Understanding the Quality of Life Among Patients With Cancer in Saudi Arabia: Insights From a Cross-Sectional Study.

INTRODUCTION: Cancer patients' quality of life (QoL) significantly influences treatment response and mortality rates. Understanding QoL domains among patients with cancer and what affects it can help create interventions that improve QoL and ease patients' experience. This study measures the OoL among patients with cancer and influencing factors. METHODS: A prospective cross-sectional questionnaire-based study included cancer patients aged >18 currently receiving treatment. The questionnaire collected social and economic data, followed by the validated Arabic version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30). Means and standard deviations for described numeric variables and frequencies and percentages described categorical variables. Analysis of variance, F-tests, and P-values were reported. RESULTS: Among 182 cancer patients, 60% were female. Younger patients exhibited higher QoL in physical and role functioning (P = .016 and .03) and experienced more significant financial impact (P = .0144). Females reported more adverse effects from cancer symptoms, including fatigue, nausea, vomiting, and pain (36.7% vs 25.5%, P = .005; 20.6% vs 11.5%, P = .0186; 34.7% vs 25.1%, P = .0281). Single patients had superior QoL in physical functioning compared to others (P = .0127). Patients traveling long distances were more likely to face adverse financial consequences (P = .007). Asthmatic patients exhibited lower QoL in physical, role, and cognitive functioning (72.3 vs 37.8, P = .0147; 76.4 vs 22.2, P = .0024; 84.7 vs 44.4, P = .0038) and reported increased dyspnea and appetite loss (16 vs 55.6 and 26.1 vs 66.7, both P < .05). CONCLUSION: Factors influencing QoL in Saudi cancer patients include age, marital status, gender, hospital distance, and chronic conditions. Thus emphasizing the necessity for personalized care strategies to enhance outcomes and alleviate the overall burden of cancer care.

Mental health status among COVID-19 patients survivors of critical illness in Saudi Arabia: A 6-month follow-up questionnaire study.

BACKGROUND: Psychological assessment after intensive care unit (ICU) discharge is increasingly used to assess patients' cognitive and psychological well-being. However, few studies have examined those who recovered from coronavirus disease 2019 (COVID-19). There is a paucity of data from the Middle East assessing the post-ICU discharge mental health status of patients who had COVID-19. AIM: To evaluate anxiety and depression among patients who had severe COVID-19. METHODS: This is a prospective single-center follow-up questionnaire-based study of adults who were admitted to the ICU or under ICU consultation for > 24 h for COVID-19. Eligible patients were contacted via telephone. The patient's anxiety and depression six months after ICU discharge were assessed using the Hospital Anxiety and Depression Scale (HADS). The primary outcome was the mean HADS score. The secondary outcomes were risk factors of anxiety and/or depression. RESULTS: Patients who were admitted to the ICU because of COVID-19 were screened (n = 518). Of these, 48 completed the questionnaires. The mean age was 56.3 ± 17.2 years. Thirty patients (62.5%) were male. The main comorbidities were endocrine (n = 24, 50%) and cardiovascular (n = 21, 43.8%) diseases. The mean overall HADS score for anxiety and depression at 6 months post-ICU discharge was 11.4 (SD ± 8.5). A HADS score of > 7 for anxiety and depression was detected in 15 patients (30%) and 18 patients (36%), respectively. Results from the multivariable ordered logistic regression demonstrated that vasopressor use was associated with the development of anxiety and depression [odds ratio (OR) 39.06, 95% confidence interval: 1.309-1165.8; P < 0.05]. CONCLUSION: Six months after ICU discharge, 30% of patients who had COVID-19 demonstrated a HADS score that confirmed anxiety and depression. To compare the psychological status of patients following an ICU admission (with vs without COVID-19), further studies are warranted.

Safety and quality of AI chatbots for drug-related inquiries: A real-world comparison with licensed pharmacists.

Introduction: Pharmacists play a pivotal role in ensuring patients are administered safe and effective medications; however, they encounter obstacles such as elevated workloads and a scarcity of qualified professionals. Despite the prospective utility of large language models (LLMs), such as Generative Pre-trained Transformers (GPTs), in addressing pharmaceutical inquiries, their applicability in real-world cases remains unexplored. Objective: To evaluate GPT-based chatbots' accuracy in real-world drug-related inquiries, comparing their performance to licensed pharmacists. Methods: In this cross-sectional study, authors analyzed real-world drug inquiries from a Drug Information Inquiry Database. Two independent pharmacists evaluated the performance of GPT-based chatbots (GPT-3, GPT-3.5, GPT-4) against human pharmacists using accuracy, detail, and risk of harm criteria. Descriptive statistics described inquiry characteristics. Absolute proportion comparative analyses assessed accuracy, detail, and risk of harm. Stratified analyses were performed for different inquiry types. Results: Seventy inquiries were included. Most inquiries were received from physicians (41%) and pharmacists (44%). Inquiries type included dosage/administration (34.2%), drug interaction (12.8%) and pregnancy/lactation (15.7%). Majority of inquires included adults (83%) and female patients (54.3%). GPT-4 had 64.3% completely accurate responses, comparable to human pharmacists. GPT-4 and human pharmacists provided sufficiently detailed responses, with GPT-4 offering additional relevant details. Both GPT-4 and human pharmacists delivered 95% safe responses; however, GPT-4 provided proactive risk mitigation information in 70% of the instances, whereas similar information was included in 25.7% of human pharmacists' responses. Conclusion: Our study showcased GPT-4's potential in addressing drug-related inquiries accurately and safely, comparable to human pharmacists. Current GPT-4-based chatbots could support healthcare professionals and foster global health improvements.

Early Versus Late Antipseudomonal ß-Lactam Antibiotic Dose Adjustment in Critically Ill Sepsis Patients With Acute Kidney Injury: A Prospective Observational Cohort Study.

Background: Acute kidney injury (AKI) is a common complication of sepsis, contributing to an increased mortality rate. However, some studies have demonstrated that renal function improves in sepsis patients with AKI within 48 hours, raising questions about the necessity for early antibiotic adjustment. This study evaluates the association between the timing of antipseudomonal ß-lactam dose adjustment and the outcomes of critically ill sepsis patients with AKI. Methods: A prospective, multicenter observational study of critically ill patients aged ≥18 years admitted to the intensive care unit with sepsis and AKI and started on antipseudomonal ß-lactam therapy. After the initial dose, eligible patients were grouped as early ß-lactam antibiotic (E-BLA) or late ß-lactam antibiotic (L-BLA) dose adjustments based on the administration of subsequent renally adjusted doses within 24 hours and after 24 hours of sepsis recognition, respectively. The main outcome of interest was in-hospital mortality. Results: Among 1185 patients screened, 224 (mean age, 62.7 ± 16.8 years; 62% were male) met inclusion criteria. Eighty-four and 140 patients were included in the E-BLA and L-BLA groups, respectively. Approximately half of the cohort presented with AKI stage II, and piperacillin-tazobactam was prescribed as initial empirical therapy in more than 50% of the cohort. In the multivariable Cox proportional hazards model, L-BLA was associated with a significant reduction in in-hospital mortality compared to E-BLA (hazard ratio, 0.588 [95% confidence interval, .355-.974]). Conclusions: In sepsis patients with AKI, L-BLA was associated with in-hospital mortality benefits.

Quality of life tools among patients on dialysis: A systematic review.

Introduction:  The universal increase in obesity and diabetes has increased the chronic kidney disease (CKD) rate. In 2017, almost 800 million individuals suffered from CKD worldwide. Kidney dialysis becomes necessary as the disease progresses. Dialysis negatively impacts CKD patients' quality of life (QoL). It causes several complications that affect patients' physical, social, psychological, and spiritual aspects of life. This systematic review aims to identify condition-specific tools used to assess CKD patients' quality of life on dialysis. Material and Methods: A systematic literature search was conducted to investigate studies using QoL tools among patients on dialysis from February 2000 to June 2023. The search was conducted in several databases and followed the PRISMA guidelines. The focus was to identify tools that capture intrinsic factors, such as spiritual subdomains, rather than extrinsic factors, such as environmental subdomains. Results: The review identified five studies and seven dialysis-specific tools for assessing the QoL of CKD patients on dialysis. The physical domain was the most assessed, followed by the psychological and social domains. Fatigue, muscle weakness, sleep disorders, and pain were identified as the most common concerns in the physical domain. Conclusion: Dialysis negatively impacts all aspects of QoL in CKD patients. This review can guide clinicians in understanding the disease and treatment burden by identifying the most appropriate tools for assessing the QoL of adult CKD patients undergoing dialysis. There is a need for further studies to explore the detrimental effects of CKD treatment and better understand its impact on patients' QoL.

Diffuse axonal injury on magnetic resonance imaging and its relation to neurological outcomes in pediatric traumatic brain injury.

OBJECTIVE: Diffuse axonal injury (DAI), a frequent consequence of pediatric traumatic brain injury (TBI), presents challenges in predicting long-term recovery. This study investigates the relationship between the severity of DAI and neurological outcomes in children. METHODS: We conducted a retrospective analysis of 51 pediatric TBI patients diagnosed with DAI using Adam's classification. Neurological function was assessed at 2, 3, and 6 weeks, and 12 months post-injury using the Pediatric Glasgow Outcome Scale-Extended (PGOSE). RESULTS: PGOSE scores significantly improved over time across all DAI grades, suggesting substantial recovery potential even in initially severe cases. Despite indicating extensive injury, patients with DAI grades II and III demonstrated significant improvement, achieving a good recovery by 12 months. Although the initial Glasgow Coma Scale (GCS) score did not show a statistically significant association with long-term outcomes in our limited sample, these findings suggest that the severity of DAI alone may not fully predict eventual recovery. CONCLUSIONS: Our study highlights the potential for significant neurological recovery in pediatric patients with DAI, emphasizing the importance of long-term follow-up and individualized rehabilitation programs. Further research with larger cohorts and extended follow-up periods is crucial to refine our understanding of the complex relationships between DAI severity, injury mechanisms, and long-term neurological outcomes in children.

Clinical pharmacy services in acute care setting during mass gatherings (Hajj): Insights from a task force.

BACKGROUND: Hajj is the largest mass gathering worldwide that takes place every year in Makkah, Saudi Arabia. This paper aims to provide a comprehensive guide and expectations for delivering and optimizing clinical pharmacy services during one of the largest mass gatherings in the world, Hajj pilgrimage METHODS: A task force initiated and included members of clinical pharmacists who previously participated in delivering clinical pharmacy services during the Hajj pilgrimage, members of the Saudi Society of Clinical Pharmacy (SSCP), and policymakers from different sectors and representatives from pharmaceutical care of the Ministry of Health (MOH). The members established an expert task force to conceptualize and draft the proposed suggestions highlighting the roles and responsibilities of clinical pharmacists during the annual Hajj season. RESULTS: The task force determined the following key domains 1) pharmaceutical care (administration and strategic plan, resources, formulary management); 2) pharmacists' activities (clinical pharmacy services and documentation, professional training and development, and staff credentials, and qualifications); 3) challenges and proposed solutions. The task force was divided into groups to draft each domain and provide suggested statements and insights for each section. Finally, the group members of the task force issued 15 opinion statements. CONCLUSION: Mass gatherings such as Hajj pilgrimage, represent a unique opportunity to demonstrate the value of pharmacists in advancing health care delivery within a multidisciplinary team. These suggestions and insights could guide the implementation of clinical pharmacy services in acute settings during mass gatherings (Hajj). Future studies should focus on assessing the applicability and the impact of the provided suggestions.

Characteristics of Critical Care Pharmacy Services in Saudi Arabia.

Purpose: Critical care pharmacists (CCPs) in intensive care units (ICUs) are associated with improved patient outcomes, reduced adverse events (ADEs), and reduced mortality rates. This study aimed to describe the activities and pharmacy services provided by CCP in ICUs in hospitals in Saudi Arabia (SA). Methods: In this cross-sectional prospective study, a questionnaire was electronically sent to CCPs practicing in SA between September 2022 and January 2023. A modified version of a previously published and validated survey was sent to the Saudi Critical Care and Emergency Specialty Network. The questionnaire focused on four CCP activities: clinical, educational, scholarly, and administrative. The level of services was similarly classified into three domains: fundamental, optimal, and desirable. The responses were analyzed using descriptive statistics. Results: The study surveyed 44 CCPs in SA, with a response rate of 52.3%. These CCPs were predominantly located in the central (47.8%) and eastern (30.4%) regions. Hospitals' ICU bed capacity ranged from 10 to 100, with 82% reporting mixed medical and surgical ICUs. Most CCPs had 4-10 years of critical care experience, and 60% held advanced degrees, with a substantial portion having completed PGY-1 and PGY-2 pharmacy residencies. CCPs were actively involved in patient care, with 86.9% participating in multidisciplinary rounds five days a week. They were engaged in clinical, educational, and administrative activities, with 82.6% involved in retrospective research and educational activities. Furthermore, 78.2% were engaged in pharmacy and therapeutic committees, 56.5% in critical care committees, and 56.5% in pharmacy department policy development. Conclusion: The study reveals that CCPs in SA play integral roles in ICU patient care and contribute significantly to clinical, educational, and administrative activities. The study highlights the need for standardized CCP-to-patient ratios and further support for CCPs to expand their services, thus contributing to enhanced healthcare quality.

Excessively High Chronic Propranolol Overdose in Infantile Hemangioma: A Case Report.

BACKGROUND Infantile hemangiomas are the most common benign tumors of childhood, occurring in approximately 5% of infants. Oral propranolol at 2 to 3 mg/kg daily is recommended for systemic treatment of high-risk infantile hemangiomas. Multiple propranolol formulations exist, and propranolol overdose can occur due to improper patient counseling. Propranolol acute toxicity in the pediatric population and its management are well described in the literature. However, data are lacking on chronic propranolol overdose and how to manage it, with the awareness that abrupt discontinuation of therapeutic doses of propranolol can lead to rebound sinus tachycardia. CASE REPORT A 7-month-old girl was prescribed a therapeutic dose of propranolol (1 mg/kg/day) to treat infantile hemangioma. However, due to an administration error, the patient received approximately 8 times the recommended dose (7.6 mg/kg/day for 2 months, then increased to 15.5 mg/kg/day for 2 weeks) and, surprisingly, remained asymptomatic. Her electrocardiogram was normal, and all routine laboratory tests were within the reference range. Propranolol was successfully tapered over 3 weeks by reducing the dose by 50% weekly until it reached the therapeutic dose. After tapering, the patient was asymptomatic, with a mild increase in hemangioma size. After 6 weeks of the therapeutic dose, the hemangioma was fading away. CONCLUSIONS This case is one of the few cases reported in the literature of high, chronic propranolol overdose in pediatric patients. The patient remained asymptomatic, and the overdose was successfully managed with gradual tapering over several weeks. This case report can serve as a guide in managing subsequent cases.

Comparison of medical documentation between pharmacist-led anticoagulation clinics and physician-led anticoagulation clinics: A retrospective study.

Background and objectives: High-quality documentation is critical in medical settings for providing safe patient care. This study was done with the objective of assessing the standard of medical records in anticoagulation clinics and investigating the distinctions between notes written by pharmacists and physicians. Methods: A retrospective cross-sectional analysis of data from electronic health records (EHRs) was performed on patients who received anticoagulation and were observed at anticoagulation clinics from October to December 2020. Patients were monitored in two anticoagulation clinics, one administered by pharmacists and the other by physicians. The quality of the documentation was assessed using a score, and the note was assigned one of five categories according to its score: very good, good, average, poor, and very poor. The data was analyzed using Stata/SE 13.1. P value<0.05 was considered significant in all analytical tests. Results: A total of 331 patients were included. While 160 patients (48.3%) were followed by the physician-led clinic, 171 (51.6%) were by the pharmacist-led clinic. The average age of the patients was 54 ± 15. 60.73% of them were female, and 90.3% of them were Saudi nationals. Warfarin was the most widely used anticoagulant (70%), followed by rivaroxaban (15.7%). Compared to physicians, pharmacists demonstrated very strong documentation (54% vs. 18%). The examination of the variables considered in the study revealed that physicians had significantly less drug-drug interaction documentation (17 vs. 71 times) or drug-food interaction documentation (23 vs. 71 times) than pharmacists. In terms of follow-up frequency, pharmacists were found to adhere to the clinic protocol (150 times) more frequently than physicians (104 times). However, there was no significant difference in therapeutic plan documentation between the two groups. (p = 0.416). Conclusion: Pharmacists were more comprehensive in their documentation than physicians in anticoagulation clinics. Unified clinic documentation can ensure consistent documentation within EHRs across all disciplines.

Reactive Arthritis in Children: Case report and Narrative Review and Proposed therapy.

Reactive arthritis is an acute inflammatory aseptic arthritis that is preceded by an infectious process in genetically predisposed individuals. It has been associated with gastrointestinal or genitourinary infection. Reactive arthritis is rare in children. In this review, we present two index cases that need biologic treatment followed by a thorough review of reactive arthritis in children and adolescents with proposed treatment algorithm.

Effectiveness of antibiotic-loaded bone cement in total joint arthroplasty at a tertiary medical center: A retrospective cohort study.

Background: Data regarding the effectiveness of antibiotic-loaded bone cement (ALBC) in preventing prosthetic joint infections (PJI) after total joint arthroplasty (TJA) is inconsistent. The objective of this study was to evaluate if the routine use of ALBC influenced the risk of revision surgery due to PJI. Methods: This is a retrospective cohort study performed between January 2018 and September 2020. Adult patients aged ≥ 18 years who underwent TJA (knee or hip) and received either ALBC or plain cement (PC) were included. The outcome of this study was the rate of revision due to PJI. Multivariate analysis using logistic regression was used to identify factors that may be associated with increased risk of PJI, using STATA 15.1 (StataCorp LP, College Station, Texas, USA). Results: A total of 844 patients were screened and 319 patients were included. There were 247 patients in ALBC group and 72 patients in the PC group. Only vancomycin powder was used in all ALBC cases, with a 2 g dose in 50% of the cases (dose ranged between 1 g and 8 g). The status of the prosthetic joint was assessed and recorded up to 2 years of the TJA. Overall, the difference in the rates of PJI between the two groups after primary arthroplasty was not statistically significant (5.6% vs 1.4%; p = 0.173; OR, 4.2; 95% CI, 0.5-33). Conclusion: ALBC was not associated with a reduction in PJI rates after primary TJA. More research is needed to further evaluate the effectiveness of ALBC in preventing PJI.

Clinical Pharmacy Faculty Provision of Direct Patient Care, Challenges, and Opportunities.

Background: The quadripartite mission of clinical track faculty members involves research, teaching, services, and direct patient care. However, the extent of faculty involvement in direct patient care remains a challenge. Thus, the study's objective is to evaluate the effort spent on direct patient care by clinical faculty of pharmacy schools in Saudi Arabia (S.A.) and identify factors that hinder or facilitate providing direct patient care services. Methods: This multi-institutional, cross-sectional questionnaire study conducted between July 2021 and March 2022 involved several pharmacy schools' clinical pharmacy faculty members in S.A. The primary outcome was the percentage of time/effort spent on patient care services and other academic responsibilities. The secondary outcomes were the factors affecting the effort spent on direct patient care and the barriers preventing the provision of clinical services. Results: A total of 44 faculty members took the survey. The percentage of effort spent on clinical education was highest at a median (IQR) of 37.5 (30, 50), followed by that spent on patient care [19 (10, 28.75)]. The percentages of effort spent on education and the length of academic experience were negatively associated with efforts spent on direct patient care. The most commonly reported barrier affecting fulfilling patient care duties was the lack of a clear practice policy (68%). Conclusion: Although most clinical pharmacy faculty members were involved in direct patient care, half of them devoted only 20% or less of their time to it. An effective effort allocation for clinical faculty duties will require the development of a clinical faculty workload model that sets realistic expectations about the time spent on clinical and non-clinical duties.

The Toothbrushing Effects on Surface Properties and Color Stability of CAD/CAM and Pressable Ceramic Fixed Restorations-An In Vitro Study.

Pressable ceramic restorations have been introduced and investigated, and found comparable to CAD/CAM ceramic in terms of mechanical properties; however, the effect of toothbrushing on the pressable ceramic has not been thoroughly investigated. The objective of the current study was to assess the effect of artificial toothbrushing simulation on the surface roughness, microhardness, and color stability of different ceramic materials. Three lithium disilicate-based ceramics (IPS Emax CAD [EC], IPS Emax Press [EP]; (Ivoclar Vivadent AG), and LiSi Press [LP] (GC Corp, Tokyo, Japan)) were examined. For each ceramic material, eight bar-shaped specimens were prepared and subjected to 10,000 brushing cycles. Surface roughness, microhardness, and color stability (∆E) were measured before and after brushing. Scanning electron microscopy (SEM) was used for surface profile analysis. The results were analyzed using one-way ANOVA, Tukey's post hoc test, and paired sample t-test α = 0.05. The findings revealed a non-significant decrease in the surface roughness of EC, EP, and LP groups (p > 0.05), and both LP and EP have the lowest surface roughness values (0.64 ± 0.13, 0.64 ± 0.08 µm) after brushing, respectively. Toothbrushing showed a decrease in the microhardness of the three groups: EC and LP, p < 0.001; EP, p = 0.012). EP showed the lowest hardness value after brushing (862.45 ± 273.83). No significant changes (∆E) were observed in all groups (p > 0.05); however, the EC group was found to be considerably affected by color changes, in comparison to the EC and LP groups. Toothbrushing had no effect on surface roughness and color stability of all tested materials, but it decreased the microhardness. Material type, surface treatments, and glazing of ceramic materials contributed to the surface changes in the ceramic materials, necessitating further investigations in terms of the toothbrushing effect with different glazing as variables.

Standard dosing of enoxaparin versus unfractionated heparin in critically ill patient with COVID-19: a multicenter propensity-score matched study.

BACKGROUND: Thrombotic events are common in critically ill patients with COVID-19 and have been linked with COVID-19- induced hyperinflammatory state. In addition to anticoagulant effects, heparin and its derivatives have various anti-inflammatory and immunomodulatory properties that may affect patient outcomes. This study compared the effectiveness and safety of prophylactic standard-doses of enoxaparin and unfractionated heparin (UFH) in critically ill patients with COVID-19.  METHODS: A multicenter, retrospective cohort study included critically ill adult patients with COVID-19 admitted to the ICU between March 2020 and July 2021. Patients were categorized into two groups based on the type of pharmacological VTE thromboprophylaxis given in fixed doses (Enoxaparin 40 mg SQ every 24 hours versus UFH 5000 Units SQ every 8 hours) throughout their ICU stay. The primary endpoint was all cases of thrombosis. Other endpoints were considered secondary. Propensity score (PS) matching was used to match patients (1:1 ratio) between the two groups based on the predefined criteria. Multivariable logistic, Cox proportional hazards, and negative binomial regression analysis were used as appropriate.  RESULTS: A total of 306 patients were eligible based on the eligibility criteria; 130 patients were included after PS matching (1:1 ratio). Patients who received UFH compared to enoxaparin had higher all thrombosis events at crude analysis (18.3% vs. 4.6%; p-value = 0.02 as well in logistic regression analysis (OR: 4.10 (1.05, 15.93); p-value = 0.04). Although there were no significant differences in all bleeding cases and major bleeding between the two groups (OR: 0.40 (0.07, 2.29); p-value = 0.31 and OR: 1.10 (0.14, 8.56); p-value = 0.93, respectively); however, blood transfusion requirement was higher in the UFH group but did not reach statistical significance (OR: 2.98 (0.85, 10.39); p-value = 0.09). The 30-day and in-hospital mortality were similar between the two groups at Cox hazards regression analysis. In contrast, hospital LOS was longer in the UFH group; however, it did not reach the statistically significant difference (beta coefficient: 0.22; 95% CI: -0.03, 0.48; p-value = 0.09). CONCLUSION: Prophylactic enoxaparin use in critically ill patients with COVID-19 may significantly reduce all thrombosis cases with similar bleeding risk compared to UFH.

The role of drug information centers to improve medication safety in Saudi Arabia - a study from healthcare professionals' perspective.

Background and objective: The primary function of the Drug Information Center (DIC) is to provide drug-related information to healthcare professionals. The purpose of this research was to assess the use of drug information centers by health care the professionals to improve medication safety in Saudi Arabia. Methods: A retrospective study was carried out at King Khalid University Hospital's drug and poison information center (DPIC). During the study period, requests received by drug information specialists were saved in the DPIC questions' bank. Patients' demographic, type of drug information request, caller information, number of references used, medications, class of medication, medication error type and subclass were assessed and analyzed using descriptive analysis. Medication error types were captured based on nature of questions. Results: A total of 243 drug information inquiries were assessed. Most of the inquiries were about adult population (n = 168; 69.1%). Most drug information inquiries were received from pharmacists (n = 117; 48.1%), followed by physicians (n = 94; 38.7%), then nurses (n = 23; 9.5%). Prescribing error were the most type of medication error prevented by drug information specialists (n = 214; 88.1%) followed by dispensing errors (n = 11; 4.5%). Approximately half of the medication errors in this study were near-misses (n = 110; 45.3%), followed by potential near misses (n = 84; 34.6%). Only, (n = 49; 20.2%) were identified as errors. Conclusion: This study highlights the role of drug information specialists in providing evidence-based information and helps in preventing possible medication errors which will enhance the safety of the services provided to the patients.

Crossword puzzle as a learning tool to enhance learning about anticoagulant therapeutics.

BACKGROUND: Educational games make the learning process more enjoyable, fun, and create a competitive classroom environment that can positively affect learning. The purpose of this study was to evaluate pharmacy students' perceptions of crossword puzzles (CWPs) as a learning tool in the pharmacotherapy cardiovascular module focusing on anticoagulants' therapeutics and assessing if students' preference of learning style influenced their perception. METHODS: Clues for the puzzle were developed, validated, and piloted by course faculty. A free internet puzzle generator was used to create puzzles with 10 to 20 clues. Students were given 30 min to solve the puzzle following six hours of didactic lectures about the topic. An 8-item survey instrument and Pharmacists' Inventory of Learning Styles (PILS) questionnaire were administered to examine students' perceptions of the game and their learning style preference, respectively. RESULTS: Two hundred sixty-seven students participated in the activity from both undergraduate programs (BPharm and PharmD) over three consecutive course offerings. Most students expressed favorable perceptions of the puzzle. Female and BPharm students had significantly more favorable perceptions than male and PharmD students on several perception items. The dominant preferred learning style (PLS) was converger (35.6%), followed by assimilator (25.3%), while 15.1% had mixed learning styles. The study did not find a significant association between PLS and students' perceptions toward the CWP. CONCLUSIONS: The CWP game presented an innovative, creative, and easy active learning tool to enhance information recall, retention, and class engagement while accommodating all learning style preferences.

Assessing the impact of chemotherapy-induced nausea and vomiting on patients' quality of life: An Arabic version of the Functional Living Index-Emesis.

INTRODUCTION: Chemotherapy-induced nausea and vomiting is a serious complication of cancer treatment that compromises patients' quality of life and treatment adherence, which necessitates regular assessment. Therefore, there is a need to assess patient-reported nausea and vomiting using a validated scale among Arabic speaking cancer patient population. The objective of this study was to translate and validate the Functional Living Index-Emesis (FLIE) instrument in Arabic, a patient-reported outcome measure designed to assess the influence of chemotherapy-induced nausea and vomiting on patients' quality of life. METHODS: Linguistic validation of an Arabic-language version was performed. The instrument was administered to cancer patients undergoing chemotherapy in a tertiary hospital's cancer center in Saudi Arabia. RESULTS: One-hundred cancer patients who received chemotherapy were enrolled. The participants' mean age was 53.3 ± 14.9 years, and 50% were female. Half of the participants had a history of nausea and vomiting with previous chemotherapy. The Cronbach coefficient alpha for the FLIE was 0.9606 and 0.9736 for nausea and vomiting domains, respectively, which indicated an excellent reliability for the Arabic FLIE. The mean FLIE score was 110.9 ± 23.5, indicating no or minimal impact on daily life (NIDL). CONCLUSIONS: The Arabic FLIE is a valid and reliable tool among the Arabic-speaking cancer population. Thus, the Arabic version of the FLIE will be a useful tool to assess the quality of life among Arabic speaking patients receiving chemotherapy. Additionally, the translated instrument will be a useful tool for future research studies to explore new antiemetic treatments among cancer patients.

The potential role of adjunctive ascorbic acid in the prevention of colistin-induced nephrotoxicity in critically ill patients: A retrospective study.

Background: Colistin is considered a valuable and last-resort therapeutic option for MDR gram-negative bacteria. Nephrotoxicity is the most clinically pertinent adverse effect of colistin. Vivo studies suggest that administering oxidative stress-reducing agents, such as ascorbic acid, is a promising strategy to overcome colistin-induced nephrotoxicity (CIN). However, limited clinical data explores the potential benefit of adjunctive ascorbic acid therapy for preventing CIN. Therefore, this study aims to assess the potential nephroprotective role of ascorbic acid as adjunctive therapy against CIN in critically ill patients. Method: This was a retrospective cohort study at King Abdulaziz Medical City (KAMC) for all critically ill adult patients who received IV colistin. Eligible patients were classified into two groups based on the ascorbic acid use as concomitant therapy within three days of colistin initiation. The primary outcome was CIN odds after colistin initiation, while the secondary outcomes were 30-day mortality, in-hospital mortality, ICU, and hospital LOS. Propensity score (PS) matching was used (1:1 ratio) based on the patient's age, SOFA score, and serum creatinine. Results: A total of 451 patients were screened for eligibility; 90 patients were included after propensity score matching based on the selected criteria. The odds of developing CIN after colistin initiation were similar between patients who received ascorbic acid (AA) as adjunctive therapy compared to patients who did not (OR (95 %CI): 0.83 (0.33, 2.10), p-value = 0.68). In addition, the 30-day mortality, in-hospital mortality, ICU, and hospital LOS were similar between the two groups. Conclusion: Adjunctive use of Ascorbic acid during colistin therapy was not associated with lower odds of CIN. Further studies with a larger sample size are required to confirm these findings.