Knowledge, perception, attitude and experience of pharmacist in Qatar towards drug use in pregnancy: a cross-sectional study.

Pregnancy is a state of altered physiology and medication use during this period is remarkably challenging. Pharmacists are medication experts with great knowledge of pharmacology, pharmacokinetics and are trained to apply evidence based clinical knowledge. In a study done in the USA Mitchell et al found that use of medications, either prescribed or purchased over the counter (OTC), occurred in 88.8% of all pregnancies. Whereas, in Europe, prevalence estimates of prescribed medication use vary considerably across countries, ranging from 26% in Serbia to 93% in France. Given their central role to provide medication related advice to patients we conducted a questionnaire based survey to identify the knowledge, attitude, perception and experience of pharmacist in Qatar towards drug use in pregnancy

Safety of levetiracetam in pregnancy and lactation: a systematic review.

Most women with active seizures are often encouraged to continue their antiepileptic medications during pregnancy to avoid serious fetal or maternal complications. Levetiracetam (LEV) is a newer antiepileptic drug used as adjunctive therapy in patients with refractory partial seizures with or without secondary generalization. Because of its broad-spectrum activity, LEV is becoming increasingly used in women with epilepsy of childbearing potential, during pregnancy and thus also during lactation. First generation anti-epileptics are known to cause Major Congenital Malformations (MCM) and developmental problems. However, there is paucity of literature on information regarding safety of Levetiracetam (second generation), use in pregnancy and breastfeeding. The purpose of the present study was to summarize the scientific evidence behind use of LEV during pregnancy and lactation

Cost-effectiveness analysis of dapagliflozin in addition to standard therapy in heart failure with reduced ejection fraction: A Qatari healthcare perspective

Background: Dapagliflozin has been shown to reduce the risk of heart failure hospitalization and cardiovascular mortality in patients with heart failure with reduced ejection fraction (HFrEF). 1,2 This work aims to determine the cost-effectiveness of dapagliflozin added to standard therapy versus standard therapy alone in patients with HFrEF, regardless of the presence or absence of type 2 diabetes mellitus (T2DM). Methods: A lifetime Markov model was constructed to compare the health outcomes and costs of dapagliflozin added to standard therapy versus standard therapy alone from a Qatari public healthcare perspective (Figure 1). 2 The cohort is comprised of HFrEF patients with left ventricular ejection fraction (LVEF) ? 40%, and New York Heart Association (NYHA) class II-IV with an average age of 65 years, based on Dapagliflozin and Prevention of Adverse-Outcomes in Heart Failure (DAPA-HF) trial (Table 1). 1,2 The model consisted of three health states: 'stable', 'hospitalization for heart failure', and 'dead'. Clinical inputs were derived from the results of DAPA-HF trial and costs, and utilities were estimated from published sources as well as publicly available sources in Qatar. 3 The main outcome was the incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year gained (QALY). All outcomes and costs were discounted at a rate of 3% annually. Sensitivity analyses were conducted to confirm the robustness of the results. The study was based on published data; therefore ethics approval was not required. Results: Dapagliflozin added to standard care prevented 112 heart failure hospitalization and resulted in an additional cost of QAR 33,890 (USD 9,309). This equated to an ICER of QAR 101,763 (USD 27,951) per QALY gained, below the US willingness-to-pay threshold of USD 150,000 per QALY gained. Sensitivity analyses showed the findings to be robust. Conclusion: Dapagliflozin in addition to standard care appears to be a cost-effective strategy for patients with HFrEF, regardless of the presence or absence of T2DM.qscienc

Incidence, nature and causes of medication errors in hospitalised patients in Middle Eastern countries: a systematic review protocol.

The review will consider studies, which focus on errors in hospitalised patients (of any age or speciality) in any of the countries of the Middle East. Studies of hospital practitioners (or other key stakeholders) which capture data on causes of errors will also be included. Quantitative outcomes are related to each of the review questions as follows: the incidence of medication errors and incidence of classifications of prescribing, administration and dispensing errors; the nature (e.g. classification, severity, patient outcomes) of errors; causes and contributory factors leading to errors

A case of probable esomeprazole-induced transient liver injury in a pregnant woman with hyperemesis.

We report a case of 22-year-old primigravida presented to Women's Hospital - Hamad Medical Corporation emergency with severe epigastric pain, nausea, and vomiting. On admission, she was dehydrated with remarkably worsening symptoms. Laboratory findings revealed significantly elevated liver enzymes with unknown etiology. Her past medical history showed an admission for nausea and vomiting 3 weeks previously and she was discharged on antiemetics, and esomeprazole for the first time. Due to the predominantly elevated liver enzymes, the clinical pharmacist discussed the possibility of esomeprazole-induced adverse effects and suggested to suspend esomeprazole based on the evidence from literature review. The liver enzymes showed a substantial improvement within days after the discontinuation of the drug; however, a rechallenge was not done since it could have adversely affected the mother or the fetus. Using the Naranjo Adverse Drug Reaction Probability scales, the adverse reaction due to esomeprazole was classified as 'probably'

Medication errors in hospitals in the Middle East : a systematic review of prevalence, nature, severity and contributory factors

Acknowledgements Open Access funding provided by the Qatar National Library. The authors would like to acknowledge the contribution of Doua Al Saad to quality assessment. Funding This systematic review was undertaken as part of the selffunded PhD at Robert Gordon University, UK.Peer reviewedPublisher PD

Maternal and perinatal outcomes and pharmacological management of Covid-19 infection in pregnancy: a systematic review protocol

Over 4.2 million confirmed cases and more than 285,000 deaths, COVID-19 pandemic continues to harm significant number of people worldwide. Several studies have reported the impact of COVID-19 in general population; however, there is scarcity of information related to pharmacological management and maternal and perinatal outcomes during the pandemic. Altered physiological, anatomical, and immunological response during pregnancy makes it more susceptible to infections. Furthermore, during pregnancy, a woman undergoes multiple interactions with the health care system that increases her chance of getting infected; therefore, managing pregnant population presents a unique challenge. This systematic review seeks to answer the following questions in relation to COVID-19: What are the different clinical characteristics presented in maternal and perinatal population? What are the different maternal and perinatal outcome measures reported? What are the distinct therapeutic interventions reported to treat COVID-19? Is it safe to use "medications" used in the treatment of COVID-19 during antenatal, perinatal, postnatal, and breastfeeding? The search will follow a comprehensive, sequential three step search strategy. Several databases relevant to COVID-19 and its impact on pregnancy including Medline, CINAHL, and LitCovid will be searched from the inception of the disease until the completion of data collection. The quality of this search strategy will be assessed using Peer Review of Electronic Search Strategies Evidence-Based Checklist (PRESS EBC). An eligibility form will be developed for a transparent screening and inclusion/exclusion of studies. All studies will be sent to RefWorks, and abstraction will be independently performed by two researchers. Risk of bias will be assessed using Cochrane Risk of Bias tool for randomized controlled trials, Newcastle-Ottawa Quality Assessment Scale for non-randomized studies, and for case reports, Murad et al. tool will be used. Decision to conduct meta-analysis will be based on several factors including homogeneity and outcome measures reported; otherwise, a narrative synthesis will be deemed appropriate. This systematic review will summarize the existing data on effect of COVID-19 on maternal and perinatal population. Furthermore, to the best of our knowledge, this is the first systematic review addressing therapeutic management and safety of medicines to treat COVID-19 during pregnancy and breastfeeding. This systematic review has been registered and published with Prospero ( CRD42020172773 )

Exploring facilitators and barriers to medication error reporting among healthcare professionals in Qatar using the theoretical domains framework : A mixed-methods approach

This work was supported by the Qatar National Research Fund, NPRP-7-388-3-095.Peer reviewedPublisher PD

Perspectives of healthcare professionals in Qatar on causes of medication errors : A mixed methods study of safety culture

This publication was made possible by NPRP grant NPRP 7-388-3-095 from Qatar National Research Fund (a member of Qatar Foundation). The statements made herein are solely the responsibility of the authors.Peer reviewedPublisher PD

Views and experiences of decision-makers on organisational safety culture and medication errors

ACKNOWLEDGEMENTS The authors wish to acknowledge the contributions of all interviewees, as well as support departments at Hamad Medical Corporation, Doha, Qatar. This work was supported by NPRP grant NPRP 7‐388‐3‐095 from Qatar National Research Fund (a member of Qatar Foundation). The statements made herein are solely the responsibility of the authors.Peer reviewedPublisher PD