Correction: Pharmacist-led educational interventions provided to healthcare providers to reduce medication errors: A systematic review and meta-analysis.

[This corrects the article DOI: 10.1371/journal.pone.0253588.].

The use of a modified Delphi technique to develop a critical appraisal tool for clinical pharmacokinetic studies.

BACKGROUND: Critical appraisal aids in assessing the quality of scientific literature, which is central to the practice of evidence-based medicine. Several tools and guidelines are available for critiquing and assessing the quality of specific study types. However, limited guidance exists for critical appraisal of clinical pharmacokinetic studies. AIM: We aimed to achieve experts' consensus regarding the quality markers for clinical pharmacokinetic studies in an attempt to develop a critical appraisal tool. METHOD: Quality markers related to clinical pharmacokinetic studies, were derived from the published literature and categorized according to manuscript reporting domains (abstract, introduction/background, methodology, results, discussion, and conclusion). Questions that aid in appraising pharmacokinetic studies were formulated from these quality markers. Experts were involved in a modified Delphi process to achieve a consensus regarding the formulated questions. The proposed tool was pilot tested on 30 recently published clinical pharmacokinetic studies. Inter-observer agreement was measured to determine the reliability of the included items. RESULTS: Twenty-five experts consented to participate. Three rounds of a modified Delphi survey were required to generate a consensus for a 21-item tool aimed at appraising the quality of clinical pharmacokinetic studies. When applied to 30 recently published clinical pharmacokinetic studies, most items scored fair to moderate levels of agreement (61.90-95.24%). CONCLUSION: The clinical pharmacokinetic critical appraisal tool (CACPK) developed in this study consisted of 21 items aimed at helping an end-user to determine the quality of a pharmacokinetic study. Further studies are warranted to reaffirm the validity and reliability of the CACPK tool.

Creation of an inventory of quality markers used to evaluate pharmacokinetic literature: A systematic review.

WHAT IS KNOWN AND OBJECTIVE: Robust critical appraisal tools for clinical pharmacokinetic studies are limited. Before development of such a tool is possible, quality markers (items deemed important for credibility of study results) must be identified. We aim to create an inventory of quality markers intended for the appraisal of clinical pharmacokinetic studies and to categorize identified markers into associated domains of study quality. METHODS: Medline via ProQuest central (1946-Sep 2020, EMBASE (1974-Sep 2020), Cochrane database of systematic reviews, Google and Google Scholar were searched using the following search categories: pharmacokinetics, reporting guidelines and quality markers. Reference lists of the identified articles were searched manually. Any article (review, study or guideline) reporting quality markers related to the appraisal of pharmacokinetic literature was eligible for inclusion. Articles were further screened and limited to those reported in English on human subjects only. Cell-based and animal-based pharmacokinetic studies were excluded. Extracted data from included articles included identified or perceived markers of quality and baseline article data. Identified quality markers were then categorized according to manuscript reporting domains (abstract, introduction/background, methodology, results, discussion and conclusion). RESULTS AND DISCUSSION: Of 789 studies identified, 17 articles were included for extraction of quality markers. A total of 35 quality markers were identified across eight categories. The most frequently reported quality markers were related to method (13/35) and result sections (6/35). Quality markers encompassed all aspects of study design and reporting and were both similar and different to established reporting checklists for clinical pharmacokinetic studies. WHAT IS NEW AND CONCLUSION: The inventory of quality markers is now suitable to undergo further testing for inclusion in a tool designed for the appraisal of clinical pharmacokinetic studies.

Pharmacist-led educational interventions provided to healthcare providers to reduce medication errors: A systematic review and meta-analysis.

INTRODUCTION: Medication errors are avoidable events that can occur at any stage of the medication use process. They are widespread in healthcare systems and are linked to an increased risk of morbidity and mortality. Several strategies have been studied to reduce their occurrence including different types of pharmacy-based interventions. One of the main pharmacist-led interventions is educational programs, which seem to have promising benefits. OBJECTIVE: To describe and compare various pharmacist-led educational interventions delivered to healthcare providers and to evaluate their impact qualitatively and quantitatively on medication error rates. METHODS: A systematic review and meta-analysis was conducted through searching Cochrane Library, EBSCO, EMBASE, Medline and Google Scholar from inception to June 2020. Only interventional studies that reported medication error rate change after the intervention were included. Two independent authors worked through the data extraction and quality assessment using Crowe Critical Appraisal Tool (CCAT). Summary odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model for rates of medication errors. Research protocol is available in The International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42019116465. RESULTS: Twelve studies involving 115058 participants were included. The two main recipients of the educational interventions were nurses and resident physicians. Educational programs involved lectures, posters, practical teaching sessions, audit and feedback method and flash cards of high-risk abbreviations. All studies included educational sessions as part of their program, either alone or in combination with other approaches, and most studies used errors encountered before implementing the intervention to inform the content of these sessions. Educational programs led by a pharmacist were associated with significant reductions in the overall rate of medication errors occurrence (OR, 0.38; 95% CI, 0.22 to 0.65). CONCLUSION: Pharmacist-led educational interventions directed to healthcare providers are effective at reducing medication error rates. This review supports the implementation of pharmacist-led educational intervention aimed at reducing medication errors.

Impact of pharmacist interventions on medication errors in hospitalized pediatric patients: a systematic review and meta-analysis.

Background Medication errors are avoidable events that may occur at any stage of the medication use process. Implementing a clinical pharmacist is one strategy that is believed to reduce the number of medication errors. Pediatric patients, who are more vulnerable to medication errors due to several contributing factors, may benefit from the interventions of a pharmacist. Aim of the review To qualitatively and quantitatively evaluate the impact of clinical pharmacist interventions on medication error rates for hospitalized pediatric patients. Methods PubMed, EMBASE, Cochrane Controlled Trials Register and Google Scholar search engines were searched from database inception to February 2020. Study selection, data extraction and quality assessment was conducted by two independent reviewers. Observational and interventional studies were included. Data extraction was done manually and the Crowe Critical Appraisal Tool was used to critically appraise eligible articles. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model for rates of medication errors. Results 19 studies were systematically reviewed and 6 studies (29,291 patients) were included in the meta-analysis. Pharmacist interventions involved delivering educational sessions, reviewing prescriptions, attending rounds and implementing a unit-based clinical pharmacist. The systematic review indicated that the most common trigger for pharmacist interventions was inappropriate dosing. Pharmacist involvement was associated with significant reductions in the overall rate of medication errors occurrence (OR 0.27; 95% CI 0.15 to 0.49). Conclusion Pharmacist interventions are effective for reducing medication error rates in hospitalized pediatric patients.

Pass-Fail Decisions for Borderline Performers After a Summative Objective Structured Clinical Examination.

Objective. To determine what expert assessors value when making pass-fail decisions regarding pharmacy students based on summative data from objective structured clinical examinations (OSCE), and to determine the reliability of these judgments between multiple assessors. Methods. All assessment data from 10 exit-from-degree OSCE stations for seven borderline pharmacy students (determined by standard setting methods) and one control was given to three of eight assessors for review. Assessors determined an overall pass-fail decision based on their perception of graduate competency. Assessors were interviewed to determine their decision-making rationale. Intraclass correlation coefficients were used to calculate reliability between assessor judgments. Results. Expert consensus was achieved for three of the eight students, however, the assessors' decisions did not align with standard-setting results. The reliability of assessors' decisions was poor. Assessors focused on ability to make correct recommendations rather than on gathering information or providing follow-up advice. Global evaluations (including a student's communication skills) rarely influenced the assessors' decision-making. Conclusion. When faced with making pass-fail decisions for borderline students, the assessors focus on evaluating the same competencies in the students but differed in their expected performance levels of these competencies. Pass-fail decisions are primarily based on task-focused components instead of global components (eg, communication skills), despite that global components are weighted the same for scoring purposes.

A psychometric analysis of a newly developed summative, multiple choice question assessment adapted from Canada to a Middle Eastern context.

INTRODUCTION: Accreditation necessitates that assessment methods reflect the standards established by the accrediting body. The process of adapting assessments to a new context can present unique challenges with uncertainty around psychometric defensibility of the adapted exam. METHODS: A psychometric analysis of a summative multiple-choice-question (MCQ) assessment, adapted from Canada, for graduating pharmacy students from a Canadian accredited program in Qatar was conducted. Rates of difficult items, item discrimination measured by point biserial correlation (rpb), and non-functioning distractors (NFDs) were calculated to identify deficiencies and challenges with an adapted exam. Challenges encountered throughout the adaption process and recommendations were documented. RESULTS: Overall score of a 90-item, four option, MCQ exam ranged from 46.7% to 78.9% (mean of 61.9%). For difficulty, there were 17 items with less than 30% of students answering correctly, while 29 items had unacceptable or poor discrimination (rpb < 0.1). NFDs occurred in 78 items with 49 containing at least two NFDs. DISCUSSION AND CONCLUSIONS: Difficulty of the exam was deemed acceptable yet discriminator ability requires improvement. The high frequency of questions with NFDs suggests that faculty have difficulty developing plausible distractors for an adapted MCQ exam. This could be due to a lack of training or requirement for inclusion of too many distractor options. While it is feasible to implement an assessment adapted from a different learning environment, measures need to be taken to improve psychometric defensibility. The high number of questions with NFDs indicates that the current method of exam development does not encourage the incorporation of functional distractors.

Comparing student self-assessments of global communication with trained faculty and standardized patient assessments.

BACKGROUND AND PURPOSE: Assess the reliability of first year pharmacy student assessments completed by faculty members in comparison with a standardized patient (SP), and student self-assessments during a structured educational module on communication. EDUCATIONAL ACTIVITY AND SETTING: Pharmacy students completed four stations focused on communication with an SP. During each encounter, students completed a self-assessment and were evaluated by a faculty member and a trained SP. A five point Likert scale was used to evaluate student performance. Faculty assessments were compared against all others. A Pearson correlation coefficient for total scores was used and a Cohen's kappa was used to compare inter-rater reliability. Agreement and correlation was performed with student results categorized into poor, adequate, and exceptional performance based on faculty evaluation. FINDINGS: Twenty-four students participated. In all stations, student self-assessments were graded higher than corresponding faculty and SP assessments. Agreement between faculty, SP, and self-assessment was fair to slight (k < 0.4) for all comparisons but only significant (p < 0.05) between the faculty and self-assessment. After categorization, there was a small, non-significant correlation between faculty and self-assessment (r = 0.13, p = 0.21) and moderate and significant correlation between faculty and SP (r = 0.32, p = 0.001). Categorized inter-rater agreement was fair for all comparisons (k < 0.2) and only significant (p < 0.05) between faculty and SP assessment. DISCUSSION: Pharmacy students in their first professional year assess their communication skills more positively than other evaluators. Further instruction for students and reflection may be required to build understanding of global assessment in communication. SUMMARY: There is high incongruity between student self-assessment and faculty appraisal.

Pharmacy Preceptor Judgments of Student Performance and Behavior During Experiential Training.

Objective. To report the findings of how Canadian preceptors perceive and subsequently evaluate diverse levels of trainees during pharmacy clerkships. Methods. Using modified Delphi technique, 17 Doctor of Pharmacy (PharmD) preceptors from across Canada categorized 16 student narrative descriptions pertaining to their perception of described student performance: exceeds, meets, or falls below their expectations. Results. Twelve (75%) student narratives profiles were categorized unanimously in the final round, six of which were below expectations. Out of 117 ratings of below expectations by responding preceptors, the majority (115, 98%) of post-baccalaureate PharmD students described would fail. Conversely, if the same narrative instead profiled a resident or an entry-to-practice PharmD student, rotation failure decreased to 95 (81%) and 89 (76%), respectively. Conclusion. Pharmacy preceptors do not uniformly judge the same described student performance and inconsistently apply failing rotation grades when they do agree that performance falls below expectations.

Team-Based Decision-Making in an Objective Structured Clinical Examination (OSCE): Are Pre-Licensure Healthcare Students "Collaborative Practice-Ready"?

Evaluation of pre-licensure students' competency in team-based decision-making is lacking. The purposes of this study were to evaluate pre-licensure pharmacy students' competency in team-based decision-making in the context of an objective structured clinical examination (OSCE), and to determine whether performance correlated with reflective assignment scores. Students' self-assessment and conceptualization of team-based decision-making in practice was also evaluated. Twenty-three pre-licensure pharmacy students' competency in team-based decision-making was evaluated in an OSCE station and with a reflective journal assignment; rubric scores for both evaluations were compared using Spearman's rank order analysis. Students completed an 18-item questionnaire regarding attitudes, confidence, and perceptions related to team-based decision-making. Descriptive statistics and construct analysis with open coding were used to analyse questionnaire results. Mean OSCE station and reflective journal scores were 45% and 66.3%, respectively, and were not correlated. Students' attitudes toward team-based decision-making were positive, and they reported performing associated behaviours during experiential education rotations. Students appropriately defined 'team-based decision-making' and were highly confident in performing related activities. However, students' conceptualization of team-based decision-making did not align with the pharmacy program's competency framework. Three key themes were identified through the study analyses: 1) student performance is dependent on assessment context when evaluating collaborator-related competencies; 2) there is a mismatch between students' perceived competency and objectively measured competence when collaborator outcomes were assessed within an OSCE; and 3) students' perceptions of team-based decision-making do not align with the program's competency framework. Future research is necessary to assess competency and perceptions of team-based decision-making in students from other healthcare professions, and to further evaluate whether pre-licensure students are "collaborative practice ready".

A description of medication errors reported by pharmacists in a neonatal intensive care unit.

Background Patients in the Neonatal Intensive Care Unit (NICU) are at an increased risk for medication errors. Objective The objective of this study is to describe the nature and setting of medication errors occurring in patients admitted to an NICU in Qatar based on a standard electronic system reported by pharmacists. Setting Neonatal intensive care unit, Doha, Qatar. Method This was a retrospective cross-sectional study on medication errors reported electronically by pharmacists in the NICU between January 1, 2014 and April 30, 2015. Main outcome measure Data collected included patient information, and incident details including error category, medications involved, and follow-up completed. Results A total of 201 NICU pharmacists-reported medication errors were submitted during the study period. All reported errors did not reach the patient and did not cause harm. Of the errors reported, 98.5% occurred in the prescribing phase of the medication process with 58.7% being due to calculation errors. Overall, 53 different medications were documented in error reports with the anti-infective agents being the most frequently cited. The majority of incidents indicated that the primary prescriber was contacted and the error was resolved before reaching the next phase of the medication process. Conclusion Medication errors reported by pharmacists occur most frequently in the prescribing phase of the medication process. Our data suggest that error reporting systems need to be specific to the population involved. Special attention should be paid to frequently used medications in the NICU as these were responsible for the greatest numbers of medication errors.

Contemporary Professional Skills Development for Pharmacists in the Middle East.

Objective. To determine professional skills development and its utility among the "bridge" curriculum for undergraduate and graduate students in the Middle East. Methods. Qatar University College of Pharmacy offers a part-time Doctor of Pharmacy (PharmD) program for licensed pharmacists, which includes pre-internship or "bridge" courses adapted from the undergraduate baccalaureate program. Assessments for all professional skills courses delivered in the undergraduate and post-baccalaureate part-time PharmD curriculums between 2011 and 2015 academic years were inventoried. The number and nature of assignments and exams administered to both student cohorts were identified and aggregate class scores recorded. Results were compared using Mann-Whitney tests for non-parametric continuous data with significance level (2-sided) set at α <.05. Results. Twenty-seven common assessments were conducted over a 5-year period. Overall, the performance between the undergraduate and graduate students was comparable except for specific assignments and in certain cohorts. Chart note documentation skills were poor among part-time PharmD students in both professional skills years and may be attributed to lack of prior instruction or current use in practice. Conclusion. Our comparison of graduate and undergraduate student performance in a professional skills course series has reinforced its legitimacy in our part-time PharmD bridge curriculum. Such quality assurance is relevant for programs offering advanced degree training for licensed professionals to ensure ongoing alignment of student abilities with desired educational outcomes and ultimately, delivery of patient care.

The Therapeutic Effects of Camel Milk: A Systematic Review of Animal and Human Trials.

The clinical effectiveness and value of camel milk as a therapeutic agent is currently unclear. MEDLINE (1946 to March 2016), EMBASE (1974 to March 2016), and Google Scholar were searched using the following terms: milk, bodily secretions, camels, camelus, camelini, camelidae, dromedary, bactrian camel, body fluid, and bodily secretions. Articles identified were reviewed if the study was investigating the use of camel milk for the potential treatment of diseases affecting humans. Of 430 studies, 24 were included after assessment. Identified studies highlighted treatment with camel milk of diseases, including diabetes, autism, cancer, various infections, heavy metal toxicity, colitis, and alcohol-induced toxicity. Although most studies using both the human and animal model do show a clinical benefit with an intervention and camel milk, limitations of these studies must be taken into consideration before widespread use. Based on the evidence, camel milk should not replace standard therapies for any indication in humans.

A review of pharmacokinetic drug-drug interactions with the anthelmintic medications albendazole and mebendazole.

Medications indicated for helminthes and other parasitic infections are frequently being used in mass populations in endemic areas. Currently, there is a lack of guidance for clinicians on how to appropriately manage drug interactions when faced with patients requiring short-term anthelmintic therapy with albendazole or mebendazole while concurrently taking other agents. The objective of this review was to systematically summarize and evaluate published literature on the pharmacokinetics of albendazole or mebendazole when taken with other interacting medications. A search of MEDLINE (1946 to October 2014), EMBASE (1974 to October 2014), International Pharmaceutical Abstracts (1970 to October 2014), Google, and Google Scholar was conducted for articles describing the pharmacokinetics of albendazole or mebendazole when given with other medications (and supplemented by a bibliographic review of all relevant articles). Altogether, 17 articles were included in the review. Studies reported data on pharmacokinetic parameters for albendazole or mebendazole when taken with cimetidine, dexamethasone, ritonavir, phenytoin, carbamazepine, phenobarbital, ivermectin, praziquantel, diethylcarbamazine, azithromycin, and levamisole. Cimetidine increased the elimination half-life of albendazole and maximum concentration (Cmax) of mebendazole; dexamethasone increased the area under the plasma concentration-time curve (AUC) of albendazole; levamisole decreased the Cmax of albendazole; anticonvulsants (phenytoin, phenobarbital, carbamazepine) decreased the AUC of albendazole; praziquantel increased the AUC of albendazole; and ritonavir decreased the AUC of both albendazole and mebendazole. No major interactions were found with ivermectin, azithromycin, or diethylcarbamazine. Future research is required to clarify the clinical relevance of the interactions observed.

Strategies for improving antibiotic use in Qatar: a survey of pharmacists' perceptions and experiences.

OBJECTIVES: The objectives of this study were to identify antimicrobial stewardship activities in Qatar, identify pharmacist involvement in activities and summarize perceived barriers for implementation of antimicrobial stewardship programs (ASPs). METHODS: A cross-sectional survey was developed based on study objectives and completed by pharmacists in Qatar. KEY FINDINGS: Most hospital settings have implemented components of ASP. Lack of infectious disease specialists and training of healthcare providers was the most common barrier to implementation or expansion of ASP identified in the hospital and community settings respectively. CONCLUSION: Pharmacists report some components of ASP have been implemented; however, barriers must be overcome to further expand ASPs.

Pediatric post-discharge mortality in resource poor countries: a systematic review.

OBJECTIVES: Mortality following hospital discharge is an important and under-recognized contributor to overall child mortality in developing countries. The primary objective of this systematic review was to identify all studies reporting post-discharge mortality in children, estimate likelihood of death, and determine the most important risk factors for death. SEARCH STRATEGY: MEDLINE and EMBASE were systematically searched using MeSH terms and keywords from the inception date to October, 2012. Key word searches using Google Scholar™ and hand searching of references of retrieved articles was also performed. Studies from developing countries reporting mortality following hospital discharge among a pediatric population were considered for inclusion. RESULTS: Thirteen studies that reported mortality rates following discharge were identified. Studies varied significantly according to design, underlying characteristics of study population and duration of follow-up. Mortality rates following discharge varied significantly between studies (1%-18%). When reported, post-discharge mortality rates often exceeded in-hospital mortality rates. The most important baseline variables associated with post-discharge mortality were young age, malnutrition, multiple previous hospitalizations, HIV infection and pneumonia. Most post-discharge deaths occurred early during the post-discharge period. Follow-up care was examined in only one study examining malaria prophylaxis in children discharged following an admission secondary to malaria, which showed no significant benefit on post-discharge mortality. CONCLUSIONS: The months following hospital discharge carry significant risk for morbidity and mortality. While several characteristics are strongly associated with post-discharge mortality, no validated tools are available to aid health workers or policy makers in the systematic identification of children at high risk of post-discharge mortality. Future research must focus on both the creation of tools to aid in defining groups of children most likely to benefit from post-discharge interventions, and formal assessment of the effectiveness of such interventions in reducing morbidity and mortality in the first few months following hospital discharge.

Pharmacokinetic profile of artemisinin derivatives and companion drugs used in artemisinin-based combination therapies for the treatment of Plasmodium falciparum malaria in children.

Malaria is one of the most common parasitic infections worldwide. Plasmodium falciparum is the most prevalent strain in Africa and also the most fatal. The disease especially affects children, with those under age 5 years accounting for approximately 86 % of malaria deaths in 2010. The objectives of this review are to summarize and evaluate published literature reporting the pharmacokinetic parameters of artemisinin-based combinations used to treat P. falciparum in paediatric populations and to identify and discuss controversies regarding pharmacokinetics of these agents in children. A search of MEDLINE (1948-September 2012), EMBASE (1980-September 2012), International Pharmaceutical Abstracts (1970-September 2012), Google and Google Scholar was conducted for articles describing pharmacokinetics of antimalarials in children. Our search produced 30 articles, of which 23 were included in the review: artemisinin compounds, 12 articles; lumefantrine, four articles; amodiaquine, five articles; sulfadoxine, six articles; pyrimethamine, one article; mefloquine, three articles; and piperaquine, two articles. Studies were summarized based on comparison groups and major findings. Many controversies were identified, including pharmacokinetic equivalence of novel dosage forms, altered pharmacokinetic parameters in children versus adults, effect of drug interactions, and association of pharmacokinetic changes with clinical outcomes. A large variation in pharmacokinetic parameters of many antimalarial agents was shown, which may be a consequence of the wide range of ages and/or bodyweights of each paediatric cohort. These studies may mask important associations with age and bodyweight and produce mean data that do not adequately represent the paediatric population as a whole. In order to properly assess the clinical implications of such pharmacokinetic changes and recommend safe and effective dosage regimens, there is an urgent need for dose-optimization studies for all recommended first- and second-line agents, along with the different drug formulations, used in paediatric populations with P. falciparum.