Pharmacist-led medication-related needs assessment in rural Ghana

Access to both essential and non-essential medications is increasing worldwide. While increased drug access is a positive development, many countries lack the infrastructure for appropriate distribution, administration, and monitoring of drug therapy. The objective of this study was to assess medication and pharmacy-related needs in the rural Ashanti Region of Ghana and to determine barriers of achieving optimal health outcomes in this region. Qualitative domains and associated themes were identified by observations from integration into community culture and from conduction of semi-structured interviews with local community leaders, health workers, or those with knowledge of health-related issues. Eight semi-structured interviews were completed and four thematic domains were identified; access to care, resource shortages, medication safety, and education/training. Barriers and challenges identified under each thematic domain included (but were not limited to) availability of clean water sources, shortages of medications and diagnostic equipment, financial considerations, misunderstanding of medication indications and directions for use, and shortages of qualified pharmacy or dispensary staff. Most respondents also expressed a need for continuing education and training of healthcare personnel. It can be concluded that there is a need for development of health services related to medications. Locally supported interventions and future research should focus on barriers and challenges identified from the thematic domains

Key challenges for implementing a Canadian-based objective structured clinical examination (OSCE) in a Middle Eastern context

Globalization of medical education is occurring at a rapid pace and many regions of the world are adapting curricula, teaching methods, and assessment tools from established programs. In the Middle East, the use of Objective Structured Clinical Examinations (OSCEs) is rare. The College of Pharmacy at Qatar University recently partnered with the University of Toronto and the Supreme Council of Health in Qatar to adapt policies and procedures of a Canadian-based OSCE as an exit-from-degree assessment for pharmacy students in Qatar. Despite many cultural and contextual barriers, the OSCE was implemented successfully and is now an integrated component of the pharmacy curriculum. This paper aims to provide insight into the adoption and implementation process by identifying four major cultural and contextual challenges associated with OSCEs: assessment tools, standardized actors, assessor calibration, and standard setting. Proposed solutions to the challenges are also given. Findings are relevant to international programs attempting to adapt OSCEs into their contexts, as well as Canadian programs facing increasing rates of cultural diversity within student and assessor populations

Structured Multi-Skill Assessment (SMSA) in pharmacy: A contextual adaptation for authentic assessment for colleges of pharmacy and beyond

There is a need for a contextual adaptation model of the Objective Structured Clinical Examination (OSCE) procedures and assessment methods into diverse contexts with great cultural diversity that is both affordable and achievable. This manuscript aims to describe the principles, organizational structure and theoretical framework of the Structured Multi-Skill Assessment (SMSA), a modified version of the OSCE and a performance-based assessment method developed at the Qatar University College of Pharmacy (QU CPH) that addresses contextual and cultural considerations when used in undergraduate pharmacy curricula

A Course-based Cross-Cultural Interaction among Pharmacy Students in Qatar and Canada

Objective. To develop, implement, and evaluate a course-based, cross-cultural student interaction using real-time videoconferencing between universities in Canada and Qatar. Design. A professional skills simulation practice session on smoking cessation was run for students in Qatar (n=22) and Canada (n=22). Students role played cases in small group situations and then interacted with colleagues from the other country regarding culturally challenging situations and communication strategies. Assessment. Students were assessed on analytical content and communication skills through faculty member and peer evaluation. Cultural competency outcomes were assessed using a postsession survey. Overall, 92.3% of respondents agreed that learning was enhanced through the cross-cultural exchange, and 94.9% agreed that insight was gained into the health-related issues and needs of people from another culture. Conclusion. A course-based, cross-cultural interaction was an effective method to incorporate cultural competency principles into student learning. Future initiatives should increase direct student interaction and focus on culturally sensitive topics

Blood glucose control for patients with acute coronary syndromes in Qatar

Background: Blood glucose is known to be elevated in patients presenting with acute coronary syndromes. However a gap in knowledge exists regarding effective management strategies once admitted to acute care units. It is also unknown what factors (if any) predict elevated glucose values during initial presentation. Objectives: Objectives of the study were to characterize blood glucose control in patients admitted to the cardiac care unit (CCU) in Qatar and to determine predictive factors associated with high glucose levels (>10mmol/l) on admission to the CCU. Setting: All data for this study were obtained from the CCU at Heart Hospital in Doha, Qatar. Method: A retrospective chart review was completed for patients admitted to the CCU in Qatar from October 1st, 2012 to March 31st, 2013, of which 283 were included. Baseline characteristics (age, gender, nationality, medical history, smoking status, type of acute coronary syndrome), capillary and lab blood glucose measurements, and use of insulin were extracted. Time spent in glucose ranges of 10mmol/1 was calculated manually. Univariate and multivariate logistic regression were performed to assess factors associated with high glucose on admission. The primary analysis was completed with capillary data and a sensitivity analysis was completed using laboratory data. Main outcome measure: Blood glucose values measured on admission and throughout length of stay in the CCU. Results: Capillary blood glucose data showed majority of time was spent in the range of >10mmol/l (41.95%), followed by 4–8mmol/l (35.44%), then 8–10mmol/l (21.45%), and finally 10mmol/l on admission (p<0.05) in a univariate analysis but only diabetes remained significant in a multivariate model (OR 23.3; 95% CI, 11.5–47.3). Conclusion: Diabetes predicts high glucose values on hospital admission for patients with ACS and patients are not being adequately controlled throughout CCU stay.Open Access funded by King Saud University. UREP Grant #UREP 13-060-3-014 from the Qatar National Research Fund (a member of Qatar Foundation)

Students' conception of local responses to global problems for a more peaceful and sustainable world: A collaborative education project between Brazil, Canada, Qatar, and New Zealand

Background: The concept of global citizenship aims to prepare learners to be able to function and be competitive within a global environment. Successful learners may effectively “think globally” but “act locally,” aiming to contribute to positive global change. Objective: The goal of this project was to develop research-informed curricular content for global citizenship tailored to pharmacy students using a pre-established pedagogical framework. The intended learning outcome for the content was for students to “generate local responses to global problems for a more peaceful and sustainable world.”. Methods: This study occurred over three phases. Phase 1 consisted of semi-structured interviews with practicing pharmacists in Brazil (n = 4), Canada (n = 4), New Zealand (n = 4), and Qatar (n = 4) to identify global issues for case development. Phase 2 consisted of pilot testing developed cases from Phase 1 via individual interviews with target students in Canada (n = 2) and a focus group in New Zealand (n = 5). Phase 3 consisted of implementation of a 1.5-hours teaching event in New Zealand using the refined case material and formative assessment of final-year pharmacy students (n = 120). Results: Phase 1 resulted in five case scenarios (antimicrobial resistance, drug shortages, ocean pollution, climate change, and rise of nationalism) across three categories (global health and wellbeing, climate and environment, and geopolitics and power) that were tested and refined in Phase 2. Phase 3 resulted in student groups being able to achieve the intended learning outcome on a median of 4 (range, 2-5) of the developed cases. Students' interventions included new dispensing models, use of technology, community engagement, education initiatives, and others. Conclusion: Findings support the notion that when tasked to “think globally,” students are able to “act locally” by designing pharmacy practice interventions to reduce the impact of political, environmental, and health-related global problems.This study was funded by an Internationalisation of the Curriculum Grant from the University of Otago. Open access publishing facilitated by University of Otago, as part of the Wiley - University of Otago agreement via the Council of Australian University Librarians

Impact of Genetic Polymorphisms on Phenytoin Pharmacokinetics and Clinical Outcomes in the Middle East and North Africa Region

Background Genetic polymorphisms are known to influence outcomes with phenytoin yet effects in the Middle East and North Africa region are poorly understood. Objectives The objective of this systematic review was to evaluate the impact of genetic polymorphisms on phenytoin pharmacokinetics and clinical outcomes in populations originating from the Middle East and North Africa region, and to characterize genotypic and allelic frequencies within the region for genetic polymorphisms assessed. Methods MEDLINE (1946–3 May, 2017), EMBASE (1974–3 May, 2017), Pharmacogenomics Knowledge Base, and Public Health Genomics Knowledge Base online databases were searched. Studies were included if genotyping and analyses of phenytoin pharmacokinetics were performed in patients of the Middle East and North Africa region. Study quality was assessed using a National Institutes of Health assessment tool. A secondary search identified studies reporting genotypic and allelic frequencies of assessed genetic polymorphisms within the Middle East and North Africa region. Results Five studies met the inclusion criteria. CYP2C9, CYP2C19, and multidrug resistance protein 1 C3435T variants were evaluated. While CYP2C9*2 and *3 variants significantly reduced phenytoin metabolism, the impacts of CYP2C19*2 and *3 variants were unclear. The multidrug resistance protein 1 CC genotype was associated with drug-resistant epilepsy, but reported impacts on phenytoin pharmacokinetics were conflicting. Appreciable variability in minor allele frequencies existed both between and within countries of the Middle East and North Africa region. Conclusions CYP2C9 decrease-of-function alleles altered phenytoin pharmacokinetics in patients originating from the Middle East and North Africa region. The impacts of CYP2C19 and multidrug resistance protein 1 C3435T variants on phenytoin pharmacokinetic and clinical outcomes are unclear and require further investigation. Future research should focus on the clinical outcomes associated with phenytoin therapy.The quality of each study included in the primary review was assessed by two reviewers (RD, KW) using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies, from the National Institutes of Health, National Heart, Lung, and Blood Institute [16].Scopu

A Middle Eastern journey of integrating Interprofessional Education into the healthcare curriculum: a SWOC analysis

Interprofessional education (IPE) is an emerging concept in the Middle East with a number of health professional degree programs continually striving to meet international accreditation requirements to enhance the quality of education and ensure high standards are maintained. Using the College of Pharmacy at Qatar University (CPH QU) as a model, this article describes the IPE initiatives coordinated through the College's IPE Committee, with representation from fourteen programs at four Healthcare institutions: Qatar University; Weill Cornell Medical College in Qatar; the University of Calgary in Qatar; and the College of North Atlantic in Qatar. These activities are based on the model proposed by the University of British Columbia across the different pharmacy professional years. Learning objectives for these initiatives were selected from the IPE shared competency domains and competency statements developed for Qatar context. A meeting with six faculty members, who have been instrumental to designing and executing the IPE activities in the previous 2 years, was convened. Faculty members reflected on IPE activities and collaborations with other participating programs. A structured SWOC (Strengths, Weaknesses, Opportunities, Challenges) framework was used to guide discussion. The discussion was recorded and notes were taken during the meeting. Raised points were categorized into each SWOC category for the final analysis. Implementation of IPE program is a major undertaking with a number of challenges that require invested time to overcome. This article highlights the importance of incorporating IPE into healthcare curricula to graduate students ready for collaborative practice in the workforce. Learning objectives for IPE initiatives need to be based on shared competency domains. When developing and implementing an IPE program it is necessary to align activities under a strong theoretical framework. This should be done under the leadership of an IPE steering group or committee to oversee the integration of IPE into the healthcare curriculum. The article presents many lessons learned through IPE implementation that are relevant to other academic institutions keen to incorporate IPE into their programs and also provides a successful model for integrating IPE into healthcare curricula

Evaluation of a Cumulative Performance-based Assessment for Pharmacy Students in Qatar

Background: Objective structured clinical examinations (OSCEs) are considered the most psychometrically robust form of clinical skills assessment in the health professions. In 2014, the College of Pharmacy at Qatar University (CoP-QU) piloted the first cumulative OSCE for graduating students in collaboration with the Supreme Council of Health and the University of Toronto. Since then, interest has grown in measuring the psychometric properties of this examination to ensure adequate reliability, validity and defensibility. Objectives: This study aimed to evaluate the psychometric properties of the OSCE conducted in 2015 at the CoP-QU. A secondary objective of this study was to identify quality improvement opportunities for design, implementation, and evaluation of the OSCE. Methods: The psychometric analysis occurred as follows: We calculated cut scores and pass rates of the 10 stations being used in the OSCE assessment using borderline regression method. Predictive validity of undergraduate courses grades with OSCE grades were calculated using correlation and regression statistics. Concurrent validity of similar cumulative exams were evaluated using Pearson correlation. Risk of bias was calculated using Spearman correlation between assessors' analytical (checklist sheet of required tasks to be performed in a station) and global (the score of whole performance including communication skills on a scale from 1 to 5) scoring. Content validity was assessed quantitatively using 18 student-feedback forms and qualitatively through focus groups with OSCE participants and contributors (total of 5 assessors, 3 students, 3 administrators, 3 standardized patients). Interrater reliability was assessed using intra-class correlation coefficients (ICCs). Construct validity was evaluated by comparing interrater reliability between the first and second OSCE cycles. Cronbach's alpha was used to determine internal consistency of students' performance in all stations in terms of global and total scores. Correlation statistics were conducted at ? level 0.05), 0.65 (P 0.05) respectively. OSCE grades can be moderately predicted by Professional skills course grades (52.3%) and its practical assessment (61.2%). Average correlation between analytical and global grades for all assessors was 0.52. A total of 90% of the stations were deemed to reflect practice, according to student perceptions. The average ICC of analytical checklists scores, global scores, and total scores were 0.88 (0.71-0.95), 0.61 (0.19-0.82), and 0.75 (0.45-0.88) respectively. Cronbach's alpha of students' performance in global scores across stations was 0.87, and 0.93 in terms of total scores. Conclusion: The cumulative OSCE conducted in 2015 showed acceptable validity and reliability as a high stakes examination and therefore is suitable to be implemented as a mandatory core curriculum component for student pharmacist assessment in Qatar.qscienc

Creation of an inventory of quality markers used to evaluate pharmacokinetic literature: A systematic review

What is known and objective: Robust critical appraisal tools for clinical pharmacokinetic studies are limited. Before development of such a tool is possible, quality markers (items deemed important for credibility of study results) must be identified. We aim to create an inventory of quality markers intended for the appraisal of clinical pharmacokinetic studies and to categorize identified markers into associated domains of study quality. Methods: Medline via ProQuest central (1946–Sep 2020, EMBASE (1974–Sep 2020), Cochrane database of systematic reviews, Google and Google Scholar were searched using the following search categories: pharmacokinetics, reporting guidelines and quality markers. Reference lists of the identified articles were searched manually. Any article (review, study or guideline) reporting quality markers related to the appraisal of pharmacokinetic literature was eligible for inclusion. Articles were further screened and limited to those reported in English on human subjects only. Cell-based and animal-based pharmacokinetic studies were excluded. Extracted data from included articles included identified or perceived markers of quality and baseline article data. Identified quality markers were then categorized according to manuscript reporting domains (abstract, introduction/background, methodology, results, discussion and conclusion). Results and discussion: Of 789 studies identified, 17 articles were included for extraction of quality markers. A total of 35 quality markers were identified across eight categories. The most frequently reported quality markers were related to method (13/35) and result sections (6/35). Quality markers encompassed all aspects of study design and reporting and were both similar and different to established reporting checklists for clinical pharmacokinetic studies. What is new and conclusion: The inventory of quality markers is now suitable to undergo further testing for inclusion in a tool designed for the appraisal of clinical pharmacokinetic studies