Ali Shakir Dauod

Evidence‐based medicine among hospital doctors in Jordan: awareness, attitude and practice

OBJECTIVES The aim of this cross-sectional study was to determine the awareness and attitude of hospital doctors towards evidence-based medicine (EBM) and their related educational needs. METHODS A questionnaire study was performed on a randomly selected sample of 386 hospital doctors from both a teaching hospital and the Ministry of Health general hospitals in Jordan. Attitude towards EBM, best method of moving from opinion-based medicine to EBM, accessing and interpreting evidence and perceived barriers to practise EBM among participants were the main outcome measures. RESULTS Participants welcomed promotion of EBM and 91.2% agreed that research findings are helpful in daily management of patients. About one-third of respondents (32.7%) thought that the most appropriate way to move towards EBM was by seeking and applying EBM summaries. About one half of participants (47.9%) were unaware of Cochrane database and only 5% used it to help in clinical decision making. More than half (53.7%) reported that they had access to the Internet at their office. Only minority understand the technical terms used in EBM. The major barriers to practising EBM were threat to clinical freedom/judgement, limited resources and facilities, patient overload absence of library in the locally and lack of personal time. CONCLUSIONS Although there is a high support among doctors for the promotion of EBM, there is a deficit in knowledge and skills of EBM. Hence, the time appears ripe for planning and implementing an effective EBM educational programme for both undergraduate and postgraduate doctors.

Glycaemic control among patients with type 2 diabetes mellitus treated in primary care setting in Jordan.

AIMS Determine the rate of glycaemic control among patients with type 2 diabetes treated in a university teaching family health centre and determine factors associated with glycaemic control. METHODS A family physician reviewed medical records of all type 2 diabetic patients aged 18 years or older, who attended the university medical centre of Jordan University of Science and Technology between September 2007 and December 2008. All relevant information were abstracted from medical records and filled in a special form. RESULTS Of the total 337 patients, 56.1% had HbA1c<7%. The mean HbA1c was 7.1%. About half (46.6%) achieved target blood pressure <130/80. Furthermore, half of the patients achieved the target levels of total cholesterol, triglycerides and HDL. However, only 10.4% achieved the target level of LDL. In multivariate analysis only increased duration of disease (>5 years vs. < or =5 years) and type of treatment (insulin alone or combination therapy vs. oral therapy only) were significantly associated with increased odds of HbA1C>7%. CONCLUSIONS More than half (56.1%) of diabetic patients had HbA1c values of less than 7%. Such finding highlight the importance of providing an organised care in managing diabetic patients in primary care setting and can be a base for further longitudinal studies to evaluate such care.

Awareness, attitude and practice of evidence‐based medicine among primary health care doctors in Jordan

OBJECTIVES To assess the awareness, attitude and knowledge towards evidence-based medicine (EBM) among primary health care doctors in Jordan and to identify the perceived barriers for practising EBM. METHODS A simple random sample of 34 comprehensive primary health care centres was selected from a list of 64 centres in Jordan using random number table. A family doctor visited all selected centres and invited the available doctors to participate in the study. Participants were asked to fill the self-administrated questionnaire that was designed to assess beliefs and attitude of doctors towards EBM. RESULTS Of the total 220 clinicians approached, 202 (91.8%) completed the questionnaire. About 80.7% welcomed promotion of EBM and 91.1% agreed on that research findings are helpful in daily management of patients. About 85.1% stated that practising EBM improves patient care, 68.3% stated that EBM reduces health care costs, 74.8% stated that EBM improves quick knowledge update, 93.6% reported that the doctor-patient relationship is affected positively by practising EBM. About 60.9% reported that they know the concept of EBM and 56.1% reported that they ever used the EBM. Patient overload, limited resources and facilities, and the absence of an effective computer system were the most commonly reported barriers to the implementation of EBM. CONCLUSIONS In spite of the positive attitude towards EBM, this study demonstrated numerous personal, interpersonal and institutional barriers towards implementing EBM which necessitate prompt action to formulate a national plan to overcome such barriers.

Vitamin D and PTH Status among Adolescent and Young Females with Severe Dysmenorrhea

OBJECTIVE To investigate Vitamin D and parathyroid hormone (PTH) status among adolescent and young females with severe and very severe dysmenorrhea. DESIGN Cross-sectional study in specific selected sample. SETTING One Jordanian university. PARTICIPANTS Fifty-six females, ages between 17 and 24 years, with severe and very severe dysmenorrhea were surveyed regarding demographics, pain with menstruation, and dietary intake of dairy products. Plasma Vitamin D, PTH levels were measured. RESULTS About 61% of the studied population experience very severe dysmenorrhea. Half of participants had dairy intake less than 1 serving per day. The majority of participants (80%) had insufficient plasma vitamin D and 48% of them had hyperparathyroidism. CONCLUSION A high prevalence of vitamin D insufficiency and secondary hyperparathyroidism and/or low dietary calcium intake among adolescent and young adult females who experience severe and very severe dysmenorrhea may negatively affect bone metabolism during achievement of peak bone mass at a young age and adverse bone health at older age.

Prevalence of chronic obstructive pulmonary disease among adult male cigarettes smokers: a community-based study in Jordan

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. The prevalence of COPD among cigarette smokers in the Middle East is not well studied. A prospective descriptive study was performed in the north of Jordan. Male cigarette smokers (≥10 pack-year) aged 35 years and older were recruited from the community. They completed a questionnaire and a postbronchodilator spirometry. Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria (postbronchodilator forced expiratory volume in 1 second <70%) was used to define COPD. A total of 512 subjects completed the study protocol. According to the GOLD criteria, 42 subjects (8.2%) had COPD. Of those, 27 subjects (64.3%) had symptomatic COPD. Using the GOLD criteria, eight subjects (19%) with COPD had mild disease, 24 (57.1%) had moderate disease, eight (19%) had severe disease, and two (4.8%) had very severe disease. Only 10.6% were aware of COPD as a smoking-related respiratory illness, and 6.4% had received counseling about risk for COPD by a physician. Chronic bronchitis (cough for 3 months in 2 consecutive years) was reported by 15% of the subjects, wheezes by 44.1%, and dyspnea by 65.2%. Subjects with COPD reported having more chronic bronchitis 18/42 (42.9%) and wheezing 28/42 (66.7%) than subjects without COPD. The prevalence of COPD increased with increased number of pack-years smoked. In conclusion, COPD prevalence among cigarette-smoking men in Jordan is lower than in the developed world. COPD was largely underdiagnosed, despite the majority of participants being symptomatic and having moderate to severe disease.

Knowledge, attitudes and current practice of Jordanian family physicians about prescribing aspirin in primary and secondary prevention of vascular diseases: a self-reported survey.

Background: Long-term aspirin therapy is crucial for patients with increased risk of occlusive vascular diseases. However, inconsistencies in the methods for risk assessment and the perception among health care providers are major contributing factors for challenges in risk assessment. Methods: A questionnaire was distributed to a total of 124 family physicians working at two university teaching centers and Ministry of Health primary health care centers in Jordan. Results: A majority of the physicians reported prescribing aspirin for patients if they have peripheral vascular disease (93%), post-coronary artery bypass graft (92%), stroke (90%), or stable angina (95%). A smaller percentage of physicians reported that they prescribe aspirin if patients have atrial fibrillation (81%) or acute myocardial infarction (85%). The percentage of physicians who prescribe aspirin markedly declined when patients have potential bleeding disorder (52%) or asthma (52%). For patients without cardiovascular diseases but with one or more risk factors, the prophylactic use of aspirin was reported by 85% to 95% of family physicians. Conclusions: The presence of co-morbidity along with vascular diseases tended to hinder physicians from prescribing aspirin even when it is indicated. A majority of family physicians recommends the use of aspirin in primary prevention in spite of its questionable or even negative benefits. Furthermore, self-reported aspirin prescribing rates among physicians in Jordan are higher than those reported by physicians in the U.S. and Europe. Therefore, we believe that proper dissemination of updated evidence-based treatment guidelines is required to ensure appropriate and efficient preventive services for cardiovascular diseases.

Vildagliptin efficacy in combination with metformin among Jordanian patients with type 2 diabetes mellitus inadequately controlled with metformin

Abstract Objective: To assess the efficacy and safety of vildagliptin added to metformin in patients with type 2 diabetes mellitus (T2DM) inadequately controlled with metformin monotherapy. Methods: This was a 12-week prospective observational study where vildagliptin 50 mg twice daily was added to patients with T2DM inadequately controlled (glycosylated hemoglobin type A1c (Hba1c) 7–10%) by a daily dose of metformin ≥1700 mg between June 2012 and May 2013. Efficacy was assessed by change in Hba1c and fasting plasma glucose (FPG) levels, and safety was assessed by reported adverse events (AEs). Results: A total of 58 patients were enrolled in this study. Their age ranged between 39.0 and 71.0 years, with a mean of 52.6 years, and a standard deviation (SD) of 7.8. The average duration of diabetes mellitus (DM) was 4.0 years (SD 3.0) and half of the patients have had DM for more than three years. The mean baseline levels of Hba1c and FPG were 8% and 10.8 mmol/L, respectively. Patients treated with vildagliptin achieved clinically significant reductions in Hba1c of 1.1% (p value <.005) and reduction in FPG of 1.8 mmol/L (p value <.005) from baseline. Overall, 62.1% had achieved the target of Hba1c of <7% after vildagliptin use. Greater reductions in Hba1c were linked to higher baseline levels as well as to the daily frequency of metformin use. Mild AEs were reported by 16 patients. There was no incidence of hypoglycemia and there were no significant changes in body weight after treatment. Conclusions: Vildagliptin as add-on therapy to metformin improved glycemic control and was highly tolerable in T2DM patients who were inadequately controlled by metformin monotherapy.

Knowledge and attitudes of students of College of Medicine towards evidence-based medicine and barriers to its use in clinical practice in Erbil city, Iraq

* Department of community medicine, college of medicine, Hawler Medical University, Erbil, Iraq. Introduction Evidence-based medicine (EBM) is defined as the “conscientious, explicit, and judicious use of current best evidence”. Later David Sackett et al, refined the definition of EBM as “Integrating the best research evidence with clinical expertise and patient values and circumstances to achieve the best possible patient management”. By best research evidence we mean valid and relevant research, often from the basic sciences of medicine, however the patient-centered clinical research into the accuracy of diagnostic tests, the power of prognostic markers, the efficacy and safety of therapeutic, rehabilitative and preventive regimens should be taken in consideration. By clinical expertise we mean the ability to use our clinical skills and past experience to rapidly identify each patient’s unique health state and diagnosis, their individual risks and benefits of potential interventions, their personal circumstances and expectations. Background and objective: Evidence-based medicine, by guiding medical care towards meaningful outcomes to patients, has a significant worldwide impact on medical care and education. It is important that medical students, whom are the future physicians, keep themselves updated with recent advancement in medical knowledge and health care. The aim of this cross-sectional study was to determine the attitude, knowledge and barriers among students towards evidence-based medicine and making them familiar with the concept and advantage of evidence based medicine. Methods: A cross-sectional study was conducted on 163 sixth year students of the College of Medicine at Hawler Medical University during the period from October 2012 to May 2013. The response rate was 86.5%. Knowledge towards evidence-based medicine, accessing and interpreting evidence and perceived barriers to practice evidence-based medicine among participants were the main outcome measures. Results: Of 141 of participants that filled the questionnaire, only 69.5% had heard about evidence-based medicine. Around 82% stated that they had knew evidence-based medicine and only 23.5% had knew steps of evidence-based medicine. Around 65% of respondents welcomed the promotion of evidence-based medicine and 74.4% agreed with that finding from the current study in which it would be helpful in daily management of patients. Furthermore, 31.6% of students reported that standard textbook as a frequent source used for medical knowledge. Around 91% of students did not know the strongest evidence in the hierarchy of evidence and only small proportion of students reported that they understand the common epidemiological concepts that are used in evidence-based medicine. Conclusion: Evidence-based medicine is relatively a new concept among students at the College of Medicine in Erbil. Although the students appeared interested in learning and implementing evidence-based medicine in clinical practice, they need more guidance and training to ensure the correct use of evidence-based medicine ideals.