Rana Abu Farha

Pharmacist’s knowledge, practice and attitudes toward pharmacovigilance and adverse drug reactions reporting process

Background Adverse drug reactions (ADRs) are a major cause of drug related morbidity and mortality. Pharmacovigilance is the science that plays an essential role in the reduction of ADRs, thus the evolution and growth of this science are critical for effective and safe clinical practice. Objectives This study is considered the first study in the region to evaluate pharmacist’s knowledge, practice and attitudes toward ADRs reporting after establishing the national ADRs reporting center in Jordan. Method A cross sectional study was used to evaluate pharmacist knowledge and attitude toward ADRs reporting. A structured validated questionnaire was developed for this purpose and a total of 208 pharmacists were recruited to participate in this study. Results The majority of pharmacists have insufficient awareness and lack of knowledge about pharmacovigilance and ADRs reporting. Also the rate of reporting of ADRs was extremely poor. Several factors were found to discourage pharmacists from reporting ADRs, which include inadequate information available from the patient, unavailability of pharmacist ADRs form when needed, unawareness of the existence of the national ADRs reporting system. Also pharmacists think that ADRs are unimportant or they did not know how to report them. Conclusion The results of this study suggest that pharmacists have insufficient knowledge about the concept of pharmacovigilance and spontaneous ADRs reporting. On the other hand, pharmacists had positive attitudes toward pharmacovigilance, despite their little experience with ADRs reporting. Educational programs are needed to increase pharmacist’s role in the reporting process, and thus to have a positive impact on the overall patient caring process.

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.

Reliability and validity of Arabic translation of Medication Adherence Report Scale (MARS) and Beliefs about Medication Questionnaire (BMQ)-specific for use in children and their parents

Objectives to evaluate the reliability and discriminant validity of Arabic translation of the Medication Adherence Report Scale (MARS) and the Beliefs about Medication Questionnaire-specific (BMQ-specific). Methods Having developed Arabic translations of the study instruments, a cross-sectional study was carried out between March and October 2015 in two multidisciplinary governmental hospitals in Jordan. An expert panel monitored the forward and backward translation of the MARS and BMQ. Standard Arabic was used (with no specific dialect inclusion) to allow greater generalisability across Arabic speaking countries. Once the Arabic translations of the questionnaires were developed they were tested for consistency, validity and reliability on a group of children with chronic diseases and their parents. Results A total of 258 parents and 208 children were included in the study. The median age of participated children and parents was 15 years and 42 years respectively. Principle component analysis of all questionnaires indicated that all had good construct validity as they clearly measured one construct. The questionnaires were deemed reliable based on the results of Cronbach alpha coefficient. Furthermore, reliability of the questionnaires was demonstrated by test-retest intraclass correlation coefficients (ICC) which ranged from good to excellent for all scales (ICC>0.706). The Pearson correlation coefficient ranged from 0.546–0.805 for the entire sample which indicated a significant moderate to strong positive correlation between MARS and BMQ items at time 1 and 2. Reported adherence was greater than 59% using MARS-children and MARS-parents scales, and was correlated with beliefs in necessity and independent of the concerns regarding medications. Conclusion The Arabic translations of both BMQ and MARS for use in children and their parents have good internal consistency and proved to be valid and reliable tools that can be used by researchers in clinical practice to measure adherence and beliefs about medications in Arabic speaking patient populations.

A Cross-Sectional Study On Knowledge and Perceptions of Pharmacovigilance Among Pharmacy Students of Selected Tertiary Institutions In Jordan

Background: Although a large body of evidence exists on the effect of long-term exercise training program on pulmonary function, much less attention has been dedicated to investigating the acute effect of short-term exercise program on improving the ventilatory function. Objective: The present study was carried out to investigate the effect of short term high intensity aerobic exercise on lung function in adults to start first step in establishing an evidence based exercise program designed for chest patients who can only be supervised in short term hospitalization phase. Methods: A pre-post test study design was carried out on thirty healthy men students with their mean age 21.7 ± 1.26 who were enrolled in this study. Every student performed a 20-minute high-intensity monitored stationary arm Ergometer exercise and ventilatory function tests was performed in order to measure forced vital capacity (FVC), forced expiratory volume at the end of the first second (FEV1), FEV1/FVC ratio and peak expiratory flow rate PEFR before and after the exercise. Results: The result showed significant increase in the mean value of FEV1, and a non-significant difference in the mean values of (FVC), FEV1/FVC and PEFR. Conclusion: A single high intensity arm Ergometer exercise sitting has a significant effect on improving forced expiratory volume in the normal adult.3 Abstract: Immunological techniques have been developed over years using different Fasciola antigens for diagnosis of fascioliasis and as to replace the parasitological techniques which are time consuming and usually lack sensitivity and reproducibility. In this study, Fasciola gigantica purified metacercarial antigen was early detected in sera of infected sheep using both sandwich and Dot-ELISA in order to evaluate the efficacy of purified metacercarial antigen performance in diagnosing early fascioliasis. This work was conducted on 150 sheep blood samples which were classified according to their parasitological manifestation into 110 sera infected with fascioliasis, 20 infected with other different parasites and 20 healthy control sera. The sensitivity and specificity of sandwich ELISA compared to those of the Dot-ELISA were 92.7% and 93.7% versus 95.5% and 97.5%, respectively. On the other hand, the parasitological examination recorded 68.6% sensitivity and 100% specificity. The purified F. gigantica metaceraial antigens have shown a powerful antigencity for early immune-diagnosis of fascioliasis in both ELISA techniques, however, Dot- ELISA was trouble-free, more sensitive, greater specific and affordable as well as feasible test; the features recommended for any technique to be used in detecting the light infection, particularly, at the early stages that precede the onset of parasite eggs.Several factors may contribute to the rising of water-pipe smoking. Objectives: Several factors may contribute to the rising of water pipe smoking. The objectives of our study were to determine the prevalence, individual and social factors of water pipe smoking among undergraduate medical students of King Saud University in Riyadh, Saudi Arabia. Methods: A cross-sectional descriptive/analytical study was done among a representative sample of 408 male and female undergraduate medical students. A simple random sampling method was used to select the participants. Aself-administered questionnaire was constructed based on the National Youth Tobacco Survey in the United States. Multiple logistic regression analysis was performed to analyze the data. Results: The prevalence of water-pipe smoking among medical students was 11.8% for males and 2% for females. Factors associated with water pipe smoking were water pipe smoking among siblings (OR=6.6; 95% CI = 2.3 – 18.2),parents (OR=4.6; 95% CI = 1.7 – 12.0), and closefriend (OR=65.7; 95% CI = 8.8 – 490.0). The odds of water pipe smoking among the 5th year students were five times higher (OR = 5.5; 95% CI = 1.4 – 24.6) compared to other years. Students whose parents were widowed had 4.2-fold (95% CI = 1.213.7) odds of water pipe smoking compared to students with full families. Conclusion: Social determinants, such as water pipe smoking among siblings, parents and close friends, as well as individual factors such as years of a study and parental marital status were associated with water pipe smoking among undergraduate medical students. Our finding can potentially improve tobacco control programs in Saudi Arabia and decrease the prevalence of water pipe smoking among students.M tourism has transformed from a cottage industry to a sector experiencing tremendous growth and becoming a focus area for governments regionally.As the coming rise in domestic demand brings strong growth and stability to the health care industry, further expansion into the world market through medical tourism represents an untapped resource that could take the sector to a new level. However, medical tourism is a highly competitive market and the emirate is working to establish itself within a crowded field – namely from South East Asia cities, who are accelerating their push into solidify their position as hubs for medical tourism.The key to entering and establishing a foothold will be from promoting existing strengths and reaching patients across different mediums, on both a continuous basis and during the time of decision making.”Objectives: to assess the Prevalence of anxiety and depression among secondary school students and to compare male and female group Methods: This is an observational cross section study using The sampling technique followed stratified convenient sampling and data was collected using self-administered questionnaires (Arabic version of the symptom revised SCL 90- R). Data was collected from 331 secondary school students between 15 and 18 years old from both genders after raking an informed consent Results: Results show 25.7% of the students had anxiety, On comparing boys and girls,23 boys (10.1%) had anxiety, while 62 (59.6%) of the girls had anxiety. In depression 28.4% is the Prevalence of depression in both genders, on comparing boys and girls, 34 male students (14.9%), while 60 female students (57.7%) had depressive symptoms with strong significance when comparing boys to girls Conclusion: This study analyzed the importance of mental health assessment and follow-up in secondary school students, especially girls. However, further assessment for other co – factors such as socioeconomic differences should be considered.Methods: Using a previously validated questionnaire that comprises 38 questions to assess the level of knowledge, attitude and practices towards blood donation, 469 Saudi adults who attended different shopping malls in Riyadh, Saudi Arabia were interviewed. Based on calculated scores, level of knowledge and attitude of our study cohort were categorized into different groups. Multiple regression analyses were used to identify significant predictors of blood donation.Procedure: A sample of 250 postmenopausal women ranging in age between 45 to 80 years was selected by purposive sampling from various parts of north India (Haryana, Punjab, and Chandigarh). Anthropometric parameters (height, weight), physiological variables (systolic and diastolic blood pressure, pulse rate), hypertension (as per JNC VII criteria) and bone mineral density (using dual Energy X-ray Absorptiometry at lumbar spine L1-L4) of all the participants were recorded. Findings indicated that 40.4% women were identified with hypertension, out of which 12.8% had normal bone mineral density, 16.4% and 11.2% were osteopenic and osteoporotic respectively.

Identification of medication discrepancies during hospital admission in Jordan: Prevalence and risk factors

Objectives Medication errors are considered among the most common causes of morbidity and mortality in hospital setting. Among these errors are discrepancies identified during transfer of patients from one care unit to another, from one physician care to another, or upon patient discharge. Thus, the aims of this study were to identify the prevalence and types of medication discrepancies at the time of hospital admission to a tertiary care teaching hospital in Jordan and to identify risk factors affecting the occurrence of these discrepancies. Methods A three months prospective observational study was conducted at the department of internal medicine at Jordan university hospital. During the study period, 200 patients were selected using convenience sampling, and a pre-prepared data collection form was used for data collection. Later, a comparison between the pre-admission and admission medication was conducted to identify any possible discrepancies, and all of these discrepancies were discussed with the responsible resident to classify them into intentional (documentation errors) or unintentional. Linear regression analysis was performed to assess risk factors associated with the occurrence of unintentional discrepancies. Results A total of 412 medication discrepancies were identified at the time of hospital admission. Among them, 144 (35%) were identified as unintentional while the remaining 268 (65%) were identified as intentional discrepancies. Ninety-four patients (47%) were found to have at least one unintentional discrepancy and 92 patients (46%) had at least one documentation error. Among the unintentional discrepancies, 97 (67%) were found to be associated with a potential harm/deterioration to the patients. Increasing patients’ age (beta = 0.195, p-value = .013) and being treated by female residents (beta = 0.139, p-value = .045) were significantly associated with higher number of discrepancies. Conclusion The prevalence of unintentional discrepancies at the time of hospital admission was alarmingly high. Majority of these discrepancies were associated with a potential harm to the patients. These findings support the necessity for implementing the medication reconciliation service in the country, engaging healthcare providers in the process of identification and resolution of medication discrepancies.

Perceptions and attitudes towards off-label dispensing for pediatric patients, a study of hospital based pharmacists in Jordan

Background With growing responsibility of the pharmacists in ensuring public health and safe medicine use, an understanding of the issues surrounding off-label prescribing is crucial to allow pharmacists to make informed decisions about such practice. The aim of this study is to assess the perceptions and attitudes of hospital based pharmacists toward off-label medicine dispensing to children. Methods After obtaining the required approvals, a validated questionnaire about off-label dispensing to pediatric patients was administered to 250 randomly selected hospital pharmacists. Results One hundred and fifty (150) completed questionnaires were returned. Less than half of the respondents (44%, n = 66) admitted to being familiar with the concept of off-label dispensing, claiming to have obtained this knowledge basically through their dispensing experience rather than education. A minority of respondents (36%, n = 54) reported dispensing off-label medicines within their practice knowingly. The majority of respondents had concerns regarding the efficacy (82%, n = 123) and safety (98%, n = 147) of off-label medicines. The most common reasons given by respondents for a dispensed prescription being off label were younger age than recommended (88%, n = 132). Most of respondents (94%, n = 141) claimed to double check the calculations of doses of medicines before dispensing off-label medicines and 60% (n = 90) of them felt that parents and guardians should be told when an off-label medicine has been prescribed for their children. Conclusion The majority of respondents were not familiar with the concept of offlabel medicines. While reporting to have gained their knowledge from their professional experience, only a minority of respondents reported knowingly dispensing off-label medicines for pediatric patients. Respondents indicated that manufacturing more appropriate formulations for pediatric patients would reduce such practices in this population. Having concerns regarding the efficacy and safety of off-label medicines used for pediatric patients, respondents felt that the use of off-label medicines would increase the likelihood of adverse drug reactions (ADRs). Finally, respondents felt that such practice of prescribing and dispensing should receive parental consent.

Effect of educational intervention on healthcare providers knowledge and perception towards pharmacovigilance: A tertiary teaching hospital experience

Objective Based on the theory on planned behavior, perception or attitude is found to be a well-established predictor of healthcare providers’ intentions to perform different behaviors. Also, improving knowledge was proposed to affect their practice as well. In Jordan, many studies have been conducted to evaluate healthcare providers’ knowledge and perception towards pharmacovigilance but no intervention or training was provided. Thus, the aim of this study was to evaluate the impact of an educational workshop on the knowledge and perception of healthcare providers towards pharmacovigilance in a Jordanian tertiary teaching hospital. Methods An interventional study conducted in Jordan University Hospital on various healthcare providers to assess their pre- and post-knowledge and perception towards pharmacovigilance and adverse drug reactions (ADRs) reporting via questionnaire before and after an educational workshop. Results Among the 200 invited healthcare providers, 150 attended the educational workshop (response rate 75.0%). Pre-workshop, healthcare providers showed an overall low knowledge score (7.8/19), where only 8.7% could define pharmacovigilance correctly. On the other hand, they showed a favorable perception score (33.6/39). Following educational workshop, knowledge scores significantly improved by 67.9% (P-value <0.05). A similar finding was obtained for perception scores, where perception scores significantly improved by 10.1% following workshop (P-value <0.05). Conclusion Continuous efforts are needed to implement different strategies including education modules and the provision of appropriate training programs to increase awareness and improve perception towards pharmacovigilance among healthcare providers. Future study is needed to evaluate the impact of improving knowledge and perception on ADRs reporting practice.

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.

An audit on parental attitudes towards medicines used in children

Introduction There is growing concerns regarding the use of medicines in children. Therefore, many strategies were implemented to improve such use and make safe and effective medicines more available for children. Enhancing interaction between parents and health care providers plays an important role in insuring the proper use of medicines. In order to optimize such interaction, the attitudes, beliefs and practices of parents toward medicine use in children need to be explored. Methods A validated questionnaire was administered via face to face interviews to 1000 parents attending pediatric outpatient clinics with their children in order to investigate their attitudes toward childrens medicines. Results The majority of respondents (83.2%) were mothers. The majority participants (84.4%) agreed that medicines are necessary in treating illnesses, 80% of the parents had worries about the side effects and interactions of medicines, and 60% of the parents said they try to avoid giving medicines to their children. Moreover, parents in this study varied considerably in their views toward prescription and over-the- counter medicines. More than half of the participants (55.2%) declared that doctors in Jordan prescribe antibiotics to children too easily. Conclusion Participants had positive attitudes toward the necessity of medicines for ill children. However, a considerable proportion of the parents had negative attitudes toward childrens medicines with respect to their side effects and interactions, their capability of disturbing the bodys own capability of healing illnesses, their unnatural characteristic and other aspects related to medicines.