Utilization of adjusted body weight for dosing unfractionated heparin in obese patients with venous thromboembolism: A retrospective matched cohort study

Purpose: To evaluate the effectiveness of adjusted body weight (AjBW)-based dosing of unfractionated heparin (UFH) in obese patients vis a vis actual body weight (ABW)-based dosing in non-obese patients with venous thromboembolism (VTE).Methods: A retrospective chart review was conducted for obese and non-obese patients initiated on UFH for treating VTE from September 2013 to December 2014. Patients were excluded from the study if they were under 18 years old, developed heparin-induced thrombocytopenia during treatment, received thrombolytic therapy prior to UFH, or received UFH at a dose that did not follow the institution’s protocol. The primary objective was to assess the efficacy of dosing UFH based on AjBW in achieving a therapeutic activated partial thromboplastin time (aPTT) within the first 24 h in obese patients, in comparison to the standard ABW-dosing for non-obese.Results: Of the 57 patients included in the study, 27 patients (47.4 %) were obese, and 30 patients (52.6 %) were non-obese; 16 (59.25 %) of the obese patients achieved a therapeutic aPTT within the first 24 h of AjBW-based dosed UFH, while 18 (60 %) of the non-obese patients achieved a therapeutic aPTT within the first 24 h of ABW-based dosed UFH (p = 0.45).Conclusion: AjBW-based dosing of UFH in obese patients demonstrates comparable efficacy to ABWbased dosing in non-obese patients. Keywords: Obesity, Unfractionated heparin, Venous thromboembolism, Adjusted body weight, Ideal body weigh

A comparative study of voluntarily reported medication errors among adult patients in intensive care (IC) and non- IC settings in Riyadh, Saudi Arabia

Purpose: To investigate the risk factors associated with medication errors and to compare the incidence and types of voluntarily reported medication errors among adult intensive care unit (ICU) and non-ICU patients at King Abdulaziz Medical City, Riyadh, Saudi Arabia.Methods: The design of this study was retrospective. All voluntarily reported medication errors involving adult patients (≥ 18 years) who were admitted into King Abdulaziz Medical City during the study period (January 2012 to June 2013) were included in the study. Reported medication errors were classified as ICU or non-ICU errors. Medication errors were also classified according to the node of medication use, harm category, and type of medication errors.Results: A total of 31,399 patients admitted into the hospital were included in the study, with 1,966 (6 %) admitted into the ICU and 29,433 (94 %) admitted into the non-ICU units. Overall, the incidence of medication errors was 1.2 % (390/31,399), 1. Over half of the errors were administration-related (51 %). The incidence of medication errors was 5.5 % (108/1,966) in ICU compared with 0.96 % (282/29,433) in non-ICU units (p < 0.001. In both settings, prescribing errors, delay in drug administration and dispensing extra dose were the most common medication errors. Higher risk for medication errors was significantly associated with admission into ICU vs. non-ICU units [OR = 5.24, 95 % CI: (4.12, 6.65); p < 0.001] and with patients’ age ≥ 60 vs. < 60 years [OR = 1.48, 95 % CI: (1.19, 1.83); p < 0.001].Conclusion: Medication errors are common in the health facility and occur during all stages of medication use from prescribing to administration. Higher risk for medication errors is associated with admission into the ICU and with patients’ age ≥ 60. Physician, pharmacists, and nurses need to be vigilant, up-to-date, and continuously trained to reduce the incidence of medication errors.Keywords: Medication errors, Voluntary reporting, Intensive care unit, Hospital settin

Prevalence and associated factors of polypharmacy among adult Saudi medical outpatients at a tertiary care center

Objective: The objective of this study was to assess the prevalence of polypharmacy (PP) and the associated factors in medical outpatients. Materials and Methods: A cross-sectional, observational, descriptive study was carried out in adult medical outpatients attending internal medicine clinics at King Abdulaziz Medical City, Riyadh, Saudi Arabia from 1 March 2009 to 31 December 2009. PP was defined as the concomitant use of ≥5 medications daily. The number of medications being currently taken by patient was recorded. Effect of patients′ age, gender, educational level, number of prescribers, disease load and disease type on PP was assessed by multivariate analysis using Statistical Package for Social Sciences Incorporated (SPSS Inc) Version 18. Results: Out of 766 patients included in the study, 683 (89%) had PP. The mean number of prescribed medications, oral pills and doses was 8.8, 9.6 and 12.1, respectively. Factors significantly associated with PP included age (≥61 years), disease load and the number of prescribers. Gender had no impact on PP while education beyond primary education significantly decreased PP. Hypertension, diabetes mellitus and dyslipidemia alone and as a cluster increased PP. Conclusion: We found an extremely high level of PP in medical outpatients at our tertiary care center. The impact of PP on medication compliance and control of underlying diseases in Saudi Arabia is unknown and needs to be studied at different levels of care

The Perceptions and Attitudes of Undergraduate Healthcare Sciences Students of Feedback: A Qualitative Study

Purpose: Regardless of the importance of feedback, many students are dissatisfied with the feedback they receive. This study was conducted to evaluate undergraduate healthcare sciences students' perceptions and attitudes toward, and their lived experiences of feedback Methods: To evaluate undergraduate healthcare sciences students' perceptions and attitudes toward feedback using a descriptive approach. A Phenomenological qualitative study. Healthcare sciences students were invited to participate in semi-structured focus groups interviews; open-ended questions were developed per the study objectives and the knowledge deficit to guide the discussion. Results: Five major themes were apparent during the discussion regarding the perceptions and attitudes of healthcare sciences students towards feedback. Students highly regard honest and continuous feedback before grading or final assessment. Students preferred receiving feedback as a private dialogue that contains balanced positive comments and points for improvements. Comparing student performance with others or providing subjective and unspecific feedback were the most common reasons for students to disregard feedback. The value of the level of faculty or years of experience was controversial among students. Limited time, poor communication skills and unavailability of a faculty member were perceived as major barriers for constructive feedback. Students recommended both peer feedback and mutual feedback between students and faculty members to be applied continuously. Conclusion: This study demonstrates that healthcare sciences students need continuous constructive feedback. Providing mutual and peer feedback as a dialogue considering balanced positive comments and points for improvement should be implemented during the educational process. Training for both faculty members and students is highly recommended. Keywords: Qualitative study, Feedback, Health-care students, Focus group

Awareness of venous thromboembolism and thromboprophylaxis among hospitalized patients: a cross-sectional study

Abstract Background Patient awareness of venous thromboembolism (VTE) and thromboprophylaxis is essential for their safety. In this study, we evaluated patients’ awareness of VTE and their perceptions of thromboprophylaxis. Methods We administered a cross-sectional survey to patients hospitalized at the King Abdulaziz Medical City, Riyadh, Saudi Arabia. Results Of 190 patients approached, 174 completed the survey, constituting a response rate of 95%. Most participants (72%) were receiving thromboprophylaxis. However, only 32 and 15% reported knowledge of deep vein thrombosis (DVT) and pulmonary embolism (PE), respectively. Fifty-five percent of participants with knowledge of DVT identified swelling of the leg as a symptom. Risk factors for blood clot development were correctly identified by about half of participants, although most agreed that blood clots can cause death (77%). The level of awareness of DVT or PE did not significantly differ by respondents’ demographics. However, awareness of DVT or PE was significantly higher among those with a personal or family history of VTE. Participants had positive perceptions of thromboprophylaxis and were satisfied with treatment (> 69%), but perceived its adverse effects less favorably and reported lower satisfaction with the information provided about DVT and PE (46%). Conclusion This study demonstrates the lack of awareness of VTE, DVT, and PE among hospitalized patients. More attention must be paid to patient education to ensure safe and high-quality patient care

Experience of and Attitudes toward Research among Pharmaceutical Sciences and PharmD Students in Saudi Arabia

Purpose: The aim of this study was to investigate attitudes toward, experience of, and perceived barriers to conducting research among Pharmaceutical Sciences and Doctor of Pharmacy (PharmD) students in pharmacy colleges in Saudi Arabia. Methods: We conducted a cross-sectional study using a validated questionnaire distributed electronically between July and August 2016 to a convenient sample of Pharmaceutical Sciences and PharmD students in Riyadh, Saudi Arabia. The questionnaire consisted of four sections: demographic information, and perceptions, experience, and knowledge of conducting research. Results: Of the 245 respondents, most (73.5%) agreed that research is important. Sixty percent agreed that conducting research should be mandatory for PharmD students. However, the majority disagreed that research experience should be a criterion for acceptance on a residency program. Of the PharmD students, 73.8% believed that research projects would improve their ability to work and think independently, whereas only 58% of Pharmaceutical Sciences students agreed (p = 0.03). More PharmD students than Pharmaceutical Sciences students believed that they would learn from research experience (65.2% vs. 40.7% [p = 0.00]) and publishing or presenting research work (61.6% vs. 39.5% [p = 0.26]). The students’ major motivations to perform research were that it is a mandatory requirement of the curriculum (43.7%), is a positive addition to one’s résumé (22.4%), and facilitates acceptance to a residency program (18.8%). Lack of time and training courses were the most commonly cited barriers to conducting research. Regarding knowledge about performing research, PharmD students had a slightly better average score than Pharmaceutical Sciences students (38.6 vs. 37.28 [p = 0.49]) in an objective assessment of knowledge. Conclusion: Overall, PharmD and Pharmaceutical Sciences students share a positive perception of the importance of research. However, their general knowledge about conducting research is low; thus, more training on time management and research processes is recommended. Keywords: Attitude, Pharmaceutical Sciences, Doctor of Pharmacy, Researc

Prevalence of Self-prescribing Propranolol Among Medical and Dental Students in Riyadh, Saudi Arabia: A Cross-sectional Study

Purpose: The life of students is full of stressors that might have an impact on their mood and academic performance. These stressors are exaggerated among medical and dental students, as they have to worry more about financial, social, and academic issues. The study aimed to estimate the prevalence and predictors of inappropriate self-prescribing of propranolol (Inderal®) among medical and dental students at King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) Riyadh, Saudi Arabia. Methods: A cross-sectional study using consecutive sampling was carried out among Saudi medical and dental students, who were enrolled in KSAU-HS during the study period. A validated newly developed English questionnaire was sent via E-mail to all eligible participants with response rate of 86.9%. Chi-square test was used to compare between groups, whereas multivariate logistic regression analysis was carried out, where the variables that were included in the model were the ones that showed statistical significance at the bivariate level. Results: Around 30% of the sample used propranolol (Inderal®) during their college years. Propranolol use predictors showed that females from both specialties were less likely to use propranolol (OR=0.11, 95% CI=0.06–0.24, P-value<.001), whereas medical students were more likely to be propranolol users (OR=12.38, 95% CI=4.89–31.35, P-value<.001). Notably, junior students were less likely to use the drug (OR=0.08, 95% CI=0.01–0.49, P-value= .006). Conclusions: The overall results showed a slightly high rate of propanol misuse among medical and dental students. The majority of users are aware of the risks and potential side effects of self-prescribing medications, however; the anxiety relieving effect of propranolol increased its use prior to oral exams and presentations. Educational activity targeting students must be implemented

Quality of Life and Stress Level Among Health Professions Students

Purpose: Numerous studies have shown that students of health professions report higher perceived stress and lower quality of life (QOL) levels than those in other disciplines. The purpose of this cross-sectional survey study is to assess variations in students’ QOL and perceived stress levels by demographic and college-related factors. Methods: The World Health Organization QOL (WHOQOL) – BREF and Perceived Stress Scale (PSS-14) were used to assess QOL and stress levels among students at King Saud Bin Abdul-Aziz University for Health Sciences (KSAU-HS), Riyadh, during December 2015–June 2016. The WHOQOL-BREF comprises four broad QOL domains: physical health, psychological health, social relationships and environment. A total score from responses to the 14 questions in the PSS was computed. Univariate statistical analyses were performed using the Chi-square/Fisher's exact test or the t-test/Mann-Whitney U test, as appropriate. Linear regression models were used to examine the independent effect of numerous demographic and college-related factors on QOL and PSS. Results: A total of 479 students completed the questionnaire, representing a response rate of 95%. Fifty nine percent of the respondents were females. Then vast majority of respondents were single (96%) and reported a household income of SAR 10,000 or higher (82%). The distribution of college enrollment was as follows: Medicine 37%, Applied Medical Sciences 18%, Nursing 16%, Dentistry 13% and Pharmacy 14%. Scores in a number of QOL domains were significantly different by gender, household income, college, academic level and smoking status. Scores in all four QOL domains were negatively correlated with PSS, indicating that better QOL is strongly and highly significantly related to lower perceived stress levels with correlations ranging from −0.27 to −0.58 (p < 0.001). PSS scores were independently and significantly associated with QOL scores in the physical and psychological health domains. Conclusions: Most students that participated in this study appeared to acknowledge challenges in various aspects of their QOL which have been shown to be associated with their perceived stress. Further studies are needed to evaluate the effect of implementing educational and counseling programs to improve QOL and reduce stress levels among health sciences students

Do clinicians want recommendations? A multicenter study comparing evidence summaries with and without GRADE recommendations

Objectives: Evidence-based clinical practice guidelines provide recommendations to assist clinicians in decision-making and to reduce the gap between best current research evidence and clinical practice. However, some argue that providing preappraised evidence summaries alone, rather than recommendations, is more appropriate. The objective of the study is to evaluate clinicians’ preferences, and understanding of the evidence and intended course of action in response to evidence summaries with and without recommendations. Study Design Setting: We included practicing clinicians attending educational sessions across 10 countries. Clinicians were randomized to receive relevant clinical scenarios supported by research evidence of low or very low certainty and accompanied by either strong or weak recommendations developed with the GRADE system. Within each group, participants were further randomized to receive the recommendation plus the corresponding evidence summary or the evidence summary alone. We evaluated participants’ preferences and understanding for the presentation strategy, as well as their intended course of action. Results: One hundred eighty-nine of 219 (86%) and 201 of 248 (81%) participants preferred having recommendations accompanying evidence summaries for both strong and weak recommendations, respectively. Across all scenarios, less than half of participants correctly interpreted information provided in the evidences summaries (e.g., estimates of effect, certainty in the research evidence). The presence of a recommendation resulted in a more appropriate intended course of action for two scenarios involving strong recommendations. Conclusion: Evidence summaries alone are not enough to impact clinicians’ course of action. Clinicians clearly prefer having recommendations accompanying evidence summaries in the context of low or very low certainty of evidence (Trial registration NCT02006017)