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    Living with Medicines and its Impact on Quality of Life in Dialysis Patients in West Bank, Palestine.
    (Al-Quds University, 2023-08-19) Reem Hasan Abdel Majeed Natsheh; ريم حسن عبد المجيد نتشه
    Background: End-stage renal disease (ESRD) is the final stage of chronic kidney disease (CKD), characterized by an irreversible loss of kidney function. Globally, the prevalence of ESRD is increasing, resulting in a significant economic and health burden for patients and the health system. This study aims to investigate the impact of medication burden and adherence on health-related quality of life (HR-QOL) for patients who received hemodialysis in the West Bank, Palestine. Methods: A cross-sectional study was conducted to assess HR-QOL through the KDQOL-36TM questionnaire, medication-related burden through the LMQ-3 scale, and medication adherence using the ARMS questionnaire in 120 hemodialysis (HD) patients. The sample was recruited from two dialysis units at the Ministry of Health Hospital (the Palestinian Medical Complex (PMC) in Ramallah and the Hebron Governmental Hospital in Hebron). Results: The majority of HD patients were between 50 and 69 years old (30.8%), resided in villages (62.5%), were married (83.3%), and had a relatively even distribution between males (47.5%) and females (52.5%). The overall HR-QOL global score was 1958.5 (IQR= 2007.50) out of a possible 3600, indicating a moderate level of quality of life. Among the HR-QOL dimensions, symptoms and problems of kidney disease had the highest mean score, while burdens of kidney disease had the lowest. The majority of HD patients (45.8%) experienced a moderate burden. Patient-doctor relationships, effectiveness, and cost-related burden have been shown to be the most significantly influencing factors in medication burden. According to the ARMS scale, the majority of participants (73.3%) had low adherence to their medicine. Correlation tests revealed significant negative relationships between medication-related burden and HR-QOL (R= -0.431, p-value < 0.05), indicating higher medication-related burden is associated with poorer quality of life. Additionally, a positive relationship between medication-related burden and non-adherence (R= 0.61, p-value < 0.05) indicates that higher medication-related burden is associated with higher non-adherence. Conclusion: This study reveals significant insights about the HR-QOL, medication burden, and adherence of HD patients in the West Bank. The study shows that among HD patients, medication burden significantly lowers HR-QOL and increases medication non-adherence. The findings highlight the importance of addressing medication burden as a component of comprehensive treatment to improve patients' quality of life and enhance medication adherence among HD patients.
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    Assessment of Patient’s Satisfaction with Pharmaceutical Care Services in Community Pharmacies in west bank: A cross sectional study
    (Al-Quds University, 2023-05-20) Sujood Theab Nemer Mashaala; سجود ذياب نمر مشاعلة
    The provision of pharmaceutical services to the community and the care of patients are significant responsibilities of pharmacists. It is unclear if the general public completely understands the important role that pharmacists play in the healthcare system. This study aim was to examine general public perception about community pharmacy services, and how satisfied they are with pharmaceutical care services utilizing the health beliefs model (HBM).Methods A cross-sectional study was carried out on a randomly chosen sample population (n = 400) in West Bank from January through June 2022 for a period of six months. A standardized, self-administered questionnaire with 35 items was used to gather information on the respondents' demographics and satisfaction with pharmacy services utilizing (HBM). Results:The response rate of the survey was 87%. The majority of the respondents perceived benefit of utilizing pharmaceutical care services with mean score (24.5 ± 4.6). There was a significant differences between mean perceived benefit and perceived barriers (24.5 vs. 17.5, p <0.05). Participants generally did not express a high level of agreement on the four susceptibility-assessing items (mean = 11.55 ± 2.44, range 4-20). However, the four questions measuring perceived severity had better agreement (mean = 13.3 ± 3.0, range 4-20). The participants express modest satisfaction with pharmaceutical services and managing therapy, the mean (± SD) score on the satisfaction scale was (24.1±7.1, range 10 - 50). The items regarding lack of privacy and explain side effects of drugs had the highest dissatisfaction percentages (91% and 55%, respectively). Multiple linear regression demonstrated four variables to be significantly correlated with satisfaction with pharmaceutical care services included perceived susceptibility (β = .157, p = .002), residency (β = -.203, p = 0.001), number of medications (β = -.237, p = .001), and perceived barriers (β = -.132, p = .012). Indicating, that participants with higher number of medication and those perceived susceptibility were more satisfied and those perceived barriers were less satisfied with pharmaceutical care provided by community pharmacies. Conclusion: The majority of the participants express modest satisfaction with pharmaceutical care services. The community pharmacists in ideal position to and have the ability to improve the benefit patients perceive by providing comprehensive pharmaceutical care services and managing medication therapy.
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    تأثير جودة المنتجات الدوائية على قرار الشراء: دراسة تحليلية لوجهة نظر الاطباء والصيادلة
    (Al-Quds University, 2023-05-29) نور فؤاد محمود دنادنه; Nour Fuad Mahmoud Danadna
    هدفت الدراسة إلى التعرف على تأثير جودة المنتجات الدوائية على قرار الشراء، دراسة تحليلية لوجهة نظر الأطباء والصيادلة، ومن أجل تحقيق هدف الدراسة استخدمت الباحثة المنهج الوصفي والتحليلي، وتكون مجتمع الدراسة من جميع الأطباء والصيادلة العاملين في الضفة الغربية ويمارسون المهنة، من العام 2023، والبالغ عددهم (24664)، وكان عدد الأطباء (15667) بنسبة (%63.5)، والصيادلة (8997) بنسبة (%36.5) حسب إحصائية وزارة الصحة الفلسطينية، في حين تم اخذ عينة طبقية عشوائية بسيطة تكونت من (378) طبيباً وصيدلانياً، ومن أجل جمع البيانات من عينة الدراسة تم تصميم استبانة الكترونية وتم توزيعها عبر وسائل التواصل الإلكتروني على عينة الدراسة، ومن أجل التعرف على مدى تأثير جودة المنتجات الدوائية في قرار الشراء، تم استخدام تحليل الانحدار الخطي المتعدد وذلك باستخدام برنامج التحليل الإحصائي SPSS، وخلصت الدراسة إلى العديد من النتائج أهمها: أن تأثير جودة المنتجات الدوائية على قرار الشراء من وجهة نظر الأطباء والصيادلة جاء بدرجة مرتفعة، وأظهرت النتائج أن أهم أبعاد جودة المنتوجات الدوائية من وجهة نظر الأطباء والصيادلة في الضفة الغربية كان بالتسلسل التالي: الجودة المدرجة للمنتج والذي جاء بدرجة مرتفعة جدا، الخدمة المستفادة من المنتج، المميزات الثانوية للمنتج، متانة المنتج، مطابقة المنتج للمعايير والموثوقية في المنتج، وكان أقلها أهمية بعد جمالية المنتج وبعد أداء المنتج، حيث جاءت هذه الأبعاد بدرجة استجابة مرتفعة، كما أوضحت النتائج أن أهم أبعاد قرار شراء المنتوجات الدوائية من وجهة نظر الأطباء والصيادلة في الضفة الغربية كان بالتسلسل التالي: السعر والجودة، اختيار الماركة، خيارات المنتج، وجاء أقل أبعاد قرار شراء المنتوجات الدوائية أهمية بعد وقت الشراء، كما كشفت النتائج أنه يوجد تأثير لجودة المنتوجات الدوائية بأبعادها (الميزات الثانوية، المتانة، الجودة المدركة، المطابقة) على قرار الشراء من وجهة نظر الأطباء في الضفة الغربية، في حين تبين عدم وجود تأثير لجودة المنتوجات الدوائية بأبعادها (أداء المنتج، جمالية المنتج، الخدمة المستفادة من المنتج، الموثوقية في المنتج)، وتبين أنه يوجد تأثير لجودة المنتوجات الدوائية بأبعادها (أداء المنتج، الميزات الثانوية للمنتج، جمالية المنتج، الجودة المدركة للمنتج، الخدمة المستفادة من المنتج، الموثوقية في المنتج) على قرار الشراء من وجهة نظر الصيادلة في الضفة الغربية، في حين لا يوجد تأثير لجودة المنتوجات الدوائية بأبعادها (متانة المنتج، مطابقة المنتج للمعايير)، وفي ضوء ذلك أوصت الدراسة: تعد جودة المنتج الدوائي أحد أبرز محددات القرار الشرائي للمستهلكين، وعليه فإن الباحثة توصي بأنه يجب على شركات التصنيع الدوائي أن تعمل وتعز من جودة منتوجاتها باستمرار، بما يحقق الرغبة في الشراء لدى المستهلكين، وضرورة أن تهتم شركات الصناعات الدوائية في فلسطين بتطبيق كافة أبعاد الجودة في المنتوجات الدوائية واعتبار الجودة أساساً للتفوق على المنتوجات المنافسة لها، وأن تحقيق ذلك يعتمد على جميع العاملين في الشركة وعلى اهتمامهم بمفاهيم الجودة والتصنيع الجيد لتحسين جودة المنتج ومنافسته للمنتوجات الأخرى اعتمادا على الجودة العالية، وأن على الشركات الدوائية أن تهتم بتبني برامج تسويقية موجهة بحيث تتلاءم مع الأسواق المحلية، بحيث يمكنها تقديم حزمة متكاملة للسوق بالتركيز على جودة المنتجات الدوائية والمنافع المتحقق من استخدامها.
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    The Efficiency of FLAIR-Weighted BLADE in image Quality Parameter Correction for Moved Patient
    (Al-Quds University, 2023-03-11) maram mohammad motee ghazawna; مرام محمد مطيع غزاونة
    Magnetic resonance imaging (MRI) is a medical tool that can provide detailed information about the inner structure of a person's body. The use of the fluid-attenuated inversion recovery (FLAIR) sequence in imaging the brain is very useful, as it can help identify subtle changes in the brain's structure and function. Due to the sensitivity of MRI to artifacts, it is not always possible to achieve high-quality imaging. The presence of motion artifacts can affect the overall diagnostic value. In this study dipole filling for k-space (BLADE) was implemented for 46 different images with different motion types including right rotation, left rotation, right bending, left bending, flexion, extension, and combination. In this work, we aimed to measure signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and percentage of signal ghosting (PSG). RADIANT DICOM viewer was used to calculate signal intensity (SI) and its standard deviation (SD), the SD is used as the noise index. ImageQC was used to calculate PSG while these measurements are plotted in Microsoft Excel. In this research, we used a control group of 46 patients who have standard images which use the cartesian filling for k-space for comparing the measurements with standard FLAIR sequence. Results showed using BLADE lead to a significant improvement in SNR, CNR, and ghosting in almost all types of motion while failing to correct ghosting from severe patient motion. The mean value of SNR was 1.08 for the dipole filling (BLADE) sequence and significantly reduced to 0.92 for the routine sequence (p<0.05). While the mean CNR was 0.75 for dipole filling and significantly reduced to 0.49 for routine sequence (p<0.05). Finally, the mean PSG for dipole filling was 0.75 and significantly reduced to 0.18 for routine sequence (p<0.05). In conclusion, the dipole filling sequence enhances SNR, and CNR due to flow and eye motion. Although BLADE reduced ghosting artifacts in most types of motion, BLADE was unable to eliminate ghosting appearance from the severe patient motion.
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    Investigate Factors that Influence Dispensing Non- Prescription Antibiotics from Community Pharmacies in West Bank, Palestine
    (Al-Quds University, 2023-05-20) Yazan Nael Aref Nofal; يزن نائل عارف نوفل
    Objectives and Background: Antibiotic resistance (ABR) is considered one of the most risky problems with respect to human health, in which several pathogens are no longer sensitive to current antimicrobials and still have the ability to cause infections. Major bacterial infectious diseases kill over 11 million people per year. The aims of this study were to determine if respondents' proposed provision of antibiotics for URIs, diarrhea, and mild wounds is appropriate, and to examine the association between variables pertaining to respondents' prescription of antibiotics and demographic information about the pharmacies where they work, such as the pharmacy's type (independent or chain) and geography, and to look at the elements that are associated with respondents prescribing antibiotics and their demographic information, such as age, gender, years of experience, position within a pharmacy, and highest degree of education. In addition, the study aimed to examine respondents' perspectives about ABR and the connection between the characteristics that affect how respondents dispense antibiotics and how they feel about ABR. Moreover, the study aimed to gather respondents' opinions about prospective developments in the sensible use of antibiotics from community pharmacies. All these domains were examined to choose measures to increase the rationale use of antibiotics in the community. Methodology: A total of 314 respondents were recruited in this study by a quantitative research method using a cross-sectional survey with a self-completing online questionnaire. The questionnaire was developed from the literature, and combined both closed-ended questions with tick boxes and statements with a Likert scale as well as open-ended inquiries. Three sections made up the questionnaire: the first section of the questionnaire covers case studies, information about resistance to antibiotics, and strategies for influencing the sensible use of antibiotics. In the second section, respondents are asked to provide demographic data regarding their local pharmacy, including its location and type. In the third section, questions are posed iii regarding the respondents' history, including his or her age, gender, educational background, job title, and amount of pharmacy experience. The questionnaire was tested for content validity and reliability and was measured in our setting by Cronbach's alpha. Data collected online using Google forms were then exported to IBM SPSS version 22 to be evaluated and analysed regarding the tendency to supply inappropriate antibiotics and associated factors. Results: According to the study, the highest rate of inappropriate supply of antibiotics was particularly for URIs from respondents. Employees and full-time pharmacists (p value=0.047), morning shift workers (p value=0.033) and bachelor of pharmacy degree holders (p value=0.044) were more likely to supply inappropriate antibiotics. Additionally, when the age variable was increased by one unit inappropriate antibiotic supply decreased by approximately 4.8 times and when the experience variable was increased by one unit, providing inappropriate antibiotics decreased by approximately 0.25 according to logistic regression analysis. With respect to diarrhea cases, employees and part-time pharmacists (p value=0.035), evening shift workers (p value=0.023), male pharmacists (p value=≤0.001) and pharmacy workers in rural areas (p=≤0.001) were more likely to supply inappropriate antibiotics. Regarding wound cases, owners and full-time pharmacists (p value= 0.03), both shift workers (p value=≤0.001), male pharmacists (p=0.002), bachelor of pharmacy degree holders (p value=0.018) and those working in chain pharmacies (p=≤0.001) were more likely to supply inappropriate antibiotics. Logistic regression regarding all cases combined revealed that when the gender variable was female, the inappropriate antibiotic supply decreased by approximately 8 times compared with males. Conclusion: This study has effectively demonstrated that respondents' provision of antibiotics is not always appropriate and is impacted by clinical circumstances and demographic factors as well as their knowledge and awareness of antibiotics and ABR. These results indicate the need for a plan to enhance the proper supply and use of antibiotics, aimed at policymakers and healthcare professionals.