Clinical Pharmacy

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A CROSS-SECTIONAL STUDY OF SELF-REPORTED SIDE EFFECTS OF BREAST CANCER TREATMENT AND QUALITY OF LIFE IN PALESTINE
(An-Najah National University, 2025-01-16) Breek, Karin
Background: Breast cancer is the most common cancer among women in terms of incidence. This study aimed to determine the side effects of breast cancer treatment reported by Palestinians with breast cancer and their quality of life. Methods: This study was a cross-sectional questionnaire-based survey. The study was undertaken in Nablus. The data collection instrument was divided into two distinctive sections. Part (A) collected data covering sex, age at diagnosis, clinical symptoms, complications, treatment measures, and side effects of the treatments. While part (B) of the questionnaire involved the quality-of-life assessment tool, the current study employed the WHOQOL-BREF (Arabic version) as an assessment tool. Results: A total of 258 patients with breast cancer participated in this study. In addition to breast cancer, 207 (80.2%) patients had one or more comorbid conditions. Of the patients, 153 (59.3%) were diagnosed less than 3 years ago. With respect to disease stage, 147 (57%) patients were in Stage I, 51 (19.8%) patients were in Stage II, 54 (20.9%) patients were in Stage III, and 6 (2.3%) patients were in Stage IV. Among the patients, 207 (80.2%) received chemotherapy, 159 (61.6%) underwent lumpectomy, 156 (60.5%) received radiotherapy, and 102 (39.5%) underwent mastectomy. When screened for the adverse effects of breast cancer treatments, the patients reported adverse effects and health issues that were categorized as follows: pain, gastrointestinal, skin and hair, health issues; pain, sleep and mental health, and respiratory/mouth and throat, hematologic, genitourinary, sensory, and general health issues. Multiple linear regression showed that the overall scores were negatively associated with having comorbidities, having advanced-stage breast cancer, receiving mastectomy, and experiencing headaches, vomiting, depression, anxiety, mood swings, mouth and throat sores (mucositis), fever, and insomnia. Conclusions: The findings of this study highlighted the heavy burden of disease and therapy-related adverse effects on the quality of life of patients with breast cancer who received treatment in Palestine. A multidisciplinary holistic care plan for breast cancer patients who integrates physical and mental health support is urgently needed to improve the quality of life of these patients.
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.
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.
ASSESSMENT OF ANTIBIOTIC PRESCRIBING AND COST IN PALESTINIAN HOSPITALS
(2022-11-14) Rufayda Dawood Manassrah
Background: One of the largest problems facing the world today is the enormous morbidity and mortality caused by antibiotic resistance in bacterial infections. A major factor in antimicrobial resistance (AMR) is the irrational use of antibiotics. The objective of this study was to assess the prescribing and cost of antibiotics in two major governmental hospitals in the West Bank of Palestine. Methods: A retrospective cohort study was conducted on 428 inpatient prescriptions containing antibiotics from two major governmental hospitals in the West Bank of Palestine, from December 2020 to March 2021, they were evaluated by some drug use indicators. Descriptive statistics were performed using IBM-SPSS version 21. Results: The mean ± SD number of drugs per prescription (NDPP) was 6.72 ± 4.37. Of these medicines, 38.9% were antibiotics. The mean ± SD number of antibiotics per prescription (NAPP) was 2.61 ± 1.54. The average ± SD cost per prescription (CPP) was 392 ± 744 USD. The average ± SD antibiotic cost per prescription (ACPP) was 276 ± 553 USD. The most commonly prescribed antibiotics were ceftriaxone (52.8%), metronidazole (24.8%), and vancomycin (21.0%). About 19% of the antibiotics were prescribed for intra-abdominal infections; followed by 16% used as prophylactics to prevent infections. Almost all antibiotics prescribed were administered intravenously (IV) 94.63%. In general, the average duration of antibiotic therapy was 7.33 ± 8.19 days. The study indicated that the number of antibiotics per prescription was statistically different between the hospitals (p = 0.022), and it was also affected by other variables like the diagnosis (p = 0.006), the duration of hospitalization (p < 0.001), and the NDPP (p < 0.001). The most commonly prescribed antibiotics and the cost of antibiotics per prescription were significantly different between the two hospitals (p < 0.001); The cost was much higher in the Palestinian Medical Complex. Conclusion: The practice of prescribing antibiotics in Palestine's public hospitals may be unnecessary and expensive. This has to be improved through education, adherence to recommendations, yearly immunization, and stewardship programs; intra-abdominal infections were the most commonly seen infection in inpatients and ceftriaxone was the most frequently administered antibiotic. Keywords: Antibiotics, Antimicrobial resistance, Cost analysis, Prescribing, Rational use of medicine.
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.
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.
ASSOCIATION BETWEEN TREATMENT SATISFACTION AND URINARY INCONTINENCE AMONG DIABETIC PATIENTS: A CROSS-SECTIONAL STUDY FROM PALESTINE
(An - Najah National University, 2023-07-06) Shaharzad Byadseh
Background: Type 2 diabetes mellitus (DM) is a chronic metabolic disorder. Such diseases can harm and cause daily life complexities related to mortality and other disorders. Therefore, this disease greatly affects daily routines in life and influences health quality. Furthermore, satisfaction with treating patients' daily life and routines is a frequent and important aspect. Thus, research is needed to find further such associations with treatment satisfaction. Objectives: This study will investigate the correlation between treatment satisfaction and its domains with urinary incontinence (UI). Additionally, the researcher checked the variables of predictability of the confounding demographics and urinary incontinence to predict treatment satisfaction. Methodology: A cross-sectional study was performed to recruit diabetic patients from primary care centers in Palestine between the first of June 2022 and the first of October 2022. Four hundred diabetic patients were surveyed to fill in sociodemographic questions, urinary incontinence (ICIQ-UI-SF), and treatment satisfaction questionnaire (TSQM 1.4). The findings were analyzed for descriptive statistics, correlations, and regressions between satisfaction treatment and urinary incontinence. The analysis was performed using the statistical package of social sciences (SPSS). Results: The study included four hundred diabetic patients from primary centers in the northern part of West Bank. The patients ranged in age between 18 and 89 years, with 210 males and 190 females. The patients were asked to answer ICIQ-UI-SF, and the findings showed that 101 out of 400 patients (25.25%) had urinary incontinence. These patients' UI severity ranged from slight (15%), moderate (65%), severe (18%), and very severe (3%). In addition, the patients were asked to fill in the TSQM (1.4) to assess their satisfaction with the treatment. Analysis of the questionnaire revealed four domains' scores out of 100; the higher the score, the higher the satisfaction. For instance, domain effectiveness was 66.125±16.6, domain side effects was 94.68± 17.9, domain convenience was 68.11±14.57, and global satisfaction was 67.17±16.46. However, the correlation analysis between treatment satisfaction and urinary incontinence was insignificant (p>0.05). This means the patients did not correlate their urinary incontinence status and satisfaction with treatment. The scores were statistically significant with the level of education (p<0.05) and the use of sitagliptin (p<0.05). In addition, the quantity of leaked urine and incontinence status were significantly correlated with ICIQ scores (p<0.05). Additionally, regression analysis showed that urinary incontinence status could predict treatment satisfaction. Conclusions: The study findings showed that diabetic patients' satisfaction with their treatment is not correlated with their urinary incontinence status. However, more studies must be conducted with interventional designs to explore the relations further.
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
BACTERIAL PROFILE AND ANTIBIOTIC SUSCEPTIBILITY PATTERNS IN HOSPITALIZED PATIENTS WITH INFECTED DIABETIC FOOT
(An-Najah National University, 2025-08-05) Hammad, Aseel
Background: Diabetes mellitus (DM) represents a major public health concern and has been increasingly associated with serious complications. One of the most complex and costly complications of diabetes is diabetic foot infection (DFI). Early diagnosis, promote an appropriate treatment based on pathogen identification and antibiotic susceptibility testing, is essential for achieving favorable clinical outcomes. The aim of this study is to assess the bacterial profile and antibiotic susceptibility patterns in patients with infected diabetic foot. Methodology: A retrospective design to evaluate bacterial profile and antibiotic susceptibility patterns in patients with infected diabetic foot ulcers (DFUs) was used. The study was conducted at Salfeet Governmental Hospital. The files of all type 2 diabetes mellitus patients who meet the inclusion criteria during the previous three years were included. Statistical Package for Social Sciences (SPSS) was used for data analysis. Results The study included 211 participants, in which the majority (45.0%) aged between 50-59 years, & males comprised 66.8% of the sample. Regarding diabetes mellitus (DM) duration, most participants (87.2%) had been diagnosed for > 10 years. Neuropathy was present in 34.6%, nephropathy in 24.6%, and angiopathy in 8.5% of the study population. Among the study participants, the most common ulcer site was the forefoot (33.1%). Ulcers penetrating to the bone (Grade D) were present in 20.4% of cases, and 7.1% had ulcers with osteomyelitis or abscess (Grade E). A statistically significant association was found between nephropathy and severity of ulcer grade (p = 0.007). The most commonly isolated microorganism was Escherichia coli, detected in 26.5% of cases, followed by Staphylococcus aureus (20.9%) and Pseudomonas aeruginosa (10.9%). Among the antibiotics tested for sensitivity, Meropenem/Ertapenem showed the highest sensitivity, with 63.03%, followed by Amikacin at 47.39%, Gentamycin (40.28%), and Piperacillin+Tazobactam (39.81%). Amoxicillin + Clavulanic acid showed the lowest sensitivity, at only 3.79%, Conclusion: The microbiological profiles revealed a high prevalence of Gram-negative bacteria, notably Escherichia coli, and Pseudomonas aeruginosa, accompanied by considerable treatment resistance. Meropenem, was the most often prescribed and effective antibiotic. The results affirm the necessity for multidisciplinary management strategies that encompass early detection, prompt surgical and antimicrobial interventions to enhance clinical outcomes and reduce amputations.
CANCER-RELATED POST-TREATMENT PAIN AND ITS IMPACT ON TREATMENT SATISFACTION WITH MEDICATION IN BREAST CANCER PATIENTS: A CROSS-SECTIONAL STUDY FROM PALESTINE
(جامعة النجاح الوطنية, 2022-03-27) Daifallah, Aiman Hussein Mohammed
Background: Pain after therapy is an important clinical problem in breast cancer patients. Unfortunately, patients with cancer have a lower quality of life due to undertreatment of post-treatment pain; therefore, improving medication management plans and palliative care became one of the most important targets of cancer therapy. Objectives: The current study aimed to examine the impact of posttreatment pain (pain severity and interference) on medication satisfaction in patients with various stages of breast cancer in Palestine. Methods: A correlational cross-sectional study was conducted at Al-Watani Hospital and An-Najah National University Hospital in the Nablus area. Using the Brief Pain Inventory (BPI), the intensity and interference of pain will be evaluated. Patients’ satisfaction with cancer management medications will be measured using the Treatment Satisfaction Questionnaire for Medication (TSQM). Results: Two hundred and fifty-four patients were included in this study. All were women, with a mean ± SD age of 53.1 ± 10.7 years. Patient satisfaction with medication reported was measured using the median scores of 4 domains (Effectiveness satisfaction 61.0 [50.0-72.2], Side effects satisfaction 59.4 [31.3-100.0], Convenience satisfaction 66.7 [61.1-77.8] and Global satisfaction 64.3 [50.0-78.6]). There were significant negative correlations (p < 0.05) between pain severity and effectiveness interference (r = -0.258, -0.319, respectively), side effects (r = -0.414, -0.514, respectively), convenience (r = -0.274, -0.307, respectively), and global satisfaction domain scores (r = -0.293, -0.287, respectively). The regression analysis results indicated an independent association between chemotherapy use and a higher global satisfaction score (p = 0.011). Also, lower pain interference score (p = 0.01) and patients without side effects (p = 0.47) were independently associated with higher Effectiveness satisfaction scores. Finally, lower pain interference scores (p < 0.001), patients without post-treatment pain (p = 0.034), and patients without side effects were independently associated with higher side effects satisfaction scores. There were significant positive correlations indicated between global satisfaction score and the use of cyclophosphamide (p =0.018), between effectiveness satisfaction score and the use of (p = 0.035), and between convenience satiasfaction score and the use of tamoxifen (p = 0.038). There were significant negative correlations between convenience satisfaction score and the use of adriamycin (p = 0.005), docetaxel (p = 0.008), capeciatabine (p = 0.022), gemcitabine (p = 0.026), and trastuzumab (p = 0.002). Conclusions: Patients with posttreatment pain, side effects, and greater pain interference with their functioning had lower satisfaction scores. Therefore, better management of their treatment medications, side effects, and pain medications is recommended to enhance their satisfaction and quality of life.
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.
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.
COMMUNITY PHARMACISTS’ PERCEPTIONS AND ROLE IN THE MANAGEMENT OF COMMON DERMATOLOGICAL PROBLEMS IN PALESTINE: A CROSS-SECTIONAL STUDY
(An-Najah National University, 2024-09-10) Salah, Zohdeya
Background: Skin diseases are common health issues that affect 30% to 70% of the global population. This study aims to explore the perceptions and role of community pharmacists in the management of common dermatological problems in Palestine. Methods: This study was implemented in a cross-sectional design. The study was conducted in different community pharmacies that were distributed all over the different governorates of the West Bank of Palestine. The data collection instrument was a questionnaire that was developed after a search of the literature. Results: In this study, a total of 385 community pharmacists returned complete questionnaires. Of the community pharmacists, 367 (95.3%) stated that they refer patients to consult a dermatologist. The common reasons for referrals to dermatologists included being unsure of diagnosis, when a dermatologist supervision was needed, and when a prescription product was needed. The community pharmacists who were female (p = 0.043), were in practice for 10 or more years (p = 0.035), received a dedicated course on dermatology during pharmacy training (p = 0.045), and have seen 10 or more dermatological cases seen per week (p = 0.017) practiced significantly more referrals compared to the community pharmacists who were male, practice for less than 10 years, did not receive a course on dermatology, and have seen less than 10 dermatological cases per week. When the community pharmacists were asked to rate their confidence in providing education/counseling to patients with dermatological issues on a scale of 1-5, the median score was 3.0 [IQR = 2.0, 4.0]. Acne, dry skin, nail problems, fungal infections, skin rash, skin blisters, scalp problems, lip problems, sunburn, eczema/dermatitis, candidiasis, insect bites, head lice, psoriasis, and alopecia were the commonly encountered dermatological problems. Combination products containing antibiotics/antifungals/steroids, topical antibiotics, topical steroids, topical retinoids, vitamins/vitamin derivatives/pantothenic acid, topical antihistamines/anticholinergics were the most commonly dispensed dermatological products. The majority of the community pharmacists agreed or strongly agreed that they should be consulted by patients with dermatological conditions, they have a valuable role in assisting patients with dermatological conditions, they are an important source of advice/counseling/education on medications use for dermatological conditions, and the pharmacy-based dermatology services are helpful for patients with dermatological conditions. Conclusions: The findings of this study showed that community pharmacists in Palestine provided care services to patients with dermatological health issues. The findings of this study also showed that community pharmacists often referred patients with complex dermatological health issues to consult dermatologists, notably, when prescription dermatological products were required. This might suggest that community pharmacists need to be integrated with the multidisciplinary team to care for patients with dermatological health issues.
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.
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.
EVALUATION OF ANTIBIOTIC RESISTANCE AT A TERTIARY CARE HOSPITAL IN PALESTINE: A THREE- YEAR RETROSPECTIVE STUDY
(2022-08-15) Aya Ayed Abu-Diak
Background: Antimicrobial resistance is now one of the most critical medical threats worldwide. Historical facts and diverse data collected over the years have proved that something urgent should be done to control this growing phenomenon. The problem arises from the overuse and misuse of antibiotics. This has made —in some circumstances— the treatment of a simple infection a complicated process. Therefore, many countries around the world have found themselves compelled to devote efforts to control this antibiotic overuse and misuse in the hope of controlling it and its clinical, economic and societal consequences. Against this background, this study has sought to assess the frequency and antibiotic susceptibility patterns of the most common bacterial pathogens and candida isolated at An-Najah National University Hospital (NNUH) in Nablus, Palestine, between 2018–2020. Methodology: A retrospective cross-sectional study was done to assess antimicrobial resistance patterns of the pathogens isolated from patients in different hospital wards during the study period (2018–2020), using sensitivity reports saved into the computerized database of NNUH microbiology lab. Data was then collected, coded and imported to Statistical Package for Social Sciences (SPSS) version 21 for further analysis. Descriptive statistics were run to generate frequency and percentages, tables and graphs. Approval was obtained from the university’s Institutional Review Board. Results: Out of 5, 585 clinical cultures, 46.9% were Gram-Negative Bacteria (GNB), 37.9% were Gram-Positive Bacteria (GPB) and 15.2% were candida. The most frequent Enterobacteriaceae was ESBL E. coli (15.6% of GNB) followed by E. coli (14%), ESBL k. pneumoniae (7.7%), k. pneumoniae (5.5%). P. aeruginosa and A. baumannii were the most obtained Non-Fermenting Gram Negative Bacilli (NFGNB). For GBP, the most frequent isolate was Coagulase-negative Staphylococci (CoNS), representing an isolation rate of 38.8% of GPB in total, followed by E. faecalis (18.6%), S. aureus (8.2%), and VRE E. faecium (7.5%). Clinical specimens were mostly collected from 27.7% of the urine samples. This was followed by wound specimens (19.6%) and blood specimens (19.2%). The total in-patients from all wards was 3, 895 cases (N%=69.7%). Of these, the surgical ward (SW) was the most prominent (14.6%) followed by the Intensive Care Unit (ICU): 10.7%. A. baumannii showed high resistance (over 85%) for ceftazidim, cefipim, gentamycin, ciprofloxacin, levofloxacin, piperacillin, and imipenem. ESBL E. coli. ESBL k. pneumoniae showed nearly complete resistance to ampicillin and cephalosporin agents. MRSA S. aureus was also nearly completely resistant to penicillin, oxacillin, amoxicillin\clavulinic acid, cefuroxime. VRE E. faecium showed full resistance to penicillin, amoxicillin\clavulinic acid, ampicillin, vancomycin, levofloxacin, ciprofloxacin, and erythromycin. Conclusions: High rates of resistance were observed during the study period for most isolated bacteria species. Efforts need to be made on enhancing appropriate control and monitoring measures to stop the overuse and misuse of antibiotics and limit the prevalence of Multi-Drug Resistant Organisms (MDRO). Keywords: Antibiotics; resistance; Palestine; MDRO.
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.
Evaluation of Potential Drug-drug Interactions among Medications Prescribed in Primary Health-Care Centers for Type 2 Diabetes Mellitus Patients: A Cross-Sectional Study From Palestine
(An-Najah National University, 2020-10-19) Athamneh, Sabrine
Background Nowadays, there is a global healthcare concern associated with the risk of high incidence medication errors, many of which are attributed to drug-drug interactions (DDIs). Co-morbid conditions such as; diabetes mellitus, hypertension, dyslipidemia, renal disease and peripheral artery diseases require complex therapy with multiple medications. Thus, administration of more than one medication concomitantly is a common practice to control their conditions and, for this reason, polypharmacy patients are more prone to DDIs. In our country there are no local studies concerned with the prevalence of potential DDIs among type 2 diabetes mellitus patients (T2DM), that is why the study was carried out. Aim of the Study The aim of this study is to evaluate the potential of DDIs among medication prescribed for T2DM patients and examine factors associated with these interactions, in primary healthcare centers. Methods The study is an observational survey employing a cross sectional design and encompassing all T2DM patients, whom visited the primary healthcare centers of the ministry of health (MOH) between July and September 2018. The sample size is comprised of 400 patients, all from the southern part of the West Bank; Hebron and Beitlehem. The patients were interviewed for their social demographic characteristics, their medical conditions, management and treatment by questionnaire-guided interviews. All their prescriptions of drugs were input to Lexi-Comp checker to find out the potential DDIs in their medications. Besides, the assessing the modalities of DDIs according to severity to contraindicated, major, moderate, or minor interaction. Results Among 400 patients, a little less than the half were over 60 years, the majority of them were female. The most common co-morbid conditions present in the diabetes mellitus (DM) patients were as follows; 77.3% had cardiovascular disease (CVD), 64.5% had dyslipidemia, and 12.0% had gout. Moreover, a total of 114 different medications were used, the most commonly prescribed medications were metformin being used by 85.5%, followed by atorvastatin 74.5%, and Acetyl salicylic acid (ASA) used by 74.0% patients. The most common interactions in 61.5 % patients were ASA with Metformin followed by Glimepiride with Metformin in 40.5 % cases. Out of participants 96% patients had at least one potential DDIs. Overall 2627 interactions were identified, with an average of 6 interaction per prescription. According to the risk rating classification, 1.33% were A, 11.72% were B, 76.67% were C, 10.01%, and 0.27% were X risk rating. The number of potential DDIs that the patients had were also related to their age, educational level, comorbidities, number of medications prescribed and complication (p value < 0.05 for each one). However, there was no significant relationship with gender, material status or smoking (p value > 0.05). Conclusions The prevalence of DDIs among medications prescribed for T2DM was very common. This potentially is increasing parallel with increasing age, educational level, comorbidities, number of medications, in addition to the presence of complications. Updating data related to DDIs with good and effectively communicate among healthcare providers, especially prescribers and dispensers can play an important role in minimizing DDIs.
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.

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