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OBJECTIVE: This study aimed to assess the appropriateness of direct oral anticoagulants (DOACs) utilization in a Saudi tertiary hospital. PATIENTS AND METHODS: Adult inpatients and outpatients diagnosed with atrial fibrillation, deep vein thrombosis, or pulmonary embolism were included in a retrospective cohort study. Patients received at least one month of apixaban, rivaroxaban, or dabigatran. The duration of the study at the Armed Forces Hospital Southern Region in Khamis Mushait, Saudi Arabia, was from January 1, 2019, to December 31, 2021. The study assessed the appropriateness of DOACs dosing, initial and follow-up monitoring, the presence of clinically significant interactions, and treatment duration adherence. RESULTS: 778 patients were included in the analysis (mean age 71.34 ± 15.98 years, equal male and female representation). Rivaroxaban was administered to 40.8% of the patients, while apixaban and dabigatran were administered to 31.02% and 28.18% of the patients, respectively. The most prevalent indication for DOACs was atrial fibrillation (72.84%), followed by deep vein thrombosis and pulmonary embolism (27.16%). The most prevalent category of medication errors was inappropriate maintenance dose (41.7%), followed by inappropriate initial dose (37.97%) and lack of laboratory parameter monitoring (36.42%). 31.5 percent of the study sample lacked baseline renal functions, while 24.5% of patients lacked baseline liver functions. 115 patients (14.8%) had potential clinically significant interactions. Regarding treatment duration, 232 patients (29.8%) were improperly prescribed DOACs based on their indications. CONCLUSIONS: In a significant proportion of DOAC patients, the prescribed rational DOAC utilization parameters were not implemented. The results of the study provide specific improvement areas and objectives for Anticoagulation stewardship programs. [ABSTRACT FROM AUTHOR]

Pain is a prevalent complaint in emergency departments (EDs) worldwide. Traditional pharmacological methods for pain relief, such as opioids and non-steroidal anti-inflammatory drugs (NSAIDs), have notable side effects and risks. Transcutaneous electrical nerve stimulation (TENS) is a non-pharmacological alternative that has shown promise in various clinical settings. This systematic review and meta-analysis aimed to evaluate the effectiveness of TENS for pain management and other outcomes in ED settings. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was conducted across six major databases: PubMed, Web of Science (WOS), Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL), from inception until June 25, 2024. Randomized clinical trials involving the use of TENS in ED settings were included. Data extraction and quality assessment were performed independently by two reviewers, with conflicts resolved by a third reviewer. The search yielded 3,569 papers, of which 2,889 were screened after removing duplicates. Thirteen full-text articles were reviewed, and seven studies met the inclusion criteria for qualitative synthesis, with five of these suitable for meta-analysis. The studies demonstrated that TENS significantly reduced pain, heart rate, and the requirement for rescue medication in some cases, while also improving patient satisfaction and overall well-being. However, no significant changes were observed in blood pressure. The quality of the included studies varied, with some failing to meet the criteria for blinding and intention-to-treat analysis. TENS is an effective non-pharmacological intervention for pain management in ED settings, with additional benefits such as reduced heart rate and increased patient satisfaction. Further high-quality randomized controlled trials are necessary to confirm these findings and better understand the potential of TENS in acute care environments., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ahmed et al.)