Systematic review of the safety of medication use in inpatient, outpatient and primary care settings in the Gulf Cooperation Council countries

Background Errors in medication use are a patient safety concern globally, with different regions reporting differing error rates, causes of errors and proposed solutions. The objectives of this review were to identify, summarise, review and evaluate published studies on medication errors, drug related problems and adverse drug events in the Gulf Cooperation Council (GCC) countries. Methods A systematic review was carried out using six databases, searching for literature published between January 1990 and August 2016. Research articles focussing on medication errors, drug related problems or adverse drug events within different healthcare settings in the GCC were included. Results Of 2094 records screened, 54 studies met our inclusion criteria. Kuwait was the only GCC country with no studies included. Prescribing errors were reported to be as high as 91% of a sample of primary care prescriptions analysed in one study. Of drug-related admissions evaluated in the emergency department the most common reason was patient non-compliance. In the inpatient care setting, a study of review of patient charts and medication orders identified prescribing errors in 7% of medication orders, another reported prescribing errors present in 56% of medication orders. The majority of drug related problems identified in inpatient paediatric wards were judged to be preventable. Adverse drug events were reported to occur in 8.5–16.9 per 100 admissions with up to 30% judged preventable, with occurrence being highest in the intensive care unit. Dosing errors were common in inpatient, outpatient and primary care settings. Omission of the administered dose as well as omission of prescribed medication at medication reconciliation were common. Studies of pharmacists’ interventions in clinical practice reported a varying level of acceptance, ranging from 53% to 98% of pharmacists’ recommendations. Conclusions Studies of medication errors, drug related problems and adverse drug events are increasing in the GCC. However, variation in methods, definitions and denominators preclude calculation of an overall error rate. Research with more robust methodologies and longer follow up periods is now required.Peer reviewe

Characteristics of Leaders of Change for Principals in Al Ain Schools, the United Arab Emirates

This study investigates the characteristics and skills of leaders of change that are exhibited by AI Ain Education Zone school principals. The research design is mainly a quantitative survey study. Data were gathered from 434 teachers in AI Ain schools. Means, standard deviations, t test and one-way analysis of variance were used as statistics to analyze the data. The study found out that school principals in AI Ain exhibit the characteristics of leaders of change regarding sharing vision and values, valuing human resources, fostering collaborative relationships, communicating effectively, being proactive, creating and sharing knowledge, and managing resistance to change. The study also found out that there is a significant difference in the perceptions of female and male teachers regarding school principals\u27 characteristics as leaders of change. The statistical differences were in valuing human resources and being proactive. A significant difference in the perceptions of Emirati and non-Emirati teachers of their school principals\u27 characteristics as leaders of change was also found. Non-Emirati teachers rated their principals higher in valuing human resources, communicating effectively, being proactive, creating and sharing knowledge, and managing resistance to change. However, years of experience had no impact on the teachers\u27 perceptions

Women in Cybersecurity: A Study of the Digital Banking Sector in Bahrain

Cybersecurity is of utmost importance due to the sophisticated cyber-attacks occurring, mainly in the banking sector. Cybersecurity is considered a vital industry to protect and secure both the consumer and the owner. This study aims to examine and investigate women in the field of cybersecurity in the digitized banking sector. This study covers several factors that affect women\u27s contributions in this field, including challenges and limitations, women in Fintech and ecosystem, women involved in digital transformation, women in applying cybersecurity management strategy, social and economic impacts, and skills and qualifications in the field of cybersecurity for banking. Most of the studies highlight the shortage of women in this field and the need for improvement and innovation. Quantitative and qualitative methods were conducted to ensure the credibility of the information provided. The results illustrate that women in Bahrain can work successfully in the cybersecurity field and overcome the challenges and limitations. Moreover, women are interested in advancing in this field and promoting their skills in improving cybersecurity in the digitized banking sector. Most of the previous studies have mainly focused on women joining the cybersecurity field, but they have not sufficiently addressed their role and importance in the banking sector, which is considered one of the most important sectors requiring cybersecurity. The study results recommend that the government of Bahrain and organizations can positively impact women\u27s progress in this field through encouragement and incentives, which will eventually lead to the economy\u27s growth in Bahrain. Furthermore, women\u27s awareness of the cybersecurity field as a career option should be increased through training sessions and opportunities to achieve professional qualifications and certifications

CTGA: the database for genetic disorders in Arab populations

The Arabs comprise a genetically heterogeneous group that resulted from the admixture of different populations throughout history. They share many common characteristics responsible for a considerable proportion of perinatal and neonatal mortalities. To this end, the Centre for Arab Genomic Studies (CAGS) launched a pilot project to construct the ‘Catalogue of Transmission Genetics in Arabs’ (CTGA) database for genetic disorders in Arabs. Information in CTGA is drawn from published research and mined hospital records. The database offers web-based basic and advanced search approaches. In either case, the final search result is a detailed HTML record that includes text-, URL- and graphic-based fields. At present, CTGA hosts entries for 692 phenotypes and 235 related genes described in Arab individuals. Of these, 213 phenotypic descriptions and 22 related genes were observed in the Arab population of the United Arab Emirates (UAE). These results emphasize the role of CTGA as an essential tool to promote scientific research on genetic disorders in the region. The priority of CTGA is to provide timely information on the occurrence of genetic disorders in Arab individuals. It is anticipated that data from Arab countries other than the UAE will be exhaustively searched and incorporated in CTGA ()

Acquisition of prescribing skill by medical students in a problem-based learning curriculum: preclerkship to clerkship phase transition

Background: Medical school training for students in pharmacotherapy is sub-optimal and junior doctors are not confident to prescribe drugs. This study was conducted to assess the prescribing competency of students in preclerkship and clerkship phases at a medical school that implements problem-based learning curriculum.Methods: Objective structured practical examination was used to assess prescribing competency of students in both phases. The prescribing performance was empirically categorized into poor, moderate and good competency.Results: The prescription writing skills achieved by the clerkship students did not significantly differ from that attained by students in preclerkship phase. Good prescribing competency was attained by approximately 20% of the students at the end of both phases. Preclerkship students performed better on therapeutic reasoning than those in clerkship phase. Cognitive skill that involves choosing the superior drug(s) among several alternatives as achieved less satisfactorily by majority of students from both phases of the program.Conclusions: Acquisition and further development of the prescribing competency during the clerkship phase was sub-optimal. The continuation of pharmacotherapeutic context-learning program during clerkship phase is recommended

Understanding Preclerkship Medical Students’ Poor Performance in Prescription Writing

Objectives: This study aimed to explore reasons for poor performance in prescription writing stations of the objective structured practical examination (OSPE) and absenteeism in prescription writing sessions among preclerkship medical students at the Arabian Gulf University (AGU) in Manama, Bahrain. Methods: This descriptive study was carried out between September 2014 and June 2015 among 157 preclerkship medical students at AGU. Data were collected using focus group discussions and a questionnaire with closed- and open-ended items. Results: All 157 students participated in the study (response rate: 100.0%). The most frequently cited reasons for poor performance in OSPE stations were an inability to select the correct drugs (79.6%), treatment duration (69.4%), drug quantity (69.4%) and drug formulation (68.2%). Additionally, students reported inadequate time for completing the stations (68.8%). During focus group discussions, students reported other reasons for poor performance, including examination stress and the difficulty of the stations. Absenteeism was attributed to the length of each session (55.4%), lack of interest (50.3%), reliance on peers for information (48.4%) and optional attendance policies (47.1%). Repetitive material, large group sessions, unmet student expectations and the proximity of the sessions to summative examinations were also indicated to contribute to absenteeism according to open-ended responses or focus group discussions. Conclusion:This study suggests that AGU medical students perform poorly in prescription writing OSPE stations because of inadequate clinical pharmacology knowledge. Participation in prescription writing sessions needs to be enhanced by addressing the concerns identified in this study. Strategies to improve attendance and performance should take into account the learner-teacher relationship

Management of Acute Diarrhoea in Primary Care in Bahrain: Self-reported Practices of Doctors

This nationwide study was conducted to assess the extent of adherence of primary-care physicians to the World Health Organization (WHO)-recommended guidelines on the use of oral rehydration therapy (ORT), antimicrobials, and prescribing of other drugs used in treating symptoms of acute diarrhoea in Bahrain. A questionnaire-based, cross-sectional survey was carried out in primary-care health centres. During a six-week survey period (15 August–30 September 2003), 328 (25.2%) completed questionnaires were returned from 17 of 20 health centres. In a sample of 300 patients, oral rehydration salts (ORS) solution was prescribed to 89.3% (n=268) patients; 12.3% received ORS alone, whereas 77% received ORS in combination with symptomatic drugs. Antimicrobials were prescribed to 2% of the patients. In 11.4% of the cases, rehydration fluids and other drugs were given parenterally. The mean number of drugs was 2.2+0.87 per prescription. In approximately one-third of the patients, three or more drugs were used. Primary-care physicians almost always adhered to the WHO guidelines with respect to ORT and antimicrobials. However, in several instances, ORT was prescribed along with polypharmacy, including irrational use of drugs for symptomatic relief. Effective health policies are needed to reduce the unnecessary burden on the healthcare system

Medical Students’ Perceptions of Peer Assessment in a Problem-based Learning Curriculum

Objectives: Peer assessment (PA) is believed to support learning and help students develop both professionally and personally. The aim of this study was to examine medical students’ perceptions of intragroup PA in a problem-based learning (PBL) setting. Methods: This study was carried out between September and November 2014 and involved six random groups of fourth-year undergraduate medical students (n = 60) enrolled at the Arabian Gulf University in Manama, Bahrain. While working on set tasks within a curriculum unit, each student evaluated a randomly selected peer using an English language adapted assessment tool to measure responsibility and respect, information processing, critical analysis, interaction and collaborative skills. At the end of the unit, students’ perceptions of PA were identified using a specifically-designed voluntary and anonymous selfadministered questionnaire in English. Results: A total of 55 students participated in the study (response rate: 92%). The majority of students reported that their learning (60%), attendance (67%), respect towards group members (70%) and participation in group discussions (71%) improved as a result of PA. Regarding problem analysis skills, most participants believed that PA improved their ability to analyse problems (65%), identify learning needs (64%), fulfil tasks related to the analysis of learning needs (72%) and share knowledge within their group (74%). Lastly, a large proportion of students reported that this form of assessment helped them develop their communication (71%) and self-assessment skills (73%), as well as collaborative abilities (75%). Conclusion: PA was well accepted by the students in this cohort and led to self-reported improvements in learning, skills, attitudes, engagement and other indicators of personal and professional development. PA was also perceived to have a positive impact on intragroup attitudes

Structural and mechanical characterization of custom design cranial implant created using additive manufacturing

Background: Reconstruction of customized cranial implants with a mesh structure using computer-assisted design and additive manufacturing improves the implant design, surgical planning, defect evaluation, implant-tissue interaction and surgeon's accuracy. The objective of this study is to design, develop and fabricate cranial implant with mechanical properties closer to that of bone and drastically decreases the implant failure and to improve the esthetic outcome in cranial surgery with precision fitting for a better quality of life. A customized cranial mesh implant is designed digitally, based on the Digital Imaging and Communication in Medicine files and fabricated using state of the Art-Electron Beam Melting an Additive Manufacturing technology. The EBM produced titanium implant was evaluated based on their mechanical strength and structural characterization. Results: The result shows, the produced mesh implants have a high permeability of bone ingrowth with its reduced weight and modulus of elasticity closer to that the natural bone thus reducing the stress shielding effect. Scanning electron microscope and micro-computed tomography (CT) scanning confirms, that the produced cranial implant has a highly regular pattern of the porous structure with interconnected channels without any internal defect and voids. Conclusions: The study reveals that the use of mesh implants in cranial reconstruction satisfies the need of lighter implantswith an adequate mechanical strength, thus restoring better functionality and esthetic outcomes for the patients