Clinical Pharmacy
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- ItemEVALUATION OF ANTIBIOTIC RESISTANCE AT A TERTIARY CARE HOSPITAL IN PALESTINE: A THREE- YEAR RETROSPECTIVE STUDY(2022-08-15) Aya Ayed Abu-DiakBackground: 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.
- ItemASSOCIATION BETWEEN TREATMENT SATISFACTION AND URINARY INCONTINENCE AMONG DIABETIC PATIENTS: A CROSS-SECTIONAL STUDY FROM PALESTINE(An - Najah National University, 2023-07-06) Shaharzad ByadsehBackground: 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.
- ItemHealth-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, هبةخلفية 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.
- ItemClinical Pharmacokinetics: Perceptions of Hospital Pharmacists in Palestine about how it is Taught and Applied(جامعة النجاح الوطنية, 2020-12-02) Aqel, RafeefBackground: 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.
- ItemEvaluation of anemia management among hemodialysis patients in Palestine: associated factors and clinical outcomes(Nada Sadek Rajabi, 2020-01-23) Rajabi, NadaBackground: 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.