Awareness and prevalence of metabolic syndrome among high-risk individuals attending internal medicine clinics across Jordan

Purpose: To examine the prevalence and awareness of metabolic syndrome (MetS) in high-risk individuals attending 30 internal medicine clinics in Amman, Jordan, and also to evaluate the various factors associated with increased risk of MetS among them.Methods: This retrospective cross-sectional study was carried out across Amman, Jordan from October to December 2014. During the study period, 900 high-risk individuals (with hypertension, diabetes, central obesity and/or dyslipidemia) were recruited from thirty internal medicine clinics in Amman, Jordan. Data collection forms were filled based on patient interview and medical case file.Results: The prevalence of MetS among high-risk individuals was around 40 % (361/900), with around 79 % (284/361) of MetS patients unaware of their condition. Older age, lower income and family history of premature cardiovascular diseases were associated with a higher prevalence of MetS.Conclusion: Although MetS was found to be highly prevalent among high-risk individuals in this study, the awareness of the condition in this group is very poor. These findings support the need for educational programs that involve both health care providers and patients. These programs should especially target those at risk of MetS, in order to improve awareness of the concept of MetS.Keywords: Prevalence, Metabolic syndrome, Jordan, Awareness, Risk factor

A Cross-Sectional Study on Knowledge and Perceptions of Pharmacovigilance among Pharmacy Students of Selected Tertiary Institutions in Jordan

Purpose: To assess the perceptions and knowledge of pharmacovigilance and adverse drug reactions (ADRs) reporting among Bachelor of Pharmacy (BPharm) and Doctor of Pharmacy (PharmD) students of selected tertiary institutions in Jordan.Methods: A cross-sectional study involving 434 pharmacy students from three different Jordanian universities was conducted from March - April 2014. During the study period, a validated structured questionnaire was administered to the participants to assess their knowledge and perceptions regarding pharmacovigilance and ADRs reporting process.Results: Majority of the students had insufficient awareness and lack of knowledge ofpharmacovigilance and ADRs reporting with a mean knowledge score of 4/10. PharmD students had better knowledge about pharmacovigilance and ADRs reporting system than the BPharm students (knowledge score of 5.4 versus 3.2, respectively; p < 0.001). Also, higher knowledge scores were recorded for public university and fifth-year students (p < 0.001). About two-thirds of the students expressed a positive attitude toward pharmacovigilance and ADRs issues and agreed that they would be willing to report ADRs during their clerkship programme.Conclusion: BPharm and PharmD students have insufficient knowledge of the concept ofpharmacovigilance and ADRs reporting. There is a need to incorporate pharmacovigilance into pharmacy curriculum in order to increase its awareness among pharmacy students as this will positively impact on their practice and enhance public health.Keywords: Pharmacovigilance, Adverse drug reactions reporting, Pharmacy students, Knowledge, Perception, Awareness, Attitud

Inappropriate prescribing of proton pump inhibitors among patients in two Jordanian tertiary health facilities

Purpose: To evaluate the current prescription pattern and appropriateness of proton pump inhibitors (PPIs) in two of the largest tertiary hospitals in Jordan, and also to determine their utilization rate among the admitted patients.Methods: A retrospective cross-sectional study was conducted over 10 months (February-November 2013) at two Jordanian tertiary hospitals. A total of 193 patients, both in intensive care unit (ICU) and non-ICU, who were receiving PPIs prescriptions as part of their drug regimen during their hospitalization, were recruited. Patients were accessed from different hospitals’ wards (non-ICU and ICU) using a convenient sampling technique. The appropriateness of PPIs and the rationale for their prescription as a treatment or prevention therapy were evaluated according to the recent treatment guidelines.Results: The results showed that PPIs were being overused; only 53 patients (27.5 %) were prescribed PPIs for a correct indication, while the remaining 140 patients (72.5 %) were receiving PPIs without any documented valid indication. By comparing the patients according to their site of care, 52.4 % (43/82) of ICU patients compared to 87.4 % (97/111) of medically hospitalized patient (non-ICU) were inappropriately receiving PPIs (p = 0.000).Conclusion: Adherence to the current practice guidelines for safe prescription of PPIs is poor. Thus, updating physicians on the practice guidelines, participation of a clinical pharmacist in making therapeutic decisions and modifying hospital formularies are measures that would be helpful and thus contribute to improved healthcare in Jordan.Keywords: NSAID-induced ulcer, Overuse of medications, Proton pump inhibitor, Stress ulcer, Intensive care uni

Parental views of antibiotic use in children with upper respiratory tract infections in Jordan

Purpose: To assess the knowledge, attitudes and practices of parents towards antibiotics use for upper respiratory tract infections (URTIs) in Jordan.Methods: A cross-sectional study was carried out at 10 private outpatients’ pediatric clinics across Amman-Jordan from September to December 2013. During the study period, 1329 parents of young children who fulfilled the inclusion criteria and agreed to participate were interviewed, and completed a validated structured questionnaire.Results: A large proportion of parents (903, 68 %) believed that weather change was the main cause of acute URTIs in their children. Although 1098 (82.8 %) of parents were aware that the recurrent use of antibiotics leads to a decrease in effectiveness due to bacterial resistance, 859 (64.6 %) of the respondents reported that they would give antibiotics without prescription. Fathers (135, 40.2 %), were significantly more aware that URTIs follow its natural course without antibiotic administration compared to mothers (N = 327, 32.9 %), respectively (p = 0.005).Conclusion: There is a lack of adequate parental knowledge concerning the use and misuse of antibiotics in children in Jordan. National publicity campaign should be mounted to improve awareness. Furthermore, existing laws should be enforced to prevent parents from purchasing antibiotics over-thecounter (OTC).Keywords: Antibiotics, Attitude, Knowledge, Parents, Upper respiratory tract infections, Publicity campaig

Diagnosis and treatment of stroke associated pneumonia: qualitative exploration of clinicians' practice

Background: Establishing and implementing a gold standard criteria for diagnosing and treating stroke-associated pneumonia (SAP) would have a significant positive impact on stroke outcomes and antibiotic stewardship. This study aimed to qualitatively explore current diagnostic and treatment practice for SAP among clinicians. Methods: A qualitative study was employed to conduct semi-structured interviews at the tertiary-care Jordan University Hospital. A purposive sampling technique was employed to recruit the participants, including respiratory consultants (n=3) and residents (n=9) practicing in the internal medicine wards and intensive care unit, where stroke patients are treated. The interviews were audio-recorded, transcribed verbatim, translated, and analyzed thematically using framework analysis. Results: Clinicians expressed their experiences, which were organized into two themes and eight emerged sub-themes: Terminology and diagnostic approach of SAP involved; no definite terminology, reliance on both clinical evidence and X-ray findings to decide, reliance on clinical evidence alone to suspect SAP and initiate empirical therapy, and SAP overdiagnosis. The treatment strategies include early treatment of SAP, treating SAP the same as CAP/HAP, predominant anaerobes coverage, and SAP overtreatment. Conclusion: Our findings show a wide range of physician-based diagnostic and treatment approaches for SAP, with clinical criteria serving as the main driver for antibiotic initiation. Standard validated algorithmic-based criteria need to be established and implemented

Evaluation of knowledge, experiences, and fear toward prescribing and dispensing corticosteroids among Egyptian healthcare professionals: A cross-sectional study

Background: Corticosteroids (CS) are essential drugs in the treatment of several medical conditions. Assuming different roles, physicians and pharmacists play a primary role in prescribing and dispensing these medications to optimize patients' clinical management. The data on assessing knowledge and experience of healthcare professionals toward CS is scarce. Therefore, this study aimed to assess and compare knowledge, experience, and fears towards CS among Egyptian physicians and pharmacists. Methods: A cross-sectional, self-administrated, validated online questionnaire was used to collect the data from Egyptian healthcare professionals. The questionnaire consisted of four sections with multiple choice questions: sociodemographic (7 questions), knowledge about CS (13 questions), experience with CS prescription/dispensing (5 questions), and fears and preferences toward CS prescription/dispensing (13 questions). Descriptive and inferential statistics were used to analyze the data. Results: A total of 600 responses were analyzed in this study. The study sample was almost two-half of healthcare providers: 303 (50.5%) pharmacists and 297 (49.5%) physicians. Pharmacists had marginally higher knowledge scores as compared to those recorded for physicians (11.29 versus 10.16, respectively; P = 0.047). Physicians had more experience choosing corticosteroids in treatment plans based on their experience (51.8% vs 38.5%) and guideline recommendations (72.8% vs 50.9%) than pharmacists. However, pharmacists had more experience dealing with corticosteroid use based on patients' preferences (19.5% vs 4.9%) and showed a broader scope of experiencing side effects of corticosteroids with their patients. The two professions demonstrated high levels of fear, with pharmacists acknowledging significantly lower concerns about CS than physicians (3.72 versus 4.0, respectively; P = 0.003). Conclusion: Discrepancies exist among healthcare professionals in knowledge and experience, favoring better scientific knowledge of pharmacists related to corticosteroids. Based on these findings, the interprofessional collaborative efforts would provide comprehensive, patient-centered care that maximizes the benefits of CS while minimizing their risks

Pharmaceutical Care in Children: Self-reported knowledge, attitudes and competency of final-year pharmacy students in Jordan

Objectives: Pharmacists require a baseline level of knowledge in paediatric pharmaceutical care in order to be able to adequately care for paediatric patients and counsel their families. This study aimed to explore the self-reported knowledge, attitudes and competency of final-year pharmacy students in Jordan regarding paediatric pharmaceutical care. Methods: This study took place in Jordan between November 2016 and May 2017. A 28-item questionnaire was designed and administered to 400 students from all pharmacy programmes in Jordan during their final year of training. Results: A total of 354 students agreed to take part in the study (response rate: 88.5%). Most respondents (95.2%) were aware of the term ‘paediatrics’. However, almost one-third of the respondents (30.5%) reported never having taken paediatric dose calculation courses and more than half (55.6%) were unfamiliar with the term ‘off-label medicines’. Moreover, most respondents (65.1%) had low knowledge scores (≤2 out of 5) when presented with realistic paediatric case scenarios. There were no significant differences in knowledge and attitudes between undergraduate and doctoral students or between those from public or private universities (P >0.05). Conclusion: The findings of this study highlight an alarming deficiency in paediatric pharmaceutical knowledge among final-year pharmacy students in Jordan. As such, paediatric-related content should be emphasised in the pharmacy curricula of Jordanian universities so that pharmacy students receive more formalised education and more extensive training in this area. Keywords: Pharmaceutical Care; Pediatrics; Pharmacy Students; Knowledge; Attitudes; Competency-Based Education; Jordan

Assessing the predictive value of neutrophil percentage to albumin ratio for ICU admission in ischemic stroke patients

BackgroundAcute ischemic stroke (AIS) remains a substantial global health challenge, contributing to increased morbidity, disability, and mortality. This study aimed at investigating the predictive value of the neutrophil percentage to albumin ratio (NPAR) in determining intensive care unit (ICU) admission among AIS patients.MethodsA retrospective observational study was conducted, involving AIS cases admitted to a tertiary hospital in Jordan between 2015 and 2020. Lab data were collected upon admission, and the primary outcome was ICU admission during hospitalization. Descriptive and inferential analyses were performed using SPSS version 29.ResultsIn this study involving 364 AIS patients, a subset of 77 (21.2%) required admission to the ICU during their hospital stay, most frequently within the first week of admission. Univariable analysis revealed significantly higher NPAR levels in ICU-admitted ischemic stroke patients compared to those who were not admitted (23.3 vs. 15.7, p < 0.001), and multivariable regression models confirmed that higher NPAR (≥19.107) independently predicted ICU admission in ischemic stroke patients (adjusted odds ratio [aOR] = 4.85, 95% CI: 1.83–12.83). Additionally, lower GCS scores and higher neutrophil-to-lymphocyte ratio (NLR) were also associated with increased likelihood of ICU admission. In terms of predictive performance, NPAR showed the highest accuracy with an AUC of 0.885, sensitivity of 0.805, and specificity of 0.854, using a cutoff value of 19.107. NPAR exhibits an AUC of 0.058, significantly outperforming NLR (Z = 2.782, p = 0.005).ConclusionNPAR emerged as a robust independent predictor of ICU admission in ischemic stroke patients, surpassing the predictive performance of the NLR

Pregabalin Dispensing Patterns in Amman-Jordan: an Observational Study from Community Pharmacies

Objectives Pregabalin is currently approved for the treatment of epilepsy, generalized anxiety disorder, neuropathic pain and fibromyalgia. Rising attention to the abuse liability of pregabalin causing addictive behaviors is partially based on case reports and published literature of pregabalin used in dosages that override the approved therapeutic range. This study was conducted to provide background data regarding the abuse/misuse of pregabalin from community pharmacy in Jordan. Methods A prospective cross-sectional observational study design was used, which was conducted at different community pharmacies in Amman-Jordan. During the study period (November 2016-January 2017), a total 77 requests for pregabalin were observed from 14 pharmacies. A structured interview was conducted with all customers to gather information regarding their demographic and their request of pregabalin. Results A total of 77 pregabalin requests form 77 customers in a community pharmacy setting were observed in this study. Spinal disc herniation was the most common complaint for which the customer asked for the medication (n= 27, 35.1%). Self-medication was the most frequent method of requesting pregabalin (n= 44, 57.1%), while a total of 33 customers (42.9%) asked for the product using a prescription. During the observation period the number of customers suspected of abusing pregabalin for non-medical reason was 35 (45.5%). A total of 33 out of the 35 suspected customers (94.3%) asked for the product without a prescription, and 19/35 weren‘t sold due to suspicion of abuse (54.3%). Conclusion The study underscores the need for regulatory efforts to manage pregabalin abuse, through the addition of pregabalin containing products to the controlled drug list which can’t be purchased without a prescription. Also, pharmacists and customers must be educated at a community pharmacy level regarding potential hazards of pregabalin abuse