Understanding adverse drug-related emergency department visits: development of a conceptual model through a systematic review

Background: The burden of adverse drug event (ADE)-related emergency department (ED)visits is increasing despite several preventive measures. The objective of this paper was todevelop and validate a conceptual model for a better understanding of ADE-related ED visitsand to guide the design and implementation of effective interventions.Methods: The development of the model involved a systematic review of the literatureusing PubMed and Embase databases. Studies reporting the risk factors associatedwith ADE-related ED visits were included. The methodological qualities of the includedstudies were assessed using the Mixed Methods Appraisal Tool (MMAT). The model wasmapped and validated using face and content validity by an expert panel. Deficiencies andtargeted interventions were identified, and steps for the design and implementation wererecommended.Results: The literature search generated 1361 articles, of which 38 were included in thereview; 41 risk factors associated with ADE-related ED visits were identified. All factors weremapped, and the model was validated through face and content validity. The model consistedof six concepts related to sociodemographic factors, clinical factors, ADE-related to ED visits,ADE while in the ED, outcomes, and consequences. Interventions could be targeted at thefactors identified in each concept to prevent ADE-related ED burden.Conclusion: A conceptual model to guide the successful design and implementation ofstrategies to prevent ADE-related ED visits and the occurrence of ADE at ED was developed.Clinicians should take these factors into consideration to prevent untoward events, especiallywhen treating high-risk patients

National assessment of pharmaceutical workforce and education using the International Pharmaceutical Federation’s global development goals: a case study of Qatar

Background: The sustainable development goals were launched by the United Nations in 2015. Its fifth goal was describing the achievement of universal health coverage by 2030. This goal reaffirms the importance of investing in the development and training of the global health workforce. In alliance with this, the International Pharmaceutical Federation (FIP) has published reports about pharmacy workforce planning in several countries. However, data about Qatar were not included in these reports. In 2017, FIP developed a transformational roadmap of pharmaceutical workforce and education. One systematic framework component of the roadmap is the Pharmaceutical Workforce Development Goals (DG[w]s) that were released in late 2016 and subsequently incorporated into the more comprehensive Global Development Goals1 in 2020, encompassing not only workforce development, but additionally practice and pharmaceutical science development. This study aimed to evaluate the current situation of pharmacy workforce and education in Qatar in relation to the original 13 Pharmaceutical Workforce Development Goals (DG[w]s). The objective was to identify the gaps in pharmacy workforce and education and to recommend evidence-led strategies to be included in both the Ministry of Public Health and the Qatar University College of Pharmacy workforce development plans. Methods: Three rounds of conventional Delphi technique were conducted with expert panels of key decision-makers in pharmacy practice from the College of Pharmacy at Qatar University and the Ministry of Public Health, utilizing the FIP’s self-assessment survey. Qualitative content analysis was used to analyze and prioritize the identified gaps from the collected data. DG[w] was considered “met” if all the provided indicators were achieved, “partially met” if at least one of the indicators were achieved, and “not met” if none of the indicators were achieved Results: The lack of competency framework (DG[w]5), workforce data (DG[w]12), and workforce policy formation (DG[w]13) are three major gaps in the provision of pharmaceutical workforce and pharmacy education in Qatar, influencing other DG[w]s. These gaps need to be addressed by the formation of Qatar Pharmaceutical Association through which academic, practice, and policymaking sectors can work together in developing health workforce intelligence system. Conclusion: The results indicated that DG[w]s are interrelated and a gap in one goal can negatively influence others. Results and recommendations of this research will facilitate the implementation of strategic plans across leading pharmacy sectors to meet health needs in Qatar and achieve the third pillar of the Qatar National Vision 2030

Perception and intentions to quit among waterpipe smokers in Qatar: a cross-sectional survey

Objective: To evaluate the perceptions and attitudes of waterpipe (shisha) smokers in Qatar regarding the health risks associated with addiction and to determine their intentions to quit. Methods: A cross-sectional survey was conducted among 181 self-reported waterpipe smokers. Participants were approached in public places as well as in shisha cafes in Qatar. The questionnaire included items related to perception, attitude and intention to quit. Both descriptive and inferential statistics were performed for data analyses, with P ≤ 0.05 considered statistically significant. Results: About 44% of the respondents believed that waterpipe smoking was safer than cigarette smoking, and more than 70% would not mind if their children became involved in waterpipe smoking. More than half of the current smokers wanted to quit smoking shisha at some point, and 17% identified health concerns as the main motivating factor for their intention to quit. Conclusion: A large proportion of shisha smokers viewed shisha as a safer alternative to cigarettes, yet they admitted to intending to quit. These findings underscore the need to design educational interventions and awareness campaigns as well as impose stringent laws on waterpipe smoking in public places in Qatar.Undergraduate Research Experience Program (UREP) grant (UREP 13-063-3-016) from the Qatar National Research Fund (a member of the Qatar Foundation)

Clinical and Pharmacokinetic Outcomes of Peak–Trough-Based Versus Trough-Based Vancomycin Therapeutic Drug Monitoring Approaches: A Pragmatic Randomized Controlled Trial

Background Vancomycin therapeutic drug monitoring (TDM) is based on achieving 24-h area under the concentration–time curve to minimum inhibitory concentration cure breakpoints (AUC24/MIC). Approaches to vancomycin TDM vary, with no head-to-head randomized controlled trial (RCT) comparisons to date. Objectives We aimed to compare clinical and pharmacokinetic outcomes between peak–trough-based and trough-only-based vancomycin TDM approaches and to determine the relationship between vancomycin AUC24/MIC and cure rates. Methods A multicentered pragmatic parallel-group RCT was conducted in Hamad Medical Corporation hospitals in Qatar. Adult non-dialysis patients initiated on vancomycin were randomized to peak–trough-based or trough-only-based vancomycin TDM. Primary endpoints included vancomycin AUC24/MIC ratio breakpoint for cure and clinical effectiveness (therapeutic cure vs therapeutic failure). Descriptive, inferential, and classification and regression tree (CART) statistical analyses were applied. NONMEM.v.7.3 was used to conduct population pharmacokinetic analyses and AUC24 calculations. Results Sixty-five patients were enrolled [trough-only-based-TDM (n = 35) and peak–trough-based-TDM (n = 30)]. Peak–trough-based TDM was significantly associated with higher therapeutic cure rates compared to trough-only-based TDM [76.7% vs 48.6%; p value = 0.02]. No statistically significant differences were observed for all-cause mortality, neutropenia, or nephrotoxicity between the two groups. Compared to trough-only-based TDM, peak–trough-based TDM was associated with less vancomycin total daily doses by 12.05 mg/kg/day (p value = 0.027). CART identified creatinine clearance (CLCR), AUC24/MIC, and TDM approach as significant determinants of therapeutic outcomes. All patients [n = 19,100%] with CLCR ≤ 7.85 L/h, AUC24/MIC ≤ 1256, who received peak–trough-based TDM achieved therapeutic cure. AUC24/MIC > 565 was identified to be correlated with cure in trough-only-based TDM recipients [n = 11,84.6%]. No minimum AUC24/MIC breakpoint was detected by CART in the peak–trough-based group. Conclusion Maintenance of target vancomycin exposures and implementation of peak–trough-based vancomycin TDM may improve vancomycin-associated cure rates. Larger scale RCTs are warranted to confirm these findings.Open Access funding provided by the Qatar National Library. We would like to thank Dr. Hani Abdelaziz and Dr. Eman El-Mekaty for their efforts and contributions in the design and implementation of this study. We would also like to thank all staff at HMC who helped to conduct the study

Rare case of norethisterone-induced hepatitis: A case report.

We report a case of probable norethisterone-related liver injury, manifesting as a significant rise in liver transaminases in a 62-year-old woman. Upon discontinuation of norethisterone, liver transaminases decreased to normal level within two weeks. Knowledge of rare adverse effects of drugs such as norethisterone is necessary for rapid identification and management, especially in patients with risk factors such as non-alcoholic liver disease and obesity

Is pyridoxine effective and safe for post-partum lactation inhibition? A systematic review

What is known and objective: It has been suggested that pyridoxine has an antilactogenic effect. Studies of the efficacy of pyridoxine in suppressing lactation have reported conflicting results. The aim of this review was to evaluate the effectiveness and safety of high-dose pyridoxine in post-partum lactation inhibition. Methods: This systematic review included published trials that compared the efficacy and/or safety of pyridoxine to placebo or to other pharmacological agents for the inhibition of post-partum lactation. We searched PubMed, Embase, ScienceDirect, CINAHL, AMED, the Cochrane library and the clinical trials registry to identify relevant literature. No limit was imposed on the year of publication of the studies, and the review included studies published until 15 January 2016. Two reviewers independently extracted data and assessed the risk of bias. Results and discussion: Seven studies were included, with a total of 1155 women, of which 471 women received pyridoxine. Three studies were randomized controlled trials, whereas the remaining four studies were non-randomized controlled trials. All of the included studies were relatively small (n=18-482). The studies compared pyridoxine with placebo, bromocriptine and/or stilboestrol. Pyridoxine was given orally, with a total daily dose of 450-600 mg for 5-7 days. Two trials (n=349 participants) indicated that pyridoxine was effective in inhibiting lactation in approximately 95% of the enrolled patients. All other studies failed to demonstrate pyridoxine efficacy through either clinical assessment or prolactin level measurements. Pyridoxine safety was assessed by two trials in which no serious untoward side effects were reported. Overall, the risk of bias for most of the studies was low to moderate. What is new and conclusion: Current evidence supporting the effectiveness of high-dose pyridoxine in the inhibition of post-partum lactation is inconsistent and insufficient. Larger randomized trials are needed to confirm the efficacy of pyridoxine in post-partum lactation inhibition. 1 2017 John Wiley & Sons LtdScopu

Smoking cessation intervention: Can diabetic patients’ change their motivation to quit and nicotine dependence?

Introduction: Considering smoking tobacco is a bad habit that drive smokers to nicotine dependence; that argue an urgent need to evaluate factors keep them smoke and how a smoking cessation intervention can affect these factors and minimize their effect. As well as intervention impact on their nicotine dependence and motivation to quit. Methods: This was a randomised controlled trial involving patients with diabetes who smoked tobacco and attended the out-patient diabetes clinic at Hospital Pulau Pinang in Malaysia. Results: Among 126 participants followed over the study period, Malays represent about 41% of the participants. No significant difference between the patients in the two groups with respect to their nicotine dependence. However repeated measures test showed a significant difference over the study period but not with respect to the groups (intervention and control) Fagerström test F (2,220) = 3.663. Significant main effects were found among participants in the different groups with respect to their motivation to quit F (1,110) = 3.975. Conclusion: changing patients behaviour may need consistent and comprehensive intervention for longer time. © 2018, Pharmainfo Publications. All rights reserved