Assessing insomnia management in community pharmacy setting in Jordan: A simulated patient approach.

Insomnia is one of the most common minor ailments to which patients seek advice in a community pharmacy setting. Due to the availability of a wide variety of over-the-counter (OTC) products, community pharmacists are in the front line to safe-guard patients looking for self-medication or advice for treatment of insomnia. The purpose of this study was to assess the content of community pharmacists' interactions with patients seeking advice for insomnia in Jordan. A cross-sectional study using a simulated patient methodology was conducted across a stratified convenience sample of community pharmacies in three major cities in Jordan. The visits were evaluated using pre-defined criteria adapted from published literature relating to content and counseling skills. Visits were audio-recorded using a hidden microphone and the simulated patient completed a data collection form immediately after each visit. A total of 67 community pharmacies (response rate = 93.0%) agreed to participate and were all visited once by the simulated patient. The median duration of the visit was 2 minutes (range: 0.2-4 minutes). The majority (86.6%) of visits resulted in the sale of a drug, most commonly a combination product (paracetamol and diphenhydramine) for 30 recommendations (44.8%). This was followed by a natural plant extract combination product, namely valerian and lemon balm (Melissa officinalis L.) for 23 (34.3%). Pharmacists often did not question medical history or other symptoms prior to product sale. Frequently, the recommended dose (49.3%) and administration time (38.8%) were the only information provided to the patient. No information was provided in relation to potential drug interactions or contraindications. No advice was offered on lifestyle or good sleeping hygiene. This study provided evidence that community pharmacists in Jordan in general did not offer adequate counseling for patients seeking advice for insomnia. Exploration of the reasons and factors contributing to this practice and highlighting professional opportunity and responsibility is recommended

Use of secret simulated patient followed by workshop based education to assess and improve inhaler counseling in community pharmacy in Jordan

Objectives: To assess inhaler technique demonstration skills of community pharmacists located in Amman, Jordan via incorporating the trained secret simulated patient (SSP) approach. Secondly, to evaluate the effectiveness of a 2-hour educational workshop focused on SSP feedback. Methods: This cross-sectional study involved community pharmacies located in Amman, Jordan. Initially, a trained SSP was involved to enact baseline visits requesting advice on how to use Ventolin® (a pressurized metered-dose inhaler; pMDI) and Pulmicort® (a Turbohaler inhaler, TH). Immediately after each visit, the SSP completed an inhaler technique evaluation form with inhaler checklists based on previously published checklists (consisting of 9 and 10 items for pMDI and TH respectively). The SSP invited all participating pharmacists to a 2-hour workshop that included feedback on their demonstration skills, and the second evaluation of their inhaler technique. The workshop included a summary of the initial visits’ results highlighting pharmacists’ performance. Results: Sixty pharmacies were visited and 120 inhaler assessments were completed. During baseline assessment, pharmacists scored an average of 4.5 out of 9 for pMDI and 4.9 out of 10 for TH. Only 11 pharmacists (18.3%) attended the workshop. During the workshop, inhaler technique demonstration skills significantly improved, as scores improved from 5.4 (SD 1.6) to 7.8 (SD 0.9) (p=0.008) and from 4.6 (SD 2.5) to 9.9 (SD 0.6) (p=0.003) for pMDI and TH respectively.  Conclusions: The SSP approach revealed a lack of ability to demonstrate correct inhaler technique for pMDI and TH inhalers by community pharmacists in Amman, Jordan. A focused educational workshop based on SSP feedback improved inhaler technique significantly

A comparative study assessing variety and management effects on C4 perennial grasses in a northern climate

In the province of Ontario, Canada, markets are emerging for biomass for a range of end-uses including combustion, gasification and bio-products. Given concerns over the technical feasibility and sustainability of crop residue removal, dedicated C4 perennial grasses were identified as potential candidates to meet this emerging demand. In 2008, a multi-site trial was initiated across the province to comparatively evaluate C4 perennial grasses, including miscanthus (Miscanthus spp.), switchgrass (Panicum virgatum) and big bluestem (Andropogon gerardii). Four varieties of miscanthus (M. sinensis × M. sacchariflorus - Nagara, Amuri, M1 Select and Polish) were compared to two upland varieties of switchgrass (Cave-in-Rock and Shelter), two varieties of big bluestem (Prairieview and Southlow), and one variety of prairie cordgrass (Red River). Treatments were set up in a factorial experiment with four nitrogen rates (0, 40, 80, 160 kg N ha-1) and two harvest dates (late fall and early spring). A treatment representing the prominent land use pattern in the region was also included to assess land use change effects and relative biomass yield. Data is given for measurements taken to assess treatment effects on establishment success, winter survival, yield and moisture content. Variation in winter tolerance was observed, but it can be concluded that varieties for each of the evaluated species exist that are adapted and suitable to be grown under Ontario conditions. For many of the measured parameters, including yield, significant interactions between year, location, species, variety, and agronomic management were observed