Conference Book significant and important for all healthcare professionals, health consumer groups, the pharmaceutical industry, and the government. For healthcare professionals QUM

1

Table of Content

Quality Use of Medicine and Patient Care:

An Interprofessional Approach

12

th-13

th March 2016

Applied Science Private University

Amman- Jordan

Conference Book

ASU-Second International Medical Conference

Location: Conference Palace

Applied Science University, Alarab St 11931,

Amman, Jordan www.asuconf.org

2

Table of Content

Table of Content

Table of Contents

2

Important Information

3

Welcome from the Chair

4

About the Conference

5

Conference Higher Committee Members

6

Conference Agenda

8

Moderators List

14

Speakers’ Profile

15

Speakers’ Abstracts

23

Workshops

37

Posters Abstracts

43

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65

3



Registration

Conference registration will be held at the entrance of

the Conference Palace.

Registration will be open from 9:00 am till 10:00 am, on

both conference days.

Registration fees will be as following:

25 JD for Healthcare Providers

15 JD for Students

Badges and conference bags will be available at the

registration desk.

Workshops

Workshops registration can be completed during the

conference, before the workshop.

The fee per workshop is: 20 JD.

Workshops will be held at the Faculty of Pharmacy,

ASU (5 minutes walking distance from the Conference

Palace).

Prayer

Coffee breaks are organized to suit prayer times.

The Conference Palace is very close (1 minute walking

distance) from the University Mosque.

Dinner

Dinner on both days will be served in the Conference

Palace, Second floor.

The dinner will include a buffet. Suitable for vegetarians

as well.

4

Chair Welcoming Words

Welcoming Words from the Chair

Under the patronage of his Excellency Doctor Haitham Abu Khadija, deputy in the Jordanian

parliament and Council Vice President of Applied Science Private University, the Faculties

of Pharmacy and Nursing are pleased to invite you to join us for the Second ASU

International Medical Conference 2016.

This year’s conference theme ‘Quality Use of Medicines (QUM) and Patient Care’ is

interesting, significant and important for all healthcare professionals, health consumer

groups, the pharmaceutical industry, and the government. For healthcare professionals QUM

ensures the availability of evidence-based information to ensure proper prescribing and

knowledge of alternative options. For consumers, QUM ensures access to a medicine that

will help their particular condition at the time they need it, comprehending why they have

been prescribed the medicine and how to use it properly. For the industry, QUM involves

patient support initiatives, appropriate marketing and education through post-marketing

surveillance. For the government, QUM means overall improvements to quality of life of

consumers and their careers, in addition to cost savings to the health system.

Today, more than ever, QUM demands a multidisciplinary approach. The conference

guarantees a forum that will present the most recent findings in QUM in Jordan and around

the world. In addition to practical presentations and wide-ranging debates which answer the

question about how health professionals from different areas of specialization can best work

together to achieve greater treatment results and better patient care. The conference will host

leaders, experts, scientists, and researchers in the field of pharmacy, nursing, and medicine.

This conference should offer a unique opportunity to promote the international exchange of

expertise and I hope that you will find it both valuable and enjoyable.

Dr Iman Amin Basheti

Chair of the Conference

5



At Applied Science Private University (ASU), the Faculties of Pharmacy and Nursing are

dedicated to excellence and innovation in research and teaching directed towards quality use

of medications and patient care. Our mission is to promote people’s health and wellbeing

through implementing inter-professional collaboration, addressing existing public health

issues, and proposing solutions to policy makers in the country.

To meet our mission, we are pleased to

announce the hosting of the ASU-Second

International Medical Conference, under the

patronage of his Excellency Doctor Haitham

Abu Khadija, Council Vice President of

Applied Science Private University. The

conference will be held under the theme

‘Quality Use of Medicines and Patient Care:

an inter-professional Approach’. Last year’s first installment of the ASU-First Medical

Conference introduced a forum hosting the most recent findings in quality use of medications

in Jordan. This year’s conference will repeat last year’s story of success, in addition to

bringing a group of worldwide experts and leaders in the field of pharmacy and quality use of

medications. Keynote speakers will include top national and international researchers from

the medical field.

The conference guarantees a forum that will present the most recent findings in Quality Use

of Medicine in Jordan and abroad. The conference will include keynote presentations, invited

papers and five workshop sessions provided/endorsed by international scientists.

The conference will wrap up by presenting chief recommendations for the direction of

Quality Use of Medications in the country. Conference abstracts, executive summary and

recommendations will be published in the Jordan Journal of Applied Science as a way of

disseminating the presentations and discussion that will occur during the event to interested

parties.

6

Conference Committee

Higher Committee Members

Dr. Rana Abu Farha

Assistant Professor

Member

Faculty of Pharmacy

ASU

Dr. May Abu Taha

Assistant Professor

Member

Faculty of Pharmacy

ASU

Dr. Maysoon Saleh

Assistant Professor

Member

Faculty of Pharmacy

ASU

Dr. Raghad Abdelqader

Assistant Professor

Member

Faculty of Nursing

ASU

Dr. Hikmat Alaksh

Assistant Professor

Member

Faculty of Nursing

ASU

Dr. Alberto Berardi

Assistant Professor

Member

Faculty of Pharmacy

ASU

Dr. Iman Basheti

Chair of the

Conference

Associate Professor

Dean of Pharmacy

Faculty of Pharmacy

ASU

Prof. Samiha Jarrah

Head of Organizing

Committee

Professor

Dean of Nursing

Faculty of Nursing

ASU

Dr. Wamidh Talib

Associate Professor

Member

Faculty of Pharmacy

ASU

Dr. Feras El-Hajji

Assistant Professor

Member

Faculty of Pharmacy

ASU

7

Conference Committee

Higher Committee Members

MSc. Jumana Alshiekh

Lecturer

Member

Faculty of Nursing

ASU

Ph. Ena'm Atieh

Teaching Assistant

Member

Faculty of Pharmacy

ASU

MSc. Ghadeer Dwaiek

Lecturer

Member

Faculty of Nursing

ASU

MSc. Samar Khater

Lecturer

Member

Faculty of Pharmacy

ASU

Ph. Dalal Alnatour

Teaching Assistant

Member

Faculty of Pharmacy

ASU

Ph. Yara Salhi

Teaching Assistant

Member

Faculty of Pharmacy

ASU

MSc. Raja Al-Quda

Lecturer

Member

Faculty of Pharmacy

ASU

Rozan Ibdah

IT Technician

Member

Faculty of Pharmacy

ASU

Mr. Fawzi Arini

Lab Technician

Member

Faculty of Pharmacy

ASU

8

Conference Agenda

Conference Agenda

First Day Saturday 12

th March 2016

10:00-10:05

Dr. Haitham Abu Khadija Welcoming Words

Council Vice President of Applied Science University

10:05-11:20

Silver Jubilee Ceremony

11:20-11:25

Dr. Iman Basheti Welcoming Words

Chair of the Conference, Applied Science University, Jordan

11:25-12:00

Signing Memorandum of Understanding

Applied Science University with University of Sydney


12:00-12:30

Opening of Exhibition and Poster Session

Coffee Break with Continental Breakfast

12:30-12:35

Professor Samiha Jarrah Welcoming Words

Dean of Nursing, Applied Science University, Jordan


9:00-10:00

Registration

http://asuconf.org/schedule/00-3/



9

Conference Agenda

12:35-1:05

Prof. Iqbal Ramzan, Dean of Pharmacy, Sydney University, Australia

Pharmacy Education and National Registration and Accreditation

Scheme for Pharmacists in Australia

1:05-1:35

Prof. Francesco Amenta, Dean of Pharmacy, University of Camerino, Italy

Revisiting Profile/Indications of Old Drugs: An Experience in the

Field of Cognitive Dysfunction

1:35-1:45

Dr. Yousef Najajreh, Dean of Pharmacy, Al-Quds University, Palestine

Quality Use of Medicines and Patient Care Challenges in Palestine

1:45-2:00

Dr. Maher Khdour, AlQuds University, Palestine

Antimicrobial Stewardship Program in the ICU at Palestine Medical

Complex: Multidisciplinary Team Led by Clinical Pharmacist

2:00-2:20

Dr. Lama Alnazer, Clinical Pharmacy Specialist, KHCC, Jordan

Improving the Quality of Care through Research

2:20-2:50

Poster Session, Exhibition and Coffee Break

2:50-3:15

Dr. Hayel Obeidat, JFDA Director General, Jordan

Jordan Food and Administration, and its Role in the Enhancement

of medicines rational use

3:15-3:40

Prof. Nathir Obeidat, Respiratory Consultant, JUH, Jordan

Non Invasive Ventilation: Latest Trends in Patient Care

10

Conference Agenda

4:40-6:00

Conference Formal Dinner

Workshops

4:20-4:40

Dr. Zeid Abu Goush, Chief Medical Officer, Hakeem-EHS, Jordan

Electronic Health Solutions Profile

3:40-4:00

Dr. Majed Habahbeh, Neurology Consultant, RMS, Jordan

Epilepsy: Diagnostic and Treatment Pitfalls

4:00-4:20

Dr. Dalia Bajis, Pharmacy Specialist, Sydney University, Australia

Education and Training in the Arab Region: Food for thought

2:20-4:20

Learning Evidence Based Medicine in Hospitals

Hosted by Dr. Delia Omar, Dr. Enas Hijjih and Dr. Hanan Abu Nema, Ibn

Alhaitham Hospital, Amman, Jordan

2:20-4:20

Diabetes Complication and Patient Care in the MENA Region:

an Example of New Approaches in Palestine

Hosted by Dr. Abdulsalam Alkhayyat, An-Najah University, Palestine

11

Conference Agenda

12:15-12:45

Coffee Break, Poster Session and Exhibition

Conference Agenda

Second Day Sunday 13th March 2016

10:15-10:45

Prof. Lynn Weekes, NPS Medicine Wise, Sydney University, Australia

Rational Use of Medicines and Medical Tests

10:45-11:15

Dr. Nadir Kheir, Assoc Prof. in pharmacy Practice, Qatar University, Qatar

Continuing Professional Development in Pharmacy: Quality

Expectations and Relevance to QUM

11:15-11:35

Dr. Iman Basheti, Dean of Pharmacy, Applied Science University, Jordan

Home Medication Management Review Service in Jordan and the

UAE: a Story of Success

11:35-11:55

Dr. Betty Chaar, President of AAPAE, Sydney University, Australia

Research in Healthcare Ethics at the University of Sydney

11:55-12:15

Dr. Rebeka Moles, Sydney University, Australia

Education through Simulation


9:00-10:00

Registration



12

Conference Agenda

Dr. Iman Basheti , Associate Profes

Chair of the Conference

Dean of Pharmacy

Faculty of Pharmacy/ASU

12:45-1:15

Dr. Abdulsalam Alkhayyat, An-Najah University, Palestine

Retinopathy Among Diabetes Patients in Jordan: Time for Action

1:15-1:35

Prof. Giovanni Palmieri, University of Camerino, Italy

Drugs beyond the Label

1:35-1:50

Dr. Omaima Nassar, HCAC, Jordan

Promoting Patient Safety through the Implementation of Health Care

Accreditation Council Medication Management Standards

1:50-2:05

Dr. Thaira Madi, HCAC, Jordan

The Effect of HCAC Primary Health Care Accreditation on PHC

Core Principles

2:05-2:25

Poster Session, Exhibition and Coffee Break

2:25-2:45

Dr. Mohammad Samaha, Neurology Consultant, Ibn Alhaitham Hospital

Neuromodulation of Brain for Control of Movement Disorders

and Gamma Knife Radiosurgery

2.45-3:05

Prof. Naiyla Bulatova, The University of Jordan, Jordan

An Innovative Geriatric-Psychiatric Rotation: Example of

Pharmacist Interprofessional Collaboration

3:05-3:25

Dr. Mohammad Alshara, Vice Dean of Pharmacy, JUST, Jordan

Current Pharmacy Practice: What is Clinical and Why? Settings,

Expertise & Opportunities

13

Conference Agenda

1:30-4:30

Applications in Pharmacy Education

Hosted by Dr. Betty Chaar, Dr. Rebeka Moles and Dr. Dalia Bajes, Sydney

University, Australia

Workshops

3:25-3:55

Dr. Nile Khanfer, Assistant Dean of Pharmacy, Nova University, USA

Direct-To-Consumer-Advertising (DTCA) from a Pharmaceutical

Marketing Perspective

3:55-4:30

Recommendation Session, Awards and Closing Ceremony

11:30-1:30

Strategies to Reduce Medication Errors in Hospital Patients

Hosted by Nursing Faculty, Applied Science University, Jordan

2:30-4:30

Professional Ethics: Basic Principles and a Tool Kit to Practice Ethically

Hosted by Dr. Nadir Kheir, Qatar University, Qatar


4:30-6:00

Conference Formal Dinner

14

Moderators List

Moderators List

Prof. Mayyada

Wazayfi

The University of

Jordan

Prof. Mahmoud Abu

Samak

Applied Science

University

Prof. Tariq AL-Qirim

Alzaytoona University

Prof. Enam Ayoub

Applied Science

University

Dr. Emad Nsoor

Royal Medical Service

Dr. Ibrahim Al-abbadi

Alyarmouk University

Dr. Penelope Shihab

MONOJO

Dr. Karem Al-zoubi

Jordan University of

Science and

Technology

Prof. Samiha Jarrah

Applied Science

University

Prof. Abla Bsoul

The University of

Jordan

15

Speakers’ Profiles


16


Prof. Iqbal Ramzan, Australia Professor Iqbal

Ramzan is Dean and

Professor of

Pharmacy at The

University of

Sydney’s Faculty of

Pharmacy. Professor

Ramzan is a

recognized expert in

drug

pharmacokinetics/pharmacodynamics, has

published 141 refereed papers and provides high

level advice to the Australian Federal Government

on drug registration. Professor Ramzan is an

international leader in pharmacy education and is

Past-President of the Asian Association of Schools

of Pharmacy and current Director of the Council of

Pharmacy Schools – Australia and New Zealand.

Professor Ramzan is also a Director of the

Australian Pharmacy Council and the current Chair

of the Australian Pharmacy Leaders Forum. He is a

Pharmacist and holds a Diploma from the

Australian Institute of Company Directors.

Prof. Francesco Amenta, Italy

Professor Francesco

Amenta is Dean and

Professor of Human

Anatomy in the

School of Medicinal

and Health Products,

faculty of Pharmacy

at the University of

Camerino in Italy.

Prof Amenta

graduated with first

honors as Doctor of Medicine and Surgery in 1977

and later received his speciality in neurology.

Since 1992, Professor Amenta has been teaching

and doing research as a professor in the faculty of

Pharmacy at the University of Camerino. He has

more than 500 publications in international

journals. His scientific interests include

neurochemistry, neurohistology, clinical

neuropharmacology, drug pharmacokinetics and

analysis of pharmacological therapy of aging. He

is also an expert of telemedicine, telepharmacy and

E-health. Professor Amenta has professional

associations with universities in the U.S., U.K.,

Germany and Hungary. He has been a consultant

to several pharmaceutical companies and to the

European Economic Community.

Dr Lynn Weekes, Australia

Dr Lynn Weekes is

the inaugural Chief

Executive Officer of

NPS Medicine Wise.

Lynn has a MSc in

Pharmaceutics and a

PhD in Community

Medicine. Currently

in her role at NPS

Medicine Wise she

works with a talented team of people to support the

best use of medicines and medical tests – both by

health professionals and within the community. She

and her colleagues have implemented a wide range of

behavioural interventions that have been shown to

influence the prescription and use of medicines. She

has a strong professional interest in quality assurance,

behaviour change and pharmacoepidemiology. Lynn

believes that the public health benefits of quality use

of medicines and medical tests include better patient

care, improved patient safety and better value for

health expenditure.

Dr. Nile Khanfer, USA Dr. Nile Khanfar is

the Assistant Dean

/Associate Professor

of Department of

sociobehavioral and

Administration

Pharmacy, College

of Pharmacy at Nova

Southeastern

University. He is

also the Adjunct

Professor (Marketing / Entrepreneurship Master

Program), H.Wayne Huizeng a school of Business

and Entrepreneurship for Lauderdale in Florida.

He completed his PhD in pharmacy

Administration. Interestingly his Masters was in

Business Administration MBA, both from

University of Louisiana. He is interested in Direct

to Consumer Advertising of Prescription

Medication and its Influence on their behavior, as

well as in Management Leadership research.

17


Dr. Nadir Kheir, Qatar

Dr. Kheir holds an

Honorary Senior

Clinical Lectureship

with the School of

Pharmacy, University

of Auckland. He is

also a Fellow with

New Zealand College

of Pharmacists,

member of the

Pharmaceutical Society of New Zealand, the

Clinical Advisory Pharmacists Association, and

New Zealand’s Healthcare Pharmacists’

Association. While in New Zealand, he functioned

as pharmaceutical care consultant and clinical

pharmacy consultant. Dr. Kheir has 22 peer-

reviewed publications, over 50 research abstracts

and presentations, and over 40 invited presentations

to his credit. He has published a chapter in a book

edited by Professor Linda Strand, Cipolle, and

Morley on Medication Therapy Management, and

is an international research advisor in collaborative

projects with research teams from Brazil and New

Zealand, involving the application and evaluation

of pharmaceutical care.

Dr. Nathir Obeidat, Jordan

Dr. Nathir M Obeidat

is a full professor and

Department

Chairman of Internal

Medicine at the

faculty of Medicine,

University of Jordan.

He is also the

Division Director of

Respiratory and

Sleep Medicine and

Director of Medical ICU at Jordan University

Hospital. Dr. Obeidat is member and head of

several committees: to mention some, he is Head

of Jordanian Board Committee for Internal

Medicine, Head of Drug and Therapeutic

Committee at Jordan University Hospital and Head

of National committee for pharmacovigilance in

the Jordanian FDA (from 2004 to 2008). Dr.

Obeidat holds a degree of Medicine and received

his speciality in internal medicine. Aside from his

long medical and academic career in Jordan, Dr.

Obeidat worked as senior registrar in Sydney,

Australia, from 1996 to 2000.

Dr. Hayel Obeidat, Jordan

Dr. Hayel M. Obeidat

is the Director General

of Jordan Food and

Drug Administration

since the year 2012.

He received his BSc of

Medicine in 1985. He

joined the Jordanian

Board of

Ophthalmology in

1999. He received his Fellowship in

Ophthalmology from the University of Tubingen /

Germany in (2001-2002). Throughout his extensive

career he held the following positions: Technical

Advisor to the Minister of Health and Chief of

Ophthalmology Directorate (2011-2012). Head of

the Ophthalmology Department at several

Jordanian hospitals: AL- Bashir Hospital (2009),

Prince Hamza Hospital (2005) and Princess Basma

Hospital (1999). Clinical Lecturer at: Hashemite

University and Balqa Applied University (2006), as

well as Teaching Assistant at Jordan University of

Science and Technology (2009-2011). He is head

of the steering committee for the Drug

Transparency Project and the higher committee for

drug and pharmacy/ JFDA.

Prof. Giovanni Palmieri, Italy

Prof. Giovanni

Palmieri graduated in

Industrial Pharmacy

with full marks the

1989 at the University

of Camerino. In

October 1990, he

began to approach

technological

problematics of

research, such as the use of cyclodextrins, during

his post-graduated stage inside the department of

Chemical Sciences of Camerino University.

From June 1991 to December 1993 he was a

visiting scientist in the laboratory of

Pharmaceutical Technology of Prof. André Stamm

in Strasbourg. In the meanwhile he became

researcher of Pharmaceutical Technology at the

Faculty of Pharmacy of the University of

Camerino.

18


Prof. Nailya Bulatova, Jordan

Prof. Bulatova, MD,

PhD, is a Professor of

Pharmacology and

Therapeutics also the

Chair of the

Department of

Biopharmaceutics and

Clinical Pharmacy,

Faculty of Pharmacy,

The University of

Jordan.

Prof. Bulatova has more than 23-year teaching and

research experience in the field of Pharmacology

and Therapeutics. She has 50 publications in peer-

reviewed journals in addition to 15 conference

presentations and reviewing manuscripts for a

number of international journals in the field of

pharmacotherapy. Dr. Nailya has supervised 28

Master in Clinical Pharmacy dissertations. She is

the member of Jordan Medical Association, DAAD

Committee for selection of candidates for

postgraduate study in Germany and World Society

of Anti-aging Medicine.

Dr. Mohammad Alshara, Jordan

Dr. Mohammad

AlShara, PharmD,

Ph.D, FACN.

Dr. Alshara is an

associate professor

of clinical pharmacy

at Department of

Clinical Pharmacy,

Jordan University of

Science and

Technology (2010-

current). He is the clinical pharmacy department

chairman at King Abdullah University Hospital and

Clinics, and Vice Dean of Research. From the

University of Nebraska Medical Center, dr.

Mohammad completed his PharmD in 1985, his

M.Sc. in 1985, and his PhD in 1990. He has

worked as clinical pharmacist from 1991 till 1993

at Alegent Health, Omaha Nebraska. Aferwards, he

joined Creighton University School of Pharmacy,

Dept. clinical pharmacy from 1994 till 2010.

Expertise: Clinical pharmacy, clinical research

trials & Implementing US standard Doctor of

Pharmacy clinical pharmacy training.

Dr. Rebekah Moles, Australia

Dr. Rebekah

completed her PhD in

the area of Private

Hospital Pharmacy

Services. She is

interested in the

transition from

hospital to home

(continuity of care).

Her doctoral research focused on developing a

Medication Education Service (MES) for patients

on multiple medications at the time of discharge.

This tailored counselling service - coupled with

recommendations for ongoing care - resulted in

intervention patients being on significantly fewer

medications (and having fewer expenses) in

comparison with control patients who did not

receive this service.

Having a background in hospital pharmacy,

including being Assistant Secretary on the Hospital

Pharmacy Section of The International Pharmacy

Federation (FIP), there is also scope to explore

hospital pharmacy from an international policy

perspective. In 2008, the FIP developed global

statements for the future of hospital pharmacy, and

exploration of factors that influence how hospitals

comply with these statements needs to be explored.

In 2006 Rebekah was awarded the International

Pharmacy Federation's Young Scientists' Award for

Professional Innovation, for a project to develop

medication education packages for children. This

triggered the initiation of several projects in the

area of paediatric medicines.

19


Dr. Lama Al-Nazer, Jordan

Dr Nazer is a Clinical

Pharmacy Specialist

at King Hussein

Cancer working in

both adult and

pediatric intensive

care units. She is also

Clinical Assistant

Professor with the

college of pharmacy

at Rosalind Franklin

University in Chicago. Prior to this, she held

clinical, academic and administrative positions at

universities, hospitals, and pharmaceutical

companies. Dr. Nazer is actively involved with

local and international societies and is the President

of the Middle East Critical Care Assembly. She is

also active in research and her areas of publication

and interests are infectious diseases and medication

safety in critically ill patients.

Dr. Iman Basheti, Jordan

Dr. Basheti is the

Dean of Pharmacy

at ASU and Head of

the Pharmaceutical

Care Unit at Ibn

AlHaitham

Hospital. She has

more than 60

conference

presentations and

over 45 publications

in International Journals. A reviewer to prestigious

International journals such as the British Medical

Journal, Respiratory Care, and BMC Medical

Journal. She published many papers and book

chapters focusing on exploring various educational

methods to maximize the effectiveness of

pharmacy undergraduate education. She specializes

in asthma research, working in collaboration with

researchers from the Woolcock Institute of Medical

Research (Sydney University) one of the top

institutions in respiratory research worldwide. Dr.

Basheti has numerous publications sighted in

International Therapeutic Guidelines such as GINA

and the NHLBI, the Current Australian Asthma

Handbook and the Australian NPS Medicine Wise.

She won many prizes, including Excellence in

teaching award presented by the Faculty of

Pharmacy, University of Sydney; Young

Investigator of the year prize (Australia); Best

Researcher Award for the years 2012, 2013, 2014

and 2015 (Applied Science University), wining

university level over two years.

Dr. Betty Chaar, Australia

Dr Betty Chaar is a

senior lecturer in

Pharmacy Practice in

the Faculty of

Pharmacy at the

University of Sydney,

Australia. She has

been working in the

field of pharmacy for

many years, with experience in community

pharmacy ownership, hospital pharmacy,

pharmaceutical industry, academia and research. Dr

Chaar has more than 50 publications in

international scientific journals. Her current

research involves several practice-based projects,

such as health literacy, weight management,

hospital pharmacy, direct-to-consumer advertising

and the needs of patients from various ethnic

backgrounds. Dr Chaar is also an active member on

a number of Human Research Ethics committees

and she is immediate past President of the

Australian Association for Professional and

Applied Ethics [AAPAE].

Dr. Dalia Bajis, Australia

Ms. Dalia Bajis is

currently a PhD

candidate at the

University of

Sydney. She

graduated with a

Bachelor of

Pharmacy from the

University of

Sydney with First

Class Honors. Her

past pharmacy experience includes practice in

community and hospital settings. In 2011, Ms.

Bajis moved to Saudi Arabia where she

commenced work in the academic field. Dalia’s

areas of interest in her research are competency-

based pharmacy education, pharmacy human

resource management and staff professional

development with particular focus on the Eastern

Mediterranean Region (EMR). Ms. Bajis aspires to

join transformational leaders of tomorrow in the

EMR to foster a competent and capable pharmacy

workforce in the region in hospital and community

pharmacy.

20


Dr. Maher Khdour, Palestine

Dr. Maher Khdour

is an associate

professor of

Pharmacotherapy

and Pharmacy

Practice in the

Faculty of

Pharmacy at Al-

Quds University in

Palestine. He

obtained his PhD in

Clinical Pharmacy and Practice from Queen's

University Belfast (UK) in 2008, working in the

research group of Professor James McElnay. Dr

Khdour gained his clinical setting experience in the

Newham Hospital, Matter Hospital and Antrim

Hospital in the UK. Since then, he has worked and

published in the clinical research fields of “off-

label” medication in pediatric population,

prevention of medication errors and drug related

problems in hospitals, and Pharmaceutical care

Practice. Dr. Khdour has received several awards

throughout his career, including the Award from

the Chest Heart and Stroke, UK (2007), the Best

Researches award for press release at the British

Pharmaceutical Conference, Manchester, UK

(2008) and the Daniel Turnberg Fellowship UK/

Middle East (2010).

Dr. Abdulsalam Alkhayyat,

Palestine

Dr. Abdulsalam

Alkhayyat,

pharmacist (BSc),

trained in molecular

biology, and

epidemiology (PhD),

pursues research on

non-communicable

diseases in the Middle

East region.

Abdulsalam is a post-

doctoral scientific collaborator at the Swiss

Tropical and Public health Institute in Switzerland

and Assistant Professor at the Faculty of Medicine

and Health Sciences at An-Najah National

University, in Palestine.

Dr. Omaima Nassar, Jordan

Ms. Omaima

Nassar is HCAC’s

Standards

Development

Senior Specialist

since 2011. She is

a Certified Hospital

Surveyor, Certified

Primary Health

Care Surveyor,

Certified Breast

Imaging Surveyor, and Certified Center of

Excellence Assessor at HCAC. She chairs the

research and development committee at HCAC.

Additionally, Omaima has special expertise in the

developing and maintaining HCAC standards that

improving the quality and safety and driving

change in patient care.

Ms. Omaima holds a Master’s in quality control

and management from Jordan University of

Science and Technology, and a Bachelor in

Pharmacy from Jordan University of Science and

Technology, Ms. Omaima is a certified CAP

inspector within the Middle East region, she

participated in inspections at Lebanon, Cairo, UAE,

and Saudi Arabia.

Dr. Thaira AlMadi, Jordan

Ms. Thaira Madi is the Director, Surveys and

Standards Development in the Health Care

Accreditation Council, the Arab region’s only

independent non-profit organization that aims at

improving the quality

of health care

services across the

spectrum. She has

over 22 years’

experience in health

care industry with

special expertise in

management, staff

development, and

performance improvement. Ms. Madi holds a

Master’s in Quality Management and a Bachelor of

Nursing from University of Jordan. She started her

career working as a registered nurse in medical

wards including oncology, nephrology, neurology

and general medicine. She had been later assigned

as Hospital Nursing Supervisor. Since 2004 she has

been involved in healthcare quality and

accreditation.

21


Dr. Mohammad Samaha, Jordan

Dr. Mohamed is a

specialist at the

director gamma

Nayef Center and

Surgery corrected

(stereotactic) at Ibn

al-Haytham Hospital,

Amman/Jordan. He is

an adviser to the brain

and nerves and spinal surgery and Surgery

corrected radiographic and functional surgery for

Parkinson's. Dr. Mohammad is currently the

president of the Jordanian Association for surgical

brain and nerves. He has a fellowship from the

Surgery British brain and nerves, and the American

University of Pittsburgh surgically corrected

stereotactic surgery and radiotherapy.

He holds the Certificate of Jordanian Medical

Council surgery and Jordanian Medical Council of

brain and nerve surgery. He is the first director of

the Center for Middle East and the Arab world (the

only one in region) to treat brain tumors and other

diseases without surgery, in addition to the

treatment of Parkinson's and involuntary

movements surgically.

Dr. Majed Habahbeh, Jordan

Dr. Majed Habahbeh.

MBBS (London),

FRCP (London)

Dr. Majed has

specialty certificate in

Neurology from the

UK, and is currently a

clinical Associate

Professor at the

University of Jordan. He is a member in the

European Board of Neurology and Jordanian Board

of Neurology, and is a consultant Neurologist at

King Hussein Medical Centre.

22



23


Pharmacy Education and National Registration and

Accreditation Scheme for Pharmacists in Australia

Prof. Iqbal Ramzan, Dean of Pharmacy, Sydney University, Australia

Professor Iqbal Ramzan, Dean of Pharmacy, the University of Sydney, Sydney, Australia.

This presentation will provide an overview of Pharmacy education programs at Australian

Universities using the University of Sydney undergraduate B Pharm, graduate entry M Pharm

and post degree Internship Training Program (ITP) as exemplars of the programs available in

Australia as entry into the pharmacy profession as Pharmacists. In addition, a synopsis will be

provided of the national (Australia-wide) registration scheme for Pharmacists and the

accreditation of pharmacy degrees and ITP programs by the Australian Pharmacy Council

(APC) on behalf of the Pharmacy Board of Australia (PBA) which undertakes this function as

part of the remit of The Australian Health Practitioner Registration Authority (AHPRA)

which regulates Australia’s health practitioners. One major objective of the NRAS scheme is

to provide for the protection of the public but ensuring a balance between the burden (cost) of

registration and accreditation vs the need to ensure public safety. Future trends in Pharmacy

education in Australia and internationally will also be discussed.

Drugs beyond the Label

Prof. Giovanni Palmieri, University of Camerino, Italy

The presentation introduces and defines the concept of off-label use of medicines in

derogation from the authorized mode by some Regulatory Agency.

The term off-label use refers to the prescribing or administration of an authorised medicinal

product outside any of the terms of the marketing authorisation, as reflected in the Summary

of Product Characteristics (SmPC). This might include use for a different indication, at a

different dosage (or dosage frequency) or in a different patient group (for example, children

or pregnant women).

Some examples of off-label use of medicines are subsequently listed and discussed.

pharmacological, and clinical technology.

Reasons for off label use in clinical practice are also discussed.

Although precise figures are unavailable, it is clear that off-label use is common. This is

particularly so in neonatology, where the percentage of off-label use could be as high as 90%,

and paediatrics. Other areas where off-label use is particularly common include oncology,

infectious diseases (HIV/AIDS), psychiatry and disphagic patients.

Finally, the role of the hospital pharmacist in the use of off-label drugs will be discussed.

Pharmacists bear a significant responsibility for ensuring optimal outcomes from all drug

therapy. With respect to unlabeled uses, the pharmacist should fulfil the roles of patient

advocate and drug information specialist, and develop policies and procedures for evaluating

drug prescriptions and dispensing drugs for unlabeled uses in their own work settings.

24


Revisiting Profile/Indications of Old Drugs: An Experience in

the Field of Cognitive Dysfunction

Prof. Francesco Amenta, Dean of pharmacy, University of Camerino,

Italy

Treatment of adult-onset dementia disorders represents a challenge for pharmacotherapy. The

‘‘only’’ approved treatments by US Food and Drug Administration (FDA) and European

Agency for the Evaluation of Medicinal Products (EMEA) , include five drugs used to treat

the cognitive manifestations of Alzheimer’s disease (AD), namely the (acetyl)-cholinesterase

inhibitors (ChE-I) rivastigmine (Exelon), galantamine (Razadyne, Reminyl), tacrine (Cognex,

marketed only in the USA), donepezil (Aricept) and NMDA receptor antagonist memantine

(Namenda). The above drugs have all been shown to modestly slow the progression of

cognitive symptoms and reduce problematic behaviors in some people, but at least half of the

people who take these drugs do not respond to them. The first therapies introduced into the

clinical practice for symptomatologic treatment of AD were cholinergic precursors.

Controlled clinical trials with choline or the choline-containing phospholipid

phosphatidylcholine (lecithin) failed to show relevant effects. These negative results,

although should not be extended to all cholinergic precursors, were probably the cause of the

discontinuation of the precursor loading strategy for treating AD.

It is since 1993 that a group of neuromorphology research started its activity in Camerino for

investigating neuroanatomical correlates of hypertensive brain damage primarily using

spontaneously hypertensive rats (SHR). Analysis of the above topic did bring to the

suggestion that SHR may represent a reasonable model of cerebrovascular brain injury and to

some extent of vascular dementia. From a basic neuromorphological analysis, research in this

field was extended to the investigation of cholinergic and monoaminergic systems on the

above animal model and to the analysis of the influence of drugs (primarily cholinesterase

inhibitors and choline-containing phospholipids) on neuroanatomical, neurochemical and

behavioural correlates of brain injury in SHR. A main contribution of this research was the

identification that the association between a cholinesterase inhibitor and the cholinergic

precursor choline alphoscerate is more affective than single compounds in countering brain

damage occurring in this model. The above pharmacological association was also

investigated in clinical settings, by the ASCOMALVA (Effect of association between a ChE-

I and choline alphoscerate on cognitive deficits in AD associated with cerebrovascular injury)

trial. It is a double-blind trial investigating if the ChE-I donepezil and choline alphoscerate in

combination are more effective that donepezil alone. The trial has recruited AD patients

suffering from ischemic brain damage documented by neuroimaging and has completed 2

years of observation in 113 patients of the 210 planned. Patients were randomly allotted to an

active treatment group (donepezil + choline alphoscerate) or to a reference group (donepezil

+ placebo). Cognitive functions were assessed by the Mini-Mental State Evaluation and

Alzheimer’s Disease Assessment Scale Cognitive subscale. Daily activity was evaluated by

the basic and instrumental activities of daily living tests. Behavioral symptoms were assessed

by the Neuropsychiatric Inventory. Over the 24/36-month observation period, patients of the

reference group showed a moderate time-dependent worsening in all the parameters

investigated. Treatment with donepezil plus choline alphoscerate significantly slowed

changes of the different items analyzed suggesting that combination of choline alphoscerate

with a ChE-I may prolong/increase the effectiveness of cholinergic therapies in AD with

concomitant ischemic cerebrovascular injury.

25


Rational Use of Medicines and Medical Tests

Prof. Lynn Weekes, NPS Medicine Wise, Sydney University,

Australia

NPS MedicineWise is an independent, non-profit and evidence-based organization that

provides practical tools such as medicines lists, evidence-based information, shared decision

making tools and educational activities for health professionals and patients. The aim to

improve the way health technologies, medicines and medical tests are prescribed and used

and so to improve the health and economic outcomes of care.

NPS MedicineWise works across Australia and throughout the Asia-Pacific region to

positively change the attitudes and behaviours which exist around the use of medicines and

medical tests, so that consumers and health professionals are equipped to make the best

decisions when it counts.

The organisation has demonstrated significant impact on the way health technologies are used

in Australia, so much so that our work has become a benchmark for similar organizations

overseas. Our educational programs reach over half of all Australian GPs, and through our

website, resources and campaigns consumers are now able to access important health

information which previously didn't exist.

Since inception in 1998, we have directly saved the Australian Government over AUD 700

million in reduced cost of pharmaceuticals. Recent independent showed that for every dollar

invested in NPS MedicineWise, nine dollars are returned either as savings to the health

system or improved productivity in the overall economy. More importantly we now also have

data to show the improvements in health outcomes that arise from our work including

reductions in diabetes complications and reductions in stroke secondary to antipsychotic use

in older people.

NPS MedicineWise is globally recognized for its work in quality use of medicines and

medical tests, and is acknowledged by the World Health Organization (WHO) as a world-

leading organization in this space.

Improving the Quality of Care through Research

Dr. Lama Alnazer, Clinical Pharmacy Specialist, KHCC, Jordan

Research within health-care settings is essential for developing knowledge in drug therapy, as

well as for optimizing the quality of care that we provide. The goal of this presentation is to

demonstrate the importance of clinical research through examples of research projects that

helped improve the quality of care and the safe use of medications in the inpatient setting.


http://www.nps.org.au/topics/how-to-be-medicinewise/managing-your-medicines/medicines-list

http://www.nps.org.au/about-us/what-we-do#Building%20the%20evidence%20base

http://www.nps.org.au/health-professionals/cpd

http://www.nps.org.au/health-professionals/professional-development/online-learning

26


Direct-To-Consumer-Advertising (DTCA) from a

pharmaceutical marketing perspective

Dr. Nile Khanfer, Assistant Dean of Pharmacy, Nova University, USA

The effect of direct-to-consumer advertising (DTCA) of prescription medications is a

growing concern worldwide. While it is still illegal in the Middle East, actually has been only

legalized in 2 countries (United States and New Zealand), the current technologies and

availability of internet allowed unrestricted access to such advertising. That being said, the

impact of DTCA overcame preset geographical boundaries and is obviously able to reach

millions of consumers worldwide. Due to such power, pharmaceutical companies have and

continue to invest billions of dollars every year on direct-to-consumer advertising of their

drugs. Different types of DTCA have emerged over time and accordingly new laws and

regulations were put in place to protect the consumers and ensure complete and non-

fragmented information dissemination to the public. In this presentation, we will discuss

further the emergence of DTCA from a marketing perspective. We will review DTCA

evolvement in parallel with regulations timeline and then differentiate among the different

types of DTCA while going over real examples. Before we conclude, being pharmacists, it is

always important to explore pharmacy perception toward DTCA as well as other Healthcare

professionals and global reactions to DTCA.

Continuing Professional Development in Pharmacy: Quality

Expectations and Relevance to QUM

Dr. Nadir Kheir, Assoc Prof. in pharmacy Practice, Qatar University,

Qatar

Continuing Professional Development (CPD) is fundamental to the professional development

of all health care practitioners, and is a pre‐requisites for the delivery of high quality patient

care. Quality use of medicines (i.e. the judicious selection of treatment options and the safe

and effective use of medicines) requires that healthcare providers acquire the professional

competencies necessary to provide patient‐centered care. These attributes, personal and

professional, are best acquired through embracing a culture of lifelong learning, facilitated by

participation in a structured, relevant, and focused CPD program. In Qatar, the Accreditation

department of Qatar Council for Healthcare Practitioners (QCHP) has been established and

tasked with developing and implementing a coordinated system to facilitate accreditation of

CPD providers and activities in advance of launching a new licensure system in 2016 that

shall affect all healthcare practitioners, including pharmacists, in the state of Qatar. In this

presentation, the speaker shall introduce Qatar’s CPD experience (using the Continuing

Professional Development for Healthcare Practitioners Program of the College of Pharmacy;

Qatar University) as a model to discuss the place of CPD in this new era, and what makes a

truly effective CPD program.

27


Non Invasive Ventilation: Latest Trends in Patient Care

Prof. Nathir Obeidat, Respiratory Consultant, JUH, Jordan

NIV is a type of mechanical ventilation used to treat patient with respiratory

failure caused by different diseases affecting normal breathing without use of endotracheal

intubation, laryngeal mask or tracheostomy.

NIV can be negative pressure ventilation but most of the centers use a positive pressure

ventilation which is a subtype of a pressure control ventilation.

Positive Pressure Non Invasive Ventilation( PPNIV) can be in form of continuous pressure

airway pressure (CPAP) or Bilevel Positive Airway Pressure (BiPAP).

The best results from treating patient by NIV was seen in the treatment of patients with acute

exacerbation of COPD. Treatment of patient with acute cardiogenic pulmonary edema,

Obesity Hypoventilation Syndrome is also showed encouraging results. The uses of patients

with other acute or chronic respiratory diseases are not very well established.

Jordan Food and Administration and its Role in the

Enhancement of medicines rational use

Dr. Hayel Obeidat, JFDA Director General, Jordan

The aims of rational medicine use and pharmacovigilance at Jordan food and drug

administration (JFDA) are to enhance patient care and patient safety in relation to the use of

medicines; and to support public health programs by providing reliable, balanced information

for the effective assessment of the risk-benefit profile of medicines. Side by side with the

policy of rational medicine use to insure that patients receive medications appropriate to their

clinical needs, in doses that meet their own individual requirements, for an adequate period of

time, and at the lowest cost to them and their community. Taking into consideration patient

safety through the time receiving their medications, and where ever there is a required action

should be done Therefore, guidelines were approved to achieve the aim of patient safety and

to enable us as a health authority to take the appropriate regulatory action in a systematic

approach depending on JFDAs data base so to improve patients safety and to maintain

medicines sustainability in the market at the appropriate price.

28


An Innovative Geriatric-Psychiatric Rotation: Example of

Pharmacist Inter-Professional Collaboration

Prof. Naiyla Bulatova, The University of Jordan, Jordan

Similar to most healthcare professionals, pharmacists contribute to the health and wellness of

individuals and communities. It is well recognized that in complex clinical cases, and in

complex health organizations, no one person has the capability to deliver high-quality care by

acting alone. The paradigm of an ‘inter-professional approach’ in patient-centered care has

thus emerged in recognition of the synergistic roles that discipline specialists bring to

decision-making and care provision.

Pharmacists work collaboratively as members of an inter-professional healthcare team to

provide patient-centered care by functioning as the medication experts. A pharmacist’s

unique role is in ensuring the safe, effective, and appropriate use of medications.

Nearly all health professional students and prescribers, regardless of specialty, will care for

older adults. Given the growing numbers of older adults, the increased burden of chronic

disease, and the escalating costs of health care, health professionals across disciplines should

learn strategies to promote cost-effective medication use and collaborate with each other.

People with severe and persistent mental illnesses, such as schizophrenia or depression, often

receive inadequate general medical care and are documented to have shorter lifespan than

those without serious mental illness. In addition, it is important for pharmacists, as health

care professionals to be familiar with the most common drugs (whether prescription, OTC or

illicit) and the medical complications they pose upon misuse/abuse, understand the drug user

and the most common methods applied in treatment of drug dependence. A new team that

involves sixth year PharmD students, their preceptors and Master in Clinical Pharmacy

students was established recently to provide training and education to clinical pharmacists in

the area of geriatrics and psychiatrics. Examples of successful pharmacists’ interventions

towards detection, prevention and/or resolution of medication-related problems in geriatric

and psychiatric patients are discussed.

Epilepsy: Diagnostic and Treatment Pitfalls

Dr. Majed Habahbeh, Neurology Consultant, RMS, Jordan

Epilepsy is a common neurological disorder, but it is also commonly misdiagnosed. This talk

will address the diagnostic and treatment approach to patients with suspected epilepsy.

Potential diagnostic and treatment errors will be highlighted and real local data will be

presented as an example of how common this problem is in clinical practice in Jordan.

29


Current Pharmacy Practice: What is Clinical and

Why? Settings, Expertise and Opportunities

Dr. Mohammad Alshara, Vice Dean of Pharmacy, JUST, Jordan

Patient-centered pharmacy practice is often referred to as pharmaceutical care. This

terminology which supplanted “clinical pharmacy” is currently being replaced particularly in

the USA with medication therapy management (MTM). In fact, any and all actions performed

by pharmacists beyond medications dispensing can improve patient outcomes and should be

practiced by most if not all pharmacists regardless of their degree type. There is some

confusion in the ranks of current pharmacy and particularly Doctor of pharmacy (Pharm.D.)

students and recent graduates. Many Pharm.D. graduates apparently feel that there is no

defined role or a specific job description for them. They often bemoan the lack of "befitting"

job opportunities and often express frustration with the lack of "clarity" of their role. Some,

strictly describe themselves as "Clinical" without mentioning the word “pharmacist” and

expressing concern that clinical people like us have no job opportunities. Conversely, some

BS pharmacy graduates appear content that their primary responsibility is medication

dispensing and that their education simply prepared them for that task and in all likelihood to

be practiced in a community pharmacy setting. In contrast, PharmD. graduates tend to believe

that they are overqualified for work as community pharmacists. While the advent of the

Doctor of Pharmacy degree training (Pharm.D.) in Jordan has certainly strengthened

pharmacists preparedness for a clinical practice, only a few of each graduating PharmD. class

possess the knowledge, skills, and attitude to immediately serve in advanced clinical practice

setting. Yet, all pharmacy graduates regardless of the degree type are adequately prepared to

provide some level of pharmaceutical care in any setting. Advancing one’s skills either

requires further advanced training such as a pharmacy residency and/or hard work and a

commitment to continued personal development and accepting the responsibility of being a

life-long learner. Acceptance of this path requires perseverance and most of all commitment

to caring for the patients. The pharmacy profession in Jordan is in dire need of a unified

vision that recognizes that delivering patient centered care will be mutually beneficial to both,

the profession and the community.

Education through Simulation

Dr. Rebeka Moles, Sydney University, Australia

Often we are asked to learn only by reading and listening to facts. For some, this will suffice,

and they will be able to put knowledge into practice. For others, the application of knowledge

is a difficult process, and practice at skills is required in order to learn and master essential

skills. Unfortunately practice is not always an option before one is required to master a skill.

This presentation will outline new approaches to learning through simulation including the

use of "mystery shopping" placements, teaching asthma first-aid to educators, teaching

parents to manage their children's fever and redesigning a large unit of study in the final year

of the bachelor of pharmacy degree at Sydney University to incorporate more competency

based learning.

30


Home Medication Management Review Service in Jordan

and the UAE: a Story of Success

Dr. Iman Basheti, Dean of Pharmacy, Applied Science University,

Jordan

Medication Management Review (MMR) service is a patient-focused, structured and

collaborative health care service provided in the community and hospital settings to optimize

patient understanding and quality use of medicines. MMR identifies treatment related

problems (TRPs) and measure patient medication adherence. TRPs have a variety of different

causes, ranging from unneeded medications, adverse effects and interactions to

ineffectiveness, inappropriate use, inappropriate dosage regimen and poor adherence. As a

result of increase in medication complexity, in the use and in the costs of medications, the

need emerged for the MMR service. Worldwide, the expansion of clinical services provided

by pharmacists includes different models of MMR, such as the Medication Therapy

Management (MTM) in the USA and MMRs in Australia. It has been suggested that it is

necessary to visit patients in their own homes to get the complete representation of a patient’s

medication regimen. TRPs which can be identified at home visits include poor adherence

with medication regimens, inappropriate medication storage, multiple medication storage

locations and expired medication. A number of studies related to MMR conducted in Jordan

and the UAE involving home visits (HMMR) have been published by Basheti et al. These

interventional outpatient HMMR randomized control trials were delivered by clinical

pharmacists with the aim of identifying TRPs through home visits, assessing TRP types and

frequencies, physician’s acceptability to the program, physician approval rate of the TRPs

identified, and eventual effect of resolving the identified and physician’s accepted TRPs on

the health outcomes of the participating patients including adherence, self-care and quality of

life. Collectively these studies have shown that the HMMR service is successful at decreasing

the mean number of TRPs, improving medication adherence, patient self-care, and quality of

life.

Research in Healthcare Ethics at the University of Sydney

Dr. Betty Chaar, President of AAPAE, Sydney University, Australia

There is a plethora of interesting research projects and topics in healthcare

to explore at the University of Sydney.

Topics relating to professional ethics and contemporary issues of concern to healthcare

providers are of particular interest to Dr Betty Chaar and her research team at the Faculty of

Pharmacy. In this day and age there are many ethical issues for consideration in healthcare.

The advent of high level technology and the healthcare needs of ever growing and ageing

populations are examples.

At this plenary, Dr Betty Chaar will provide an overview of some of the many aspects and

topics that have been explored in our research projects at the Faculty of Pharmacy – the

University of Sydney. Topics will range from those related to everyday practice, to the

broader issues pertinent to healthcare in general.

31


Education and Training in the Arab Region: Food for

Thought.

Dr. Dalia Bajis, Pharmacy Specialist, Sydney University, Australia

In the Arab region, non-communicable diseases such as heart disease and diabetes are

causing increasingly more premature mortality and morbidity. This shift in chronic disease

burden, compounded by the increasingly dynamic environment of rising healthcare costs, has

increased demand for health services. Pharmacists are uniquely positioned as the most

accessible of all healthcare providers to the public and can play an important role in the

delivery of healthcare services. However, ensuring a competent pharmaceutical workforce

that is able to adapt to new roles and responsibilities poses challenges to stakeholders of the

profession. Upon the request of UNESCO Office in Beirut, Regional Education Bureau for

the Arab States and in light of improving pharmacists’ competence in the Arab region,

recommendations for quality assurance in pharmacy education in the Arab Region were

produced. A collaborative authorship was formed to produce a document which forms an

integral part of the Regional Higher Education Policy Framework and Resource Pack (in the

course of publication). The presentation by Dalia Bajis will provide a summary of the

recommendations outlined in this document and aims to initiate dialog amongst key

stakeholders from the region to share ideas and strategies on how to successfully implement

some of the outlined recommendations when deemed applicable.

Neuromodulation of Brain for Control of Movement

Disorders and Gamma Knife Radiosurgery

Dr. Mohammad Samaha, Neurology Consultant, Ibn Alhaitham

Hospital

The Stereotactic target calculation and reaching any point in deep brain in accurate way was

introduced to our hospital in 1996 to treat the brain tumors without surgery by Gamma Knife

and treat of Movement Disorders and Parkinson's disease by accurate lesioning of small foci

in brain or implantation of chronic leads to the basal ganglia for deep brain stimulation by

modulation of the abnormal brain electrical signals in movement disorders, Parkinson's

disease, and Psychosomatic diseases.

Since that time we treated more than 4000 patients with successful rate ranging between 85-

90% and many minimal complications.

32


Antimicrobial Stewardship Program in the Intensive

Care Unit at Palestine Medical Complex:

Multidisciplinary Team Led by Clinical Pharmacist

Dr. Maher Khdour, Al-Quds University, Palestine

Background: High rates of antimicrobial use and increasing antimicrobial resistance make

intensive care units (ICUs) ideal wards to implement antimicrobial stewardship program

(ASP) efforts. The purpose of this study was to determine if the implementation of a

pharmacist-led ASP in a community hospital ICU decreased antimicrobial utilization and

improved antimicrobial susceptibilities. Methods: An ASP was established at a community

teaching hospital in April 2015, with 12 ICU beds. The program was led by an infectious

diseases-trained pharmacist who worked daily with a clinical pharmacist rounding with the

ICU care team to make ASP interventions. Prospective audit with intervention and feedback

began in Sep, 2015. We chose to compare 4 months of pre-ASP data with 4-months of post-

ASP data. Data collected included clinical and demographic data; included utilization of

antimicrobials which was calculated using Defined Daily Doses DDD/100 bed, hospital stay ,

intervention Type, acceptance rate and susceptibility trends. Results: A total of 376

antimicrobial prescriptions for 157 patients were revised during a 4 month period. There

were 8 drugs in the DU 90% segment out of 21 drugs prescribed in the ICU. In all, 166

prescriptions (44.1%) were considered inappropriate in 93 patients. The majority of

interventions were de-escalating or discontinuing antimicrobial therapy (68.7%), intravenous

to oral conversion (16.8%). and dose optimization (12.7%) and with acceptance rate of

(80.7%), Overall Utilization Reduced By 33.0% (95.4 DDD/100 bed. vs 63.9 DDD/100 bed

p<0.001). Carbapenems Utilization decreased by 39 (11.3 DDD/100 vs 6.9 DDD/100 bed

p<0.001) and Pip/Taz Utilization decreased by 30.1% (9.9 DDD/100 bed vs 6.7 DDD/100

p<0.001). there was a non-significant reduction in the average hospital stay (7.4 day Vs 6.3

day ; p=0.17). Conclusions: A pharmacist-led ASP in a community teaching hospital ICU

significantly impacted antimicrobial prescribing, reduced antimicrobial utilization and

hospital stay with high acceptance rate.

33


Promoting Patient Safety through the Implementation of

Health Care Accreditation Council Medication

Management Standards

Dr. Omaima Nassar, HCAC, Jordan

Background: The HCAC standards for Medication Management (MM) are among the most

rigorous and challenging for health care organizations to implement. To prepare your health

care organization for compliance, all stages of the medication use process — selection,

storage, ordering, dispensing, administration, and monitoring — must be appropriately

integrated into a comprehensive medication management system. The standards require a

hands-on approach that assures implementation of practices that are evidence-based and in

line with the applicable laws and regulations according to the scope of practice. The aim of

this paper is to highlight how the medication management standards have contributed to

improving the safety and quality of medication usage in Jordan through accreditation. This

has led to improving patient outcomes by reducing error and harm from medicines through

safe and quality usage. Methods: The study included all health care organizations that have

participated in accreditation and showed compliance with the medication management

standards and awarded accreditation. The data was captured from survey reports which

completed by HCAC surveyors during the survey process of the health care organizations.

Results: HCAC Accreditation Medication Management Standards contain the following

sections: Planning the Medication Management System ,Training and Competency

Evaluation, Accessing client and Medication Information, Selecting and Procuring

Medications Storing Medications in the Pharmacy and Client Service Areas, Prescribing and

Ordering Medications, Preparing Medication, Labelling and Packaging Medications,

Dispensing and Delivering Medications, Administering Medications and Client Monitoring,

Evaluating the Medication Management System.

The survey report results showed that the compliance with the medication management

standards have led to improving the patient safety in the healthcare organizations awarded the

accreditation, the health care organizations have assessed their medication system and

identify risk points, reduced medication errors, improved patient outcomes, and boosted staff

performance and confidence. Conclusion: The medication management is a patient safety

priority, it’s one of the most important processes in treating patients, at the same time,

medication management is one of the most complex parts in health care delivery. Medication

management is an integrated process that needs different disciplines at multi levels in care,

without full coordination of among clinicians who orders a drug, the pharmacy that fills the

order, the staff delivers the medication, the nurse who administers it, the risk of potentially

harmful medication errors multiplies. Accreditation is one of the tools that promotes the

quality and safety of medication usage and accreditation has activated the implementation of

the applicable drug laws and regulations and implementing the clinical guidelines related to

medication safe practices in different health care settings which indicated the need of the

presence of follow up and monitoring system to maintain the quality and safety of medication

care.

34


Retinopathy among Diabetes Patients in Palestine: Time

for Action

Dr. Abdulsalam Alkhayyat, An-Najah University, Palestine

Diabetes remains a major contributor to the burden of diseases in Palestine and the wider

Middle East region. Patient care, adequate tertiary prevention, appropriate medication and

follow up can retard its serious complications including retinopathy. The aim of this research

was to investigate the importance of early detection of diabetic retinopathy through means of

screening.

The study was conducted in the National Palestine Diabetes Institute. A total of 278 diabetic

patients registered at the institute were screened for diabetic retinopathy. An investigator-

administered questionnaire was conducted among 232 patients.

Out of the 278 patients screened, 14.38% had signs of diabetic retinopathy; 62.5% had

nonproliferative diabetic retinopathy (NPDR), 20% had proliferative diabetic retinopathy

(PDR) and 17.5% had maculopathy. Of all participants, 16.6% had combined NPDR and

maculopathy while 25% percent had PDR and maculopathy. Around 40% were referred to an

ophthalmologist for follow up and management. It was found that old age group, long

duration of diabetes and poor glycemic control were significantly associated with diabetic

retinopathy. Among the 232 patients interviewed, 83.7% defined diabetes as an increase in

blood sugar. Awareness toward retinopathy as a complication of diabetes was the highest

(97.3%).

Treatment interventions at early stages of diabetic retinopathy can reduce burden of blindness

attributed to diabetic retinopathy. With the available cost-effective methods of early

screening, appropriate strategies/models need to be developed to spread and promote

awareness and establish screening programs on a national level.

35


The Effect of HCAC Primary Health Care Accreditation

on PHC Core Principles

Dr. Thaira Madi, HCAC, Jordan

Background: Primary health care became a core policy for WHO in 1978, with the adoption

of the Declaration of Alma-Ata and the strategy of "Health for all by the year 2000". The

WHO describes primary health care as the principal vehicle for the delivery of health care at

the most local level of a country’s health system. Primary health care is essential health care

made accessible at a cost the country and community can afford with methods that are

practical, scientifically sound and socially acceptable. Health Care Accreditation Council in

Jordan (HCAC) developed the Primary Health Care (PHC) Accreditation Standards within

this context and in line with the common philosophical framework used throughout the

world. HCAC framework, focus on five core principles; accessibility, appropriate technology,

health promotion, public participation, and evidence-based practice.

To get the HCAC accreditation, the PHC center has to achieve predetermined percentages of

the HCAC PHC standards requirements. This will be evident while assessing the PHC

performance by a group of surveyors, who will submit the survey’s results for the Board of

Directors for the accreditation decision.

Objectives: To measure the effect of being an HCAC accredited PHC center on the main five

PHC core principles; accessibility, appropriate technology, health promotion, public

participation, and evidence-based practice at 48 accredited PHC centers in Jordan.

Methods: Indicators were identified from the requirement of the HCAC primary health care

standards, the achievement of these indicators will lead to achieve at least one core principle;

five indicators for accessibility, two indicators for appropriate technology, nine indicators for

health promotion, four indicators for public participation, and two for evidence-based

practice were identified. The percentage of compliance is calculated for each indicator at two

times; during the mock survey (pre-accreditation) and during the accreditation survey (6-8

months after the mock survey) for all 48 PHC accredited centers.

Results: There was a significant progress in the compliance percentage results for all

indicators, from the pre-accreditation to accreditation results. Table (1) shows the result of

improvement for each indicator.

Conclusion: The adoption and implementation of HCAC primary health care accreditation

will lead to achieve and improve PHC core principles (accessibility, use of appropriate

technology, health promotion, public participation, and evidence-based practice), and will

assist services to incorporate the core principles in PHC everyday practices.

36


Electronic Health Solution Profile

Dr. Zeid Abu Goush, Chief Medical Officer, Hakeem-EHS, Jordan

Electronic Health Solutions

Electronic Health Solutions is a private non-profit company funded by the Jordanian

government for serving public sector healthcare projects. Our vision is “To transform and

sustain a continuously improving healthcare system in Jordan by leveraging technology”.

Hakeem Program

‘Hakeem’ program was launched in 2009 under the patronage of his Majesty King Abdullah

II. 'Hakeem' program represents the company's first initiative aiming to deploy a nationwide

electronic health record system in Jordan, based on the VistA system developed by the US

Department of Veterans Affairs. 'Hakeem' is currently implemented in 17 governmental

hospitals, 21 comprehensive clinics and 52 primary care clinics by the end of February, 2016

and another 7 projects in progress and due in the 1st quarter of 2016.

Health Analytics Department

Hakeem “Health Analytics Department” is dedicated to the analysis and use of big data in

evidence-based decision making. We aim to aid healthcare providers in improving the quality

of delivered care, decreasing resource waste and increasing efficiency. Through conducting

innovative research, we strive to conduct not only preventive, but also predictive medicine.

37

Workshops

Workshops

38

Workshops

Workshop 1

Learning Evidence Based Medicine in Hospitals

Hosted by Dr. Delia Omar, Dr. Enas Hijjih and Dr. Hanan Abu Nema, Ibn

Al-haitham Hospital, Amman, Jordan

Venue: Faculty of Pharmacy/ASU

Date: 12th March 2016

Time: 2:20-4:20

Referring to authentic clinical and pharmacotherapeutic sources is considered crucial for

clinical pharmacy practice in hospitals. Large number of evidence based medicine resources

(books, indices, websites, medical journals search engines, and mobile applications) are

available for use by the clinical pharmacists and medical staff working in the hospital wards.

However, available references vary in the quality, sufficiency, specialty and reliability of

information they provide for along different therapeutic cases. They even differ in the level of

accessibility, ease of use, and searching efficiency.

This workshop aims to show the importance of evidence based medicine in clinical pharmacy

routine practice and decision making. The facilitators, who are professional clinical

pharmacists, will explore the commonly used resources of information in the Pharmacy Care

Unit in Ibn Al-Haytham Hospital in Amman. The trainees will work in groups, and each

group will refer to a different resource of clinical information. Based on the clinical case that

will be presented, participants are going to be asked to take therapeutic decisions supported

by the reference they use. Then participants will prepare formal recommendations based on

their decision. The facilitators and participants will then discuss and compare the decisions

and recommendations made by the different groups, and then decide on the weaknesses and

strengths of the different references used for that specific clinical case.

This workshop is expected to encourage group work in searching for evidence based

medicine. It is also designed to give the chance for the participants to participate in the

discussions about clinical pharmacy practice tools and resources.

39

Workshops

Workshop 2

Diabetes Complication and Patient Care in the MENA Region: an Example

of New Approaches in Palestine

Hosted by Dr. Abdulsalam Alkhayyat, An-Najah University, Palestine



Time: 2:20-4:20

This workshop aims to inform participants about the complications that the diabetic patients

usually have, and the challenges that face the healthcare professionals in providing the

optimum care to this group of patients. The Middle East and North Africa (MENA) region is

considered as a hotspot for diabetes mellitus (DM) due to the high and increasing number of

diabetic patients. A considerably high percentage of these patients do suffer from DM

complications. Based on a research that was carried out in Palestine, the workshop will use

the surveillance materials and epidemiological tools to create a model of care for diabetic

patients in the MENA region, and hopefully globally. Participants are expected to be familiar

with diabetes as a chronic disease with long-term complications and morbidities.

40

Workshops

Workshop 3

Medication Errors in Hospitals: An Interprofessional Approach to

overcome the problem

Hosted by Nursing Faculty, Applied Science University, Jordan



Time: 11:30-1:30

Medication error are "Any preventable event that may cause or lead to inappropriate

medication use or patient harm, while the medication is in the control of the health care

professional, patient, or consumer. Such events may be related to professional practice, health

care products, procedures, and systems including prescribing, order communication, product

labeling, packaging, and nomenclature, compounding, dispensing, distribution,

administration, education; monitoring, and use." Medication errors in the Middle East are

high, ranging between 7.1 % to 90.5 %.

Medication errors are classified into five stages according to where they occur in the

medication use process: prescribing, transcription, dispensing, administration, and

monitoring.

It is important to classify medication errors. It helps the health care system to determine the

occurrence and severity of errors, and to develop measures that improve the medication use

process and minimize the incidence of medication errors.

This workshop will provide knowledge and skills on how to identify, classify and prevent

medication errors happening in Jordanian hospitals

41

Workshops

Workshop 4

Professional Ethics: Basic Principles and a Tool Kit to Practice Ethically

Hosted by Dr. Nadir Kheir, Qatar University, Qatar



Time: 2:30-4:30

Aim:

To provide participants with the foundational knowledge that would allow them to

demonstrate understanding of the ethical principles in general, recognize ethical dilemmas,

and apply a structured decision‐making process to resolve ethical dilemmas.

Learning Outcomes:

By the conclusion of this workshop, participants will be able to:

1. Explain some ethical terms and provide example to demonstrate.

2. Discuss a number of ethical decision‐making systems and provide critical views about each

of them.

3. Explain the steps involved in ethical reasoning and the ethical decision‐making process.

4. Apply the steps of the ethical decision‐making process in situations involving ethical

dilemmas.

Workshop style: Interactive and hands on

Workshop content:

1. Background information about ethics: definitions; relevance, why learn ethics

2. Ethical principles

3. Professional Ethics

4. Resolving ethical dilemmas

5. Discussing cases involving ethical dilemmas

42

Workshops

Workshop 5

Application in Pharmacy Education

Hosted by Dr. Betty Chaar, Dr. Rebeka Moles and Dr. Dalia Bajes, Sydney

University, Australia



Time: 1:30-4:30

In the Arab region, asthma prevalence is increasing at an alarming rate and remains a major

challenge. In managing asthma optimally, healthcare providers including pharmacists must

optimize therapy and advice on lifestyle changes to reduce morbidity and mortality. In

Jordan, prevalence of asthma has doubled over the past decade and is on the rise.

As pharmacy students and pharmacists, we are educated on asthma medications and asthma

management protocols. However, are we able to put our knowledge to practice and perform

asthma first aid on an adult or child if experiencing a severe asthma attack?

In this comprehensive workshop, students will learn how to manage a severe asthma attack

following Asthma Australia guidelines. They will be able to put their knowledge to practice

by applying what they have learned to “simulated” patient case scenarios followed by

feedback and group-based discussion.

Objectives:

At the completion of this workshop, students will:

Receive up to date asthma first aid training.

Be exposed to two different methods of learning and given an opportunity to ascertain

which way they like to be taught.

43

Posters Abstracts

Posters Abstracts

44

Posters Abstracts

Poster Evaluation Committee

45

Posters Abstracts

Overuse of Proton Pump Inhibitors among Medically Hospitalized and

Intensive Care Unit Patients

Author: Needa Zalloum

Co-Authors: Rana Abu Farha, Oriana Awwad, Nabil Samara

Author’s Organization: The University of Jordan, Amman, Jordan.

Abstract

Background: The main Purpose of this study was to evaluate the current prescription

patterns and appropriateness of proton pump inhibitors (PPIs) to determine their overuse rate

among Jordanian population admitted to hospitals.

Methods: One hundred ninety three patients (ICU and non-ICU patients) who were receiving

PPIs prescriptions as part of their drug regimen during their hospitalization have been

recruited. The appropriateness of PPIs and the rationale for their prescription as a treatment

or prevention therapy was evaluated according to the recent treatment guidelines.

Results: Results showed that PPIs are currently being overused; only 53 patients (27.5%)

have been received PPIs for correct valid indication while the remaining 140 patients (72.5%)

have been prescribed and overused PPIs without a documented valid indications. By

comparing patients according to their site of care, 52.4% (43/82) of ICU patients compared to

87.4% (97/111) of medically hospitalized patient (non-ICU) were found to receive PPIs for

no valid medical indication (P-value = 0.000).

Conclusion: Adherence tocurrent practice guidelines for safe prescription of PPIs was poor.

Thus updating physicians on practice guidelines, inclusion of a clinical pharmacist in making

therapy decisions and modifying hospital formularies are the most urgent recommendations

to improve healthcare systems in the region.

46

Posters Abstracts

Medication Errors in Voluntary Reported Incidents at Jordan University

Hospital

Author: Khawla Abu Hammour

Co-Author: Mariam Abdel Jalil

Author’s Organization: The University of Jordan, Amman, Jordan.

Abstract

Background: Appropriate error reporting systems are the cornerstone of any plan designed

to enhance patient safety*. This study will assess the prevalence, origin, type, and severity of

reported medication incidents at Jordan University Hospital, utilizing a voluntary non-

punitive reporting system.

Methods: The present study is of a retrospective design. All voluntary non-punitive incident

reports that occurred between January/2014 to March/2015 at Jordan University Hospital

were retrieved from the quality department of the hospital. Detailed content analysis was

conducted to obtain all relevant information. Data were coded anonymously and analyzed

using SPSS version 20.

Results: There was an increase in reporting of medication errors overtime and almost all of

the reporters were nurses. A total of 58 medication error reports including 86 medications

were related to errors in medication management process starting from prescribing,

dispensing to administration of medications. Two-thirds of those reports originated from the

internal medicine department and the neonatal intensive care unit. The most common drug

classes associated with those reports, anti-infectives, cardiovascular and chemotherapy

agents. The majority of errors occurred during the administration phase where missed doses

and wrong time accounted for more than 52% of the reported incidents. Around 98.8% of

reported incidents did not cause major harm to patients.

Conclusion: A low number of medication errors were reported in multiple hospital

departments that increased overtime utilizing the non-punitive system of reporting.

Additional research is required to identify possible improvements to optimize and encourage

reporting in addition to enhancing the response to each report.

47

Posters Abstracts

The Use and Safety of Medications Known to Affect Driving in Jordan: A

Cross-Sectional Study

Author: Eman Elayeh

Co-Authors: Nailya Bulatova, Iman Basheti, Rana AbuFarha, Nasser Al-Rawi, Ahmad

Abu Snaineh, Ibrahim Alahwal

Author’s Organization: University of Jordan, Amman, Jordan

Abstract

Background: The aim of this study was to estimate the main driving-impairing medications

used by drivers in Jordan, the reported frequency of medication side effects, the frequency of

motor vehicle crashes (MVCs) while using driving-impairing medicines, as well as factors

associated with MVCs.

Methods: A cross-sectional study involving 1,049 individuals (age 18-75 years) who are

actively driving vehicles and taking at least one medication known to

affect driving (anxiolytics, antidepressants, hypnotics, antiepileptics, opioids, sedating

antihistamines, hypoglycemic agents, antihypertensives, central nervous system [CNS]

stimulants, and herbals with CNS-related effects) was conducted in Amman, Jordan, over a

period of 8 months (September 2013-May 2014) using a structured validated questionnaire.

Results: Sixty-three percent of participants noticed a link between a medicine taken and

feeling sleepy and 57% stated that they experience at least one adverse effect other than

sleepiness from their medication. About 22% of the participants reported having a MVC

while on medication. Multiple logistic regression analysis showed that among the

participants who reported having a crash while taking a driving-impairing medication, the

odds ratios were significantly higher for the use of inhalant substance (odds ratio [OR] =

2.787, P = .014), having chronic conditions (OR = 1.869, P = .001), and use of antiepileptic

medications (OR = 2.348, P = .008) and significantly lower for the use of antihypertensives

(OR = 0.533, P = .008).

Conclusion: The study results show high prevalence of adverse effects of medications with

potential for driving impairment, including involvement in MVCs. Our findings highlight the

types of patient-related and medication-related factors associated with MVCs in Jordan, such

as inhalant use, presence of chronic conditions, and use of antiepileptics.

http://www.ncbi.nlm.nih.gov/pubmed/?term=Elayeh%20E%5BAuthor%5D&cauthor=true&cauthor_uid=26421446

http://www.ncbi.nlm.nih.gov/pubmed/?term=Bulatova%20N%5BAuthor%5D&cauthor=true&cauthor_uid=26421446

http://www.ncbi.nlm.nih.gov/pubmed/?term=Basheti%20I%5BAuthor%5D&cauthor=true&cauthor_uid=26421446

http://www.ncbi.nlm.nih.gov/pubmed/?term=Farha%20RA%5BAuthor%5D&cauthor=true&cauthor_uid=26421446

http://www.ncbi.nlm.nih.gov/pubmed/?term=Al-Rawi%20N%5BAuthor%5D&cauthor=true&cauthor_uid=26421446

http://www.ncbi.nlm.nih.gov/pubmed/?term=Snaineh%20AA%5BAuthor%5D&cauthor=true&cauthor_uid=26421446

http://www.ncbi.nlm.nih.gov/pubmed/?term=Alahwal%20I%5BAuthor%5D&cauthor=true&cauthor_uid=26421446

48

Posters Abstracts

Terminalia bellirica Stimulates the Secretion and Action of Insulin and

Inhibits Starch Digestion and Protein Glycation in vitro

Author: Kasabri V

Co-Authors: Flatt PR, Abdel-Wahab YH

Author’s Organization: University of Jordan, Amman, Jordan

Abstract

Background: Traditional plant treatments have been used throughout the world for the

therapy of diabetes mellitus. The aim of the present study was to investigate the efficacy and

mode of action of Terminalia bellirica used traditionally for the treatment of diabetes in

India.

Methods: In vitro cellular, enzymatic and cell-free based bioassays were recruited.

Results: T. bellirica aqueous extract stimulated basal insulin output and potentiated glucose-

stimulated insulin secretion concentration-dependently in the clonal pancreatic beta-cell line,

BRIN-BD11 (P < 0.001). The insulin-secretory activity of the plant extract was abolished in

the absence of extracellular Ca2+ and by inhibitors of cellular Ca2+ uptake, diazoxide and

verapamil (P < 0.001; n 8). Furthermore, the extract did not increase insulin secretion in

depolarized cells and did not further augment insulin secretion triggered by tolbutamide or

glibenclamide. T. bellirica extract also displayed insulin-mimetic activity and enhanced

insulin-stimulated glucose uptake in 3T3-L1 adipocytes by 300 %. At higher concentrations,

the extract also produced a 10-50 % (P < 0.001) decrease in starch digestion in vitro and

inhibited protein glycation (P < 0.001).

Conclusions: The present study has revealed that water soluble components in T. bellirica

extract stimulate insulin secretion, enhance insulin action and inhibit both protein glycation

and starch digestion. The former actions are dependent on the active principle(s) in the plant

being absorbed intact. Future work assessing the use of T. bellirica as a dietary adjunct or as

a source of active anti-diabetic agents may provide new opportunities for the treatment of

diabetes.

49

Posters Abstracts

Hospital Based Pharmacists’ Attitudes towards off-label Pediatric

Prescribing in Jordan

Author: Amani Aburjei

Co-Authors: Karem Zoubi, Tareq Mukattash

Author’s Organization: Jordan University of Science and Technology, Irbid, Jordan

Abstract

With growing responsibility of the pharmacists in ensuring public health and safe medicine

use, an understanding of the issues surrounding off-label prescribing is crucial to allow

pharmacists to make informed decisions about such practice. The aim of this study is to

assess the experience with and attitudes, concerns towards pediatric off-label prescribing of

hospital based pharmacists.

A questionnaire survey was administered to 250 randomly selected hospital pharmacists. One

hundred and fifty (150) completed questionnaires were returned.

Less than half the respondents (44%, n=66) admitted to being familiar with the concept of

off-label prescribing, primarily through dispensing experience rather than education. The

most common reasons given by respondents for a dispensed prescription being off label were

younger age than recommended (86.6%, n= 130), and higher than (64%, n=96) or lower than

(38%, n=57) recommended dose. Lack of dosage data (74%, n= 111), risk of side-effect

(40%, n=60) and lack of clinical trials data (32%, n= 48) were recognized as major areas of

concern for pharmacists when dispensing pediatric off-label medicines. More than half of

respondents (58%, n=87) believed that the lack of appropriate formulations or the lack of

efficacy data were of concern.

50

Posters Abstracts

Integrative Literature Review: Prevention of Oral Mucositis among

Pediatric Patients with Cancer

Author: Nijmeh al-atiyyat

Co-Authors: Aseel Aljundi

Author’s Organization: The Hashemite University, Azarqa, Jordan

Abstract

Background: oral mucositis among pediatric oncology patients with cancer still to be

one of the most common side effect of chemotherapy, affecting many of the child life

aspects. Purpose: to clarify the importance of regular nurses assessment role in

improving outcome within cancer pediatric patients suffering from oral mucositis.

Methods: articles used were identified in the electronic database CINAHIL- EBISCO

published between 2008 – 2015, using the following key words or combination terms

such as: oral, mucositis, oral mucositis in pediatric, pediatric cancer, pediatric oncology,

pediatric chemotherapy, prevention of oral mucositis, stomatitis. The sample size ranges

between 26 up to 337 pediatric patients, ages ranges between 1 to 18 years old. All of

the sample participants have received chemotherapy as a treatment.

Results: there was a general senses that the oral mucositis among pediatric patient is a

common complication caused by chemotherapy that differs in severity, it is painful,

annoying, affecting the life quality. Frequent assessment and following up is the

bottom line to prevent and to reduce the incidence of oral mucositis.

Conclusion: we can inferred from the reviewed literature that oral mucositis is

inevitable complication among pediatric patient who receiving the chemotherapy as a

part of their treatment plan. In the contrary there is a good inverse relationship

between the onset of oral mucositis and frequent oral assessment. Nursing in the

different clinical sittings are highly recommended to make oral assessment as an

essential part of their daily physical assessment. Researchers are highly recommended

also to investigate more about any potential benefits or interventions that might be

provided through nursing practicing.

51

Posters Abstracts

Parental Attitudes toward Medicine Use in Children in Jordan

Author: Nuha Al.Ghzawi

Co-Authors: Khawla Nuseir, Tareq Mukattash


Abstract

Recently, there have been growing concerns regarding the use of medicines in children

among both researchers and parents; who are considered the children’s responsible

caregivers. Therefore, many strategies were implemented to improve such use and make safe

and effective medicines more available for children. Among these strategies, enhancing the

interaction between parents and health care providers plays an important role in insuring the

proper use of medicines. In order to optimize such interaction, the attitudes, beliefs and

practices of parents toward medicine use in children need to be explored, which is the main

objective of this study. In addition to exploring parental attitudes, this study also aims to

increase the awareness of Jordanian parents about the appropriate use of medicines in

children. A questionnaire was administered through face to face interviews to 1000 parents

attending with their children pediatric outpatient clinics in Amman and Irbid in order to

investigate their attitudes toward children's medicines. Results have shown that 83.2% of the

participants were mothers. The majority of the participants fall in the age category 30 to 39

years and had either a college or a university degree. Of the participants, 84.4% agreed that

medicines are necessary in treating illnesses, 80% of the parents had worries about the side

effects and interactions of medicines, and 60% of the parents try to avoid giving medicines to

their children. Moreover, parents in this study varied considerably in their views toward

prescription and over-the-counter medicines and a large proportion of the parents had

negative attitudes toward analgesics. More than half of the participants (55.2%) declared that

doctors in Jordan prescribe antibiotics to children too easily.

52

Posters Abstracts

Epidural Analgesia and its Impact on Maternal and Neonatal Outcomes: A

Jordanian

Author: Reem Ahmad Ali

Co-Authors: Reem Hatamleh, Amira Elian


Abstract

Background: Epidural Analgesia (EA) is a central nerve block technique that blocks the

transmission of painful stimuli from the contracting uterus and birth canal to control labour

pain. It’s generally a safe method, though evidence shows that it's not as safe as it was

thought to be and it has negative impact on mothers and babies.

Methods: A descriptive-comparative design was used to assess the rate of using EA during

birth in the north of Jordan and to examine maternal and neonatal outcomes when EA is

used. These outcomes including method of delivery, length of second stage of labour,

maternal complications, newborn’s Apgar scores, Naloxone administration, meconium

staining of liquor, and newborn’s admissions to neonatal intensive care unit. Medical files

were reviewed for all primigravida & primipara mothers with low risk pregnancies (N=414)

who gave births in King Abdullah University Hospital between October 2013 to the end of

September 2014.

Results: EA use was 35.8% for all deliveries (3228 women) during study period, and for the

study subjects was 52%. Significant associations were found between EA use and the

increased rate of instrumental deliveries, prolonged second stage of labour, & maternal

complication. Using Fentanyl & Marcaine was associated with maternal hypotension, fever

and post-partum hemorrhage.

Conclusion: The rate of EA use is high comparing to rates in the Middle East and

worldwide. It is recommended to weigh benefits and indications against risks when using EA

to ensure safety of mothers and their babies.

53

Posters Abstracts

Measuring the activity of platelet agonists using Multiplate®

Author: Ali Almuqdadi

Co-Authors: Nailya Bulatova, Al-Motassem Yousef

Author’s Organization: The University of Jordan, Amman, Jordan

Abstract

Background: Platelets are responsible for pathogenic thrombi formation in patients with

atherothrombotic disease (Rivera et al., 2009). Platelet aggregation is the most frequent

parameter used to measure platelet function (Yao et al., 1994).

Physiologically, platelet aggregation agonists act in combination, and the use of more than

one agonist simultaneously better reflects the pharmacodynamic effect of compounds that

affect platelets aggregation.

This study was conducted in order to measure the efficacy of several platelets agonists using

Multiplate® that, along with other instruments that use whole blood to measure platelet

aggregation, has not been used before to investigate the effect of weak platelet agonists such

as epinephrine and serotonin.

Methods: Blood was drawn from adult healthy volunteers. Whole blood aggregation was

measured using Multiplate® analyzer that detects platelets aggregation based on impedance

aggregometry principle.

Results: Among platelet agonists, collagen produced the highest (112 U), whereas serotonin

and epinephrine produced the lowest (11 U and 23 U, respectively) platelet aggregation

AUC. Significantly amplified platelet aggregation AUC was observed between serotonin and

epinephrine.

Conclusion: Our study established new practice of using Multiplate® method for

investigating weak platelet agonists such as serotonin and epinephrine. The platelet

aggregation amplification reaction between serotonin and epinephrine could have an

important clinical value.

54

Posters Abstracts

Evaluating Perceptions and Knowledge of Public about Local Generic

Medications in Jordan

Author: Samer Abdeljalil

Tareq Mukattash Author:-Co


Abstract

Background: In recent years the use of generics has markedly improved. Because of lower

manufacturing cost, generics offer a great chance for financial saving in drug expenditure

with maintaining the quality, efficacy and safety. In developing countries, health insurance

companies, health authorities and governments have suffered from pharmaceutical

expenditures that has risen rapidly especially in the Last two decades. Improper or lacking

knowledge about local generics may lead to ineffective and unsafe treatment. This situation

could increase the costs, contrary to expectations; the lack of awareness about generic

medicines was a barrier for using them. The aim of this study is to evaluate awareness and

attitude of Jordanian society toward local generics; in particular, their preferences regarding

the use of generics vs. brand medication, and the reasons for their choices and opinions.

Methods: A cross-sectional survey was conducted, and an adult consumers (aged >18 years)

were recruited. The public opinion questionnaire was “administered” using a structured

interview technique (face to face) in which members of the public were asked questions by a

trained researcher (author). The target sample size was 1,000. This sample size has been

shown in previous surveys of the general public, carried out by the Faculty of Pharmacy at

the Jordan University of Science and Technology, to yield statistically reliable results.

Results: The majority of respondents were confused regarding the quality and safety of local

generics.

Conclusions: The results showed general unawareness on generic medicines. No single

variable was found to be associated with consumers’ knowledge on generic medicines.

55

Posters Abstracts

Students’ Perceptions of Pharmacy as a Specialization and their Future

Career, a Cross Sectional Study of Final Year Pharmacy Students in

Jordan

Author: Tareq Mukattash

Co-Author: Khawla Nuseir, Eman Biltaji


Abstract

Background: This study aimed to establish a baseline understanding of the career

aspirations, motivations and expectations of students within undergraduate pharmacy

education in Jordan and to examine students’ incentives to select pharmacy and how they feel

about their choice as they are approaching graduation.

Methods: A draft survey instrument was designed to collect the required information. The

questionnaire was administered to final year pharmacy students (B.Sc. Pharmacy and

PharmD) at the University of Jordan and the Jordan University of science and Technology.

The questionnaire was administered at the end of all lectures at both universities. Following

data collection, responses were coded and entered into a customized database in SPSS,

version 17, for statistical analyses. Chi-square and Fisher exact tests were used to test for

significant differences between groups

Results: A total of 240 final-year pharmacy students took part in the present study. The

majority of respondents (n=147, 61.3%) indicated that pharmacy was not their first choice of

study at the time of application to universities. More than half (n=138, 57.5%) the

respondents claimed that they were optimistic regarding the future of pharmacy as a

profession. When asked to rank pharmacy among different suggested professions, the

majority of respondents (n=95, 39.58%) ranked pharmacy second after medicine and before

dentistry. The majority of respondents (n=202, 84.17%) thought they had a positive self

image.

Conclusion: Students studying pharmacy seem to have optimistic aspirations of their future

career and a positive image. Further qualitative research is needed to gain more in-depth

understanding of this issue and to create a realistic connection between market needs and

pharmacy education outputs.

56

Posters Abstracts

Off-label antibiotic use in children in Jordan: A descriptive study

Author: Tareq Mukattash


Abstract

Background: The majority of medicines prescribed for children are prescribed in an off-label

manner. Among all drugs, antibiotics are most frequently prescribed for paediatric patients.

The aim of the present study was to evaluate the use of off-label antibiotics in neonatal

intensive care units (NICUs) and paediatric wards in Jordan.

Methods: Data of patients admitted to the neonatal intensive care units and paediatric wards

in King Abdulla University Hospital were collected over an 8-week survey between May and

July 2012. Data collected in this study included patients’ age, weight, medical history,

diagnosis and the details of antibiotics prescribed to each patient.

Results: The study involved a total of 250 children (80 admitted to the NICU and 170

admitted to the wards). A total of 596 antibiotic prescriptions were issued for these patients

(244 in NICUs and 354 in paediatric wards). The results of the present study showed that off-

label antibiotic prescribing to paediatric patients is very common. Off-label antibiotic

prescribing to paediatric patients is related mostly to doses and indications, and rarely to age.

The majority of admitted patients received at least one off-label antibiotic during their

hospital stay.

Conclusion: This study reveals the high prevalence of off-label use of antibiotic among

paediatric children in Jordan. There is a serious need for robust and continuous educational

programs to improve the awareness of paediatricians of guidelines surrounding the use of

antibiotics in paediatric patients. Furthermore, true collaboration between paediatricians and

clinical pharmacists towards safe and effective antibiotic prescribing in paediatric patients is

crucial.

57

Posters Abstracts

Birth Control Risks for Deep Vein Thrombosis

Author: Sajid Majeed Hameed

Co-Author: Wafa Attoof

Author’s Organization: Iraqi Society of Clinical Oncology, Iraq

Abstract

Background: DVT occurs when a blood clot (thrombus) forms in one or more of the deep veins in

body, usually in legs. Deep vein thrombosis can cause leg pain or swelling, but may occur without

any symptoms. Many factors can increase risk (DVT), Birth control pills (oral contraceptives) and

hormone replacement therapy both can increase blood ability to clot. Ultrasound, A wand-like device

(transducer) placed over the part of body where there a clot sends sound waves into the area. Deep

vein thrombosis treatment is aimed at preventing the clot from getting any bigger, as well as

preventing the clot from breaking loose and causing a pulmonary embolism. After that, the goal

becomes reducing chances of deep vein thrombosis happening again. Medications used to treat deep

vein thrombosis include the use of anticoagulants, also sometimes called blood thinners, whenever

possible. These are drugs that decrease blood ability to clot. While they don't break up existing blood

clots, they can prevent clots from getting bigger or reduce risk of developing additional clots. Usually,

first be given a shot or infusion of the blood thinner heparin for a few days. After starting heparin

injections, treatment may be followed by another injectable blood thinner, such as enoxaparin

(Lovenox), Other blood thinners can be given in pill form, such as warfarin (Coumadin).

Case Report: The condition started on 7th of May 2014 where 24 years female patient presented in

emergency department in Baghdad teaching hospital (medical city teaching complex). patient exposed

to the car accident, all investigation done at moment of patient, where within normal limit, abdominal

discomfort, abdominal distention, and infrequent vomiting, ultrasound and Plain abdominal X-ray

show spleen damage, X-Ray and MRI imaging show fractured in tibia eminence, necessitating

immobilization of the right knee, as well as her spleen removed, patient a good recovery from the

surgery, patient no longer taking pain medication but has continued her oral contraceptives. Two

weeks later he started to complain right calf is reddish in color (erythematous) and warm to the touch.

It is visibly swollen. The left calf is normal in appearance and without pain. An Doppler ultrasound is

request to determination problems, diagnosed as deep venous thrombosis (DVT), and start heparin

therapy.

Conclusions: Birth control pills (oral contraceptives) and hormone replacement therapy both can

increase blood ability to clot, also bed rest in long time period risk factor increase incidence DVT

58

Posters Abstracts

The Correlation between Serum Levels of Oxytocin (OXT) and

Betatrophin in Type 2 Diabetes Mellitus (T2DM) Patients with Metabolic

Syndrome (MS) in Jordan: a Cross Sectional Study

Author: Amani Al-Rawashdeh

Co-Authors: Violet Kasabri, Nailya Bulatova


Abstract

Background: Oxytocin (OXT) has been implicated as a novel therapeutic strategy of diabetes and

obesity, reversing and/or preventing their complications. It could as well regulate appetite and energy

intake. Also, betatrophin is an adipokine/hepatokine that regulates lipid metabolism and promotes

pancreatic β-cell proliferation. However, it is not investigated yet whether OXT is correlated with

circulating levels of betatrophin in metabolic syndrome-type 2 diabetes (MS-T2DM) patients.

Methods: The aim of current study was to assess correlations between plasma betatrophin and OXT

levels in MS-diabetic (N=89) as compared to MS-non-diabetic (BMI- and age-matched; N=69)

patients. Competitive binding enzyme-linked immunosorbent assay was recruited to evaluate

betatrophin and OXT plasma concentrations. Correlations of the above biomarkers and patient clinical

characteristics such as fasting glycemia, HbA1c, blood lipids, blood pressure, body mass index and

waist circumference were also detected.

Results: As compared to the control MS participants (mean±SD; 0.32±0.25 ng/mL); betatrophin

plasma levels were increased (P<0.001) by more than four folds (P<0.001) in the MS-T2DM patients

(1.23±0.68 ng/mL). OXT concentrations, nevertheless, were decreased (P<0.001) in the MS-T2DM

patients (1222.46±514.55 pg/mL) as compared to the MS control subjects (2323.42±848.68 pg/mL).

OXT secretion was negatively correlated with betatrophin levels in the total sample (Spearman

correlation coefficient rs= -0.492, P=0.000). In the total sample, betatrophin plasma levels were

positively correlated with HbA1c and fasting glycemia (P<0.001 for both), but OXT levels were

inversely correlated with HbA1c and fasting plasma sugar (P<0.001 for both). Highly unlikely but

still, no such correlations were found in either study arm.

Conclusion: Betatrophin, is increased in MS-T2DM; unlike the OXT that is decreased in MS-T2DM.

We found an inverse correlation between the levels of the two biomarkers in addition to correlation

between their levels and the degree of glycemic control. Our data may have potential implementation

in the development of new agents for the management of MS.

59

Posters Abstracts

Baseline Characteristics and Response to Ticagrelor among Jordanian

Patients with Acute Coronary Syndrome: A Cross Sectional Study

Author: Mohammad Matarneh

Co-Author: Al-Motassem Yousef


Abstract

Background: Ticagrelor is a representative of a new chemical drug class which inhibits

P2Y12 receptors of platelets in reversiblenon competitively way. “Variability of response” or

“resistance” to antiplatelet drugs is of remarkable importance. This study aimed to examine

the variability in anti-platelet effect of ticagrelor in Acute Coronary Syndrome (ACS)

patients.

Methods: A cross sectional study included 34 individuals aimed to quantify the extent of

variability in platelet aggregation response after 6 weeks of starting ticagrelor, platelet

aggregation inhibition was tested using (Multiplate®) whole blood was measured using

different ADP concentrations (5 µM, 20 µM). Parameters calculated were aggregation,

velocity, and area under the curve (AUC).

Results: There were 2 patients considered to have high on treatment platelet reactivity

(HTPR), 6 patients were at risk of bleeding, and 24 patients had optimum response at 20 µM

ADP where at 5 µM ADP 15 patients were considered at higher risk for bleeding, 18 patients

were having optimum response, and no patient were considered at HTPR. For hypertension

patients AUC reading was almost significantly higher at 5 µM ADP (22.4 + 8.1 vs. 15.5 +

10.6, P=0.07), and significantly higher compared to non-hypertensive patients at 20 µM ADP

(30.4 + 9 vs. 20.6 + 9.6, P= 0.008).

Conclusion: Ticagrelor decrease platelet aggregation effectively, which is reflected by low

on-treatment platelet reactivity, increases the risk of major bleeding events. Therefore,

cardiologists might be facing a new challenge in the future: to individualize the level of

platelet inhibition in order to decrease thrombotic events without increasing bleeding.

60

Posters Abstracts

Cost of Antimicrobial Therapy: Review of Price of Antimicrobial Therapy

Obtained Through Different Methods of Purchase in Royal Medical

Services (Years 2010, 2012)

Author: Mohamad Al-Ali

Co-Author: Abla Albsoul-Younes, Mayyada Wazaify


Abstract

Background: Jordan Royal Medical Services (JRMS) along with the Ministry of Health

(MoH) are considered as the two major public health authorities that finance as well as

deliver health care in Jordan. This study aimed to compare prices of antimicrobial therapy at

JRMS main tenders for the years (2010 and 2012) and between each main tender with its

related sub procures, as well as to compare delay of delivery times between the two main

tenders.

Methods: Defined daily dose (DDD) methodology was used for all price comparisons, and

the percentage of delayed items, average delay times were used in delivery time comparisons.

Results: Assuming that the same quantities purchased in 2010 will be purchased in 2012,

estimated saving achieved by 2012 main tender was 30%. In the case of 2010 tender , the

related sub procures resulted in saving more than 30 thousands JD, but in case of 2012 tender,

it resulted in an extra cost of more than 31 thousand JD.

For 2010 tender, the percentage of delayed items was (28.74%) and the average delay time

was (58.92 days), but for 2012 tender they were (43.18%) and (77.289 days) respectively.

Conclusion: The study concluded that JRMS procurement system for antimicrobial therapy

is satisfactory, but it recommends to restrict this type of purchase through the central

procurement branch, decrease the extra tenders, decrease period for achieving main tenders,

encourage estimating the needed quantities carefully, the negotiations on prices and finally

the participation of local manufacturing companies.

61

Posters Abstracts

Technology and the Prevention of Medication Errors

Author: Ruba Haddadin

Co-Authors: Mohammad Alsadi, Zeid Abu Ghosh

Author’s Organization: Electronic Health Solutions, Amman, Jordan

Abstract

Introduction: A medication error is “any preventable event that may cause or lead to

inappropriate medication use or patient harm while the medication is in the control of the

health care professional, patient, or consumer”. As part of the report “To Err Is Human”, the

Institute of Medicine (IOM) estimated that in the United States, 7,000 deaths a year are due to

preventable medication errors. The high cost of medication errors is alarming. In the United

States alone, it is estimated that inpatient preventable medication errors cost approximately

$16.4 billion annually while outpatient preventable medication errors cost approximately $4.2

billion annually.

Why Do Medication Errors Occur? Medication errors occur for a number of reasons.

(33%) of preventable medication errors result from dosing errors, while (11%) result from

drug allergies or harmful drug interactions. Medication errors may occur at any stage of a

patient’s journey through a healthcare system. Errors may occur during admissions (22%),

transitions in care (66%), and even during discharge (12%). In pharmacies where the majority

of medications are dispensed, the high volume of medication transactions leads to medication

errors. It is estimated that approximately 100 undetected dispensing errors can occur each day

at any one pharmacy location. Fragmentation of care is considered to be one of the main

reasons for medication errors.

Technology as a Proposed Solution: EHRs offer an excellent platform to allow such

multidisciplinary collaborative efforts, ultimately reducing medication errors. These systems

often have built-in decision support tools that automatically check for duplicate orders or

incorrect medication doses. They also provide alerts to let the prescriber know that a dose is

too high or may interact with other medications, or highlight the latest clinical guidelines to

improve evidence-based treatment. One study reported that the use of EHR systems reduced

medication errors by up to 85%.

In Jordan: Jordan’s nationwide EHR ‘Hakeem®’ is currently implemented at more than 15

hospitals, 21 comprehensive clinics and 49 primary clinics. At the sites where Hakeem

® is

implemented, physicians are able to order medications and various patient care orders

electronically. Pharmacists are also supported with a system that provides alerts in case of

drug duplication, interaction or allergy. A study of BCMA implementation in an academic

medical center demonstrated a 41.1% relative reduction in non-timing errors in medication

administration, resulting in a 50.8% relative reduction in potential adverse drug events due to

such errors.

Conclusion: The use of electronic health record systems offers a promising solution to

reduce medication errors locally and internationally, ultimately improving patient safety as

patients’ transition through the multiple parts of a healthcare system.

62

Posters Abstracts

Medication Reconciliation and Patient Counseling “An Evidence-Based

Approach to Counseling Helps Patients to Adhere to their Medications”

Author: Lama A. Al-Rashdan

Co-Author: Abdulla Malkawi

Author’s Organization: Princess Badee’a Hospital, Irbid, Jordan.

Abstract

Background: This improvement work was done in Princess Badee’a Hospital. The whole

medical staff was involved in this work; physicians, nurses and pharmacists, discharge

planners, and others representing areas of focus. Our aim is to enhance patient care and

improve medication utilization.

Methods: Once medication lists have been obtained, verified with patients and other sources

if needed, and documented within the medical record, this information can then be compared

with medications ordered during the episode of care to identify unintended discrepancies,

potential drug interactions, and contraindications. Upon discharge, medications administered

during the episode of care are then compared to the patient’s pre-admission list, and the

patient’s list is then updated to reflect any changes.

Results: The effects of our changes were significant. Patients were involved effectively in the

health care process, the patient’s compliance increased, patients feel as partners to medical

practitioners, risks of medication omission, duplication and interaction were reduced

significantly.

Maintaining an efficient medication reconciliation process for patient safety in every facility

is at the forefront of national patient safety goals and initiatives.

Conclusions: Medication errors are common and often occur when patients move between

healthcare settings. At least one in six patients may have a clinically significant medication

discrepancy on transfer within a hospital. A sound medication reconciliation process must

involve all caregiver disciplines, must be integrated into their daily workflow, and must have

the support of facility leadership to be successful. The process of medication reconciliation

can significantly decrease errors. It involves obtaining, verifying and documenting a list of

the patient's current medicines and comparing this list to the medication orders and the

patient's condition to identify and resolve any discrepancies. Medication reconciliation is an

important element of patient safety.

63

Posters Abstracts

Associations between Patient Factors and Medication Adherence: A

Jordanian Experience

Author: Iman Basheti

Co-Authors: Saqf el Hait S, Qunaibi EA, Aburuz S, Nailya Bulatova

Author’s Organization: Applied Science University, Amman, Jordan.

Abstract

Background: To explore the effect of patient characteristics and health beliefs on their

medication adherence.

Methods: Patients (n=167) with chronic conditions (mean age 58.9 ± 13.54, 53 % males)

were recruited from March 2009- to March 2010 using a cross sectional study design. Data

collected included patients’ demographics, medical conditions, medications therapeutic

regimen, frequency of physician visits and health beliefs. Patient self-reported adherence to

medications was assessed by the researcher using a validated and published scale. Treatment

related problems (TRPs) were evaluated for each patient by competent clinical pharmacists.

Associations between patient characteristics/health beliefs with adherence were explored.

Results: About half of the patients (46.1%) were non-adherent. A significant association was

found between lower adherence and higher number of disease states (p<0.001), higher

number of medications (p=0.001), and higher number of identified TRPs (p = 0.003). Patient

adherence was positively affected by older age, higher educational level, and higher number

of physician visits per month, while it was negatively affected by reporting difficulties with

getting prescription refills on time.

Conclusion: This study identified different factors that may negatively affect adherence,

including higher number of medications and disease states, higher number of identified TRPs

and inability to getting prescription refills on time. Hence, more care needs to be provided to

patients with complex therapeutic regimens in order to enhance adherence.

64

Posters Abstracts

Associations between Inhaler Technique and Asthma Control amongst

Asthmatics Using pMDIs and DPIs

Author: Iman Basheti

Co-Authors: Obeidat NM, Ammari WG, Reddel HK

Author’s Organization: Applied Science University, Amman, Jordan.

Abstract

Background: To investigate associations between technique with pressurized metered-dose

inhalers (pMDI) and dry powder inhalers (DPI) used as controller medication and asthma

control variables (Asthma Control Test (ACT) scores).

Methods: In this cross-sectional study, inhaler technique of asthmatics using pMDIs or DPIs

(Turbuhaler (TH) and Accuhaler [Diskus] (ACC)), were assessed against published inhaler

technique checklists. ACT scores (maximum 25, higher score corresponding to better asthma

control) were assessed.

Results: 130 subjects were enrolled into the study (41 TH, 54 ACC, and 35 pMDI). Inhaler

technique scores (out of 9 for all devices) were low for TH (4.4±0.9) and ACC (5.4±1.0)

compared with pMDI (8.1±0.9) (p<0.001, One way ANOVA). Older age and use of pMDI

were associated with better inhaler technique. ACT scores (mean±SD) were low, consistent

with very poorly-controlled asthma (TH:13.1±3.9, ACC:13.3±3.9 and pMDI:12.8±4.2). No

significant association between inhaler technique scores and ACT scores was found. More

recent asthma diagnosis, and a higher level of education were associated with higher ACT

scores (better asthma control).

Conclusion: Asthma control was poor in this population. Lack of a significant association

between inhaler technique score and asthma control may reflect the multiple factors

contributing to poor asthma control in the Jordanian population.

65

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