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Objectives This study has evaluated the drug use pattern among adults attending the outpatient clinics of the Jordan University Hospital (JUH), by assessing the adherence of prescriptions to the World Health Organization (WHO) core prescribing indicators. Methods This is a cross-sectional study that was conducted during the period from October 2011 to January 2022 at JUH. Several prescriptions from 10 different adult outpatient clinics were reviewed to evaluate hospital adherence to the five WHO core prescribing indicators. Key findings To assess the WHO core prescribing indicators, data for 2451 prescriptions were reviewed. Around one-third of the patients (33.4%) were receiving polypharmacy (five medications or more). Results revealed that two core prescribing indicators were not following the standard values specified by the WHO; the average number of drugs prescribed per encounter (3.8 medications/prescription), and the percentage of drugs from the essential drug list (EDL) (54.1%). Endocrine clinics showed the highest average of drugs (6.3) per prescription and the highest percentage of prescriptions with injectable medicines (51.7%). On the other hand, ophthalmology clinics showed the highest percentage of prescriptions with antibiotics (29.9%) and the lowest percentage of drugs prescribed from the EDL at JUH (14.1%). Evaluating factors affecting the number of prescribed medications per encounter revealed that elderly patients (> 60 years), being female, referring to the endocrine clinic, and having insurance have a higher average number of medications per encounter compared with others (P < 0.05). Conclusion The proper prescribing practices in a sizable tertiary hospital in Amman, Jordan, are clarified by this study. The percentage of medications from EDL and the typical number of drugs/encounters did not comply with WHO requirements. The study findings should guide the Jordanian health policymakers in designing and implementing strategies to limit irrational prescribing practices and raise awareness of and ensure physician adherence to the national EDL.

Objective: The study aims to evaluate the impact of distance education on Pharmacy, Pharm.D and postgraduate students’ satisfaction and its associated factors during COVID -19 pandemic. Methods: A cross-sectional web-based survey was distributed online for Pharmacy, Pharm.D and postgraduate Diploma and Master Students across Jordanian universities. Expiratory factor analysis (EFA) and Cronbach’s alpha were conducted to examine the validity and the internal consistency of the survey, respectively. .Analysis of Covariance (ANCOVA), Chi square test and t-test were conducted to evaluate the variables associated with students’ satisfaction with distance learning. Results: A total of 860 students completed the survey. The EFA generated a three-factor model including positive impact, negative impact and general impact. The mean scores of the factors were 2.84 (SD=1.03), 2.78 (SD=0.92) and 2.34 (SD=1.22) respectively. Several factors were associated with students’ level of satisfaction with distant learning including gender, nationality, university type and field of study. Conclusion: Distance education had negative impact on Pharmacy and Pharm.D. students’ satisfaction, which opens the doors for the necessity to improve the distance education for university students. Variables including gender, nationality, university type and field of study were associated with students’ level of satisfaction.

Medication administration errors (MAEs) are the most common and significant type of medication errors worldwide. This study aims to assess the prevalence, types, and severity of MAEs. Furthermore, this study attempts to determine the factors associated with the occurrence of MAEs.This cross-sectional study was conducted over a three-month interval in the internal medicine ward of a tertiary teaching hospital in Jordan. During the study period, 13 nurses were observed while they were preparing and administering medications using a direct disguised observation method. All the recorded observations about the preparation and administration were compared with the physician's orders in the medications' records to identify any possible MAEs.Having observed a total of 1,012 opportunities for errors, 910 MAEs were identified. Among these 910 errors, adherence errors were found to be the most frequent type (n = 364, 35.9%), followed by incorrect drug preparation (n = 247, 24.4%). None of the MAEs revealed any serious harm to patients or contributed to prolonged hospitalization. Antimicrobial drugs (n = 210, 23.0%) was the most common class associated with MAEs, followed by the class of cardiovascular (n = 157, 17.2%) medicines. Results have shown that the occurrence of MAEs was significantly higher in the non-intravenous medications in comparison to the intravenous medications (While this study revealed a high rate of MAEs, all the identified errors did not cause harm to the patients. Continuous awareness and education campaigns targeting the nurses about the importance of proper and safe drug administration are highly recommended.أخطاء إعطاء الدواء هي من بين أكثر أنواع الأخطاء الدوائية شيوعا وأهمية في جميع أنحاء العالم. هدفت هذه الدراسة إلى تقييم انتشار أخطاء إعطاء الدواء وأنواعها وشدتها، وتحديد العوامل المرتبطة بحدوث مثل هذه الأخطاء.أجريت هذه الدراسة المقطعية على مدى ثلاثة أشهر في جناح الطب الباطني في مستشفى تعليمي ثلاثي في الأردن. خلال فترة الدراسة، تمت ملاحظة ما مجموعه 13 ممرضة أثناء تحضير الأدوية وإعطائها باستخدام طريقة الملاحظة المقنعة المباشرة. تمت مقارنة جميع الملاحظات المسجلة المتعلقة بالتحضير والإدارة مع أوامر الطبيب في سجل الأدوية لتحديد أي أخطاء محتملة.لوحظ ما مجموعه 1012 فرصة للأخطاء، وتم تحديد 910 خطأ في إعطاء الأدوية. من بين هذه الأخطاء البالغ عددها 910، كانت أخطاء الالتزام هي النوع الأكثر شيوعا (العدد 364 ، 35.9٪)، يليها تحضير دواء غير صحيح (العدد 247، 24.4٪). لم يسفر أي من أخطاء إعطاء الأدوية عن ضرر جسيم للمرضى أو ساهم في البقاء في المستشفى لفترات طويلة. كانت الأدوية المضادة للميكروبات (العدد 210 ، 23.0٪) هي الفئة الأكثر شيوعا المرتبطة بـأخطاء إعطاء الأدوية، تليها أدوية أمراض القلب والأوعية الدموية (العدد 157 ، 17.2٪). أظهرت النتائج أن حدوث أخطاء إعطاء الأدوية كان أعلى بشكل ملحوظ في الأدوية غير الوريدية مقارنة بالأدوية الوريدية (القيمة الاحتمالية أقل من 0.001).كشفت هذه الدراسة عن وجود معدل مرتفع من أخطاء إعطاء الأدوية. على الرغم من أن جميع الأخطاء التي تم تحديدها لم تسبب أي ضرر للمرضى، إلا أن الأخطاء كانت موجودة دائما. يوصى بشدة بحملات التوعية والتثقيف المستمرة للممرضين والممرضات حول أهمية الإدارة السليمة والآمنة للأدوية.

Aya Aldabagh,1 Rana Abu Farha,1 Samar Karout,2 Rania Itani,2 Khawla Abu Hammour,3 Eman Alefishat3– 5 1Department Clinical Pharmacy, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan; 2Pharmacy Practice Department, Faculty of Pharmacy, Beirut Arab University, Beirut, Lebanon; 3Department Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan, Amman, Jordan; 4Department of Pharmacology, College of Medicine and Health Science, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates; 5Center for Biotechnology, Khalifa University of Science and Technology, Abu Dhabi, United Arab EmiratesCorrespondence: Eman Alefishat, Department of Pharmacology, College of Medicine and Health Science, Khalifa University of Science and Technology, P O Box 127788, Abu Dhabi, United Arab Emirates, Tel +9715018466, Email Eman.alefishat@ku.ac.aePurpose: The main aim of the study is to assess physicians’ prescribing patterns using the World Health Organization (WHO) prescribing indicators among pediatric outpatient clinics, and to identify areas in need of intervention regarding the rational use of medicines among pediatric outpatients in Jordan.Methods: This is a descriptive observational cross-sectional study that was conducted at the outpatient pediatric clinics at Jordan University Hospital (JUH). During the study period, prescriptions were collected over a period of two months. Prescribing patterns were assessed using the five WHO drug prescribing indicators.Results: A total of 1011 prescriptions/encounters were assessed. More than half of the encounters were for male patients (n= 595, 58.9%), and the median age of patients was eight years (IQR = 7.9). The average number of drugs prescribed per encounter was 1.8 ± 1.3; however, a specific individual clinic, the respiratory clinic, witnessed an average of 2.1 drugs prescribed per encounter. All of the prescribed drugs were prescribed by generic name (100%). Only 47.7% of the drugs were from the essential drug list of the JUH. Overall, antibiotics were prescribed in 19.5% of the encounters, but at higher rates in some clinics such as respiratory clinics (50.8%). Injectables were prescribed in 9.5% of the 1011 encounters; however, they were prescribed at higher rates in endocrinology and neurology clinics, in 44.8% and 31.3% of encounters, respectively.Conclusion: This study revealed some adequate prescribing habits with an optimal prescribing pattern of generics and number of drugs per encounter among pediatric patients. However, the prescribing patterns of the essential drug list, antibiotics, and injectables, in specific clinics, failed to meet WHO standards. The findings of this study shed light on the need to establish national strategies to improve prescribing practices among the pediatric population.Keywords: World Health Organization, irrational drug use, pediatrics, drug prescribing indicators, outpatient, Jordan

Objectives: In this systematic review, we aimed to evaluate the clinical features, therapeutic options, and outcomes of children with multisystem inflammatory syndrome in children (MIS-C) and to investigate whether MIS-C is a new variant of Kawasaki disease. Materials and methods: Adhering to PRISMA principles, we searched for eligible studies between December 2019 and June 2020 through the following databases: PubMed, ISI Web of Science, SCOPUS, and Science Direct. Studies including original data of patients aged Results: A total of 84 studies were identified, for which 48 were eligible for full screening and only 13 studies (n=657) met our inclusion criteria. More than 70% of patients with MIS-C tested positive for severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2). The most common symptoms were gastrointestinal (80 to 100%) and most patients presented with fever for >4 days. Mucocutaneous manifestations are similar to Kawasaki disease presented in up to 64% in some studies. Almost all patients had significant elevations in inflammatory markers, and up to 50 to 100% had elevated troponin suggesting myocardial damage. Intravenous immunoglobulin (IVIG) was administered to 60% of patients in 12 studies and 80 to 100% in five studies. Steroids were administered to 10 to 95% of patients. The overall mortality rate was 0.9%. Conclusion: The temporal association between novel coronavirus disease 2019 (COVID-19) onset and Kawasaki-like disease and MIS-C suggests a causal link. Both syndromes have similar cascades of symptoms and hyperinflammation, which likely explain their response to the same immunomodulatory agents. However, it is unclear yet why some children appear more susceptible to develop MIS-C.

Digoxin is a cardiac glycoside that was introduced to cardiovascular medicine more than 200 years ago. Its use is associated with large variability, which complicates achieving the desired therapeutic outcomes. To present a synthesis of the available literature on the population pharmacokinetics of digoxin in adults and to identify the sources of variability in its pharmacokinetics. This is a PROSPERO registered systematic review (CRD42018105300). A literature search was conducted using the ISI Web of Science, Science Direct, PubMed, and SCOPUS databases to identify digoxin population pharmacokinetic studies of adults that utilized the nonlinear mixed-effect modeling approach. Sixteen articles were included in the present analysis. Only two studies were conducted in elderly subjects as a separate population. Both the pharmacokinetics and pharmacodynamics of digoxin were investigated in one study. Furthermore, the reviewed studies were mostly conducted in East Asian populations (68.8%). Digoxin's pharmacokinetics were usually described by a one-compartment model because of the nature of the collected data. Weight, age, kidney function, presence of heart failure, and co-administered medications such as calcium channel blockers were the most commonly identified predictors of digoxin clearance. The value of apparent clearance in a typical study individual ranged from 0.005 to 0.2 l/h/kg, while the value of the apparent volume of distribution ranged from 3.14 to 15.2 l/kg. The quality of model evaluation was deemed excellent only in 31.3% of the studies. This review provides information about variables that need to be considered when prescribing digoxin. The results highlight the need for prospective studies that allow two-compartment pharmacokinetic/pharmacodynamic models to be established, with a special focus on the elderly subpopulation.

Background: In hospital surgical wards, patients are at higher risk for medication errors, in part because physicians may not consider themselves sufficiently trained to prescribe medications. Hence, collaborative teamwork involving the pharmacist is needed. Objectives: To assess the impact of medication reconciliation directed by pharmacists on decreasing medication discrepancies after discharge from the surgical ward. Methods: Patients admitted to the surgical unit at a tertiary teaching hospital in Amman, Jordan, between July 2017 and July 2018 were selected and randomly assigned to either the control or the intervention group. Upon admission, the number and kinds of unintentional medication discrepancies were determined for both groups. Medication reconciliation was then provided to patients in the intervention group. The number of unintentional discrepancies was re-evaluated upon discharge for both groups. To assess differences between the control and intervention groups, the χ2 or Fisher exact test was used for categorical variables and an independent-sample t test for continuous data. A paired t test was conducted to determine whether the number of medication discrepancies was reduced as a result of pharmacists’ recommendations. Results: A total of 123 patients met the inclusion criteria, 61 in the intervention group and 62 in the control group. Discrepancies of omission and wrong dose constituted 41 (77%) of the 53 discrepancies in the intervention group and 25 (76%) of the 33 discrepancies in the control group. The number of unintentional discrepancies was significantly reduced from admission to discharge in both the intervention group (p = 0.002) and the control group (p = 0.007). Of 53 recommendations made by pharmacists, 20 (38%) were accepted by the treating physician, and all of these discrepancies were resolved. Conclusions: This study sheds light on the existence of unintentional medication discrepancies upon admission for surgical patients, which may expose the patients to potential harm upon discharge from hospital. Additional studies with a larger sample size are needed to gain further insights on pharmacists’ role in implementing medication reconciliation for surgical patients. Trial Registration: ClinicalTrials.gov NCT03928106 RÉSUMÉ Contexte : Dans les services chirurgicaux des hôpitaux, les patients sont exposés à un risque d’erreurs de médication plus élevé, en partie parce que les médecins ne se considèrent pas suffisamment formés pour prescrire des médicaments. Par conséquent, un travail d’équipe collaboratif impliquant le pharmacien est nécessaire. Objectifs : Évaluer l’impact du bilan comparatif des médicaments dirigé par les pharmaciens sur la diminution des écarts médicamenteux après la sortie du service de chirurgie. Méthodes : Les patients admis à l’unité chirurgicale d’un hôpital d’enseignement tertiaire à Amman, en Jordanie, entre juillet 2017 et juillet 2018 ont été sélectionnés et affectés au hasard au groupe témoin ou au groupe d’intervention. Lors de l’admission, le nombre et les types de divergences médicamenteuses non intentionnelles ont été définis pour les deux groupes. Le bilan comparatif des médicaments a ensuite été fourni aux patients du groupe d’intervention. Le nombre d’écarts non intentionnels a été réévalué à la sortie pour les deux groupes. Pour évaluer les différences entre le groupe témoin et le groupe d’intervention, le test χ2 ou le test exact de Fisher a été utilisé pour les variables catégorielles et un test t pour échantillon indépendant, pour les données continues. Un test t apparié a été effectué pour déterminer si le nombre d’écarts de médicaments a été réduit à la suite des recommandations des pharmaciens. Résultats : Au total, 123 patients répondaient aux critères d’inclusion : 61 dans le groupe d’intervention et 62 dans le groupe témoin. Les divergences d’omission et de mauvaise dose constituaient 41 (77 %) des 53 divergences dans le groupe d’intervention et 25 (76 %) des 33 divergences dans le groupe témoin. Le nombre d’écarts non intentionnels a été significativement réduit de l’admission à la sortie à la fois dans le groupe d’intervention (p = 0,002) et dans le groupe témoin (p = 0,007). Sur 53 recommandations émises par des pharmaciens, 20 (38 %) ont été acceptées par le médecin traitant et toutes ces divergences ont été résolues. Conclusions : Cette étude met en lumière l’existence d’écarts médicamenteux non intentionnels lors de l’admission des patients chirurgicaux, ce qui peut exposer les patients à des risques au moment de leur sortie de l’hôpital. D’autres études avec un échantillon plus important sont nécessaires pour mieux comprendre le rôle des pharmaciens dans la mise en œuvre du bilan comparatif des médicaments pour les patients chirurgicaux. Enregistrement de l’essai : ClinicalTrials.gov NCT03928106

Objectives:The novel 2019 coronavirus outbreak that first appeared in Wuhan has quickly gained global attention, due to its high transmissibility and devastating clinical and economic outcomes. The aim of this study was to assess the possible roles of Jordanian pharmacists in minimizing the stage of community transmission.Methods:A cross-sectional survey using Google forms targeting Jordanian pharmacists was conducted during March 2020 and distributed electronically by means of social media. Using the survey tool, we measured the pharmacists’ knowledge, the educative activities they perform, and their perceptions regarding undertaking traditional and untraditional roles during the COVID-19 outbreak, as specified by the International Pharmaceutical Federation (FIP). Collected data were analyzed using SPSS version-19.Results:Jordanian pharmacists (n = 449) reported performing various educative activities, and in general, they were knowledgeable about various aspects of the COVID-19 disease (median knowledge score: 20 [range, 13-25]), but certain gaps in knowledge were detected that must be addressed. Pharmacists had positive perceptions about both their traditional and untraditional roles specified by the FIP, the median perceptions score was 4 (range, 1-5).Conclusions:Jordanian pharmacists can be used to reduce community transmission of the outbreak. However, more actions are required to keep pharmacists knowledgeable with recent disease updates to enable them to perform their tasks effectively during times of crisis.

This is a PROSPERO registered systematic review (CRD42018105207), conducted to summarize the available knowledge regarding the population pharmacokinetics of digoxin in paediatrics and to identify the sources of variability in its disposition. PubMed, ISI Web of Science, SCOPUS and Science Direct databases were searched from inception to January 2019. All paediatric population pharmacokinetic studies of digoxin that utilized the nonlinear mixed‐effect modelling approach were incorporated in this review, and data were synthesized descriptively. After application of the inclusion–exclusion criteria 8 studies were included. Most studies described digoxin pharmacokinetics as a 1‐compartment model with only 1 study describing its pharmacokinetics as 2‐compartments. Age was an important predictor of clearance in studies involving neonates or infants, other predictors of clearance were weight, height, serum creatinine, coadministration of spironolactone and presence of congestive heart failure. Congestive heart failure was also associated with an increased volume of distribution in 1 study. The estimated value of apparent clearance in a typical individual standardized by mean weight ranged between 0.24 and 0.56 L/h/kg, the interindividual variability in clearance ranged between 7.0 and 35.1%. Half of the studies evaluated the performance of their developed models via external evaluation. In conclusion, substantial predictors of digoxin pharmacokinetics in the paediatric population in addition to model characteristics and evaluation techniques are presented. For clinicians, clearance could be predicted using age especially in neonates or infants, weight, height, serum creatinine, coadministration of medications and disease status. For future researchers, designing pharmacokinetic studies that allow 2‐compartment modelling and linking pharmacokinetics with pharmacodynamics is recommended.

Background: Establishing and implementing a gold standard criteria for diagnosing and treating stroke-associated pneumonia (SAP) would have a significant positive impact on stroke outcomes and antibiotic stewardship. This study aimed to qualitatively explore current diagnostic and treatment practice for SAP among clinicians. Methods: A qualitative study was employed to conduct semi-structured interviews at the tertiary-care Jordan University Hospital. A purposive sampling technique was employed to recruit the participants, including respiratory consultants (n=3) and residents (n=9) practicing in the internal medicine wards and intensive care unit, where stroke patients are treated. The interviews were audio-recorded, transcribed verbatim, translated, and analyzed thematically using framework analysis. Results: Clinicians expressed their experiences, which were organized into two themes and eight emerged sub-themes: Terminology and diagnostic approach of SAP involved; no definite terminology, reliance on both clinical evidence and X-ray findings to decide, reliance on clinical evidence alone to suspect SAP and initiate empirical therapy, and SAP overdiagnosis. The treatment strategies include early treatment of SAP, treating SAP the same as CAP/HAP, predominant anaerobes coverage, and SAP overtreatment. Conclusion: Our findings show a wide range of physician-based diagnostic and treatment approaches for SAP, with clinical criteria serving as the main driver for antibiotic initiation. Standard validated algorithmic-based criteria need to be established and implemented.

The present study aimed to see how well the newly designed internet hospital drug delivery platform model worked in the pharmacy department during the COVID-19 pandemic to make it easier for patients to get their prescribed drugs during the home quarantine. Methods: The internet hospital drug delivery platform was designed and activated by the pharmacy department in collaboration with the information technology department. The pharmacy department, in partnership with the information technology department, built and launched the internet hospital drug delivery platform (IHDD) immediately after the Jordanian government declared a full lockdown. Results: During the quarantine, a total of 5994 prescriptions, including 28494 medications, were delivered to 4853 patients. The majority of the patients (n = 1835; 37.8%) were aged 60 to 74.Nearly three quarters (4722; 78.8%) of the patients were from Amman, the capital of Jordan, and the top five online prescription departments were cardiology (n = 1737, 31.6%), endocrinology (n = 624, 11.4%), nephrology (n = 557, 10.1%), respiratory (n = 462, 8.4%), and neurology (n = 412, 7.5%). Conclusion: The IHDD platform was found to be efficient and convenient because it handled the challenge of precisely delivering medications to patients on time. To meet the pandemic's challenge, the pharmacy department has extended its inventive powers. In addition to safeguarding the environment, health technology was used to provide a coordinated, systematic program for the administration of medications. The pharmacy department, in partnership with the information technology department, built and deployed the internet hospital drug distribution infrastructure shortly after Jordan's government proclaimed a full lockdown. During the quarantine, a total of 5994 prescriptions, including 28494 medications, were delivered to 4853 patients. The majority of the patients (n = 1835; 37.8%) were between the ages of 60 and 74.Nearly three quarters (4722; 78.8%) of the patients were from Amman, the capital of Jordan, and the top five online prescription departments were cardiology (n = 1737, 31.6%), endocrinology (n = 624, 11.4%), nephrology (n = 557, 10.1%), respiratory (n = 462, 8.4%), and urology (n = 412, 7.5%). The pharmacy department has expanded its capabilities creatively to face the challenge posed by the pandemic. Health technology was utilized to ensure a coordinated, systematic program for the delivery of medications, in addition to preserving the safety of the dedicated staff.

Potential prescribing omission (PPO) represents a failure in prescribing drugs when indicated due to lack of the evidence base. Published data are scarce on the prevalence of prescribing omissions in Jordan. This study aimed to assess the prevalence of prescribing omissions in elderly patients in a Jordanian teaching hospital. Screening Tool to Alert doctors to the Right Treatment (START) version 2 was used to identify the prescribing omissions in older adults admitted to a tertiary hospital in Jordan for 18 months. During the study period, data relating to the patients’ medical problems and prescribed medicines were collected by two clinical pharmacists via reviewing the clinical and prescription records of the included patients. Data were collected using a predefined data collection form and statistical analysis was conducted using Statistical Package of Social Sciences (SPPSS). One or more prescribing omissions were found in 40.5%, 41.0%, and 39.5% of the patients upon admission, during hospitalization, and on discharge, respectively. The most common prescribing omission was about START criterion I1 which was “seasonal trivalent influenza vaccine annually” in 54.8% upon admission, 51.5% during hospitalization, and 51.9% on discharge. Logistic regression found that the higher number of medical conditions was associated with an increased risk of PPO occurrence upon admission, during hospitalization, and on discharge (p value < 0.05). Acts of omission of appropriate medications were highly prevalent among older patients in our hospital setting. A validated screening tool (START) is one method of systematically identifying appropriate omitted medicines in clinical practice. Application of validated START criteria can help detect and prevent PPO occurrence among older patients

This study aimed to describe the process of the institutionalization of health technology assessment (HTA) in Jordan. In particular, this study presents local policy perspectives on capacity building for HTA and the progress made toward its use in pricing and reimbursement decisions.University-based education and professional development training in pharmacoeconomics and pharmaceutical policy have been the starting points to create a receptive environment, necessary expertise, and local tools across many settings in Jordan. International collaboration with HTA supporting bodies helped to build connections and informed policy development on local levels through projects, meetings, and discussions. HTA INSTITUTIONALIZATION AND ITS USE IN PRICING AND REIMBURSEMENT DECISIONS: Institutionalizing HTA in the King Hussein Cancer Center and the Royal Medical Services was the driving factor for HTA implementation and practice advancement; nevertheless, process transparency and experience sharing through reports and publications are still limited. The Jordan Food and Drug Administration's pricing and formulary decisions require pharmacoeconomic consultation in selected cases according to the Jordanian Drug Law. Nevertheless, there is a lack of local methodological guidelines for conducting HTA. In addition, HTA practitioners and the regulatory scope of future HTA activities in Jordan cannot be determined yet.Over the past 2 decades, Jordan has crossed a number of milestones and advanced further to implement HTA as a tool for evaluating health interventions. As a next step, legislation is needed to mandate the use of HTA and to enhance transparency in decision-making processes.

Introduction The main leading cause of the upper respiratory tract infections (URTIs) is viral infection. However, parental attitudes often lead to inappropriate prescription of antibiotics contributing to development of antibiotic resistance. The aim of this study is to assess parental knowledge, attitude, and practice (KAP) towards the use of antibiotics in Dubai and to reveal the associated factors. Method Questionnaires were distributed to 500 parents of children who were visiting Al Jalila Children's Specialty Hospital in Dubai. Result A total of 467 subjects agreed to participate in the study. Family income, educational level, nationality, age of the respondents, and numbers of children were identified as factors that significantly associated with inadequate knowledge, negative attitude, or malpractice. Conclusion The study has identified key factors associated with misuse of URTI antibiotics and highlights the importance of targeting those groups with intervention programs and campaigns to increase awareness and decrease misconception of antibiotic use.

An analysis was conducted to assess the factors affecting the public's knowledge about coronavirus disease (COVID-19) vaccines and the influence of that knowledge on their decision to get vaccinated.Cross-sectional survey.An online, self-administered questionnaire was instrumentalized to assess the factors affecting the Jordanian public's knowledge about COVID-19 vaccines and the influence of that knowledge on their decision to get vaccinated. A multiple linear regression analysis was carried out to determine the variables that affected the participants' knowledge score regarding COVID-19 vaccines. The Mann-Whitney U test was used to evaluate the differences in knowledge scores among different groups. P0.05 was considered statistically significant.Only 45.9% of the 468 participants reported being willing to receive the vaccine, and only 38.5% (n = 180) had registered on the Ministry of Health platform to get vaccinated. Moreover, very few of them (26/468, 5.6%) had received the vaccine. The participants showed inadequate knowledge, with a median knowledge score of 4 out of 8 (interquartile range = 4). The linear regression analysis showed that participants aged above 45 years, those with bachelor's or graduate degrees, and those with medical-related degrees had higher knowledge scores regarding COVID-19 vaccines than the others (P0.001). Participants who were willing to receive the vaccine, those who had registered to receive the vaccine, and those who had got vaccinated had higher knowledge scores than the others (P0.001 for all).This cross-sectional analysis indicated that urgent education is needed to improve the public's knowledge and awareness about the COVID-19 vaccine to reduce the adverse impact of lack of knowledge on decision making for the COVID-19 vaccination.

Clinical, genetic, and laboratory characteristics of Middle Eastern patients with multisystem inflammatory syndrome in children (MIS-C) have not yet been documented.To assess the genetic and clinical characteristics of patients with MIS-C of primarily Arab and Asian origin.A prospective, multicenter cohort study was conducted from September 1, 2020, to August 31, 2021, in the United Arab Emirates and Jordan. Forty-five patients with MIS-C and a matched control group of 25 healthy children with a confirmed SARS-CoV-2 infection status were recruited. Whole exome sequencing in all 70 participants was performed to identify rare, likely deleterious variants in patients with MIS-C and to correlate genetic findings with the clinical course of illness.SARS-CoV-2.Fever, organ system complications, laboratory biomarkers, whole exome sequencing findings, treatments, and clinical outcomes were measured. The Mann-Whitney U test was used to assess the association between genetic variants and MIS-C attributes. The Fisher exact test was used to compute the genetic burden in MIS-C relative to controls.A total of 45 patients with MIS-C (23 [51.1%] male; 30 [66.7%] of Middle Eastern origin; mean [SD] age, 6.7 [3.6] years) and 25 controls (17 [68.0%] male; 24 [96.0%] of Middle Eastern origin; mean [SD] age 7.4 [4.0] years) participated in the study. Key inflammatory markers were significantly dysregulated in all patients with MIS-C. Mucocutaneous and gastrointestinal manifestations were each reported in 36 patients (80.0%; 95% CI, 66.1%-89.1%), cardiac findings were reported in 22 (48.9%; 95% CI, 35.0%-63.0%), and neurologic findings were reported in 14 (31.1%; 95% CI, 19.5%-45.6%). Rare, likely deleterious heterozygous variants in immune-related genes, including TLR3, TLR6, IL22RA2, IFNB1, and IFNA6, were identified in 19 patients (42.2%; 95% CI, 29.0%-56.7%), of whom 7 had multiple variants. There was higher enrichment of genetic variants in patients relative to controls (29 vs 3, P .001). Patients with those variants tended to have earlier disease onset (7 patients [36.8%; 95% CI, 19.1%-58.9%] with genetic findings vs 2 [7.7%; 95% CI, 2.1%-24.1%] without genetic findings were younger than 3 years at onset) and resistance to treatment (8 patients [42.1%; 95% CI, 23.1%-63.7%] with genetic findings vs 3 patients [11.5%; 95% CI, 4.0%-29.0%] without genetic findings received 2 doses of intravenous immunoglobulin).The results of this cohort study suggest that rare, likely deleterious genetic variants may contribute to MIS-C disease. This finding paves the way for additional studies with larger, diverse populations to fully characterize the genetic contribution to this new disease entity.

Objectives To measure the prevalence of cases of potentially inappropriate prescribing (PIP) for older patients and to identify the risk factors for identified cases of PIP. Methods STOPP criteria version 2 were used for identifying cases of PIP for older patients (>65 years) who were admitted to a tertiary hospital in Jordan over a period of 18 months. Data were collected by prospectively reviewing the clinical and prescription records of included patients. Descriptive analysis, univariate analysis and multiple linear regression were used to analyse the results. Results Upon admission, during hospitalisation and on discharge, 144, 182 and 156 cases of PIP were identified, respectively. There was a statistically significant association between the number of prescribed medications and cases of PIP during the hospital journey (P Conclusion Inappropriate prescribing of medications is highly prevalent among older patients. Application of validated (STOPP) criteria can help to detect and direct development of interventions to prevent PIP occurrence among older patients.

Objectives:Outbreaks and containment measures implemented to control them can increase stress in affected populations. The impact of the coronavirus disease 2019 (COVID-19) outbreak on perceived stress levels in the Jordanian population is unknown. The aim of the study was to determine the perceived stress level and factors associated with it in the Jordanian population during the COVID-19 outbreak.Methods:Required data, such as those from the Perceived Stress Scale (PSS-10) and possible predictors of perceived stress, were collected through a Web-based survey. Statistical analysis was conducted through SPSS.Results:The mean (SD) of perceived stress score was 19.8 (6.7). Regression analysis revealed that stress was increased in females, young adults, usually being stressed more than others by a health problem, increased perceived severity of the disease, increased overall worry score, and student’s worry regarding their studies/graduation. Perceived stress was decreased if participants’ self-rated health status score increased.Conclusions:In the context of increasing public health preparedness, the results of this study can be used in designing interventions to alleviate stress in susceptible segments of the Jordanian community.

OBJECTIVES In this study we aimed to evaluate the completeness of three different medication information sources that are commonly used to collect and obtain the Best Possible Medication History (BPMH). METHODS This is an observational study which was held at Jordan University Hospital. After identifying eligible patients, the BPMH was obtained from three different sources separately. These sources include medical file, pharmacy database, and patients' interview. Information from all of these sources was compiled to create the BPMH. The BPMH was used as the standard against which every other information source was compared and given a "completeness score" according to a systematic scoring system. RESULTS Among the 196 participating patients who were included in the study, 113 (57.7%) were recruited from internal medicine and 83 (42.3%) from surgical department. Patients' interview showed the highest median completeness score (71.4%) among the three used sources followed by pharmacy database (35.3%), and medical files (28.2%). The median completeness score for the compiled BPMH obtained by the pharmacist was 93.0%. The compiled BPMH completeness score was inversely proportional to the numbers of medications in the compiled BPMH (R = -.392, P value

This study aimed to evaluate the prevalence and predictors of polypharmacy in hospitalised patients in Jordan to help guide healthcare efforts in decreasing the burden on the healthcare system.This cross-sectional study was conducted at the University of Jordan Hospital in Amman, Jordan. During the study period, a convenience sample of patients admitted to the internal medicine and surgical wards were approached to take part in this study. Following patients' recruitments, patients were interviewed and their medical files were reviewed to obtain demographic and clinical information regarding their medical conditions and their regular use of medicines. Then, the prevelence of patients with polypharmacy were identified, and factors predicting polypharmacy among them were determined.Among the 300 participants who agreed to participate in this study, females represented 45.3% of the recruited sample (n = 139), and around 48.0% (n = 144) of the study sample were elderly people (≥65 years old). Most of the recruited patients (n = 248, 82.7%) were found to use polypharmacy (≥ 5 medications). Hypertension was the most frequent medical condition among study participants (n = 240, 80.0%) followed by diabetes (n = 185, 61.7%). Results of logistic regression analysis showed that polypharmacy was only significantly affected by patients' age (OR = 2.149, P-value = .024) and monthly income (OR = 0.336, P-value = .009), while other factors were not associated with polypharmacy. Elderly patients (≥65 years) were found to have polypharmacy more significantly than non-elderly patients. Also, those with lower monthly income (500 JD) were found to use lower polypharmacy compared with those with higher monthly income (500 JD).The present study showed that polypharmacy is prevalent among patients in Jordan. While polypharmacy was not affected by smoking status, gender, BMI and educational level, it was significantly affected by monthly income and age. Further plans should be put in place to reduce polypharmacy, starting with effective pharmaceutical care services leading to treatment optimisation and ensuring desired treatment outcomes.

Objectives: The present study aimed to evaluate the parents' knowledge, attitudes and practices (KAP) towards the use of antibiotics for childhood upper respiratory tract infections (URTIs), at the Jordanian University Hospital. Methods: This was a cross-sectional study. During the study period, 1301 parents of young children completed a validated – structured questionnaire. Results: Gaps in common knowledge related to antibiotics and their use were noted among participants. Nearly half of respondents believed that antibiotics are void from adverse effects, while 72.4% of them believed that a child should be given an antibiotic if it develops fever, even though 60% they were aware that most URTIs were viral in nature. Parents reported that they administered antibiotics to children without medical advice most of the time for various causes, including using a previously prescribed antibiotic for a similar illness (27.1%), or based on pharmacist's recommendation (23.8%). Conclusion: The results demonstrated the need for educational interventions to increase the awareness of parents about antibiotics to reduce inappropriate use and its consequences. Keywords: Antibiotics, Attitude, Knowledge, Parents, Upper Respiratory Tract infections, Hospital

Objectives In Jordan, drive-thru pharmacy service has recently been introduced representing a new trend in community pharmacy services. This study aimed to evaluate pharmacy customers' awareness and perceptions towards the drive-thru service to unveil important information regarding such service. Methods A Self-administered questionnaire was used in this cross-sectional study which was conducted in Amman-Jordan between April and August 2017. A Self-administered questionnaire was used to evaluate pharmacy customers' awareness and perceptions towards pharmacy drive-thru services. Factors affecting customers' use of this service was also investigated. Key findings A total of 789 pharmacy customers participated in the current study. Mean age of study participants was 27.7 years (SD = 10.6) and half of them were men (n = 397, 50.4%). Although 26.8% (n = 212) of the customers knew that the drive-thru pharmacy service was newly implemented in Jordanian pharmacies, only 10.9% (n = 86) reported to have used this service. Customers (59.1%) expressed their support for the introduction of this service to pharmacy practice in the country. Certain factors affected customers' use of the drive-thru pharmacy service positively, including male gender, Jordanian nationality, non-single marital status and having children (P-value Conclusions This study demonstrated positive customer awareness and perceptions towards the drive-thru pharmacy service. Busy customers seem to use this service more (men being married and having children). Hence, this service seems to be most beneficial to a certain type of customers. However, concerns about poor communication between the pharmacist and the patient represented the main disadvantage of the drive-thru service.

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

Introduction Viral infection is the main cause of Upper respiratory tract infections (URTIs). However, antibiotic resistance is promoted through inappropriate prescription of antibiotics for children with URTIs. This study aimed to assess the possible risk factors which may be associated with such antibiotic misuse. Methods This prospective study was designed to evaluate parents' knowledge and attitudes towards antibiotic use for their children. Study questionnaires were distributed to adult parents caring for children aged between 4 and 8 years at Jordan University Hospital. Detailed content analysis was conducted to obtain all relevant information. Results A total of 1301 parents agreed to participate in this study. Parents’ knowledge score was 7.02/14 (SD = 1.52). The knowledge score was positively associated with both the age of parents and the income level (p-value = .001 and Conclusions This study showed there was a relationship between the number of children, the age of parents and income on parent’s knowledge and attitude towards using antibiotics. Additional intervention programs may be required for such groups of parents.

Surgical site infections (SSIs) following caesarean surgeries are common. The present study aimed to evaluate the frequency of SSIs following caesareans at Jordan University Hospital during the 30 postoperative days and to identify factors associated with increased SSIs risk. Data regarding the occurrence of SSIs were collected both prospectively via follow-up phone calls and retrospectively via reviewing wound culture results and clinical notes. SSI cases were subsequently determined utilizing predefined criteria. Data relating to possible risk factors of SSIs were collected from patient interviews and hospital records. Risk factors for SSIs were identified via logistic regression. A high rate of SSIs (14.4%) was detected; implicated factors included body mass index ≥36 kg/m2 prior to pregnancy odds ratio (OR) 3.8, 95% confidence interval (95% CI) 1.6–9.4, hospital stay longer than 3.5 days OR 2.3, 95% CI 1.4-3.6, having the operation at a gestational age greater than 40 weeks OR 2.2, 95% CI 1.3-3.9. Receiving a higher weight-adjusted dose of the prophylactic antibiotic cefazolin was associated with lower SSIs risk OR 0.967, 95% CI 0.94-0.99. In conclusion , a high rate of SSIs following caesareans was detected, and modifiable risk factors of SSIs should be incorporated into targeted policies aiming to reduce the rate of SSIs.

Rationale, aims, and objectives Underreporting of adverse drug reactions (ADRs) by health care professionals is a common inherent health problem encountered in many countries. This could be explained by the lack of awareness and knowledge about the guidelines to follow to identify and report ADRs. Thus, this study aimed to evaluate the awareness, knowledge, and perceptions among medical doctors and nurses regarding their role as ADRs reporters in Jordan. Methods A cross-sectional study was conducted between September 2015 to January 2016 at the Jordan University Hospital in Amman. During the study period, a total of 670 validated questionnaires were distributed to medical doctors and nurses in different departments. Results Most of health care professionals were not aware of the concept of pharmacovigilance. Medical doctors showed a better overall knowledge compared with nurses (P

Rationale, aims and objectives The primary aim of this study is to gain an insight into hospital pharmacists' current practice and perceptions towards medicine reconciliation and to identify common challenges preventing pharmacists from providing this service. Methods A cross-sectional study was conducted over 2 months (September-October 2015) at four Jordanian hospitals accredited by the Joint International Commission. A total of 76 pharmacists were recruited. Each pharmacist completed a validated structured questionnaire evaluating (1) pharmacist's current practice of medication reconciliation, (2) pharmacist's perceptions towards practicing medication reconciliation and (3) pharmacist's perceived barriers towards implementing medication reconciliation. Results There was relatively low awareness of the presence of current medication reconciliation policy in the hospitals. The majority of recruited pharmacists believed that pharmacists must have an integral role in providing such services to patients. They were also willing and able to provide help and support to all healthcare providers regarding the appropriateness of prescribed medications. It was evident that the greater the practice of medication reconciliation services and the higher the educational level, the better the overall perception score (r = 0.416 and r = 0.366, respectively; P-value = 0.000 for both). 'Time constraint' was the primary barrier discouraging pharmacists from practicing such service. Conclusion This study demonstrates a relatively low awareness of the concept and policy of medication reconciliation process among Jordanian pharmacists. This suggests that educational programs are urgently needed to increase pharmacists' role and responsibilities in implementing and practicing reconciliation services with expected positive impact on patient care.

Objective This study aimed to identify and point out the number and types of medication discrepancies among cancer patients admitted to Jordan University Hospital. Method This is a cross-sectional observational study that was conducted on cancer patients in the internal medicine department at Jordan University Hospital, Amman, Jordan. During a period of six months, a convenience sample of cancer patients was recruited, and their medical records were reviewed to collect information regarding their demographics, clinical, and medication information. Also, patients’ Best Possible Medication History (BPMH) was collected using different methods, and a comparison between patients’ BPMH and their current medications was conducted where discrepancies were recognized. Results Seventy-eight medical records were reviewed, with a total of 166 discrepancies identified. Of these, 110 discrepancies (66.3%) were unintentional. Exactly 67.9% of the study participants ( n = 53) were found to have at least one unintentional discrepancy, with the most common type being omissions ( n = 71, 65.1%,) and the second most common type being additions ( n = 16, 14.7%). Most of the discrepancies ranged between low to moderate in severity. Fifty-six (33.7%) intentional undocumented discrepancies (documentation errors) were also identified. Conclusion This study revealed a high rate of medication discrepancies among hospitalized cancer patients, most commonly unintentional omissions. Nevertheless, undocumented intentional discrepancies can equally harm this critically ill population. So, do we need medication reconciliation in cancer patients? Yes. Cancer patients are critically ill, and therefore more effort should be paid towards implementing medication reconciliation services in their treatment plan.

Objectives The main objective of this study was to evaluate community pharmacists' awareness and perception about medication reconciliation service and to assess the completeness of collecting patients' medication histories in the community pharmacy setting. Methods A cross-sectional study was conducted between February to March 2018 in Amman-Jordan. During the study period, 150 community pharmacists were invited to participate in the study. Each pharmacist completed a validated structured questionnaire evaluating their awareness, current practice, perceived attitude and perceived barriers towards the implementation of medication reconciliation and the collection of medication histories at the community pharmacy setting. Results A total of 121 pharmacists agreed to participate and filled the questionnaire. Our results showed that only 13.2% of the pharmacists were able to define "medication reconciliation" correctly, and around 31% have a misconception that the medication reconciliation process should be performed only at the inpatient setting. Only 19.8% (n = 24) of the participating pharmacists stated that they ask all patients for a complete current medication list of medications when they arrive at the pharmacy site. Medication histories for most patients were lacking information about the dosage, route, frequency, and time of the last refill for each medication listed. "Patients lack of awareness about all the medications they are receiving" was the main barrier discouraging community pharmacists from collecting medication histories and participating in reconciliation service. Conclusion Community pharmacists in Jordan showed a low awareness about the medication reconciliation concept and demonstrated a modest role in obtaining medication histories in community pharmacies. But still, they showed a positive attitude towards their role in implementing the different steps of medication reconciliation. This suggests that educational workshops to increase pharmacists' awareness about their role and responsibilities in collecting a complete and accurate medication history are warrented.

Background Surgical site infections are common, especially in developing countries. Nevertheless, up to 60% of surgical site infections can be prevented with appropriate perioperative care, which includes among other measures using suitable surgical antimicrobial prophylaxis (SAP). Methods After a short interview with patients and retrospective review of medical charts, compliance with 6 SAP parameters was assessed for appropriateness; those parameters are indication, choice, dose, time of administration, intraoperative redosing interval, and duration of prophylaxis in 1,173 operations. Results Overall compliance was poor; nevertheless, certain components showed high compliance rates, such as indication and choice of antibiotics. The most frequent error noted was extended administration of prophylactic antibiotics, which was observed in 88.2% of the study population. Emergency operations were associated with a lower risk of noncompliance in administering the correct dose at the correct time (odds ratio, 0.63; 95% confidence interval, 0.47-0.83 and odds ratio, 0.21; 95% confidence interval, 0.14-0.3, respectively). On the other hand, women who underwent an emergency operation were associated with a 6-fold higher risk of receiving prophylactic therapy following surgery. Conclusions The present study demonstrated the existence of a surprisingly low level of overall compliance with the hospital-adapted SAP guidelines. Factors implicated in noncompliance were investigated, and the present results create a starting point to improve the current practice.