The prevalence of hepatic and thyroid toxicity associated with imatinib treatment of chronic myeloid leukaemia: a systematic review.

BACKGROUND: Imatinib, a potent inhibitor of targeted protein tyrosine kinases, treats chronic myeloid leukaemia (CML). Data on imatinib-associated changes in hepatic and thyroid functions are limited and conflicting. AIM: To report the prevalence of hepatic and thyroid toxicity associated with the use of imatinib in CML patients. METHOD: Articles for the systematic review were selected from electronic databases (PubMed, CINALH, Web of Science). Readily accessible peer-reviewed full articles in English published 1st January 2000 to 18th July 2023 were included. The search terms included combinations of: imatinib, CML, liver toxicity, hepatic toxicity, thyroid toxicity. Screening of titles, abstracts, full text articles was conducted independently by two reviewers. Inclusions and exclusions were recorded following PRISMA guidelines. Detailed reasons for exclusion were recorded. Included articles were critically appraised. RESULTS: Ten thousand one hundred and twenty-three CML patients were reported in the 82 included studies corresponding to 21 case reports, 2 case series, 39 clinical trials and 20 observational studies were selected. Excluding case studies/reports, 1268 (12.6%; n = 1268/10046) hepatotoxicity adverse events were reported, of which 64.7% were rated as mild grade I & II adverse events, 363 (28.6%) as severe, grade III and IV adverse events; some led to treatment discontinuation, liver transplantation and fatal consequences. Twenty (35.1%) studies reported discontinuation of imatinib treatment due to the severity of hepatic toxicity. Fourteen (8.4%, n = 14/167) thyroid dysfunction adverse events were reported. CONCLUSION: High frequency of mild and severe hepatotoxicity, associated with imatinib in CML patients, was reported in the published literature. Low numbers of mild and manageable thyroid toxicity events were reported.

Characterising the health and social care segment of the BCS (The Chartered Institute for IT) membership and their continuing professional development needs.

OBJECTIVES: The aim of this study was to identify and characterise the health and social care membership of the British Computer Society (BCS), an international informatics professional organisation, and to determine their ongoing development needs. METHODS: A prepiloted online survey included items on professional regulatory body, job role, work sector, qualifications, career stage, BCS membership (type, specialist group/branch activity (committees, event attendance)), use of BCS.org career planning/continuing professional development (CPD) tools, self-reported digital literacy and other professional registrations. The quantitative data were analysed using descriptive statistics in JASP V.0.9.2 to report frequencies and correlations. RESULTS: Responses were received from 152 participants. Most were male (n=103; 68%), aged 50-59 years (n=41; 28%), working in England (n=107; 71%) with master's or honours degrees (n=80; 53%). Most were either new (5 years or less; n=61; 40%) or long-term members (21 years or more; n=43; 28%) of BCS. Most were not interested in health specialist groups (n=57; 38%) preferring non-health specialist groups such as information management (n=54; 37%) and project management (n=52; 34%). DISCUSSION: This is the first paper to characterise the health and social care membership of an IT-focused professional body and to start to determine their CPD needs. There are further challenges ahead in curating the content and delivery. CONCLUSION: This study is the starting point from which members' CPD needs, and ongoing interest, in being recognised as health and social care professional members, can be acknowledged and explored. Further research is planned with the participants who volunteered to be part of designing future CPD content and delivery.

The physical and mental health effects of housing homeless people: A systematic review.

Housing is a significant determinant of health and is widely accepted as a key solution to address some of the health disparities that exist among the homeless. It is estimated that 150 million people worldwide are homeless, and approximately 1.8 billion lack adequate housing. However, understanding of how housing has a positive impact on the health of the homeless remains unclear and underdeveloped. This systematic review investigates intervention studies that report on the physical and mental health effects of housing homeless persons. A search of PubMed, PsycINFO, EBSCOHost-Academic Search Complete and the Cochrane Library was conducted for peer-reviewed articles published in English from 1999 to 2020 that had a combination of at least one housing intervention and health outcome, with a homeless sample. Three previous reviews and 24 studies were included for analysis. Most of the studies (n = 20) encompassed permanent supportive housing interventions that emphasised placing homeless people with mental illness directly into affordable housing with access to support services. The primary health outcomes reported were general physical and mental health, well-being, and quality of life. Despite inconsistent findings and significant issues identified in the reviewed literature, housing (in the short term) improves some aspects of health in homeless populations with human immunodeficiency virus, anxiety and depression.

Thrombotic Adverse Events Reported for Moderna, Pfizer and Oxford-AstraZeneca COVID-19 Vaccines: Comparison of Occurrence and Clinical Outcomes in the EudraVigilance Database.

Vaccination against COVID-19 is the cornerstone of controlling and mitigating the ongoing pandemic. Thrombotic adverse events linked to Moderna, Pfizer and the Oxford-AstraZeneca vaccine have been documented and described as extremely rare. While the Oxford-AstraZeneca vaccine has received much of the attention, the other vaccines should not go unchallenged. This study aimed to determine the frequency of reported thrombotic adverse events and clinical outcomes for these three COVID-19 vaccines, namely, Moderna, Pfizer and Oxford-AstraZeneca. A retrospective descriptive analysis was conducted of spontaneous reports for Moderna, Pfizer and Oxford-AstraZeneca COVID-19 vaccines submitted to the EudraVigilance database in the period from 17 February to 14 June 2021. There were 729,496 adverse events for the three vaccines, of which 3420 were thrombotic, mainly Oxford-AstraZeneca (n = 1988; 58.1%) followed by Pfizer (n = 1096; 32.0%) and Moderna (n = 336; 9.8%). As serious adverse events, there were 705 reports of pulmonary embolism for the three vaccines, of which 130 reports (18.4%) were for Moderna, 226 reports (32.1%) for Pfizer and 349 (49.5%) for Oxford-AstraZeneca vaccines. The occurrence of pulmonary embolism is significantly associated with a fatal outcome (p ≤ 0.001). Sixty-three fatalities were recorded (n = 63/3420; 1.8%), of which Moderna (n = 6), Pfizer (n = 25) and Oxford-AstraZeneca (n = 32).

The Impact of COVID-19 on Smoking Behaviours and Support for Smoke-Free Zones in Saudi Arabia.

This article focuses on the impact of COVID-19 on smoking and smoking cessation behaviours and support for smoke-free zones in Jeddah, Saudi Arabia. A pre-tested structured survey was distributed by email in October-November 2020 to students and staff at the University of Jeddah. Responses were analysed using descriptive statistics with summative content analysis of open text. Participants providing open text comments (n = 374/666; 56.4%) were non-smokers (n = 293; 78.3%), former smokers (n = 26; 7.0%) and current smokers (n = 55; 14.7%). Some had household members (n = 220; 58.8%) and friends who smoke (n = 198; 52.9%) plus daily exposure to secondhand smoke at home (n = 125; 33.4%). There was an awareness during COVID-19 of: smoking inside cafes/restaurants and other indoor and outdoor public places; exposure to warnings in the media both against and promoting smoking; widespread support for smoke-free zones. Smokers plans for accessing smoking cessation support are inconsistent with retrospective reports. Many express positivity highlighting reductions in smoking but there were also negative reports of increased smoking. The COVID-19 pandemic has affected every aspect of society worldwide. People have been at home more with restricted freedom of movement and limitations on social liberty. These individual accounts can help to focus evidence-based smoking prevention and cessation programmes during and post-COVID-19.

Analysis of Thrombotic Adverse Reactions of COVID-19 AstraZeneca Vaccine Reported to EudraVigilance Database.

The development of safe, effective, affordable vaccines against COVID-19 remains the cornerstone to mitigating this pandemic. Early in December 2020, multiple research groups had designed potential vaccines. From 11 March 2021, several European countries temporarily suspended the use of the Oxford-AstraZeneca vaccine amid reports of blood clot events and the death of a vaccinated person, despite the European Medicines Agency (EMA) and the World Health Organization's assurance that there was no indication that vaccination was linked. This study aimed to identify and analyse the thrombotic adverse reactions associated with the Oxford-AstraZeneca vaccine. This was a retrospective descriptive study using spontaneous reports submitted to the EudraVigilance database in the period from 17 February to 12 March 2021. There were 54,571 adverse reaction reports, of which 28 were associated with thrombotic adverse reactions. Three fatalities were related to pulmonary embolism; one fatality to thrombosis. With 17 million people having had the AstraZeneca vaccine, these are extremely rare events The EMA's Pharmacovigilance Risk Assessment Committee (18 March 2021) concluded that the vaccine was safe, effective and the benefits outweighed the risks. Conducting further analyses based on more detailed thrombotic adverse event reports, including patients' characteristics and comorbidities, may enable assessment of the causality with higher specificity.

Public perceptions and experiences of the minor ailment service in community pharmacy in Scotland

BACKGROUND: The Minor Ailment Service (MAS) in Scottish community pharmacy allows eligible people to gain improved access to care by providing free treatment for self-limiting conditions. OBJECTIVE: To determine the perceptions and experiences of individuals using MAS and to quantify the potential impact on usage of other healthcare services. METHODS: A cross-sectional survey was conducted of patients accessing MAS across Scotland during June and July 2018. Questionnaire items included reasons for choosing treatment through MAS, which other services they may have accessed had MAS not been available, experiences of consultation, overall satisfaction, and perceived effectiveness of treatment. Those accessing MAS were given a study pack including an information sheet, pre-piloted questionnaire, and pre-paid return envelope. Participants had the option to consent to an optional one-week follow up questionnaire that focused on perceived effectiveness of treatment after seven days and any further access to healthcare services such as general practice, emergency departments or repeat pharmacy visits. RESULTS: There were 1,121 respondents to the initial questionnaire. Most reported 'convenient Location' as the main reason for their access to community pharmacy (n=748; 67.1%). If MAS had not been available, 59% (n=655) of participants reported that they would have accessed general practice for treatment of their minor ailment. Experience of consultations was also rated highly with all ten outcome measures scoring 'Excellent' overall. Satisfaction was reported positively with most participants reporting full satisfaction with the overall experience (n=960; 87.2%). At one-week follow up, 327 participants responded, over 85% (n=281) did not require further access to care to treat their minor ailment and 99.7% (n=326) said they would use MAS again. CONCLUSIONS: Positive perceptions and experiences of those using MAS demonstrate a highly regarded service in terms of satisfaction and experience of consultation. The capacity for MAS to impact on the use of higher-cost healthcare services is evidenced through the number of participants who reported these services as a point of access to care should community pharmacy not be available. This national evaluation demonstrates MAS to be a positively experienced service and outlines the factors determining access for treatment of minor ailments

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Public perceptions and experiences of the minor ailment service in community pharmacy in Scotland.

BACKGROUND: The Minor Ailment Service (MAS) in Scottish community pharmacy allows eligible people to gain improved access to care by providing free treatment for self-limiting conditions. OBJECTIVE: To determine the perceptions and experiences of individuals using MAS and to quantify the potential impact on usage of other healthcare services. METHODS: A cross-sectional survey was conducted of patients accessing MAS across Scotland during June and July 2018. Questionnaire items included reasons for choosing treatment through MAS, which other services they may have accessed had MAS not been available, experiences of consultation, overall satisfaction, and perceived effectiveness of treatment. Those accessing MAS were given a study pack including an information sheet, pre-piloted questionnaire, and pre-paid return envelope. Participants had the option to consent to an optional one-week follow up questionnaire that focused on perceived effectiveness of treatment after seven days and any further access to healthcare services such as general practice, emergency departments or repeat pharmacy visits. RESULTS: There were 1,121 respondents to the initial questionnaire. Most reported 'convenient Location' as the main reason for their access to community pharmacy (n=748; 67.1%). If MAS had not been available, 59% (n=655) of participants reported that they would have accessed general practice for treatment of their minor ailment. Experience of consultations was also rated highly with all ten outcome measures scoring 'Excellent' overall. Satisfaction was reported positively with most participants reporting full satisfaction with the overall experience (n=960; 87.2%). At one-week follow up, 327 participants responded, over 85% (n=281) did not require further access to care to treat their minor ailment and 99.7% (n=326) said they would use MAS again. CONCLUSIONS: Positive perceptions and experiences of those using MAS demonstrate a highly regarded service in terms of satisfaction and experience of consultation. The capacity for MAS to impact on the use of higher-cost healthcare services is evidenced through the number of participants who reported these services as a point of access to care should community pharmacy not be available. This national evaluation demonstrates MAS to be a positively experienced service and outlines the factors determining access for treatment of minor ailments.

Health-related stakeholders' perceptions of clinical pharmacy services in Qatar.

Background In Qatar, the National Vision 2030 and the National Health Strategy 2018-2022 articulate the need to improve healthcare delivery by better utilisation of the skilled workforce. In this regard, pharmacy practice is rapidly advancing and several extended pharmacy services are now available in institutionalised settings. Objective This study aimed to determine health-related stakeholders' perceptions of current clinical pharmacy services in Qatar, and the potential development and implementation of further patient-centred roles. Setting All major organisations and institutions relating to the practice, education, regulation, and governance of pharmacy in Qatar. Method Qualitative, face-to-face semi-structured interviews were conducted with individuals in key strategic positions of policy development and influence (i.e. health-related academic leaders, healthcare policy developers, directors of medicine/pharmacy/nursing, and patient safety leaders). Participants were recruited via a combination of purposeful and snowball sampling, until the point of data saturation was reached. The interview guide was grounded in the Consolidated Framework for Implementation Research domains of innovation characteristics, outer and inner setting, characteristics of individuals, and implementation process. The interviews were digitally recorded, transcribed and independently analysed by two researchers using the Framework approach. Main outcome measure Perceptions of stakeholders regarding current and potential for future clinical pharmacy services in Qatar. Results Thirty-seven interviews were conducted with stakeholders of policy influence in healthcare. The interviewees reported a variety of clinical pharmacy services available in Qatar, which they perceived as positively impacting patient care outcomes, pharmacists' professional autonomy, and the healthcare system in general (innovation characteristics). However, they perceived that these services were mainly performed in hospitals and less in community pharmacy setting (inner setting) and were undervalued by patients and the public (outer setting). Expansion of pharmacists' clinical activities was supported, with recognition of facilitators such as the skillset and training of pharmacists, potential time release due to automation and well-considered implementation processes (characteristics of individuals, inner setting, process). Conclusion Health-related stakeholders in Qatar have positive perceptions of current clinical pharmacy services and support the expansion of pharmacist's roles. However, service development needs to consider the issues of patient and public awareness and initially target institutionalised healthcare settings.

Staff and student experiences and attitudes towards smoking and smoking cessation, University of Jeddah, Saudi Arabia.

INTRODUCTION: Tobacco smoking causes an estimated 7 million deaths per annum with 70 thousand of those occurring in the Kingdom of Saudi Arabia (KSA) where the National Transformation Program highlights the need to prioritize smoking cessation. The objective of this study was to determine the experiences and attitudes of university staff and students, who have been or are currently smokers, towards smoking and smoking cessation. METHODS: A link to a cross-sectional online survey was distributed by email in October and November 2020 to students and staff (n=34872) at the University of Jeddah, KSA. The survey was based on WHO GATS, CSS-21 and a systematic review. Data were analyzed using descriptive statistics in JASP (version 0.14.1) [Computer software]. RESULTS: A total of 666 responses were collected. Most respondents had never smoked (n=556; 83.5%) with some current smokers (n=72; 10.8%) and few former smokers (n=12; 1.8%). Major challenges of quitting smoking identified by the CSS-21 tool were intrinsic factors such as 'withdrawal symptoms' (n=28; 37.8%), 'being addicted to cigarettes' (n=24; 34.8%), 'having strong emotions or feelings' (n=28; 38.4%), and 'seeing things or people which reminded me' (n=25; 34.2%). The extrinsic factors were mostly reported as 'not a challenge', such as 'use of other substances like cannabis, alcohol, etc.' (n=60; 87.0%) or 'lack of support or encouragement from health professionals to stop smoking' (n=50; 69.4%). Many staff and students were 'asked if you smoked tobacco products' at a healthcare professional appointment with (n=5; 83.3%) and (n=27; 71.1%), respectively. Both staff (n=6; 75.0%) and students (n=19; 34.5%) thought 'face-to-face counselling' would help support their future attempts to quit. CONCLUSIONS: The majority of smokers who participated saw intrinsic factors more of a challenge than extrinsic factors. This new knowledge has the potential to influence decision makers. There is potential for encouraging healthcare practitioners to promote smoking cessation conversations.

A pilot study to identify elderly patients with cognitive impairment for clinical pharmacist polypharmacy review in General Practice.

Background: Polypharmacy in elderly patients is common with potential for harm. Cognitive impairment is postulated as the biggest contributor to poor medication management with increased risk of hospital admission. There is limited information about approaches to identify high risk patients for polypharmacy review. Objective: Pilot study to determine if a new patient prioritisation tool would identify appropriate patients for pharmacist polypharmacy review. Method: Prioritisation tool developed to rank community-dwelling elderly patients prescribed 10 or more medications with cognitive impairment for pharmacist polypharmacy review. Tool used General Practice (GP) appointments, Emergency Department attendances, repeat medications and cognitive impairment to create a score to prioritise review invitations. Reviews were completed by GP clinical pharmacists who recorded interventions and measured outcome assessments using the adapted RiO scoring tool. Results: Polypharmacy reviews completed for 34 patients from three GP practices. Demographic results were 62% female (n = 21), median 78 years [IQR 72-80], median 3 comorbidities [IQR 2-4] with most reviews conducted face-to-face (n = 29; 85%). Pharmaceutical care interventions were hospital admission possible or likely prevention for the majority of patients (85%, n = 29) which contrasts with the historical level of 33% (n = 228) patients with traditional processes. Conclusion: Pilot study demonstrated that the new tool identified appropriate patients for review prioritisation as patients had complex pharmaceutical care needs.

Investigating the incidence, nature, severity and potential causality of medication errors in hospital settings in Qatar.

Background Medication errors are a major public health concern that negatively impact patient safety and health outcomes. Effective and efficient medication error reporting systems and practices are imperative in reducing error incidence and severity. Objective The objectives were to quantify the incidence, nature and severity of medication errors, and to explore potential causality using a theoretical framework. Setting The study was conducted at Hamad Medical Corporation, the largest public funded academic healthcare center in the state of Qatar. Methods A retrospective review of medication error reports submitted to the Hamad Medical Corporation incident reporting system during 2015 to 2017. Data related to number of reports, reporter, medication, severity and outcomes were extracted. Reason's Accident Causation Model was used as a theoretical framework for identifying potential causality. Two researchers independently categorized errors as: active failures (e.g. forgetting to administer medication at scheduled time); error provoking conditions (e.g. medication prescribed by an unauthorized physician and administered to the patient); and latent failures (e.g. organizational factors, lack of resources). Main outcome measures Incidence, classes of medications, reporter, error severity and outcomes, potential causality. Results A total of 5103 reports provided sufficient information to be included in the study giving an estimated error incidence of 0.044% of prescribed medication items. Most of the reports (91.5%, n = 4667) were submitted by pharmacists and majority (87.9%, n = 4485) were prescribing errors. The most commonly reported medications were anti-infectives for systemic use (22.0%, n = 1123) followed by medications to treat nervous system disorders (17.2%, n = 876). Only three errors reported to have caused temporary harm requiring intervention while one contributed to or resulted in temporary harm requiring initial or prolonged hospitalization. In terms of potential causality of medication errors, the majority (91.5%, n = 4671) were classified as active failures. Conclusion Almost all reports were submitted by pharmacists, indicating likely under-reporting affecting the actual incidence. Effort is required to increase the effectiveness and efficiency of the reporting system. The use of the theoretical framework allowed identification of potential causality, largely in relation to active failures, which can inform the basis of interventions to improve medication safety.

Smokers' and Non-Smokers' Attitudes towards Smoking Cessation in Saudi Arabia: A Systematic Review.

Literature on smoking in Saudi Arabia is extensive. However, studies capturing the attitudes of both smokers and non-smokers towards smoking cessation are few. A PRISMA-P protocol guided systematic searches in MEDLINE and CINAHL on MeSH terms (smoking cessation AND Saudi Arabia). Peer reviewed articles in English were included in the narrative analysis. Screening reduced the 152 articles identified to 15 and independent critical appraisal identified 10 final articles for review. Few adopted validated survey tools or mentioned the best practice to be followed. There was considerable variation in the prevalence of smoking reported (13.7-49.2%) and survey response rates (8.9-100%). There was a paucity of quality evidence but it is clear that the smoking pandemic is still resonant in Saudi Arabia. Despite support for education programs to prevent the uptake of smoking, policy-driven action to reduce environmental second-hand smoking, and provision of support for smoking cessation, more needs to be done.

Frequency and Management of Acute Poisoning Among Children Attending an Emergency Department in Saudi Arabia.

Background: Acute poisoning is one of the common medical emergencies in children that leads to morbidity and mortality. Medications and chemical agents play a major role in these adverse events resulting in social, economic, and health consequences. Aims of the study: This study aimed to evaluate the frequency and management of acute poisoning among children attending the emergency room at East Jeddah Hospital, Jeddah city, Saudi Arabia. Methods: This study was a retrospective chart review of all acute pediatric poisoning incidences in children (0-16 years of age) from October-21-2016 to March-03-2020 who were attending the emergency department. Data were analyzed via SPSS software. Results: A total of 69 incidences of acute poisoning in children who attended the emergency department at East Jeddah Hospital; males (n = 38, 55.1%). Most children were aged 5 years or younger (n = 41, 59.4%). Unintentional poisoning occurred among 56.5% of observed cases of which 52.2% occurred in children younger than 5 years; 7.20% (n = 5) of patients were 12 to 16 years of age and had deliberate self-poisoning. The association between type of poisoning and age groups was statistically significant (chi-square = 28.5057, p = 0.0001). Most incidences occurred at home (n = 64, 92.8%). Medicines were the most common cause of poisoning (n = 53, 76.8%). An excessive dose of prescribed medicine poisoning accidents was reported in 10.1% cases. Analgesics such as paracetamol were the most documented medication associated with poisoning (39.1%) followed by anticonvulsants and other central nervous system acting medicines (18.8%). The most common route of poisoning was oral ingestion (81.2%). One mortality case was documented. Conclusion: Although not common, accidental and deliberate acute poisoning in children does occur. More can be done to educate parents on safe storage of medicines, household cleaning and other products associated with acute poisoning in children. Likewise, children can be taught more about the risks of poisoning from an early age. As importantly, clinicians need to include more detailed notes in the electronic medical records (EMR) or the system needs to be improved to encourage completeness to more accurately inform the research evidence-base for future service design, health policy and strategy.

Parental Experience of Potential Adverse Drug Reactions Related to Their Oral Administration of Antipyretic Analgesic Medicines in Children in Saudi Arabia.

BACKGROUND: Oral antipyretic analgesic medicines are commonly used in children and have the potential for adverse drug reactions (ADRs). OBJECTIVE: The aim of this study was to explore parental experiences of potential ADRs related to their oral administration of antipyretic analgesics in children in the Kingdom of Saudi Arabia. METHODS: For this cross-sectional survey, a paper-based questionnaire, consent form and information sheet were handed out to 1000 parents who had administered an oral antipyretic analgesic medicine to their children during the previous 3 months. Data were entered and analyzed using SPSS version 21.0 (IBM-SPSS Inc, Armonk, NY). Simple descriptive and inferential statistics were used. Management and ethical approvals were attained. RESULTS: During March to April 2017, 661 parents agreed to participate, giving a response rate of 66.1%. Of the surveyed sample, 208 parents had observed 1 or more potential ADRs (31.5%, n = 208 out of 661). Parents' (n = 208) most commonly reported potential ADRs (n = 523) were loss of appetite (23%, n = 120 out of 523), stomachache (20.3%, n = 106 out of 523), abdominal colic (13%, n = 68 out of 523), and diarrhea (10.3%, n = 54 out of 523). Parents described severity of the ADRs as slight (71.8%, n = 342 out of 476), annoying to the child (7.9%, n = 85 to of 476), significant and affecting daily tasks (3.6%, n = 17 out of 476) and significant and led to the hospital (6.7%, n = 32 out of 476). Fever was the top-ranked reason for using antipyretic analgesic medicines (41.0%, n = 271 out of 661), followed by toothache (25.0%, n = 165 out of 661) and tonsillitis/laryngitis (24.7%, n = 163 out of 661). Among parents, 34.7% (n = 165 out of 476) did not seek medical attention when a potential ADR occurred, whereas 26.3% (n = 125 out of 476) of parents took their children to hospital clinics. CONCLUSIONS: Although the majority of parentally reported (but not proven) ADRs were mild, a number of significant ADRs were reported. Future research should consider whether there is a role for physicians and pharmacists in educating parents in Saudi Arabia, and perhaps more widely, about the optimal use of oral antipyretic and analgesic medicines in children. (Curr Ther Res Clin Exp. 2020; 81:XXX-XXX)© 2020 Elsevier HS Journals, Inc.

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

BACKGROUND: In 2017, the World Health Organization published "Medication Without Harm, WHO Global Patient Safety Challenge," to reduce patient harm caused by unsafe medication use practices. While the five objectives emphasise the need to create a framework for action, engaging key stakeholders and others, most published research has focused on the perspectives of health professionals. The aim was to explore the views and experiences of decision-makers in Qatar on organisational safety culture, medication errors and error reporting. METHOD: Qualitative, semi-structured interviews were conducted with healthcare decision-makers (policy-makers, professional leaders and managers, lead educators and trainers) in Qatar. Participants were recruited via purposive and snowball sampling, continued to the point of data saturation. The interview schedule focused on: error causation and error prevention; engendering a safety culture; and initiatives to encourage error reporting. Interviews were digitally recorded, transcribed and independently analysed by two researchers using the Framework Approach. RESULTS: From the 21 interviews conducted, key themes were the need to: promote trust within the organisation through articulating a fair blame culture; eliminate management, professional and cultural hierarchies; focus on team building, open communication and feedback; promote professional development; and scale-up successful initiatives. There was recognition that the current medication error reporting processes and systems were suboptimal, with suggested enhancements in themes of promoting a fair blame culture and open communication. CONCLUSION: These positive and negative aspects of organisational culture can inform the development of theory-based interventions to promote patient safety. Central to these will be the further development and sustainment of a "fair" blame culture in Qatar and beyond.

People with intellectual disabilities and their experience of medication: A narrative literature review.

BACKGROUND: People with intellectual disabilities are known to have increased medical needs and are prescribed more medication than the general population. Understanding the reality of incorporating medication into their lives would help healthcare professionals provide care in more meaningful and personalised ways. AIM: A narrative review of the current literature relating to people with intellectual disabilities and their experience of medication/pharmaceutical care. METHOD: Electronic databases were searched for articles relating to intellectual disabilities and medication administration or pharmaceutical care. Other relevant papers identified from included article reference lists were also identified. A narrative literature was undertaken due to the heterogeneity of the identified papers. RESULTS: A total of 29 studies from the literature searches were included alongside other relevant papers. CONCLUSIONS: The published literature noted some aspects of the medication-related experiences of people with intellectual disabilities. However, a greater understanding of medication-related experiences is still required.

Assessment of Preventative Measures Practice among Umrah Pilgrims in Saudi Arabia, 1440H-2019.

:Background: Annually, approximately 10 million pilgrims travel to the Kingdom of Saudi Arabia (KSA) for Umrah from more than 180 countries. This event presents major challenges for the Kingdom's public health sector, which strives to decrease the burden of infectious diseases and to adequately control their spread both in KSA and pilgrims home nations. The aims of the study were to assess preventative measures practice, including vaccination history and health education, among Umrah pilgrims in Saudi Arabia. Methods: A cross sectional survey was administered to pilgrims from February to April 2019 at the departure lounge at King Abdul Aziz International airport, Jeddah city. The questionnaire comprised questions on sociodemographic information (age, gender, marital status, level of education, history of vaccinations and chronic illnesses), whether the pilgrim had received any health education and orientation prior to coming to Saudi Arabia or on their arrival, and their experiences with preventative practices. Results: Pilgrims (n = 1012) of 41 nationalities completed the survey. Chronic diseases were reported among pilgrims (n = 387, 38.2%) with cardiovascular diseases being the most reported morbidity (n = 164, 42.3%). The majority of pilgrims had been immunized prior to travel to Saudi Arabia (n = 770, 76%). The most commonly reported immunizations were influenza (n = 514, 51%), meningitis (n = 418, 41%), and Hepatitis B virus vaccinations (n = 310, 31%). However, 242 (24%) had not received any vaccinations prior to travel, including meningitis vaccine and poliomyelitis vaccine, which are mandatory by Saudi Arabian health authorities for pilgrims coming from polio active countries. Nearly a third of pilgrims (n = 305; 30.1%) never wore a face mask in crowded areas during Umrah in 2019. In contrast, similar numbers said they always wore a face mask (n = 351, 34.6%) in crowded areas, while 63.2% reported lack of availability of face masks during Umrah. The majority of participants had received some form of health education on preventative measures, including hygiene aspects (n = 799, 78.9%), mostly in their home countries (n = 450, 44.4%). A positive association was found between receiving health education and practicing of preventative measures, such as wearing face masks in crowded areas (p = 0.04), and other health practice scores (p = 0.02). Conclusion: Although the experiences of the preventative measures among pilgrims in terms of health education, vaccinations, and hygienic practices were at times positive, this study identified several issues. These included the following preventative measures: immunizations, particularly meningitis and poliomyelitis vaccine, and using face masks in crowded areas. The recent COVID-19 pandemic highlights the need for further studies that focus on development of accessible health education in a form that engages pilgrims to promote comprehensive preventative measures during Umrah and Hajj and other religious pilgrimages.

Key stakeholders' views on the potential implementation of pharmacist prescribing: A qualitative investigation.

BACKGROUND: An accumulation of international evidence demonstrates that pharmacist prescribing is effective, safe and well-accepted. While there is potential for such development in the Middle East, the majority of published studies are largely reported from Western countries and the perspectives of individuals in strategic positions of policy and practice in the Middle East were unknown. OBJECTIVE: To explore the views of key stakeholders in Qatar regarding the potential development and implementation of pharmacist prescribing. METHODS: Qualitative, face-to-face semi-structured interviews were conducted with stakeholders in strategic positions of policy influence (i.e. medical, pharmacy and nursing department directors, health-related academics, patient safety and quality directors, professional regulators). Stakeholders were recruited via purposive and snowball sampling. The interview schedule was constructed from an extensive literature review and grounded in the Consolidated Framework for Implementation Research (CFIR) to ensure comprehensive exploration of potential facilitators and barriers. Interviews were conducted from April to August 2017, digitally recorded, transcribed, and independently analysed by two researchers using CFIR as a coding framework. RESULTS: Thirty-seven interviews were conducted with directors of medicine (n = 5), pharmacy (n = 6) and nursing (n = 5), healthcare policy developers (n = 6), healthcare academics (n = 9), and patient safety advocates (n = 6). Interviewees were aware of pharmacist prescribing models internationally and generally supported development and implementation in Qatar due to perceived benefits of improved patient care, professional development and enhanced team working. While there were more facilitators than barriers, it was clear that there was a requirement to systematically plan the development and implementation of pharmacist prescribing, with reference to all five CFIR domains. The need for further training, demonstration of pharmacists' prescribing competence, and extensive engagement of stakeholders were considered crucial. CONCLUSION: There is potential for pharmacist prescribing to be developed and implemented in Qatar. Further research is warranted to define the models of prescribing suitable for Qatar, and to highlight issues of education, training and accreditation.

A modified-Delphi study of a framework to support the potential implementation of pharmacist prescribing.

BACKGROUND: There is an extensive evidence base of the effectiveness and safety of pharmacist prescribing around the globe. There is therefore potential to develop a framework to support the implementation in Qatar to achieve the National Vision 2030 of establishing a comprehensive world-class healthcare system by better utilisation of its healthcare workforce. AIM: To determine the levels of agreement amongst key stakeholders regarding a framework for the potential development and implementation of pharmacist prescribing in Qatar. METHOD: A quantitative, consensus-based modified Delphi study involving stakeholders in Qatar with key strategic positions of health policy influence (directors of medicine/nursing/pharmacy, lead administrators, health-related academics, patient safety leads, professional regulators) was conducted. Delphi statements were developed from extensive literature reviews, semi-structured interviews, pharmacist prescribing frameworks implemented in other countries, and based on the Consolidated Framework for Implementation Research. The scope of the statements included definitions and scope of prescribing, education and training, and governance, were validated with eight specialists from UK and Qatar, and presented as an online Delphi. Consensus was set at 70% or higher agreement and less than 15% disagreement for each statement. RESULTS: Thirty-three experts agreed to participate in the Delphi, with a response rate of 94% for Round 1 and 91% for Round 2, at which point the Delphi stopped. Consensus was achieved for 38 out of 47 statements indicating that a collaborative prescribing model was preferred, and that experience and additional training were required along with robust governance. Consensus was not reached in relation to independent prescribing, prescribing controlled drugs, and ordering certain diagnostic/monitoring investigations (e.g. ECG, X-ray). CONCLUSION: High levels of agreement were attained for statements, which can constitute a framework for the development and implementation of pharmacist prescribing in Qatar. Further work is required to translate this framework into healthcare policy and practice.