role of clinical pharmacist in initiation and/or dose adjustment of insulin therapy in diabetic patients in outpatient clinic in Jordan

Glycemic control in diabetic patients is a challenging issue and requires pharmacist involvement in the patient care plan and patient's awareness to optimize diabetic regimen

Objectives: the aim of this study is to investigate the role of clinical pharmacist on glycemic control of diabetic patients by insulin therapy management in the endocrine outpatient clinic in a teaching hospital in Jordan

Method: this is a prospective, randomized controlled study carried out in the Endocrine-outpatient clinic in Jordan University Hospital [JUH]. Patients with type 1 or type 2 diabetes were randomly assigned to intervention [n=50] or control group [n=50]. Newly diagnosed patients with [HbA1c > 10%]; or those who are diabetic with [HbA1c >7%] and taking insulin with or without oral hypoglycemic agents; or patient with [HbA1C > 7%] and on two or more oral hypoglycemic gents for >/= 6 months were recruited either in the intervention group or the control group. Follow up started concurrently with data collection; patients were followed up for 3 months after enrollment. During the first visit demographic data, history of diabetes and diabetes assessment, other chronic disease, anti-diabetic medications and current medications used, adherence to medications, diabetes life style adherence and baseline data for HbA1c, FBG and weight were obtained. Moreover, the patients' medical records were reviewed by the pharmacist to obtain other related information. Data analysis was performed using SPSS software version [17.0]. Glycosylated hemoglobin A1C [HbA1c], fasting blood glucose [FBG], frequency of hypoglycemic episodes and weight gain were measured

Results: 88 patients completed the study; clinical pharmacist interventions resulted in a significant reduction in HbA1c by 1% [p-value <0.001] and fasting blood sugar by [28.44+/-84.62] mg/dl compared to the baseline [p-value=0.029] with a statistically significant difference between both groups [p-value <0.05]. Insignificant difference in weight gain was found between the 2 groups [p-value = 0.117], but with higher significant weight increase in the intervention group from baseline [p-value=0.001]. Although hypoglycemic episodes frequency was significantly higher during the first month in the intervention group compared to the control group [p-value=0.016], none of these episodes required hospitalization

Conclusion: this study supports the role of clinical pharmacist in glycemic control in diabetic insulin users', in a country like Jordan in which clinical pharmacy practice is relatively new

Knowledge and practice of foot care among diabetics at King Hussein medical center, Jordan

Objective: To assess the knowledge and practices of foot care among a diabetic Jordanian cohort

Methods: A cross-sectional design was employed. The study implied a randomized study selecting every other patient who is suffering from diabetes and attending the endocrine and internal medicine clinics of a large tertiary hospital in Amman. Written consent was obtained from participants who were interviewed on individual bases using a questionnaire seeking information on knowledge and practice of foot self-care. Medical records were checked for latest reading of HbA1C. Data obtained were analyzed using Statistical Package for Social Sciences [SPSS] version 17. Levels of knowledge as well as levels of foot care practices were classified as good, satisfactory or poor according to scores computed for participants' responses to questionnaire items. Each correct response worthed one score [point]

Results: A total of 982 participants, were involved in the study, 505 [51.4%] were males and 477 [48.6%] were females. The mean age is 52.16 years [SD +/-13.4]. Of all participants, 156 [15.9%] were illiterate, 640 [65.2%] had an education of high school or less, and 186 [18.9%] had more than high school education. Out of 982 participants, 16.6% had poor knowledge; 41.9% had satisfactory and 41.5% had good knowledge scores of diabetic foot care. The mean knowledge score for the participants was 6.6 [SD +/-2.1]. Regarding practice scores, 24.8% of the study participants had poor practice, 56.9% had satisfactory score and only 18.2% had good practice of diabetic foot self-care. The mean practice score for the participants was 7.1 [SD +/-2.3]

Conclusion: Our study documented variations between knowledge and practice of diabetic foot self-care. Specifically, patients' satisfactory knowledge is associated with inadequate practices of foot self-care. In order to improve concordance between knowledge and practice of foot self-care; staff and patient's education must be encouraged and carried out at all primary health care centers and hospitals. Furthermore, measures must be taken to improve patient compliance to proper foot care practices

Transverse colon volvulus: case report and review of literature

Transverse colon volvulus is an uncommon cause of large bowel obstruction. Clinical presentation is not specific and therefore, diagnosis is usually made by radiological investigation. Plain abdominal radiograph resembles sigmoid volvulus, but gastrograsphin enema in non emergency cases will reveal a more proximal obstruction. Therapy consists of urgent surgery, usually with resection of the twisted transverse colon. We present a case with an overview of the literature

Successful management of thigh necrotizing fasciitis with debridement-continuous irrigation method: Case report and review of the literature

This study reports an interesting case of left upper thigh necrotizing fasciitis following internal fixation of femur neck fracture in a 60 -year-old man. The patient developed severe necrotizing fasciitis post operatively which was managed by aggressive surgical debridement of infected tissues and intravenous antibiotics. Continuous Irrigation System [CIS] was established on the first debridement session and continued for one week. The patient eventually recovered after one month where he showed no signs of complications or recurrence. The authors describe a new method of treatment combining surgical debridement and continuous irrigation of the wound. Continuous irrigation is a simple and practical way to control soft tissue infections and may contribute substantially to the management of patients with necrotizing fasciitis after initial debridement

New scoring system for diabetic foot ulcers

To review the management and outcome of diabetic foot ulcers based on a novel scoring system for ulcers depending on the Phase of the ulcer [P], Extent of the ulcer [E], Degree of infection [D], Associated problems [A]. This scoring system is called PEDA score. Design: A prospective study. Setting: Jordan University Hospital The database of 80 diabetic patients seen at Jordan University Hospital with foot lesions between September 97 to April 2000 were studied prospectively. Data for gender, age, nature of foot lesions, presence of peripheral vascular disease, peripheral neuropathy, associated bone deformity, types of surgical procedure, morbidity and mortality were reviewed. Eighty patients with foot infections were seen at the hospital during the period from Sept 97 to April 2000. Patients were followed up from 1 month to 30 months. Mean age of the patients was 55 years ranging between 17-90 years. They were 50 males [62.5%] and 30 females [37.5%] Peripheral neuropathy was documented in 52 patients [65%]. Distal pulses were not present in 18 patients [22.5%]. Twenty four patients with superficial cellulitis without ulcers were excluded from the study. Twenty two patients [39%] had Low grade ulcers [PEDA score <6] all had complete healing of their original ulcers in 4-6 weeks, twenty patients [36%] had moderate grade ulcers [PEDA score7-9], sixteen patients from this group had complete healing in 6-12 weeks. Fourteen patient [25%] had high-grade ulcers [PEDA score 10-12], two patients had ulcers in association with Charcot joints, and another two with hallux valgus deformity. Local bone excision was performed on these patients and all had good results. Ten patients had significant peripheral vascular disease, one patient had a successful reconstruction, and the remainder required amputation at different levels. Patients with high-grade ulcers required in hospital management in excess of 12 weeks. Diabetic foot ulcers inflect a huge cost to society and disrupt the quality of life. We have developed a new scoring system [FED A] that allows categorization of diabetic foot ulcers into three groups depending on severity; low, moderate and high grade ulcers. The goal of this system is to optimize local ulcer care, provide an idea about the place, duration and the outcome of management. According to this score 75% of diabetic foot ulcers will fit the low and moderate grade ulcers with 90% success rate of ulcer healing in 2-3 months