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In Jordan, research ethics committees exist in most health settings. However, little is known about Jordanian public views regarding the ethics of clinical research. This study aimed to evaluate Jordanian public understanding and attitudes about ethics in clinical research. A questionnaire was used to collect information that included demographics, public knowledge, and attitudes towards ethics in clinical research. It was administered via face-to-face interviews in two major cities in Jordan from 1st June to 15th August 2017. Of the 2315 respondents, 2.33% were found to have poor knowledge, 22.16% had fair knowledge, and 75.51% had good knowledge of ethics in clinical research. Furthermore, 75.81% of respondents had positive attitudes towards ethics in research. However, only 45.23% reported that they trust clinical researchers in Jordan. Even though a large majority of respondents were aware of key features of research ethics, efforts are needed to address negative perceptions and knowledge deficits.

Background: The pharmacist plays an essential role in identifying and managing drug-related problems. The aim of this research was to assess the costs avoided by clinical pharmacist interventions to resolve drug-related problems. Research design and methods: Clinical pharmacists identified drug-related problems and interventions to address them in consecutive outpatients visiting internal medicine clinics at major teaching and public hospitals in Jordan from September 2012 to December 2013. The costs avoided by each intervention to address drug-related problems were collected from the literature. The collected data were used to calculate the overall cost saved and avoided by the interventions implemented to address the identified drug-related problems, adopting a Jordanian healthcare system perspective. Results: A total of 2747 patients were enrolled in the study. Diagnostic interventions, such as the need for additional diagnostic testing, were employed in 95.07% of the 13935 intervention to address the drug-related problem "Miscellaneous" which was the most frequent drug-related problems. Other common drug-related problems categories included inappropriate knowledge (n = 6972), inappropriate adherence (4447), efficacy-related drug-related problem (3395) and unnecessary drug therapy (1082). The total cost avoided over the research period was JOD 1418720 per month and total cost saved over the study period was JOD 17250.204. Drug-related problems were associated the number of prescription medications (odds ratio = 1.105; 95% confidence interval = 1.069–1.142), prescribed gastrointestinal drugs (3.485; 2.86–4.247), prescribed antimicrobials (3.326; 1.084–10.205), and prescribed musculoskeletal drugs (1.385; 1.011–1.852). Conclusions: The study revealed that pharmacists have provided cognitive input to rationalize and optimize the medication use and prevent errors, that led to the reported projected avoided and saved expenditures via various interventions to address drug-related problems. This highlights the added economic impact to the clinical impact of drug-related problems on patients and the healthcare system. The high prevalence and cost of drug-related problems offer strong rationale for pharmacists to provide more vigilant intervention to improve patient outcomes while maintaining cost effectiveness. [ABSTRACT FROM AUTHOR]

Objective: To evaluate predictors of the use of anti-plagiarism detection tools (APTs) in higher education institutions. Methods: An online survey based on the theory of planned behavior was sent to members of science faculties in Jordan. Multivariate Logistic regression was conducted to determine predictors of previous use of APTs, and multivariate linear regression to predict future intentions. Results: A total of 173 faculty members completed the survey, with 78.13% indicating previous APTs use. Turnitin® (43%) and Ithenticate® (32.8%) were the most commonly used APTs. These tools were mainly used to evaluate papers before sending them to journals (65.5%) and to detect plagiarism in theses/dissertations (50.4%). Predictors of previous use were academic rank (p = 0.02) and perceived understanding of APT use (p = 0.043). Intentions for future use were predicted by attitudes (p < 0.001) and perceived behavioral control (p = 0.036). Conclusion: The theory of planned behavior successfully predicted intentions to use APTs. The use of APTs should be encouraged to all faculty members and students. [ABSTRACT FROM AUTHOR]

Self-medication can facilitate patients' access to medicinal products, save time, and reduce financial and health-care service use burden. On the other hand, irresponsible use of self-medications can result in adverse consequences. Self-medication is common among different demographic groups including pregnant women. In general, medicinal products might have harmful effects on mothers and baby. This study aimed to assess self-medication practices among pregnant women in the northern region of Jordan. A cross-sectional study was conducted on pregnant women attending outpatient clinics in the northern region of Jordan. Self-medication practices among the target population were assessed using a survey questionnaire that was administered through interviewer-assisted mode. Data were collected between December 2019 and September 2020, and descriptive statistics and inferential analysis were applied. A total of 1,313 pregnant women were surveyed (response rate = 95.50%). Self-medication and the use of herbal remedies were practiced by 33.10% and 32.14% of the participant, respectively. Headaches and general pains were the most frequently reported conditions treated by self-medication practice with either conventional medicinal products or herbal remedies. The gravidity (≥4) and the gestational stage (≥28 weeks) were the predictors of self-medication practice. This study showed that self-medication was not widely practiced by pregnant women in the northern region of Jordan. Disease simplicity and previous history were the main motives for self-medicating. Efforts should be made by health-care providers to address pregnant women and educate them to increase their awareness about the unsafe use of medicines and the harmful effects on fetus. [ABSTRACT FROM AUTHOR]

Objectives: Medication errors are among the most common medical errors. They can result in mortality, morbidity and additional healthcare costs. Surveillance of medication errors is encouraged to identify gaps in the healthcare system and work on them. This study aimed to compare medication errors in outpatient prescriptions in two hospitals in Jordan: one with a paper‐based and one with an electronic prescription system. Methods: This was a cross‐sectional observational study in two large hospitals in Jordan over a three‐month period. Prescribing and dispensing of medicines were screened for medication errors in both centres: 2500 prescriptions were screened in each hospital. Key findings: In the hospital with electronic prescriptions, of the 2500 prescriptions screened, 631 medication errors were detected: 231 (36.6%) prescription errors and 400 (63.4%) dispensing errors. In the hospital with paper‐based prescriptions, 3714 medication errors were found: 288 (7.8%) prescription errors and 3426 (92.2%) dispensing errors. The most common prescription and dispensing errors in electronic prescriptions were, respectively, prescription of drugs that could have a drug–drug interaction, and omitting to dispense a drug on the prescription. In the paper prescriptions, the most common prescription and dispensing errors were, respectively, inappropriate dose/quantity/frequency or route of administration, and inappropriate and/or inadequate labelling of medication when dispensed, of which there were a large number (2496 (67.2%)). Conclusion: This study highlights the effect of the prescription system used by hospitals. Fewer medication errors were found in the electronic system. Healthcare policymakers, professionals and administrators are encouraged to invest in electronic systems to minimize medication errors. [ABSTRACT FROM AUTHOR]

Objectives: The concept of health literacy (HL) is globally evolving, and understanding its nature and impact is essential for disease prevention and treatment. Therefore, we aimed in this study to assess level of HL and predictors of inadequate HL in Jordanian population as an example case of a developing country. Method: This cross‐sectional study was conducted in a public tertiary hospital and community pharmacies in Jordan. All respondents answered a questionnaire, which included demographic data, Rapid Estimate of Adult Literacy in Medicine‐Revised (REALM‐R), Short Test of Functional HL in Adults (S‐TOFHLA), and All Aspects of HL Scale (AAHLS). Chi‐square test and logistic regression analysis were conducted to determine the relationship and significant predictors for HL. Key findings: Among 310 participants, REALM‐R showed that around 27.1% had limited HL. Similar findings with S‐TOFHLA and AAHLS were shown with a mean score 25.6 out of 35 (SD = 3.54, Range = 16–33) for AAHLS. Functional and critical HL were comparably low. Education level, age, living area and chronic conditions were significant predictors of HL (P < 0.05). Conclusions: Health literacy was inadequate among Jordanians. Further research is required to assess the effect of inadequate HL on healthcare access and health outcomes. Health education programmes are required to improve HL particularly for patients with chronic diseases. [ABSTRACT FROM AUTHOR]

Background: The key patient rights entail respecting human decency, receiving healthcare services of high-quality, the right to information, the initial agreement of the patient to medical intervention, respecting privacy and personal life, and sustaining care and treatment. This study aims to survey the knowledge and practice of nurses in various healthcare industries toward sharing and confidentiality of patients' data. Methods: A descriptive cross-sectional design was employed through an online survey from May to June 2020. The authors sent a developed tool containing 19 statements reflecting the understanding of nurses' knowledge and practice of privacy and sharing of data required to safeguard patient privacy. A total of 800 nurses agreed to participate in the study out of 1000 nurses. Results: Roughly, all participants agreed that junior nurses should participate in a data sharing and confidentiality course before engaging in practice. Regarding institution policies for data sharing and protection, many nurses agreed that there are special recommendations and instructions from the institution in which they work to exchange patient information among nurses and the medical staff. The predictors of sharing practices and confidentiality among nurses include age, gender, marriage status, and attending a security course before practice. Young age, female, not attending a data sharing course, and single nurses are less engaging with data sharing and confidentiality of the patients for unauthorized patients. Conclusion: A significant proportion of the staff had appropriate practices that ensured data security. However, practices that ensure patient confidentiality in the aspects of access, sharing, and transferring of patient data need improvement. Training is essential since it will have a beneficial relationship with knowledge, opinions, views, and actions. Thus, planning continuous training on policies and regulations about data safety and privacy may assist in improving healthcare setting practices. [ABSTRACT FROM AUTHOR]

Objectives: Appropriate ethical framework should be considered when research involves children. The purpose of this study was to investigate parental knowledge and views regarding the ethical aspects of participation in medical research involving their children. Methods: A cross‐sectional survey was conducted at different areas in Jordan. The questionnaire was administered to the parents using a face‐to‐face interview. Key findings: A total of 2000 questionnaires were collected from Jordanian parents, and 72.4% of them were knowledgeable. Parents with Bachelor's degree (OR = 1.33; 95% CI = 1.05–1.68; P = 0.016) and monthly income >1000 JD (OR = 2.12; 95% CI = 1.50–2.98; P < 0.001) indicated better knowledge. In contrast, parents with comorbidity were found to be less knowledgeable (OR = 0.60; 95% CI = 0.44–0.82; P = 0.001). The majority of parents agreed on that different factors such as permission of partner and involvement of healthcare professionals could affect their children's participation in medical research. Interestingly, three quarters of parents (76.3%) were willing to let their children participate in research to help others. Conclusions: These findings highlighted that parental educational level and high monthly income were predictors of good ethical research knowledge, which was opposed by parental comorbidity. Further investigations of other perspectives influencing the decision‐making process of children participation in research, including children and paediatricians, are highly recommended. [ABSTRACT FROM AUTHOR]

Background: Patients with chronic diseases require long-term use of medications and are at risk for prescription of unnecessary drugs.Objective: To determine the prevalence, risk factors, and costs associated with unnecessary drugs in patients with chronic diseases at outpatient settings.Methods: Clinical and demographic data, unnecessary drug therapy and prices of drugs were obtained from 2,677 patients from the outpatient setting of six major hospitals in Jordan. Multivariate logistic regression was used to determine risk factors associated with unnecessary drug therapy.Results: A total of 936 unncessary medications were identified with an average of one unnecessary medication per every three patients. Monthly costs of unnecessary medications, at the national level, were estimated to range between JD 438,930.24 [(618,821.41 USD) (payer's perspective)] and JD 744,765.5 [(1,050,000.19 USD) (patient's perspective)]. Unnecessary drug was associated with cardiac catheterization (adjusted odds ratio [AOR] = 1.29, 95% CI: 1.01-1.71, p = 0.041), increased number of medications (AOR = 3.11, 95% CI: 2.51-3.86, p < 0.001), and inadequate knowledge/understanding of drug use (AOR = 2.4, 95% CI: 1.24-4.64, p = 0.009).Conclusion: Unnecessary drug therapy is common in the outpatient setting. Identified risk factors should be specifically targeted to reduce its burden. [ABSTRACT FROM AUTHOR]

Purpose: The main focus of this study is to assess the knowledge and practices of healthcare practitioners regarding data sharing, security, and confidentiality, with a focus on the use of health data retrieved from electronic health records (EHRs) for research purposes. Methods: A descriptive, cross-sectional, questionnaire-based survey study was conducted across all academic institutions including all researchers in the medical field in Jordan. Personal and administrative practices in data sharing were assessed through collecting data from respondents. Results: The response rate was 22% with an average of 10.25 years of experience in publications. Almost 60% had published at least 1 to 3 studies using EHRs. The prevalence of researchers who "Always" used antivirus software and preserved patient's information was 75.5% and 92.2%, respectively. However, other personal security and confidentiality measures were not satisfactory. Less than half of health data used in the research was "Always" anonymised or encrypted and only around 44.0% had "Always" used sensitive data with more specificity than normal data. Conclusion: Confidentiality and data sharing practices of healthcare practitioners and researchers were generally less than optimal. Efforts from healthcare providers, health institutions, and lawmakers should be put in place to protect the security and confidentiality of electronic patient data. [ABSTRACT FROM AUTHOR]

Background: Treatment-related problems (TRPs) may pose risks for patients if unaddressed. With the increased complexity of health care, it is important to target pharmacists' efforts to patients that are at high risk for TRPs.Objectives: The present study aimed to identify medications most commonly associated with TRPs.Setting: Outpatient departments of five public and teaching hospitals in Jordan.Method: TRPs and drugs most commonly implicated with TRPs were assessed for patients recruited from outpatient clinics in five major hospitals in Jordan using a standardized and validated pharmaceutical care manual.Main Outcome Measure: Drugs associated with different types of TRPs.Results: Ultimately, 2,747 patients, with a total of 10,672 TRPs, were included in the study. The medication groups most commonly associated with TRPs were cardiovascular (53.0%), endocrine (18.1%), and gastrointestinal (7.7%) drugs. The most common specific drugs associated with TRPs from any category were atorvastatin (12.5%), metformin (8.5%), simvastatin (6.2%), and enalapril (5.9%). Cardiovascular medications were the most common drugs implicated with multiple subtypes of TRPs - most commonly, allergic reaction or undesirable effect (88.5%), drug product not available (87.3%), safety interaction issues (81.8%), a need for additional or more frequent monitoring (78.0%), and more effective drugs available (77.2%). Hypertension, diabetes mellitus, and dyslipidemia were the most common diseases associated with different subtypes of TRPs.Conclusion: The present study identified high-risk drugs for TRPs, which can be used as identification of targeting approach TRPs. Such an approach would improve care provided to patients and can inform health care policies. [ABSTRACT FROM AUTHOR]

Background Medication adherence is an important element for the success of any therapeutic plan. The picture is more complicated with warfarin, due to its small therapeutic window and patients' needs to have effective anticoagulation control. Objective To measure warfarin-adherence, warfarin-knowledge and to assess the relationship between adherence and anticoagulation control. Setting Adult outpatients (≥18 years) taking warfarin at two medical sites in north of Jordan were invited to participate. Method This was a cross sectional study in which survey questionnaire that included demographic, clinical, warfarin related questions and Morisky Medication Adherence Scale (MMAS-8) was administered to patients in Arabic language. International normalization ratio (INR) readings were retrieved from patients' medical records. Main outcome measure MMAS-8 adherence scores and time within therapeutic range were calculated. Results More than half of study participants (54 %) were adherent (MMAS-8 = 8). The MMAS-8 adherence scores were significantly associated with warfarin-knowledge scores (Spearman's ρ = 0.291, p = 0.000). Adherent patients were more likely to have good anticoagulation control compared to non-adherent patients (MMAS-8 ≤ 7). Conclusion Adherence to warfarin therapy can have a substantial effect on anticoagulation control. Thus, healthcare practitioners should consider strategies to improve patient adherence to warfarin. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the compliance of healthcare workers with standard safety guidelines during the preparation and administrations of antineoplastic medications. Design: A cross-sectional survey study. Setting: All hospitals in Jordan where healthcare workers are involved in preparation and administration of antineoplastic medications. Participants: All healthcare workers who are involved in preparation and administration of antineoplastic medications in Jordanian hospitals. Intervention: A questionnaire that covered information about work place, healthcare workers, and use of personal protective equipments during handling of antineoplastic medications was self-filled by each participant. Main outcome measures: Compliance rates with workplace requirements, healthcare workers, and use of personnel protective equipments. Results: Majority of participants (74.2%), representing nine out of 15 (60%) hospitals, reported full compliance of workplace with all requirements of the guidelines. Items with full compliance in all hospitals were availability of policies and procedures for safe handling of antineoplastic agents, availability of reporting system, and availability of sharp containers. Concerning healthcare workers’ guidelines, worker with full compliance were 46.4% of participants. Items with least compliance rate were working inside biological safety cabinet (65.1%) and having training program on handling chemotherapy medications (66.7%). Finally, concerning items-related personal protective equipments, only 10.7% of participants reported full compliance. Items with least compliance rates were wearing goggles (eye protection), shoe cover, and hair cover. Conclusions: Results of this study showed the levels of compliance with guidelines pertaining to work place and workers who prepare and administer antineoplastic medications. Among other points, compliance with guidelines pertaining to wearing personnel protective equipments was limited and required further improvement. [ABSTRACT FROM AUTHOR]

Introduction: The use of antimicrobial prophylaxis for surgical procedures is one of the measures employed to prevent the development of surgical site infections (SSI). The appropriate choice of antimicrobial agents, dosage regimen, timing, duration and use of intravenous route must be evidence based. This study aimed to assess the practice of surgical antibiotic prophylaxis and adherence of practitioners to the American Society of Health- System Pharmacists (ASHP) guidelines for antimicrobial prophylaxis in surgery and to explore reasons for non-compliance. Methodology: A cross-sectional study was conducted in 20 Jordanian hospitals from October 2006 to June 2007. A questionnaire was designed to collect information from physicians regarding the practice of surgical antibiotic prophylaxis (SAP), references used for guiding SAP practice, prevalence of surgical site infection (SSI), and causative microorganisms. Results: SAP was employed in almost all surgical departments of hospitals. The improper timing of antimicrobial administration for SAP was attributed to lack of knowledge of the guidelines (46.1%), while the improper antimicrobial choice was ascribed to drug unavailability (61.8%). Conclusion: This study shows that physicians are aware of the importance of antimicrobial prophylaxis before surgical procedures. However, further efforts are needed to ensure the implementation of the standard SAP guidelines in Jordanian hospitals. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objectives: A survey was conducted to estimate the prevalence of self-medication with antibiotics in Jordan and evaluate the factors associated with antibiotic misuse. Methods: Validated questionnaire was used to collect data from a sample of 1943 households (9281 persons) selected from among different cities in Jordan. Results: 842 (39.5%) of 2133 antibiotic users identified via the survey had used antibiotics without a prescription within a one-month study period. Self-medication with antibiotics was found to be significantly associated with age, income, and level of education. The main reason for self-medication as reported by the participants was their previous experience on the efficacy of treatment. The main sources of antibiotics were the previously prescribed pharmaceuticals stored in the household and those purchased in pharmacies. Conclusion: The prevalence of self-medication with antibiotics in Jordan is alarmingly high. Given the growing global resistance to antibiotics and the documented health problems related to their inappropriate use, our findings may have major public health policy implications in Jordan. [ABSTRACT FROM AUTHOR]

Evidence based information sources for physicians are needed for informed antibiotic prescribing practices. The aim of this study was to explore physicians' preferred sources of information and evaluate physicians' awareness of available information and initiatives on prudent antibiotic prescribing in Jordan. A cross-sectional study was conducted utilizing an online questionnaire and included physicians (n = 409) from all sectors and specialties in Jordan. Published guidelines (31.8%), the workplace (25.7%), colleagues or peers (20.0%), group or conference training (18.3%), and the medical professional body (18.1%) were the main sources of information about avoiding unnecessary antibiotic prescribing, with the influence of these sources on changing prescribers' views being 34.7%, 17.1%, 11%, 13.4%, and 7.6%, respectively. One-third of physicians (33.7%) reported no knowledge of any initiatives on antibiotic awareness and resistance. Regarding awareness of national action plans on antimicrobial resistance, 10.5%, 34%, and 55.5% of physicians were aware, unaware, and unsure of the presence of any national action plans, respectively. Physicians showed interest in receiving more information on resistance to antibiotics (58.9%), how to use antibiotics (42.2%), medical conditions for which antibiotics are used (41.3%), prescribing of antibiotics (35.2%), and links between the health of humans, animals, and the environment (19.8%). The findings can inform interventions needed to design effective antimicrobial stewardship, enabling physicians to prescribe antibiotics appropriately. [ABSTRACT FROM AUTHOR]

More research is needed on the drivers of irrational antibiotic prescribing among healthcare professionals and to ensure effective prescribing and an adequate understanding of the issue of antibiotic resistance. This study aimed at evaluating prescribers' knowledge, attitudes and behaviors about antibiotic use and antibiotic resistance. A cross-sectional study was conducted utilizing an online questionnaire and included physicians and dentists from all sectors in Jordan. A total of 613 prescribers were included (physicians n = 409, dentists n = 204). Respondents' knowledge on effective use, unnecessary use or associated side effects of antibiotics was high (>90%), compared with their knowledge on the spread of antibiotic resistance (62.2%). For ease of access to the required guidelines on managing infections, and to materials that advise on prudent antibiotic use and antibiotic resistance, prescribers agreed in 62% and 46.1% of cases, respectively. 28.4% of respondents had prescribed antibiotics when they would have preferred not to do so more than once a day or more than once a week. Among respondents who prescribed antibiotics, 63.4% would never or rarely give out resources on prudent use of antibiotics for infections. The findings are of importance to inform antibiotic stewardships about relevant interventions aimed at changing prescribers' behaviors and improving antibiotic prescribing practices. [ABSTRACT FROM AUTHOR]

Background: The diabetes prevalence is escalating in Jordan; as a consequence, the risk of developing diabetic kidney diseases is also increasing., Objective: This study evaluated the effect of risk factors and comorbidities on kidney function in patients with type 2 diabetes mellitus (T2DM)., Design: A cross-sectional, survey-based study., Setting: Participants were recruited from the endocrinology and cardiology clinics of a tertiary hospital in Jordan., Participants: Patients with T2DM aged 18 years and more who had undergone a kidney function test within a year before data collection., Outcome Measures: The estimated GFR (eGFR) mean values and proteinuria presence were used to evaluate the impact of risk factors on kidney function. Descriptive and analytical statistical approaches were used to calculate mean, prevalence and correlations. The SPSS software was used with a p value < 0.05 for significance., Results: Of the total 331 study participants, 54.1% were men and 45.9% were women. The mean age was 60 years. The eGFR mean values were significantly reduced in patients with T2DM with hypertension, hyperlipidaemia and proteinuria (p<0.01). The correlation analysis results showed that the eGFR was positively correlated with hypertension and hyperlipidaemia presence (r s =0.253, 0.220), and negatively correlated with age, body mass index and diabetes duration (r s =-0.395, -0.151, -0.221), respectively. However, the eGFR did not corelate with income, sex, smoking and anaemia. Of note, about 68% of the patients with T2DM had uncontrolled diabetes., Conclusions: Kidney function were severely affected in patients with T2DM in the presence of risk factors and comorbidities. It is highly recommended to control diabetes through medications and life style, and to regularly check for kidney function to halt the deteriorations in kidney function., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: Polypharmacy is usually associated with duplication of therapy, unnecessary medications and adverse drug reactions. Therefore, it is crucial to study the factors that increase the risk of polypharmacy. The objective of this study was to assess the risk factors for polypharmacy (i.e. the concomitant use of at least five medications) with a special focus on comorbidity in Jordan., Methods: Using a retrospective cross-sectional study design, medical records of patients (age ≥55 years), which covered slightly over one-fourth of the population, found in a national electronic healthcare database from 2018 to 2019 were retrieved. Polypharmacy, the main outcome, was defined as the current use of at least five medications (the patient should have at least one chronic condition, one medication refill and continuous use of the medication for at least 30 days). Comorbidity, the main exposure, was summarized using the Charlson Comorbidity Index (CCI). Potential predictors of polypharmacy were examined using a multivariable logistic regression analysis., Key Findings: An eligible sample of 113 834 individuals (mean age 68 years, 51.5% female) were included in the analysis, of whom 38% met the polypharmacy definition (28% were categorized as having major [5-9 medications] and 10.2% exhibited excessive polypharmacy [≥10 medications]). Approximately, 20% of the patients had a CCI of ≥1. The most significant predictors of polypharmacy were a CCI score between 3 and 4 (adjusted odds ratio [AOR] = 5.89; 95% CI, 5.10 to 6.80; P < 0.001), gender (AOR = 0.86; 95% CI, 0.82 to 0.86; P < 0.001), and age ≥75 years (AOR = 1.62; 95% CI, 1.57 to 1.67; P < 0.001)., Conclusions: Polypharmacy is common among patients in Jordan. Comorbidity is positively, independently and strongly related to polypharmacy. Identifying groups who are at the greatest risk for polypharmacy can help optimize patients' treatment, which can lead to better outcomes and improved quality of life., (© The Author(s) 2021. Published by Oxford University Press on behalf of the Royal Pharmaceutical Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: Hypoglycaemia is one of the most serious adverse effects of diabetes treatment. Older adults are at the highest risk to develop hypoglycaemia. Several studies have established the important positive role of educational interventions on achieving glycaemic control and other clinical outcomes, however, there is still a lack in studies that evaluate the impact of such type of interventions on hypoglycaemia risk in elderly patients with type 2 diabetes. The purpose of this research is to evaluate the effectiveness of pharmacist-led patient counselling on reducing hypoglycaemic attacks in older adults with type 2 diabetes mellitus., Methods: and analysis: This study is an open-label, parallel controlled randomised trial, which will be conducted in the outpatient clinics at the largest referral hospital in the north of Jordan. Participants who are elderly (age ≥ 65 years), diagnosed with type 2 diabetes mellitus, and taking insulin, sulfonylurea, or any three anti-diabetic medications will be randomly assigned to intervention (SUGAR Handshake) and control (usual care) groups. The SUGAR Handshake participants will have an interactive, individualised, medications-focused counselling session reinforced with a pictogram and a phone call at week six of enrolment. The primary outcome measure is the frequency of total hypoglycaemic events within 12 weeks of follow up. Secondary outcomes include the frequency of asymptomatic, symptomatic, and severe hypoglycaemic events, hypoglycaemia incidence, and time to the first hypoglycaemic attack. We will also conduct a nested qualitative study for process evaluation., Ethics and Dissemination: The Human Research Ethics Committee of the University of Lincoln and the Institutional Review Board of King Abdullah University Hospital approved this protocol. The findings of this study will be presented in international conferences and published in a peer-reviewed journal., Trial Registration Number: The study protocol has been registered with ClinicalTrials.gov, NCT04081766., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Irrational drug prescribing is considered one of the major challenges for the healthcare sectors worldwide, leading to negative outcomes in patients including various drug-related problems, such as polypharmacy, adverse drug events, more demands on drug monitoring, and unwanted increase in treatment cost., Objective: The main objective of this study was to evaluate the trends and issues related to prescription at outpatient hospital pharmacies in Jordan and to contrast that to the WHO rational medication list and WHO drug use indicators., Method: This study was a cross-sectional study, conducted between January 2014 and May 2014. It involved a total number of 24,089 patient encounters from five teaching and referral hospitals in Jordan. The encounters included patients who were prescribed at least one medication during their visit to outpatient clinics in those hospitals., Results: The average number of drugs per prescription was 2.93. The percentage of encounters which had antibiotics or injections in the prescription was 17.7% and 8.1%, respectively. The top three most common prescribed antibiotics were amoxicillin (n = 2,129, 49.9%), ciprofloxacin (n = 609, 14.3%), and clarithromycin (n = 267, 6.3%), while the most common prescribed injections were insulin and insulin analogs (n = 766, 39.2%), cyanocobalamin (Vitamin B 12 ) (n = 612, 31.3%), and erythropoietin (n = 80, 4.1%). The percentage of prescriptions by generic was 57.6%, whereas the prescribing from the essentials drug list (formulary) was close to optimal (99.8%)., Conclusion: The average number of prescribed drugs per encounter was higher than what was considered ideal according to WHO standards; the other issue found was a lower percentage of generic prescribing compared to WHO ideal value. The rest of prescribing indicators including the injections prescribing, antibiotics prescribing, and prescribing from the essential drug list were within the optimal range of values recommended by the WHO.
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Quality of life among colorectal cancer (CRC) patients was evaluated using the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ) C30 and EORTC QLQ-CR29. We interviewed 74 CRC patients, and our results indicated lower anxiety functional scores and higher abdominal pain and embarrassment symptom scores among patients aged 55 and under. Patients with disease metastasis showed significantly lower global health scores and higher fatigue, loss of appetite, hair loss, and change in taste symptom scores. Scores for emotional functioning were significantly lower among patients with stage IV disease. Fatigue, nausea and vomiting, loss of appetite, abdominal pain, and change in taste symptom scores were significantly higher in patients treated with a combination of surgery and chemotherapy compared to surgery alone. Age, disease metastasis, late disease stage, and combined treatment modalities were associated with lower scores on health-related quality-of-life scales; patients likely to have low scores on these measures should receive special attention from healthcare providers and be targeted by supportive care strategies.

Background: Due to the lack of properly tested medicines for children, there is little available information with regards to indications and dosing of medications in children., Aim: To collect data on sources where hospital based pediatricians obtain prescribing information when treating children and the extent of collaboration with the hospital pharmacist., Method: Two hundred and fifty pediatricians in different hospitals within different cities in Jordan were asked to fill in a structured questionnaire regarding information sources used when prescribing for children., Results: Questionnaires were collected from 162 (64.8%) hospital based pediatricians, who have completed the questionnaire by the designated date. Most (75.5%) reported that the Lexi Comp's Drug Information Handbook was the source that they most frequently used for drug information when prescribing for in children. The BNF and the BNFc (British National Formulary for children) were found to be the most sources that contain sufficient information that aids pediatricians when prescribing for children. A minority (22%) claimed to consult with the hospital pharmacist when they face difficulties when prescribing for children., Conclusions: Pediatricians rely on different information sources when they prescribe for children. Those sources vary in their reliability in aiding pediatrician when prescribing. Further work should be done in the provision of useful information on pediatric drug therapy to pediatricians. More steps should be taking place to activate collaboration and interaction between pediatricians and pharmacists as well.

Objective: Clinical pharmacy services are still in the early stages of implementation in the Middle East. This study assessed the implementation of clinical pharmacy services at a major university hospital., Methods: All recommendations and services provided by clinical pharmacists were recorded for a period of 7 months., Key Findings: During the study period a total of 3026 patients were followed up and 10,783 recommendations and services were provided. The physicians' rate of acceptance of clinical pharmacists' recommendations was 69.4%., Conclusion: The implementation of clinical pharmacy services in this setting was successful and should positively impact patient care., (© 2012 The Authors. IJPP © 2012 Royal Pharmaceutical Society.)

Objective: Aspirin is an antiplatelet agent commonly used in treatment of patients with high risk to develop stroke and myocardial infarction. However, inter-individual variability regarding the inhibition of platelet function by aspirin is well documented. In this study, the correlation between platelet glycoproteins (GPIa C807T and GPIba C-5T) and cyclooxygenase 2 (COX-2G-765C) polymorphisms and antiplatelet response in patients treated with aspirin was investigated., Methods: Jordanian adult patients (n=584) who are taking aspirin as an antiplatelet agent participated in the study. Platelet aggregation response was measured using Multiplate Analyzer® system. Polymerase chain reaction-restriction fragment length polymorphism assay (PCR-RFLP) was used for genotyping of the examined polymorphisms., Results: Aspirin resistance was found in 15.8% of patients. Response to aspirin was significantly associated with GPIba C-5T polymorphism (P<0.05). However, the GPIa C807T and COX-2G-765C polymorphisms were not related to aspirin resistance (P>0.05)., Conclusion: A considerable fraction of the Jordanian population is resistant to the antiplatelet effect of aspirin, which might be related to GPIba C-5T polymorphism., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Objective: To assess the level of the current knowledge and understanding of cardiovascular disease (CVD) among Jordan's general public, their behaviour towards CVD and the factors associated with different CVD knowledge levels., Methods: The data in the present study were collected using an interview-administered questionnaire. One thousand members of the general public were interviewed face to face. CVD knowledge was computed as a continuous variable., Key Findings: The present study reports limited public knowledge and awareness of CVD. Participants were more likely to have better CVD knowledge scores if they were non-smokers, always or often paid attention to their diet, reported having an 'about right' weight, occupied a very high socioeconomic level, held a university degree and had positive family history of CVD. Participants indicated that the community pharmacists had to play a role in helping patients manage their prescribed medicines; however, they did not recognise the community pharmacists' role in other areas of CVD prevention and management., Conclusion: The present study reports that the general public in Jordan has limited knowledge and awareness of CVD. In planning to positively impact CVD prevention and management, community pharmacists must develop and promote effective and accessible services., (© 2012 The Authors. IJPP © 2012 Royal Pharmaceutical Society.)

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.

Objectives: The aim was to evaluate the awareness and implementation of the Smoking Cessation Clinical Practice (SCCP) guidelines., Methods: A self-reported questionnaire based on the updated version of the SCCP guidelines was completed by 422 healthcare providers (HCPs) including physicians, dentists, dental hygienists and pharmacists recruited from both public and private sectors in Jordan., Key Findings: The majority of HCPs reported good smoking-cessation practices. However, their awareness about the SCCP guidelines was inadequate. Approximately 68% of HCPs lacked knowledge of the 5As; about 74% lacked knowledge of the 5Rs of the clinical guidelines for smoking cessation, which are the principal guidelines for smoking intervention and motivation to quit smoking. Fortunately, about 70% of participants from all groups examined and applied most of the steps in the guideline spontaneously without previous knowledge of the guideline. This spontaneous practice could be due to their vast practical experience, and the use of logic and/or basic knowledge about smoking cessation. Compared to physicians, pharmacists and dental hygienists showed significantly more frequent practice of most steps with patients willing to quit smoking., Conclusions: Jordanian HCPs showed good, spontaneous smoking-cessation practice. However, this practice could have been better if HCPs had adequate awareness of the SCCP guidelines.

Review of literature revealed no studies about the predominant causes and risk factors of acute renal failure in Jordan. This study identifies the most common causes of acute renal failure and the possible risk factors among hospitalized Jordanian population. A total of 111 patients were admitted to both King Abdullah University Hospital and Princess Basmah Teaching Hospital from December 2005 to April 2006 with a diagnosis of acute renal failure or developed acute renal failure in hospital during their stay. A written form was filled from the patients and their files. Results showed that 31.5% of patients were diabetic, 44.1% were hypertensive, and 40.5% had preexisting chronic renal failure. On admission, creatinine blood levels were high in 97 patients (87.4%), while at discharge, they were high in 61 patients (55%). Urgent dialysis was done for 20 patients (18%). In all, 95 patients (85.6%) were discharged home, and 16 patients (14.4%) died in hospital. Causes of acute renal failure included dehydration, diuretics, sepsis, contrast media, nonsteroidal anti-inflammatory drugs, glomerulonephritis, systemic lupus erythematosus, stones, and others. In conclusion, one-third of the causes of acute renal failure in this sample of hospitalized Jordanian patients were due to drugs, which makes this problem preventable. Mortality was affected by the age of patients and the duration of hospitalization.

Background: Chronic renal failure (CRF) is a major medical problem, not only because of its prevalence, but also because of its complications, which have a huge impact on a person's life, both mentally and socially. By investigating the etiologies predisposing patients to CRF, we might be able to give recommendations about what should be done to avoid it., Methods: A questionnaire was filled in from patients who presented with CRF to 2 major hospitals in Irbid, Jordan, investigating the causes and risk factors for CRF available in those patients., Results: A total of 235 patients were diagnosed with CRF in 2 major hospitals in Irbid, Jordan. Around 72.8% of these patients were older than 40 years, 53.6% were females. Diabetes mellitus was the leading cause of CRF (44.7%); the second cause was glomerulonephritis (9.8%); and chronic use of nonsteroidal antiinflammatory drugs (NSAIDs) was the third cause (8.9%)., Conclusion: A large percentage of patients had CRF due to diabetes. We provide evidence that our prescriptions must be revised, as chronic use of NSAIDs was the third leading cause of CRF. Both of these causes are seemingly preventable, and efforts should be made to eliminate them from the list of etiologies.