Apabetalone (RVX-208): A Potential Epigenetic Therapy for the Treatment of Cardiovascular, Renal, Neurological, Viral, and Cancer Disorders.

Bromodomain and extra-terminal domain proteins (BET proteins) are epigenetic reader proteins that have been implicated in regulating gene expression through binding to chromatin and interaction with transcription factors. These proteins are located in the nucleus and are responsible for recognizing acetylated lysine residues on histones, reading epigenetic messages, recruiting key transcription factors, and thereby regulating gene expression. BET proteins control the transcription of genes responsible for maladaptive effects in inflammation, cancer, and renal and cardiovascular diseases. Given the multifaceted role of BET proteins in the pathogenesis of various diseases, several small molecule inhibitors of BET proteins have been developed as potential therapeutic targets for treating different diseases in recent years. However, while many nonselective BET inhibitors are indicated for the treatment of cancer, a selective BET inhibitor, apabetalone, is the only oral BET inhibitor in phase III clinical trials for the treatment of cardiovascular diseases and others. Thus, this review aims to present and discuss the preclinical and clinical evidence for the beneficial effects and mechanism of action of apabetalone for treating various diseases.

Exploring determinants of antimicrobial prescribing behaviour using the Theoretical Domains Framework.

BACKGROUND: Few theoretically-based, qualitative studies have explored determinants of antimicrobial prescribing behaviour in hospitals. Understanding these can promote successful development and implementation of behaviour change interventions (BCIs). OBJECTIVE: (s): To use the Theoretical Domains Framework (TDF) to explore determinants of clinicians' antimicrobial prescribing behaviour, identifying barriers (i.e., impediments) and facilitators to appropriate antimicrobial practice. METHODS: Semi-structured interviews with purposively-sampled doctors and pharmacists with a wide range of specialties and expertise in Hamad Medical Corporation hospitals in Qatar. Interviews based on previous quantitative research and the TDF were audio-recorded, transcribed and independently analysed by two researchers using the TDF as an initial coding framework. RESULTS: Data saturation was achieved after interviewing eight doctors and eight pharmacists. Inter-related determinants of antimicrobial prescribing behaviour linked to ten TDF domains were identified as barriers and facilitators that may contribute to inappropriate or appropriate antimicrobial prescribing. The main barriers identified were around hospital guidelines and electronic system deficiencies (environmental context and resources); knowledge gaps relating to guidelines and appropriate prescribing (knowledge); restricted roles/responsibilities of microbiologists and pharmacists (professional role and identity); challenging antimicrobial prescribing decisions (memory, attention and decision processes); and professional hierarchies and poor multidisciplinary teamworking (social influences). Key facilitators included guidelines compliance (goals and intentions), and participants' beliefs about the consequences of appropriate or inappropriate prescribing. Further education and training, and some changes to guidelines including their accessibility were also considered essential. CONCLUSIONS: Antimicrobial prescribing behaviour in hospitals is a complex process influenced by a broad range of determinants including specific barriers and facilitators. The in-depth understanding of this complexity provided by this work may support the development of an effective BCI to promote appropriate antimicrobial stewardship.

Costs of revision operations for distal junctional kyphosis following thoracic posterior spinal fusion for adolescent idiopathic scoliosis.

PURPOSE: To assess direct costs and risks associated with revision operations for distal junctional kyphosis/failure (DJK) following thoracic posterior spinal instrumented fusions (TPSF) for adolescent idiopathic scoliosis (AIS). METHODS: Children who underwent TPSF for AIS by a single surgeon (2014-2020) were reviewed. Inclusion criteria were minimum follow-up of 2 years, thoracolumbar posterior instrumented fusion with a lower instrumented vertebra (LIV) cranial to L2. Patients who developed DJK requiring revision operations were identified and compared with those who did not develop DJK. RESULTS: Seventy-nine children were included for analysis. Of these, 6.3% developed DJK. Average time to revision was 20.8 ± 16.2 months. Comparing index operations, children who developed DJK had significantly greater BMIs, significantly lower thoracic kyphosis postoperatively, greater post-operative lumbar Cobb angles, and significantly more LIVs cranial to the sagittal stable vertebrae (SSV), despite having statistically similar pre-operative coronal and sagittal alignment parameters and operative details compared with non-DJK patients. Revision operations for DJK, when compared with index operations, involved significantly fewer levels, longer operative times, greater blood loss, and longer hospital lengths of stay. These factors resulted in significantly greater direct costs for revision operations for DJK ($76,883 v. $46,595; p < 0.01). CONCLUSIONS: In this single-center experience, risk factors for development of DJK were greater BMI, lower post-operative thoracic kyphosis, and LIV cranial to SSV. As revision operations for DJK were significantly more costly than index operations, all efforts should be aimed at strategies to prevent DJK in the AIS population.

Combined Anterior Thoracic Vertebral Body Tethering and Posterior Lumbar Tethering Results in Quicker Return to Sport and Activity Compared to Posterior Spinal Instrumented Fusion in Patients with Adolescent Idiopathic Scoliosis.

STUDY DESIGN: Retrospective comparative study. OBJECTIVE: To compare patient-reported physical activity between anterior thoracic vertebral body tethering and posterior lumbar spine tethering (ATVBT/PLST) and posterior spinal instrumentation and fusion (PSIF) with minimum 2 year follow-up. METHODS: Consecutive skeletally immature patients with idiopathic scoliosis and a thoracic and lumbar curve magnitude ≥40° who underwent either ATVBT/PLST or PSIF from 2015-2019 were included. The primary outcome was rate of returning to sport. Secondary outcomes included ability to bend and satisfaction with sport performance as well as weeks until return to sport, school, physical education (PE) classes, and running. RESULTS: Ten patients underwent ATVBT/PLST and 12 underwent PSIF. ATVBT/PLST patients reported significantly faster return to sport (13.5 weeks vs 27.9 weeks, P = .04), running (13.3 weeks vs 28.8 weeks, P = .02), and PE class (12.6 weeks vs 26.2 weeks, P = .04) compared to PSIF patients. ATVBT/PLST patients reported that they had to give up activities due to their ability to bend at lower rates than PSIF patients while reporting "no changes" in their ability to bend after surgery at higher rates than PSIF patients (0% vs 4% giving up activities and 70% vs 0% reporting no changes in bending ability for ATVBT/PLST and PSIF, respectively, P = .01). Compared to PSIF patients, ATVBT/PLST patients experienced less main thoracic and thoracolumbar/lumbar curve correction at most recent follow-up (thoracic: 41 ± 19% vs 69 ± 18%, P = .001; thoracolumbar/lumbar: 59 ± 25% vs 78 ± 15%, P = .02). No significant differences in the number of revision surgeries were observed between ATVBT/PLST and PSIF patients (4 (40%) and 1 (8%) for ATVBT/PLST and PSIF, respectively, P = .221). CONCLUSIONS: ATVBT/PLST patients reported significantly faster rates of returning to sport, running, and PE. In addition, ATVBT/PLST patients were less likely to have to give up activities due to bending ability after surgery and reported no changes in their ability to bend after surgery more frequently than PSIF patients. However, the overall rate of return to the same or higher level of sport participation was high amongst both groups, with no significant difference observed between ATVBT/PLST and PSIF patients.

Economic impact of clinical pharmacist interventions in a general tertiary hospital in Qatar.

BACKGROUND: With an increasingly strained health system budgets, healthcare services need to continually demonstrate evidence of economic benefits. This study sought to evaluate the economic impact of interventions initiated by clinical pharmacists in an adult general tertiary hospital. METHODS: A retrospective review of clinical pharmacist interventions was carried out throughout follow-up durations in March 2018, July/August 2018, and January 2019 in Hamad General Hospital (HGH) at Hamad Medical Corporation (HMC) in Qatar. The study included clinical pharmacy interventions data of patients admitted to the internal medicine, critical care, and emergency wards. Included interventions were documented by clinical pharmacists or clinical pharmacy specialists, and approved by physicians. Interventions by non-clinical pharmacists or with missing data were excluded. Adopting the perspective of HMC, we calculated the total economic benefit, which is the sum of the cost savings and the cost avoidance associated with the interventions. Cost savings was defined as the reduced cost of therapy associated with therapy changes minus the cost of intervention and cost avoidance was the cost avoided by eliminating the occurrence of adverse drug events (ADEs). Sensitivity analyses were performed to assess the robustness of results against uncertainties. RESULTS: A total of 852 interventions, based on 340 patients, were included. The analysis projected an annual total benefit of QAR 2,267,036 (USD 621,106) based on a negative cost-savings of QAR-175,139 (USD-47,983) and a positive cost avoidance of QAR741,898 (USD203,260) over the 3-month follow-up period. The uncertainty analysis demonstrated the robustness of outcomes, including a 100% probability of positive economic benefit. CONCLUSIONS: The clinical pharmacist intervention was associated with an increased cost of resource use, which was overtaken by the cost avoidance generated. The pharmacy intervention, therefore, is an overall economically beneficial practice in HGH, reducing ADEs with considerable consequential positive economic savings.

Radiographic and perioperative outcomes following anterior thoracic vertebral body tethering and posterior lumbar spine tethering: a pilot series.

BACKGROUND AND CONTEXT:  In patients with adolescent idiopathic scoliosis (AIS) of main thoracic and lumbar spine regions, combined anterior thoracic vertebral body tethering and posterior lumbar spine tethering (ATVBT/PLST) is a novel non-fusion treatment option for growth modulation and conservation of motion. METHODS:  Fourteen patients with AIS who underwent ATVBT/PLST with at least 2-year follow-up were included. Primary outcomes included quality of life as assessed by SRS-22 instruments, radiographic analysis, and revision operations. We secondarily reported perioperative metrics and post-operative opiate morphine equivalents (OME). Clinical success was defined as patients who achieved skeletal maturity with ≤ 30° curve magnitude of both their main thoracic and thoracolumbar/lumbar curves and who did not undergo posterior spine instrumentation and fusion (PSIF). RESULTS: Patients had a mean age of 11.6 years (range 10-14 years), majority were girls (92%), and mean follow-up was 3.0 years (range 2-4.8 years). All patients were skeletally immature with a Risser ≤ 2. Included curves were Lenke 1C, 3C, or 6C. Mean preoperative curve magnitudes were 53° ± 8° (range 45°-65°) main thoracic and 49° ± 9° (range 40°-62°) thoracolumbar/lumbar curves. At most recent follow-up, patients had a mean main thoracic curve of 29° ± 8° (range 15°-40°) and a mean thoracolumbar/lumbar curve of 20° ± 15° (range 4°-35°). 50% required a revision operation. Cable breakage occurred in 43%, which did not always require revision. One patient progressed to thoracic fusion, but no patient underwent lumbar fusion. Patients had a mean SRS-22 outcome score of 4.2 ± 0.4. CONCLUSIONS: ATVBT/PLST is a potential alternative to spine fusion for select immature patients with AIS at a minimum 2-year follow-up. ATVBT/PLST potentially offers motion conservation at the cost of a higher revision rate. Further study and reporting of results are necessary to refine indications and techniques, which in turn will improve outcomes of this procedure. LEVEL OF EVIDENCE: Level IV-Case series without comparative group.

Examining Pharmacy Alumni's Perceptions of Job Satisfaction, Achievements, and Preparedness: A Mixed-Methods Study.

OBJECTIVES: There is a scarcity of research that holistically explores pharmacy alumni's employment experience and their professional performance. Job satisfaction is linked to professionals' productivity and their educational preparedness. This study aimed to explore the professional experiences of the College of Pharmacy-Qatar University alumni. METHODS: A convergent mixed-methods design was utilized to examine the alumni's perceptions of job satisfaction, achievements in the workplace, and preparedness for practice through both quantitative and qualitative approaches. This study involved the administration of a pre-tested online questionnaire among all alumni (n = 214) and the conduction of 7 focus groups of which the participants were selected from a heterogeneous purposive sample (n = 87). Herzberg's motivation-hygiene theory was applied in both approaches. RESULTS: One hundred thirty-six alumni completed the questionnaire (response rate = 63.6%), and 40 alumni attended the focus groups. A good level of job satisfaction was shown (median score = 30 [IQR = 12], [out of 48]). Sources of job satisfaction and dissatisfaction were recognition and limited opportunities for professional growth, respectively. Also, good satisfaction was revealed (median score = 20 [IQR = 21], [out of 56]) with the alumni's ability to attain several achievements (eg, developing pharmacy-related services), which allowed for career success. Moreover, fair agreement concerning the adequacy of the preparedness for practice was indicated (eg, being care providers) (mean = 37 [SD = 7.5], [out of 52]). However, certain aspects, such as the enhancement of non-clinical knowledge, warranted further improvement. CONCLUSION: Overall, pharmacy alumni had positive perceptions of their professional experiences. However, alumni's excellence in different pharmacy career prospects needs to be supported throughout their learning experience.

Perioperative Outcomes of Open Anterior Vertebral Body Tethering and Instrumented Posterior Spinal Fusion for Skeletally Immature Patients With Idiopathic Scoliosis.

BACKGROUND: Correcting adolescent idiopathic scoliosis (AIS) without fusion can be achieved with anterior vertebral body tethering (AVBT). However, little is known about the perioperative outcomes, pain control, and clinical outcomes in patients undergoing AVBT compared with instrumented posterior spinal fusion (IPSF). METHODS: In this retrospective cohort study, we compared pediatric patients with AIS who underwent either AVBT or IPSF. Inclusion criteria were based on the AVBT group, which included primary thoracic idiopathic scoliosis, Risser ≤1, curve magnitude 40 to 70 degrees, age 9 to 15, no prior spine surgery, index surgery between 2014 and 2019, and minimum 2-year follow-up. Patient demographics, perioperative metrics, pain visual analog scale scores, opiate morphine equivalent usage, cost data, and radiographic outcomes were compared. RESULTS: We identified 23 patients who underwent AVBT and 24 matched patients in the IPSF group based on inclusion criteria. Patients undergoing AVBT and PSF were similar in age (12±1 y vs. 13±1 y, P =0.132) and average follow-up time (3.8±1.6 y vs. 3.3±1.4 y, P =0.210). There were 23 female patients (87%) in the AVBT group and 24 female (92%) patients in the IPSF group. Intraoperatively, estimated blood loss (498±290 vs. 120±47 mL, P <0.001) and procedure duration (419±95 vs. 331±83 min, P =0.001) was significantly greater in the IPSF group compared with AVBT. Length of stay was lower in the AVBT group compared with PSF (4±1 vs. 5±2 d, P =0.04). PSF patients had significantly greater total postoperative opiate morphine equivalent use compared with AVBT (2.2±1.9 vs. 5.6±3.4 mg/kg, P <0.001). Overall direct costs following PSF and AVBT were similar ($47,655+$12,028 vs. $50,891±$24,531, P =0.58). Preoperative radiographic parameters were similar between both the groups, with a major thoracic curve at 51±10 degrees for AVBT and 54±9 degrees for IPSF ( P =0.214). At the most recent follow-up, IPSF patients had greater curve reduction to a mean major thoracic curve of 11±7 degrees (79%) compared with 19±10 degrees (63%) in AVBT patients ( P =0.002). Nine patients (39%) required revision surgery following AVBT compared with 4 patients(17%) following IPSF ( P =0.09). CONCLUSIONS: In a select cohort of patients, AVBT offers decreased surgical time, blood loss, length of stay, and postoperative opiate usage compared with IPSF. Although IPSF resulted in greater deformity correction at 2-year follow-up, the majority of patients who underwent AVBT had ≤35 major curves and avoided fusion. There is optimism for AVBT as a treatment option for select AIS patients, but long-term complications are still being understood, and the risk for revision surgeries remains high. LEVEL OF EVIDENCE: Level III.

Anterior vertebral body tethering for adolescent idiopathic scoliosis associated with less early post-operative pain and shorter recovery compared with fusion.

PURPOSE: While posterior spinal instrumentation and fusion (PSIF) for severe adolescent idiopathic scoliosis (AIS) is the gold standard, anterior vertebral body tethering (AVBT) is becoming an alternative for select cases. Several studies have compared technical outcomes for these two procedures, but no studies have compared post-operative pain and recovery. METHODS: In this prospective cohort, we evaluated patients who underwent AVBT or PSIF for AIS for a period of 6 weeks after operation. Pre-operative curve data were obtained from the medical record. Post-operative pain and recovery were evaluated with pain scores, pain confidence scores, PROMIS scores for pain behavior, interference, and mobility, and functional milestones of opiate use, independence in activities of daily living (ADLs), and sleeping. RESULTS: The cohort included 9 patients who underwent AVBT and 22 who underwent PSIF, with a mean age of 13.7 years, 90% girls, and 77.4% white. The AVBT patients were younger (p = 0.03) and had fewer instrumented levels (p = 0.03). Results were significant for decreased pain scores at 2 and 6 weeks after operation (p = 0.004, and 0.030), decreased PROMIS pain behavior at all time points (p = 0.024, 0.049, and 0.001), decreased pain interference at 2 and 6 weeks post-operative (p = 0.012 and 0.009), increased PROMIS mobility scores at all time points (p = 0.036, 0.038, and 0.018), and faster time to functional milestones of weaning opiates, independence in ADLs, and sleep (p = 0.024, 0.049, and 0.001). CONCLUSION: In this prospective cohort study, the early recovery period following AVBT for AIS is characterized by less pain, increased mobility, and faster recovery of functional milestones, compared with PSIF. LEVEL OF EVIDENCE: IV.

Thoracic posterior spinal instrumented fusion vs. thoracic anterior spinal tethering for adolescent idiopathic scoliosis with a minimum of 2-year follow-up: a cost comparison of index and revision operations.

PURPOSE: To compare direct costs of index and revision operations of thoracic posterior spinal instrumented fusion (TPSIF) and thoracic anterior spinal tethering (TAST) for adolescent idiopathic thoracic scoliosis in children. METHODS: Children (ages 11-18 years) who underwent TPSIF and TAST (2/2013-9/2019) were reviewed. Follow-up < 2 years and cervical instrumentation and/or instrumentation of a lumbar level at L3 or below were exclusion criteria. Patient demographics, radiographic curve magnitude, index operations and postoperative data, as well as indications for revisions/readmissions were collected. Direct costs were identified and compared for index and revision operations during follow-up. RESULTS: One hundred and four patients were included (TPSIF: 78; TAST: 25). TAST procedures were performed in children significantly younger and for smaller curve magnitudes. They had significantly fewer levels instrumented, shorter operating room (OR) times, and less estimated blood loss (EBL). After operation, a significantly higher percentage of TAST were admitted to ICU. Hospital length of stay (LOS) was similar between groups. Index operations' average direct costs were significantly higher for TAST than TPSIF ($52,947 v. $46,641; p = 0.02). Major cost drivers for both groups were implants, OR services, post-anesthesia care unit (PACU), and room/board. Revisions following TAST were more frequent than for TPSIF (36 v. 11.5%). Majority of TPSIF revisions were for junctional deformity. Curve progression and overcorrection were most common reason for TAST revisions. Average direct costs for revisions/readmissions were similar between groups (TPSIF: $28,485 v. TAST: $27,590; p = 0.46). CONCLUSIONS: Index operations' average direct costs were statistically similar between TPSIF and TAST for adolescent idiopathic scoliosis. Major cost drivers were implants, OR services, PACU, and room/board. TAST index operations' direct costs and associated direct costs for implants and room/board were significantly higher, while their anesthesia and OR services were significantly lower than TPSIF. TAST revisions were for overcorrection and curve progression, while TPSIF revisions were most commonly for junctional deformity. Overall average direct costs for revisions were similar despite revision rates being higher for TAST. LEVEL OF EVIDENCE: III.

Health sciences students' and instructors' perceptions of the emergency switch to virtual internship amid the COVID-19 pandemic: A case from Qatar.

In efforts to contain the COVID-19 pandemic, health colleges at Qatar University shifted their clinical training to virtual internships (VI) and project-based learning (PBL). The shift was new to students and faculty alike, and a major change that posed many challenges. This study aimed to explore the experience of changing to VIs during the pandemic from both the clinical instructors' and health sciences students' perspectives. A qualitative study was conducted based on the framework of readiness to change. It involved focus group discussions with students from the departments of Public Health and Human Nutrition and in-depth interviews with clinical instructors using appropriate online platforms. A total of 4 focus groups with 20 students and 4 interviews with instructors were conducted. Transcripts were analyzed following the inductive-deductive approach. The major themes that emerged from the analysis described students' and clinical instructors' perceptions of the necessity and efficiency of the switch to VI; the design of the VI and the extent of the clinical/field experience and skills that it offered; confidence in the ability to succeed in this type of internship and confidence about reaching expected goals; academic and moral support from clinical faculty and coordinators and the communication process with faculty and preceptors; and finally, the benefits gained and how employers would view this type of internship. Health sciences students' readiness for VI was generally low. Several student and faculty needs have to be addressed, specifically regarding the design of the program and the level of preceptors' communication with students. The findings would direct health programs, clinical instructors, and preceptors to better understand students' needs and efficiently plan for virtual internships during not only emergencies but also whenever there is a need to deliver online experiential learning courses.

Institution-wide shape analysis of 3D spinal curvature and global alignment parameters.

The spine is an articulated, 3D structure with 6 degrees of translational and rotational freedom. Clinical studies have shown spinal deformities are associated with pain and functional disability in both adult and pediatric populations. Clinical decision making relies on accurate characterization of the spinal deformity and monitoring of its progression over time. However, Cobb angle measurements are time-consuming, are limited by interobserver variability, and represent a simplified 2D view of a 3D structure. Instead, spine deformities can be described by 3D shape parameters, addressing the limitations of current measurement methods. To this end, we develop and validate a deep learning algorithm to automatically extract the vertebral midline (from the upper endplate of S1 to the lower endplate of C7) for frontal and lateral radiographs. Our results demonstrate robust performance across datasets and patient populations. Approximations of 3D spines are reconstructed from the unit normalized midline curves of 20,118 pairs of full spine radiographs belonging to 15,378 patients acquired at our institution between 2008 and 2020. The resulting 3D dataset is used to describe global imbalance parameters in the patient population and to build a statistical shape model to describe global spine shape variations in preoperative deformity patients via eight interpretable shape parameters. The developed method can identify patient subgroups with similar shape characteristics without relying on an existing shape classification system.

Impact of pharmacist-involved collaborative care on diabetes management in a primary healthcare setting using real-world data.

Background Diabetes mellitus is a complex multi-system disorder, requiring multi-disciplinary care. The conventional care model, where physicians are the sole caregivers may not be optimal. Addition of other healthcare team members improves healthcare outcomes for patients with diabetes. Aim To evaluate the impact of pharmacist-involved collaborative care on diabetes-related outcomes among patients with diabetes attending a primary healthcare setting  in Qatar using real-world data. Method A retrospective cohort study was conducted among patients with diabetes attending Qatar Petroleum Diabetes Clinic. Patients were categorized as either receiving pharmacist-involved collaborative care (intervention group) or usual care (control group). Data were analyzed using SPSS®. Glycemic control (glycated hemoglobin A1c, HbA1c), blood pressure, lipid profile, and body mass index were evaluated at baseline and up to 17 months of follow-up. Results After 17 months of follow-up, pharmacist-involved collaborative care compared to usual care resulted in a significant decrease in HbA1c (6.8 ± 1.2% vs. 7.1 ± 1.3%, p < 0.01). Moreover, compared to baseline, pharmacist-involved collaborative care significantly improved (p < 0.05) the levels of HbA1c (7.5% vs. 6.8%), low-density lipoprotein cholesterol (3.7 mmol/L vs. 2.8 mmol/L), total cholesterol (5.43 mmol/L vs. 4.34 mmol/L), and body mass index (30.42 kg/m2 vs. 30.17 kg/m2) after 17 months within the intervention group. However, no significant changes for these parameters occurred within the control group. Conclusion The implementation of pharmacist-involved collaborative care in a primary healthcare setting improved several diabetes-related outcomes over 17 months. Future studies should determine the long-term impact of this care model.

Ureteral injury following anterior thoracolumbar spinal instrumented fusion for adolescent idiopathic scoliosis: a case report with CT angiography analysis of surgically relevant anatomy.

PURPOSE: To report a rare ureteral injury following anterior spinal fusion for adolescent idiopathic scoliosis (AIS) that resulted in complete nephrectomy and to delineate the anatomical relationship between the proximal ureter and the anterior lumbar spine based on CT angiography (CTA). METHODS: Thoracolumbar spine CTAs of children with AIS were reviewed. We measured the following relationships to the ureters: lateral-most aspect of vertebral body, anterior psoas at intervertebral disc/vertebral body levels, and lateral psoas at vertebral body level. Spine level at which the renal arteries originated from the aorta was identified. Distance from origin to corresponding vertebral body/intervertebral disc also was measured. RESULTS: Forty-one girls and seven boys (mean age 12 years, range 7-18) were analyzed. Scoliosis lumbar convexity was left 94% and right 6%. From L1 to L4, ureter was identified within 1-2 cm of vertebral body. Distance between ureter and vertebral body and ureter and anterior psoas at intervertebral disc/vertebral body levels was less on left vs. right from L1 to L4 (p < 0.0001). Distance between ureter and lateral psoas was less on left vs. right from L1 to L2 (p = 0.0205; p = 0.0132) and greater on left vs. right from L3 to L4 (p = 0.0022; p = 0.0076). Renal artery originated at L1/L2 in > 50%. There was no difference in distance from renal artery origin to vertebral body/intervertebral disc (p = 0.4764). CONCLUSION: Ureteral injury is a potentially morbid complication of anterior spine surgery. Injury can occur secondary to disrupted blood supply and mechanical tissue damage. Surgeons must clearly understand the juxta-spinal anatomy to limit dissection and modify retraction to reduce risk. LEVEL OF EVIDENCE: Level IV.

Concurrent and overlapping surgery: perspectives from surgeons on spinal posterior instrumented fusion for adolescent idiopathic scoliosis.

PURPOSE: The purpose of this study was to determine perspectives of surgeons regarding simultaneous surgery in patients undergoing posterior spine instrumentation and fusion (PSIF) for adolescent idiopathic scoliosis (AIS). METHODS: A survey was administered to orthopaedic trainees and faculty regarding simultaneous surgery for primary PSIF for AIS. A five-point Likert scale (1: 'Strongly Disagree' to 5: 'Strongly Agree') was used to assess agreement with statements about simultaneous surgery. We divided simultaneous surgery into concurrent, when critical portions of operations occur at the same time, and overlapping, when noncritical portions occur at the same time. RESULTS: The 72 respondents (78.3% of 92 surveyed) disagreed with concurrent surgery for 'one of my patients' (response mean 1.76 (sd 1.03)) but were more accepting of overlapping surgery (mean 3.94 (sd 0.99); p < 0.0001). The rating difference between concurrent and overlapping surgery was smaller for paediatric and spine surgeons (-1.25) than for residents or those who did not identify a subspecialty (-2.17; p = 0.0246) or other subspecialty surgeons (-2.57; p = 0.0026). Respondents were more likely to agree with explicit informed consent for concurrent surgery compared with overlapping (mean 4.32 (sd 0.91) versus 3.44 (sd 1.14); p < 0.001). CONCLUSION: Orthopaedic surgeons disagreed with concurrent but were more accepting of overlapping surgery and anaesthesia for PSIF for AIS. Respondents were in greater agreement that patients should be explicitly informed of concurrence than of overlap. The surgical community's evidence and position regarding simultaneous surgery, in particular overlapping, must be more effectively presented to the public in order to bridge the gap in perspectives. LEVEL OF EVIDENCE: IV.

Neurophysiologic Detection of Spinal Cord Ischemia During Anterior Vertebral Tethering.

STUDY DESIGN: Case report. OBJECTIVE: The aim of this study was to present how computed tomographic angiography (CTA) and intraoperative neurophysiologic monitoring (IONM) detect spinal cord ischemia during anterior spine surgery. These data directed expedient surgical and anesthetic interventions that restored IONM signals and prevented neurologic sequalæ. SUMMARY OF BACKGROUND DATA: Anterior vertebral tethering (AVT) is a fusionless surgical treatment of adolescent idiopathic scoliosis (AIS). METHODS: AVT was performed on a skeletally immature patient with AIS. Preoperative CTA detailed location of the dominant radicular artery (DRA). Transcranial motor (tcMEP) and somatosensory (SEP) evoked potentials were monitored during operation. RESULTS: There was significant decline in tcMEP, but not SEP, after compression of the DRA during cable tensioning of AVT. There was complete tcMEP recovery following release of instrumentation. CONCLUSION: This article identifies a rare but potentially catastrophic vascular hazard associated with anterior spine operation, including AVT. Sacrifice of multiple unilateral segmental vessels may overwhelm the capacity of collateral spinal cord perfusion to compensate for DRA blood supply. This vascular risk may be eliminated by identifying the DRA in order that it may be preserved during the procedure. LEVEL OF EVIDENCE: 5.

Evaluating prescribing competencies covered in a Canadian-accredited undergraduate pharmacy program in Qatar: a curriculum mapping process.

BACKGROUND: The objective of this study was to evaluate the existing Bachelor of Science in Pharmacy [BSc (Pharm)] curriculum at Qatar University College of Pharmacy (QU CPH), for addressing international prescribing competencies. METHODS: The Australian National Prescribing Service (NPS MedicineWise) Competencies Required to Prescribe Medicines framework (the Prescribing Competencies Framework) was used in the BSc (Pharm) curriculum mapping process. The NPS MedicineWise Prescribing Competencies Framework outlines seven competency areas that are essential for pharmacist prescribing. The first mapping activity assessed the learning outcomes (LOs) of 62 courses within the BSc (Pharm) curriculum for covering and addressing the NPS MedicineWise competencies. The second mapping activity involved matching the LOs identified to address the NPS MedicineWise prescribing competencies, to the 2017 Association of Faculties of Pharmacy of Canada (AFPC) educational outcomes, on which the QU CPH BSc (Pharm) program is based. The AFPC educational outcomes address seven key program-level learning outcomes. RESULTS: The QU CPH BSc (Pharm) curriculum addresses most of the prescribing competencies listed in the NPS MedicineWise Prescribing Competencies Framework. However, gaps were identified in the curricular content and in the LOs that were related, but not restricted, to the following: electronic prescribing, physical examinations/preparing patients for investigations, and policies/procedures and quality assurace related to prescribing. Other gaps identified include legislative and workplace requirements for obtaining consent to access confidential patient's health information. CONCLUSION: The curriculum mapping exercise provided evidence that, for the most part, the existing BSc (Pharm) curriculum at QU CPH prepares pharmacy graduates for prescribing. However, there are areas that need better alignment between the taught curriculum and training on prescribing in practice. The results of this study are important to consider if pharmacist prescribing is to be implemented in Qatar.