A Comprehensive Review of the Mechanism, Efficacy, Safety, and Tolerability of Ubrogepant in the Treatment of Migraine.

Ubrogepant is an innovative medication designed for the acute treatment of migraine, a debilitating neurological condition that profoundly impairs quality of life, productivity, and social interactions. This comprehensive review assesses the efficacy, safety, tolerability, and mechanism of action of ubrogepant through a rigorous methodology, including an in-depth literature review from reputable databases like PubMed, Web of Science, Embase, Scopus, and Cochrane. Classified as a calcitonin gene-related peptide (CGRP) receptor antagonist, ubrogepant has emerged as a potential revolutionary medication for migraine treatment. CGRP is a peptide integral to migraine pathophysiology, and its blockade has demonstrated great therapeutic potential. Unlike triptans, known for their cardiovascular risks, ubrogepant lacks vasoconstrictive properties, making it a safer alternative for a broader patient population. Ubrogepant offers significant potential for pain relief, symptom reduction, and restoration of normal function during a migraine attack, and it outperforms placebo in terms of efficacy. It also presents favorable safety, with generally mild adverse drug events (ADEs), such as nausea, dizziness, and somnolence, similar to placebo effects. Consistent results from clinical trials confirm its tolerability, with minor ADEs and no safety alerts for the tested doses, indicating that ubrogepant is a safe and well-tolerated option for migraine treatment. As an effective oral medication, ubrogepant could be an alternative to traditional acute migraine treatments. Its benefits include a unique mechanism of action, rapid onset, and favorable safety profile. However, specific contraindications, such as hypersensitivity, severe hepatic impairment, concurrent use of CYP3A4 inhibitors, pregnancy or breastfeeding, and uncontrolled hypertension, require caution or avoidance of ubrogepant. Despite these limitations, ubrogepant signals a promising new direction in migraine therapeutics.

Registered Nurses' beliefs about end-of-life care: A mixed method study.

AIMS: To examine registered nurses' (RNs) behavioural, normative and control beliefs about end-of-life care for patients who are diagnosed with advanced and life-limiting illnesses; and to identify the barriers and facilitators they experience when providing end-of-life care. DESIGN: A sequential explanatory mixed methods study. METHOD: An online cross-sectional survey was conducted using the Care for Terminally Ill Patient tool among 1293 RNs working across five hospitals in the Kingdom of Saudi Arabia. Online individual semi-structured interviews with a subgroup of survey respondents were then undertaken. Data were collected between October 2020 to February 2021. RESULTS: A total of 415 RNs completed the online survey, with 16 of them participating in individual interviews. Over half of the participants expressed the belief that end-of-life care is most efficiently delivered through multidisciplinary team collaboration. The majority of participants also believed that discussing end-of-life care with patients or families leads to feelings of hopelessness. Paradoxically, the study revealed that more than half of the participants held the negative belief that patients at the end of life should optimally receive a combination of both curative and palliative care services. The results showed that nurses' beliefs were significantly associated with their age, religion, ward type, level of education and frequency of providing end-of-life care. Data from the qualitative interviews identified four themes that explored RNs' beliefs and its related factors. The four themes were 'holistic care', 'diversity of beliefs', 'dynamics of truth-telling' and 'experiences of providing end-of-life care.' IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Wherever possible, patients at the end-of-life should be cared for in specialist settings by multidisciplinary teams to ensure effective, high-quality care. Where this is not possible, organisations should ensure that teams of multidisciplinary staff, including nurses, receive education and resources to support end-of-life care in non-specialist settings. Hospitals that employ foreign-trained nurses should consider providing targeted education to enhance their cultural competence and reduce the impact of different beliefs on end-of-life care.

Registered Nurses' attitudes towards end-of-life care: A sequential explanatory mixed method study.

AIMS: To examine registered nurses' attitudes about end-of-life care and explore the barriers and facilitators that influence the provision of high-quality end-of-life care. DESIGN: A sequential explanatory mixed methods research design was used. METHODS: An online cross-sectional survey was distributed to 1293 registered nurses working in five different hospitals in the Kingdom of Saudi Arabia. The Frommelt Attitudes Towards Care of the Dying Scale was used to assess nurses' attitudes towards end-of-life care. Following the survey, a subset of registered nurses were interviewed using individual semi-structured interviews. RESULTS: Four hundred and thirty-one registered nurses completed the online survey, and 16 of them participated in individual interviews. Although nurses reported positive attitudes towards caring for dying patients and their families in most items, they identified negative attitudes towards talking with patients about death, their relationship with patients' families and controlling their emotions. The individual interview data identified the barriers and facilitators that registered nurses experience when providing end-of-life care. Barriers included a lack of communication skills and family and cultural and religious resistance to end-of-life care. The facilitators included gaining support from colleagues and patients' families. CONCLUSION: This study has identified that while registered nurses hold generally favourable attitudes towards end-of-life care, they have negative attitudes towards talking with patients and families about death and managing their emotional feelings. RELEVANCE TO CLINICAL PRACTICE: Education providers and leaders in healthcare settings should consider developing programmes for undergraduate nurses and nurses in clinical practice to raise awareness about the concept of death in a cross-section of cultures. Nurses' attitudes towards dying patients will be enhanced with culture-specific knowledge which will also enhance communication and coping methods. REPORTING METHOD: This study used the Mixed Methods Article Reporting Standards (MMARS).

Time-Series Analysis and Healthcare Implications of COVID-19 Pandemic in Saudi Arabia.

The first case of coronavirus disease 2019 (COVID-19) in Saudi Arabia was reported on 2 March 2020. Since then, it has progressed rapidly and the number of cases has grown exponentially, reaching 788,294 cases on 22 June 2022. Accurately analyzing and predicting the spread of new COVID-19 cases is critical to develop a framework for universal pandemic preparedness as well as mitigating the disease's spread. To this end, the main aim of this paper is first to analyze the historical data of the disease gathered from 2 March 2020 to 20 June 2022 and second to use the collected data for forecasting the trajectory of COVID-19 in order to construct robust and accurate models. To the best of our knowledge, this study is the first that analyzes the outbreak of COVID-19 in Saudi Arabia for a long period (more than two years). To achieve this study aim, two techniques from the data analytics field, namely the auto-regressive integrated moving average (ARIMA) statistical technique and Prophet Facebook machine learning technique were investigated for predicting daily new infections, recoveries and deaths. Based on forecasting performance metrics, both models were found to be accurate and robust in forecasting the time series of COVID-19 in Saudi Arabia for the considered period (the coefficient of determination for example was in all cases more than 0.96) with a small superiority of the ARIMA model in terms of the forecasting ability and of Prophet in terms of simplicity and a few hyper-parameters. The findings of this study have yielded a realistic picture of the disease direction and provide useful insights for decision makers so as to be prepared for the future evolution of the pandemic. In addition, the results of this study have shown positive healthcare implications of the Saudi experience in fighting the disease and the relative efficiency of the taken measures.

Evolving Risk of Acute Kidney Injury in COVID-19 Hospitalized Patients: A Single Center Retrospective Study.

Background and Objectives: Within a year, COVID-19 has advanced from an outbreak to a pandemic, spreading rapidly and globally with devastating impact. The pathophysiological link between COVID-19 and acute kidney injury (AKI) is currently being debated among scientists. While some studies have concluded that the mechanisms of AKI in COVID-19 patients are complex and not fully understood, others have claimed that AKI is a rare complication of COVID-19-related disorders. Considering this information gap and its possible influence on COVID-19-associated AKI management, our study aimed to explore the prevalence of AKI and to identify possible risk factors associated with AKI development among COVID-19 hospitalized patients. Materials and Methods: A retrospective cohort study included 83 laboratory-confirmed COVID-19 patients hospitalized at the isolation department in a tertiary hospital in Zagazig City, Egypt between June and August 2020. Patients younger than 18 years of age, those diagnosed with end-stage kidney disease, or those on nephrotoxic medications were excluded. All study participants had a complete blood count, liver and renal function tests, hemostasis parameters examined, inflammatory markers, serum electrolytes, routine urinalysis, arterial blood gas, and non-enhanced chest and abdominal computer tomography (CT) scans. Results: Of the 83 patients, AKI developed in 24 (28.9%) of them, of which 70.8% were in stage 1, 8.3% in stage 2, and 20.8% in stage 3. Patients with AKI were older than patients without AKI, with hypertension and diabetes being the most common comorbidities. Risk factors for AKI include increased age, hypertension, diabetes mellitus, and a higher sequential organ failure assessment (SOFA) score. Conclusions: AKI occurs in a considerable percentage of patients with COVID-19, especially in elderly males, those with hypertension, diabetes, and a higher sequential organ failure assessment (SOFA) score. Hence, the presence of AKI should be taken into account as an important index within the risk spectrum of disease severity for COVID-19 patients.

Registered nurses' knowledge, attitudes and beliefs about end-of-life care in non-specialist palliative care settings: A mixed studies review.

AIM: The aim of this study was to describe, evaluate and synthesise the literature on registered nurses' knowledge, attitudes and beliefs towards end-of-life care in adult non-specialist palliative care settings. BACKGROUND: Little is known about the knowledge, attitudes and beliefs of Registered Nurses working in non-specialist palliative care settings about end-of-life care. DESIGN: A mixed-methods systematic review and narrative synthesis was conducted (PROSPERO Registration No: CRD4202148114). Five databases (Medline, CINAHL, PubMed, PsycINFO and Web of Science) were searched from inception to August 2020. Study quality was assessed using the Mixed Methods Appraisal Tool. RESULTS: Nineteen studies met the inclusion criteria. Registered nurses in non-specialist palliative care settings demonstrated good knowledge of pain symptoms and management and positive attitudes towards caring for dying patients and their families. Knowledge deficits were identified in the psychosocial and spiritual aspects of end-of-life care and registered nurses reported negative attitudes towards communication about death. Only five of the included studies explored registered nurses' beliefs towards end-of-life care. CONCLUSIONS: There is a need to enhance palliative care education in clinical practice settings and in undergraduate programs to improve registered nurses' knowledge, attitudes and beliefs about end-of-life care. Future studies that use reliable and validated methods to measure registered nurses' beliefs about end-of-life care should be conducted. TWEETABLE ABSTRACT: RNs in non-specialist palliative care settings want more education on pain management & greater knowledge on communicating about death/dying.

Data on healthcare perceptions about system risk factors associated with patient safety from the Ministry of Health hospitals in Hail Region of Saudi Arabia.

Patient protection has become one of the key elements of the quality of health care systems in Saudi Arabia. Medical errors that threaten patient safety are mediated by several factors including system risk factors. Hence, we used a self-structured questionnaire to assess and rank the system factors according to the perceptions of nurses working in the hospitals of the ministry of health in Hail, KSA. Eight out of twelve factors tested were perceived as threatening factors of the patient safety that are; 'Shortage of medical staff', 'Poor design of the hospital structure', 'Long working hours', 'Overcrowding of patients','Poor coordination between hospital departments, 'Punitive and blaming environment, 'Lack of clinical practice standards' and, 'Poor financial incentives'. Thus, considering the negative impact of the identified threatening system factors in this study on patient safety, urgent planning and managing appropriate corrective actions should be designed to improve patient safety issues.

Generalized Richards model for predicting COVID-19 dynamics in Saudi Arabia based on particle swarm optimization Algorithm.

COVID-19 pandemic is spreading around the world becoming thus a serious concern for health, economic and social systems worldwide. In such situation, predicting as accurately as possible the future dynamics of the virus is a challenging problem for scientists and decision-makers. In this paper, four phenomenological epidemic models as well as Suspected-Infected-Recovered (SIR) model are investigated for predicting the cumulative number of infected cases in Saudi Arabia in addition to the probable end-date of the outbreak. The prediction problem is formulated as an optimization framework and solved using a Particle Swarm Optimization (PSO) algorithm. The Generalized Richards Model (GRM) has been found to be the best one in achieving two objectives: first, fitting the collected data (covering 223 days between March 2nd and October 10, 2020) with the lowest mean absolute percentage error (MAPE = 3.2889%), the highest coefficient of determination (R2 = 0.9953) and the lowest root mean squared error (RMSE = 8827); and second, predicting a probable end date found to be around the end of December 2020 with a projected number of 378,299 at the end of the outbreak. The obtained results may help the decision-makers to take suitable decisions related to the pandemic mitigation and containment and provide clear understanding of the virus dynamics in Saudi Arabia.

Improving Antimicrobial Prescriptions with Computerized Decision Support Systems: Where Are We?

Antimicrobial computerized decision support systems (CDSS) have been developed to improve decision-making at the point of prescribing. Uptake of CDSS for antibiotic prescribing remains low, and evidence to suggest that CDSS provides a clear benefit for antimicrobial outcomes is scarce. We reviewed existing evidence on the impact of CDSS on antimicrobial prescribing. Based on the results of our literature search, we discuss the use of CDSS for antimicrobial management in hospitals and antibiotic prescribing practices in ambulatory primary care settings. We identify some of the issues surrounding selecting and defining appropriate outcome measures for assessing the impact of CDSS on antimicrobial prescribing in the hospital setting. In the primary care setting, we observed that CDSS has a modest impact in changing antibiotic prescribing practice, which could be related to the underutilization of antimicrobial CDSS.

Factors influencing decisions to enroll in the health informatics educational programs.

The aim of this study was to identify the most important factors associated with undergraduate students' decisions to enroll in the health informatics program at Hail University in Saudi Arabia. A cross-sectional survey was conducted among the population of 73 students (second to fourth year; 52 females, 21 males; age range 19-25 years). A hierarchy of perceived sources of influence was identified. Counselors, teachers and other professionals, and promotional materials, including information in the media, as well as the high quality characteristics of the institution, had the strongest influence. Other students, friends and family, the academic reputation of the University and the health informatics department faculty, together with interactions in the academic environment (e.g. segregation by gender) and financial, job, career, and postgraduate opportunities, were perceived to be weaker sources of influence. The strengths of the sources of influence varied significantly with respect to the socio-demographic characteristics of the students, as well as the categories associated with the decision-making process. Strong sources of influence were particularly important for the increasing number of female students who often made the final decision to enroll. These findings will support policy and decision makers to make better plans for health informatics education by understanding the influential sources that attract students into the health informatics profession, and will also assist the health care sector's attempts to avoid a deficiency in this rapidly expanding professional field.