Clinical Pharmacy
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- ItemEvaluation 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, SabrineBackground 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.
- ItemBACTERIAL PROFILE AND ANTIBIOTIC SUSCEPTIBILITY PATTERNS IN HOSPITALIZED PATIENTS WITH INFECTED DIABETIC FOOT(An-Najah National University, 2025-08-05) Hammad, AseelBackground: 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.
- ItemA 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, KarinBackground: 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.
- ItemTREATMENT SATISFACTION AND ATTITUDES TOWARD TAKING MEDICATIONS AMONG HYPERTENSIVE PATIENTS: A CROSS-SECTIONAL STUDY FROM PALESTINE(An-Najah National University, 2025-02-13) Kareman, YaseenBackground: Millions of patients are living with hypertension worldwide. This study aimed to assess the attitudes of hypertensive patients toward taking antihypertensive medications and their satisfaction with the treatment. Methods: This research employed a cross-sectional design with a questionnaire as the instrument for data collection. This study was conducted in the primary healthcare centers of the Ministry of Health in Nablus, West Bank, Palestine. In addition to the demographic and clinical variables, the questionnaire also included the Arabic translated and culturally adapted Drug Attitude Inventory (DAI-10) and the Arabic version of the Treatment Satisfaction Questionnaire for Medication (TSQM). Results: In this study, 356 patients with hypertension were included. More than half of the patients (57.6%, n = 205) were on amlodipine. Additionally, valsartan was used by 117 (32.9%) of the patients. The vast majority of the patients (95.2%) believed that they benefited from their antihypertensive drugs, and in their opinion, the benefits of their antihypertensive drugs outweighed the drawbacks. The vast majority of the patients (95.2 %) believed that they benefited from their antihypertensive drugs, and in their opinion, the benefits of their antihypertensive drugs outweighed the drawbacks. The Drug Attitude Inventory (DAI-10) measures the attitudes and adherence of hypertensive patients toward their antihypertensive medications via 10 statements. The DAI-10 scores were affected by the time since diagnosis (p = 0.004), presence of a documented food or drug allergy (p < 0.001), body mass index (p = 0.004), perceived effectiveness of the antihypertensive medications (p = 0.010), side effects (p = 0.001), convenience (p = 0.040), and global satisfaction scores (p < 0.001). The perceived effectiveness of antihypertensive medications was affected by side effect scores (p = 0.002), convenience scores (p < 0.001), and global satisfaction scores (p < 0.001). The global satisfaction scores were affected by the time since diagnosis (p = 0.008), DAI-10 score (p < 0.001), perceived effectiveness of antihypertensive medications (p < 0.001), and side effects (p < 0.001). Conclusions: The findings of this study revealed positive attitudes and high levels of satisfaction with antihypertensive medications among patients, especially with respect to the perceived effectiveness and convenience of antihypertensive medications. The time elapsed since diagnosis with hypertension, the presence of documented allergies, and high BMI are important factors that can predict negative attitudes and low satisfaction with treatment. Healthcare providers and decision makers should consider measures to improve, maintain, and support positive attitudes and satisfaction with treatment among hypertensive patients. Keywords: Attitudes, Satisfaction, Hypertension, Antihypertensive medications, Treatment, Cardiovascular disease, Primary healthcare
- ItemCOMMUNITY 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, ZohdeyaBackground: 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.