Impact of pharmacist intervention in patient counseling at point of hospital discharge in a specialized cardiac center in Saudi Arabia

Purpose: To determine the interventions associated with the pharmacist’s patient counseling and review of discharge prescriptions of patients from a specialized cardiac center in Saudi Arabia.Methods: This was a prospective interventional study conducted at Prince Sultan Cardiac Center (PSCC) in Riyadh, Saudi Arabia for a duration of 12 months. The pharmacist responsible for providing patient counseling reviewed the patient records, collected patient demographics and clinical data, as well as medical and medication history, diagnosis and discharge (treatment) plan.Results: The study included 2008 patients who met the inclusion criteria. The counseling pharmacist identified and provided interventions to 358 (18 %) patients for 508 (3.4 %) items. About half of counseling pharmacist interventions concerned involved the addition of a drug to treatment regimen followed by drug discontinuation (28.1 %). The most common reason for adding the drug during patient counseling was the omission of medications (35 %). Angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARBs), antidiabetics and antihyperlipidemics were the classes of drugs often associated with counseling pharmacist interventions. The cost-saving interventions identified were 200 (39.4 %). Out of these, drug discontinuation (n = 143) was the most frequent suggestion provided by the intervening pharmacist, followed by a dose reduction resulting in cost savings of 66.5 % (US $6,590.10) and 8.9$ 882.32), respectively.Conclusion: The results indicate that discharge medication discrepancies decrease as a result of pharmacist-facilitated patient counseling at the point of hospital discharge.Keywords: Discharged patients, Cardiac, Counseling, Pharmacist-intervention, Coronary artery diseas

Spread, circulation, and evolution of the Middle East respiratory syndrome coronavirus

The Middle East respiratory syndrome coronavirus (MERS-CoV) was first documented in the Kingdom of Saudi Arabia (KSA) in 2012 and, to date, has been identified in 180 cases with 43% mortality. In this study, we have determined the MERS-CoV evolutionary rate, documented genetic variants of the virus and their distribution throughout the Arabian peninsula, and identified the genome positions under positive selection, important features for monitoring adaptation of MERS-CoV to human transmission and for identifying the source of infections. Respiratory samples from confirmed KSA MERS cases from May to September 2013 were subjected to whole-genome deep sequencing, and 32 complete or partial sequences (20 were ≥99% complete, 7 were 50 to 94% complete, and 5 were 27 to 50% complete) were obtained, bringing the total available MERS-CoV genomic sequences to 65. An evolutionary rate of 1.12 × 10−3 substitutions per site per year (95% credible interval [95% CI], 8.76 × 10−4; 1.37 × 10−3) was estimated, bringing the time to most recent common ancestor to March 2012 (95% CI, December 2011; June 2012). Only one MERS-CoV codon, spike 1020, located in a domain required for cell entry, is under strong positive selection. Four KSA MERS-CoV phylogenetic clades were found, with 3 clades apparently no longer contributing to current cases. The size of the population infected with MERS-CoV showed a gradual increase to June 2013, followed by a decline, possibly due to increased surveillance and infection control measures combined with a basic reproduction number (R0) for the virus that is less than 1

Parental Attitudes and Hesitancy About COVID-19 vs. Routine Childhood Vaccinations: A National Survey

Objectives: To quantify parental acceptance of the COVID-19 vaccine and assess the vaccine hesitancy (VH) for COVID-19 vs. childhood vaccines. Methods: Eight vaccine hesitancy scale (VHS) items, adopted from WHO's Strategic Advisory Group of Immunization (SAGE), were used to assess VH for COVID-19 vaccine vs. routine childhood vaccines. We distributed the online survey to parents with the commence of the national childhood COVID-19 vaccination program in Saudi Arabia. Results: Among 3,167 parents, 47.6% are decided to vaccinate their children against COVID-19. The most common reasons for refusal were inadequate safety information (69%) and worry about side effects (60.6%). Parents have a significantly greater positive attitudes toward children's routine vaccines vs. the COVID-19 vaccine, with higher mean VHS (±SD) = 2.98 ± 0.58 vs. 2.63 ± 0.73, respectively (p-value < 0.001). Parents agreed more that routine childhood vaccines are more essential and effective as compared to the COVID-19 vaccine (Cohen's D: 0.946, and 0.826, consecutively; T-test p-value < 0.00). There is more parental anxiety about serious side effects of the COVID-19 vaccine vs. routine childhood vaccines (Cohen's D = 0.706, p-value < 0.001). Parents who relied on the Ministry of Health information were more predicted (OR = 1.28, p-value = 0.035) to intend to vaccinate as opposed to those who used the WHO website (OR = 0.47, −53%, p-value < 0.001). In a multivariate logistic regression analysis, the factors associated with intention to vaccinate children were parents who received COVID-19 vaccine, older parents, having children aged 12–18, and parents with lower education levels. Conclusions: Significant proportion of parents are hesitant about the COVID-19 vaccine because they are less confident in its effectiveness, safety, and whether it is essential for their children. Relying on the national official healthcare authority's website for the source of information was associated with increased acceptance of childhood COVID-19 vaccination. As parental intention to vaccinate children against COVID-19 is suboptimal, healthcare authorities could boost vaccine uptake by campaigns targeting hesitant parents

Transmission and evolution of the Middle East respiratory syndrome coronavirus in Saudi Arabia:a descriptive genomic study

BACKGROUND: Since June, 2012, Middle East respiratory syndrome coronavirus (MERS-CoV) has, worldwide, caused 104 infections in people including 49 deaths, with 82 cases and 41 deaths reported from Saudi Arabia. In addition to confirming diagnosis, we generated the MERS-CoV genomic sequences obtained directly from patient samples to provide important information on MERS-CoV transmission, evolution, and origin. METHODS: Full genome deep sequencing was done on nucleic acid extracted directly from PCR-confirmed clinical samples. Viral genomes were obtained from 21 MERS cases of which 13 had 100%, four 85-95%, and four 30-50% genome coverage. Phylogenetic analysis of the 21 sequences, combined with nine published MERS-CoV genomes, was done. FINDINGS: Three distinct MERS-CoV genotypes were identified in Riyadh. Phylogeographic analyses suggest the MERS-CoV zoonotic reservoir is geographically disperse. Selection analysis of the MERS-CoV genomes reveals the expected accumulation of genetic diversity including changes in the S protein. The genetic diversity in the Al-Hasa cluster suggests that the hospital outbreak might have had more than one virus introduction. INTERPRETATION: We present the largest number of MERS-CoV genomes (21) described so far. MERS-CoV full genome sequences provide greater detail in tracking transmission. Multiple introductions of MERS-CoV are identified and suggest lower R0 values. Transmission within Saudi Arabia is consistent with either movement of an animal reservoir, animal products, or movement of infected people. Further definition of the exposures responsible for the sporadic introductions of MERS-CoV into human populations is urgently needed. FUNDING: Saudi Arabian Ministry of Health, Wellcome Trust, European Community, and National Institute of Health Research University College London Hospitals Biomedical Research Centre

The Epidemiology and Outcome of Biliary Atresia: Saudi Arabian National Study (2000–2018)

BackgroundThe epidemiology and outcomes of biliary atresia (BA) have been well-documented in national cohorts from two main ethnicities, namely, the Asian Orientals and Caucasians, with incidence ranging from 1 in 5,000 to 1 in 9,000 live births in East Asia and 1 in 15,000 to 19,000 live births in Europe and North America.ObjectiveWe report the first nationwide BA study outside North America, Europe, and East Asia to describe the epidemiology and outcomes of BA in Saudi Arabia.MethodsA national database of BA cases diagnosed between 2000 and 2018 was analyzed. We assessed clearance of jaundice (bilirubin &lt;20 μmol/L) in all cases that underwent Kasai portoenterostomy (KPE). We then estimated survival using the Kaplan–Meier method with endpoints of liver transplantation (LT), death, or survival with native liver (SNL).ResultsBA was diagnosed in 204 infants (106 females; 10% pre-term). The incidence of BA was 1 in 44,365, or 2.254 in 100,000 live births (range, 0.5–4 in 100,000). Polysplenia was diagnosed in 22 cases (11%). The median age at referral was 65 days. A total of 146 children (71.5%) underwent KPE at a median age of 70 days. Clearance of jaundice was achieved in 66 of the 146 (45%) infants. The 10-year SNL after KPE was 25.5%, and the overall 10-year estimated survival was 72.5%. The Kaplan–Meier survival curves for patients undergoing KPE at the age of &lt;60, 61–90, and &gt;90 days showed a SNL rate at 51.6, 33, and 12.5%, respectively, at 5 years (P &lt; 0.001). The 2-, 5-, and 10-year post-LT survival rates were 92.5, 90.6, and 90%, respectively. Undergoing an initial KPE did not impact negatively on the overall LT survival rate when compared to BA cases that underwent primary LT (P = 0.88).ConclusionThe incidence rate of BA in Saudi Arabia is lower than the incidence reported elsewhere. Late referral of BA cases remains a problem in Saudi Arabia; as a result, the SNL rate was lower than reported by other national registries. Hence, national policies devoted to timely referral and earlier age at KPE are needed

The Saudi Critical Care Society practice guidelines on the management of COVID-19 in the ICU: Therapy section

BACKGROUND: The rapid increase in coronavirus disease 2019 (COVID-19) cases during the subsequent waves in Saudi Arabia and other countries prompted the Saudi Critical Care Society (SCCS) to put together a panel of experts to issue evidence-based recommendations for the management of COVID-19 in the intensive care unit (ICU). METHODS: The SCCS COVID-19 panel included 51 experts with expertise in critical care, respirology, infectious disease, epidemiology, emergency medicine, clinical pharmacy, nursing, respiratory therapy, methodology, and health policy. All members completed an electronic conflict of interest disclosure form. The panel addressed 9 questions that are related to the therapy of COVID-19 in the ICU. We identified relevant systematic reviews and clinical trials, then used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach as well as the evidence-to-decision framework (EtD) to assess the quality of evidence and generate recommendations. RESULTS: The SCCS COVID-19 panel issued 12 recommendations on pharmacotherapeutic interventions (immunomodulators, antiviral agents, and anticoagulants) for severe and critical COVID-19, of which 3 were strong recommendations and 9 were weak recommendations. CONCLUSION: The SCCS COVID-19 panel used the GRADE approach to formulate recommendations on therapy for COVID-19 in the ICU. The EtD framework allows adaptation of these recommendations in different contexts. The SCCS guideline committee will update recommendations as new evidence becomes available

Transitioning From Individuals to Team 2: East Meets West

In today’s workplace individuals are required to join teams with others they may not know. Individuals must learn to produce the needed work, sometimes with little notice, by utilizing each team member’s skills. To do this effectively, team members must understand Team Stages, what can go wrong in teams and how to prevent or deal with these challenges, as well as a basic understanding of personality types. This report is a self-evaluation of a high performing team of six graduate students in Portland State University’s 522/622 Communication and Team Building course offered through the Engineering and Technology Management (ETM) Program in the spring of 2010. The report expresses the team’s experiences through this course, which provides students with the material and experiences to effectively develop and participate in effective teams. The team, surprised by its performance and development, uses this report to examine the events of the term by comparing it to the material covered in the term. The textbook guides and best practices are only good if the team members apply them. The team felt that an analysis comparing the material to the events of the course was not sufficient to explain why the team worked so well together. The report includes a Carl Jung and Isabel Myers-Briggs personality test analysis of the team members to see if this tool, that is easily accessible, can be utilized in future teams to reproduce the same high level of team performance

An Improved Artificial Neural Network Model for Effective Diabetes Prediction

Data analytics, machine intelligence, and other cognitive algorithms have been employed in predicting various types of diseases in health care. The revolution of artificial neural networks (ANNs) in the medical discipline emerged for data-driven applications, particularly in the healthcare domain. It ranges from diagnosis of various diseases, medical image processing, decision support system (DSS), and disease prediction. The intention of conducting the research is to ascertain the impact of parameters on diabetes data to predict whether a particular patient has a disease or not. This paper develops an improved ANN model trained using an artificial backpropagation scaled conjugate gradient neural network (ABP-SCGNN) algorithm to predict diabetes effectively. For validating the performance of the proposed model, we conduct a large set of experiments on a Pima Indian Diabetes (PID) dataset using accuracy and mean squared error (MSE) as evaluation metrics. We use different number of neurons in the hidden layer, ranging from 5 to 50, to train the ANN models. The experimental results show that the ABP-SCGNN model, containing 20 neurons, attains 93% accuracy on the validation set, which is higher than using the other ANNs models. This result confirms the model’s effectiveness and efficiency in predicting diabetes disease from the required data attributes

Unmatched case-control dataset (precautionary practices & Covid19 infection) (1).sav

    Abstract­­ Aim This study aimed to evaluate the impact of self-preventive measures (handwashing, mask-wearing, and social distancing) on preventing the Coronavirus Disease-2019 (COVID-19) infection in Saudi Arabia (KSA).  Methods An unmatched case-control study (1 to 1 ratio) was conducted with a sample size of 1102. The researchers used descriptive, bivariate, and multivariate analyses to  determine the effect of handwashing, mask-wearing behavior, and social gatherings on COVID-19 infection. Results The results evinced that participants who believed that the facemask was important for preventing COVID-19 infection were more likely protected against the disease (OR=0.450; 0.320—0.631). Using a facemask during social visits and shopping indicated a lower protective effect than using it at work (OR=1.299; 1.011—1.668). The type of mask (disposable versus cloth; OR=0.929; 0.590—0.1.462) and its wearing period (1 Conclusions This study suggested that handwashing for more than 20 seconds is the most important preventive factor among all considerations investigated. Moreover, it was noticed that disposable and cloth facemasks may have the same effect regardless of the wearing period or sterilization status. Furthermore, gathering with relatives and friends, as well as praying five times a day at the mosque, were ascertained as significant social factors in acquiring the COVID-19 infection.  Keywords: COVID-19 in Saudi Arabia, Facemask, Handwashing, Social distancing   </p