Search

Background: Inhaled drug delivery has been hailed as a major advancement in respiratory therapeutics. However, a major limitation to use the inhaled medications effectively is the inability of patients and nurses to use and demonstrate the proper use of these devices correctly. Being the drug experts, pharmacists are in a pivotal position to delivered tailored education to their peers, the nurses., Aim: This study aims to examine nurses' knowledge of asthma management, their ability to demonstrate proper inhaler technique, and the impact of a specialized workshop training program delivered by skilled pharmacists on improving their performance., Methods: This is a pre- and post-cross-sectional study design in hospital setting where nurses were recruited from the respiratory and emergency departments within a healthcare facility in the United Arab Emirates (UAE). The nurses attended a training workshop prepared and delivered by skilled pharmacists on inhaler technique demonstration skills. Nurses' inhaler technique demonstration skills for Diskus, Turbuhaler, and pMDI were assessed at baseline, immediately after the workshop, and after four weeks. The nurses completed the demographic and Asthma Knowledge Questionnaire (AKQ)., Results: A random convenience sample of registered nurses (n=20) from the respiratory and emergency departments was recruited from a tertiary hospital in Sharjah, UAE, with a mean age of 35.25 (SD=6.96) years, of whom 90% were females. The mean number of years of experience was 12.00 years (SD=5.81). Inhaler technique assessment revealed low inhaler technique scores for all the three study inhalers at baseline (mean score for Diskus=3.85 (SD=2.87); Turbuhaler=3.70 (SD=3.20); pMDI=4.50 (SD=2.65)) Significant improvements in inhaler technique scores were noted after the workshop (Diskus=8.9 (SD=0.31); Turbuhaler=8.9 (SD=0.31); pMDI=8.0 (SD=0.00), P<0.001). A significant difference in AKQ scores was found before (mean=4.85 (SD=1.27)) and after (mean=7.50 (SD=0.95)) the workshop training session (P<0.001), and four weeks after the workshop training session (mean=7.55 (SD=0.76), P<0.001)., Conclusion: The UAE nurses' inhaler technique and AKQ scores were suboptimal at baseline. The specialized training program prepared and delivered by the skilled pharmacists improved nurses' inhaler technique demonstration skills and AKQ scores. Such improvements would reflect positively on patients' asthma management outcomes as nurses are the health care professionals who interact the most with the patients during hospitalization., (Copyright: © Pharmacy Practice.)

Objective: The aim of this study was to explore association of initial laboratory parameters of hospitalized patients with COVID-19, with the severity and death incident., Methods: In this retrospective study, patients were classified based on mortality outcome (survivor and non-survivor) and disease severity (non-severe, severe, and critical). The initial laboratory data (within the first two days of hospital admission) were compared between these categories., Results: Of 362 COVID-19 patients hospitalized between January-2021 and May-2021, 39.0% were non-severe, 32.2% severe, and 28.7% critical. 77.3% were lived and 22.7% died in hospital. Non-survivors were significantly older than survivors. There was a statistically significant association between exceeding the cut-points of laboratory parameters and the severity of the disease or even death. These laboratory parameters included D-dimer, C-reactive protein, prothrombin time, ferritin, white blood cells, neutrophil count, aspartate aminotransferase, creatinine, blood urea nitrogen, lymphocyte count, and albumin. Also, exceeding the cut-points of these parameters showed high odds of death. The highest odds ratio was reported for albumin <3.5 g/dL (OR=14.318 [4.784-42.851], p<0.001)., Conclusion: The cut-points of the laboratory parameters could effectively be used as predictors to assess the severity and risk of death to improve the management of COVID-19 patients., (Copyright: © Pharmacy Practice.)

Worldwide, during the COVID-19 pandemic in 2019, there was an increase in the tendency of misusing prescription drugs as well as self-medicating with over-the-counters. Additionally, an increase in the use of herbs and natural products was reported. A descriptive cross-sectional survey was conducted in Jordan from May 19th to July 29th, 2021, to assess the medications and natural products used in Jordan during the second wave of the pandemic. The survey was developed and validated, then distributed using Google Forms via social media platforms. Data was analyzed using Statistical Package for Social Sciences-24. The study participants (n = 386) had a mean age of 29.35 (SD = 11.90) years. Most of participants were females (72.8%), not married (64.5%), non-smoker (69.2%), have a Jordanian nationality (80.6%), hold a bachelor's degree (73.1%), and living in the middle of Jordan (74.1%). More than 70% of the participants used vitamin C, D and pain relievers. The most used natural products were citrus fruits (78.8%), honey (63.0%) and ginger (53.1%). The participants reported that family and friends (55.4%) played a major role in advising them to use medications and dietary supplements. Pharmacists ranked second (54.1%), followed by social media platforms (43.3%). Multiple logistic regression analysis highlighted that only the age significantly affected the participants' use of medications and natural products (P < 0.001). The results of this study warrant the need of conducting awareness campaigns guided by trained healthcare providers to educate people and minimize the risk of side effects that may arise from unsupervised use of medications and natural products., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Author(s).)

Objective: To investigate the effectiveness of an online tutorial and its impact on improving knowledge and skills of pharmacy students in the clinical problem-solving process that is necessary to implement pharmaceutical care., Methods: This is a prospective interventional study conducted during the COVID-19 pandemic restrictions using four novel templates. The first two levels of Kirkpatrick's Model (Reaction and Learning) were used., Results: 129 participants completed all of the online training parts. The findings indicated a significant improvement in the students' knowledge and skills. The participants achieved higher score following the tutorial than the baseline, with a statistically significant difference (p < 0.001). There was a significant improvement in the number of detected treatment-related problems. The majority of students were satisfied with the overall training process and stated a high evaluation score out of 10 (mean = 7.93 ± 1.42, median = 8.00)., Conclusion: The educational intervention achieved a substantial positive impact on decision-making skills of participating students and was considered effective in helping them attain basic skills such as teamwork, peer assessment, communication and critical evaluation. Healthcare providers must work together to ensure accurate medication use during care transitions. Pharmacists, as medication experts, play an important role in the implementation process. Pharmacy educators must prepare pharmacy student to use pharmaceutical care in their future practice., (Copyright: © Pharmacy Practice.)

Background: The coronavirus disease identified in 2019 (COVID-19) led to extreme actions being taken by the governments to restrict the spread of this virus. Closure of schools, sport clubs and playgrounds were among these actions; children had to stay indoors and were not allowed to pursue their normal lifestyle activities., Objectives: To assess the differences in health-related behaviors among Jordanian school-aged children (6-16 years) before and during COVID-19 quarantine and to evaluate public's perception of the role of pharmacists regarding children's health-related behaviors management., Methods: A cross-sectional study was conducted from August 2020 to January 2021 using an anonymous web-based survey. The survey was developed based on previously published surveys. Evaluation of the validity and reliability of the survey were conducted by a professional committee of clinical pharmacists and a statistician., Results: A total of 230 children, aged 9.02± 2.977 participated in the study. Physical activity and healthy balanced meals decreased (less than 1 hr or 1-3 hrs/week vs 2 meals/day, p= <0.001), whereas daily screen time (1-3 hrs/week vs 4-6 hrs/week, p= <0.001), sleep hours (8-9 hrs/day vs 10-11 hrs/day, p= <0.001) and the ingestion of unhealthy snacks had increased (1-2 meals/day vs. 2-3 meals/day, p=<0.001). A positive perception of pharmacists' role during the pandemic was revealed., Conclusion: The present study showed that a significant change in children's health-related behavior happened during the COVID-19 pandemic. Such changes can lead to social, physical and mental health problems. The public perceived community pharmacists as trusted health care professionals during the pandemic., (Copyright: © Pharmacy Practice.)

Background: Adherence to medication is the cornerstone to achieve the best treatment outcome. Pharmacists are healthcare professionals found in a pivotal position to assess asthmatic patients' adherence to medication. A brief, reliable, and valid measure of patients adherence to mediations is useful to enable the pharmacists to deliver that vital service., Objective: To develop a reliable and valid adherence assessment tool for asthmatic patients., Methods: The Adherence to Asthma Medication Questionnaire (AAMQ-13) was developed based on an extensive literature review, followed by applying the Delphi technique, and then it was pilot-tested by 55 patients. The final AAMQ-13 was completed by 213 patients. Psychometric evaluation was assessed including reliability, criterion validity, and construct validity., Results: The AAMQ-13 is a feasible 13-item questionnaire, as it can be completed within an average of two minutes. It has high reliability (Cronbach's alpha= 0.87). Criterion-concurrent validity was established by comparing the AAMQ-13 to the Test of the Adherence to Inhaler (TAI) and the pharmacy refill records. Criterion-convergent validity was established by comparing the AAMQ-13 to the Asthma Control Test (ACT) questionnaire and the Positive Health Behaviors Scale (PHBS). Construct validity was established through AAMQ-13 factor analysis which revealed two factors explaining 51.76% of the total variance., Conclusion: The AAMQ-13 is a reliable and valid questionnaire with several desirable characteristics as it has high reliability, good criterion validity, and strong construct validity. The AAMQ-13 is a suitable questionnaire that can identify non-adherent patients and reveal the reasons behind their non-adherence : Asthma; Adherence to medication; Compliance; Questionnaire; Self-report; Scale; Survey., (Copyright: © Pharmacy Practice.)

Objective: To provide an overview of instruments that measure adherence to medications to facilitate selection of an instrument and to provide a summary of some published adherence assessment tools tailored to be used by the healthcare team, especially the pharmacists., Data Sources: Studies were identified via PubMed, Medline, Embase, and Google Scholar using the search terms medication adherence, compliance, persistence, combined with the terms questionnaire, scale, survey, self-report, and instrument., Study Selection: Articles written in English, describing questionnaire instruments that were psychometrically evaluated (reporting a good coefficient of internal consistency, reliability assessed through Cronbach's alpha, and had been validated against a subjective or objective measure), and containing 30 or fewer items were included., Data Synthesis: Twelve instruments were identified and included in this review. Instruments were reviewed by evaluating specific characteristics (number of items, sample size, reliability, sensitivity, specificity, questionnaire completion time, criterion validity, and component analysis)., Conclusion: Various instruments are used to assess patient adherence to medications; however, no single one performs well on all criteria. Every instrument has different advantages and unique properties. A particular instrument can be chosen after considering certain factors, such as the specific requirements, population, the needed time to complete the questionnaire, the sensitivity, and the specificity of the questionnaire. Moreover, there is a recognized need to provide primary care medication adherence services customized to patient's needs. A link for teamwork between healthcare providers such as pharmacists and patients is needed. This link can be a validated instrument to assess patient's adherence to medication., Competing Interests: The authors declare no relevant conflicts of interest or financial relationships., (© 2022 Nassar et al.)

Background: Patients infected with coronavirus have new experiences and hence new needs from the healthcare sector. Acknowledging patients' experiences can exhibit promising outcomes in coronavirus management. Pharmacists are considered a vital pillar in managing patients' experiences during their infection., Objective: To assess the experience of individuals who have been infected with coronavirus and the roles played by pharmacists to meet their new needs., Methods: This descriptive cross-sectional survey was developed based on previous literature, validated, and conducted in Syria. The survey included items related to participants' COVID-19 experiences, and items concerning the roles played by pharmacists when participants were infected. Items were tested for face validity. Data collection was conducted in May and June 2021. Data was analyzed using the Statistical Package for the Social Sciences (SPSS)., Results: The study participants (n=576) had a mean age of 37.99 years. Fatigue was the most reported symptom by the participants. Vitamin C was the most used supplement (76.4%), and 66.5% of the participants used herbs during their infection. More than 60.0% of the participants stated that their anxiety and stress levels increased during their infection. Around 40.0% of the participants needed to visit a specialist doctor. Only 5.4% needed to use an artificial respiration apparatus. The mean of the participants' infection severity was 4.97 (SD=2.30) out of 10. The severity of the infection was significantly affected by being older, female, smoking, and having a chronic condition. Doctors followed by pharmacists were the healthcare providers who advised participants to take certain medications/herbs. More than one-third of the participants strongly agreed/agreed that the pharmacist played important and effective roles during their infection., Conclusion: Patients' experiences indicated that fatigue was the most reported symptom by the participants diagnosed with coronavirus infection, while vitamin C was the most used supplement. Pharmacists have a major role in helping participants manage their infection and are considered a vital pillar in patients' experiences since they provided patients with the needed medications., (Copyright: © Pharmacy Practice.)

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) is a highly contagious virus causing COVID-19 disease that severely impacted the world health, education, and economy systems in 2020. The numbers of infection cases and reported deaths are still increasing with no specific treatment identified yet to halt this pandemic. Currently, several proposed treatments are under preclinical and clinical investigations now, alongside the race to vaccinate as many individuals as possible. The genome of SARS-CoV2 shares a similar gene organization as other viruses in the Coronaviridae family. It is a positive-sense, single-stranded RNA. This feature suggests that RNA interference (RNAi) is an attractive prophylactic and therapeutic option for the control of this pandemic and other possible future pandemics of the corona viruses. RNAi utilizes the use of siRNA molecules, which are 21-29 nt duplexes RNA molecules that intervene with targeted gene expression in the cytoplasm by a specific mechanism of complementary destruction of mRNA. Previous experience with SARS-CoV and the Middle East respiratory syndrome (MERS) showed that siRNA molecules were effective against these viruses in vitro and in vivo. Moreover, there have been extensive advances in siRNA technology in the past decade from chemistry and target selection considerations; which concluded with the successful approval of two commercial products based on siRNA technology. In addition, the current knowledge of the genome structure and functionality of the corona viruses enables the recognition of conserved sequences to optimize siRNA targeting and avoid viral escape through mutations, either for the current SARS-CoV2 as well as future corona viruses., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background: Pharmacy practice today mandates "patient-centered care", thereby assigning higher levels of professional responsibility for pharmacists leading to ethical challenges. These challenges often involve ethical principles, institutional, personal, or other constraints that can pull practitioners in incompatible opposite directions, creating "ethical dilemmas" in many circumstances. Pharmacists are expected to handle challenges competently and in the best interest of patients. Literature underlines the positive impact of educational interventions focusing on ethical awareness and competence, and that "gaps" existed in pharmacy training/curricula for Jordanian pharmacists. The objective of this study was to develop, implement, and evaluate the utility of a tailored ethics education component in the pharmacy curriculum for students enrolled at a well-ranked Jordanian university., Educational Activity and Setting: Fifth-year pharmacy students attending summer school at a university in Jordan from July to September 2020 were invited to participate in an educational intervention (suite of didactic online lectures and skills-based workshops). This study was delivered in four parts, with a pretest administered immediately before and a posttest survey immediately after the educational intervention, the educational intervention (three phases), and focus-group discussions to elicit students' feedback., Findings: Findings indicated enhanced levels of confidence in students' decision-making. The development of students' moral reasoning and decision-making skills were also observed to be improved., Summary: This study highlighted the importance of the implementation of an ethics course in pharmacy undergraduate curricula. It emphasized the positive impact this course made on the students' learning experiences and provided a strong environment for discussion and group learning., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objectives: To assess pharmacists from Syria and Iraq on their knowledge, readiness, and perspectives on their roles during the COVID-19 pandemic. In addition to investigate pharmacists' perceived barriers towards delivering their emergency roles during the COVID-19 pandemic and perceived policymakers' responsibilities., Methods: This cross-sectional study design was conducted in Iraq and Syria during COVID-19 outbreak over one month (April 2020). The study objectives were addressed through a validated online questionnaire. Data was analyzed using statistical package for social science (SPSS)., Results: A total of 916 individuals participated in this study (447 from Iraq and 439 from Syria). Most of Iraqi participants were students while most of Syrian participants were graduates and technicians. The mean age for the Iraqi participants was 22.5 (SD= 4.1) while the mean age for the Syrian participants was 28.7 (SD= 9.1). A significant difference (p< 0.001) was found in following the latest coronavirus updates on management among pharmacy graduates and technicians and undergraduate students. Media was reported as the most used source for knowledge about epidemics/pandemics among the Iraqi and the Syrian participants. Around 72% strongly agreed/agreed that the faculties of pharmacy have a role in preparing them to deal with epidemics/pandemics. In addition, 64.3% strongly agreed/agreed that pharmacist associations and societies have a role in preparing them to deal with epidemics/pandemics such as the coronavirus. Moreover, 82.9% believed that pharmacists should receive training programs on how to provide mental health support for people during epidemic and pandemic outbreaks., Conclusion: Tertiary pharmacy education providers and pharmacy professional bodies have a strong role in preparing pharmacists to deal with pandemics. Therefore, the importance of providing beforehand training programs on epidemics/pandemics management, workshops, lectures, and online information resources for such circumstances is crucial for pharmacists., (Copyright: © Pharmacy Practice.)

Background: With the outbreak of Coronavirus infection (COVID-19), pharmacists play an important role in supporting local health during this emergency., Aim: To assess the knowledge and to identify information sources regarding COVID-19 used by pharmacists, to investigate the active and public perceived roles of pharmacists, to explore the role of the pharmacy facilities and health authorities, and to identify barriers that would hinder pharmacists from performing their duties optimally in the United Arab Emirates., Methods: This descriptive cross-sectional online study was conducted in the UAE during the COVID-19 outbreak, from 18 May to 20 June 2020. A validated online questionnaire addressing participants' current knowledge about pandemics and COVID-19, source of information, and their perspectives of their role was used. Participants were licensed pharmacists practising in community and hospital pharmacies in UAE, academics, and pharmacy students., Results: Almost two-thirds of the participants (71.2%) were aged 18-30 years, with 76.2% females. Only 57.5% of participants believed that they got enough education about pandemics, and 88.3% of them followed on the latest coronavirus updates regarding treatments, and that is mainly from the World Health Organization reports (53.9%), followed by health authorities (44.8%). Two-thirds of participants (69.7%) had good/very good current knowledge regarding COVID-19. Knowledge of pharmacy students compared to pharmacists was significantly higher (p < 0.001)., Conclusion: The majority of pharmacists and pharmacy students reported that they have a major role in managing pandemics executed through the community pharmacies and that it is their role to ensure the availability of key medications. Policymakers and health authorities are called upon to train pharmacists in advance of emerging situations, supporting and helping them to optimally fulfill their role., (© 2021. The Author(s).)

Background: The fact that pharmacists are in the front line of patients' care gives a great responsibility to focus on education and training of pharmacy students to build a 'patient-centered' clinicians. Unfortunately, pharmacy education in the developing countries, have been lagging behind actual practice delivered by pharmacists. This highlighted the need to evaluate the perceptions of undergraduate pharmacy students regarding their current pharmacy training practices and experiences., Methods: This is a cross-sectional study that was conducted in Jordan during the period from August 2018 to October 2018. During the study period, a questionnaire was distributed to pharmacy students to collect information regarding 1) pharmaceutical care services provided by them during their experiential training, 2) their perceptions towards training sites, 3) their perceptions of the outcomes of their training experience, 4) information about their training site and 5) their demographics characteristics., Results: A total of 202 pharmacy students responded to the questionnaire. The majority of them reported having the opportunity to dispense refill or new prescriptions (73.8%, n = 149), and conduct patient interviews (69.8%, n = 141, but they were not provided good opportunities to create electronic patient profiles using the information obtained (53.0%, n = 107), perform required dose calculations based on patient information (37.6%, n = 76), and interact with other healthcare professionals (34.6%, n = 70). In addition, students showed positive attitudes toward training sites, positive feedback about the outcomes of their training experience (median scores range between 4 and 5 for all statements (IQR = 1 for all))., Conclusion: Students showed positive feedback about the outcomes of their training experience, but they felt that the selected training sites do not have adequate resources to meet their training competencies. Memorandums of understanding development is needed to specify the purpose of training and define the responsibility for both parties of the training process.

Patient-centered pharmacy practice involves increased pharmacist engagement in patient care. This increased involvement can sometimes require diverse decision-making when handling various situations, ranging from simple matters to major ethical dilemmas. There is literature about pharmacy ethics in developed Western countries. However, little is known about pharmacists' practices in many developing countries. For example, there is a paucity of research conducted in the area of pharmacy ethics in Jordan. This study aimed to explore the manner in which ethical dilemmas were handled by Jordanian pharmacists, the resources used and their attitudes towards them. Semi-structured, face to face interviews were carried out with 30 Jordanian registered pharmacists. The transcribed interviews were thematically analysed for emerging themes. Four major themes were identified: legal practice; familiarity with the code of ethics; personal judgement, cultural and religious values; and Experience. Findings showed that ethical decision-making in pharmacy practice in Jordan was decisively influenced by pharmacists' personal moral values, legal requirements and managed by exercising common sense and experience. This pointed to gaps in Jordanian pharmacists' understanding and application of basic principles of pharmacy ethics and highlighted the need for professional ethics training, incorporating pharmacy ethics courses in pharmacy undergraduate curricula, as well as professional development courses. This study highlighted that paternalism, personal values and legal obligations were major drivers influencing decision-making processes of Jordanian pharmacists. Findings also highlighted an inclination towards lack of respect for patient autonomy. This illuminated the need for increasing pharmacists' literacy in professional ethics.

Background: Polycystic ovary syndrome (PCOS) is a serious health problem. In women experiencing PCOS, there are myriad physical and mental health consequences; anxiety/depression are commonly associated with this condition. Community pharmacists are in a pivotal position to identify and help women diagnosed with PCOS., Objectives: To investigate the prevalence/severity of anxiety/depression among females diagnosed with PCOS living in Syria (a war-zone country) and Jordan (a non-war zone country). Secondly, to evaluate the impact of a pharmaceutical care service delivered by a clinical pharmacist on participants' anxiety/depression severity., Methods: Females, diagnosed with PCOS above the age of 16, were recruited into the study and randomly allocated into either the active or the control group. The active group participants received a PCOS pharmaceutical care service. This service involved the provision of verbal and written educational materials, with a special focus on diet and exercise. The control group participants received only standard counseling. Both groups were followed up for four months. All participants completed the Beck Anxiety Inventory and the Beck Depression Inventory at baseline and follow-up., Results: Data from study participants (n = 118) from both Syria (n = 60) and Jordan (n = 58) highlighted a high prevalence of anxiety (Syria = 95% vs. Jordan = 98%) and depression (Syria = 83% vs. Jordan = 65%). At follow-up, active group participants, from both countries, showed significant improvements in anxiety and depression mean scores (anxiety: Syria = 34.97 ± 14.8 vs. 30.47 ± 14.3, p < 0.001; Jordan = 26.93 ± 13.7 vs. 23.37 ± 15.2, p < 0.001; depression: Syria = 26.53 ± 12.6 vs. 22.93 ± 12.2, p < 0.001; Jordan = 17.70 ± 11.0 vs. 15.76 ± 11.1, p = 0.049). No significant improvements were evident for control group participants from either countries., Conclusion: Prevalence of anxiety/depression for females with PCOS living in Syria and in Jordan is high and calls for special attention by healthcare specialists and policymakers in both countries. Females, who received the PCOS pharmaceutical care service, showed significant improvements in anxiety/depression scores. Improvements were similar in both countries., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background Healthcare ethics have been profoundly influenced by principles of bioethics that emerged post-World War II in the Declaration of Geneva 1948. 'Beneficence' (to do good), 'Non-Maleficence' (to do no harm), 'Justice' (fairness and justice in access) and 'Respect for Autonomy' (respect for patient individuality, including decision making, privacy, and right to refuse), have become foundational principles of contemporary medical codes of ethics. These principles are well reflected in most professional pharmacy code of ethics globally. This domain remains relatively unexplored in most developing countries and the majority of what has been published in this area relates to western cultures. There have been no attempts to pool findings from a similar scope of research emanating in developing countries. Aim of the review This study aims to explore the scope of pharmacy ethics in the literature pertaining to developing countries. Methods An extensive search of three relevant (Scopus, CINAHL, IPA) databases was conducted from Jan 2000 to Feb 2020, in order to identify relevant studies conducted in or focussed on ethics in pharmacy in developing countries. A separate Google Scholar search was carried out in an effort to locate supplementary articles, hand-searched articles were also included to achieve an exhaustive investigation of all current relevant studies. Results The full text of 20 relevant articles that met inclusion criteria were critically analysed and qualitatively categorised into three emerging themes; Ethical challenges in pharmacy practice, Approaches used in teaching pharmacy ethics, and Code of ethics analysis and implementation. Conclusions: Findings of this literature review illuminated a gap in pharmacy ethics literacy in developing countries and variances in pharmacists' ethical attitudes in handling ethical dilemmas, as well as a lack of familiarity with ethical principles and codes of ethics. Pharmacists' lack of respect for patients' autonomy and pharmacists being prone to financial pressure were found to have a significant impact on pharmacy practice in most of developing countries. However, attempts are being made to rectify this gap by efforts to incorporate ethical and professional education in undergraduate curricula, and by studies in which new codes of ethics are being implemented.

Background: Syrian refugees residing in Jordan suffer from chronic illnesses, low quality of life (QoL) and anxiety. Pharmacists delivering the medication review service can have a role in improving this growing worldwide problem., Objectives: To assess the effect of the medication review service on QoL and anxiety scores for Syrian refugees living with chronic medical conditions., Methods: This randomized single-blinded intervention control study was conducted in Jordan. Syrian refugees were recruited and randomized into intervention and control groups. Two home visits were organized with each participant, at baseline and three months later. The medication review service was delivered to the participants and questionnaires regarding QoL and anxiety were completed by all participants. As a part of the medication review service, drug-related problems (DRPs) were identified by a clinical pharmacist for all patients, but recommendations to resolve these DRPs were delivered to intervention group refugees' physicians only (control group patients did not receive this part of the service till the end of the study); DRPs were corrected and pharmacist-delivered counseling and education were provided as well. At follow-up, DRPs assessment, QoL and anxiety scores were assessed for refugees in the intervention and control groups., Results: Syrian refugees (n=106) were recruited and randomized into intervention (n=53) and control (n=53) groups with no significant difference between both groups at baseline. The number of medications and diagnosed chronic diseases per participant was 5.8 (SD 2.1) and 2.97 (SD 1.16), respectively. At follow-up, a significant decrease in the number of DRPs for refugees in the intervention group was found (from 600 to 182, p<0.001), but not for the control group (number stayed at 541 DRPs, p=0.116). Although no significant difference between the groups was found with regards to QoL at follow-up (p=0.266), a significant difference was found in the anxiety scores between the groups (p<0.001)., Conclusion: The medication review service delivered by clinical pharmacists can significantly improve refugees' DRPs and anxiety scores. As for QoL, significant improvements can be seen for all refugee patients, regardless of whether the DRPs identified were resolved or not., Competing Interests: CONFLICT OF INTEREST None., (Copyright: © Pharmacy Practice.)

Objectives: This study aimed to describe the effect of using an innovative teaching strategy using a video tutorial on enhancing students' knowledge about medication reconciliation, and skills in identifying medication discrepancies., Methods: This is a one group pre-post interventional study that was conducted at the School of Pharmacy at Applied Science Private University. Sixty pharmacy students were invited to attend an educational sessions that involve watching a 6-minutes video tutorial. The first two levels of the Kirkpatrick's Model were used to evaluate the effectiveness of this training tool. Level 1 (Reaction) was assessed using a satisfaction questionnaire, while level 2 (Learning) was assessed using two criteria: 1) student acquired knowledge about medication reconciliation using a questionnaire and a knowledge score out of 13 was calculated for each student, and 2) student acquired skills in identifying medication discrepancies using a virtual case scenario. If the student was able to identify any of the four impeded discrepancies he/she rewarded 1 point for each identified discrepancy, but if they identified any incorrect discrepancy they scored a negative point., Results: Among the 60 students who registered to participate in the study, 49 attended the educational training (response rate 81.6%). The majority of them (n=44, 89.8%) were satisfied with the training process. Before the video tutorial, students showed an overall low knowledge score [4.08/13.0, SD 1.81], and low ability to identify discrepancies [0.72 identified discrepancies out of 4.0, SD 1.1]. Following the video tutorial, the overall knowledge score was improved (p<0.001), and students were able to identify more discrepancies after watching the video (p<0.001)., Conclusion: In conclusion, video education has shown itself to be an effective method to educate pharmacy students.. This visualized method can be applied to other areas within pharmacy education. We encourage the integration of videos within the learning process to enhance students' learning experience and to support the traditional learning provided by the teaching staff., Competing Interests: CONFLICT OF INTEREST The Authors declare that there is no conflict of interest., (Copyright: © Pharmacy Practice.)

Background Adverse drug reactions remain to be an issue that compromise patient's safety in Jordan and worldwide. In Jordan, an assessment of factors involved in preventability of adverse drug reactions has not been conducted previously. Objectives To describe the proportion of preventable adverse drug reactions, and the causes of hospital-related preventable adverse reactions in one Jordanian hospital. Methods A prospective observational study of 4 months duration conducted by clinical pharmacists in the hospital. Setting Surgical and medical wards in one Jordanian private hospital. Main outcome measure Proportions of admissions related to adverse drug reactions, proportions of preventable reactions and analysis of the factors involved in the preventable adverse drug reactions. Results Out of 350 admissions recorded during the study period, a total of 38 (10.8%) adverse reactions were detected. Among those, 29 (8.3%) were detected in the hospital and 9 (2.6%) were the cause of the hospital admission. Many (44.7%) of the adverse drug reactions were preventable (31.6% were probably preventable and 13.1% were definitely preventable). About half (55.3%) were unpreventable. Insufficient monitoring was involved in 29.4% of the preventable adverse reactions and inappropriate dosing and drug-drug interactions were independently responsible for 17.6% of the preventable adverse reactions. Conclusion A high proportion of the identified adverse drug reactions were found to be preventable. Insufficient monitoring and inappropriate dosing were the most important factors associated with preventable adverse drug reactions. Nationally, more focused efforts need to be stimulated to prevent preventable adverse drug reactions in hospitals.

Introduction: Obtaining accurate patient medication histories and performing medication reconciliation are core pharmacy practice skills that optimize patient safety at transitions of care. Competency-based learning and assessment of medication reconciliation skills are essential methods in undergraduate pharmacy education. The aim of this study was to investigate the impact of an in-classroom simulation- and feedback-driven training activity on pharmacy students' medication reconciliation skills, self-perceived confidence, and overall student satisfaction., Methods: Over a three-day learning activity in 2016, pharmacy students from a private university in Jordan were assessed by roleplay on their ability to conduct a simulated patient medication interview, obtain the Best Possible Medication History, reconcile the history against a hospital medication chart, identify discrepancies, and document findings. Students received immediate feedback and observed peers undergo the assessment process. Pre- and post-simulation questionnaires and supplementary focus groups enabled collection of quantitative and qualitative data pertaining to student self-perceived confidence, perceptions, experiences, and usefulness of the course., Results: Assessment-based competency scores demonstrated significant improvement in student performance during the activity. Self-perceived confidence scores significantly improved after the medication reconciliation training intervention. Focus group content analysis yielded positive responses such as students valuing receiving feedback on performance and recommendations for future training., Conclusions: Simulation with feedback was a useful tool to teach pharmacy students medication reconciliation in Jordan. Subsequent to the study, medication reconciliation and interactive teaching methods were added to curriculum to supplement traditional teaching modalities., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Since patients are essential partners in determining priorities and resource allocation in the healthcare system, considerable efforts have been made to shift the focus of pharmacy profession from drug dispensing to patient-oriented care. Accordingly, the assessment of patient-oriented care has become a prominent method to evaluate the quality of the healthcare services delivered and willingness to pay (WTP) to receive them., Objective(s): To determine patients' attitude towards pharmaceutical care services among general population in Jordan and their WTP for this service., Methods: A cross-sectional study was conducted in a teaching hospital in Jordan over a period of six months. A contingent valuation method was used, with closed-ended questions to elicit participants' attitudes and WTP for pharmaceutical care services., Results: A total of 223 participants were interviewed. Most of the participants showed a positive attitude towards pharmaceutical care services, with an average attitude score of 0.82 (±0.19). Almost 96.0% of participants believed that pharmacists must be committed to more counseling roles than dispensary activities. The majority of participants (194, 87.0%) expressed their interest in pharmacists checking their medications at least once per month. Most of the participants (212, (95.1%) believed that the pharmacist should be reimbursed for providing a pharmaceutical care service that would potentially reduce medication-related problems (MRPs) by 50%. Of these, 208 (93.3%) participants were willing to pay out of their pockets an average maximum amount of $3.95 (±4.23) for the pharmaceutical care services they may receive to reduce 50% of the risk of MRPs., Conclusions: This study revealed that Jordanian people have a supportive attitude regarding pharmacists' abilities in providing pharmaceutical care services in addition to dispensing. Majority of participants in this study were willing to pay for pharmaceutical care services that would reduce the risk of MRPs., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Introduction: Pharmacists can have a valuable role in educating patients on correct inhaler technique leading to improved asthma management. Rural areas can benefit from the role of the pharmacist considering the barriers found in attending primary health-care facilities., Objectives: This study aimed to assess the impact of inhaler technique education delivered by pharmacists on patients' inhaler technique, Asthma Control Test (ACT) score, forced expiratory volume in the first 1 second (FEV 1 %), and reliever use (puffs/day)., Methods: A pre-post interventional study was conducted over 6 months from February 2017 to July 2017 in rural areas in Jordan. Asthma patients visiting respiratory clinics and using metered dose inhaler (MDI) or turbuhaler (TH) controlled medication were randomly recruited. Inhaler technique was assessed via published checklists. The ACT, FEV 1 %, and reliever use (puffs/day) were assessed. Patients were educated on inhaler technique via demonstration with return demonstration education. All assessments were repeated 3 months post education., Results: A total of 103 (TH, n=44; MDI, n=59) patients were recruited (mean age=46.5±13.5), 74% females. Patients reported an overuse of their reliever (5.1±4.2 puffs/day). Only 2 patients (1.9%) had well-controlled asthma, while the rest had either moderately (19.4%) or poorly (78.6%) controlled asthma. Patients using the MDI achieved 3.03±4.30 ACT score improvement ( p <0.001), which is a clinically significant improvement in control. Patients using the TH achieved a statistically significant improvement of 2.07±4.72 ( p =0.031). FEV 1 % improved significantly for MDI users ( p =0.005) but not for TH users ( p =0.097). Reliever use decreased significantly for MDI and TH users., Conclusion: Asthmatic patients living in rural areas in Jordan reported poor inhaler technique, ACT scores, and FEV 1 % scores and high use of reliever medications. Pharmacist-led educational intervention resulted in improved inhaler technique scores, ACT scores, and FEV 1 % scores and lowered reliever use over time., Competing Interests: Placebo inhalers were provided by AstraZeneca plc (London, UK) and GlaxoSmithKline plc (London, UK). The authors report no other conflicts of interest in this work.

Purpose: Outcomes investigating the effect of vitamin D3 (VD3) and omega-3 fatty acids (Omega-3FA) on serum estradiol (E2) are scarce and conflicting. No previous study has investigated the effect of VD3 combination with Omega-3FA on E2 levels. This study was designed to investigate the effect of VD3, Omega-3FA and VD3 plus Omega-3FA on serum E2 levels in premenopausal females diagnosed with vitamin D deficiency (VDD)., Subjects and Methods: This randomized, placebo-controlled clinical trial was designed to evaluate the effects of 50,000 IU VD3 taken weekly, 300 mg Omega-3FA taken daily and their combination by the study participants for 8 weeks. The mid-follicular serum levels of E2 and 25-hydroxy vitamin D (25OHD) were assessed at 8 weeks. The study was conducted during winter on a convenience sample of healthy premenopausal Jordanian females with diagnosed VDD. Fasting serum levels for 25OHD and E2 were assessed at baseline and the end of the trial (after 8 weeks). Data were entered into SPSS and analyzed., Results: Healthy premenopausal Jordanian females (N=86) with diagnosed VDD, mean age 32.8±8.9 years, were recruited into the study. Supplementation of VD3 alone resulted in a significant increase in serum 25OHD (13.4±7.9-28.2±7.1 ng/mL, P <0.001) and a significant decrease in E2 levels (85.7±16.5-60.3±20.6 pg/mL, P =0.001). Omega-3FA intake led to a significant decrease in serum 25OHD levels (21.2±12.8-13.6±9.2 ng/mL, P =0.001) and a significant increase in E2 levels (56.3±19.2-78.4±23.7 pg/mL, P =0.006). Combination therapy (VD3 plus Omega-3FA) resulted in a significant increase in both 25OHD (12.0±4.7-35.1±9.5 ng/mL, P <0.001) and E2 (43.0±23.4-57.3±31.5 pg/mL, P =0.028) levels., Conclusion: Results of this study provide vital insight into the effects of D3, Omega-3FA and a combination of their supplementation on premenopausal Jordanian females with diagnosed VDD. Eight weeks of therapy led to decreased E2 level by VD3 and increased level by Omega-3FA supplementation. With regard to 25OHD, its level was increased by VD3 and decreased by Omega-3FA supplementation. Combination of VD3 plus Omega-3FA increased the levels of both E2 and 25OHD., Trial Registration: This trial was registered at clinicaltrials.gov as NCT03333564., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Background: Refugees all over the world are facing several health-related problems. Chronic diseases among Syrian refugees in Jordan are high. The Home Medication Management Review (HMMR) service could be ideal to optimize refugees' health management., Objectives: To assess the impact of the HMMR service on the type and frequency of Treatment Related Problems (TRPs) among Syrian refugees living in Jordan., Methods: This prospective randomized single blinded intervention-control study was conducted in three main cities in Jordan, between May and October 2016. Syrian refugees with chronic conditions were recruited and randomized into intervention and control groups. The HMMR service was conducted for all patients to identify TRPs at baseline. Data were collected via two home visits for all study participants. Clinical pharmacist's recommendations were written in a letter format to the physicians managing the patients in the intervention group only. Physicians' approved recommendations were conveyed to the patients via the pharmacist. Interventions at the patient level were delivered by the pharmacist directly. Patients were reassessed for their TRPs and satisfaction 3 months after baseline., Results: Syrian refugees (n = 106) were recruited with no significant differences between the intervention (n = 53) and control groups (n = 53). A total of 1141 TRPs were identified for both groups at baseline, with a mean number of 10.8 ± 4.2 TRPs per patient. At follow-up, there was a significant decrease in the number of TRPs among the intervention group (P < 0.001, paired sample t-test) but not among the control group (P = 0.116). Physicians' approval rate of the pharmacist's recommendations was high (82.9%), and more than 70.0% of refugees in the intervention group reported high satisfaction with the HMMR service., Conclusion: Identified TRPs are high amongst Syrian refugees living in Jordan. The HMMR service significantly reduced the number of TRPs, and was highly accepted by the physicians. Refugees reported high satisfaction with this service., (Copyright © 2018. Published by Elsevier Inc.)

Background: Stroke is a major cause of disability and one of the leading causes of death among the elderly. Treatment related problems can lead to undesirable consequences. The Medication Management Review (MMR) service is aimed at identifying, resolving and preventing TRPs, subsiding the undesirable outcomes associated with TRPs., Objectives: To explore the types, frequencies and severity of TRPs amongst post-stroke patients recruited through hospitals via conducting the MMR service by clinical pharmacists in Jordan. Associations between patient factors and the identified TRPs were explored., Methods: This cross-sectional descriptive study was conducted over three months in 2017 in different geographical areas throughout Jordan. Randomly recruited patients were interviewed at the hospitals to collect their demographic data and clinical characteristics. Types/frequencies/severity of TRPs for each stroke patient were identified by a clinical pharmacist. Associations between the identified TRPs and patient's factors were explored through multiple regression analysis.Key findings:Out of 198 stroke patients (mean age: 56.6 ± 14.2) who completed the study, 110 (55.6%) were males. Many of the patients (82 (41.6%)) were smokers and 61 (69.2%) had hypertension and/or diabetes. The mean number of TRPs per patient was 2.5 ± 1.1. The most common TRP categories involved efficacy issues (198 (40.6%)), inappropriate drug adherence (136 (27.9%)) and inappropriate patient knowledge (114 (23.4%)). More than 70.0% (342/487) of the identified TRPs were of major severity. Higher number of TRPs was found to be associated with being a male, having a lower educational level, being a current smoker, having a higher number of drugs and a poorer quality of life., Conclusion: Lack of drug efficacy, inappropriate drug adherence and patient knowledge were the major TRPs identified via delivering the MMR service to post-stroke patients. The identified TRPs highlights the importance of the MMR service, and supports planning future strategies aimed at decreasing the incidence of strokes.

Objectives: To investigate the effect of inhaler technique education delivered by a clinical pharmacist to patients hospitalised for asthma, on inhaler technique scores and asthma control at three months post-discharge., Methods: This pre-post interventional study in Jordan enrolled patients who had been admitted for asthma and were using controller medication by Accuhaler [Diskus] (ACC), Turbuhaler (TH) or Pressurized metered dose inhalers (pMDI). Inhaler technique was assessed using published checklists (score 0-9). Asthma symptom control was assessed by Asthma Control Test (ACT, range 5-25). Patients were assessed on admission (baseline), pre-discharge, and 3 months later. All patients received a 'Show-and-Tell' inhaler technique counseling service prior to discharge., Results: Baseline data were available for 140 patients, 71% females, mean age 52.7 (SD 16.64) years, mean ACT score 10.0 (SD 4.8). Mean inhaler score was 7.5 (SD 1.52) with no significant difference between the inhaler groups (p = 0.174). After pre-discharge training, all patients had correct technique (score 9/9). After 3 months, mean inhaler scores were significantly higher than at baseline (8.14 (SD 0.87, p < 0.001), with mean change significantly higher for TH 1.21 (SD 2.25) and ACC 0.85 (SD 0.97) than pMDI (0.16; SD 0.72), p = 0.001. Symptom control improved significantly for all patients, with a mean increase in ACT score of 7.54 (SD 8.18), with no significant difference between the inhaler device groups (p = 0.326)., Conclusions: Patients hospitalized for asthma achieved correct inhaler technique after training by a pharmacist, and maintained better technique at 3 months than on admission. Significant improvements in ACT scores were documented for all inhaler groups.

Background: During the undergraduate years, laboratory practical classes using experimental animals are important in pharmacy schools. Limitations for experimental use of animals exist, including the procurement of animals, the difficulty in performing animal experiments, ethical considerations, and more often students' preferences., Objective: To evaluate pharmacy students' perceptions, barriers, and confidence regarding animal use in the pharmacology laboratory course, and the effect of animal handling on their confidence., Methods: This observational pre- and post-course parallel group design study was conducted during the Pharmacology laboratory involving 3rd-year pharmacology students from one school of pharmacy in Jordan. A questionnaire was designed and validated to collect students' demographic characteristics, perceived barriers and perceptions regarding animal handling during the lab, and the level of confidence pre- and post-course, assessing differences between those who handled and those who did not handle animals., Results: All Pharmacology lab students (n = 212) with a mean age of 21.11 (SD 1.32) and the majority being females (77.0%) were enrolled. Students who refused to handle animals (n = 105, 49.5%) stated phobia as the main barrier. Students who accepted to handle animals agreed more with the importance of seeing and practicing animal handling, with animal handling being essential to understand the effect of drugs on animals and in its importance to gain skills, than those who refused. More than half of students (55.9%) reported feeling confident/somewhat confident in animal handling and in giving animals injections (50.8%) at baseline. At the end of the course, students who accepted animal handling reported significantly higher confidence., Conclusion: This study revealed important students' barriers and perspectives to animal handling. Those who handled the animals reported better confidence in certain areas at the end of the course than those who refused. Engaging students when making decisions regarding educational practices paves the way for change to the current traditional paradigm in the education of future scholars.

Background: In an ever-changing environment, pharmacy education is in the race to catch up and excel to produce competent pharmacists. Examining academic institutions, including schools of pharmacy, their internal systems and framework, it seems appropriate to view these institutions using multiple lenses. Bolman and Deal conceptualized a method to examine organizations using four constructs (structural, human resource, political, and symbolic). The Eastern Mediterranean Region (EMR), with deep-rooted pharmacy education and practice was the setting for this research., Objectives: To explore factors affecting academic reform in undergraduate pharmacy education in the EMR from stakeholders' and students' perspectives; and to apply Bolman and Deal's four-frame organizational change model to explore how these issues might be viewed., Methods: A multiple-method approach was employed and involved collecting, analyzing and integrating qualitative semi-structured interview data with open-ended questions in a survey. Cross-sector stakeholder sample from various EMR countries was recruited and interviewed. Final year pharmacy students from one school of pharmacy in Jordan were surveyed., Results: Emergent themes were indicative that academic reform was addressed by all frames of the Bolman and Deal model. Structural and political frames received substantial weighing pointing to the importance of curricular reform, collaboration and leadership. A need for skillful and role-model teaching academic staff was highlighted, and in harmony with the human resource frame. Issues within the symbolic frame were readily apparent in the data and spanned the other three frames in relation to heritage, customs and cultural barriers., Conclusions: Issues pertinent to academic reform in pharmacy were presented. Viewing change in pharmacy schools from multiple perspectives highlighted the need for structural changes to pharmacy programs, human resource management, political will, leadership, and collaboration. The importance of understanding cultural aspects of organizations is critical as it is these that provide identity to any organization and help reformers better manage change., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Post-stroke depression is among the most frequent neuropsychiatric complications of stroke, and it is associated with poor prognosis and outcomes. This study aimed to assess the prevalence of depression; its correlates, and predictors among patients with stroke in Jordan., Methods: A cross-sectional, descriptive correlation design was used among 198 patients with stroke admitted to 9 hospitals all over Jordan. Depression was assessed using the validated hospital depression subscale (HDS) of the Hospital Anxiety and Depression scale., Results: Study patients (mean age 56.62 years [SD = 14.2], 53% were males) experienced high prevalence of depression (76%); of these, 51.6% were categorized as higher depression category (a case of depression; HDS = 11-21). Factors that correspondingly predicted higher depression categories were low level of education (odds ratio [OR] = 3.347, 95% confidence interval [CI] = 2.920-23.949, P < .001), having a preparatory level of education (OR = 8.363, 95% CI = 1.24-9.034, P = .017), having comorbid chronic diseases (OR = .401, 95% CI = .190-.847), being a smoker (OR = 2.488, 95% CI = 1.105-5.604, P = .028), patients who reported inability to perform daily activities by themselves (OR = 3.688, 95% CI = 1.746-7.790, P = .001), and patients with comorbid dysphasia (OR = 12.884, 95% CI = 4.846-34.25, P < .001)., Conclusions: Post-stroke depression is a significant health problem among Jordanian patients with stroke and warrants serious attention. Clinicians need to consider these important predictors when assessing and managing depression among patients at risk., (Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.)

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.

Objective: To test the anticancer potential activity of the combination of thymoquinone (TQ) and resveratrol (RES) against breast cancer in mice., Methods: The antiproliferative activity of TQ, RES and their combination was assessed against three breast cancer cell lines and one normal cells using MTT assay. The combination index was calculated using isobolographic method. Balb/C mice were inoculated with EMT6/P cells and in vivo antitumor activity was evaluated., Results: The combination therapy also caused significant decrease in tumor size with a percentage cure of 60%. The combination therapy induced geographic necrosis, enhanced apoptosis, and decreased VEGF expression. Serum levels of IFN-γ were elevated in mice treated with combination therapy with no liver or kidney toxicity., Conclusions: The combination of TQ and RES against breast cancer in mice can work synergistically. The anticancer effect of this combination is mediated by apoptosis induction, angiogenesis inhibition and immune modulation., (Copyright © 2017 Hainan Medical University. Production and hosting by Elsevier B.V. All rights reserved.)

Objectives: Hypertension is among the leading causes of cardiovascular disease worldwide. No previous studies have examined specifically the types of drug-related problems (DRPs) in patients with hypertension, and how these problems affect blood pressure control. So, the primary aim of this study was to investigate the prevalence and nature of DRPs in outpatients with hypertension and reveal any associations between DRPs and blood pressure control in these patients., Methods: This was a cross-sectional correlation study. A total of 200 patients who fulfilled the inclusion criteria were recruited through outpatient clinics. Patients' data were assessed to identify DRPs using a systematic evidence-based approach., Results: Two hundred participants were recruited in this cross-sectional study. About half of the participants (48.5%) had uncontrolled hypertension. The average number of DRPs was 6.31±2.63. The main identified DRPs affecting blood pressure control included patients' lack of knowledge about their medications, lack of adherence to their medications, suboptimal efficacy of medications prescribed and the need for additional monitoring. Logistic regression analysis was performed to identify the most important predictors, and significant associations were found between poor blood pressure control and the above-identified variables except for knowledge about medication (p≤0.05)., Conclusion: The number of DRPs among patients with hypertension is relatively high. These DRPs were associated with poor blood pressure control. The implementation of clinical pharmacy services for all patients with hypertension is strongly recommended., Competing Interests: Competing interests: None declared.

Background: Medication Management Review (MMR) is a patient-focused, structured and collaborative health care service provided in the community setting to optimize patient understanding and quality use of medicines., Objective: To conduct a randomized control trial of the MMR program in Jordan, by a pharmacist identifying treatment related problems (TRPs) through home visits, assessing type and frequency of TRPs, and eventual effect of resolving TRPs identified by the pharmacist and accepted by the physician on the health status of participating patients., Setting: Outpatient clinic at the Jordan University Hospital, Amman, Jordan., Method: Consecutive patients from outpatient clinics who were eligible for the study were recruited and randomly distributed into two groups (control and intervention). All patients were visited at home by the pharmacist who delivered only for intervention group counseling regarding self-reported adherence, frequency of monitoring and education regarding pharmacological and non-pharmacological therapy. After identifying TRPs, the pharmacist sent a letter to the physician with certain recommendations for patients in the intervention group only. Physician ticked the approved recommendations and returned the report to the pharmacist, allowing the pharmacist to convey the approved changes to the patients. Patients were referred back to their physicians for confirmation of any changes in treatment. Both groups were reassessed after 2-3 months during their regular follow-up visits to their physicians., Main Outcome Measure: To assess the impact of home medication review on the number of TRPs and self-reported adherence in outpatients with chronic diseases via hospital-based clinics in Jordan., Results: A total of 158 TRPs were identified in 112 patients; mean TRP number was 1.63 per patient. As a result of the pharmacist intervention, there was a significant decrease in number of TRPs in the intervention group, the change in the mean was (1.23 (±1.19), P < 0.001) versus the control group (0.29 (±1.24), P = 0.114). After 3 months, a reduction in non-adherence was observed in the intervention (-0.81 (±1.48), P < 0.001) in contrast to no change in self-reported adherence in the control (0.22 (± 1.12), P = 0.168) group., Conclusion: Overall, home-based medication review for patients with chronic conditions decreased the total number of TRPs and improved patient self-reported adherence.

Optimal effects of asthma medications are dependent on correct inhaler technique. In a telephone survey, 77/87 patients reported that their Turbuhaler technique had not been checked by a health care professional. In a subsequent pilot study, 26 patients were randomized to receive one of 3 Turbuhaler counseling techniques, administered in the community pharmacy. Turbuhaler technique was scored before and 2 weeks after counseling (optimal technique = score 9/9). At baseline, 0/26 patients had optimal technique. After 2 weeks, optimal technique was achieved by 0/7 patients receiving standard verbal counseling (A), 2/8 receiving verbal counseling augmented with emphasis on Turbuhaler position during priming (B), and 7/9 receiving augmented verbal counseling plus physical demonstration (C) (Fisher's exact test for A vs C, p = 0.006). Satisfactory technique (4 essential steps correct) also improved (A: 3/8 to 4/7; B: 2/9 to 5/8; and C: 1/9 to 9/9 patients) (A vs C, p = 0.1). Counseling in Turbuhaler use represents an important opportunity for community pharmacists to improve asthma management, but physical demonstration appears to be an important component to effective Turbuhaler training for educating patients toward optimal Turbuhaler technique.