Epidemiology, clinical characteristics, and associated cost of acute poisoning: a retrospective study.

Introduction: Poisoning is a major public health issue and a leading cause of admission to the emergency department (ED). There is a paucity of data describing the epidemiology and cost of acute poisoning. Therefore, this study investigated the epidemiology, patterns, and associated costs of acute poisoning in emergency department of the largest tertiary care healthcare centre in Qatar. Method: This study was a retrospective review of the health records of patients admitted to the ED due to poisoning between January 2015 and December 2019. Incidence, clinical characteristics, and costs associated with acute poisoning were assessed. Frequency and percentages were calculated for categorical variables and mean and SD for continuous variables. The relationship between sociodemographic characteristics and poisoning profile was assessed using the chi-square test. A micro-costing approach using the cost of each resource was applied for cost calculations. Result: The incidence of acute poisoning was 178 cases per 100,000 patients. Females (56%) and children below 14 years (44.3%) accounted for the largest proportion. Most of the exposures were accidental involving therapeutic agents (64.2%). The mean length of hospital stay was found to be 1.84 ± 0.81 days, and most patients (76.6%) were discharged within the first 8 h. A statistically significant difference was found between age groups and type of toxin (χ2 = 23.3, p < 0.001), cause and route of exposure (χ2 = 42.2, p < 0.001), and length of hospital stay (χ2 = 113.16, p < 0.001). Admission to intensive care units had the highest cost expenditure (USD 326,008), while general wards accounted for the least (USD 57,709). Conclusion: Unintentional poisoning by pharmacological agents is common in infants and children. This study will assist in the development of educational and preventive programmes to minimise exposure to toxic agents. Further studies are required to explore the impact of medical toxicology services, and post discharge monitoring of poisoning.

The cost associated with the development of the antimicrobial stewardship program in the adult general medicine setting in Qatar.

Objective: To estimate the economic impact of the developed antimicrobial stewardship program (ASP) versus the preliminary ASP use, in the adults' general medicine settings in Qatar. Methods: Patient records were retrospectively reviewed during two periods: preliminary ASP was defined as the 12 months following ASP implementation (i.e. May 2015-April 2016), and developed ASP was defined as the last 12 months of a 5-year ASP implementation in Hamad Medical Corporation (HMC) (i.e. February 2019-January 2020). The economic impact was the overall cost savings in resource use, including operational costs, plus the cost avoidance associated with ASP. Results: A total of 500 patients were included in the study. The operational costs decreased with the developed ASP. Whereas antimicrobial consumption and resource utilisation, and their associated costs, appear to have declined with the developed ASP, with a cost saving of QAR458 (US$125) per 100-patient beds, the avoided cost was negative, by QAR4,807 (US$1,317) per 100-patient beds, adding to a total QAR4,224 (US$1,160) increase in the 100-patient beds cost after ASP development. Conclusions: Despite that the developed ASP attained a total cost saving QAR458 (US$125) per 100-patient beds, the avoided cost was QAR-4,807 (US$-1,317) per 100-patient beds, which exceeded the cost savings achieved.

Behaviour and associated determinants of COVID-19 vaccine acceptance and advocacy: a nationwide survey of pharmacy professionals in Qatar.

BACKGROUND: Vaccine hesitancy poses a global challenge and is acknowledged to be a complex, multifactorial phenomenon. Of particular concern is hesitancy among health professionals, as this may also impact their advocacy roles. There is a lack of theory-based investigations of pharmacy professionals. AIM: The study aims to determine the behaviour and associated determinants influencing pharmacy professionals' attitude towards vaccine acceptance and advocacy. METHODS: A cross-sectional survey of 2400 pharmacists and pharmacy technicians at government, semi-government, and private community pharmacies in Qatar. Questionnaire items captured perspectives on COVID vaccine acceptance, advocacy and associated determinants based on the domains and constructs of the Theoretical Domains Framework (TDF). Data were analysed by descriptive and inferential statistics, with TDF items subjected to principal components analysis (PCA). FINDINGS: The response rate was 38.6% (927/2400). Almost all (n = 825, 89.0%) were willing to receive the vaccine, which was higher for males (p < 0.001) and those in polyclinics (p < 0.05). PCA of acceptance items gave five components, with response to 'emotions' being most negative, associated with acceptance (p < 0.001) and more negative in females (p < 0.001). The majority (n = 799, 86.2%) agreed that it was their professional duty to advocate vaccines. PCA for advocacy items gave two components, with the most negative responses for 'professional role and identity', which were more negative for those working in hospitals (p < 0.05). CONCLUSION: Respondents were least positive regarding emotion-related behavioral determinants for acceptance and professional role and identity for advocacy. Behavior change technique interventions that target these issues have the potential to influence the vaccine hesitancy of pharmacy professionals and other individuals.

Patterns and outcomes of paracetamol poisoning management in Hamad Medical Corporation, Qatar: A retrospective cohort study.

We aimed to investigate the characteristics and clinical outcomes of paracetamol poisoning and paracetamol overdose in Qatar. This retrospective cohort study included patients admitted to the emergency department (ED). We included patients who presented with excessive paracetamol ingestion, between December 2018 and September 2019. The primary outcomes were describing the characteristics and outcomes of paracetamol overdose (from a suicidal overdose or accidental overdose, dose ≤ 150 mg/kg, when serum levels of <60 mmol/L) or dose ingested (≤75 mg/kg) with staggered ingestion poisoning due to suicidal attempt or accidental attempt, defined as the dose ingested (>150 mg/kg), acute ingestion, nomogram level more than the treatment line, or dose ingested (>75 mg/kg) with staggered ingestion, and assessing the management of excessive paracetamol ingestion. Secondary outcomes included evaluation of the time difference between ingestion and time of administration, hospitalization, and adverse drug events. Significant differences were detected between patients who presented with paracetamol overdose and those who presented with paracetamol toxicity. A total of 69 patients were analyzed, of whom 43 received paracetamol overdose (mean age 27.5 ± 11.1 years) and 26 had paracetamol poisoning (mean age 25 ± 6.22 years). Paracetamol poisoning was identified in 26% of the patients with a 24.3% history of psychiatric illness, compared to 18.6% with paracetamol overdose. More patients presented with paracetamol toxicity in the time between ingestion and obtaining serum levels compared to the overdose group. A significantly longer length of hospitalization was observed in the toxicity group. A significantly higher number of patients in the toxicity group received N-acetylcysteine (NAC). More hypotension and rashes were observed among those who received NAC in the toxicity group. Patients presenting to the ED due to paracetamol toxicity are not uncommon, and most cases occur in young adults, and few in patients with a history of psychiatric illness, suggesting that preventive approaches are highly required.

Cost-effectiveness of Oral Versus Intravenous Ibuprofen Therapy in Preterm Infants With Patent Ductus Arteriosus in the Neonatal Intensive Care Setting: A Cohort-based Study.

PURPOSE: Use of ibuprofen for the patent ductus arteriosus (PDA) has become increasingly common. This study aimed to evaluate the clinical and economic impact of oral ibuprofen versus intravenous ibuprofen for PDA among preterm infants. METHODS: This retrospective, cohort-based pilot study examined the clinical and economic associations of oral versus intravenous ibuprofen for PDA. A decision-analytic model was constructed, from the hospital perspective, to follow the oral versus intravenous administrations of ibuprofen for PDA and their clinical and economic consequences. The course regimen of either formulation was an initial 10 mg/kg followed by 5 mg/kg at 24- and 48-h intervals. Clinical and resource utilization data were extracted from Cerner medical database, from 2014 through 2018, at the tertiary neonatal intensive care unit setting in Qatar. The primary outcome measures were the rate of successful closure based on the ductal diameter measure after the first course of treatment and the overall direct medical cost of PDA management. A population of 118 neonates was required for results with 80% power and 0.05 significance. Sensitivity analyses involving unit costs and a subgroup analysis based on gestational age and birth weight, added to a second-order probabilistic analysis of all model inputs, were performed. FINDINGS: Forty infants were available for inclusion in the oral ibuprofen study group, not achieving the desired sample size, with successful PDA closure reported in 64% of cases compared with a reduced success of 36% with intravenous ibuprofen (n = 59) (risk ratio = 0.56; 95% CI, 0.32-0.97; P = 0.04), which was associated with economic advantage to oral ibuprofen. The probabilistic analysis illustrated that oral ibuprofen costs less than intravenous ibuprofen in 72% of patient cases, with QAR 48,751 (US $13,356) (95% CI, QAR 47,500-50,000, US $13,014-$13,699) in mean savings. Sensitivity analyses confirmed the robustness of study conclusions and found that the rate of closure success versus failure was the most influential on results, followed by the occurrence of adverse drug events with both intravenous and oral ibuprofen. Although both ibuprofen formulations had similar safety profiles (P = 0.16), the intravenous formulation was associated with a larger number of adverse drug effects. IMPLICATIONS: This is the first cost-effectiveness evaluation of oral versus intravenous formulations of ibuprofen among infants with PDA. The oral ibuprofen might be associated with an enhanced ductal closure at a considerably lower cost. The study results support recent trends in neonatal intensive care unit practices in favor of the oral administration of ibuprofen.

Anaphylaxis triggers in a large tertiary care hospital in Qatar: a retrospective study.

BACKGROUND: Anaphylaxis is a serious allergic disease that may lead to death if not immediately recognized and treated. Triggers of anaphylaxis including food, drugs, and insect stings can vary widely. The incidence of anaphylaxis seems to be affected by age, sex, atopy, and geographic location. This study aims to examine the common triggers of anaphylaxis in Qatar. METHODS: A total of 1068 electronic medical records were audited using power chart system: 446 from the medical coding system of anaphylaxis and 622 from the epinephrine auto-injectors (EAIs) dispensed during January 2012-December 2017. RESULTS: Of 1068 patients, 574 (53.5%) had anaphylaxis; male to female ratio was 1.2, and 300 patients (77.9%) were less than 10 years old. The common triggers were food (n = 316, 55.0%), insect stings (n = 161, 28.0%), and drugs (n = 103, 17.9%). Common anaphylaxis food triggers were nuts (n = 173, 30.1%), eggs (n = 89, 15.5%), and seafood (n = 72, 12.5%), and common anaphylaxis medication triggers were antibiotics (n = 49, 8.5%) and nonsteroidal anti-inflammatory drugs (n = 30, 5.2%). Interestingly, 135 anaphylactic patients (23.5%) were due to black ant stings. The anaphylaxis triggers varied significantly between children and adults. Among children (less than 10 years), three quarters of the events were triggered by food (223, 74.3%) while among adults (20-55 years), insect stings (n = 59, 43.0%) and drugs (n = 44, 32.0%) were dominant. DISCUSSION: This is the first national study stratifying anaphylaxis triggers among different age groups in Qatar. This study will serve as a guide for clinical practice in allergy clinics in Qatar and will help to assess future trends of anaphylaxis in Qatar.

Knowledge and practice characteristics of pharmacists in Qatar towards medication use in pregnancy: a cross-sectional survey.

BACKGROUND: Medication use during pregnancy is common. Pharmacists have an important role in improving medication use during pregnancy. There is a lack of empirical evidence on pharmacists' knowledge and practice characteristics towards medication use in pregnancy. OBJECTIVES: This study aimed to determine the knowledge and practice characteristics of pharmacists in Qatar about medicines use in pregnancy. METHODS: A cross-sectional, questionnaire-based study was conducted over a period of 6 months in 2010. Questionnaires were distributed to 400 of 800 licensed pharmacists employed in Qatar (in government and private sectors). Data were collected on: demographics and practice characteristics of the pharmacists; their knowledge and perception about medication use in pregnancy; their confidence in dealing with pregnant women and physicians; and their source of the drug information. RESULTS: Of the 400 questionnaires distributed, 207 were returned (52% response rate). Most pharmacists (71%) had not participated in any educational activities on medication use in pregnancy. About 50% reported that < 10% of their workload involved dispensing medications to pregnant women. A lack of available resources and unknown pregnancy status were the main concerns about dispensing medication to pregnant women. The majority of the respondents had average knowledge about medication use in pregnancy. There was a significant association between knowledge, and continuing education and years of experience (P < 0.05). CONCLUSIONS: Pharmacists in Qatar had an average level of knowledge about medications use in pregnancy. Continuous educational programmes are needed for pharmacists in Qatar to enhance their knowledge and practice of medicine use during pregnancy.

Overview of pharmacovigilance practices at the largest academic healthcare system in the State of Qatar.

Adverse Drug Reactions (ADRs) are major global concern, adversely impacting patient safety and health outcomes. ADRs cause significant morbidity and mortality among hospitalised patients, causing greater length of hospital stay, increased healthcare costs and patient dissatisfaction to the treatments. Pharmacovigilance (PV), a process of detecting, monitoring and preventing drug-related harm, plays a vital role to ensure patient safety. ADR reporting is the cornerstone of PV. PV practices in Qatar are relatively new and are evolving rapidly. The purpose of this article is to explore the medication safety practices (notably ADR reporting) at the largest academic healthcare center in Qatar. The article further provides evidence on how information related to ADRs are generated and interpreted. Furthermore, it describes how a designated center for monitoring medication safety activities was established at the largest healthcare provider in Qatar.

Knowledge and practice characteristics of pharmacists in Qatar towards medication use in pregnancy: a cross-sectional survey

Background: Medication use during pregnancy is common. Pharmacists have an important role in improving medication use during pregnancy. There is a lack of empirical evidence on pharmacists' knowledge and practice characteristics towards medication use in pregnancy. Objectives: This study aimed to determine the knowledge and practice characteristics of pharmacists in Qatar about medicines use in pregnancy. Methods: A cross-sectional, questionnaire-based study was conducted over a period of 6 months in 2010. Questionnaires were distributed to 400 of 800 licensed pharmacists employed in Qatar [in government and private sectors]. Data were collected on: demographics and practice characteristics of the pharmacists; their knowledge and perception about medication use in pregnancy; their confidence in dealing with pregnant women and physicians; and their source of the drug information. Results: Of the 400 questionnaires distributed, 207 were returned [52% response rate]. Most pharmacists [71%] had not participated in any educational activities on medication use in pregnancy. About 50% reported that < 10% of their workload involved dispensing medications to pregnant women. A lack of available resources and unknown pregnancy status were the main concerns about dispensing medication to pregnant women. The majority of the respondents had average knowledge about medication use in pregnancy. There was a significant association between knowledge, and continuing education and years of experience [P < 0.05]. Conclusions: Pharmacists in Qatar had an average level of knowledge about medications use in pregnancy. Continuous educational programmes are needed for pharmacists in Qatar to enhance their knowledge and practice of medicine use during pregnancy

Contexte : L'utilisation des médicaments durant la grossesse est courante. Les pharmaciens jouent un rôle important dans l'amélioration de l'utilisation des médicaments pendant cette période Les données empiriques manquent sur les connaissances des pharmaciens et leurs pratiques en la matière. Objectifs : La présente étude visait à déterminer les connaissances et les caractéristiques des pratiques des pharmaciens qataris en matière d'utilisation des médicaments pendant la grossesse. Méthodes : Une étude transversale, reposant sur un questionnaire, a été conduite sur une période de six mois en 2010. Des questionnaires ont été distribués à 400 des 800 pharmaciens agréés exerçant au Qatar [dans les secteurs public et privé]. Des données ont été recueillies sur les caractéristiques démographiques et concernant la pratique des pharmaciens, sur leurs connaissances et leur perception de l'utilisation des médicaments pendant la grossesse, sur leur confiance lorsqu'ils s'occupent de femmes enceintes et contactent les médecins prescripteurs, et sur les sources des informations qu'ils détenaient sur les médicaments. Résultats : Sur les 400 questionnaires distribués, 207 ont été renvoyés [taux de réponse de 52 %]. La plupart des pharmaciens [71 %] n'avaient jamais participé à aucune activité de formation sur l'utilisation des médicaments pendant la grossesse. Environ 50 % ont rapporté que moins de 10 % de leur charge de travail impliquait la délivrance de médicaments aux femmes enceintes. Un manque de ressources disponibles et l'ignorance de l'état de grossesse des clientes étaient les principales préoccupations liées à la délivrance de médicaments aux femmes enceintes. La majorité des répondants avaient une connaissance moyenne de l'utilisation des médicaments pendant la grossesse. Il existait une association significative entre les connaissances, la formation continue et les années d'expérience [p < 0,05]. Conclusions : Les pharmaciens qataris avaient un degré de connaissance moyen de l'utilisation des médicaments pendant la grossesse. Des programmes de formation continue sont requis pour les pharmaciens qataris de façon à améliorer leurs connaissances et leurs pratiques en matière d'utilisation des médicaments pendant la grossesse

المعلومات الأساسية: ينبغي لجميع السياسات والبرامج الحكومية المعنية بالأمن الغذائي والتغذوي أن تشمل توفير الغذاء الصحي وإتاحته لجميع الناس بأسعار معقولة. الخلفية: يشيع استخدام الأدوية أثناء الحمل. ويضطلع الصيادلة بدور مهم في تحسين استخدام الأدوية أثناء الحمل. ولا توجد براهين تجريبية على معلومات الصيادلة وممارساتهم وخبراتهم بشأن استخدام الأدوية أثناء الحمل في قطر. الأهداف: هدفت هذه الدراسة إلى تحديد معلومات الصيادلة في قطر والسمات الخاصة بممارساتهم بشأن استخدام الأدوية أثناء الحملطرق البحث: أُجريت دراسة مقطعية على أساس استبيان خلال فترة 6 أشهر في عام 2010 . وتم توزيع الاستبيانات على 400 صيدلاني من أصل800 صيدلاني مصرح لهم بالعمل في قطر )في القطاعين الحكومي والخاص(. وجُعت بيانات حول: السمات السكانية للصيادلة وسمات ممارساتهم؛ومعلوماتهم وتصوراتهم بشأن استخدام الأدوية أثناء الحمل؛ وثقتهم في التعامل مع الحوامل والأطباء؛ ومصادر معلوماتهم عن العقاقير النتائج: من الاستبيانات الموزعة البالغ عددها 400 استبياناً، تم الرد على 207 منهم )بمعدل استجابة 52 %(. وتبيّ أن أغلب الصيادلة ) 71 %( لميشاركوا في أي أنشطة تعليمية بشأن استخدام الأدوية أثناء الحمل. وأفاد نحو 50 % منهم بأن أقل من 10 % من عبء عملهم يتضمن صرف أدويةللحوامل. وتمثلت المخاوف الرئيسية المتعلقة بصرف الأدوية للحوامل في عدم كفاية الموارد المتاحة وعدم المعرفة بوضع الحمل. كما تبين أن معظمالمستجيبين كانت لديهم معرفة متوسطة بشأن استخدام الأدوية أثناء الحمل. وسُجِّل ارتباط وثيق بين المعلومات والتعليم المستمر وسنوات الخبرة.)P >0.05(الاستنتاجات: يتمتع الصيادلة في قطر بمستوى معرفة متوسط بشأن استخدام الأدوية أثناء الحمل. ومن ثم، يلزم عقد برامج تعليم مستمر للصيادلة في قطر من أجل تحسين معلوماتهم وممارساتهم فيما يتعلق باستخدام الأدوية أثناء الحمل

Advancing the pharmacy practice research agenda: views and experiences of pharmacists in Qatar.

BACKGROUND: There is little emphasis on pharmacy practice research in Qatar, with a lack of relevant education and training and a notable lack of exposure to processes of research. OBJECTIVE: To describe views and attitudes of pharmacists in Qatar to pharmacy practice research prior to and following a 2 day introductory research workshop. METHOD: All pharmacists (n = 350) were invited to express interest in attending. All participants were required to complete a questionnaire covering views and attitudes relating to research. Workshop sessions were on: research questions; critically appraising literature; developing research methods; collecting and analysing data; and disseminating findings. Participants completed a post-course evaluation questionnaire. RESULTS: Of the ninety expressing interest, 47 were selected and participated in the first training day, with 40 of these also attending the second day. Participants expressed positive views and attitudes towards research. Most (46/47) strongly agreed/agreed that it was their professional duty to be involved; all strongly agreed/agreed with importance of an evidence base to support practice; but there were issues around time, support and training. The research workshops were positively evaluated by participants. CONCLUSION: Findings indicate pharmacists' willingness to participate in research training in Qatar. However, there is a need to ensure that views and attitudes translate into research participation thus enhancing the evidence base.