Clinical Pharmacy

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Prevalence and Predictors of Herb Use during Pregnancy (A study at Rafidia Governmental Hospital/ Palestine)
(2012) Deema Hilmi Adawi; Dr. Rowa’ Al-Ramahi; Dr. Nidal Jarradat
Abstract The use of herbal products among pregnant women is high Worldwide because they consider them safer than medication. They use herbs for nausea, vomiting, and other pregnancy related problems. Pregnant women like to use herbal products despite limited data on safety and efficacy. The objectives of this study are to measure the prevalence and predictors of herb use among a sample of Palestinian pregnant women and the possible influence of herbal consumption on pregnancy outcomes. This study was a questionnaire-based cross sectional descriptive study. It was conducted in the maternity ward of Rafedia Governmental Hospital between March and May 2012, a random sample of women who gave birth during the study period were met and asked to answer a face to face questionnaire. The results showed that the prevalence of using herbal products among pregnant women was 40.0%, the most common herbs were anise (61.7%), chamomile (53.3%), sage (55%), mixture of herbs (33.3%), and thyme (29.2%). The women preferred the herbs because they considered herbs safer than medications. There was no relation between herbal products use and any variable (age, educational level, living place, medical insurance, family income, work, chronic disease, parity and medication use). No negative relationship between herbal use and outcome on pregnant women and infants was found. This study found that the use of herbs during pregnancy is very common among Palestinian women. To provide the best care to pregnant women who use herb products, clinicians and pharmacist are recommended to stay up to date with herb use and their safety in pregnancy. The physicians are recommended to ask pregnant women about herb use because this practice is common among pregnant women, so doctors need to consider this to avoid any possible drug-herb interaction or negative outcomes on the mother or the fetus.
Community Pharmacists' Medication Knowledge: A Nation-wide Study in Palestine
(2012) Enass Majed Abd Alrahman Abu Arah; Prof. Waleed Sweileh; Dr. Adham Abu-Taha
Background: Community Pharmacists are easily accessible to the public. They have an important role and responsibility in monitoring the safety of medicines dispensed with or without a prescription. Objective: This study aims to assess medication knowledge of Palestinian community pharmacists. In specific, knowledge of community pharmacists about safety of medicines during pregnancy and evidence based therapy of herbal products will be assessed. Methodology: This is a cross-sectional survey study on community pharmacists. The medication knowledge was assessed by a set of questions specifically designed for this purpose. Scores of the test were presented as percentage from a total of 100. The internal consistency of each test was acceptable with a Cronbach alpha ≥ 0.6. Results: Approximately one third of chief community pharmacist in West-Bank, Palestine took part in the study. The sample consisted of 173 (50.6%) females and 169 (49.6%) males. The majority of the participants (303; 89.2%) had a B.Sc. degree in pharmacy while 37 (10.8%) had an M.S degree. Community pharmacists have the following median (Q1-Q3) scores: [70% (60-80)]; [40% (30-50)]; and [50% (40-70)] for the general knowledge, safety of medicines during pregnancy and in evidence based herbal therapy tests respectively. The total score was significantly and negatively correlated with the number of years since graduation (r= - 0.2; P<0.01). Female pharmacists had significantly better score than male pharmacists in all tests (general pharmacy, herbal pharmacotherapy, total parts) but not for drug safety during pregnancy (P values = 0.16, 0.008, 0.046) respectively.. Conclusion: Good proportion of the study sample lack adequate knowledge in certain important aspects of pharmacy practice such as medication safety during pregnancy, evidence based indication of herbal products, and herbal-drug interactions. This might negatively affect the role of Community pharmacists in patient counseling and education. Authorities need to improve the community pharmacists' role in healthcare system by providing continuous and up-to-date education for community pharmacists. Practice Implications: Professional development should be mandatory in Palestine. Inclusion of a course about drugs during pregnancy into pharmacy curriculum is recommended. Key Words: Community Pharmacist, Medication Knowledge, Pregnancy, Herbal Product, Palestine.
Assessing Appropriate Use of Inhaler Devices among Asthmatic Patients
(2013) Ola Adel Fawzi Salah; Prof. Waleed Sweileh; Dr. Samah Al-Jabi
Background: Appropriate use of inhaler devices such as metered-dose inhalers (MDIs) and dry-powder inhalers (DPIs) in clinical practice is not well studied in Palestine and few were carried out in the Arab world. Objectives: The objectives of this study were to assess patients’ administration technique of inhaler devices and its association with other variables. Method: A cross sectional observational evaluation was conducted at a pulmonary clinic in Nablus, Palestine. Administration technique was evaluated based on a pre-defined checklist. Asthma control was assessed using Asthma Therapy Assessment Questionnaire (ATAQ) scale. Results: MDIs (without spacer) and DPIs (turbuhalers and aerolizers) in patients with asthma disease were studied. The study included 149 patients with mean ± standard deviation (SD) age of 47.5 ± 18.5 years. Fifty five (36.9%) of the study patients had college education and higher. Forty two (28.2%) patients were using MDIs, 38 (25.5%) were using DPIs and 69 (46.3%) were using both devices. A total of 217 inhaler devices were evaluated: 111 (51.2%) for MDI and 106 (48.8%) for DPI. Mean scores ± SD for correct inhaler technique were 61 ± 20.1, 71.4 ± 14.9 and 66.2 ± 15.7 for MDIs, turbuhalers and aerolizers respectively (p = 0.00). For MDI and DPI devices, step 3 “exhale to residual volume” was the least correctly done (22.5% and 13.2% respectively). There was a significant relationship between correct score of handling inhaler device and educational level (r = 0.187; p=0.006) where higher educated patients had higher correct scores. Among patients, ATAQ scale indicated that 22 (14.8%) patients had well controlled asthma, 56 (37.6%) patients were not well controlled and 71 (47.7%) patients were poorly controlled. There was significant difference in scores of correct inhaler device handling and asthma control category (p < 0.01) where patients had higher correct scores were with higher control for their asthma. Among patients using inhaled corticosteroids (ICS), there was a significant difference between adherence score and correct handling scores (p = 0.002) where patients with better adherence had higher correct scores. Conclusion: Correct handling of inhaler devices was not common particularly among MDI devices. Regular checking of inhalation technique and proper practical teaching of patients is crucial for optimal use of most inhaler devices.
Problems Associated with Reconstitution, Administration, and Storage of Antibiotic Suspensions for Pediatrics in Nablus City-Palestine
(2013) Haya Ibrahim Anabousi; Dr.Rowa’ Al-Ramahi; Dr. Abd Al Naser Zaid
Pediatric infectious diseases either viral or bacterial remain a very common community health problem; in bacterial infection an antibiotic is the drug of choice, to achieve therapeutic effect and prevent treatment failure antibiotics must be properly used. The objective of this study is to evaluate the appropriateness of antibiotic suspensions use for pediatrics among Palestinian mothers including their reconstitution, dose administration, duration, and storage condition. This study was a questionnaire based cross sectional descriptive study. It was conducted at Ministry of Health (MoH) primary health care Al-Wosta clinic and a pediatric private clinic in Nablus city between 22 January, and 22 March 2013. A sample of400 mothers, 200 visited MOH, and 200 visited the private clinic were met and asked to answer a face to face questionnaire. The results showed that most common pediatric infections were bronchitis 110 (27.5%), throat infection (pharyngitis) 110 (27.5%), and otitis media 108 (27.0%), the most commonly prescribed antibiotic was amoxicillin, amoxicillin and clavulanic acid, and azithromycin. Regarding mothers' practice 347 (86.8%) of mothers told that they read instructions, 311 (77.8%) could understand manufacturer instructions, and 176 (44.0%) of mothers asked pharmacists for advice if they didn’t understand the instructions. In order to prepare antibiotic suspension 302 (75.5%) used boiled then cooled tap water, and 192 (84.4%) of mothers used syringe to measure the needed amount of water, and 304 (76.6%) of mothers added water in two steps, 392(98.0%) of mothers claimed that they shook the drug bottle before used. Regarding dose administration, 313 (78.2%) considered syringe as the most accurate tool for dose administration, most of mothers told that they gave drug dose with major meals when direction were to give three times daily. About use duration 6 (1.5%) of mothers claimed that they used antibiotic suspension after 2 weeks, and 26 (6.5%) gave left over antibiotic suspension to another child. One hundred seventy seven (44.2%) of mothers told they stored dry powder antibiotic in medicinal cabinet, while 226 (56.5%) of them stored suspension in refrigerator. Although our results reflect good knowledge about antibiotic suspension use between Palestinian mothers there is a room for improvement. The pharmacists are recommended to explain directions to mothers and confirm on them by writing, to supply them with syringe with suitable calibration for dose administration, and to tell them about storage condition and duration of use.
Analysis of beliefs about medicines and medication adherence in patients with chronic diseases at the Military Medical Services, Nablus, Palestine
(2014) Raniah Majed Fares Jamous; Prof. Waleed Sweileh; Dr. Adham Abu-Taha
Background: very few studies in the Arab world investigated patients’ behavior toward medications, particularly in those with multiple co-morbid and different chronic diseases. Furthermore, most studies in this field were carried out among patients with governmental insurance which could affect the reliability and validity of the results since medications are not always available in governmental pharmacies. Objective: to investigate how the presence of multiple chronic illnesses could affect the association between attitudes toward medicines and adherence practices in a non-governmental settings. Methodology: The Palestinian Medical Military Services in Nablus, Palestine was the main setting for the study. Presence and number of multiple chronic diseases were obtained from patients through interview setting and were confirmed by information available at the medical files. Attitudes toward medicines were evaluated by the Beliefs about Medicines Questionnaire (BMQ) while compliance / adherence behavior was evaluated by Morisky Medication Adherence Scale (MMAS-8). Results: One hundred and eighty seven patients were interviewed. Most participants (79.6%) had positive attitude that their medicines were necessary to maintain their good health status while 58.2% of the study sample were afraid and had negative attitude or concern about taking medicines on regular basis and 57.8% were afraid that they will get addicted and become dependent on their medicines. In the presence of multiple chronic diseases, demographic and clinical factors were not significantly associated with adherence practices. However, in patients with multiple chronic diseases, those who had higher positive attitudes and feeling of necessity had higher odds [1.4 (1.1 - 1.9)] of having adherence practices while those who had higher negative attitudes or concerns or fear about medicines had lower odds [0.8 (0.65 – 0.98)] of having adherence practices. Conclusions: In patients with multiple chronic diseases, positive and negative attitudes toward medicines are significant determinant of adherence practices.
Antimicrobial Utilizing Pattern in a Governmental Hospital in Palestine Measured Using WHO ATC/DDD Methodology
(2014) Marina Zeyad Bada; Dr. Adham Abu Taha; Prof. Waleed Swieleh
BACKGROUND: Increased consumption of antimicrobial agents is related to a worldwide increased in bacterial resistance, increased costs and dispensable effects of drugs on patients. OBJECTIVES: To investigate the pattern of antimicrobial consumption data using WHO ATC/DDD methodology in a governmental hospital in Palestine, and to assess the obstacles for implementing rational use of antimicrobial agents in hospital. METHODS: Antimicrobials consumption in Rafidia hospital was retrieved prospectively. The ATC/ DDD and DU90% methodologies were used. Defined Daily Dose (DDD) per 100 Bed-Days and DDD per 1000 inhabitants per day were calculated for total systemic antimicrobial use and by antimicrobial class. RESULTS: Antimicrobials were administered to 554 patients (55.4%) out of 1000 who were hospitalized in Rafidia hospital over two months period. The total consumption of antimicrobial agents was 1656.1 DDD that corresponding to 70.55 DDD/100 Bed-Days and 3.31 DDD/1000 Inhabitants/ Day. The most highly used antimicrobial were ceftriaxone followed by cefuroxime and metronidazole. The bulk prescription (DU90%) was made up of 8 out of 22 total antimicrobial agents. And the highest rates of antimicrobial use were found in intensive care unit (ICU) 132.64 DDD/100 Bed-Days and surgical department 98.52 DDD/100 Bed-Days. CONCLUSIONS: We found that antimicrobial utilization in Rafidia hospital was relatively high, and there were a high tendency for wide-spectrum antimicrobial utilization such as third-generation cephalosporins, carbapenems and aminoglycosides. This study proved that there is an urgent demand for national antimicrobial stewardship and education programs in infection control and prevention in Palestinian hospitals. Key words: Antibiotic, Consumptions.
Evaluation of Prescribing Pattern and Compliance to Treatment Guidelines in Hemodialysis Patients in Hebron Governmental Hospital
(2015) Bayan Jamal AL-Deen Nammourah; Dr. Rowa’ Al-Ramahi
Background: Chronic kidney disease (CKD) including end-stage renal disease (ESRD) is a growing epidemic. Hemodialysis (HD) is the most commonly used renal replacement therapy in addition to the management of diabetes, hypertension, dyslipidemia, anemia, and bone mineral disorder in hemodialysis patients. Objectives: The objectives of this study were to asses prescribing pattern and to evaluate compliance to treatment guidelines in hemodialysis patients. Method: This study was an observational retrospective cohort study, it was conducted at Hebron governmental hospital / Palestine between March and April 2014. All adult on chronic HD there were included. All information were collected from governmental electronic health record (AviCenna HIS program), and patients were asked to answer some questions when data was not found in the system. Statistical analysis was performed by using Statistical Package for Social Sciences (SPSS) program. Results: During the study period 158 HD patients were prescribed 1567 medication orders of 103 different medications, 49 medications for the management of chronic illness, and 54 medications for acute illness. The patients were taking a minimum of 2 and a maximum of 18 medications, with a mean of 9.92±2.94. The most commonly prescribed medications were calcium carbonate (91.8%), followed by alfacalcidol (84.8%), then iron/folic acid (69.6 %). About (36.7%) of the patients had diabetes, and hemoglobin A1c (HbA1c) test which reflect average blood sugar level for the past 2-3 months was not performed for these patients. Insulin mixtard, insulin actrapid, and glibenclamide were used to control diabetes . A majority of the patients (72.2%) had Hypertension. The target predialysis blood pressure of <140/90 mmHg were achieved in 77.2% of the patients (70.5% of the males vs 87.3% of the females; P- value =0.014) , and post dialysis blood pressure of < 130/80 were achieved 57.6% of the patients. Target predialysis correlate with postdialysis blood pressure ( r=0.236, P- value =0.003) and amlodipine was the most commonly used drug for the management of hypertension which is differ from what the guidelines advise. Atorvastatin was the most prescribe medication for dyslipidemia (39.9%). Patients with total cholesterol levels of < 200 mg/dl were 78.3% patients. Regarding triglycerides levels, 96.2% had levels of < 500 mg/dl. There was an association between the control of the total cholesterol and triglycerides as 80.1% of the patients had total cholesterol of < 200 mg/dl ( P- value =0.006). In the management of anemia, patients who reached goal hemoglobin (Hb) of 11-12 mg/dl according to the national kidney foundation (NKF) guidelines were 8.9% patients only. If kidney disease improving global outcome (KDIGO) guidelines are used, these guidelines accept a Hb level between 9-11.5 mg/dl but not to exceed 13 mg/dl, the patients in this range was 43.0% cases. Transferrin levels were not measured. Iron was used by 69.9% of the patients, and erythropoietin stimulating agents (ESA) by 5.1% of the patients as it was not available in the hospital, and very expensive to purchased by the patient’s own accounts. No data was available for calcium, and parathyroid hormone levels to manage bone mineral disorder, Target phosphorus level was obtained in 12% of the patients according to the NKF guidelines. If serum phosphorus normal range of 2.5–4.5 mg/dl is used according to KDIGO guidelines, this target was achieved in 4.4% patients only. Calcium carbonate was used by 91.8%, sevelamir by 15.8%, and alfacalcidol by 84.8% of the HD patients. Conclusion: The results reflect a poor compliance to treatment guidelines according to NKF and KDIGO guidelines for diabetes, hypertension, dyslipidemia, anemia, and bone mineral disorder. The target levels for treatment are not achieved in many HD patients. The medications are not prescribed optimally to the patients and many investigations and laboratory tests are not performed.
Attitudes, Knowledge and Practices of Health-Care Practitioners Toward Splitting or Crushing Oral Solid Dosage Forms in Palestine: Safety and Therapeutic Implications
(2015) Yaser Mustafa Mahmood Abdallah; Prof. Dr. Abdel Naser Zaid; Dr. Saed Zyoud
Background: Tablet splitting and crushing is a widespread practice among health-care providers and patients for different reasons, such as: (i) increasing dose flexibility, (ii) making tablet parts easier to swallow, and (iii) allowing cost savings for medications. However, this practice may be dangerous because some formulations and classes of drugs are unsuitable for crushing or splitting and may cause significant problems, especially in drugs with low therapeutic indices. Objectives: This thesis was conducted to examine the attitudes, knowledge and practice of pharmacists and nurses toward splitting or crushing oral solid dosage forms (OSDFs) in Palestine. It also aimed to determine the factors that affect health-care practitioners with regard to splitting or crushing OSDFs, in addition to determining the differences in attitudes and knowledge between nurses and pharmacists regarding this very important issue, and to determine the safety and therapeutic problems that resulted from splitting or crushing OSDFs. Methodology: This is a self-administered cross-sectional questionnaire survey involving 550 respondents and was conducted during the period May 2013 to August 2013 among pharmacists and nurses who work at community pharmacists and hospitals in the West Bank area of Palestine. Data were collected using a pretested questionnaire consisting of four sections and analysed using descriptive statistics and correlation. Results: A total of 615 questionnaires were distributed and 550 were completed. About 67.3% of the pharmacists and only 5.6% of the nurses had good knowledge. Nearly 69% of the pharmacists and 36.4% of the nurses had a good attitude. There was a positive correlation (p=0.002, r=0.18) between knowledge and attitude scores among pharmacists. There was a positive correlation (p<0.001, r = 0.24) between knowledge and attitude scores among nurses. Approximately 83.7% of the pharmacists and 41.6% of the nurses had good practices. Conclusion: This study has identified knowledge, attitude and practice gaps among health-care practitioners, especially among nurses. Therefore improving appropriate knowledge regarding splitting and crushing OSDFs is required by planning and developing programs for local health education purposes
Treatment Satisfaction and Health Related Functional Outcomes among Patients with Coronary Artery Disease in Palestine
(جامعة النجاح الوطنية, 2018-07-03) Salameh, Shurooq
Background: coronary artery disease (CAD) is considered the main reason of death worldwide. Patients after myocardial infarction (MI) may have symptoms- fatigue which is the most common of them- that worsen health related functional status. It has been found that improving treatment satisfaction can improve outcomes and survival of patients after acute coronary syndrome Objectives: The purposes of this study were to assess treatment satisfaction and health related functional outcome among CAD patients. Methodology: A cross sectional, observational study carried out at Dr. Khalil Suleiman Hospital. TSQM scale was used to evaluate treatment satisfaction, and 36-item short form health survey(SF-36) was used to evaluate health related functional outcomes among CAD patients in Palestine. Results: 303 patients were participated in the study. Majority of them were males (66.3%). Their ages ranging from 36to 93 years. Most of them had co-morbidities and used poly pharmacy. In general most of the patients were satisfied in treatment, 38.9% of patients were satisfied in the ability of the medications to treat or to prevent their disease, also most of them (71.9%) had no side effects. Treatment satisfaction scores were lower in elderly (p < 0.001) female gender (p <0.001), patients with lower educational level (p < 0.001), patients with lower income level (p <0.005), unemployed patients (p < 0.005) and patients with more co-morbidities or used more medications (p <0.001). In regard to health related functional outcomes, most of patients (38.3%) described their health as fair, most of patients had physical and emotional limitations. In addition, 91.9% of the patients had limitations in doing vigorous activities and 60.7% of them had a limitation in doing moderate activities, 11.6% of patients felt downhearted most of the time and 21.5% of them felt downhearted some of the time. Poorer functional outcomes were associated with elderly (p < 0.001) female gender (p < 0.001), lower educational level (p <0.001), lower income (p < 0.005), unemployed patients (p < 0.001), patients not married (p < 0.005), and patients with more co-morbidities and poly pharmacy (p <0.001). There was a significant positive correlation between global domain in TSQM scale and the domains of SF-36 scale (p < 0.001) Conclusion: The results concluded that most of CAD patients were satisfied in their medications. On the other hand, most of them had physical and emotional limitations also this study revealed the impact of socio-demographic and clinical factors on treatment satisfaction and health related functional outcomes. Also the study concluded that there was a significant positive relationship between treatment satisfaction and health related functional outcomes among CAD patients. HealthCare providers should be aware of factors associated with poor treatment satisfaction and health related functional outcomes in CAD patients, in order to make early interventions that improve them.
The Association Between Adherence and Beliefs about Medications among Patients with Ischemic Heart Disease: A Cross Sectional Study from Palestine
(Wafaa AL-Barbarawi, 2018-07-03) AL-Barbarawi, Wafaa
Background: optimal medication adherence in patients with ischemic heart disease (IHD) is very important to prevent cardiac events and decrease the rate of mortality. Patients' beliefs about medicines are one of the most important factors that may affect adherence. Objectives: to measure adherence to medications among Palestinian ischemic heart disease patients, and to find the effect of some patient factors and medication beliefs on their medication adherence. Methods: the study was a cross-sectional study among patients in governmental outpatient clinics, information was obtained from patients by a face to face interview and from medical files. The Morisky Medication Adherence Scale- 8 questions (MMAS-8) and Beliefs about Medicines Questionnaire (BMQ) were used to measure medication adherence and patients' beliefs about medicines respectively. Results: a total of 400 patients were included in the study, mean age ± standard deviation was 62.35± 9.30 years. Most patients 348(87.0%) had comorbid conditions. The majority 304 (76.0%) of patients were using at least 5 medicines. According to MMAS-8 score, 195 (48.8%) of participants were non adherent to their medicines (adherence score ˂ 6) and 205 (51.3%) were adherent (adherence score ≥ 6). Multivariable analysis showed that patients who had others disease (comorbid conditions) had higher odds (O.R=2.316(95%CI (1.192-4.499)) of being non-adherent. patients who had higher concerns about medicines had higher odds (O.R=1.124(95%CI (1.063-1.188)) of being non-adherent, also patients who had positive harmful beliefs of medications had higher odds (O.R=1.092(95%CI (1.018-1.171)) of being non-adherent. On the other hand, Patients who had positive beliefs of medication necessity had lower odds (O.R=0.902(95%CI (0.847-0.960)) of being non-adherent. Conclusions: Poor adherence was very common among Palestinian IHD patients. Stronger positive beliefs about necessity of treatment was associated with lower non-adherence while high concerns of long term use of medicines or harmful effects of medications were associated with higher non-adherence, which emphasizes the importance of patients' beliefs about medicines in medication adherence.
Evaluation of Rational Use of Medicines according to the World Health Organization Prescribing Indicators: A Cross-sectional Study from Palestine
(جامعة النجاح الوطنية, 2018-07-03) Shadid, Maram
Background: Rational use of medications is a global goal which is very important in achieving quality of health for patients and the whole population. Objectives: To evaluate the rational use of medicines in Palestine according to the World Health Organization/International Network for the Rational Use of Drugs (WHO\INRUD) core drug use indicators using prescribing indicators and compare it with others. Method: The study was a retrospective cross-sectional study. A sample of 2000 prescription was collected from 20 primary health care centers from 10 governorates in the West Bank of Palestine. Data collected included age, date, number of medications in every prescription, number of generics, number of medications from Essential Drug List (EDL), number of prescriptions containing injections and number of antibiotics. Data was analyzed using SPSS version 20. Result: The 2000 prescriptions included 4380 medications. The average number of medications was 2.19±1.24 (WHO goal is ≤ 2), percent of antibiotics was 43.8% (WHO goal is ≤ 30%), percent of antibiotics in children was 59.9%, percent of generic name use was 26.44% (WHO goal is 100%), percent of injections was 10% (WHO goal is ≤ 10%) and percent of drugs from EDL was 99.25% (WHO goal is 100%). There were significant differences between the 20 primary health centers studied in the WHO prescribing indicators. Conclusion: Some indicators were close to the WHO goals while others were very far from the goals. Irrational use of medications was noticed. Overuse of antibiotics specially in children and low use of generic names were the most prominent manifestations of such irrational drug prescribing. Efforts are needed to improve the situation
Effects of self-care and self-efficacy on glycemic control in patients with type 2 diabetes: A cross sectional study from Palestine
(An-Najah National University, 2018-12-12) أبو بكر, ربا عباس سليم
Background: Type 2 diabetes mellitus has become a significant public health problem in many countries including Palestine where it is considered the fourth cause of death. Self-care/self-efficacy has been shown to have strong correlation with glycemic control among patients with type 2 diabetes. However, such evidence is lacking in Palestinian primary health care centers. Objectives: To examine if there is any significant relationship between self-efficacy/self-care and blood glucose control, to determine factors associated with self-efficacy and self-care behavior, to determine factors associated with glycemic control, and to estimate the prevalence of glycemic control among diabetic patients. Method: This cross-sectional study involved 380 type 2 diabetes patients attending Al-Makhfeyyeh primary health care center in Nablus/Palestine during July to September, 2017. Patients were assessed for self-care/self-efficacy behaviors, and glycemic control (HbA1c). Results: of the total 380 patients, 82.4% had a poor glycemic control, as was indicated by HbA1c levels of > 6.5%. SES8C scale analysis revealed that high education level is a strong predictor for good type 2 diabetes self-efficacy behaviors (p value= 0.001). PEPPI scale analysis revealed positive direct effect between self-efficacy score with married participants (p-value was 0.034) and with high educated participants (p-value was <0.001). Significant correlation between participants in daily activities score was shown in participants <65years old (p-value <0.001), single or divorced (p-value 0.043), low educated (p-value 0.008), using monotherapy (p-value 0.034), using insulin injection (p-value <0.001), having ≥ 3 chronic diseases (p-value <0.001), and having high blood pressure (p-value 0.001). Physical activity shows positive correlation with young age, males, married, educated participants, not using insulin injection, and not suffering from any chronic diseases. No significant association was found between self-care/self-efficacy with glycemic control (p-values > 0.05). About half of the participants using insulin injection (48.7%). Only 12% of patients prepare a list of questions to ask their doctors about their illness and about 42% never discuss any personal problems that may related to their illness with their physicians. Conclusion: This study has found that higher self-efficacy behaviors were among high educated patients, and married participants. No relation between self-care/self-efficacy and glycemic control was found. Healthcare providers should encourage patients to increase their daily physical activity, having regular feet-care examination, and measure their blood glucose level regularly. Also patients should trust their physicians more and communicate with them to increase their knowledge about their illness and treatment.
Assessment of Patients' Satisfaction with Pharmaceutical Services in Nablus City Hospitals: A Cross Sectional Study
(جامعة النجاح الوطنية, 2019-07-16) زهير شريم, ريناد
مقدمة: رضا المرضى هو أحد العوامل المهمة التي تحدد نجاح مرافق الرعاية الصحية. لذلك، هناك حاجة لتقييم نظام الرعاية الصحية فيما يتعلق برضا المرضى لضمان جودة الخدمات الرعاية الصحية. تهدف هذه الدراسة إلى قياس رضا المرضى عن الخدمات الصيدلانية في مستشفيات نابلس ، فلسطين. طريقة البحث: هذه دراسة مقطعية. تم فيها اختيار ثلاثة مستشفيات في مدينة نابلس وصمم استبيان رضا لقياس مدى رضا المريض. احتوى الاستبيان على عناصر ركزت على العوامل المؤثرة: السرعة، الموقف، وقت الانتظار، التعليم الدوائي، والجوانب الديموغرافية للمجيب. تم اختيار 90 مجيبًا لملء الاستبيان من خلال أخذ عينات ملائمة. نتائج الدراسة: بلغ إجمالي عدد المرضى الذين كانوا على استعداد لملء استبيان البحث 90. الخصائص الديموغرافية للمرضى توزعت كالتالي: كان عدد المرضى الإناث أعلى من عدد المرضى الذكور (58.9 - 41.15 ٪) وكانت الفئة العمرية المهيمنة أكثر من 30-39 سنة بنسبة 30٪. كان 58.9٪ من المرضى متزوجين. وكان مستوى تعليم غالبية المرضى في المرحلة الثانوية 44.4 ٪. ما يصل إلى 58.9 ٪ من المرضى كانوا عاطلين عن العمل. من بينهم 36.7٪ دخل الأسرة لديهم أقل من 2000 شيكل . 42.2٪ منهم كانوا يعيشون في القرية. كانت هناك فروق ذات دلالة إحصائية في الرضا عن الخدمات الصيدلانية وفقا لوقت العمل بين الفترة الصباحية والمسائية، ، وكانت قيمة P-value هي 0.009. أظهرت البيانات تأثير إيجابي لوقت الانتظار في الصيدلة على رأي المرضى ورضاهم. كان 81.1 ٪ من المرضى راضين عن وقت الانتظار في الصيدلية. في حين أن 18.9٪ من المرضى لم يكونوا راضين عنه. غالبية المشاركين 70٪ لديهم مشكلة مع الدواء في آخر زيارة بسبب عدم توفر الادوية ، 97.8٪ ليس لديهم مشاكل مع الأدوية التي لها نفس الشكل واللون. أبلغت الدراسة عن درجة معتدلة (جيدة) من رضا المرضى عن الخدمات الصيدلانية في المستشفيات الثلاثة وكان متوسط الاستجابة 3.24. المرضى عموما راضون عن خدمات الصيدلانية في المستشفيات بنسبة 64.8 %. الخلاصة كان رضا المرضى عن خدمات الرعاية الصيدلانية جيدًا. وقد انعكس ذلك على الخدمات الصيدلانية الجيدة المقدمة للمرضى والتي منها العلاقات بين الصيدلي والمريض، والاحترام الذي أبداه الصيدلي تجاه المرضى، وسرعة خدمة صرف الأدوية ورضا المرضى عن وقت الانتظار. يجب مراجعة تواصل الصيدلي مع المرضى والاستشارات الدوائية لمنع المشاكل المتعلقة بالأدوية وتحسين الخدمات الصيدلانية في مستشفيات نابلس. توصي الدراسة بمزيد من التدريب للعاملين الصحيين على الخدمات الصيدلانية وزيادة وعي المريض اتجاه الخدمات الصحية المتوقعة من قبل مقدمي الخدمات الصحية.
مدى انتشار والتحليل الجرثومي لحالات ارتفاع الحرارة المصاحب لنقص الخلايا الحبيبية المتعادلة (النيوتروفيل) لدى الأطفال المصابين باللوكيميا الليمفاوية الحادة
(جامعة النجاح الوطنية, 2019-11-14) غانم, رانيا
الخلفية: قلة الخلايا الحبيبية المتعادلة هي أحد المضاعفات التي تهدد حياة المرضى الذين يعانون من سرطان الدم من نوع اللوكيميا الليمفاوية الحادة. هذه الحالة تنتج عن الفسيولوجيا المرضية للمرض وكآثار جانبية للعلاج الكيماوي للسرطان. الحرارة المصاحبة لنقص الخلايا الحبيبية المتعادلة (FN) هي مؤشر للعدوى بين هؤلاء المرضى الذين يعانون من نقص في المناعة، لذا يكونون أكثر عرضة للخطر بارتفاع معدلات الممراضة والوفيات. إن التدخل الفوري في علاج الإلتهابات المصحوبة بالحرارة و نقص الخلايا الحبيبية المتعادلة (FN (infections عن طريق إعطاء المضادات الحيوية الاولية المناسبة ، هو الأساس في إنقاذ حياة هؤلاء المرضى. الأهداف: تهدف هذه الدراسة إلى تحديد مدى انتشار الحرارة المصاحبة لنقص الخلايا الحبيبية المتعادلة (FN) بين الأطفال الذين يعانون من سرطان الدم اللوكيميا الليمفاوية الحادة. إضافة إلى التحليل الجرثومي لكل حالات الحرارة المصاحبة لنقص الخلايا الحبيبية المتعادلة (FN) من أجل تحديد نوع الميكروبات المسؤولة عنها . و أيضا تقييم أنماط حساسية هذه الميكروبات للمضادات الحيوية من تنائج زراعة الميكروبات. المنهجية الدراسة: هذه الدراسة هي دراسة وصفية بأثر رجعي ، أجريت في قسم هدى المصري لأورام الدم عند الأطفال في مستشفى بيت جالا الحكومي في بيت لحم و ذلك خلال الفترة ما بين 1/1/2014 و حتى 1/6/2018. حيث تم استعراض السجلات الطبية من 83 مريضا. و قد تمت مراجعة و تحليل هذه الملفات من حيث الأعراض ، والعلامات الحيوية ، وفحوصات الدم المختلفة، التأكد من وجود (FN) ، إيجابية زراعة الميكروبات، ملف الأحياء الدقيقة وأنماط حساسية الميكروبات للمضادات الحيوية. النتائج: ثلاثة وستون مريضا تم ادراجهم ضمن هذه الدراسة و قد وجد هنالك ما مجموعه 161 حالة من FN لدى هؤلاء المرضى . وقد كانت الغالبية حالات FN هي غير البكتيرية المشنأ بنسبة 54 ٪. بينما 45 ٪ من هذه الحالات كانت نتيجة لإلتهابات بكتيرية. شكلت البكتيريا إيجابية الجرام 62.5 ٪ من الحالات البكتيرية المنشأ، في حين كانت نسبة البكتيريا سلبية الجرام حوالي 37.5 ٪ من الحالات البكتيرية. من بين البكتيريا إيجابية الجرام ، كانت CONS هي اكثر البكتيريا الممرضة بنسبة 58.7 ٪ ، تلتها S.aureus 15.2٪. كلاهما تم عزلها في الغالب من عينات زراعة الدم. لقد وُجد أن CONS بكتيريا كانت حساسة بنسبة 100٪ للمضادات الحيوية التالية: تيكوبلانين والفانكومايسين والسيفترياكسون والسيفوتاكسيم. بينما كانت أقل حساسية للأمبيسلين والبنسلين بنسبة 18.5 ٪ و 7.4 ٪ على التوالي. فيما يخص بالبكتيريا سالبة الجرام ، كانت بكتيريا E.coli ESBL أكثر انواع البكتيريا المسببة للأمراض البكتيرية السالبة بنسبة 42.9٪ وقد تم عزلها في الغالب من عينات زراعة الدم ، تلتها بكتيريا E.coli بنسبة 17.9٪ وقد عزولت بشكل كبير من عينات البول. أظهرت بكتيريا E.coli ESBL حساسية بنسبة 83.3 ٪ اتجاه المضادات الحيوية التالية: الأميكاسين ، الميرونيم ، إيميبينيم والإرتابينيم، بينما كانت حساسة بنسبة 25 ٪ للسيفوتاكسيم. الأستنتاجات: لقد أظهرت هذه الدراسة ارتفاع في معدل انتشار FN 94 ٪ لدى الأطفال اللذين يعانون من سرطان الدم من نوع اللوكيميا الليمفاوية الحادة. كانت البكتيريا الموجبة للجرام هي الأكثر شيوعا، و قد كانت CONS هي اكثرها سببا لللإتهابات البكتيرية الموجبة الجرام، و قد أظهرت حساسية عالية للمضادات الحيوية التيكوبلانين والفانكومايسين والسيفترياكسون والسيفوتاكسيم. بينما كانت E.coli ESBL هي أكثر الميكروبات السالبة للجرام شيوعا إضافة إلى كونها أقل حساسية اتجاه المضادات الحيوية. توصي هذه الدراسة بضرورة مراجعة و تقييم وتحديث المضادات الحيوية الأولية المستخدمة في علاج حالات (FN) بما يناسب السلوك البكتيري اتجاه المضادات الحيوية.
Evaluation of anemia management among hemodialysis patients in Palestine: associated factors and clinical outcomes
(Nada Sadek Rajabi, 2020-01-23) Rajabi, Nada
Background: Anemia is a frequent complication in patients on maintaining hemodialysis (HD). Appropriate management involves the administration of iron supplementation and erythropoietin stimulating agents (ESA) therapy besides monitoring the response. Poor health related quality of life (HRQOL) is also a common impairment in HD patients results from the dialysis procedure it-self or its related comorbidity. This study aimed to evaluate anemia management in HD patients from Palestine, determine the associated demographic and clinical characteristics with it, describe patients HRQOL and its association with appropriate anemia treatment. Methods: The study was a cross sectional observational study; patients were included from three dialysis centers from West Bank - Palestine during the period of 24-June to 5-September 2018. The data filled by interviewing the enrolled patients and getting access to patient’s health profiles. The data collection form consisted from two portions, the initial contains demographic and clinical information about the patients while the latest consists of the European Quality of Life 5- Dimensions scale (EQ-5D-5L) that represents the descriptive system and the EQ visual analogue scale (EQ-VAS) which represents the health status of patient in their own judgment. Results: 226 patients included. Their mean age (± SD) was 57 ± 13.9 years. The mean hemoglobin (Hb) level (± SD) was 10.63 ± 1.71 g/dl, 34.1% of patients had Hb level 10-11.5 g/dl. Only 72.1% and 81.9% of patients recorded for serum ferritin and transferrin saturation (TSAT) respectively. 33.1% of patients had serum ferritin ≥ 500ng/ml and 50.3% had TSAT ≥ 30%. All patients who received iron supplementation received it by intravenous route and dose of 100mg of iron sucrose. Almost 86.7% of patients received Darbepoetin by intravenous route and weekly dose of 0.45 mcg/kg, 24% of them had Hb >11.5g/dl. On the other hand, 2.4% of patients had Hb < 10g/dl and did not received ESA therapy. Regarding EQ-5D-5L 22.6%, 54.9%, 32.3%, 29.6% and 25.2% of patients had level of “no problem” across the dimension of quality of life; mobility, self-care, usual activity, pain/ discomfort and anxiety respectively. Only 0.9% of patients had the highest degree of difficulty in the five dimensions. There was a significant association between Hb level, number of years the patients received HD and HRQOL. Conclusion: Our study found a significant association between Hb level and patients HRQOL, therefore the appropriate management of anemia in HD patients by adherence to NKF-KDOQI guideline recommendations provides an improvement in their quality of life in addition to obtain the optimal therapy. Key word: Anemia, Hemodialysis, Hemoglobin, Iron status, Erythropoietin stimulating agent, Health related quality of life.
Health-related quality of life and treatment satisfaction in patients with rheumatoid arthritis: a cross-sectional study from Palestine
(جامعة النجاح الوطنية, 2020-07-02) ابو حمدة, هبة
خلفية الدراسة: التهاب المفاصل الروماتويدي هو واحد من الأمراض غير المعدية التي تسبب المرض بشكل كبير، ولكن لا يزال يتم إهمالها لأنها ليست من الأمراض غير السارية الرئيسية الأربعة المعترف بها و التي تساهم في الوفيات. التهاب المفاصل الروماتويدي يشكل عبء متزايد في البلدان المنخفضة والمتوسطة الدخل. وقد تبين أن التهاب المفاصل الروماتويدي يؤثر بشكل كبير على جودة الحياة المتعلقة بصحة المرضى (HRQoL) ورضاهم عن الدواء. أهداف الدراسة: تهدف هذه الدراسة الى تقييم العلاقة بين رضا العلاجي و جودة الحياة الصحية، لتحديد تأثير العوامل الاجتماعية والديموغرافية والسريرية على كل من جودة الحياة الصحية والرضى العلاجي لدى مرضى التهاب المفاصل الروماتيزمي. المنهجية: شارك في هذه الدراسة 283 مريضا يعانون من التهاب المفاصل الرماتويدي، تم إجراء هذه الدراسة المقطعية خلال أشهر يوليو حتى أكتوبر 2018 ؛ كانت العينة من أربعة مستشفيات في المنطقة الشمالية من فلسطين. تم استخدام استبيان SF-36 لتقييم جودة الحياة الصحية و استبيانTSQM لتقييم الرضى العلاجي بين مجموعة الدراسة .تم استخدام Kruskal-Wallis أوMann-Whitney لاختبار الاختلافات في المتوسط ما بين المجموعات. بالإضافة إلى ذلك، تم استخدام معامل ارتباط سبيرمان لتقييم العلاقة بين SF-36 و TSQM. النتائج: تم تضمين ما مجموعه 283 مريضا. كان الجنس مرتبطا مع الدور الجسدي (RP) والصحة العقلية (MH) ، (قيمة احتمالية 0.046 و 0.049) على التوالي. كان العمر مرتبطا مع الوظيفة الجسدية (PF) و RP ، (قيمة احتمالية <0.001 و 0.043) على التوالي ، والتعليم كان مرتبطا أيضا مع PF ، RP ، الوظيفة الاجتماعية (SF) والألم الجسدي (BP) (قيمة احتمالية 0.009 ، 0.020 ، 0.016 ، و <0.001) على التوالي. كانت الوظيفة مرتبطة أيضًا معPF ، RP ، والصحة العالمية (GH) ، و(قيمة احتمالية <0.001 ، 0.013 ، و 0.015) على التوالي. كان ان مكان الإقامة كان مرتبطا مع RP (قيمة احتمالية 0.046). كان دخل الأسرة مرتبطا معFP،RP، والجوانب الحيوية (VT ) و MH ، BP ، و GH ،( قيمة احتمالية <0.001 ، 0.003 ، 0.038 ، 0.014 ، 0.012 ، 0.002) على التوالي. ارتبط نشاط المرض بشكل إيجابي مع جميع الفروع FP ،RP ، والدور العاطفي RE) وVT ، BP و GH ،( قيمة احتمالية<0.001). بينما بالنسبة MH ، SF (قيمة احتمالية 0.001 و 0.002) على التوالي. كانت مدة المرض مرتبطة مع RP و GH (قيمة احتمالية 0.007 و 0.026) على التوالي. كان العدد الإجمالي للأمراض المزمنة مرتبطة مع جميع الفروع باستثناء MH و PF و RP و BP (قيمة احتمالية<0.001) و REو VTو SFو GH (قيمة احتمالية 0.015 و0.007 و 0.004 و0.003) على التوالي. كان العدد الإجمالي للأدوية التي أخذها المريض مرتبطا مع PF ، RP ، BP وGH، (قيمة احتمالية <0.001 ، 0.001 ، 0.010 و 0.021). في حين كان المقياس المادي المركب (PCS) مرتبطا مع تقدم العمر (قيمة احتمالية 0.007) ، والمستوى التعليمي (قيمة احتمالية 0.003) ، والوظيفة (قيمة احتمالية0.001)، ودخل الأسرة (قيمة احتمالية <0.001)، ونشاط المرض (قيمة احتمالية <0.001)، مدة المرض (قيمة احتمالية 0.018) وإجمالي عدد الأدوية (قيمة احتمالية<0.001). بينما بالنسبة لمقياس المركب العقلي (MCS) ، كان مرتبطا مع نشاط المرض فقط ومع إجمالي عدد الأمراض المزمنة (قيمة احتمالية <0.001) لكليهما. تأثر الرضا العلاجي (الآثار الجانبية) بشكل إيجابي بدخل الأسرة (قيمة احتمالية 0.016) ، ونشاط المرض مع جميع فروع الرضا العلاجي (قيمة احتمالية <0.001)، والآثار الجانبية قيمة احتمالية <0.004). كما ارتبط عدد الأمراض المزمنة بشكل إيجابي مع فعالية الدواء (قيمة احتمالية 0.006). كان هناك علاقة إيجابية متواضعة بين HRQoL ورضا العلاج. كان R بين PCS هو 0.347 ، 0.425 ، 0.272 ، 0.390 مع الفعالية ، الآثار الجانبية ، الراحة والرضا العام على التوالي. الاستنتاج: وجدت هذه الدراسة أن جودة الحياة الصحية الجسدية لمرضى التهاب المفاصل الروماتويدي أكثر تأثرا من جودة الحياة العقلية لدى هؤلاء المرضى. الجنس والعمر ومؤشر كتلة الجسم والتعليم والعمالة ومكان الإقامة ودخل الأسرة ومدة المرض ونشاطه وعدد الأمراض المزمنة وعدد الأدوية التي يتناولها المريض كلها عوامل تؤثر على جودة الحياة الصحية لمرضى التهاب المفاصل الروماتويدي. كما وجدت هذه الدراسة أن رضى العلاجي لدى هؤلاء المرضى يتأثر إيجابيا بجودة الحياة الصحية لديهم.
Pharmacological Effect and Chemical Compositions Variations of the Calamintha fenzlii Essential Oil Collected From Three Regions in
(An-Najah National University, 2020-10-04) موسى, شيماء بلال صدقي
Background and Objectives Calamintha fenzlii is a medicinal aromatic plant (MAP) with a pleasant minty fragrance. It is one of the most common MAPs in eastern Mediterranean regions, including Palestine. The objective of the current work was to screen and compare the chemical components and potential pharmacological properties of C. fenzlii essential oils (EOs) collected from three different regions of the West Bank, Palestine. Methods The EOs of four C. fenzlii samples were extracted by hydrodistillation. The EO samples were analyzed for chemical constituents using Gas chromatography-mass spectrometry (GC-MS). The antimicrobial activity was examined by the broth microdilution method. Eleven bacterial strains were tested, including seven Gram-positive strains (Staphylococcus aureus and six samples of methicillin-resistant Staphylococcus aureus [MRSA]) and four Gram-negative strains (Proteus vulgaris, Pseudomonas aeruginosa, Escherichia coli and Klebsiella pneumoniae), in addition to one fungal strain (Candida albicans). Results GC-MS analysis revealed a high percentage of oxygenated components (range 97.54–99.18%) and a small percentage of non oxygenated components (range 0.74–1.64%), with the total identified compounds in each sample ranging from 98.28% to 99.9%. Several components were observed. Menthone was the most abundant component in four samples (range 14.83–93.83%) and pulegone was the most abundant in two samples (range 39.15–79.27%). Four EO samples exhibited broad antimicrobial activity, with three samples showing potent antifungal activity at minimum inhibitory concentrations (MICs) ranging from12.5 to 25 µl/ml, while one EO sample from Auja showed resistance to fungi. The sample from Wadiqana showed the highest potency against ATCC strians, with the lowest reported MIC value (12.5µl/ml), whereas the sample from Jnisinia demonstrated the lowest potency against MRSA, with the highest MIC value (50µl/ml). However, all four EO samples showed broad-spectrum antibacterial activity, with MIC values ranging from 12.5 to 50 µl/ml. Conclusion This study showed that C. fenzlii EO samples from different regions of Palestine contained different proportions of phytochemicals with different biological activities, particularly antimicrobial activity, in line with the traditional use of C. fenzlii extracts. The plant extracts showed higher antibacterial potency compared to reference plants. Further in vivo studies are required to evaluate the potential pharmacological activity, safety and toxicity of this extract. Also, further studies are needed to isolate, identify and characterize the main components responsible for the potential pharmacological activity of C. fenzlii EO....
Clinical Pharmacokinetics: Perceptions of Hospital Pharmacists in Palestine about how it is Taught and Applied
(جامعة النجاح الوطنية, 2020-12-02) Aqel, Rafeef
Background: The American society of health-system pharmacists (ASHP) defined clinical pharmacokinetic (CPK) as "the application of pharmacokinetic (PK) principles to the safe and effective therapeutic management of drugs in an individual patient". Where the main aims of CPK are optimizing efficacy and reducing toxicity. CPK is one of the main courses in pharmacy curriculum, as graduating pharmacists will be responsible of initiating and adjusting drug doses and making decisions about drugs that need therapeutic drug monitoring (TDM) when they go to their work places. Application of TDM in many studies showed improvement in patient outcomes including achieving drug levels within a fewer number of days, shortening length of hospitalization, reducing mortality and morbidity, shortening febrile period and increasing medication safety. In this study we looked at pharmacist's perceptions and training background in PK courses contents they received during their undergraduate pharmacy programs. We also aimed to determine the barriers experienced by the pharmacists when applying PK principles in their current practice and explore the influence of the respondents’ characteristics on their perception about clinical PK. Method: This is a descriptive cross sectional self-administered questionnaire that targeted licensed hospital pharmacists in most hospitals under the umbrella of the Ministry of Health (MOH) in Palestine, in addition to pharmacists working in most private hospitals in the West Bank (WB) and Jerusalem. The questionnaire was prepared to obtain the relevant answers that contribute to the final results. The data was collected between August and November of 2018. Results: In this study a total of 145 questionnaires were distributed among hospital pharmacists in Palestine. Most of the participants were female (78.6%) and the vast majority of participants (71.7%) had taken their first pharmacy degree from Palestine. PK courses were taught in 74.5% of the undergraduate programs with most of the courses (57.9%) covering basic PK principles. In addition 88.3% of participants hadn't received any PK related courses after graduation. While rating the degree to which various barriers hindered the application of PK principles in current practice, we found that the lack of PK related continuing education topics was the highest in importance category (55.2%). Furthermore, we had an agreement between more than half of pharmacists about adequacy, importance and relevance of PK courses in their undergraduate programs to current practice. Pharmacists who took their pharmacy degree from foreign countries other than Palestine were more agreed about adequacy, efficacy and way of teaching of CPK courses with significant association as (p < 0.05). Conclusions: Improving the depth and methods by which PK courses are taught, in addition to providing continuous education learning (CEL) for hospital pharmacists in PK will improve pharmacist's perception about PK courses and their application in clinical practice as only 11.7% of pharmacists had taken any related former courses after graduation, also having a CEL for other health care professionals will improve application of clinical pharmsicts role as poor understanding of PK by the health care professionals where one of the barriers that faced pharmacists in application PK.
Evaluation of Nurses' Knowledge and Understanding of Obstacles Encountered When Administering Resuscitation Medications: A Cross-Sectional Study from Palestine
(An-Najah National University, 2021-06-08) قعدان, روان عصام
Background: medication errors one of most important reason of patients' morbidity and mortality, insufficient knowledge of drug among nurses considered a major factor in drug administration errors also stressful and complex systems in resuscitation increase errors. increase nurses' knowledge about resuscitation medications is important to maximize patient safety. This study aimed to assess knowledge of nurses about resuscitation medications and the obstacles that nurses faces when giving resuscitation medications, and to evaluate resuscitation medication administration errors reporting and the reason that prevent nurses to not reporting the errors. Methods: a cross sectional study was conducted, in west bank, Palestine. convenient sampling was used to collect sample, data were collected via a face to face interview questionnaire, which was taken from a previous study. The questionnaire consisted of five parts: demographic data, knowledge of resuscitation medications (20 true - false questions), self-evaluation, causes of not reporting the medication errors, and suggestions to decrease medication errors. Results: a total of 200 nurses were participated in the study. Nurses were found to have insufficient knowledge about resuscitation medications; the correct response rate was only 58.6%. More knowledge score was associated with male nurses (P = 0.001), nurses working in CCU, ICU, and general with P value < 0.001, and who in supervisor position (P = 0.035). The major obstacle nurses faced when administering resuscitation medication was chaotic environment in CPR as a lot of people handling a single drug(62%), unavailability of pharmacists whole the day (61%), and different medications look alike in packaging (61%) were other obstacles. Most of nurses (70.5%) hoped to gain additional training. In our study we found that nursing management focused on the person rather than the system (71.5%), and If anything happens to the patient, nurses thought they would be blamed as a consequence of the ME (71.5%) were the major causes behind not reporting Medication Administration Errors. Conclusion: Nurse’s insufficient knowledge regarding resuscitation medications was one of the obstacles they faced, nurses favoured to collaborate with pharmacist to arrange medications in a good way, and having continuous learning and extra training about resuscitation medications to decrease medication errors.
Nurses' Knowledge and Practice of Mixing Medications with Foodstuff: A Cross-Sectional Study from Palestine
(جامعة النجاح الوطنية, 2021-06-09) عطالله دعيبس, مرح
الملخص الخلفية : الخصائص الصيدلانية المختلفة للشكل الدوائي (DF) لها تأثير مباشر على مدى سهولة ابتلاع الدواء الصلب فمويا. يعاني غالبية كبار السن من درجة معينة من عسر البلع، اضافة الى ذلك صعوبة البلع هي عائق علاجي شائع بين الأطفال. غالبًا ما يتم تعديل تركيبات الأدوية عن طريق سحق الأقراص أو قتح كبسولات (CT / OC) لتسهيل تناول الدواء، ولكن هذا التعديل يؤثر على سلامة وفعالية الدواء وقد يتسبب في آثار جانبية ضارة. أيضًا يجب سحق الأدوية الخاصة بالمرضى الذين يعانون من أنبوب أنفي معدوي (NGT) أو فتحها قبل الإعطاء. يمكن أن يتسبب تناول الأدوية مع الطعام في حدوث تغييرات في امتصاص الدواء ويؤدي إلى تغيير في حركية الجهاز الهضمي، مما قد يؤدي إلى تأثير غير متوقع على انحلال الدواء وامتصاصه. لذلك هدفت هذه الدراسة إلى معرفة معرفة وممارسات الممرضين بخصوص خلط الأدوية مع الطعام أو الشراب في فلسطين. المنهجية : شملت هذه الدراسة المقطعية الممرضين في المستشفيات الحكومية في مناطق مختلفة من فلسطين. تم جمع البيانات عن طريق استبيان مقابلة وجهاً لوجه. النتائج : شارك ما مجموعه 200 ممرض/ة في الدراسة. تظهر البيانات فرق معنوي بين المشاركين حسب قسم العمل (p <0.001). تم العثور على أعلى درجة متوسطة [بين الشرائح الربعية] 15 [12-15] للممرضين العامين في وحدة العناية المركزة لحديثي الولادة. أيضًا ، حصل الممرضين في جناح الأطفال وجناح الرجال على درجات عالية من 13 [11.5-15] و 13 [11-14]، على التوالي. أظهرت النتائج أن 88٪ من الممرضين قاموا بتعديل DF عن طريق الفم قبل الإعطاء للمرضى. طحن الحبوب الدوائية او فتح لكبسولات وخلطها مع العصير أكثر الإجراءات شيوعًا من قبل الممرضين (حوالي 84٪) ؛ 35٪ من الممرضين استخدموا عصير البرتقال لخلطه مع الدواء. كان السبب الأكثر شيوعًا لطحن الدواء هو إعطاء الأدوية لمرضى عن طريق النبوب الفموي المعوي ( (41.5%. بالإضافة إلى ذلك ، يطلب 58٪ من الممرضين عادة من الصيادلة معلومات حول الأدوية. كان الأسبرين أكثر الأدوية التي تم سحقها من قبل الممرضين (44٪) ؛ ومع ذلك، لم يشعر 35.5٪ من الممرضين بتدريب كافٍ للقيام بهذه الممارسة. الخلاصة: أظهرت نتائج هذه الدراسة أن سحق الأدوية وخلطها مع الطعام أمر شائع بين الممرضين، كما أن غالبية الممرضين غير مدركين للتأثير الخطير لهذه الممارسة على صحة المريض. يجب على الصيادلة تثقيف الممرضين بشكل فعال حول حالات طحن الدواء غير الضرورية أو عندما يجب تجنب الطحن ومحاولة إيجاد بديل، عند توفره .

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