Assessing community pharmacists’ responses to pregnancy-related nausea and vomiting: A national simulated patient study in Jordan

by Khalid Al Kubaisi, Derar H. Abdel-Qader, Nadia Al Mazrouei, Abduelmula R. Abduelkarem, Yahya H. Dallal Bashi Dallal Bashi, Moh’d Ahmad Shara

Background and aim

Nausea and vomiting of pregnancy (NVP) is the most common medical condition of gestation, affecting up to 90% of women and significantly impacting their quality of life. Community pharmacists (CPs) are often the first point of contact for these women, yet there is a lack of objective data on their practice quality in Jordan. This study aimed to conduct the first national, simulated patient study to assess objectively the assessment, management, counseling, satisfaction and predictors of appropriate practice among Jordanian community CPs when managing NVP.

Materials and methods

A national, cross-sectional study using a simulated patient methodology was conducted in 380 community pharmacies, selected via proportionate stratified random sampling. Two validated scenarios (mild NVP and severe NVP with red flags) were used. A validated structured data collection form documented CPs ‘ assessment, management, counseling, and patient satisfaction. Multivariable logistic regression was used to identify independent predictors of “Appropriate Practice.” All data were analysed using SPSS (V28.0).

Results

A significant gap between guideline-recommended care and actual practice was evident, particularly in high-risk situations. While most CPs (84.2%) initiated symptom inquiry, crucial assessment of red flags in the severe NVP scenario was dangerously low (e.g., inquiry about dehydration, 21.1%). This assessment failure translated directly to practice: only 56.8% of CPs correctly referred the high-risk patient, while 43.2% inappropriately sold an over-the-counter medication, delaying necessary medical care. Counseling on medication safety was consistently poor, with only 29.9% of CPs discussing potential side effects. Despite these clinical deficiencies, the overall patient satisfaction was high, appearing to be driven more by interpersonal skills than clinical accuracy. Multivariable analysis revealed that appropriate practice was independently predicted by prior maternal health training (aOR = 3.48, p p = 0.009). Conversely, a high pharmacy workload was a significant independent barrier, reducing the odds of providing appropriate care by 50% (aOR = 0.50, p = 0.018).

Conclusion

Jordanian community CPs are a critical but currently underperforming resource in maternal care. The prevalent gaps in clinical assessment and referral for severe NVP represent a significant patient safety risk. A one-size-fits-all approach to quality improvement is unlikely to succeed. Instead, a dual-pronged strategy is essential: (1) national professional pharmacy bodies must mandate targeted continuing professional development in maternal health, focusing on risk assessment and referral protocols; and (2) health policymakers and community pharmacy owners must address systemic barriers, particularly the detrimental impact of high workload on the delivery of safe and effective patient care.

Prevalence of uremic neuropathy and the effect of dialysis in children with end-stage renal disease: A cohort study

by Arwa Yahyaoui, Nouha Gammoudi, Selsabil Nouir, Sameh Mabrouk, Hela Ghali, Saoussen Abroug, Ghazi Sakly

Children with chronic kidney disease (CKD) face increased morbidity, mortality, and reduced quality of life. Uremic neuropathy (UN) is a common neurological complication, but data on its relationship with dialysis in pediatric populations are limited. This prospective study aimed to assess the prevalence of UN in children with end-stage renal disease (ESRD) in a Tunisian population and explore the association between dialysis and UN. Conducted between July and September 2023 in the nephrology and neurophysiology units of a Tunisian hospital, the study included 31 children with CKD G5. Clinical data, biological analyses, and nerve conduction studies via electroneuromyography (EMG) were performed at baseline and six months later. Participants were divided into pre-dialysis and dialysis groups for comparison. The mean age was 11 ± 3.5 years, and the average age at CKD diagnosis was 7.5 ± 4.2 years. UN was diagnosed in 45% of participants using EMG, including 13% with silent neuropathy. Axonal neuropathy was predominant, with no cases of demyelinating neuropathy identified. Initial comparisons between dialysis and pre-dialysis groups showed no significant differences in UN characteristics. However, clinical neuropathy, weight-for-age, and glomerular nephritis were significantly associated with UN. Follow-up revealed a significant improvement in UN in the dialysis group. From this study, we conclude the importance of screening for UN in pediatric ESRD care and recommend routine EMG evaluations, even in asymptomatic patients, to ensure early diagnosis and management.