. Information on patients' medication adherence, medical and medication factors, and sociodemographic were gathered. Spirometry FEV1% and FVC% measurements, and the asthma control test were used to evaluate the severity of asthma, and genotyping of the VDR gene and radioallergosorbent test (RAST) were conducted. Regression analyses were conducted to evaluate variables associated with asthma control and spirometry measures. RESULTS: A total of 313 participants (67.4% males) were recruited in the current study. The mean age was 9.37 (±3.45) years. The mean score for adherence was 4.26 (±2.52), and only 46% of the participants had controlled asthma. Forward conditional stepwise binary regression showed that low and moderate Inhaled corticosteroids (ICS) dose (OR= 0.42 (95% CI 0.20-0.90), p = 0.026; OR = 0.371 (95% CI 0.2-0.72), p = 0.003, respectively) decreased the odds of being in the controlled asthma group, while higher inhaler score (OR = 2.75 (95% CI 2.17-3.49, p < 0.001)) increased the odds of being in the controlled asthma group. However, results found no association between VDR genotype and asthma control, spirometry values or hospitalization due to asthma. CONCLUSIONS: The results indicated that many of the asthma patients had poorly controlled asthma. Factors that were associated with poor asthma control included poor inhaler technique.

Prevalence of key potentially inappropriate drugs use in pediatrics: a cross-sectional study.

BACKGROUND: Appropriate drug prescribing in the pediatric population is challenging, given this age group's unique pharmacokinetics. This has inevitably led to a high incidence of adverse drug reactions in this population. To address this issue, the Pediatric Pharmacy Association (PPA) compiled a list of 67 drugs that are inappropriately used in the pediatric population called the Key Potentially Inappropriate Drugs "KIDs list". AIM: To estimate the prevalence of potentially inappropriate medications (PIM) use in pediatric wards based on the KIDs list criteria. METHODS: A retrospective observational study was conducted and included pediatric patients who were admitted to five pediatric wards during 3 years (2019-2021). The drugs in the KIDs list were matched to the hospital formulary and 11 matched drugs were included in the study. For each individual drug, the patient's electronic file was reviewed to determine the prescription appropriateness according to the KIDs list criteria. RESULTS: Among 3,166 pediatric patients admitted to pediatric wards, a total of 415 patients received a PIM listed in the KIDs list. The mean age was 8.6 (± 4.9) years old, and 60.0% (n = 251/415) were males. The overall prevalence of PIM use was 13.0% (n = 415/3166). Among the prescribed PIM, metoclopramide was the most commonly prescribed PIM 42.8% (n = 178/415), followed by tramadol 37.6% (n = 156/415). CONCLUSION: Given the high prevalence of inappropriate medication use in the pediatric wards, future research on strategies and interventions should be recommended to limit the use of PIMs and provide safer alternatives for the pediatric population.

Public perception, satisfaction and expectations from community pharmacy services and the barriers to consult the community pharmacist.

This cross-sectional study aimed to evaluate public perception, satisfaction, expectations, and barriers to utilize the community pharmacy services. A validated self-reported online survey was distributed on 681 individuals in different regions across Jordan. The mean age of the participants was 29 (±10) years. The most reported reason for choosing a particular community pharmacy was its closure to home or workplace (79.1%), while the main reason for visiting a community pharmacy was to obtain over the counter medications (66.2%). The participants showed good perception, satisfaction, and expectations of community pharmacy services. However, several barriers were identified, including higher participants' trust in physicians when compared to pharmacists (63.1%), and lack of privacy in the pharmacy (45.7%). Community pharmacists should participate in successful education and training programs in order to raise the quality of the provided services, meet patient requirements, and re-establish consumer confidence in community pharmacists.

Artificial intelligence utilization in the healthcare setting: perceptions of the public in the UAE.

Understanding the use of AI in healthcare is essential for the successful implementation of AI-driven healthcare solutions. The aim of this study was to evaluate public perception of AI utilization in healthcare settings. A validated questionnaire assessed general perceptions towards AI utilization, the use of AI by physician , and the use of AI by pharmacists . The study included 770 participants. The median perception score indicated an unfavorable attitude. Participants who had lower education level and those with no employment had a significantly lower perception scores than their counterpart. Participants who reported low income and those who visited the pharmacy five to ten times on average had a higher perception than their counterparts did. The reported negative perception necessitates the implementation of education campaigns to improve AI literacy and dispel any misconceptions and concerns, particularly among individuals with low education, high income, unemployment, and frequent pharmacy visits.

Health-related quality of life and its associated factors among outpatients with heart failure: a cross-sectional study.

BACKGROUND: Heart Failure (HF) is a chronic disease associated with life-limiting symptoms that could negatively impact patients' health-related quality of life (HRQOL). This study aimed to evaluate HRQOL and explore the factors associated with poor HRQOL among patients with HF in Jordan. METHODS: This cross-sectional study used the validated Arabic version of the Minnesota Living with Heart Failure Questionnaire to assess HRQOL in outpatients with HF visiting cardiology clinics at two public hospitals in Jordan. Variables were collected from medical records and custom-designed questionnaires, including socio-demographics, biomedical variables, and disease and medication characteristics. Ordinal regression analysis was used to explore variables associated with poor HRQOL among HF patients. RESULTS: Ordinal regression analysis showed that the number of HF medications (P < 0.05) and not taking a loop diuretic (P < 0.05) significantly increased HRQOL, while the number of other chronic diseases (P < 0.05), stage III/IV of HF (P < 0.01), low monthly income (P < 0.05), and being unsatisfied with the prescribed medications (P < 0.05) significantly decreased HRQOL of HF patients. CONCLUSIONS: Although the current study demonstrated low HRQOL among patients with HF in Jordan, HRQOL has a considerable opportunity for improvement in those patients. Variables identified in the present study, including low monthly income, higher New York Heart Association (NYHA) classes, a higher number of comorbidities, and/or taking a loop diuretic, should be considered in future intervention programs, aiming to improve HRQOL in patients with HF.

Variables associated with asthma control among adult patients.

Objective: Asthma is one of the most prevalent chronic diseases with a substantial impact on the health status of affected patients. Further research is necessary to identify factors contributing to poor asthma control. The current study aimed to investigate the factors associated with poor asthma control among adult asthmatic patients.Methods: In this case-control study, the Asthma Control Test (ACT) was translated into Arabic and distributed to adults with asthma attending two hospitals in Jordan to evaluate the degree of asthma control. The following variables were collected for each patient: sociodemographic information, comorbidities, appropriate use of inhaler technique, spirometric measurements, and medications use. Binary regression was used to evaluate factors associated with asthma control.Results: A total of 314 participants with a mean age of 51.47 years (±16.37) completed the study. ACT score had a mean of 16.68 (±4.86). The majority of asthmatic patients had insufficiently controlled asthma (64.6%). Binary regression results showed that previous respiratory infection history (p = 0.014, OR = 0.473 (95%CI 0.261-0.857)), higher exposure to irritants (p = 0.010, OR = 0.747 (95%CI 0.598-0.933)) decreased the odds of being in the controlled asthma group. Patients receiving inhaled corticosteroids (ICS) had higher odds of being in the controlled asthma group (p = 0.039, OR = 2.372 (95%CI 1.043-5.392)).Conclusions: The majority of asthma patients had insufficiently managed disease. The main factors that contributed to poor asthma control were respiratory infection history, increased exposure to asthma symptoms triggers, and ICS nonuse.

The rate of ward to intensive care transfer and its predictors among hospitalized COPD patients, a retrospective study in a local tertiary center in Saudi Arabia.

OBJECTIVE: To investigate the prevalence of intensive care unit (ICU) admission and its predictors among hospitalized chronic obstructive pulmonary disease (COPD) patients. METHODS: An observational retrospective study was conducted. All patients with a confirmed diagnosis of COPD according to the GOLD guidelines between 28 and 2020 and 1 March 2023 at Al-Noor Specialist Hospital were included in this study. Patients were excluded if a preemptive diagnosis of COPD was made clinically without spirometry evidence of fixed airflow limitation. Descriptive results were presented as frequency (percentage) for categorical variables and mean (SD) for continuous variables and to estimate prevalence of ICU admission. Predictors of ICU admission among hospitalized COPD patients were determined using logistic regression analysis. A SPSS (Statistical Package for the Social Sciences) version 25 was used to perform all statistical analysis. RESULTS: A total of 705 patients with COPD were included in this study. The mean age was 65.4 (25.3) years. Around 12.4% of the hospitalized patients were admitted to the ICD. Logistic regression analysis identified that older age (OR; 1.92, (1.41-2.62)), smoking (OR; 1.60 (1.17-2.19)), and having specific comorbidities (Hypertension (OR; 1.98 (1.45-2.71)), Diabetes mellitus (OR; 1.42 (1.04-1.93)), GERD (OR; 2.81 (1.99-3.96)), Ischemic heart disease (OR; 3.22 (2.19-4.75)), Obstructive sleep apnea syndrome (OR; 2.14 (1.38-3.33)), stroke (OR; 4.51 (2.20-9.26))) were predictors of ICU admissions among patients with COPD. CONCLUSIONS: Our study found that a step-up approach to inpatient COPD management requires admission to the ICU in 12.4%, for which age, smoking status, cardiovascular, and stroke were important predictors. Further clinical research is needed to provide a validated model that can be incorporated into clinical practice to monitor this patient population during their admission and identify at-risk individuals for early transfer to higher acuity settings and intensive care units.

Exploring knowledge, attitudes, and practices towards artificial intelligence among health professions' students in Jordan.

INTRODUCTION: The integration of Artificial Intelligence (AI) in medical education and practice is a significant development. This study examined the Knowledge, Attitudes, and Practices (KAP) of health professions' students in Jordan concerning AI, providing insights into their preparedness and perceptions. METHODS: An online questionnaire was distributed to 483 Jordanian health professions' students via social media. Demographic data, AI-related KAP, and barriers were collected. Quantile regression models analyzed associations between variables and KAP scores. RESULTS: Moderate AI knowledge was observed among participants, with specific understanding of data requirements and barriers. Attitudes varied, combining skepticism about AI replacing human teachers with recognition of its value. While AI tools were used for specific tasks, broader integration in medical education and practice was limited. Barriers included lack of knowledge, access, time constraints, and curriculum gaps. CONCLUSIONS: This study highlights the need to enhance medical education with AI topics and address barriers. Students need to be better prepared for AI integration, in order to enable medical education to harness AI's potential for improved patient care and training.

Colorectal cancer screening among the public: knowledge, attitudes, and the perceived barriers.

Colorectal cancer (CRC)1 screening tests help in early detection of CRC and improve disease prognosis. This study aimed to assess knowledge, attitude, and barriers to CRC screening and the associated factors among the general population in Jordan. A validated self-administered online survey was distributed on 1542 individuals in Jordan. The participants (n = 1542) reported several barriers and demonstrated insufficient knowledge but positive attitude towards CRC screening. Older age (OR = 1.021, 95% CI = 1.010-1.032, P < 0.001), working in medical field (OR = 3.198, 95% CI = 2.499-4.092, P < 0.001), family history of cancer (OR = 1.248, 95% CI = 1.002-1.555, P < 0.05), and knowing someone with CRC (OR = 1.601, 95% CI = 1.186-2.161, P < 0.01) were significantly associated with higher knowledge. Personal history of CRC (OR = 3.157, 95% CI = 1.188-8.387, P < 0.05), and high knowledge of CRC (OR = 2.795, 95% CI = 2.242-3.484, P < 0.001) were significantly associated with the positive attitude. Future healthcare programs should devise effective techniques to improve public understanding and perception of CRC screening and overcome the identified barriers.

Public knowledge and attitude towards drug-food interactions: implications for improved public health safety.

Drug-Food Interaction (DFI) can potentially lead to treatment ineffectiveness and adverse health outcomes. This study investigated knowledge and attitude towards DFI and the associated factors. A validated questionnaire was distributed to 2040 participants across Jordan. The participants had moderate knowledge and attitudes regarding DFIs. Regression results revealed that male gender, lower education level, not working in the healthcare sector, and utilizing non-scientific sources of information about DFIs were associated with lower knowledge about DFI. Furthermore, male gender, being unmarried, having a low or moderate education level, not working in the healthcare sector, not having a family member with chronic disease, and having low knowledge of DFI were significantly associated with negative attitudes towards DFIs. Future health education programs should emphasize using reliable scientific sources to enhance awareness about DFIs'. Additionally, healthcare professionals should counsel patients on avoiding DFIs and provide guidance accordingly.

Information sources, attitudes, and practices of Self-Medication by Jordanian patients: A cross-sectional study.

Background and Objective: Self-medication (SM) has significantly increased worldwide in the past decades, which may have detrimental health consequences including antimicrobial resistance, adverse drug reactions, drug-drug interaction, and dependency. Although several studies have evaluated the extent of SM, such studies are still limited in Jordan. The aim of this study was to explore sources of SM information, attitudes toward SM and the practice of SM and its associated factors. Methods: The data of this cross-sectional study was collected between February and July 2022. A validated questionnaire was distributed to patients attending pharmacies from different locations in Jordan. The survey evaluated sources of information and attitudes toward SM, extent of SM practice, and attitudes towards SM, symptoms that the participants treat with SM and those that usually requires medical doctor consolation, followed by questions about the classes of medications mostly used for SM and the reasons for SM. Results and Discussion: The study enrolled 695 Jordanian adults. The most reported indications for SM included headache (86.9 %), flu (76.4 %), and fever (69.6 %). The most common causes for SM included previous knowledge about the diseases and its treatments (84.2 %), and full knowledge of the medicine to be purchased (55.2 %). Results of the ordinal regression showed that physician counseling frequency was positively and significantly associated with "not being on chronic medication" (p-value = 0.001), and having a positive SM attitude level (p-value = 0.019), while negatively correlated with being in medical field (p-value < 0.001), having no children (p-value = 0.009), and relaying on non-scientific sources to obtain information for SM (p-value = 0.014). The frequency of SM practice was positively associated with being in medical field (p-value < 0.001, having no insurance (p-value < 0.001), and relaying on nonscientific sources (p-value = 0.017). Lastly, having a positive SM attitude level (p-value < 0.001) and not being on chronic medications (p-value = 0.007) were associated with decreased SM practice. Conclusion: The study participants demonstrated increased SM practice due to the wrong perceptions toward SM and the reliance on non-scientific source of information about SM practice.

Anticholinergic burden risk and prevalence of medications carrying anticholinergic properties in elderly cancer patients in Jordan.

Background: Geriatric cancer patients are susceptible to adverse drug events due to the complexity of their chemotherapy regimens and collateral treatments for their comorbid conditions. Prescribing medications with anticholinergic burden characteristics can complicate their condition, leading to negative impacts on their health outcomes and quality of life, including an increase in adverse drug event frequency, physical and cognitive impairments. Objective: This study aims to examine the prevalence of anticholinergic prescribing and identify the cumulative anticholinergic load risk associated with drugs prescribed to elderly cancer patients. Also, to identify the predictors that might lead to raised anticholinergic burden in these patients. Methodology: This retrospective cross-sectional study included elderly patients (age ≥ 65) diagnosed with cancer and admitted to the adult oncology unit at King Abdullah University Hospital (KAUH) in Jordan during the period between (January 1st, 2019, and January 1st, 2022). The medication charts of 420 patients were evaluated for study outcomes. Results: Of the total subjects, females represented 49.3%, and the average age was 72.95 (SD = 7.33). A total of 354 (84.3%) patients were prescribed at least one drug carrying anticholinergic burden properties. Median for anticholinergic medications was 3 (IQR = 4). Our study found that 194 (46.2%) patients were at a high risk of adverse events associated with anticholinergic load (cumulative score ≥ 3). Metoclopramide, furosemide, and tramadol were the most frequently prescribed drugs with anticholinergic properties. Alimentary tract drugs with anticholinergic action were the most commonly encountered items in our study population. Conclusion: Our study revealed a significantly high prevalence of anticholinergic prescribing among elderly cancer patients. Nearly half of the patients were at high risk of developing serious effects related to anticholinergic activity from the drugs administered. Polypharmacy was strongly associated with increased anticholinergic burden score. Evidence-based recommendations utilizing prescribing strategies for safer alternatives and deprescribing of inappropriate medications could reduce such inappropriate prescribing.

Adverse-drug reaction reporting by Pharm D students during hospital training.

Background: Hospital pharmacists can play an important role in the detection, prevention, and reporting of adverse drug reaction (ADR) since they interact with patients in hospital settings. The ADR reporting practice by Pharm D students, who represent the future hospital pharmacists, has not been adequately investigated in the literature. Objective: To evaluate Pharm D students' knowledge, attitude, and practice regarding ADR reporting, and the associated barriers and motivators to ADR reporting during clinical training at different hospital sites in Jordan. Methods: The present cross-sectional study was conducted on sixth year pharm D students during clinical training at different hospital departments in different hospital sites Jordan. In addition to socio-demographic variables, a structured self-reported questionnaire was used to assess students' knowledge, attitude, practice, barriers, and motivators towards ADR reporting. Binary logistic regression was used to explore the variables associated with the study outcomes. Results: A total of 497 students participated in the study. The participants showed inadequate knowledge regarding ADR reporting, with a mean knowledge score of 3.20 (±1.78). On the other hand, the study participants showed positive attitude towards ADR reporting with a total mean score of 13.6 (±1.96). However, the ADR reporting practice was low with a mean score of 5.78 (±1.88). Not knowing how to report (60.2%) and not knowing where to report (55.9%) were the most common barriers to ADR reporting, while the most reported motivators for ADR reporting were seriousness of reaction (84.1%) and involvement of new drug (51.1%). Logistic regression analysis showed that time from the start of training (OR = 0.510; 95%CI = 0.305-0.852; P = 0.010), female gender (OR = 1.759; 95%CI = 1.083-2.857; P = 0.022), and attending a course/workshop about pharmacovigilance (OR = 0.213; 95%CI = 0.137-0.332; P = 0.00) were significant predictors of knowledge about ADR reporting. Increased age (OR = 0.93; 95%CI = 0.880-0.997; P = 0.041) and low knowledge (OR = 0.564; 95%CI = 0.380-0.837; P = 0.004) were significantly associated with negative attitude toward ADR reporting. Female gender (OR = 0.481; 95%CI = 0.302-0.766; P = 0.002) and attitude level (OR = 1.837; 95%CI = 1.205-2.802; P = 0.005) were significant predictors of ADR reporting practice. Conclusions: Pharm D students showed positive attitude towards ADR reporting, however, the knowledge and practice of ADR reporting were inadequate and the participants reported several barriers. Therefore, the topic of ADR reporting and pharmacovigilance, as well as, educational training programs need to be included in future pharmacy curriculum in order to improve students' awareness and practice of ADR reporting.

Artificial intelligence in pharmacy practice: Attitude and willingness of the community pharmacists and the barriers for its implementation.

Background: Artificial intelligence (AI) is the capacity of machines to perform tasks that ordinarily require human intelligence. AI can be utilized in various pharmaceutical applications with less time and cost. Objectives: To evaluate community pharmacists' willingness and attitudes towards the adoption of AI technology at pharmacy settings, and the barriers that hinder AI implementation. Methods: This cross-sectional study was conducted among community pharmacists in Jordan using an online-based questionnaire. In addition to socio-demographics, the survey assessed pharmacists' willingness, attitudes, and barriers to AI adoption in pharmacy. Binary logistic regression was conducted to find the variables that are independently associated with willingness and attitude towards AI implementation. Results: The present study enrolled 401 pharmacist participants. The median age was 30 (29-33) years. Most of the pharmacists were females (66.6%), had bachelor's degree of pharmacy (56.1%), had low-income (54.6%), and had one to five years of experience (35.9%). The pharmacists showed good willingness and attitude towards AI implementation at pharmacy (n = 401). The most common barriers to AI were lack of AI-related software and hardware (79.2%), the need for human supervision (76.4%), and the high running cost of AI (74.6%). Longer weekly working hours (attitude: OR = 1.072, 95% C.I (1.040-1.104), P < 0.001, willingness: OR = 1.069, 95% Cl. 1.039-1.009, P-value = 0.011), and higher knowledge of AI applications (attitude: OR = 1.697, 95%Cl (1.327-2.170), willingness: OR = 1.790, 95%Cl. (1.396-2.297), P-value < 0.001 for both) were significantly associated with better willingness and attitude towards AI, whereas greater years of experience (OR = 20.859, 95% Cl (5.241-83.017), P-value < 0.001) were associated with higher willingness. In contrast, pharmacists with high income (OR = 0.382, 95% Cl. (0.183-0.795), P-value = 0.010), and those with<10 visitors (OR = 0.172, 95% Cl. (0.035-0.838), P-value = 0.029) or 31-50 visitors daily (OR = 0.392, 95% Cl. (0.162-0.944), P-value = 0.037) had less willingness to adopt AI. Conclusions: Despite the pharmacists' positive willingness and attitudes toward AI, several barriers were identified, highlighting the importance of providing educational and training programs to improve pharmacists' knowledge of AI, as well as ensuring adequate funding support to overcome the issue of AI high operating costs.

Assessing the validity and reliability of the Arabic versions of Mini Asthma Quality of life questionnaire and Asthma Control Test in adult patients with asthma: A factor analysis study.

Background and objective: Asthma is a common disease that has a significant influence on patients' quality of life. Although Arabic tools for assessing symptom control and quality of life in individuals with asthma are available, no sufficient studies have evaluated the validity of these tools. Therefore, the aim of the current study was to validate the Arabic version of these tools. Methods: Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were conducted on the Arabic versions of the Asthma Control Test (ACT) and Mini Asthma Quality of Life Questionnaire (Mini AQLQ). Results: A total of 314 participants (70.1 % females) were enrolled in the current study. The mean age of the participants was 51.47 (±16.37). EFA suggested a three-factor model for Mini AQLQ and a one-factor model for ACT, which was confirmed by CFA analyses. High correlations were found between spirometric values and ACT and Mini AQLQ scores, indicating good concurrent validity. The area under the curve produced by the Roc curve was 0.861 (p < 0.001), and the most suitable cut-off point was 4.741. Conclusion: All analyses conducted showed that the Arabic versions of both Mini AQLQ and ACT are reliable and valid and can be administered to adults with asthma. The application of these validated instruments will improve the management and diagnosis of asthma in Arab countries.

Patterns of drug-related problems and the services provided to optimize drug therapy in the community pharmacy setting.

Introduction: Drug-related problems (DRPs) are events or circumstances involving drug therapy that actually or potentially interferes with desired health outcomes. Objectives: To assess community pharmacists' knowledge and practice regarding DRP-reduction services, as well as the barriers and factors associated with decreased provision of these services. Methods: This cross-sectional study utilized a validated questionnaire to assess pharmacists' knowledge, practice, and barriers to the provision of DRP-reduction services in the community pharmacy setting. Binary regression model was used to assess the variables associated with the practice of DRP-reduction services. Results: A total of 412 pharmacists participated in the study. The pharmacists demonstrated strong knowledge but inadequate practice of DRP-reduction services. The most reported DRPs were inappropriate combination of drugs, or drugs and herbal medications, or drugs and dietary supplements (52.4%), patients' inability to understand instructions properly (46.1%), inappropriate drug according to guidelines (43.7%), and too high dose (40.3%). The most common barriers to these services were increased workload (60.5%), limited time (53.2%), and lack of good communication skills (49.8%). The presence of a counselling area in the pharmacy increased the practice of DRP-reduction services (OR: 3.532, 95%Cl: 2.010-5.590, P < 0.001), while increased weekly working hours (OR: 0.966, 95%Cl: 0.947-0.986), P < 0.01) and serving < 10 patients daily (OR = 0.208, 95%Cl: 0.072-0.601, P < 0.01) decreased it. Conclusions: Community pharmacists' practice of DRP-reduction services showed a scope for improvement. Future pharmaceutical care initiatives should increase the number of personnel working in the pharmacy and provide them with opportunities for continued education and training in order to improve the provision of DRP services and optimize patients' outcomes.

Patients' Knowledge and Information Needs about Isotretinoin Therapy Use in Jordan.

Background: Despite being the first-line treatment for severe or moderate acne, isotretinoin has several serious side effects that necessitate the evaluation of patients' knowledge about isotretinoin side effects and its proper use. Objective: The current study aim was to explore information needs about isotretinoin by evaluating patients' knowledge about the appropriate use of isotretinoin and its associated side effects. Methods: In addition to the sociodemographic variables, a validated online questionnaire was adopted from the literature to evaluate patients' knowledge about isotretinoin use and its potential side effects. Independent t-test and one-way analysis of variance (ANOVA) test were implemented to find the correlation between the study variables and the knowledge score. Results: The most recognized side effect of isotretinoin therapy was dryness (98.1%). The study patients showed good knowledge about isotretinoin use with a mean knowledge score of 8.1 (SD = 0.7). However, more than half of them (61.0%) mistakenly thought that isotretinoin therapy should be taken continuously for more than 6 months without stop, and some of them did not know that isotretinoin is recommended to be taken with fatty meal (24%) and sunblock (24.6%). Female gender (8.2 (SD = 0.8)) and using isotretinoin for more than 6 months (8.3 (SD = 1.2)) were significantly associated with a higher knowledge score of isotretinoin use (p=0.01), when compared with male patients (7.8 (SD = 0.7)) and less than 6-month use of isotretinoin (7.7 (SD = 0.7)). Conclusions: The lack of patients' information about the potential side effects, duration of therapy, and some instructions on isotretinoin use, such as taking the medication with fatty meal and sunblock, shed the light on the necessity to prepare leaflets, educational brochures, and educational posts via social media in order to improve patients' knowledge about isotretinoin therapy and its optimal use.

Pharmacists' knowledge and attitudes toward medication therapy management service and the associated challenges and barriers for its implementation.

Background: The literature demonstrated a positive impact of medication therapy management (MTM) services provided by the pharmacists to improve the overall health outcomes. Nevertheless, limited data is available with regard to MTM service implementation by community pharmacists and its associated factors in Jordan. Objective: To evaluate community pharmacists' knowledge, attitude and practice of MTM service and to explore the challenges and barriers for its implementation. Methods: The present cross-sectional study utilized a validated online survey which was filled by community pharmacists in different areas across Jordan. In addition to the socio-demographic variables, the study questionnaire evaluated pharmacists' knowledge and attitudes towards MTM service, extent of MTM implementation and its associated challenges and barriers. Results: A total of 250 pharmacists completed the survey. The study pharmacists showed moderate knowledge level (median of the total knowledge score = 6 (4-7) out of 10) and positive attitude (median of the attitude score was 23 (19-26) out of 30) towards MTM services. The participating pharmacists recognized performing or obtaining necessary assessments of patient's health status as the most frequently provided MTM service (84.8%), while the least one was documenting the care delivered and communicating essential information to other healthcare providers (62%). Furthermore, collecting patient-related information was the most commonly recognized challenge to MTM service provision (36.8%), followed by referring the patient to a physician or consultant (36%) and collaboration with them (35.6%). The most reported barrier was negative physician attitudes (40.4%), followed by the lack of training on MTM provision (38.4%), and lack of adequate support staff (37.2%). Conclusion: Efforts are needed to enhance collaboration between pharmacists and other health care professional, to develop documentation systems that would preserve and facilitate access to patient information, and to implement appropriate training programs which aim to overcome the challenges and barriers for MTM implementation.

Predictors of poor health-related quality of life among hemodialysis patients with anemia in Jordan.

OBJECTIVE: This study examined health-related quality of life (HRQoL) and factors associated with poor HRQoL among hemodialysis (HD) patients. METHODS: A multicenter cross-sectional study was conducted on HD patients with anemia in Jordan (n = 168). Validated questionnaires were utilized to collect data on HRQoL using EQ-5D-5L, psychiatric symptoms using Hospital Anxiety and Depression Scale (HADS), and comorbidities score using the modified Charlson Comorbidity Index (mCCI). Multiple linear regression analysis was conducted to identify the variables which are independently associated with HRQoL among patients. RESULTS: The mean (± SD) age of study participants was 52.2 (± 14.6) years. The mean utility value of EQ-5D-5L was 0.44 (± 0.42). Participants reported extreme problems mostly in pain/discomfort domain (19.6%). Increased age, increased mCCI and patient complains, more years under dialysis, decreased exercise, and low family income were significantly associated with poor HRQoL (p < 0.05). CONCLUSION: The study findings revealed poor HRQoL among HD patients with anemia. Various dimensions of health were negatively affected among HD patients. Development and implementation of appropriate approaches with adequate education and psychosocial support to HD patients by healthcare professionals targeting improved HRQoL and clinical outcomes would be necessary.