Perceptions and barriers of health-care professionals to develop and implement interprofessional education in UAE: A qualitative study.

BACKGROUND: This study aimed to determine the perception, perspectives, and behaviors of health-care providers, as well as cues to action toward interprofessional education (IPE). MATERIALS AND METHODS: The interview sessions were conducted from August 2020 to November 2020 at the College of Pharmacy, Gulf Medical University (GMU), Ajman. The invited participants belonged to all the colleges which are a part of GMU, providing academic and practice support to the university. All were residents of UAE, and both genders were considered for qualitative assessment. The sample size based on data saturation plus two as standard guidelines in qualitative res earch. All the interviews were audiotaped for verbatim transcriptions. All the recorded interviews were transcribed to avoid bias. The prepared transcripts were then verified for accuracy by the relevant participant and after approval, data were analyzed. In case of an emergent theme, all the investigators were focused on refining the analysis. RESULTS: A total of 17 health-care professionals (HCPs) were interviewed. The participants were chosen from five different colleges at GMU. All the participants had similar perceptions about IPE, as it is a collaboration between different HCPs to achieve better patient outcomes. A diversity in perspectives toward IPE was found among the participants. Several barriers were identified during the interview session and also highlighted the importance of choosing the right topic for IPE, as it affects planning of the activities greatly. The participants also stressed that the lack of communication also contributes to decreased involvement of HCPs. CONCLUSION: This study identified inefficient implementation of IPE. The barriers were lack of team effort, lack of communication within the institute, and administrative support, despite the availability of resources and infrastructure in the university.

Real-Life Use of Tocilizumab in the Treatment of Severe COVID-19 Pneumonia.

Introduction: Coronavirus disease 2019 (COVID-19) can progress to severe respiratory compromise and lead to mortality due to induction of cytokine storm. Tocilizumab (TCZ) is approved by the FDA for the treatment of cytokine release syndrome (CRS). This study aims to analyze the outcomes among patients who received TCZ in the United Arab Emirates. Methods: A retrospective cohort study was conducted among COVID-19 patients who received TCZ in a tertiary care hospital from May 2020 to August 2021. For analysis, patients were divided into two groups based on survival and clinical improvement. Results: Overall, 80% of patients receiving TCZ were discharged by day 28. There was a gradual improvement in oxygen requirements in our patients with a majority of them on room air by day 28. Age more than 50 years (P=0.034) and comorbidities such as cardiovascular disease (CVD) (P=0.002) and renal insufficiency (P=0.013) were significantly associated with mortality. Discussion. In our analysis, patients who were mechanically ventilated at the time of administration of TCZ had a significantly higher risk of death by day 28. In both survived and improved groups, younger patients had better outcomes than older patients. Patients who received TCZ earlier during therapy from the onset of symptoms had better survival outcomes. There was only one death among 14 patients who received vaccination. There was no significant difference in mortality among patients with comorbidities such as diabetes, hypertension, dyslipidemia, obesity, and pulmonary diseases, hypothesizing that administration of TCZ improves the outcomes in COVID-19 patients with these comorbidities.

Choice of Antimicrobials in Surgical Prophylaxis - Overuse and Surgical Site Infection Outcomes from a Tertiary-Level Care Hospital.

Background: This study was aimed to describe the choice of Surgical Antimicrobial Prophylaxis at a tertiary-level care hospital in United Arab Emirates. It also associated the choice between two leading antimicrobials for the SAP to the site of surgery. Methods: A descriptive drug use evaluation was performed retrospectively to study choices of antimicrobials in surgical antibiotic prophylaxis. An analytical cross-sectional study design was used to develop a hypothesis regarding the choice of ceftriaxone. Data were collected from the medical records of Hospital from July 2020 to December 2020. Results were presented in numbers and percentages. Results: SAP data were collected from 199 patients, of which 159 were clean or clean-contaminated. Dirty surgeries (18) needed a higher level of antimicrobials as there were infections to be treated. For other surgeries with no infection, overuse of antimicrobials was found regarding the choice of antimicrobials. Surgical antibiotic Prophylaxis was administered within the recommended time prior to surgeries. Ceftriaxone was preferred over cefuroxime in all types of surgeries based on the timing of Surgical Antibiotic Prophylaxis, wound classification, and the surgical site. A statistically significant association for choice of ceftriaxone over cefuroxime was found regarding surgical sites (p-value <0.05). About 99% of the patients were prescribed discharge antimicrobials when 158 (80%) surgeries were clean or clean-contaminated. Conclusion: Overuse of antimicrobials was found in surgical antimicrobial prophylaxis. Ceftriaxone was preferred more than cefuroxime in all types of surgeries. No surgical site infections were reported. A follow-up comparative study is recommended to decrease antimicrobial use without increasing risk of surgical site infection.

Evaluation of inappropriate antibiotic prescribing and management through pharmacist-led antimicrobial stewardship programmes: a meta-analysis of evidence.

PURPOSE: This meta-analysis aims to evaluate inappropriate antibiotic prescribing in the Gulf region and determine the effect of pharmacist-led antimicrobial stewardship (AMS) programmes on reducing inappropriateness. METHOD: Articles were searched, analysed, and quality assessed through the risk of bias (ROB) quality assessment tool to select articles with a low level of bias. In step 1, 515 articles were searched, in step 2, 2360 articles were searched, and ultimately 32 articles were included by critical analysis. Statistical analysis used to determine risk ratio and standard mean differences were calculated using Review manager 5.4; 95% confidence intervals were calculated using the fixed-effect model. The I2 statistic assessed heterogeneity. In statistical heterogeneity, subgroup and sensitivity analyses, a random effect model was performed. The α threshold was 0.05. The primary outcome was inappropriateness in antibiotic prescribing in the Gulf region and reduction of inappropriateness through AMS. RESULT: Detailed review and analysis of 18 studies of inappropriate antibiotic prescribing in the Gulf region showed the risk of inappropriateness was 43 669/100 846=43.3% (pooled RR 1.31, 95% CI 1.30 to 1.32). Test with overall effect was 58.87; in the second step 28 AMS programmes led by pharmacists showed reduced inappropriateness in AMS with pharmacist versus pre-AMS without pharmacist (RR 0.36, 95% CI 0.32 to 0.39). CONCLUSION: Inappropriate antibiotic prescribing in the Gulf region is alarming and needs to be addressed through pharmacist-led AMS programmes.

Comparative efficacy of azithromycin versus clarithromycin in combination with beta-lactams to treat community-acquired pneumonia in hospitalized patients: a systematic review.

OBJECTIVE: The objective was to compare the efficacy of azithromycin and clarithromycin in combination with beta-lactams to treat community-acquired pneumonia among hospitalized adults. METHODS: Five databases (PubMed, Google Scholar, Trip, Medline, and Clinical Key) were searched to identify randomized clinical trials with patients exposed to azithromycin or clarithromycin in combination with a beta-lactam. All articles were critically reviewed for inclusion in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: Seven clinical trials were included. The treatment success rate for azithromycin-beta-lactam after 10 to 14 days was 87.55% and that for clarithromycin-beta-lactam after 5 to 7 days of therapy was 75.42%. Streptococcus pneumoniae was commonly found in macrolide groups, with 130 and 80 isolates in the clarithromycin-based and azithromycin-based groups, respectively. The length of hospital stay was an average of 8.45 days for patients receiving a beta-lactam-azithromycin combination and 7.25 days with a beta-lactam-clarithromycin combination. CONCLUSION: Macrolide inter-class differences were noted, with a higher clinical success rate for azithromycin-based combinations. However, a shorter length of hospital stay was achieved with a clarithromycin-beta-lactam regimen. Thus, a macrolide combined with a beta-lactam should be chosen using susceptibility data from the treating facility.

Assessment Methods and Competency Mapping in Pharmacy Education: Understanding of Components and Quality Parameters.

Centre of advanced pharmaceutical education have developed 15 subsets of competencies required to be competent pharmacist and able to provide optimum care. These competencies were further categorized; Level 1 intermediate, Level 2 efficient, and Level 3 professional. These competencies are cross-mapped to achieve desirable outcomes. Where personal and professional development skills incorporate knowledge, for being a holistic pharmacist. In healthcare education curriculums, active learning tools such as simulation-based patient cases and other innovative learning activities are used to teach clinical skills, patient assessments, and pharmacotherapy concepts. The advance team-based learning technique for the development of stepwise understanding of disease management (simple-complex cases) and students can communicate and collaborate for the critical thinking and decision-making process. Many studies showed the positive impact of the peer teaching on the students; enhanced their academic performance, increase the cognitive congruence, and allows the students to share their own learning struggles to come up with solutions to overcome these challenges. Pharmacy is a healthcare professional required intensive training and professional skills to provide optimum care to patients. The emerging clinical role of pharmacy focused on the patient-centered model, comprehensive assessment, and teaching methods are required to fulfill the professional competencies.

Hydroxychloroquine and Chloroquine in Prophylaxis and Treatment of COVID-19: What Is Known?

The corona virus disease-19 (COVID-19) pandemic has affected the entire world causing huge economic losses and considerable morbidity and mortality. Considering the explosive growth of the pandemic repurposing existing medicines may be cost-effective and may be approved for use in COVID-19 faster. Researchers and medical practitioners worldwide have explored the use of chloroquine and hydroxychloroquine, in few occasions combined with the macrolide antibiotic azithromycin, for COVID-19 treatment. These two drugs are economic and easily available, and hence gained attention as a potential option for COVID-19 management. As per the available evidence, the outcomes of treatments with these medications are conflicting from both the efficacy and safety (predominantly cardiac related) perspectives. Currently, multiple studies are underway to test the safety and efficacy of these medications and more results are expected in the near future. The retina, the endocrine system (with risk of hypoglycemia), the musculoskeletal system, the hematological system, and the neurological system may also be affected. The use of these drugs is contraindicated in patients with arrhythmias, known hypersensitivity, and in patients on amiodarone. In addition to the published literature, personal communication with doctors treating COVID-19 patients seems to suggest the drugs may be effective in reducing symptoms and hastening clinical recovery. The literature evidence is still equivocal and further results are awaited. There has been recent controversy including retraction of articles published in prestigious journals about these medicines. Their low cost, long history of use, and easy availability are positive factors with regard to use of these drugs in COVID-19.

Role and Services of a Pharmacist in the Prevention of Medication Errors: A Systematic Review.

OBJECTIVE: This systematic review aims to investigate the role and responsibilities of pharmacists in the prevention of medication errors. The study also aims to evaluate pharmacist-centered strategies that have an impact on medication error reduction and prevention. METHODS: A search was conducted through the following databases PubMed Central, Scopus, Trip, Prospero, Medline and Google Scholar using terms related to "medication errors prevention" or "pharmacist-related errors". Other search terms included "pharmacist(s)", "prevention", "medication error(s)", "dispensing error(s)", "drug incidence(s)", "medication malpractice(s)". Included studies were prospective and retrospective cohort, case-control and cross-sectional full-text studies published in the last 10 years (2010-2020). The review team screened the articles for inclusion criteria and evaluated the quality of the articles. The PRISMA guidelines were used to report the selected articles and screening process. Then, the articles were sent to a third independent reviewer for the quality assessment using the STROBE Checklist. RESULTS: A clinical pharmacist's duties are to supervise the medication treatment of admitted patients and to notify the healthcare team when a discrepancy is found. A total of seven reviewed studies highlighted the importance and positive impact of increasing the number of clinical pharmacist's interventions. Literature showed that an average of 64.9% of medication discrepancies happen during patient discharge, highlighting the necessity of a clinical pharmacist intervention at that stage. The systematic review focused on the significant impact of clinical pharmacists' role in preventing errors (studies reported=5); encouraging pharmacist-led education to increase medication error awareness (studies reported =5), incorporating better and innovative pharmacy-related work approaches (studies reported =4); and implementing appropriate and secured policies for medication error reporting (studies reported =1). The screened literature highlighted the significant reduction in the number of medication errors and an increase in medication error identification and awareness. These findings suggest the crucial role of a pharmacist in healthcare policies for the prevention of medication errors and patient safety. CONCLUSION: This systematic review suggests multiple pharmacist-centered strategies that have been implemented in several studies showing the positive impact on the reduction and prevention of medication errors commenced by not only the pharmacist but the rest of the healthcare team.

Scholarly Pathway: Understanding, Planning, and Competency Mapping in Pharmacy Education.

Pharmaceutical education has extensive integration of courses from life sciences to technology application and drug discovery to clinical trials. Pharmacy students are capable of diverse career selection due to acquired competencies during professional education. However, there is always a lack of real-time research exposure to pharmacy students at the undergraduate level. Therefore, the purpose is to design an effective research series that provides first-hand research experience to pharmacy students during 2-4 years of PharmD studies. The course design and delivery focused on three elements, namely, quality assurance, curriculum requirement, and assessment method. The outcomes of the course series are consistent with the emerging research skills and evidence-based practitioner role. The series and multilevel of course sequels comprising from knowledge - comprehension - argument - to - synthesis of research article. Students are expected to conduct independent research project under the supervision of college faculty. This will help them to develop and advance research skills for lifelong learning. The scholarly pathway series will develop critical appraisal skills to argue/support/value the literature and develop competency for evidence-based medicines. It will be highly beneficial to develop critical thinking, professionalism, and research skills among pharmacy students.

Comparative Efficacy of Beta-Lactams and Macrolides in the Treatment of Pediatric Pneumonia: A Systematic Review.

BACKGROUND: Pneumonia is an acute infection of the lung parenchyma that is differentiated among three main diagnoses: community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), and healthcare-associated pneumonia (HCAP). Though CAP is initially presented as a mild infection, it contributes to childhood mortality rates globally. A vast number of pathogens are the cause of CAP, but the two main causative organisms include Streptococcus pneumoniae and Haemophilus influenzae, with the former causing up to 50% of all childhood cases. In the current treatment guidelines from the Infectious Diseases Society of America (IDSA), amoxicillin is the recommended treatment choice for mild-to-moderate CAP while ampicillin is recommended for cases of severe CAP. Previous studies compared treatment between macrolides and beta-lactams to provide more information on the effectiveness in the pediatric population. OBJECTIVE: The objective of this article is to systematically review the literature on the comparative efficacy of beta-lactams and macrolides in the treatment of community-acquired pneumonia among children and to evaluate the outcomes that are used to determine drug efficacy in order to provide medication recommendations. METHODS: A systematic literature search was conducted in PubMed, TRIP, Cochrane and SCOPUS. Cohort studies and randomized controlled trials between the years 2000 and 2020 that compared the efficacy of amoxicillin and macrolides in treating pediatric pneumonia were included in the systematic review. Eligible patients included patients who were 17 years and younger, diagnosed with community-acquired pneumonia, and were given beta-lactams or macrolides, either as monotherapy or combination. Two reviewers were involved in the appraisal process to assess the quality of the methods used in the selected studies. RESULTS: A total of six articles were eligible according to the inclusion criteria and quality assessment. Four articles compared beta-lactam monotherapy with beta-lactam and macrolide combination therapy, while Kogan R et al. compared macrolide therapy monotherapy with beta-lactam and macrolide combination therapy and Leyenaar JK et al. compared ceftriaxone monotherapy to ceftriaxone plus macrolide combination therapy. The studies defined treatment failure as either a change in antibiotic therapy or hospital admission within 14 days of CAP diagnosis. Three studies used the length of hospital stay as their primary outcome for comparison of treatment efficacy. Four studies showed that the use of macrolides provided better treatment outcomes by reducing hospital stay and treatment failure rates. Beta-lactam and macrolide combination therapy did not show a significant effect on treatment failure compared to beta-lactam monotherapy regimens and it did not affect mortality compared to placebo or diet alone. Within the macrolide class, azithromycin was more clinically significant compared to erythromycin. CONCLUSION: The use of macrolides as monotherapy or add-on therapy to beta-lactams is more effective in the treatment of community-acquired pneumonia in the pediatric population.