Eman Alefishat

Evidence-based medicine use in pharmacy practice: a cross-sectional survey

RATIONALE, AIMS AND OBJECTIVES This study aimed to evaluate the awareness, attitude, knowledge and use of evidence-based medicine (EBM) among pharmacists in Jordan. METHODS A cross-sectional self-reported survey was conducted on 122 pharmacists (both hospital and community) who were asked to fill a validated structured questionnaire. RESULTS The participants showed a positive attitude towards EBM; more than 80% thought that EBM improves patient care, improves quick knowledge update, helps to unify the quality of care provided, is a good educational tool and a convenient source of advice. But despite this positive attitude, pharmacists showed partial understanding of the technical terms used in EBM; also they relied on their own judgment, medical representatives and standard textbooks in making their decision, resources that can no longer be considered sufficiently updated and/or evidence based. Patient overload, lack of personal time and limited access to EBM sources were the most commonly identified barrier to practicing EBM. Also this study suggest that pharmacists experience is negatively associated with EBM knowledge score (Spearmans rho value -0.187, P-value 0.04). CONCLUSIONS In spite of the positive attitude towards EBM, this study showed numerous personal and institutional barriers towards implementing EBM in Jordan, which necessitate immediate action by all health care decision makers to formulate a national plan to overcome such barriers, and to further investigate the evidence that teaching, learning and daily application of EBM in practice can improve the quality of care and reduce the cost.

Effects of NAD at purine receptors in isolated blood vessels.

Nicotinamide adenine dinucleotide (NAD) belongs to the family of naturally occurring adenine dinucleotides, best known for their various intracellular roles. However, there is evidence that they can also be released from cells to act as novel extracellular signalling molecules. Relatively little is known about the extracellular actions of NAD, especially in the cardiovascular system. The present study investigated the actions of NAD in the rat thoracic aorta, porcine coronary artery and porcine mesenteric arteries, mounted in organ baths for isometric tension recording. In the rat thoracic aorta and porcine coronary artery, NAD caused endothelium-independent concentration-dependent vasorelaxations which were unaffected by palmitoylCoA, a P2Y1 receptor antagonist, but which were blocked by CGS15943, a non-selective adenosine receptor antagonist. In the porcine coronary artery, NAD-evoked relaxations were abolished by SCH58261, a selective A2A receptor antagonist. In the rat thoracic aorta, NAD-evoked relaxations were attenuated by A2A receptor antagonism with SCH58261 but were unaffected by an A2B receptor antagonist, MRS1754. In contrast, in the porcine mesenteric artery, NAD-evoked endothelium-independent contractions, which were unaffected by a P2 receptor antagonist, suramin, or by NF449, a P2X1 receptor antagonist, but were attenuated following P2X receptor desensitisation with αβ-meATP. In conclusion, the present results show that NAD can alter vascular tone through actions at purine receptors in three different arteries from two species; its molecular targets differ according to the type of blood vessel.

Adherence to 6-Mercaptopurine in children and adolescents with Acute Lymphoblastic Leukemia

Objective Studies on children with Acute Lymphoblastic Leukemia (ALL) reported non-adherence in 2–54% of cases. The primary objective of this study was to assess rates of adherence to 6-MP using two different methods in children and adolescents with ALL. Secondary aim was to identify factors that influence adherence to 6-MP in children with ALL. Methods All eligible children with ALL who are (≤ 19) years old and receive 6-MP therapy for at least 1 month were approached to participate in the study. A total of 52 children with ALL and their primary caregivers were recruited. Adherence measures included an objective method (measuring 6-MP metabolites in packed Red Blood Cells (RBCs)) and a subjective method (using parent and child self-report via the Medication Adherence Report Scale; MARS; Adherence was defined as 90% or greater). Results Rates of adherence varied across the measurement methods. Packed RBCs sample analysis indicated forty-four patients (84.6%) to be adherent. Using the MARS questionnaires, a total of 49 children (94.2%) were classified as being adherent according to the parental MARS questionnaire scores, while all the 15 children (100%) who answered the MARS (child) questionnaire were classified as adherent. Overall adherence rate was 80.8% within the studied population. Conclusion MARS scale was shown to overestimate adherence compared to measurement of 6-MP metabolites in the blood. A combination of both methods led to increased detection of non-adherence to thiopurine in children with ALL.

Drive-thru pharmacy service: Assessments of awareness, perception and barriers among pharmacists in Jordan

Objective Drive-thru pharmacy services have become widely recognized service worldwide. Despite its proven success, there were doubts in its ability to maintain safe practice. Thus, the aim of the current study was to investigate the awareness, perception and barriers of drive-thru pharmacy services among pharmacists in Jordan. Methods A cross-sectional study was conducted in Amman-Jordan between February-May 2017. During the study period, 226 pharmacists were approached. Pharmacists were interviewed to assess their perception toward drive-thru services, and to assess their opinions regarding the advantages and disadvantages of this system using validated questionnaire. Results Although the majority of pharmacists reported that they were aware about the concept of drive-thru pharmacy service (n = 194, 85.5%), but only 27.9% (n = 63) reported that they are willing to register with this service. The most important advantage of drive-thru pharmacy service was serving sick patients, elderly, disabled people or women with child in the car (n = 166, 88.0%). Most of pharmacists agreed that drive-thru pharmacy service may negatively affect the image of pharmacy profession (n = 168, 74.6%), and it makes pharmacists feel more like a fast food worker than a pharmacist (n = 147, 65.9%). Pharmacists working in chain community pharmacies showed better perception to drive-thru pharmacy service compared to pharmacists who are working in independent community pharmacies (p-value = 0.004). Conclusion Most of the study pharmacists showed relatively poor perception toward drive-thru pharmacy service and were unwilling to use this service. More effort is needed to better introduce the concept of drive-thru pharmacy service among pharmacists in Jordan since the benefit of this service is well established across the world.

Determinants of vitamin d status among Jordanian employees: Focus on the night shift effect.

OBJECTIVES To assess the association between night work and 25-hydroxy vitamin D (25OHD) levels, and to evaluate effect of potential risk factors on 25OHD levels. MATERIAL AND METHODS A total of 140 adult Jordanian employees were recruited. Demographic, lifestyle and working patterns data were documented through a well-structured questionnaire. Vitamin D status was assessed by measuring circulating concentrations of 25OHD. RESULTS Mean 25OHD level was 23.8 ng/ml. No significant difference was found in 25OHD levels between the summer and winter (p = 0.46), or between males and females (p = 0.35). The female night workers had significantly lower serum 25OHD levels compared to the female day workers (p = 0.01). No significant difference in serum 25OHD levels was found between the night and day male workers (p = 0.25). The number of night shifts/month was negatively correlated with 25OHD levels in both the males and females (p = 0.01 and p = 0.007, respectively). Age was positively correlated with 25OHD levels in both the males and females (p = 0.02 and p = 0.001, respectively). Body mass index was negatively associated with 25OHD levels in the whole sample (p = 0.03), but not within each gender group (p = 0.21 for the males and p = 0.09 for the females). Smoking had no significant association with 25OHD levels (p = 0.99 for the males and p = 0.22 for the females). CONCLUSIONS Our results suggest that women working night shifts are at higher risk of 25OHD deficiency, and, consequently, of other health problems linked to 25OHD deficiency. Int J Occup Med Environ Health 2016;29(5):859-870.

Premenstrual syndrome and premenstrual dysphoric disorders among Jordanian women

PURPOSE The aim of this study was to investigate the frequency, associated factors, and management approaches of premenstrual dysphoric disorder (PMDD) and premenstrual syndrome (PMS) in Jordanian women. DESIGN AND METHODS Three hundred premenopausal women completed a self-administered questionnaire. FINDINGS Moderate-severe PMS was reported by 29% of women, while 14% had PMDD. Younger unmarried women had the more severe condition. Herbal remedies and no medication were the most common approaches used to manage PMS/PMDD. IMPLICATIONS FOR NURSING PRACTICE High rates of PMS and PMDD found in this study highlight the need to increase awareness to this condition among health providers in order to facilitate its identification, diagnosis, and management.

Shift Work and the Risk of Cardiovascular Diseases and Metabolic Syndrome Among Jordanian Employees

Objectives We sought to evaluate the effect of night shift working on increasing the risk of developing cardiovascular disease (CVD) using three different predictors. Methods One hundred and forty adult Jordanian employees were recruited in this cross-sectional study. Demographic data, anthropometric parameters, and working patterns information were documented. Metabolic syndrome (MetS) was diagnosed, and atherogenic index of the plasma (AIP) and Framingham risk score were calculated. Results Night shift workers had a significantly higher AIP ratio compared to daytime workers (p = 0.024). No significant association was observed between the two groups in term of 30-year Framingham risk score (p = 0.115). However, the duration of night shifts and the number of night shifts per months were found to significantly increase the 30-year Framingham risk (p = 0.000 and 0.012, respectively). Furthermore, the incidence of MetS among night shift workers was 15.9% (13/82) compared to 10.3% (6/58) among daytime workers (p = 0.484). Conclusions This is the first study to assess the association between night shift work and AIP as well as the 30-year Framingham risk score as predictors of CVDs. Night shift work was associated with an increase in AIP score compared to daytime work. Also, the duration of night shifts and the number of night shifts per month significantly increased the 30-year Framingham risk among night shift workers. These findings suggest an association between night shift work and the risk of CVD and atherosclerosis. Our results highlight the need for interventional strategies to diminish the risk of CVD in night shift workers.

Exploring variables associated with poor health-related quality of life in patients with type 2 diabetes in Jordan

The study aim was to evaluate health‐related quality of life (HRQoL) and to explore factors associated with poor HRQoL in patients with type 2 diabetes in Jordan.

Investigation of variables associated with medication nonadherence in patients with hypertension

Medication nonadherence represents a major barrier to achieve optimal health outcomes in patients with hypertension. The study aim was to identify obstacles to medication adherence in patients with hypertension in Jordan.

Factors associated with poor Hemoglobin A1c control in Patients with Type 2 Diabetes

BACKGROUND The limited implementation of clinical pharmacy service programs and the lack of studies identifying barriers to achieve blood glucose control have all attributed to the increased proportion of type 2 diabetes patients who have poor glycemic control in Jordan. OBJECTIVE To explore factors associated with higher HbA1c in patients with type 2 diabetes in Jordan. METHODS Variables including socio-demographics, disease and treatment factors were collected from171 patients with type2 diabetes at an outpatient diabetes clinic in Amman. Validated questionnaires were used to assess medication adherence, self-care activities, diabetes knowledge and healthrelated quality of life in addition to data collected from medical records. After the single-predictor analysis, stepwise linear regression was performed to develop a model with variables that best predicted hemoglobin A1c. RESULTS Medication adherence was inversely associated with HbA1c values (β = -0.275; t = 2.666; P < 0.01), indicating better glycemic control. Receiving insulin therapy was also associated with less HbA1c values and better glycemic control (β = - 0.184; t = 2.080; P < 0.05). Patients who had one or more comorbid conditions (β = 0.215; t = 2.264; P < 0.05) and those with longer diabetes duration (β = 0.092; t = 1.339; P < 0.05) were found to have significantly higher HbA1c values. CONCLUSION Emphasizing medication adherence, particularly for patients with longer duration of diabetes and those with multiple comorbid diseases should be strongly considered in future diabetes management programs implemented to improve glycemic control in patients with type 2 diabetes.