An Evaluation of Medication Safety related Communications in the Patient Healthcare Pathway in Kuwait

Background: Patient safety is a recognised public health issue. When post-market medication safety information emerges, the benefits and risks of the medication concerned are usually evaluated by drug regulatory agencies. The outcomes of such pharmacovigilance activities are communicated to the public, patients and other healthcare professionals (HCPs). The aim of these medication safety communications might vary from improving the intended recipients’ knowledge or attitudes to outlining specific actions to be followed by them. However, it is currently recognised that sharing medication-related information does not improve patients’ safety on its own if not accompanied by an accurate implementation of these recommendations in clinical practice. Despite their importance in protecting patient safety and subsequently affecting public health, no previous study was found to have evaluated or described the process of creating and disseminating medication safety communications by the Kuwaiti drug regulatory agency. Equally, no study was found to have investigated the impact of or the factors affecting the implementation of regulatory-related medication safety communications in Kuwait. Therefore, this thesis aimed to address these gaps in knowledge by evaluating medication safety communications in the patient healthcare pathway in Kuwait. Methods: This multiphase study was preceded by a systematic literature review of the factors affecting HCPs’ implementation of regulatory-related medication safety communications, using a narrative synthesis approach. Following the systematic review, multiphase research was initiated. This consisted of three phases, each of which focused on a specific stakeholder group involved in the process of medication safety communication. Phase 1 involved Kuwait Drug and Food Control (KDFC), an administration within the Ministry of Health (MOH), as the regulatory agency responsible for pharmacovigilance activities. This was a convergent mixed-methods study. Data collection in this phase included documents produced by KDFC or issued to KDFC relating to medication safety and three face-to-face interviews with KDFC employees involved in pharmacovigilance activities. Documents were analysed using a descriptive quantitative approach and a framework analysis technique. Phase 2 focused on healthcare professionals working in MOH hospitals in Kuwait. This phase was an exploratory mixed-methods study, where focus group discussions were conducted followed by the distribution of an online survey. The focus group discussions were analysed using a thematic analysis technique. In the second part of this phase, an online survey was developed based on Phase 1, the focus group discussions and the systematic literature review. Survey data analysis included descriptive analysis (frequency and percentile) and statistical analysis including principal component analysis (PCA) and the Kruskal–Wallis H test, which was followed by a post hoc analysis of variables that had significant results. Other statistical tests applied included Fisher’s exact test, the Mann–Whitney U Test, and multivariate regression analysis. Participants’ answers to open-ended survey questions were analysed using a conventional content analysis technique. Phase 3 was an interpretive phenomenology study. This phase involved semi-structured phone interviews with six female patients of childbearing age who used a valproate-related medication for epilepsy or migraine. These patients had been prescribed the valproate-related medication in one of six secondary hospitals and one specialist neurology hospital within the MOH hospitals. An interpretive phenomenological analysis technique was applied to analyse the transcripts. Results: The results of the systematic literature review indicated that the factors affecting HCPs’ implementation of medication safety communications occur at multiple levels. These levels included the sources or senders of the safety information (delays in the delivery of medications safety communications), healthcare institutions (hospitals’ position and interpretations of the recommendations), the HCPs (knowledge of the content of medications safety communications), and the patients and/or their carers (willingness to use the medication concerned). Phase 1 revealed a lack of legislation and a pharmacovigilance-specific policy. Results from Phase 2 reflected poor knowledge of the concept of medication safety communications within the context of pharmacovigilance and a lack of familiarity with the tools used by KDFC to communicate emerging medication information among HCPs. In the survey, although the majority of HCPs who responded were aware of the teratogenicity of VRM (65.1%, (n = 110/169)), only 2.6% had responded correctly to the statements of the VRM KDFC recommendations. More than half of the participants (57%) reported changing their practice to accommodate at least one intended KDFC recommendation. Providing female patients with written information (37.2%) and counselling female patients about contraceptive use (37.2%) were the most reported intended changes in practice. The most reported barriers to implementation included not having the capacity in terms of time and/or the infrastructure to implement the recommendations (33.8%). Four themes originating from patient interviews included (1) the timeline of the patient’s experience (2) varied knowledge and perception with valproate use, (3) patient’s expectations from HCPs and (4) experiences and preferences towards medication safety communications. Conclusion: Medication safety communications are essential tools for disseminating information related to medication safety updates to HCPs, patients and the public. This research identified challenges at the level of the sender (KDFC) and the intended recipients (HCPs and patients) that could reduce the ability of KDFC’s medication safety communications to reach clinical practices. The first step in increasing their reach is to adapt electronic methods for disseminating such information. Involving stakeholders, such as HCPs and patients, in evaluating the clarity and understandability of KDFC’s medication safety communications should be the focus of future research

A mobile application for improving student reading fluency, comprehension, engagement and satisfaction using Universal Design for Learning and digital storytelling

The purpose of this research is to examine the effect of a novel mobile education application that uses Universal Design for Learning (UDL) and digital storytelling on the reading fluency, comprehension, engagement and satisfaction of children learning to read Arabic. For the purpose of this research, an interactive mobile learning application was developed based on the idea of targeting learners’ individual needs, where students progress from reading single words to sentences and creating their own stories and sharing them on a bespoke website. The participants for this study were second-year primary school children, their parents and their Arabic language teachers from different primary schools in Saudi Arabia. Due to the closure of the schools in Saudi Arabia as a result of the Covid-19 pandemic, this study was conducted online. This study employed both qualitative and quantitative approaches to measure the effectiveness of the interactive tool and to obtain knowledge about the pupils' technological backgrounds. The qualitative approach involved online semi-structured interviews for the teachers and online observations of children interacting with the application. The quantitative approach is based on online questionnaires for both the children and their parents to obtain opinions about the system, while the parent survey also examined the children’s prior knowledge of using technology and the home literacy environment. Additionally, the quantitative phase involved pre- and post-tests to assess reading fluency and comprehension of the experimental and control groups before and after the experimental group engaged with the application. The qualitative results showed that the application elicited a high level of engagement and satisfaction; and the quantitative results strongly indicated that children who used the system had increased reading fluency and comprehension compared to the control group. The results of this research strongly indicate that a mobile system based on UDL and digital storytelling can have a significant positive effect on fluency, comprehension, engagement and satisfaction when learning to read Arabic

An investigation into the effectiveness of antimicrobial stewardship during a pandemic- COVID-19 in acute care setting

Review question 1. What strategies have been employed for effective antibiotic utilization/antimicrobial stewardship during pandemics? 2. What challenges have arisen in the use of antibiotics due to pandemics? 3. What antibacterial stewardship strategies have been employed in the acute care setting during the COVID-19 pandemic? 4. What antibacterial stewardship strategies can be adapted for use in acute care settings during pandemics? Searches [1 change] Firstly, rapid reviews in the PROSPERO were conducted for previously accepted systematic reviews, using different search terms that were used to carry out database searches for published articles from 2007 to March 2021. Then, the first search was completed on MEDLINE, using a comprehensive list of search terms, and this search was then amended or modified in the subsequent databases depending on the subject headings and keywords and their synonyms identified in the databases with more relevant and related keywords. A combination of keywords (searching the title and abstract) and index terms, as well as their synonyms where applicable, were used depending on the database. Spelling variations for different search terms were also employed. then search continued using the title field of the following databases: AMED (Allied and Complementary data Medicine); EMBASE; Embase classic; Global Health; HMIC (Health Management Information Consortium); International Pharmacutical Abstracts; Health and Psychosocial Instruments; PsycEXTRA; PsycINFO; Maternity & Infant Care Database (MIDIRS); PubMed; Scopus; Web of Science; C​I​N​A​H​L

Antimicrobial stewardship implementation before and during the COVID-19 pandemic in the acute care settings: a systematic review

© The Author(s) 2023. This article is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.Introduction: Antibiotics are widely administered for various indications, leading to increased antimicrobial resistance (AMR) in acute care hospitals. Since the onset of the COVID-19 pandemic, Antimicrobial Stewardship (AMS) effective strategies should be used to maintain the rational use of antibiotics and decrease the threat of Antimicrobial Resistance (AMR). Aim: This systematic literature review aims to investigate the AMS intervention Before-the-pandemic (BP) and During-the-pandemic (DP) from the literature. Design and setting: Systematic literature review of primary studies on AMS implementation in acute care settings. Methods: Relevant studies published between 2000 and March 2021 were obtained from Medline (via PubMed), OVID, CINAHL, International Pharmaceutical Abstracts, Psych Info, Scopus, Web of Science, Cochrane Library, OpenGrey, and Google Scholar, using a comprehensive list of search terms. Public Health England (PHE) toolkit was agreed upon as a gold standard for the AMS implementation. Results: There were 8763 articles retrieved from the databases. Out of these, 13 full-text articles met the inclusion criteria for the review. The AMS implementation was identified in the included studies into AMS strategies (Core strategies & Supplemental strategies), and AMS measures BP and DP. Conclusion: This Systematic literature review summarises AMS implementation strategies and measures all over the previous 20 years of research. There are many lessons learnt from COVID-19 pandemic. The proper selection of the AMS implementation strategies and measures appeared to be effective in maintaining the appropriate use of antibiotics and decreasing the AMR threat, especially during the COVID-19 pandemic. Further studies are required to provide empirical data to evaluate the AMS implementation and identify which of these strategies and measures were effective BP and DP. In order to be prepared for any emergency/crisis or future pandemics.Peer reviewe

The influential factors of business development among SMEs in the food Industry of the GCC region

SMEs are the core engine of most economies around the world. Empowering SMEs with the right tools, especially those tools utilized to formulate business models would help the ventures to thrive more successfully. This study aims to provide such business development support tools to the food sectors SMEs of the GCC. This paper presents the results of an on-going research, part of which is investigating the factors influencing business development decision making, among SMEs operating in the food industry of the Gulf Cooperation Council (GCC). To that end, the paper conducts an extensive literature review on the topic, which is followed by an industrial field study, and analysis of the data obtained. The field study involved 36 companies within the food industry of the GCC region. The findings from this study show that the SMEs in the food industry in the GCC region will need to have an effective business model in order to successfully run or grow their businesses. The initial result of this research shows that the business model canvas is the most suitable for SMEs in the GCC food sector. Furthermore, from the field study, a total of eleven influential factors have been identified, and these factors influence the approach to the business development process and the eventual success of such business development activities. Finally, from the eleven factors, three themes were established. These themes showed the relationship between the influential factors and the BMC; the themes were the value proposition design, customer segmentation and business planning. In conclusion, it was identified that the major challenge the food SMEs face is that of establishing a product-market fit in the development of their products and services. Product market fit as a challenge in the GCC is associated with the rapid geopolitical and social changes being experienced in the region. Hence, leading to changes in the demand and delivery of food products. Product market fit challenge is also linked to the fundamental weakness of the BMC identified in the study. Therefore, further research is required to see how the BMC can be enhanced, to make it more effective to the specific needs and structure of the GCC market environment. To do this will require to capture and incorporate the knowledge from this study and those from successful food SMEs into a single enhanced BM

The Level of Participation of Parents of Students with Learning Disabilities in the Preparation of the Individual Educational Plan in Al-Qassim Region

The study aimed to identify the level of participation of parents of students with learning disabilities in the preparation of the individual educational plan and identify obstacles of their participation from the perspective of teachers of learning disabilities. The sample consisted of 59 elementary school teachers in the region of Qassim. The study data were collected by a questionnaire prepared by the researchers. The study used the descriptive approach. The results showed that the level of participation of parents was at medium, as well as the high degree of obstacles that prevent their participation in the preparation of the individual educational plan. The results showed that there were no statistically significant differences in the level of participation and its obstacles due to the variable years of experience. It also revealed that there were no statistically significant differences in the level of participation due to the education level variable. There were statistically significant differences in participation obstacles due to the variable of scientific qualification between the sample mean and the virtual mean of the study population

The impact of moderate combination exercise on HbA1c, IL-6, and TNF in type 2 diabetic and non-diabetic subjects: an interventional non-randomized clinical trial

open access articleIntroduction: The main causes of worldwide increase in prevalence of type 2 diabetes are the daily consumption of excessive number of calories and sedentary lifestyle. Diabetes is usually accompanied by hypertension, lipid disorders and obesity that are considered as risk factors for developing diabetes. This study is designed to assess the benefit of a combined exercise programme (cardio “aerobic” and resistance) on HbA1c and the inflammatory markers (IL-6, and TNF) in type 2 diabetic (T2D) and non-diabetic (ND) subjects. Materials and methods: This is an interventional non randomized clinical trial conducted from 2016 to 2019 at exercise physiology laboratory at De Montfort University (DMU). Our target volunteers are T2D (HbA1c > 6.4), and ND (HbA1c < 5.8) with age group from 18-60 years old who are fit and able to do exercise. No restriction on weight. HbA1c, weight, BMI, waist and lung capacity were measured at baseline and at the 12th exercise session. In each exercise session the participant performed a combined exercise program consists of 30 min of resistance exercise followed by 20 min moderate cycling to be done twice a week for 6 weeks. Results: We enrolled 17 T2D intervention group 4 female and 13 male and 8 ND control group 5 female and 3 male. In both groups there was a significant reduction in HbA1c level after 6 weeks (P= 0.000). In T2D there were a significant weight reduction that decreased from (92.0± 4.3) to (90.0±4.5), (P< 0.001), BMI reduction that decreased from (30.8± 1.0) to (30.2± 0.9), (P< 0.001). In ND, the changes in weight reduction and BMI level were not significant. In T2D the changes in IL-6 level were only significant after the last exercise session. It was increased from 1.79±0.4 to 3.88±1.9 pg/ml (P=0.002), while it was not significant in ND group. In T2D and ND subjects, the changes in TNF level were insignificant. Conclusion: Development of combination exercise programs as a non-pharmacological intervention for diabetic and non-diabetic population are essential to decrease the prevalence of diabetes worldwide. In addition to conduction of public awareness events for proper implementation

Ptdins(4,5)p2 and ptdins(3,4,5)p3 dynamics during focal adhesions assembly and disassembly in a cancer cell line

Focal adhesions (FAs) are large assemblies of proteins that mediate intracellular signals between the cytoskeleton and the extracellular matrix (ECM). The turnover of FA proteins plays a critical regulatory role in cancer cell migration. Plasma membrane lipids locally generated or broken down by different inositide kinases and phosphatase enzymes to activate and recruit proteins to specific regions in the plasma membrane. Presently, little attention has been given to the use of phosphatidylinositol 4,5-bisphosphate (PtdIns(4,5)P2) and Phosphatidylinositol 3,4,5-trisphosphate (PtdIns(3,4,5)P3) fluorescent biosensors in order to determine the spatiotemporal organisation of PtdIns(4,5)P2 and PtdIns(3,4,5)P3 within and around or during assembly and disassembly of FAs. In this study, specific biosensors were used to detect PtdIns(4,5)P2, PtdIns(3,4,5)P3, and FAs proteins conjugated to RFP/GFP in order to monitor changes of PtdIns(4,5)P2 and PtdIns(3,4,5)P3 levels within FAs. We demonstrated that the localisation of PtdIns(4,5)P2 and PtdIns(3,4,5)P3 were moderately correlated with that of FA proteins. Furthermore, we demonstrate that local levels of PtdIns(4,5) P2 increased within FA assembly and declined within FA disassembly. However, PtdIns(3,4,5)P3 levels remained constant within FAs assembly and disassembly. In conclusion, this study shows that PtdIns(4,5)P2 and PtdIns(3,4,5)P3 localised in FAs may be regulated differently during FA assembly and disassembly

The impact of law enforcement on the dispensing antibiotics without prescription in Saudi Arabia : findings and implications

Background: Dispensing of antibiotics without a prescription (DAwP) has been widely practised in Saudi Arabia despite being illegal. This is a concern increasing AMR. In May 2018, the law and regulations were enforced including fines up to 100,000 SR (equivalent to US$26,666) and cancellation of licences. Consequently, we wanted to evaluate the impact. Methods: Mixed method study among 116 community pharmacies in two phases. Pre-law enforcement phase between December 2017 and March 2018 and post-law enforcement phase one year later. Each phase consisted of a cross-sectional questionnaire-based survey and a simulated client method (SCM). In the SCM, clients presented with either pharyngitis or urinary tract infections (UTI) with 3 levels: level 1 – SC asked for something to relieve the symptoms, level 2 – SC asked for something stronger if an antibiotic was not dispensed, level 3 – SC requested an antibiotic. In SCM for each phase, all 116 pharmacies were visited with at least one of the scenarios. Results: Before the law enforcement, 70.7% of community pharmacists reported DAwP was common. 96.6% and 87.7% of participating pharmacies dispensed antibiotics without a prescription for pharyngitis and UTI respectively. After law enforcement, only 12.9% of community pharmacists indicated that DAwP was common, with only 12.1% and 5.2% dispensing antibiotics without prescriptions for pharyngitis and UTI respectively and mostly after level 3. Conclusion: Law enforcement was effective. However, there is still further scope for improvement as community pharmacists are worried patients may go elsewhere if no antibiotic dispensed on request. This could include educational activities

AWARENESS OF RISK FACTORS OF DKA AMONG DIABETIC ADULTS IN KSA

Background: Diabetic ketoacidosis (DKA) is a complication of Diabetes mellitus (DM) that lingers to have high rates of morbidity and mortality regardless of advances in the management of DM. DKA mainly results from insulin deficiency from new-onset diabetes, insulin noncompliance and increased insulin need because of infection Most persons with DKA have type 1 diabetes however, a subgroup of type 2 diabetes patients might as well have ketosis-prone diabetes. Awareness of Aim of the work: To assess the level of awareness of the risk factors of DKA as well as the adherence of DM patients with drugs. Methods: This is a questionnaire-based cross-sectional study enrolling a total of 100 randomly selected diabetic Saudi adults ensuring diversity in age range and educational stages. Descriptive analysis was done using Statistical Package for Social Sciences (SPSS) 23. Awareness levels for DKA were calculated as absolute frequencies and were reported as overall percentages. Results: a total of 100 randomly selected diabetic Saudi adults (81 females and 19 males), 56% were diagnosed with DM-1 while 44% had DM-2 and only 11% were active sport practitioners. Moreover, only 62% reported a robust adherence to DM medications. The majority of the respondents scored low knowledge on DKA (54%). Regarding awareness of predisposing risk factors: 9% and 29% of the participants have related DKA to infection and febrile illness respectively. While 50% suggested an association between physical stress and DKA. Conclusion: Our results revealed a compelling need to bridge the disparity in awareness of DKA among Saudi adults with both types. The current knowledge gap doesn’t only incur a significant cost burden on the patients and their sponsors because of the high cost treatment and rehabilitation but also and more severely the complications that can be life-threatening if not spotted and treated quickly. Accordingly, we recommend the launch of education and awareness programs for the public at large, in the hope that this will lead to improved quality of life particularity for DM patients and their caregivers aa well as establishing nutrition and sports programs at schools and universities that can teach children and young adults the preventive measures and appropriate management of DKA early on in life. Other public Awareness raising campaign through TV & Radio spots, culture and art activities and informational events would add a great value. Keywords: Diabetic Ketoacidosis, Dka, Type 1 Diabetes Mellitus, Type 2 Diabetes Mellitus, Cross Section, Awareness, Risk Factors