Pharmaceutical care in the Arabic-speaking Middle East: literature review and country informant feedback

The philosophy and practice of pharmaceutical care (PC) has challenged Middle Eastern pharmacists to embrace a new paradigm that focuses on outcomes of care rather than products or tasks. Although the application of PC was found to be associated with a reduction in adverse drug reactions, length of hospital stay and cost of care in the developed world, the status and application of the practice remains less clear in the Arabic-speaking Middle East (ME). The aim of this project was to describe the current status of PC services in a number of Arabic-speaking ME countries. Methods We conducted literature search to identify what had been published on the status of PC in the ME. We also invited individuals who have good understanding of the pharmacy environment in the respective country. The individuals identified were asked to respond to a set of standardized questions relating to PC services in their countries. Results The literature search generated 12 publications in total. Ten country informants agreed to provide information on PC practice and pharmacy practice in general in their respective countries and they ultimately provided information related to these areas. Conclusions The PC concept is still often confused with clinical pharmacy, which remains to be a priority in several countries in the region. Pharmacy education is rapidly changing change in many of the ME. These changes are hoped to reflect a wider recognition and application of PC services in the hospital and community settings.qscienc

Knowledge, perception, attitude and experience of pharmacist in Qatar towards drug use in pregnancy: a cross-sectional study.

Pregnancy is a state of altered physiology and medication use during this period is remarkably challenging. Pharmacists are medication experts with great knowledge of pharmacology, pharmacokinetics and are trained to apply evidence based clinical knowledge. In a study done in the USA Mitchell et al found that use of medications, either prescribed or purchased over the counter (OTC), occurred in 88.8% of all pregnancies. Whereas, in Europe, prevalence estimates of prescribed medication use vary considerably across countries, ranging from 26% in Serbia to 93% in France. Given their central role to provide medication related advice to patients we conducted a questionnaire based survey to identify the knowledge, attitude, perception and experience of pharmacist in Qatar towards drug use in pregnancy

Safety of levetiracetam in pregnancy and lactation: a systematic review.

Most women with active seizures are often encouraged to continue their antiepileptic medications during pregnancy to avoid serious fetal or maternal complications. Levetiracetam (LEV) is a newer antiepileptic drug used as adjunctive therapy in patients with refractory partial seizures with or without secondary generalization. Because of its broad-spectrum activity, LEV is becoming increasingly used in women with epilepsy of childbearing potential, during pregnancy and thus also during lactation. First generation anti-epileptics are known to cause Major Congenital Malformations (MCM) and developmental problems. However, there is paucity of literature on information regarding safety of Levetiracetam (second generation), use in pregnancy and breastfeeding. The purpose of the present study was to summarize the scientific evidence behind use of LEV during pregnancy and lactation

Incidence, nature and causes of medication errors in hospitalised patients in Middle Eastern countries: a systematic review protocol.

The review will consider studies, which focus on errors in hospitalised patients (of any age or speciality) in any of the countries of the Middle East. Studies of hospital practitioners (or other key stakeholders) which capture data on causes of errors will also be included. Quantitative outcomes are related to each of the review questions as follows: the incidence of medication errors and incidence of classifications of prescribing, administration and dispensing errors; the nature (e.g. classification, severity, patient outcomes) of errors; causes and contributory factors leading to errors

Knowledge and practice characteristics of pharmacists in Qatar towards medication use in pregnancy: a cross-sectional survey.

Background: Medication use during pregnancy is common. Pharmacists have an important role in improving medication use during pregnancy. There is a lack of empirical evidence on pharmacists’ knowledge and practice characteristics towards medication use in pregnancy. Objectives: This study aimed to determine the knowledge and practice characteristics of pharmacists in Qatar about medicines use in pregnancy. Methods: A cross-sectional, questionnaire-based study was conducted over a period of 6 months in 2010. Questionnaires were distributed to 400 of 800 licensed pharmacists employed in Qatar (in government and private sectors). Data were collected on: demographics and practice characteristics of the pharmacists; their knowledge and perception about medication use in pregnancy; their confidence in dealing with pregnant women and physicians; and their source of the drug information. Results: of the 400 questionnaires distributed, 207 were returned (52% response rate). Most pharmacists (71%) had not participated in any educational activities on medication use in pregnancy. About 50% reported that < 10% of their workload involved dispensing medications to pregnant women. A lack of available resources and unknown pregnancy status were the main concerns about dispensing medication to pregnant women. The majority of the respondents had average knowledge about medication use in pregnancy. There was a significant association between knowledge, and continuing education and years of experience (P < 0.05). Conclusions: Pharmacists in Qatar had an average level of knowledge about medications use in pregnancy. Continuous educational programmes are needed for pharmacists in Qatar to enhance their knowledge and practice of medicine use during pregnancy

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Clinical pharmacy considerations in special population: Pregnancy and lactation

The physiological changes that occur during pregnancy and lactation may affect pharmacokinetics and pharmacodynamics of drugs. Hence, administration of medications during pregnancy and lactation may require adjustments in dose, duration, or frequency. In addition, certain drugs are known to have teratogenic effects and are therefore contraindicated in pregnancy and lactation. This article outlines the clinical considerations to be taken when treating pregnant and lactating women with medical disorders such as hypertension, diabetes, hematological disorders, gastrointestinal disorders, and postpartum depression as well as the clinical considerations in the use of medications for labor and delivery. 2019 Elsevier Inc.Scopu