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Biosimilar vaccines and immunotherapeutic are innovative approaches in medical research. This commentary addresses the current disparities in regulations of biosimilar vaccines and immunotherapeutic products across different nations. It also navigates the benefits of global regulatory alignment and challenges that may be encountered. The current discrepancies in regulations across different countries, which pose significant challenges for the development and approval of biosimilar vaccines and immunotherapeutic products. These disparities often lead to delayed market access, increased development costs, and hindered innovation. The commentary stresses that such obstacles could be mitigated through harmonized regulations, resulting in faster approvals, reduced healthcare costs, and improved patient outcomes. Moreover, the commentary explores the specific complexities associated with biosimilar vaccines and immunotherapeutic, such as the intricate evaluation of biosimilarity due to their molecular composition and immunogenic properties. In conclusion, the editorial advocates for collaborative efforts to overcome the challenges in achieving global regulatory harmonization for biosimilars. This includes establishing uniform standards, fostering international cooperation among regulatory agencies, and promoting educational initiatives for healthcare providers and regulators. The ultimate goal is to ensure that patients worldwide have timely access to safe, effective, and affordable biosimilar treatments.

Skin cancer, notably melanoma, poses a significant global health burden, with rising incidence and mortality rates. While therapeutic advancements have improved outcomes, metastatic melanoma remains challenging to treat. This study aims to systematically review systemic treatment options for advanced melanoma, focusing on efficacy and safety in the first-line setting. Through a comprehensive search and meta-analysis of randomized controlled trials conducted from 2013 to 2023, 11 studies encompassing 2816 participants were analyzed. Treatment options included BRAF inhibitors (vemurafenib, dabrafenib), MEK inhibitors (trametinib, cobimetinib), and immune checkpoint inhibitors (ipilimumab). Combined therapy with vemurafenib, cobimetinib, and ipilimumab demonstrated superior overall survival (OS) and progression-free survival (PFS) compared to monotherapy, with a significant odds ratio (OR) of 6.95 (95% CI: 4.25-9.64, p < 0.00001) for OS and 2.49 (95% CI: 1.42-3.56, p < 0.00001) for PFS. Additionally, dabrafenib and trametinib combination therapy showed improved outcomes with favorable tolerability, including a significant reduction in adverse event (AE) risk, with an OR of 2.20 (95% CI: 1.72-2.81). Furthermore, our analysis highlighted vemurafenib-associated dermatological toxicities, emphasizing the need for effective management strategies. The study underscores the evolving treatment landscape in melanoma management, with a potential shift towards immune checkpoint inhibitors in the adjuvant setting, particularly for BRAF-mutated disease. However, limitations in meta-analysis methodologies and the need for long-term investigations into treatment implications on survival and quality of life underscore the importance of continued research., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: The purpose of this study was to assess the health-related quality of life (HRQOL) and investigate the variables contributing to reduced HRQOL in patients with rheumatoid arthritis., Methods: The present cross-sectional study was conducted on patients diagnosed with rheumatoid arthritis at two teaching hospitals in Jordan using a convenience sampling technique. The participants were interviewed face-to-face during the scheduled appointment at the outpatient rheumatology clinic. The HRQOL was evaluated by the validated EuroQol-5 Dimension (EQ-5D) questionnaire, which included the EQ-5D utility index that evaluated HRQOL in terms of 5 domains, including mobility, self-care, usual activities, pain/discomfort, and anxiety/depression, and the EQ-5D visual analogue scale (EQ-5DVAS), which evaluated HRQOL on a vertical scale ranging from 0 (worst imaginable health) to 100 (best imaginable health). The validated short version of the 19-item Compliance Questionnaire for Rheumatology (CQR-5) was used to evaluate medication adherence. The Clinical Disease Activity Index (CDAI) was used to assess disease activity among the study participants. A stepwise quantile regression model (q = 0.5) was conducted to explore the factors associated with the EQ-5DUtility Index and EQ-5DVAS scores., Results: In total, 261 patients with RA participated in the study. The median (interquartile range) of the EQ-5DUtility Index and EQ-VAS scores was 0.552 (0.006-0.726) and 0.506 (0.233-0.690), respectively. Regression analysis results demonstrated that medication non-adherence (regression coefficient (β) = -0.348, P<0.01), not performing regular physical activity (β = -0.209, P<0.01), and higher disease activity as measured by the CDAI score (β = -0.015, P<0.01) were significant predictors of a lower EQ-5DUtility Index score. In addition, medication non-adherence (β = -0.199, P<0.01), not performing regular physical activity (β = -0.117, P<0.01), increased body mass index (BMI) (β = -0.009, P<0.01), and higher CDAI score (β = -0.009, P<0.01) were significant predictors of low EQ-5DVAS score., Conclusions: Patients with RA experienced significantly impaired HRQOL. Medication non-adherence, not performing regular physical activity, increased body weight, and increased disease activity were identified as determinants of poor HRQOL among patients with RA in the present study. Treating physicians should encourage regular physical activity, maintaining a healthy body weight, and controlling disease activity to improve HRQOL in patients with RA., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Jarab et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: This study aimed to evaluate pharmacists' attitude and willingness to provide extended community pharmacy services (ECPS), the barriers to ECPS, and the factors associated with attitude and willingness to implement ECPS., Methods: In this cross-sectional study, a validated, self-administered questionnaire was distributed online to community pharmacists across the United Arab Emirates between September and November 2023. In addition to sociodemographic data, the questionnaire evaluated attitudes toward ECPS, willingness to provide ECPS, and barriers to its implementation. Binary logistic regression was conducted to explore the factors associated with attitude and willingness to implement ECPS., Results: The study included 409 pharmacists. Over half of the participants reported below the median attitude (58.7%) and willingness (59.4%) scores. Female pharmacists had a lower attitude towards ECPS (OR = 0.425, 95%CI: 0.242-0.747). Higher number of daily prescriptions (OR = 1.066, 95%CI: 1.029-1.105) and being a Pharm D graduate (OR = 2.664, 95%CI: 1.439-4.932) were associated with higher willingness to provide ECPS, while an increased number of employed pharmacists (OR = 0.518, 95%CI: 0.397-0.676) was associated with a lower willingness (OR = 0.049, 95%CI: 0.004-0.660). Patients' preoccupation (76.5%), lack of specific training (76.3%), lack of clinical problem-solving skills (74.6%) and lack of a private consultation room (74.6%) were the most commonly reported barriers to ECPS., Conclusions: Community pharmacists demonstrated unsatisfactory levels of attitude and willingness towards ECPS provision. Therefore, providing training and education programs that enhance pharmacists' perception and willingness to implement ECPS and emphasize improving clinical problem-solving skills, as well as setting up specific private consultation rooms, is deemed necessary. Female pharmacy graduates, pharmacists dispensing fewer daily prescriptions, and those working with a higher number of employed pharmacists should be specifically targeted when implementing these strategies., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Jarab et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Addressing antimicrobial resistance (AMR) stands as a major global health challenge threatening humanity. Resolving this issue can be initiated through emphasizing the significance of AMR education among students in health colleges during their undergraduate studies. Hence, the aim of this study is to assess the pharmacy students' knowledge, attitudes, and practices regarding antibiotic resistance in 7 Middle Eastern countries. A cross-sectional study was conducted among undergraduate pharmacy students at universities in Egypt, Jordan, Saudi Arabia, Lebanon, the United Arab Emirates, Qatar, and Kuwait between March 2021 and January 2022. The first section of the questionnaire gathered demographic information. The knowledge section comprised 7 questions. Subsequently, the questionnaire explored participants' attitudes (6 items) and practices (2 items) concerning antibiotic resistance. Mann-Whitney and Kruskal-Wallis tests were used to compare the median knowledge score between different demographic groups. Logistic regression was used to estimate odds ratios, with 95% confidence intervals (CIs) for being more knowledgeable about antibiotic resistance. A 2-sided P < .05 was considered statistically significant. A total of 4265 pharmacy students were involved in this study (Egypt (2249), Jordan (n = 704), Saudi Arabia (n = 531), Lebanon (n = 401), United Araba Emirates (n = 130), Qatar (n = 129), and Kuwait (n = 121)). The median knowledge score for the participating pharmacy students was 5.00 (IQR = 4.00-6.00) out of 7, equals to 71.4% with 4th, and 5th year students and bachelor of pharmacy program students have higher odds of being more knowledgeable about antibiotics resistance compared to other students (P < .05). The majority of the students agreed that antibiotic resistance is increasing, they should be more concerned regarding antibiotic consumption and that government should create more awareness of antibiotic resistance, and that they should have enough knowledge to prevent antibiotic resistance. Around 3 quarters of the students (73.0%) confirmed that they take antibiotic only after getting prescription from their physician and almost half (51.7%) reported that they take antibiotic to manage their fever. The study concluded good educational programs in Middle East pharmacy schools with the need for targeted educational interventions promoting responsible antibiotic stewardship practices among future pharmacists., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Telepharmacy, utilizing telecommunications to dispense pharmaceutical products and deliver patient care, offers numerous benefits for both the public and pharmacists. Previous research on exploring attitudes and willingness to use telepharmacy services has primarily focused on pharmacists rather than the general population. Aim: This study is aimed at assessing the attitudes and willingness of the United Arab Emirates (UAE) population to utilize telepharmacy services and identifying the factors influencing their inclination to use these services. Methods: In this cross-sectional study, a survey was distributed using convenience and snowball sampling to individuals aged 18 or older across the UAE through various social media platforms, including Twitter, Facebook, and WhatsApp. The survey domains included sociodemographics, attitudes, and readiness to utilize a telepharmacy service. A binary logistic regression analysis was conducted to investigate the variables associated with participants' willingness to utilize telepharmacy in the future. Results: In total, 963 individuals participated in the study. Participants showed overall positive attitudes towards telepharmacy, with 70.9% believing that telepharmacy saved time and effort. While only 32% of the participants acknowledged that numerous telepharmacy services were available for use in the UAE, most were interested in using telepharmacy services in the future (79.2%). Participants who had higher attitude scores (AOR = 1.147, 95% confidence interval [CI]: 1.11-1.18) and those who had used these services previously (AOR = 3.270, 95% CI: 1.692-6.320) were more interested in using telepharmacy services in the future. Conclusion: Forthcoming healthcare strategies should focus on expanding the availability of telepharmacy services throughout various regions of the country. This expansion will facilitate the broader utilization of these services and ultimately contribute to improved health outcomes., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Anan S. Jarab et al.)

Drug-Food Interaction (DFI) can potentially lead to treatment ineffectiveness and adverse health outcomes. This study investigated knowledge and attitude towards DFI and the associated factors. A validated questionnaire was distributed to 2040 participants across Jordan. The participants had moderate knowledge and attitudes regarding DFIs. Regression results revealed that male gender, lower education level, not working in the healthcare sector, and utilizing non-scientific sources of information about DFIs were associated with lower knowledge about DFI. Furthermore, male gender, being unmarried, having a low or moderate education level, not working in the healthcare sector, not having a family member with chronic disease, and having low knowledge of DFI were significantly associated with negative attitudes towards DFIs. Future health education programs should emphasize using reliable scientific sources to enhance awareness about DFIs'. Additionally, healthcare professionals should counsel patients on avoiding DFIs and provide guidance accordingly.

Aims: Lifestyle modification involving active engagement of specialised dietitian with diet and exercise education, can be effective as first-line treatment for diabetes., Methods: 192 patients were enrolled with diabetes in a randomised controlled trial and followed up for one year. Ninety-four patients in the intervention group participated in a comprehensive structured diet and exercise education conducted by a specialised dietitian at ambulatory centre in the United Arab Emirates., Results: The mean difference in the change in body mass index between study groups at study exit and baseline was statistically significant (BMI difference = -1.86, 95 % CI -2.68 - -1.04, P < 0.01). The intervention group reported significant decrease in total carbohydrate and daily energy intake compared to baseline (173.7 g vs 221.1 g and 1828.5 kcal vs 2177.9 kcal, respectively). Moreover, the mean metabolic equivalents (METs) in the intervention group increased significantly at study exit from baseline compared to control group METs, with mean difference between all between-group differences after baseline of 0.63 (95 % 0.29 - 0.97, P < 0.01)., Conclusions: Structured diet and exercise counselling by specialised dietitian in ambulatory settings significantly reduced carbohydrate and daily energy intake, with improved anthropometric measurements and physical activity., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Understanding the use of AI in healthcare is essential for the successful implementation of AI-driven healthcare solutions. The aim of this study was to evaluate public perception of AI utilization in healthcare settings. A validated questionnaire assessed general perceptions towards AI utilization, the use of AI by physician , and the use of AI by pharmacists . The study included 770 participants. The median perception score indicated an unfavorable attitude. Participants who had lower education level and those with no employment had a significantly lower perception scores than their counterpart. Participants who reported low income and those who visited the pharmacy five to ten times on average had a higher perception than their counterparts did. The reported negative perception necessitates the implementation of education campaigns to improve AI literacy and dispel any misconceptions and concerns, particularly among individuals with low education, high income, unemployment, and frequent pharmacy visits.

Colorectal cancer (CRC) 1 screening tests help in early detection of CRC and improve disease prognosis. This study aimed to assess knowledge, attitude, and barriers to CRC screening and the associated factors among the general population in Jordan. A validated self-administered online survey was distributed on 1542 individuals in Jordan. The participants ( n  = 1542) reported several barriers and demonstrated insufficient knowledge but positive attitude towards CRC screening. Older age (OR = 1.021, 95% CI = 1.010-1.032, P  < 0.001), working in medical field (OR = 3.198, 95% CI = 2.499-4.092, P  < 0.001), family history of cancer (OR = 1.248, 95% CI = 1.002-1.555, P  < 0.05), and knowing someone with CRC (OR = 1.601, 95% CI = 1.186-2.161, P  < 0.01) were significantly associated with higher knowledge. Personal history of CRC (OR = 3.157, 95% CI = 1.188-8.387, P  < 0.05), and high knowledge of CRC (OR = 2.795, 95% CI = 2.242-3.484, P  < 0.001) were significantly associated with the positive attitude. Future healthcare programs should devise effective techniques to improve public understanding and perception of CRC screening and overcome the identified barriers.

Objective: This study aimed to assess the confidence, attitude, and scientific research practices of undergraduate students of different health profession specialties., Methods: In this cross-sectional study, an online-based questionnaire was distributed as a Google Form via groups and pages of medical universities available on social media sites such as Facebook, WhatsApp, and Twitter to the second- to sixth-year students of different health profession specialties in different universities across the United Arab Emirates (UAE) in the period from October through December 2023 using the convenience sampling technique. The questionnaire included four parts that assessed socio-demographics and custom-designed research-related questions (6 items), perceived confidence (8 items), attitudes (14 items), and the practice in the context of scientific research and its implementation (9 items). Multivariate logistic regression analyses were conducted to explore the variables associated with the study outcomes, including confidence, attitudes, and practice levels., Results: The study included 522 undergraduate students. The participants reported low confidence, a negative attitude, and low scientific research practice. Regression results revealed that individuals without prior research experiences were less likely to have high confidence and practice compared to those with previous research experience (OR = 0.634, 95% CI: 0.426-0.945, p = 0.025; and OR = 0.139, 95%Cl: 0.090-0.216, P<0.001, respectively). Additionally, participants who reported difficulty in differentiating between various literature resources were less likely to have high confidence and practice compared to those who reported the ability to differentiate (OR = 0.627, 95% CI: 0.42-0.935, p = 0.022, and OR = 0.370, 95%Cl: 0.237-0.579, p<0.001, respectively). Furthermore, individuals who had not taught research methods in their undergraduate studies were less likely to have high practice (OR = 0.505, 95%Cl: 0.309-0.823, p = 0.06)., Conclusions: Undergraduates of different medical specialties in the UAE demonstrated acceptable levels of confidence and attitude toward scientific research, with several areas for practice improvement. Education and training courses focusing on various aspects of scientific research should be incorporated into the medical curricula in order to enhance students' confidence and practice of scientific research., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Jarab et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: The health-related quality of life (HRQOL) of patients with myocardial infarction (MI) is suboptimal because of the disease's life-threatening nature, the requirement for long-term lifestyle modifications, and the treatment regimens following MI. This study aimed to evaluate HRQOL and its associated factors in MI patients., Material and Methods: This study was conducted on patients with MI who attended the outpatient cardiology clinic at a major teaching hospital in Jordan. The EQ-5D-3L questionnaire was used to assess HRQOL of the study participants. Quantile regression analysis was conducted to identify the variables associated with HRQOL., Results: The study included 333 patients with a history of MI, with a median age of 58 (57-60). The median of the total EQ-5D score was 0.65 (0.216-0.805). Regression results revealed that male patients (Coefficient= 0.110, 95%Cl (0.022-0.197), P=0.014) and not being diagnosed with diabetes (Coefficient= 0.154, 95%Cl (0.042-0.266), P=0.007) were associated with increased HRQOL. On the other hand, low income (Coefficient= -0.115, 95%Cl (-0.203 - -0.026), P=0.011), not receiving DPP-4 (Dipeptidyl Peptidase -4) inhibitors (Coefficient= -0.321 95%Cl (-0.462 - -0.180), P<0.001), and having low (Coefficient= -0.271, 95%Cl (-0.395 - -0.147), P<0.001) or moderate (Coefficient= -0.123, 95%Cl (-0.202 - -0.044), P=0.002) medication adherence was associated with decreased HRQOL., Conclusion: The current study demonstrated diminished HRQOL among patients with MI, highlighting the necessity of tailoring interventions to tackle medication adherence barriers in this population. Personalized interventions such as educational programs, counseling, and reminders that consider each patient's needs and circumstances can greatly enhance medication adherence and, thus, the HRQOL of MI patients. Individuals with lower income levels, female patients, and those with diabetes should be the specific targets of these interventions., Competing Interests: The authors declare that they have no competing interests., (© 2024 Jarab et al.)

Background: Antimicrobial stewardship (ASP) is considered a key prevention strategy in addressing the worldwide concern of accelerating antimicrobial resistance. Limited research is available regarding healthcare providers' knowledge and attitude toward antimicrobial stewardship and the barriers for its implementation., Methods: The present cross-sectional study was conducted on pharmacists and healthcare prescribers (HCPs) in different hospital sites across Jordan. A validated survey was used to evaluate HCPs and pharmacists' knowledge, and attitudes towards ASP and the barriers for its implementation. Logistic and linear regression were conducted to identify the factors associated with knowledge and attitude toward ASP, respectively., Results: A total of 603 participants, 69 (11.4%) pharmacists and 534 (88.6%) HCPs completed the study questionnaire, with a response rate of 80.4%. The overall mean knowledge about ASP was 7.16 out of 10, ranging from 0 to 10 (SD 2.22). Being a pharmacist and increased awareness/familiarity about ASP were associated with improved ASP knowledge. The overall average attitude score was = 3.8 ± 0.49 (range: 1.8-4.8). Results revealed that being a pharmacist and improved knowledge were associated with improved attitude toward ASP. Lack of specialized staff with expertise in ASP and lack of access to education and training programs were the major barriers hinder ASP implementation., Conclusion: Despite the reasonable knowledge and the positive attitude toward the ASP, several barriers were reported, particularly by the pharmacists. Therefore, promoting the presence of adequately skilled healthcare personnel, creating easily accessible online courses, and establishing a comprehensive database of ASP resources are all suggested approaches to improve the application of ASP in healthcare settings., (© 2024. The Author(s).)

This cross-sectional study aimed to evaluate public perception, satisfaction, expectations, and barriers to utilize the community pharmacy services. A validated self-reported online survey was distributed on 681 individuals in different regions across Jordan. The mean age of the participants was 29 (±10) years. The most reported reason for choosing a particular community pharmacy was its closure to home or workplace (79.1%), while the main reason for visiting a community pharmacy was to obtain over the counter medications (66.2%). The participants showed good perception, satisfaction, and expectations of community pharmacy services. However, several barriers were identified, including higher participants' trust in physicians when compared to pharmacists (63.1%), and lack of privacy in the pharmacy (45.7%). Community pharmacists should participate in successful education and training programs in order to raise the quality of the provided services, meet patient requirements, and re-establish consumer confidence in community pharmacists.

Background: Community pharmacists must be well-equipped to advance pharmacogenomics services. Nevertheless, limited data is available regarding pharmacists' knowledge and attitudes toward pharmacogenomics testing. The present study aimed to evaluate community pharmacists' knowledge and attitudes toward pharmacogenomics testing in the UAE., Methods: In this cross-sectional study, a validated, online, self-administered survey, was randomly distributed to community pharmacists across the United Arab Emirates (UAE)., Results: The participants demonstrated poor knowledge about pharmacogenomic testing (median score < 8). Having 10-29 (Adjusted odds ration [AOR]: 0.038; 95% CI: 0.01-0.146, p = 0.001) and 30-49 (AOR: 0.097; 95% CI: 0.04-0.237, p = 0.001) patients per day was associated with poorer knowledge. Also, receiving 10-29 (AOR: 0.046; 95% CI: 0.005-0.401, p = 0.005), 30-49 (AOR: 0.025; 95% CI: 0.003-0.211, p = 0.001), and > 50 (AOR: 0.049; 95% CI: 0.005-0.458, p = 0.008) prescriptions decreased the odds of having good knowledge. Around half (43.9%) of the participants did not show a positive attitude toward pharmacogenomic testing (median score < 11). Having 30-49 patients per day (AOR: 5.351; 95% CI: 2.414-11.860, p = 0.001) increased the odds of good knowledge while receiving 10-29 (AOR: 0.133; 95% CI: 0.056-0.315, p = 0.001) and 30-49 (AOR: 0.111; 95% CI: 0.049-0.252, p = 0.001) prescriptions a day were associated with decreased odds of positive attitude toward the pharmacogenomics testing., Conclusions: The findings indicate a lack of knowledge and less-than-ideal attitudes among community pharmacists regarding pharmacogenomics testing. Enhanced efforts focused on educational initiatives and training activities related to pharmacogenomics testing is needed. Additionally, reducing workload can facilitate better knowledge acquisition and help mitigate unfavorable attitudes., (© 2024. The Author(s).)

Purpose: To investigate knowledge, attitude, and practice of asthma management counseling and the perceived barriers by community pharmacists., Methods: This cross-sectional study was conducted on 416 community pharmacists using an online-based questionnaire. The questionnaire included five parts that assessed socio-demographics and medical references used to seek drug-related information, pharmacists' knowledge (7 items), attitudes (5 items), practice (22 items) and the barriers for the provision of asthma management counseling (10 items). Binary logistic regression was conducted to find the variables that were significantly and independently associated with knowledge, attitude and asthma management counseling practice., Results: Increased years of experience was associated with decreased knowledge (OR = 0.918, 95% Cl (0.869:0.970), P = 0.002) and less positive attitude toward asthma management (OR = 0.876, 95% Cl. (0.821:0.935), P < 0.001), while working in independent community pharmacy (OR = 2.097, 95% Cl. (1.273:3.454), P = 0.004) and increased awareness of asthma management guidelines (OR = 1.60, 95% CI. (1.044:2.453), P = 0.031) increased the odds of being in the high knowledge group. In contrast, increasing the daily number of pharmacy visitors OR = 1.009, 95% Cl. (1.001:1.016), P = 0.024) and having a pharmacy degree (OR = 2.330, 95% Cl. (1.256:4.326), P = 0.007) increased the odds of having a positive attitude. Male pharmacists (OR = 0.553, 95% Cl. (0.350:0.873), P = 0.011) and having bachelor in pharmacy (OR = 0.354, 95% Cl. (0.179:0.700), P = 0.003) decreased the odds of being in the high practice group. On the other hand, increased awareness of asthma management guidelines tripled the odds of being in the high practice group (OR = 3.067, 95% Cl. (1.964:4.787), P < 0.001)., Conclusion: The current study findings offer valuable insights into the gaps in knowledge, attitude, and practice of asthma management counseling among community pharmacists, as well as the barriers and factors that impede the provision of these services. These insights serve as a guide for developing future strategies aimed at enhancing the role of pharmacists in asthma care., Competing Interests: The authors declare no conflicts of interest in this work., (© 2024 Jarab et al.)

Objectives: This study investigated factors associated with anxiety and depression in COPD outpatients., Methods: A cross-sectional study of 702 COPD outpatients from two major Jordanian hospitals using the Hospital Anxiety and Depression Scale (HADS) was conducted., Results: Significant associations were found with gender (Anxiety OR: 5.29, 95%CI: 2.38-11.74; Depression OR: 0.20, 95%CI: 0.08-0.51), disease severity (Anxiety OR: 2.97, 95%CI: 1.80-4.91; Depression OR: 15.95, 95%CI: 5.32-52.63), LABA use (Anxiety OR: 16.12, 95%CI: 8.26-32.26; Depression OR: 16.95, 95%CI: 8.33-34.48), medication count (Anxiety OR: 0.73, 95%CI: 0.59-0.90; Depression OR: 0.51, 95%CI: 0.40-0.64), mMRC score (Anxiety OR: 2.41, 95%CI: 1.81-3.22; Depression OR: 2.31, 95%CI: 1.76-3.03), and inhalation technique (Anxiety OR: 0.95, 95%CI: 0.93-0.97; Depression OR: 0.92, 95%CI: 0.90-0.95). Other factors associated with anxiety included high income, urban living, diabetes, hypertension, LAMA use, and fewer COPD medications. Depression was also linked with heart disease, increased age, and longer disease duration., Conclusion: The prevalence of anxiety and depression among COPD patients necessitates targeted interventions. Future research that recruits a more diverse sample in multiple sites and establishes the cause-effect relationship between the study predictors and outcome could provide a more robust conclusion on factors associated with anxiety and depression among COPD patients.

Objective: To investigate the prevalence of intensive care unit (ICU) admission and its predictors among hospitalized chronic obstructive pulmonary disease (COPD) patients., Methods: An observational retrospective study was conducted. All patients with a confirmed diagnosis of COPD according to the GOLD guidelines between 28 and 2020 and 1 March 2023 at Al-Noor Specialist Hospital were included in this study. Patients were excluded if a preemptive diagnosis of COPD was made clinically without spirometry evidence of fixed airflow limitation. Descriptive results were presented as frequency (percentage) for categorical variables and mean (SD) for continuous variables and to estimate prevalence of ICU admission. Predictors of ICU admission among hospitalized COPD patients were determined using logistic regression analysis. A SPSS (Statistical Package for the Social Sciences) version 25 was used to perform all statistical analysis., Results: A total of 705 patients with COPD were included in this study. The mean age was 65.4 (25.3) years. Around 12.4% of the hospitalized patients were admitted to the ICD. Logistic regression analysis identified that older age (OR; 1.92, (1.41-2.62)), smoking (OR; 1.60 (1.17-2.19)), and having specific comorbidities (Hypertension (OR; 1.98 (1.45-2.71)), Diabetes mellitus (OR; 1.42 (1.04-1.93)), GERD (OR; 2.81 (1.99-3.96)), Ischemic heart disease (OR; 3.22 (2.19-4.75)), Obstructive sleep apnea syndrome (OR; 2.14 (1.38-3.33)), stroke (OR; 4.51 (2.20-9.26))) were predictors of ICU admissions among patients with COPD., Conclusions: Our study found that a step-up approach to inpatient COPD management requires admission to the ICU in 12.4%, for which age, smoking status, cardiovascular, and stroke were important predictors. Further clinical research is needed to provide a validated model that can be incorporated into clinical practice to monitor this patient population during their admission and identify at-risk individuals for early transfer to higher acuity settings and intensive care units., (© 2023. The Author(s).)

A validated self-reported questionnaire was used to evaluate pharmacists' knowledge about isotretinoin and their awareness of isotretinoin dispensing practice. The majority were not able to recognize the initial dose of isotretinoin, the potential side effects such as dyslipidemia and liver toxicity, the potential interaction with tetracycline and Vitamin A and the contraindications of isotretinoin. Around 41.3 % of the pharmacists dispensed isotretinoin without a prescription, and the majority did not recognize that isotretinoin should be dispensed for only 30 days, should not be dispensed without an emphasis on the appropriate indication, and did not know the appropriate duration of isotretinoin therapy. Male gender and postgraduate degree were associated with better awareness, while increased work experience and postgraduate degree were associated with better knowledge about isotretinoin therapy. Nevertheless, both male and female pharmacists demonstrated equivalent knowledge levels. The current study demonstrates the need to implement educational programs to improve pharmacists' knowledge and awareness about isotretinoin and its dispensing practice., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Uncontrolled blood pressure (BP) has been associated with increased risk of cardiovascular events including heart failure. This study aimed to explore the factors associated with poor BP control among patients with heart failure at two major outpatient cardiology clinics in Jordan. Variables including socio-demographics, biomedical variables, in addition to disease and medication characteristics were collected using medical records and custom-designed questionnaire. The validated 4-item Medication Adherence Scale was used to assess medication adherence. Binary logistic regression analysis was conducted to explore the significant and independent predictors of poor BP control. Regression analysis results revealed that being not satisfied with the prescribed medication (OR = 2.882; 95% CI: 1.458-5.695; P < 0.01), reporting moderate medication adherence (OR = 0.203; 95% CI: 22 0.048-0.863; P < 0.05), not receiving digoxin (OR = 3.423; 95% CI: 1.346-8.707; P < 0.05), and not receiving aldosterone antagonist (OR = 2.044; 95% CI: 1.038-4.025; P < 0.05) were associated with poor BP control. Future interventions should focus on increasing medication satisfaction and enhancing medication adherence, in order to improve BP control among patients with heart failure., (© 2023. The Author(s), under exclusive licence to Springer Nature Limited.)

Objective: The present study aimed to evaluate HRQOL and to explore the factors associated with poor HRQOL among patients with COPD., Methods: In the present cross-sectional study, the validated St George's Respiratory Questionnaire for COPD patients (SGRQ-C) was used to evaluate HRQOL among 702 patients with COPD at two major hospitals in Jordan in the period between January and April 2022. Quantile regression analysis was used to explore the factors associated with HRQOL among the study participants., Results: According to SGRQ-C, the HRQOL of the study participants was greatly impaired with a total SGRQ of 55.2 (34-67.8). The highest impairment in the HRQOL was in the impact domain with a median of 58.7 (29-76.3). Increased number of prescribed medications (β = 1.157, P<0.01), older age (β = 0.487, P<0.001), male gender (β = 5.364, P<0.01), low education level (β = 9.313, P<0.001), low and moderate average income (β = 6.440, P<0.05, and β = 6.997, P<0.01, respectively) were associated with poorer HRQOL. On the other hand, being married (β = -17.122, P<0.001), living in rural area (β = -6.994, P<0.01), non-use of steroids inhalers (β = -3.859, P<0.05), not receiving long acting muscarinic antagonists (LAMA) (β = -9.269, P<0.001), not receiving LABA (β = -8.243, P<0.001) and being adherent to the prescribed medications (β = -6.016, P<0.001) were associated with improved HRQOL. Furthermore, lower disease severity (stage A, B, and C) (β = -23.252, -10.389, and -9.696 respectively, P<0.001), and the absence of comorbidities (β = -14.303, P<0.001) were associated with better HRQOL., Conclusions: In order to maximize HRQOL in patients with COPD, future COPD management interventions should adopt a multidisciplinary approach involving different healthcare providers, which aims to provide patient-centered care, implement personalized interventions, and improve medication adherence, particularly for patients who are elderly, males, have low socioeconomic status, receive multiple medications and have multiple comorbid diseases., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Jarab et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Aims of the Study: This study aimed to identify the prevalence and significant predictors of both potentially inappropriate medications (PIMs) and potentially omitted medications (POMs) events among geriatric patients with advanced cancer using the STOPP (Screening Tool of Older Persons' Prescriptions) and START (Screening Tool to Alert to Right Treatment) criteria., Methods: This retrospective cross-sectional study included patients aged ≥65 years who were diagnosed and treated for advanced stage of cancer. Patients' medical charts were evaluated to identify polypharmacy (≥5 medications) prevalence as well as potential PIMs and POMs incidents and their associated predictors. SPSS software was used to perform the analysis. Multivariate logistic regression models were used to identify factors associated with dependent variables including PIMs use and POMs., Results: Electronic medication charts of 510 patients were evaluated. The average age of the patients was 73.25 years, and 264 (51.8%) patients were males. The average number of medications prescribed per patient was 10.3 (range-2-26). Polypharmacy was present in 85.9% of patients, while excessive polypharmacy prevalence was 52.2%. At least one PIM was encountered in 253 patients (49.6%), while at least one POM was encountered in all patients owing to the omission of pneumococcal vaccines. The most common PIMs were opioid analgesics, followed by benzodiazepines, and hypnotics. Additionally, the most omitted medications, excluding vaccinations, were cardiovascular agents and laxatives in patients on regular opioid analgesics. Polypharmacy and diagnosis with solid cancer compared to hematological cancer were associated with increased odds for PIMs occurrence (ORs = 1.293 (p < 0.001) and 3.022 (p = 0.03), respectively), while coexistence of hypertension diagnosis in cancer patients was associated with increased the odds for POMs events (OR = 2.286 (p = 0.007))., Conclusion: Polypharmacy, PIMs, and POMs were highly prevalent among older cancer patients based on the polypharmacy definition and STOPP/START Criteria., Competing Interests: The authors declare no conflicts of interest in this work., (© 2023 Al-Azayzih et al.)

Background: Geriatric cancer patients are susceptible to adverse drug events due to the complexity of their chemotherapy regimens and collateral treatments for their comorbid conditions. Prescribing medications with anticholinergic burden characteristics can complicate their condition, leading to negative impacts on their health outcomes and quality of life, including an increase in adverse drug event frequency, physical and cognitive impairments., Objective: This study aims to examine the prevalence of anticholinergic prescribing and identify the cumulative anticholinergic load risk associated with drugs prescribed to elderly cancer patients. Also, to identify the predictors that might lead to raised anticholinergic burden in these patients., Methodology: This retrospective cross-sectional study included elderly patients (age ≥ 65) diagnosed with cancer and admitted to the adult oncology unit at King Abdullah University Hospital (KAUH) in Jordan during the period between (January 1st, 2019, and January 1st, 2022). The medication charts of 420 patients were evaluated for study outcomes., Results: Of the total subjects, females represented 49.3%, and the average age was 72.95 (SD = 7.33). A total of 354 (84.3%) patients were prescribed at least one drug carrying anticholinergic burden properties. Median for anticholinergic medications was 3 (IQR = 4). Our study found that 194 (46.2%) patients were at a high risk of adverse events associated with anticholinergic load (cumulative score ≥ 3). Metoclopramide, furosemide, and tramadol were the most frequently prescribed drugs with anticholinergic properties. Alimentary tract drugs with anticholinergic action were the most commonly encountered items in our study population., Conclusion: Our study revealed a significantly high prevalence of anticholinergic prescribing among elderly cancer patients. Nearly half of the patients were at high risk of developing serious effects related to anticholinergic activity from the drugs administered. Polypharmacy was strongly associated with increased anticholinergic burden score. Evidence-based recommendations utilizing prescribing strategies for safer alternatives and deprescribing of inappropriate medications could reduce such inappropriate prescribing., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Author(s).)

Introduction: Drug-related problems (DRPs) are events or circumstances involving drug therapy that actually or potentially interferes with desired health outcomes., Objectives: To assess community pharmacists' knowledge and practice regarding DRP-reduction services, as well as the barriers and factors associated with decreased provision of these services., Methods: This cross-sectional study utilized a validated questionnaire to assess pharmacists' knowledge, practice, and barriers to the provision of DRP-reduction services in the community pharmacy setting. Binary regression model was used to assess the variables associated with the practice of DRP-reduction services., Results: A total of 412 pharmacists participated in the study. The pharmacists demonstrated strong knowledge but inadequate practice of DRP-reduction services. The most reported DRPs were inappropriate combination of drugs, or drugs and herbal medications, or drugs and dietary supplements (52.4%), patients' inability to understand instructions properly (46.1%), inappropriate drug according to guidelines (43.7%), and too high dose (40.3%). The most common barriers to these services were increased workload (60.5%), limited time (53.2%), and lack of good communication skills (49.8%). The presence of a counselling area in the pharmacy increased the practice of DRP-reduction services (OR: 3.532, 95%Cl: 2.010-5.590, P < 0.001), while increased weekly working hours (OR: 0.966, 95%Cl: 0.947-0.986), P < 0.01) and serving < 10 patients daily (OR = 0.208, 95%Cl: 0.072-0.601, P < 0.01) decreased it., Conclusions: Community pharmacists' practice of DRP-reduction services showed a scope for improvement. Future pharmaceutical care initiatives should increase the number of personnel working in the pharmacy and provide them with opportunities for continued education and training in order to improve the provision of DRP services and optimize patients' outcomes., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Author(s).)

Background: Access to accurate and relevant patient health information is crucial for community pharmacists to deliver high-quality care. The use of electronic patient medication records (e-PMR) in the United Arab Emirates (UAE) is currently limited to hospital settings, and community pharmacists do not have access to patient records., Objective: To evaluate the perceptions of community pharmacists regarding the potential benefits, barriers, and concerns associated with the implementation of the e-PMR system in community pharmacies in the UAE., Method: A validated questionnaire was administered to a sample of licensed community pharmacists using proportionate random sampling. The survey was structured and consisted of 40 questions in four sections: characteristics of community pharmacists and pharmacies; perceived usefulness of e-PMR; perceived barriers; and concerns about the use of e-PMR., Results: In total, 552 pharmacists filled out the questionnaire (82.1% response rate). The majority of participants somewhat or strongly agreed that e-PMR would reduce drug abuse (71.6%), dispensing errors (64.4%) and prescribing errors (69.0%), and believed that e-PMR would enhance pharmacists' ability to perform medication reviews (76.0%). Pharmacists in charge (adjusted odds ratio (AOR) = 2.5; 95% confidence interval (CI): 1.6-3.6), facing difficulty tracking the medical history of patients (AOR = 3.2; 95% CI: 2.8-3.9) and working in pharmacies providing telepharmacy services (AOR = 3.4; 95% CI: 2.7-3.8) were more likely to consider e-PMR useful., Implications: The implementation of the e-PMR system in community pharmacies has potential benefits for patient safety and medication therapy management in the UAE.

Background: Artificial intelligence (AI) is the capacity of machines to perform tasks that ordinarily require human intelligence. AI can be utilized in various pharmaceutical applications with less time and cost., Objectives: To evaluate community pharmacists' willingness and attitudes towards the adoption of AI technology at pharmacy settings, and the barriers that hinder AI implementation., Methods: This cross-sectional study was conducted among community pharmacists in Jordan using an online-based questionnaire. In addition to socio-demographics, the survey assessed pharmacists' willingness, attitudes, and barriers to AI adoption in pharmacy. Binary logistic regression was conducted to find the variables that are independently associated with willingness and attitude towards AI implementation., Results: The present study enrolled 401 pharmacist participants. The median age was 30 (29-33) years. Most of the pharmacists were females (66.6%), had bachelor's degree of pharmacy (56.1%), had low-income (54.6%), and had one to five years of experience (35.9%). The pharmacists showed good willingness and attitude towards AI implementation at pharmacy (n = 401). The most common barriers to AI were lack of AI-related software and hardware (79.2%), the need for human supervision (76.4%), and the high running cost of AI (74.6%). Longer weekly working hours (attitude: OR = 1.072, 95% C.I (1.040-1.104), P < 0.001, willingness: OR = 1.069, 95% Cl. 1.039-1.009, P-value = 0.011), and higher knowledge of AI applications (attitude: OR = 1.697, 95%Cl (1.327-2.170), willingness: OR = 1.790, 95%Cl. (1.396-2.297), P-value < 0.001 for both) were significantly associated with better willingness and attitude towards AI, whereas greater years of experience (OR = 20.859, 95% Cl (5.241-83.017), P-value < 0.001) were associated with higher willingness. In contrast, pharmacists with high income (OR = 0.382, 95% Cl. (0.183-0.795), P-value = 0.010), and those with<10 visitors (OR = 0.172, 95% Cl. (0.035-0.838), P-value = 0.029) or 31-50 visitors daily (OR = 0.392, 95% Cl. (0.162-0.944), P-value = 0.037) had less willingness to adopt AI., Conclusions: Despite the pharmacists' positive willingness and attitudes toward AI, several barriers were identified, highlighting the importance of providing educational and training programs to improve pharmacists' knowledge of AI, as well as ensuring adequate funding support to overcome the issue of AI high operating costs., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Author(s).)

Background: Heart Failure (HF) is a chronic disease associated with life-limiting symptoms that could negatively impact patients' health-related quality of life (HRQOL). This study aimed to evaluate HRQOL and explore the factors associated with poor HRQOL among patients with HF in Jordan., Methods: This cross-sectional study used the validated Arabic version of the Minnesota Living with Heart Failure Questionnaire to assess HRQOL in outpatients with HF visiting cardiology clinics at two public hospitals in Jordan. Variables were collected from medical records and custom-designed questionnaires, including socio-demographics, biomedical variables, and disease and medication characteristics. Ordinal regression analysis was used to explore variables associated with poor HRQOL among HF patients., Results: Ordinal regression analysis showed that the number of HF medications (P < 0.05) and not taking a loop diuretic (P < 0.05) significantly increased HRQOL, while the number of other chronic diseases (P < 0.05), stage III/IV of HF (P < 0.01), low monthly income (P < 0.05), and being unsatisfied with the prescribed medications (P < 0.05) significantly decreased HRQOL of HF patients., Conclusions: Although the current study demonstrated low HRQOL among patients with HF in Jordan, HRQOL has a considerable opportunity for improvement in those patients. Variables identified in the present study, including low monthly income, higher New York Heart Association (NYHA) classes, a higher number of comorbidities, and/or taking a loop diuretic, should be considered in future intervention programs, aiming to improve HRQOL in patients with HF., (© 2023. The Author(s).)

Background: Hospital pharmacists can play an important role in the detection, prevention, and reporting of adverse drug reaction (ADR) since they interact with patients in hospital settings. The ADR reporting practice by Pharm D students, who represent the future hospital pharmacists, has not been adequately investigated in the literature., Objective: To evaluate Pharm D students' knowledge, attitude, and practice regarding ADR reporting, and the associated barriers and motivators to ADR reporting during clinical training at different hospital sites in Jordan., Methods: The present cross-sectional study was conducted on sixth year pharm D students during clinical training at different hospital departments in different hospital sites Jordan. In addition to socio-demographic variables, a structured self-reported questionnaire was used to assess students' knowledge, attitude, practice, barriers, and motivators towards ADR reporting. Binary logistic regression was used to explore the variables associated with the study outcomes., Results: A total of 497 students participated in the study. The participants showed inadequate knowledge regarding ADR reporting, with a mean knowledge score of 3.20 (±1.78). On the other hand, the study participants showed positive attitude towards ADR reporting with a total mean score of 13.6 (±1.96). However, the ADR reporting practice was low with a mean score of 5.78 (±1.88). Not knowing how to report (60.2%) and not knowing where to report (55.9%) were the most common barriers to ADR reporting, while the most reported motivators for ADR reporting were seriousness of reaction (84.1%) and involvement of new drug (51.1%). Logistic regression analysis showed that time from the start of training (OR = 0.510; 95%CI = 0.305-0.852; P = 0.010), female gender (OR = 1.759; 95%CI = 1.083-2.857; P = 0.022), and attending a course/workshop about pharmacovigilance (OR = 0.213; 95%CI = 0.137-0.332; P = 0.00) were significant predictors of knowledge about ADR reporting. Increased age (OR = 0.93; 95%CI = 0.880-0.997; P = 0.041) and low knowledge (OR = 0.564; 95%CI = 0.380-0.837; P = 0.004) were significantly associated with negative attitude toward ADR reporting. Female gender (OR = 0.481; 95%CI = 0.302-0.766; P = 0.002) and attitude level (OR = 1.837; 95%CI = 1.205-2.802; P = 0.005) were significant predictors of ADR reporting practice., Conclusions: Pharm D students showed positive attitude towards ADR reporting, however, the knowledge and practice of ADR reporting were inadequate and the participants reported several barriers. Therefore, the topic of ADR reporting and pharmacovigilance, as well as, educational training programs need to be included in future pharmacy curriculum in order to improve students' awareness and practice of ADR reporting., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Author(s).)

Background: Poor adherence to heart failure (HF) medications represents a major barrier to achieve the desired health outcomes in those patients., Objective: To assess medication adherence and to explore the factors associated with medication non-adherence among patient with HF in Jordan., Methods: The current cross-sectional study was conducted at the outpatient cardiology clinics at two main hospitals in Jordan from August 2021 through April 2022. Variables including socio-demographics, biomedical variables, in addition to disease and medication characteristics were collected using medical records and custom-designed questionnaire. Medication adherence was assessed using the 4-item Morisky Medication Adherence Scale. Multinomial logistic regression analysis was performed to identify the factors that are significantly and independently associated with medication non-adherence., Results: Of the 427 participating patients, 92.5% had low to moderate medication adherence. Results of the regression analysis revealed that that patients who had higher education level (OR=3.36; 95% CI 1.08-10.43; P=0.04) and were not suffering from medication-related side effects (OR=4.7; 95% CI 1.91-11.5; P=0.001) had significantly higher odds of being in the moderate adherence group. Patients who were taking statins (OR=16.59; 95% CI 1.79-153.98; P=0.01) or ACEIs/ ARBs (OR=3.95; 95% CI 1.01-15.41; P=0.04) had significantly higher odds of being in the high adherence group. Furthermore, Patients who were not taking anticoagulants had higher odds of being in the moderate (OR=2.77; 95% CI 1.2-6.46; P=0.02) and high (OR=4.11; 95% CI 1.27-13.36; P=0.02) adherence groups when compared to patients who were taking anticoagulants., Conclusion: The poor medication adherence in the present study sheds the light on the importance of implementing intervention programs which focus on improving patients' perception about the prescribed medications particularly for patients who have low educational levels, receive an anticoagulant, and do not receive a statin or an ACEI/ ARB., Competing Interests: The authors declare that they have no competing interests., (© 2023 Jarab et al.)

Background: Dyslipidemia is common among patients with heart failure, and it negatively impacts clinical outcomes. Limited data regarding the factors associated with poor lipid control in patients with HF patients. Therefore, this study aimed to evaluate lipid control and to explore the factors associated with poor lipid control in patients with HF., Methods: The current cross-sectional study was conducted at outpatient cardiology clinics at two major hospitals in Jordan. Variables including socio-demographics, biomedical variables, in addition to disease and medication characteristics were collected using medical records and custom-designed questionnaire. Medication adherence was assessed using the validated 4-item Medication Adherence Scale. Binary logistic regression analysis was conducted to explore significant and independent predictors of poor lipid control among the study participants., Results: A total of 428 HF patients participated in the study. Results showed that 78% of the participants had poor lipid control. The predictors that were associated with poor lipid control included uncontrolled BP (OR = 0.552; 95% CI: 0.330-0.923; P  < 0.05), higher Hb levels (OR = 1.178; 95% CI: 1.013-1.369; P  < 0.05), and higher WBC (OR = 1.133; 95% CI: 1.031-1.246; P  < 0.05)., Conclusions: This study revealed poor lipid control among patients with HF. Future intervention programs should focus on blood pressure control in order to improve health outcomes among HF patients with dyslipidemia., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Jarab, Al-Qerem, Hamam, Abu Heshmeh, Mukattash and Alefishat.)

Objectives: The purpose of this study was to describe the services provided by community pharmacists and their confidence in providing advice on self-medication for women during pregnancy and breastfeeding., Methods: A cross-sectional, questionnaire-based study was distributed online to community pharmacists across Jordan in the period from August through December 2020. The questionnaire identified the services most frequently offered to women throughout pregnancy or breastfeeding and evaluated the community pharmacists' confidence in providing advice on self-medication and other services for this population group., Key Findings: A total of 340 community pharmacists completed the questionnaire. Most of them were female (89.4%), and just over half (55%) had less than 5 years of experience. The services offered by community pharmacists to women throughout pregnancy were dispensing medicine (49.1%), and dispensing herbal products (48.5%), whereas the services mainly provided for women during breastfeeding were providing advice on contraception (71.5%), and dispensing medication (45.3%).The most frequent complaints reported by women during pregnancy were gastrointestinal and urinary symptoms, and for women during lactation low milk supply and contraception. Regarding pharmacists' confidence in providing advice on self-medication, nearly half of the respondents (50% and 49.7%) reported that they had confidence in solving medication and health challenges during pregnancy and breastfeeding, respectively., Conclusion: Although community pharmacists provided different services for women who were pregnant or breastfeeding, many did not feel confident handling them. Continuous training programs are required to enhance community pharmacists' ability to provide adequate care for women during pregnancy and breastfeeding., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Royal Pharmaceutical Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: The literature demonstrated a positive impact of medication therapy management (MTM) services provided by the pharmacists to improve the overall health outcomes. Nevertheless, limited data is available with regard to MTM service implementation by community pharmacists and its associated factors in Jordan., Objective: To evaluate community pharmacists' knowledge, attitude and practice of MTM service and to explore the challenges and barriers for its implementation., Methods: The present cross-sectional study utilized a validated online survey which was filled by community pharmacists in different areas across Jordan. In addition to the socio-demographic variables, the study questionnaire evaluated pharmacists' knowledge and attitudes towards MTM service, extent of MTM implementation and its associated challenges and barriers., Results: A total of 250 pharmacists completed the survey. The study pharmacists showed moderate knowledge level (median of the total knowledge score = 6 (4-7) out of 10) and positive attitude (median of the attitude score was 23 (19-26) out of 30) towards MTM services. The participating pharmacists recognized performing or obtaining necessary assessments of patient's health status as the most frequently provided MTM service (84.8%), while the least one was documenting the care delivered and communicating essential information to other healthcare providers (62%). Furthermore, collecting patient-related information was the most commonly recognized challenge to MTM service provision (36.8%), followed by referring the patient to a physician or consultant (36%) and collaboration with them (35.6%). The most reported barrier was negative physician attitudes (40.4%), followed by the lack of training on MTM provision (38.4%), and lack of adequate support staff (37.2%)., Conclusion: Efforts are needed to enhance collaboration between pharmacists and other health care professional, to develop documentation systems that would preserve and facilitate access to patient information, and to implement appropriate training programs which aim to overcome the challenges and barriers for MTM implementation., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Author(s).)

Background: Enhancing the contribution of practicing pharmacists into scientific evidence via practice-based research (PBR) is crucial in maintaining high-quality clinical practice and healthcare delivery. Involving community pharmacists in PBR can potentially can also help break barriers to the utilization of the current best evidence in everyday pharmacy practice. The impact of pharmacists' attitude towards PBR on their utilization of current best evidence in pharmacy practice is understudied., Objectives: The aim of the study was to investigate the impact of community pharmacists' attitudes toward PBR on their utilization of current best evidence, barriers for conducting PBR in clinical practice were also investigated., Methods: In this cross-sectional study, 169 community pharmacists working across Jordan filled a questionnaire to assess their attitudes towards PBR, barriers to PBR, and their utilization of the current best evidence in clinical practice., Results: Pharmacists in this study showed a positive attitude toward PBR (attitude mean score >3.5). A positive attitude towards PBR was associated with high utilization of the best current scientific evidence. We also investigated several barriers to PBR and their association with utilization those included; the lack of perceived benefits, lack of institutional support, and lack of self-engagements of community pharmacists to PBR. The lack of perceived benefit was found to be negatively associated with pharmacists' utilization of the current best scientific evidence., Conclusion: In this study, pharmacists' utilization of current best evidence was found to be significantly impacted by their attitude toward PBR. The current study findings highlight the importance of supporting, promoting, and facilitating PBR among community pharmacists which can potentially enhance their utilization of the current best evidence in their everyday pharmacy practice., Competing Interests: The authors have declared that no competing interests exist.

Background: Despite being the first-line treatment for severe or moderate acne, isotretinoin has several serious side effects that necessitate the evaluation of patients' knowledge about isotretinoin side effects and its proper use., Objective: The current study aim was to explore information needs about isotretinoin by evaluating patients' knowledge about the appropriate use of isotretinoin and its associated side effects., Methods: In addition to the sociodemographic variables, a validated online questionnaire was adopted from the literature to evaluate patients' knowledge about isotretinoin use and its potential side effects. Independent t -test and one-way analysis of variance (ANOVA) test were implemented to find the correlation between the study variables and the knowledge score., Results: The most recognized side effect of isotretinoin therapy was dryness (98.1%). The study patients showed good knowledge about isotretinoin use with a mean knowledge score of 8.1 (SD = 0.7). However, more than half of them (61.0%) mistakenly thought that isotretinoin therapy should be taken continuously for more than 6 months without stop, and some of them did not know that isotretinoin is recommended to be taken with fatty meal (24%) and sunblock (24.6%). Female gender (8.2 (SD = 0.8)) and using isotretinoin for more than 6 months (8.3 (SD = 1.2)) were significantly associated with a higher knowledge score of isotretinoin use ( p =0.01), when compared with male patients (7.8 (SD = 0.7)) and less than 6-month use of isotretinoin (7.7 (SD = 0.7))., Conclusions: The lack of patients' information about the potential side effects, duration of therapy, and some instructions on isotretinoin use, such as taking the medication with fatty meal and sunblock, shed the light on the necessity to prepare leaflets, educational brochures, and educational posts via social media in order to improve patients' knowledge about isotretinoin therapy and its optimal use., Competing Interests: The authors declare that there are no conflicts of interest., (Copyright © 2022 Anan S. Jarab et al.)

Objectives: Anemia is prevalent in hemodialysis (HD) patients. Data about factors associated with medication non-adherence in anemic HD patients is limited. This study examined determinants of medication non-adherence and its association with achievement of therapeutic goals of anemia measures among HD patients., Methods: A cross-sectional study was conducted among a representative group of HD patients in Jordan. Medication adherence was assessed using Morisky Green Levine Medication Adherence Scale (MGL). Other utilized instruments were modified Charlson Comorbidity Index (mCCI), general Health-Related Quality of Life (HRQoL) EQ-5D-5 L, and Hospital Anxiety and Depression Scale (HADS). Pharmacy claim data during the years of (2016-2017) were also retrieved from patients' medical records. Logistic regression was conducted to identify factors associated with medication non-adherence and achieving therapeutic goals of anemia therapy., Results: More than two-thirds of the participants (69.1%) were found non-adherent and the mean score of MGL scale was 2.4 ± 1.4. The non-adherence rate measured using refill data (69.6%) was comparable to that observed using self-reported MGL instrument. Education level of college or over was significantly associated with lower odds of non-adherence (OR = 0.365, p = 0.036), while complaining of a headache was associated with 2.5-fold risk of medication non-adherence (OR = 2.5, p = 0.017). A trend toward better achievement of iron indices therapeutic goals was observed with improved adherence measured using refill data. Multiple factors such as improved knowledge about prescribed medications was significantly associated with achieving anemia therapeutic goals (p < 0.05)., Conclusion: The findings suggest poor medication adherence among HD patients with anemia. Future interventions by health-care providers should target modifiable factors to improve medication adherence and, hence, health outcomes among HD patients with anemia.

Providing vaccination in community pharmacies could increase the vaccination coverage rate as well as help reducing the workload of the healthcare system. The current study was conducted to evaluate community pharmacists' willingness and barriers to provide vaccination in community pharmacy setting. A validated questionnaire which included eight items to evaluate willingness and eleven items to evaluate the barriers to provide vaccines was distributed online. Binary logistic regression was conducted to explore the factors that are significantly associated with willingness and barriers to provide the vaccine. Among the 201 participating pharmacists, 174 (86.6%) had a high willingness level. Lack of authorization (91.6%), lack of collaboration with other healthcare professionals (85.6%), and lack of space for storage (74.1%) were the most recognized barriers to vaccinate. Pharmacists with BSc degree demonstrated less willingness (OR = 0.18 (0.07-0.46), and increased barriers (OR = 4.86 (1.56-15.17) to provide the vaccine when compared with Pharm D and postgraduate pharmacists P < .01. Factors including male gender (OR: 6.10), working in chain pharmacy (OR: 8.98) and rural areas (OR: 4.31), moderate income (OR: 19.34) and less years of experience (OR:0.85) were significantly associated with increased barriers to provide the vaccine ( P < .05). Despite the high willingness of the community pharmacists to vaccinate, several barriers were present. Enhancing pharmacists' authorization and collaboration with other healthcare professionals and providing space for storage along with providing training courses and workshops should be considered to enhance pharmacist's engagement in vaccination service.

Objectives: This study aimed to explore the experiences and views of domiciliary coronavirus disease (COVID-19) patients towards pharmaceutical care services provided during their infection., Methods: This was a single-centred observational study conducted among home-treated COVID-19 patients (n = 500), who were tested positive for COVID-19 in a medical centre in Lebanon., Key Findings: Out of the 500 home-treated COVID-19 patients invited to participate in the study, 279 patients completed the questionnaire. Although the participants had a good view of pharmacists caring for COVID-19 patients (mean view score: 17.79/25), their treatment experiences were unsatisfactory (mean experience score: 1.51/4)., Conclusions: COVID-19 patients reported minimal involvement of pharmacists in their treatment. Therefore, in response to the COVID-19 pandemic, healthcare authorities should intervene in restructuring, guiding and reviewing unrealized new pharmaceutical services to COVID-19 outpatients., (© The Author(s) 2021. Published by Oxford University Press on behalf of the Royal Pharmaceutical Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: The aim of this study was to determine pharmacists' perceived knowledge and expertise required to deliver pharmaceutical care services to pediatric patients., Methods: Once ethical approval was obtained, a questionnaire was posted on local pharmacy groups. The questionnaire is composed of 4 domains: 1) Demographics, 2) Perceived knowledge of pediatric treatment and dosing, 3) Real-life pediatric cases, and 4) Future aspirations to enhance pediatric pharmacy., Results: A total of 200 questionnaires were completed and submitted online. Most participants (62.5%) practiced in a community setting. Most respondents (40%) reported that 41% to 60% of their patients were pediatrics. In general, respondents had a good perception of their knowledge and expertise to deliver pharmaceutical care services to pediatric patients. However, most respondents had a low knowledge score when faced with real-life pediatric cases. On a scale of 7 most respondents obtained the score of 2 (32%)., Conclusions: The present study sheds light on an alarming lack of knowledge in pediatric pharmaceutics among pharmacies in Jordan. Further training and educational programs should be put in place to address this gap in knowledge., Competing Interests: Disclosures. The authors declare no conflicts or financial interest in any product or service mentioned in the manuscript, including grants, equipment, medications, employment, gifts, and honoraria. The authors had full access to all the data and take responsibility for the integrity and accuracy of the data analysis., (Copyright. Pediatric Pharmacy Association. All rights reserved. For permissions, email: mhelms@pediatricpharmacy.org 2022.)

Introduction: This study aims to assess existing sleep apps for mobile phones to determine the perceived effect of these applications on user's attitudes, knowledge, willingness to change, and its likelihood to change behavior from a user's perspective., Material and Methods: A systematic search was conducted through Google play store and iTunes Apple store using terms related to sleep tracking. Apps were evaluated using Mobile Application Rating Scale (MARS) tool for assessing and classifying mobile health applications quality. Additionally, a convenience sample of subjects were asked to evaluate the included apps for perceived sleep behavior changes., Results: The average MARS app quality score on a 5-point scale was 3.3. Between 30-50% of participants believed that sleep tracker apps are likely to increase awareness about sleep patterns and sleep hygiene, infuence sleep hygiene habits, and are likely to encourage help seeking for sleep hygiene when required., Conclusion: Apps available for sleep self-management and tracking may be valuable tools for self-management of sleep disorder and/or improving sleep quality, yet they require improvement in terms of quality and content, highlighting the need for further validity studies.

Objective: This study examined health-related quality of life (HRQoL) and factors associated with poor HRQoL among hemodialysis (HD) patients., Methods: A multicenter cross-sectional study was conducted on HD patients with anemia in Jordan (n = 168). Validated questionnaires were utilized to collect data on HRQoL using EQ-5D-5L, psychiatric symptoms using Hospital Anxiety and Depression Scale (HADS), and comorbidities score using the modified Charlson Comorbidity Index (mCCI). Multiple linear regression analysis was conducted to identify the variables which are independently associated with HRQoL among patients., Results: The mean (± SD) age of study participants was 52.2 (± 14.6) years. The mean utility value of EQ-5D-5L was 0.44 (± 0.42). Participants reported extreme problems mostly in pain/discomfort domain (19.6%). Increased age, increased mCCI and patient complains, more years under dialysis, decreased exercise, and low family income were significantly associated with poor HRQoL (p < 0.05)., Conclusion: The study findings revealed poor HRQoL among HD patients with anemia. Various dimensions of health were negatively affected among HD patients. Development and implementation of appropriate approaches with adequate education and psychosocial support to HD patients by healthcare professionals targeting improved HRQoL and clinical outcomes would be necessary., (© 2021. The Author(s).)

Objective: This study aims to assess medication adherence and explore its predictors in outpatients with type 2 diabetes., Method: This cross-sectional study collected socio-demographics, disease-related information, and different biomedical variables for type 2 diabetes patients attending a Jordanian Diabetes center. The four-item medication adherence scale (4-IMAS) and the beliefs about medications questionnaire (BMQ) which includes necessity and concerns were used. Stepwise backward quartile regression models were conducted to evaluate variables associated with the Necessity and Concerns scores. Stepwise ordinal regression was conducted to evaluate variables associated with adherence., Results: 287 diabetic patients participated in the study. Almost half of the participants (46.5%) reported moderate adherence and 12.2% reported low adherence. Significant predictors of the adherence were necessity score (OR = 14.86, p <0.01), concern score (OR = 0.36, p <0.05), and frequency of medication administration (OR = 0.88, p- <0.01). Education was a significant predictor of Necessity and Concerns scores (β = 0.48, -0.2, respectively)., Conclusion: Simplifying the medication regimen, emphasizing medication necessity and overcoming medication concerns should be targeted in future diabetes intervention programs to improve medication adherence and hence glycemic control among diabetic patients., Competing Interests: The authors have declared that no competing interests exist.

Aims of the Study: This study aims to determine females' views, experiences and attitudes regarding the caesarean section (CS) and to explore the factors that increase the prevalence of CS in Jordan., Design: This is a cross-sectional study using a questionnaire that was distributed electronically through social media websites. Study participants included 1005 females with a history of at least one CS. Awareness, experiences about CS, complications and reasons for performing CS were investigated., Settings: The participants were recruited from all Jordan cities by social media and emails., Findings: Most of the respondents stated that the source of their knowledge about CS was from the internet (36.2%) followed by family and friends (31.6%). The majority of respondents were satisfied with their CS experience (72.8%). More than half of the participants (56.9%) reported that CS carries no risk for infants. About 53% of respondents stated that the most common reason leading women to choose to give birth via CS is the fear of labour pain. However, the majority of the respondents disagree with performing CS under maternal request (59.2%)., Conclusions and Implications: This study indicated that Jordanian females do not have reliable sources of information about CS. This leads to lower awareness of CS and its complications, and, as expected, CS is more likely to be performed by privately insured women., (© 2021 John Wiley & Sons Ltd.)

Lack of medication adherence among patients with dyslipidemia negatively affects health-related outcomes. This study aims to evaluate medication adherence; we also aim to investigate the predictors of non-adherence among patients with dyslipidemia in Jordan. Medication adherence was evaluated in a total of 228 dyslipidemia patients. The Beliefs about Medicines Questionnaire was also used to assess patients' beliefs about medications. The majority of the current study participants (73.2%) reported non-adherence to the prescribed medications. There were significant negative associations between medication adherence and concerns of prescription drug use (B = -0.41, p -value < 0.01), duration of dyslipidemia (B = -0.22, p -value < 0.01), and the number of medications (B = -0.64, p -value < 0.01). Positive associations were found between medication adherence and the necessity of prescription drug use (B = 0.43, p -value < 0.01), taking statin and fibrate (B = 2.04, p -value < 0.01), and moderate-intensity statin (B = 2.34, p -value < 0.01). As for patients' beliefs about medications, the item "My medicine to lower my cholesterol disrupted my life" had the highest mean (3.50 ± 0.99). This study revealed a low adherence rate to medication among patients with dyslipidemia. It also demonstrates modifiable factors such as beliefs regarding perceived risk, medication harms, treatment duration, and the number of medications associated with poor adherence in patients with dyslipidemia.