Assessing Pharmacists Knowledge and Attitude Toward the Direct Oral Anticoagulants in Qatar

Pharmacists were found to play a key role in anticoagulation care. In order to make an appropriate selection and counselling regarding direct oral anticoagulants (DOACs), pharmacists should be knowledgeable and abiding by evidence-based practice. We aim in this study to assess the knowledge and practices of practicing hospital and community pharmacists in Qatar regarding DOACs and their reflection on the dispensing and patient education. A prospective cross-sectional survey was developed. It included questions on demographic and professional characteristics. Additionally, it evaluated the awareness regarding safety, efficacy, and dispensing of DOACs. Lastly, a separate question was used to address the participant’s satisfaction with their knowledge. A total response were received from 211 pharmacists participating in the survey. Overall awareness score was moderate (41.6% ± 26%). These scores were in alignment with participants’ self-satisfaction with knowledge on DOACs (72% of participants were not satisfied). Being a clinical pharmacist, of male gender, and with a board certification were factors associated with increased awareness on DOACs. Results from this survey point to the importance of having more educational activities in order to improve pharmacist’s knowledge of DOACs.The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The publication of this article was funded by the Qatar National Library.Scopu

What women think about consent to research at the time of an obstetric emergency: A qualitative study of the views of a cohort of World Maternal Antifibrinolytic Trial participants

Objective: The WOMAN Trial was the first in the UK to use the option of waiver of informed consent at the time of an obstetric emergency. This qualitative study aimed to investigate participants’ views of the acceptability of the recruitment methods used. Design: Qualitative study using in-depth interviews with women who did and did not give consent at the time of their recruitment to the WOMAN Trial. Setting: Highest UK recruitment site for the WOMAN Trial (129/569). Interviews were conducted in participants’ homes. Population: 40 of the 129 women who were recruited to the WOMAN Trial at one UK site were invited to take part, 15 women were interviewed. Methods: Qualitative, interview study Main outcome measures Facilitators and barriers to successful recruitment during obstetric emergencies. Guidance for future researchers. Results: Findings revealed that what is important is not so much the consent process used or a signature on a form, but the way in which consent is obtained. Clinicians who successfully negotiate consent to research during childbirth emergencies engage in a “humane choreography” of words and actions. This emphasises the importance of prompt decision making and treatment, whilst respecting the woman’s personal situation and experience. Conclusions Our findings do not support a single pathway to consent in the context of an obstetric emergency. Women understand that consent to research in an emergency is complex. Clinicians’ skills in considering the clinical, ethical and emotional aspects within the context of the clinical emergency can hamper or promote women’s satisfaction

Improving Skin Color Diversity in Cancer Detection: Deep Learning Approach

BackgroundThe lack of dark skin images in pathologic skin lesions in dermatology resources hinders the accurate diagnosis of skin lesions in people of color. Artificial intelligence applications have further disadvantaged people of color because those applications are mainly trained with light skin color images. ObjectiveThe aim of this study is to develop a deep learning approach that generates realistic images of darker skin colors to improve dermatology data diversity for various malignant and benign lesions. MethodsWe collected skin clinical images for common malignant and benign skin conditions from DermNet NZ, the International Skin Imaging Collaboration, and Dermatology Atlas. Two deep learning methods, style transfer (ST) and deep blending (DB), were utilized to generate images with darker skin colors using the lighter skin images. The generated images were evaluated quantitively and qualitatively. Furthermore, a convolutional neural network (CNN) was trained using the generated images to assess the latter’s effect on skin lesion classification accuracy. ResultsImage quality assessment showed that the ST method outperformed DB, as the former achieved a lower loss of realism score of 0.23 (95% CI 0.19-0.27) compared to 0.63 (95% CI 0.59-0.67) for the DB method. In addition, ST achieved a higher disease presentation with a similarity score of 0.44 (95% CI 0.40-0.49) compared to 0.17 (95% CI 0.14-0.21) for the DB method. The qualitative assessment completed on masked participants indicated that ST-generated images exhibited high realism, whereby 62.2% (1511/2430) of the votes for the generated images were classified as real. Eight dermatologists correctly diagnosed the lesions in the generated images with an average rate of 0.75 (360 correct diagnoses out of 480) for several malignant and benign lesions. Finally, the classification accuracy and the area under the curve (AUC) of the model when considering the generated images were 0.76 (95% CI 0.72-0.79) and 0.72 (95% CI 0.67-0.77), respectively, compared to the accuracy of 0.56 (95% CI 0.52-0.60) and AUC of 0.63 (95% CI 0.58-0.68) for the model without considering the generated images. ConclusionsDeep learning approaches can generate realistic skin lesion images that improve the skin color diversity of dermatology atlases. The diversified image bank, utilized herein to train a CNN, demonstrates the potential of developing generalizable artificial intelligence skin cancer diagnosis applications. International Registered Report Identifier (IRRID)RR2-10.2196/3489

A comprehensive review of artificial intelligence methods and applications in skin cancer diagnosis and treatment: Emerging trends and challenges

A substantial body of research has been published on artificial intelligence applications in skin cancer influenced by the latter's rising rates, the scarcity of specialized healthcare professionals, and rapid advancements in automated diagnosis and treatment methods. We present a comprehensive review employing text mining to identify key themes of artificial intelligence in skin cancer diagnosis and treatment research. Our text mining model uncovers nine key topics, including dermatological data, machine and deep learning methods, segmentation, data generation, melanoma, basal cell carcinoma, model validation, and treatment. We extensively review the literature on each topic to offer valuable insights and highlight research gaps. Our findings indicate a need for a comprehensive and diverse dataset that includes lesion images, clinical data, and treatment information. In addition, our topic analysis ranks deep learning-based diagnosis as the top topic, followed by data generation and melanoma diagnosis. These insights demonstrate the bias towards deep learning methods and the shortage of studies on rare and precancerous skin lesions. Despite the gaps defined, artificial intelligence can be utilized for triage, initial screening, providing second opinion in diagnosing complex cases, and educational purposes. Additionally, artificial intelligence models can enhance patient outcomes through early diagnosis, treatment recommendation, and response prediction

An Advanced Nursing Directive for Children With Suspected Appendicitis: Protocol for a Quality Improvement Feasibility Study

BackgroundPediatric appendicitis accounts for an estimated 7% to 10% of abdominal pain cases in the emergency department (ED). The diagnosis is time-consuming, and the investigative process depends on physician assessment, resulting in delays in diagnosis and therapeutic management. The utility of an advanced nursing directive (AND) to expedite this process is unclear and needs further exploration. ObjectiveThis study aims to describe key components of ED flow in patients with suspected appendicitis seen at a pediatric ED and pilot a directive that allows ED nurses to perform an order set that includes blood work, urine tests, analgesics, fluids, and an abdominal-pelvis ultrasound prior to physician assessment. MethodsThis study involves conducting a retrospective chart review alongside a quality improvement initiative to compare key ED flow metrics before and after AND implementation. Primary outcome measures include median time from ED triage assessment to ultrasound completion, analgesia administration, blood work results, and time to disposition (consult or discharge), alongside other key ED flow metrics for suspected appendicitis. Secondary outcomes will involve patient and caretaker satisfaction surveys. Descriptive statistics will be used to summarize the data. For differences in proportions, a chi-square test will be used. The Student t test will be used for continuous variables. A variable-controlled run chart will be performed to assess impact on ED flow metrics. Patient and family satisfaction surveys are administered immediately after the directive encounter and 7 days afterward. ResultsThere are currently 3900 patients who have been screened, 344 patients who have been enrolled, and 90 patients who have received the medical directive since implementation in June 2020. Interim results on reduction of time to diagnostic and therapeutic ED flow parameters and satisfaction surveys are expected to be published in February 2022. The final study endpoint will be in June 2022. ConclusionsThis study proposes a novel protocol for improving the diagnosis and treatment of suspected pediatric appendicitis through implementation of an evidence-based AND. This model may provide a standardized, international pathway for management of common pediatric and adult emergencies. International Registered Report Identifier (IRRID)RR1-10.2196/3315

Patients' and primary carers' views on clozapine treatment for schizophrenia: A cross-sectional study in Qatar

Subjective views of clozapine treatment among patients with schizophrenia in the Middle East and North African MENA Region have not previously been assessed. Globally, few studies have assessed the views of carers to clozapine treatment. We conducted a cross-sectional survey, using a clinician administered structured interview, of patients with schizophrenia/schizoaffective disorder prescribed clozapine in Qatar, and their primary carers. Participants were asked to rate clozapine against prior their antipsychotic treatment in terms of specific benefits and side effects. Forty-two patients and 33 carers participated in the study. Of the patients, two thirds were male, approximately half were Qatari and the mean age was 33.9 years. Patients and carers rated clozapine as superior to prior antipsychotic treatment on all 7 potential benefits inquired about. The greatest perceived benefit was improved mood. Patients rated clozapine as less likely to cause extrapyramidal side effects but more likely to cause 18 other potential side effects compared to prior antipsychotic treatment, with the greatest difference being for nocturnal salivation, increased appetite, and constipation. Nearly half of patients (48 %) and two thirds of carers (64 %) stated that they would have preferred to start clozapine earlier in their illness. Sixty percent of patients and 37 % of carers regarded the information that they had received from health professionals on clozapine as inadequate. Less than half of patients and approximately-two thirds of carers had adequate knowledge of haematological monitoring for clozapine. Generally, there were significantly positive correlation between patients and carers regarding the overall side effects of clozapine treatment. Likewise, improvement in hearing voices paranoid thoughts correlated with improved quality of life. In summary, the results show that patients and carers appreciate the benefits of clozapine despite its side effects being problematic. The results support clozapine being offered earlier in treatment and services providing more information on clozapine to patients and carers.We wish to thank the patients and carers who took part in this studyScopu

Genetic etiology of adult intellectual disability (ID) of unknown cause in Qatar: a retrospective study

Background: Intellectual disability (ID) is a common condition that consists of a heterogeneous group of clinical conditions with different etiologies, including genetic conditions. Identifying those with a genetic cause results in better clinical management. Aim: To identify the genetic etiology of ID in adult patients with unknown etiology presenting to a specialist learning disability service in Qatar. Methods: Retrospective review of chart notes of patients referred for ID service from January 1, 2015 to January 1, 2020. Results: Of the 228 patients, 82 had a known cause of ID and did not require genetic testing, 22 had an unknown cause and underwent genetic testing, and 124 had an unknown cause and did not undergo genetic testing. Of the 82 patients with a known cause of ID, about one-half had an autistic spectrum disorder (ASD) and 18 patients had a genetic disorder. Of the 22 patients who underwent genetic testing, 2 were positive for the Fragile-X mental retardation 1 gene, 3 underwent chromosomal microarray, and 7 underwent whole-exome sequencing. Seven abnormal genes were identified. Conclusions: Identifying the underlying genetic etiology of patients with ID has major implications for diagnostic and therapeutic approaches. Additionally, it guides a prediction of the natural history of the disease and makes it possible to test at-risk family members.Hamad Medical Corporation agreed to contribute toward the publication fee.Scopu

Insulin Infusion Dosing in Pediatric Diabetic Ketoacidosis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

OBJECTIVES:. In children with diabetic ketoacidosis (DKA), insulin infusions are the mainstay of treatment; however, optimal dosing remains unclear. Our objective was to compare the efficacy and safety of different insulin infusion doses for the treatment of pediatric DKA. DATA SOURCES:. We searched MEDLINE, EMBASE, PubMed, and Cochrane from inception to April 1, 2022. STUDY SELECTION:. We included randomized controlled trials (RCTs) of children with DKA comparing intravenous insulin infusion administered at 0.05 units/kg/hr (low dose) versus 0.1 units/kg/hr (standard dose). DATA EXTRACTION:. We extracted data independently and in duplicate and pooled using a random effects model. We assessed the overall certainty of evidence for each outcome using the Grading Recommendations Assessment, Development and Evaluation approach. DATA SYNTHESIS:. We included four RCTs (n = 190 participants). In children with DKA, low-dose compared with standard-dose insulin infusion probably has no effect on time to resolution of hyperglycemia (mean difference [MD], 0.22 hr fewer; 95% CI, 1.19 hr fewer to 0.75 hr more; moderate certainty), or time to resolution of acidosis (MD, 0.61 hr more; 95% CI, 1.81 hr fewer to 3.02 hr more; moderate certainty). Low-dose insulin infusion probably decreases the incidence of hypokalemia (relative risk [RR], 0.65; 95% CI, 0.47–0.89; moderate certainty) and hypoglycemia (RR, 0.37; 95% CI, 0.15–0.80; moderate certainty), but may have no effect on rate of change of blood glucose (MD, 0.42 mmol/L/hr slower; 95% CI, 1 mmol/L/hr slower to 0.18 mmol/L/hr faster; low certainty). CONCLUSIONS:. In children with DKA, the use of low-dose insulin infusion is probably as efficacious as standard-dose insulin, and probably reduces treatment-related adverse events. Imprecision limited the certainty in the outcomes of interest, and the generalizability of the results is limited by all studies being performed in a single country