Clinical Pharmacy

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    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.
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    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.
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    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.
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    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.
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    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