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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 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.

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.

Purpose: To examine the quality of pharmaceutical experiential training by developing an experiential training survey. Methods: An online survey was placed on E-learning platforms in Jordan and UK to develop a validated instrument that can assess pharmacy students' perceptions of the experiential program implemented in their curricula. Results: A total of 377 students from Jordan (250 students) and the UK (127 students) completed the survey. Principal component analysis was used to conduct exploratory factor analysis and to assess the factor structure for the data. A two-factor model was applied to the data obtained from the students. These factors included students’ feelings toward experiential training (Perceiver Feelings; PF) and their ability to conduct a full Pharmaceutical Care Plan (PCP). Students from both Jordan and the UK showed a higher satisfaction PF score toward the experiential training program compared to PCP. Being female and not having prior practice experience led to significantly lower PCP scores compared to males and having a prior practice experience, respectively. Conclusion: The availability of a validated questionnaire will help in investigating the effectiveness of experiential training courses. Keywords: Experiential training; Factor Analysis; Survey development; Pharmacy

Purpose The objective of this study was to explore community pharmacists' views on providing influenza vaccine administration services in community pharmacies in Jordan. Methods The current study is a cross-sectional exploratory study conducted using semi-structured telephone interviews. The semi-structured interview schedule was developed by the researchers and comprised open-ended questions aligned with the study objectives. The telephone interviews were recorded and fully transcribed, and the transcripts were quantitatively coded following a generic qualitative approach. Results A total of 19 pharmacists took part in this study. Eight participants (42.1%) reported that they had administered the influenza vaccine during their practice. The three overarching themes which described the participating pharmacists' views towards providing influenza vaccine administration services in community pharmacies were benefits, enablers, and barriers. The reported benefits included enhanced therapeutic relationships with patients and increased patient accessibility to vaccines. The majority of the participants indicated that they would be more willing to provide influenza vaccine administration if they received the support they needed from the Jordan Pharmacists Association, third-party insurance companies, and drug stores. Further, from the participants' perspectives, the main barriers to this change in practice were physicians, regulations, and lack of sufficient training. Conclusion Overall, the participating pharmacists had positive attitudes towards administering the influenza vaccine in community pharmacies. The participants highlighted the need for support from regulatory bodies and stakeholders to change the current scope of practice in Jordan. Moreover, the study highlighted the need to incorporate vaccine administration in the curricula used to train new pharmacy graduates.

Introduction The purpose of this study was to evaluate whether a public health (PH) micro-level case-based learning exercise increased pharmacy students' self-perceived understanding and confidence in their role as PH pharmacists. Methods Three PH micro-level case-based learning exercises in community pharmacy settings were developed and integrated into the third professional year PH course. Students enrolled in the PH course from January 2012 – May 2015 completed a pre- and post-activity survey consisting of 22 statements with Likert scale responses. Survey questions were grouped into domains: perceptions of pharmacist roles (ROLES) in PH, confidence in ability to identify and address PH problems (CONF), pharmacist impact on improving PH outcomes for patients with human immunodeficiency virus (IMPACT-HIV), diabetes (IMPACT-DM), or alcoholism (IMPACT-AL), perceiving pharmacists as role models in PH (MODEL), and whether PH is beyond the scope of pharmacy practice (SCOPE). Within each domain, paired t-tests were performed on summated scores (pre- vs. post-, alpha = 0.05). Results Both surveys were completed by 271 of 336 students (80.7%). Baseline scores were lowest in the CONF and MODEL domains. The activity resulted in significant changes in 21 out of 24 survey questions. Significantly higher scores were found for domains of ROLES (+1.22), CONF (+1.60), IMPACT-HIV (+0.65), IMPACT-DM (+0.42), IMPACT-AL (+0.70), and MODEL (+1.50). Cronbach's alpha ranged from 0.73 to 0.93 for each domain. Conclusion A PH case-based learning session increased students' scores on a pre- and post-activity survey regarding PH challenges at the micro-level. The activity improved students' perceptions and confidence in providing PH interventions.

Objective: To assess the prevalence of potential drug-drug interactions (pDDIs) among polypharmacy patients in Jordan using Lexicomp®. Additionally, this study aims to categorize and rate the identified pDDIs according to interaction risk, severity, and reliability. Methods: A descriptive cross-sectional study was conducted at six different hospitals representing different public health sectors in Jordan (ministry of health, royal medical services, and university-affiliated hospitals). Polypharmacy patients from outpatient clinics (e.g., cardiology,& and internal medicine) were identified, recruited, and interviewed by clinical pharmacists. pDDIs were assessed using the Lexicomp® mobile application and classified according to interaction risk rating, severity, and reliability rating. Furthermore, the prevalence of pDDIs across chronic medical conditions was assessed. P-value

Background: Deprescribing refers to the partnered discontinuation of chronic medications to limit the negative impacts of polypharmacy. Polymedicated patients play a key role in the success of deprescribing efforts. eHealth literacy reflects patients' ability to appraise electronically available health-related information to make informed health care decisions, which partly reflect their desire to deprescribe. Objectives: The current study aimed to explore the relationship between eHealth literacy and willingness to deprescribe among patients with chronic diseases. Additionally, the predictors of willingness to deprescribe were examined. Materials and Methods: This cross-sectional study was conducted among adult patients with chronic diseases in Jordan. An online questionnaire comprising two validated tools, namely the Electronic Health Literacy Scale (eHEALS) and the Revised Patients' Attitudes Toward Deprescribing (rPATD) Questionnaire, was used for data collection. The questionnaire targeted adult patients with chronic medical conditions in Jordan and was posted to social media portals, following a convenience sampling technique. Results: A total of 719 responses were recorded and included in the final analysis. Participants with higher levels of eHealth literacy were more willing to get their medications deprescribed, as indicated by the perceived use of unneeded medications (p = 0.042). Meanwhile, participants with low levels of eHealth literacy were more likely to report fear of missing out on the potential benefits of deprescribed medications (p = 0.003). Other items that were commonly agreed upon by both the low and high eHealth literacy groups, respectively, included desire for dose reduction (p < 0.001, p < 0.001), belief in the lack of effectiveness of some prescribed medications (p < 0.001,p < 0.001), and fear of precipitating side effects (p = 0.001,p = 0.007). Conclusions: The present study highlighted the relationship between eHealth literacy and a number of items reflecting willingness to deprescribe, and these indicators can be used to guide future deprescribing efforts among eligible patients.

Anaemia is associated with poor health outcomes and is considered a serious public health problem particularly in low- and middle-income countries. Specific subgroups are at higher risk of anaemia, such as women of reproductive age.This study examined the prevalence and risk factors of anaemia among ever-married women in Jordan using a secondary analysis of the Jordan Population and Family Health Survey.This is a secondary analysis of data from a nationally representative sample of ever-married women aged 15-49 years that were tested for haemoglobin levels in the 2012 JPFHS. Anaemia was categorized according to the WHO criteria. Univariate and multivariate logistic regression analyses were used to investigate risk factors associated with anaemia.The prevalence of any anaemia was 37.3%; specifically, 20% had mild anaemia (haemoglobin 11.0-11.9 g/dl), 16.3% had moderate anaemia (hemoglobin 8.0-10.9 g/dl) and 1% had severe anaemia (haemoglobin8.0 g/dl). Factors that were associated with anaemia in the multivariate regression included urban women (P = 0.01), living in the north (P = 0.014) or south regions (P = 0.013) of Jordan, having multiple children (P0.001), being pregnant (P0.01), and using IUD as a contraceptive method (P0.001).A high prevalence of anaemia among ever-married women of reproductive age in Jordan was noticed. The results emphasize the importance of urgent public health interventions to prevent anaemia in Jordan, particularly among high-risk subgroups.معدل انتشار فقر الدم وعوامل الخطر الخاصة به بين النساء المتزوجات حاليًا أو اللاتي تزوجن من قبل في الأردن.رشا عربيات، غيث عربيات، غيث الطعاني.يرتبط فقر الدم بالمخرجات الصحية الضعيفة ويعد مشكلة خطيرة بالنسبة للصحة العامة، لا سيّما في البلدان منخفضة ومتوسطة الدخل. وتعد الفئات الفرعية المحددة معرضة لخطر الإصابة بفقر الدم بشكل أكبر، مثل النساء في سن الإنجاب.فحصت هذه الدراسة معدل انتشار فقر الدم وعوامل الخطر المرتبطة به بين النساء المتزوجات حاليًا أو اللاتي تزوجن من قبل في الأردن، باستخدام تحليل ثانوي لمسح السكان والصحة الأسرية في الأردن.يعد هذا تحليلاً ثانويًا للبيانات المأخوذة من عينة ممثلة وطنية للنساء المتزوجات حاليًا أو اللاتي تزوجن من قبل واللاتي تراوحت أعمارهن بين 15 و 49 عامًا وتم فحص مستويات الهيموجلوبين لديهن في مسح السكان والصحة الأسرية في الأردن لعام 2012. وتم تصنيف فقر الدم وفقًا لمعايير منظمة الصحة العالمية. واستُخدمت تحليلات الارتباط المنطقي وحيدة المتغير ومتعددة المتغيرات لاستقصاء عوامل الخطر المرتبطة بفقر الدم.بلغ معدل انتشار فقر الدم 37.3 %؛ وبالتحديد 20 % يعانون من فقر الدم الخفيف (الهيموجلوبين 11.9 – 11.0 جرام/ديسيلتر)، و 16.3 % يعانون من فقر الدم المعتدل (الهيموجلوبين 10.9 – 8.0 غرام/ديسيلتر)، و 1% يعانون من فقر الدم الشديد (الهيموجلوبين8.0 جرام/ديسيلتر). وشملت العوامل المرتبطة بفقر الدم في الارتباط متعدد المتغيرات نساء الحضر ((الاحتمالية) 0.01 = P)، واللاتي يعشن في المناطق الشمالية (0.014 = P) أو المناطق الجنوبية (0.013 = P) في الأردن، واللاتي لديهن عدة أطفال (0.001P)، والحوامل (0.01P)، واللاتي يستخدمن اللولب بمثابة وسيلة لمنع الحمل (0.001P).لُوحِظَ معدل انتشار مرتفع لفقر الدم بين النساء في سن الإنجاب المتزوجات حاليًا أو اللاتي تزوجن من قبل في الأردن. وأكدت النتائج أهمية التدخلات العاجلة في الصحة العامة للوقاية من فقر الدم في الأردن، لا سيّما بين الفئات الفرعية المعرضة لخطر مرتفع.Prévalence et facteurs de risque d’anémie chez les femmes mariées ou l’ayant été en Jordanie.L’anémie est associée à des conséquences néfastes sur la santé et constitue un grave problème de santé publique, en particulier dans les pays à revenu faible ou intermédiaire. Des sous-groupes spécifiques présentent un risque d’anémie plus élevé, comme par exemple les femmes en âge de procréer.La présente étude a examiné la prévalence et les facteurs de risque de l’anémie chez les femmes mariées ou l’ayant été en Jordanie au moyen d’une analyse secondaire de l’enquête de santé familiale de la population jordanienne.Il s’agit d’une analyse secondaire des données obtenues à partir d’un échantillon national représentatif de femmes mariées ou l’ayant été, âgées entre 15 et 49 ans, dont le taux d’hémoglobine a été mesuré dans le cadre de l’enquête de santé familiale de la population jordanienne réalisée en 2012. L’anémie a été classée selon les critères fixés par l’OMS. Des analyses de régression logistique univariée et multivariée ont été conduites afin d’analyser les facteurs de risque associés à l’anémie.La prévalence de l’anémie était de 37,3 % ; plus précisément, 20 % présentaient une légère anémie (taux d’hémoglobine compris entre 11,0 et 11,9 g/dl), 16,3 % une anémie modérée (taux d’hémoglobine compris entre 8,0 et 10,9 g/dl) et 1 % une anémie sévère (taux d’hémoglobine8,0 g/dl). Les facteurs associés à l’anémie dans la régression multivariée étaient les suivants : femmes vivant en milieu urbain (p = 0,01), dans les régions du nord (p = 0,014) ou du sud (p = 0,013) de la Jordanie, ayant plusieurs enfants (p0,001), étant enceintes (p0,01), et ayant recours au dispositif intra-utérin comme méthode contraceptive (p0,001).Une prévalence élevée de l’anémie a été constatée chez les femmes en âge de procréer mariées ou l’ayant été en Jordanie. Les résultats soulignent l’importance des interventions urgentes de santé publique visant à prévenir l’anémie en Jordanie, en particulier parmi les sous-groupes à risque élevé.

Background Patients with chronic obstructive pulmonary diseases (COPD) suffer from impaired Health-Related Quality of Life (HRQoL). Having an adequate social/emotional support may improve the quality of life of COPD patients. Objective To study the relationships between social/emotional support and HRQoL, depression and disability among patients with COPD. Methods We applied a propensity score model using data from a large U.S. population-based health survey to match COPD patients who reported rarely/never receiving social/emotional support with those who received that support. Social/emotional support and all dependent variables were dichotomized into yes/no responses. For HRQoL domains, number of days of poor physical or mental health and activity limitations, “yes” indicated ≥14 unhealthy days in the last 30 days. McNemar’s test was used to compare the matched groups. Results Social/emotional support was rarely/never received by 37% of responders. Standardized differences between matched groups, after propensity score matching, were less than 10% indicating successful matching. COPD patients who rarely/never receive social/emotional support were more likely to report: depression (n = 321 pairs, odds ratio (OR) = 2.2, 95% confidence interval (CI): 1.56–3.14, p < .001), ≥14 poor mental HRQoL days (n = 310 pairs, OR = 3.12, 95% CI: 2.1–4.73, p < .001) and ≥14 poor physical HRQoL days (n = 307 pairs, OR = 1.5, 95% CI: 1.06–2.13, p = .02). There were no significant differences in general health, disability, or activity limitations. Conclusion Among COPD patients, lower levels of social/emotional support are associated with depression and deterioration of mental and physical HRQoL. The importance of social/emotional support should be emphasized by policy makers, healthcare providers, and family members, to improve functioning among COPD patients.

Background Influenza virus is responsible for substantial morbidity and mortality. Specific populations are at higher risk for exacerbations from influenza virus, such as patients with chronic obstructive pulmonary disease (COPD). Influenza vaccination coverage among COPD patients is low. Pharmacists can improve influenza vaccination among COPD patients by recognizing factors that influence vaccination and addressing these factors. Objectives To (1) determine the recent influenza vaccination coverage among patients with COPD, (2) identify factors that were associated with immunization, and (3) interpret the results based upon Andersen's healthcare utilization model. Methods The 2012 Behavioral Risk Factor Surveillance System (BRFSS) was accessed for the study. Among respondents age ≥ 25 years with COPD, presence of influenza vaccination was captured along with demographic, provider, insurance, and clinical variables. Weighted multiple logistic regression was used to identify significant factors associated with receiving influenza vaccination. The findings were interpreted according to predisposing, enabling, and need factors relevant to Anderson's model. Results Influenza vaccination rate was 53% among COPD patients. Older age was a significant predisposing factor that increased vaccination (adjusted odds ratio [AOR] = 2.4; 95% CI:2.02–2.88). Predisposing factors that decreased vaccination were being Black or Hispanic (AOR = 0.72, 95% CI:0.59–0.86, and AOR = 0.78, 95% CI:0.61–0.98 respectively), and being a non smoker (former and never smokers had higher vaccination rates [AOR = 1.53, 95% CI = 1.3–1.72, and AOR = 1.36, 95% CI = 1.19–1.55 respectively]). Significant enabling factors included having health insurance (AOR = 1.68, 95% CI = 1.37–2.06), a primary physician (AOR = 1.63, 95% CI = 1.30–2.02), and the ability to see a physician regardless of cost (AOR = 1.33, 95% CI = 1.17–1.52). Significant need factors included the presence of comorbidities such as asthma (AOR = 1.18, 95% CI = 1.1–1.3), or diabetes (AOR = 1.36, 95% CI = 1.20–1.53), activity limitation (AOR = 1.16, 95% CI = 1.04–1.29), and having the last medical checkup within less than one year (AOR = 1.49, 95% CI = 1.31–1.70). Conclusion Influenza vaccination coverage among COPD patients is far below the Healthy People 2020 national goal. Several predisposing, enabling, and need factors influenced vaccination rate among COPD patients. Pharmacists can improve vaccination rate among COPD patients by recognizing these influencing factors and by acting as advocates, counselors, and administrators of influenza vaccine. Ultimately, with the collaborative efforts of other healthcare providers and public health initiatives, pharmacists can help achieve Healthy People 2020 objectives related to influenza vaccination.

To review and summarize reports of tendon rupture associated with each fluoroquinolone (FQ) currently marketed in the United States (US), as reported to the FDA's Adverse Event Reporting System (FAERS).FAERS data were reviewed for reports of tendon rupture associated with each FQ from their respective approval date through September 2012. Disproportional reporting signal detection was estimated using empirical Bayes geometric mean (EBGM) with 95% confidence intervals (CI).There were 2495 FAERs reports of tendon rupture associated with currently approved FQs. Most FAERS reports were associated with levofloxacin (n = 1555) followed by ciprofloxacin (n = 606) and moxifloxacin (n = 230). Signal detection results for FQs were as follows: levofloxacin (EBGM = 55.2, 95% CI = 52.3 - 58.0), ciprofloxacin (EBGM = 20.0, 95% CI = 18.2 - 21.6), moxifloxacin (EBGM = 13.3, 95% CI = 11.7 - 15.1), norfloxacin (EBGM = 9.6, 95% CI = 6.5 - 13.5), ofloxacin (EBGM = 8.2, 95%CI = 6.3 - 10.2) and gemifloxacin (EBGM = 1.9, 95% CI = 0.7 - 4.5). The mean age of affected individuals was 59.6 ± 5.1 years. Corticosteroids were administered concomitantly with FQs in 21.2% of cases.As noted in boxed warnings, FQ use is associated with increased tendon rupture risk. Risk factors for FQ associated tendon rupture include use in the elderly, and in patients with concomitant corticosteroids. Further monitoring may be needed due to antibiotic overuse and marketing of newer FQs.

To summarize reports of anaphylaxis associated with gadolinium-based contrast agents (GBCAs) reported to the Food and Drug Administrations Adverse Event Reporting System (FAERS), examine the safety signals of anaphylaxis from GBCAs, and perform a literature review of relevant case reports.FAERS (1/1988-8/2012) was searched using groups of preferred event terms for anaphylaxis combined with all drug names for GBCAs Signal detection involved determination of proportional reporting ratios (PRRs) and empirical Bayes geometric means (EBGM). Published case reports were identified through a Medline search (1/1988-7/2013).There were 614 GBCA FAERS reports of anaphylaxis, resulting in a safety signal (PRR = 6.2, 95% confidence interval (CI) = 5.7 - 6.7; EBGM = 5.1 CI = 5.6 - 6.6). Among GBCAs, 43% were associated with gadopentetate dimeglumine (PRR = 4.9, CI = 4.3 - 5.5; EBGM = 4.8, CI = 4.3 - 5.4), 29% with gadobenate dimeglumine (PRR = 17.5, CI = 15.2 - 20.2; EBGM = 17.1, CI = 14.6 - 19.8) , and 17% with gadoteridol (PRR = 5.7, CI = 4.7 - 6.8; EBGM = 5.6, CI = 4.6 - 56.7). There were 14 anaphylaxis case reports in the literature.GBCAs used as medical imaging agents, can cause life-threatening or fatal anaphylaxis. There were differences in disproportionality of reporting between between agents. Although differences in numbers of reports of anaphylaxis reflect relative utilization rates of the various agents, disproportionality analyses (PRR, EBGM) disclose significant safety signals of anaphylaxis associated with most GBCAs.

Background On 30 January 2012, the US FDA approved vismodegib (Erivedge®, Genentech, CA, USA) for the management of both metastatic and locally advanced basal cell carcinoma. Objective Our objective was to identify evidence of hepatotoxicity with vismodegib in the FDA Adverse Event Reporting System (FAERS) in treated patients in two National Cancer Institute Comprehensive Cancer Centers. Methods FAERS was searched for reports dated 1 January 2009 through 31 December 2015 using terms including hedgehog pathway and vismodegib and hepatic-related terms such as liver, jaundice, and hepatitis, among others. Disproportionality analyses with estimates of proportional reporting ratio and empirical Bayesian geometric mean were conducted. A comprehensive literature review was conducted, and the clinical databases at the University of Texas MD Anderson Cancer Center and Robert H. Lurie Comprehensive Cancer Center of Northwestern University were searched. Results Two cases of severe liver dysfunction were published (Common Terminology Criteria for Adverse Events [CTCAE] class III), and 94 reports of adverse events (AEs) were detected in FAERS, 35 of which were serious AEs. Safety notifications related to hepatotoxicity have not been issued by the manufacturer or the FDA, although vismodegib is listed in LiverTox and the European Medicines Agency website. Conclusion We identified a detectable safety signal for hepatotoxicity for vismodegib within 4 years of FDA approval. Vismodegib should be used in patients with severe liver disease only after careful consideration, and concomitant hepatotoxic medications should be avoided. Rapid dissemination of such safety concerns is expected to result in fewer serious hepatotoxic AEs and more optimal outcomes for patients with cancer receiving vismodegib. Electronic supplementary material The online version of this article (doi:10.1007/s40268-016-0168-2) contains supplementary material, which is available to authorized users.