Aims: The aim of this study was, to use a multiple methods approach, including, for the first time, dried blood spot (DBS) sampling with population pharmacokinetic interpretation, to assess adherence to mycophenolate in children with kidney transplant. A second aim was to identify patient/parental factors that influenced adherence and to link adherence behaviour to clinical outcomes.Methods: A convenience sample of 33 children with kidney transplant (age ≤ 18 years) who had been prescribed mycophenolate for at least 3 months were recruited from participating outpatient clinics in the UK and Jordan. Medication adherence was determined via self-report questionnaires, medication refill data from dispensing records, and via mycophenolic acid concentrations in plasma and DBS samples obtained from children during a clinic visit.Results: Through triangulation of results from the different methodological approaches a total of 12 children (36.4%) were deemed to be nonadherent with their prescribed mycophenolate treatment. Logistic regression analysis indicated that nonadherence was significantly associated with the presence of mycophenolate side effects. Poor adherence was positively linked to measures of poor clinical outcomes (hospitalisation and the need for kidney biopsy).Conclusions: Despite the imperative regarding medication adherence to help prevent organ rejection, a significant proportion of children are not fully adherent with their therapy. Side-effects appear to be an important factor leading to nonadherence.Measurement of mycophenolate in DBS samples, coupled with the use of population pharmacokinetics modelling, was a convenient direct approach to assessing adherence in children with kidney transplant and has the potential to be introduced into routine practice. KEYWORDS adherence, dried blood spot, kidney transplant, mycophenolic acid The clinical responsibility for patients throughout the study lay with their hospital doctors and their individual general practitioners. Dr Reham Almardini acted as local PI in Queen Rania Hospital for Children, Amman while Dr Karl McKeever acted as local PI in the Royal Belfast Hospital for Sick Children.

ObjectivesThe main aims of the study were to highlight the impact of clinical pharmacist in patient education on the correct use of inhalers, and its consequences on medication adherence, asthma control and clinical outcomes. Methods Pre-post-interventional study was conducted over two patient visits in Jordan at Alkarak Governmental Hospital. Inhaler technique evaluation was assessed at first and second visits. All patients received inhaler technique counselling service prior to second visit. Patient adherence was assessed using MMAS-8, and asthma control was assessed by spirometry and ATAQ scale. Key findings Complete data were available for 100 patients, 52% women, median age 45 (range 18-60) years and median duration of diagnosis 20 (range 2-55) years. Ninetysix per cent of patients (n = 96) were previously educated about the correct use of inhalers by different healthcare professionals' specialty. There was a statistically significant improvement in the correct handling of inhalers after patient re-education (P = 0.000). There also was a significant improvement in the level of control (from 7% (n = 7) to 90% (n = 90) of participants had high disease control) and adherence (from 6% (n = 6) to 12% (n = 12) of participants had high adherence rate) after education (P = 0.000 and P = 0.000 respectively). Significant number of asthmatic patients uses inhalers incorrectly despite the previous education on the correct inhaler technique. Incorrect use of inhalers is associated with negative outcomes. In this study, the result showed that incorrect handling of MDIs was significantly associated with frequent emergency department (ED) visits and hospitalizations (P = 0.031, P = 0.039) respectively. Conclusions The researchers concluded that effective educational intervention to the patients along with reassessment of inhaler technique and re-education by a well-trained clinical pharmacist gave positive impressive outcomes.

Due to the shortage of literature related to the safe use of over‐the‐counter (OTC) products by patients worldwide, the aim of this study was to evaluate people's knowledge and attitudes regarding the use of OTC products in Jordan. Using an internet‐based questionnaire mainly spread through social media platforms, a descriptive cross‐sectional study was conducted with Jordanian candidates who consume OTC products. A total of 274 OTC product users answered the survey questions. The results showed that analgesics were the most commonly used OTC products among the participants (50.4%). The majority used the OTC products only as needed rather than on a regular basis. Only 42.4% of the participants sought a pharmacist's help in determining the dose of the OTC medicine. Most of the participants were very interested in reading a patient information leaflet (80.3%) and the side effects and contraindications (89.5%). The majority of participants agreed that antibiotics have to be prescribed (68.5%), and anti‐allergy medications should not be used as sleep aid medications (75.0%). About 53.4% thought that OTCs are sometimes enough to treat their health conditions without the need to follow‐up with a physician. A chi‐square analysis showed an association between gender, age, educational level and having a family member in the medical field and OTC products knowledge among Jordanians. Females, for example, were more interested in reading leaflet, checking production and expiry dates, knowing adverse effects, and appropriate storage conditions (P < .001, 0.022, 0.003, 0.007, respectively). We concluded that a good level of knowledge on the use of OTC products among the study population was identified in the present study.

Background: The magnitude of postpartum depression in Jordan is under documented, and little is known about its potential sociodemographic and clinical correlates. Purpose: The aim of this study was to explore the prevalence and risk factors associated with postpartum depression among Jordanian mothers in the first 18 months after delivery. Method: This descriptive cross-sectional study was carried out from April to June 2020 in Jordan. A web-based survey was used for recruiting eligible participants. An Arabic version of the validated self-administered Edinburgh Postnatal Depression Scale questionnaire was used to measure postpartum depression with a cut-off score of ⩾12 which indicates probable depression. Results: A total of 1,071 Jordanian women participated in the study. Of those, 567 women had postpartum depression (52.9%). Multivariate logistic regression analysis revealed that postpartum depression was significantly associated with marital conflict (OR: 4.91; 95% CI: 2.36–10.20), negative attitude from the pregnancy (OR: 0.67; 95% CI: 0.45–0.99), unplanned pregnancies (OR: 1.73; 95% CI: 1.16–2.60), lack of social support (OR: 1.93; 95% CI: 1.12–3.32), time from last delivery (OR: 0.99; 95% CI: 0.98–1.00), insomnia (OR: 0.53; 95% CI: 0.35–0.82), and depression during the pregnancy (OR: 0.51; 95% CI: 0.33–0.78). Most of the participants (65.7%) sought social support to avoid, reduce, or treat postpartum depression. Conclusions: Postpartum depression among Jordanian women was the highest in comparison to that of women in other countries in the region. Therefore, screening for the presence of depressive symptoms should be implemented during regular pregnancy care visits. Social support should be encouraged in order to avoid, reduce, or treat postpartum depression.

Background: Knowledge of medication use during pregnancy presents a concern to pharmacists upon graduation since they will be responsible for drug related inquiries and counselling pregnant women about their medications. The present study aimed to assess undergraduate senior pharmacy students’ knowledge about medication use during pregnancy in Jordan. Methods: A cross-sectional survey was conducted in Jordanian universities. A total of 409 senior pharmacy students participated in the study. Results: The results found that the majority of the students (60.6%) did not have enough instruction on medications during pregnancy through their undergraduate study. Overall, only 2.5% of the participating students were considered to have good knowledge about medicine use during pregnancy and accordingly the majority (52.6%) were not confident to recommend medicines for pregnant women in the future. In view of that, participating students suggested the addition of an obligatory course to the current curriculum. Students in public universities, Pharm.D. students, and those in their sixth year of study were more knowledgeable than others (P > 0.05). Conclusion: It was concluded that pharmacy students have low knowledge regarding medication use in pregnancy. The results call for a reassessment of the current pharmacy curriculum.

Nanoaggregates made from amino acid-based polymers have been an important platform for targeted drug delivery systems such as the lungs. Therefore, the aim of the present study is to develop tyrosine-based poly(ester amide)s (Tyr-PEA) for dry powder inhaler (DPI) of a potent drug (fluticasone propionate [FP]) using interfacial polymerization. The molecular and surface profiling characteristics were evaluated using Fourier-transformed infrared spectroscopy, X-ray diffraction, transmission electron microscopy, particle size analysis, nuclear magnetic resonance, differential scanning calorimetry, and scanning electron micrographs. The aerodynamic performance was evaluated using the NGI. The results confirmed the formation of the PEA and FP-loaded Tyr-PEA with an average particle size of, 45.39 ± 6.32 nm. The produced FP/Tyr-PEA showed entrapment efficiency and encapsulation capacity of FP of 92.32% and 0.526% respectively, which enabled the delivery of this potent drug in a reasonable dose. The in-vitro performance of the FPloaded PEA was compared to a marketed product and results revealed a significant enhancement of the emitted dose (87.29% vs. 59% respectively [t-test, p < 0.05]). FP-loaded Tyr-PEA produced a higher respirable dose when compared to the marketed FP DPI (48.63 μg vs. 34.15 μg). Overall, FP-loaded Tyr-PEA was successfully prepared with optimal performance. Tyr-PEA-based nanoparticles provide a potential platform for targeted drug delivery, particularly potent actives.

Objectives: Hypotension is overlooked because it is often harmless, easily reversed, and can have few or even no symptoms. However, complications of untreated hypotension are dangerous and can result in death. The aim of this study was to examine the trend of hospital admission due to hypotension in Australia and in England and Wales between 1999 and 2020. Method: This was a secular trend analysis study that examined the hospitalisation pattern for hypotension in Australia, England, and Wales between 1999 and 2020. Hospitalisation data were obtained from the National Hospital Morbidity Database in Australia, Hospital Episode Statistics database in England, and Patient Episode Database for Wales. We analysed the variation in hospitalisation rates using the Pearson chi-square test for independence. Results: Our study showed that hypotension hospital admission rates increased significantly between 1999 and 2020 by 168%, 398%, and 149% in Australia, England, and Wales, respectively. The most common hypotension hospital admissions reason was orthostatic hypotension. All types of hypotension-related hospital admissions in Australia, England, and Wales were directly related to age, more common among the age group 75 years and above. Bed-days hypotension hospital admission patients accounted for 84.6%, 99.5%, and 99.7% of the total number of hypotension hospital admissions in Australia, England, and Wales. Conclusion: In the past two decades, orthostatic hypotension was the most prevalent type of hypotension that required hospitalization in Australia, England, and Wales. Age was identified as the primary risk factor for hypotension across all causes. Future research should focus on identifying modifiable risk factors for hypotension and developing strategies to reduce the burden of orthostatic hypotension.

This study aims to assess and evaluate the knowledge, beliefs, behaviors, and practices about COVID-19 among different categories of Jordanian people including pregnant and breastfeeding mothers. A cross-sectional study is designed using an online survey questionnaire and a five-section questionnaire was devised to address perceptions and attitudes of the participants towards COVID-19. This study was found that more than 80% of the participants had a belief that COVID-19 can be transmitted through direct contact or spreading of air droplets from infected people to healthy ones. Around 15% of pregnant and breastfeeding women realized that the COVID-19 virus could transmit the virus to their babies. Third-fourth of the participants agreed that the elderly, pregnant, and immunocompromised people have a higher risk of being infected with COVID-19. In addition, 80% of the participants believed that using paracetamol is a good way of treating COVID-19 or reducing symptoms, while the remaining believed that they should use antibiotics as well as some vitamins to combat COVID-19. Around 70% of the participants have got their information about COVID-19 through social media while others got the information through the Jordanian Ministry of Health official website, other websites, television news, friends, relatives, and colleagues. Participants’ practices to avoid transmission of COVID-19 were adequate in more than 80% of the participants who reported that they should protect themselves as well as their families as a priority. we believe that this study allow other governments worldwide to understand the views of public people in Jordan during pandemic disease outbreaks.