Evaluating the appropriateness of carbapenem and piperacillin-tazobactam prescribing in a tertiary care hospital in Saudi Arabia

Background: Antimicrobial resistance (AMR) is presently considered an emergent major global public health concern and excessive and/or inappropriate use of broad-spectrum antimicrobials contribute to the development of AMR. Objective: To evaluate the appropriateness of carbapenems and piperacillin-tazobactam use in a tertiary care hospital. Methods: A retrospective, observational, cross-sectional, drug-utilization study was conducted. The study included all adult hospitalized patients who had received at least one dose of the antimicrobials during their admission for the period between 1 January 2016 and 31 December 2017. The appropriateness of antimicrobial therapy was evaluated according to the Infectious Diseases Society of America (IDSA) guidelines with the consideration of the institutional antibiogram. Results: Overall, 2731 patients received 5005 courses with one of the antimicrobials, for a total of 5045.9 defined daily doses (DDD) of imipenem-cilastatin, 6492.3 of meropenem and 15,595 of piperacillin-tazobactam (4.93, 6.34 and 15.24 DDD/100 bed days, respectively). The mean age of the patients who received either antimicrobial was 55.5 ± 20.3 years, with a 14-day average length of hospital stay. About half (52%) of the prescriptions were written for patients treated in the medical ward. Pneumonia (26.6%) and sepsis (24.9%) were the most common indication for the initiation of antimicrobial therapy. Of the assessed prescriptions, only 2787 (56.5%) were prescribed appropriately, with 2142 (43.5%) deemed inappropriate. The three most common reasons for inappropriate prescription were: the spectrum of activity was too broad (44.6%), followed by antimicrobial use without culture request (32.4%), and failure of suitable antimicrobial de-escalation (19.9%). Conclusions: The study indicates that the overall rate of inappropriateness was high, emphasizing the need to develop initiatives to effectively improve broad-spectrum antimicrobial prescribing

Exploring physicians' views, perceptions and experiences about broad-spectrum antimicrobial prescribing in a tertiary care hospital Riyadh, Saudi Arabia : a qualitative approach

Antimicrobial resistance (AMR) is a global public health threat associated with increased mortality, morbidity and costs. Inappropriate antimicrobial prescribing, particularly of broad-spectrums antimicrobials (BSAs), is considered a major factor behind growing AMR. The aim of this study was to explore physician perception and views about BSAs and factors that impact upon their BSAs prescribing decisions. Qualitative semistructured telephone interviews over an eleven-week period were conducted with physicians in a single tertiary care hospital in Riyadh, Saudi Arabia. Purposeful and snowball sampling techniques were adopted as sampling strategy. All interviews were audio recorded, transcribed verbatim, uploaded to NVivo® software and analysed following thematic analysis approach. Four major themes emerged: views on BSAs, factors influencing BSA prescribing and antimicrobial stewardship: practices and barriers and recommendations to improve appropriate BSA prescribing. Recommendations for the future include improving clinical knowledge, feedback on prescribing, multidisciplinary team decision-making and local guideline implementation. Identification of views and determinants of BSA prescribing can guide the design of a multifaceted intervention to support physicians and policymakers to improve antimicrobial prescribing practices

Criteria for Designing Pedagogical Agents in E-learning Environments

هدفت الدراسة الحالي إلى تحديد معايير تصميم شخصية الوكيل التربوي في بيئة التعلم الإلكتروني وفقا لثلاثة مجالات: المعايير التربوية والتعليمية، والمعايير الفنية (الصوت والتواصل اللفظي)، ومعايير المظهر الخارجي. وقد استندت الدراسة على منهج البحث الوصفي التحليلي؛ وذلك بالاستناد إلى ثلاث مراحل ابتداء من قراءة محتوى الدراسات والأبحاث السابقة في مجال الوكيل التربوي وتحليلها، ثم استخدام النتائج لبناء أداة الدراسة (الاستبانة) وتطويرها، وأخيرا اختبار الأداة كميا بتطبيقها على عينة الدراسة. تم تحديد المعايير الأساسية لشخصية الوكيل التربوي وتصنيفها بالاستناد إلى النظرية المعرفية لتعلم الوسائط المتعددة والنظرية البنائية الاجتماعية. طبقت استبانة المعايير على عينة الدراسة التي تألفت من 31 طالبة ملتحقة ببرنامج الماجستير في قسم تقنيات التعليم بجامعة الملك سعود. وقد توصلت نتائج الدراسة إلى قائمة المعايير التي تكونت من 34 معيارا، 13 معيارا تربويا وتعليميا، و10معايير فنية (الصوت والتواصل اللفظي) و11 معيارا للمظهر الخارجي. وأوصىت الدراسة بتبني تقنية الوكيل التربوي في بيئات التعلم الإلكتروني العربية وتصميمه وفقا للمعايير السابقة، كما أوصت الدراسة بتدريب المعلمين وأعضاء هيئة التدريس على التقنيات المساعدة في تصميم شخصية الوكيل التربوي.This study aimed to identify the criteria for designing the Pedagogical Agent in the e-learning environment according to three areas: educational and instructional criteria, technical criteria (voice and verbal communication), and external appearance criteria. This study adopted the analytical descriptive methodology which was conducted in three stages: reading and analysing the previous literature and research, using the data to develop the research tool, and finally testing the research tool quantitatively by applying it to the study sample. The criteria were designed based on the Cognitive Theory of Multimedia Learning and social constructivism theory. The questionnaire was applied to the study sample, which consisted of 31 students enrolled in the master program in the Department of Educational Technology at King Saud University. The study resulted in a list of 34 criteria: 13 criteria for educational and instructional areas, 10 technical criteria for the voice and verbal, and 11 criteria for the external appearance. The study recommends the adoption of the pedagogical agent technology in Arabic e-learning environments and designing it according to the criteria identified in this study. It also recommends training teachers and faculty on using different techniques for designing the pedagogical agent

Knowledge, attitudes, beliefs, and barriers associated with the uptake of influenza vaccine among pregnant women

Objective: The purpose of the study was to assess the knowledge, attitudes, beliefs, and factors associated with the uptake of the influenza (flu) vaccination in women within Saudi Arabia during their pregnancy period. Methods: A cross-sectional prospective survey was conducted on 1085 pregnant women at the antenatal clinic over a period of 6 weeks with the provision of influenza vaccination. The questionnaire collected demographic and other data; it included 12 questions on their general knowledge and assessed their attitude toward influenza vaccination, and their awareness of vaccine risk and the potential benefits during pregnancy. The knowledge score obtained was then calculated and compared. Results: A total of 998 patients took part in the questionnaire with a response rate of 92%. There was poor awareness that the flu vaccine is safe to administer during pregnancy (130, 13.1%) and that all pregnant women should receive the flu vaccine (190, 19.1%). Pregnant women with flu vaccine knowledge score of ⩽5 (range 0–12) were significantly less likely to take the vaccine (OR 3.78, 95% CI 2.68–5.26, p < 0.001). There was a low uptake of the vaccine (178, 18.1%) and only 29 (3.0%) had previously been offered the flu vaccine by any doctor during their pregnancy. In addition, 255 (25.8%) were against taking the flu vaccine during pregnancy. Conclusion: The knowledge and uptake of the influenza vaccine among Saudi pregnant women are low. One quarter was against the vaccine during pregnancy. Very few believed the flu vaccine to be safe during pregnancy. Rarely, physicians advise their clients to take flu vaccine

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population