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Ziad G Nasr,1 Alya Higazy,1 Kerry Wilbur21College of Pharmacy, Qatar University, Doha, Qatar; 2Faculty of Pharmaceutical Sciences, the University of British Columbia, Vancouver, CanadaBackground: Antimicrobial resistance is a public health issue and is the focus of antimicrobial stewardship (AMS) teams within health care institutions. However, AMS is not comprehensively and fully taught in medical or pharmacy curricula and little is known about the relevance of pharmacist training to meet AMS needs in the Middle East region. We aimed to explore the discord that may exist between infectious diseases education and actual clinical practice with regard to AMS knowledge and training skills in Qatar. Then, we sought to further explore pharmacist perceptions of their AMS roles in hospital environments.Methods: A qualitative study was undertaken at Qatar University using three focus groups consisting of 15 pharmacy alumni who are currently practicing as clinical pharmacists in Qatar. Focus groups were facilitated using a topic guide developed by study investigators. Discussions were audio-recorded and transcribed verbatim. Results were analyzed using framework analysis.Results: Two major themes related to the first objective emerged throughout the discussions and associated recommendations made to improve (i) infectious diseases (ID) module content and delivery and (ii) ID knowledge and skills application. Two themes related to the second objective included (i) impact of pharmacist’s interventions on decision-making and (ii) continuing professional development programming.Conclusion: Our findings guide ongoing efforts to enhance ID content in the curriculum and will close gaps related to AMS training. Pharmacists are core AMS team members where there is an ongoing need to align continuing education for health professionals with realities of practice.Keywords: antimicrobial stewardship, education, clinical practice, pharmacist, Middle East, infectious diseases

Objectives: The Objective Structured Clinical Examination (OSCE) is a key tool in healthcare education, assessing clinical skills and competencies. This study explores OSCE's impact on pharmacists' competence, confidence, and practice readiness, focusing on its role in professional development and long-term practice improvement., Methods: A cross-sectional survey was conducted among Qatar University pharmacy graduates with at least a year of practice experience. The survey included 10 items on a 4-point Likert scale to capture quantitative data, along with open-ended questions for more detailed reflections and qualitative insights. Quantitative data were analyzed using SPSS, and qualitative data were thematically analyzed through an inductive approach, with two researchers independently coded responses and identifying themes., Key Findings: Out of 75 eligible pharmacists, 46 responded (61.3% response rate). Over 85% reported that OSCE improved communication and interprofessional collaboration skills, and 80% felt it helped apply essential professional skills effectively. However, opinions varied on making OSCE a licensure requirement. Six main themes emerged: (i) Enhanced Interprofessional Collaboration Skills, (ii) Application of Professional Skills, (iii) Practical Application of Pharmacy Education, (iv) Adaptability for Evolving Healthcare Challenges, (v) Enhancement of Patient-Facing Communication Skills, and (vi) Identification of Personal Strengths and Weaknesses., Conclusions: This study demonstrates that OSCEs enhance pharmacists' clinical skills, communication, and practice readiness. Pharmacy programs should continue integrating OSCEs alongside other assessments for comprehensive evaluation. Policymakers are encouraged to explore OSCEs for licensure, ensuring standardization and evaluator training. Future research should assess OSCE's long-term impact on pharmacists' career development and patient outcomes., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Royal Pharmaceutical Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Objective: Pharmacists play pivotal roles in improving vaccination rates. However, absence of vaccination-related undergraduate education impedes their ability for these roles. The study aims were to scope vaccination-related education in pharmacy colleges in the Middle East (ME) and to describe potential facilitators and barriers to vaccination administration education using Consolidated Framework for Implementation Research., Methods: A multinational survey of pharmacy faculty across 14 Arabic-speaking ME countries, involving 132 colleges, examined vaccination education. Data collection involved contacting deans for faculty nominations. Data was analyzed using Statistical Package for the Social Sciences., Results: The questionnaire response rate was 64.7% (89/132), with 89.9% of colleges including vaccination in their curricula. The topics commonly covered included vaccine development (n = 44, 97.8%), vaccine routes of administration (n = 43, 97.7%), and vaccine indications (n = 38, 95%). Planning and marketing vaccination programs (n = 35, 77.8%), documentation and record-keeping of vaccinations (n = 33, 75.0%), and legal and regulatory issues related to vaccinations (n = 32, 69.6%) were the least adequately covered topics. Most common methods used in teaching were didactic lectures (n = 74, 92.5%). Overall, 53 of 87 respondents (60.9%) responded that their college does not currently teach "vaccination administration". Lack of resources, attitudes of other health professionals and not prioritizing vaccination were considered as barriers for implementing vaccination administration., Conclusion: Most pharmacy colleges in the ME cover vaccination-related topics in undergraduate curricula, yet they underemphasize vaccination administration and lack experiential learning methods. Implementing vaccination administration education requires addressing barriers related to the outer and inner settings, and planning, with stakeholder engagement., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2024 American Association of Colleges of Pharmacy. Published by Elsevier Inc. All rights reserved.)

Background: Coronavirus Disease 2019 (COVID-19) is a highly infectious disease that can be treated with antivirals in addition to other antimicrobials in cases of secondary or concomitant infections. This creates potential for antimicrobials misuse, which increases antimicrobial resistance (AMR). Pharmacists are known to undertake prominent roles in combatting AMR., Aim: The aim of this review was to characterize pharmacist-driven interventions that have been performed in patients with COVID-19 globally and describe their impact on antimicrobial use., Method: We followed the Joanna Briggs Institutes manual framework for scoping reviews in our study. Studies that reported antimicrobial stewardship (AMS) interventions performed by pharmacists in COVID-19 patients were included. Articles that did not report outcomes or did not mention pharmacists in the intervention were excluded. Restrictions included English-only articles from inception date until June 2022. Articles were searched from four databases., Results: Eleven publications were included in the review. The most common AMS intervention was pharmacist-driven interventions reported in 63.2% of all studies, followed by guideline development and application (26.3%), and medication supply coordination (10.5%), respectively. The outcomes of the interventions were difficult to compare but showed a reduction in antimicrobial use and prevention of adverse drug reactions with a relatively high acceptance rate from physicians., Conclusion: Pharmacists played an important role in performing AMS-related interventions in COVID-19 patients and helped in the fight against the worsening of AMR during the pandemic. The impact of pharmacist-driven AMS interventions in patients with COVID-19 seemed to be positive and improved outcomes related to antimicrobial use., (© 2023. The Author(s).)

Background: We intended to compare the efficacy and safety outcomes of colistin versus tigecycline as monotherapy or combination therapy against multi-drug resistant (MDR) and extensively drug-resistant (XDR) pathogens. Methods: A search was conducted in PubMed, Cochrane CENTRAL, EMBASE, and in the grey literature (i.e., ClinicalTrials.gov and Google Scholar) up to May 2021. Outcomes were clinical response, mortality, infection recurrence, and renal and hepatic toxicity. We pooled odd ratios (OR) using heterogeneity-guided random or fixed models at a statistical significance of p < 0.05. Results: Fourteen observational studies involving 1163 MDR/XDR pathogens, receiving tigecycline versus colistin monotherapy or combination, were included. Base-case analyses revealed insignificant differences in the clinical response, reinfection, and hepatic impairment. The 30-day mortality was significantly relatively reduced with tigecycline monotherapy (OR = 0.35, 95% CI 0.16−0.75, p = 0.007). The colistin monotherapy significantly relatively reduced in-hospital mortality (OR = 2.27, 95%CI 1.24−4.16, p = 0.008). Renal impairment rates were lower with tigecycline monotherapy or in combination, and were lower with monotherapy versus colistin-tigecycline combination. Low-risk of bias and moderate/high evidence quality were associated with all studies. Conclusions: Within the limitations of this study, it can be concluded that there were no statistically significant differences in main efficacy outcomes between colistin and tigecycline monotherapies or combinations against MDR/XDR infections, except for lower rates of 30-day mortality with tigecycline and in-hospital mortality with colistin. Tigecycline was associated with favourable renal toxicity outcomes.

Background: Antimicrobial stewardship programs (ASPs) play a big role in minimizing antimicrobial resistance. Pharmacists are essential members of the health care team and in order for them to fulfill roles on ASP teams and become antimicrobial stewards, they must be prepared adequately by pharmacy schools prior to entry into actual practice. Although programming has been implemented into entry-to-practice programs worldwide, little is known about how students interpret antimicrobial stewardship (AMS) data and arrive at clinical decisions. We aimed to explore students' cognitive processes and determine how they formulate therapeutic decisions when presented with AMS cases., Methods: This was a qualitative study conducted using a case study approach, in which a sample (n=20) of pharmacy students was recruited to interpret AMS cases. Semi-structured 1-on-1 interviews were arranged with each participant. A think-aloud procedure with verbal protocol analysis was adopted to determine students' decision-making processes. Thematic analysis was used to interpret themes from the interview data., Results: Two themes were interpreted from the data: students' focus and students' approach to case interpretation. Students' focus relates to external factors students consider when interpreting AMS case data and use to make and justify therapeutic decisions including patient-centered factors, drug-related factors, AMS interventions, and pharmacist's role. Students' clinical reasoning describes the approach that students use to interpret the data and the decision-making processes they employ to arrive at a clinical decision including a systematic approach versus non-systematic approach., Conclusions: Students vary in their focus and the cognitive strategies used to interpret AMS cases. Findings support the notion that clinical reasoning and decision-making should be explicitly taught in pharmacy curricula, in order to help students become aware of their own cognitive processes and decision-making abilities., (© 2022. The Author(s).)

Objective. To conduct a scoping review of the existing literature to identify published studies on innovative teaching and assessment practices for antimicrobial stewardship in the Doctor of Pharmacy curriculum and to provide a foundation for future scholarly research in this important area. Findings. Seven studies were found that met the inclusion criteria. Two of the studies explored the extent, content, and methods of delivery of antimicrobial stewardship, four studies described elective courses in antimicrobial stewardship, and one study described an interprofessional module. Most studies were conducted in the United States. Several pharmacy schools in the UK and the US incorporated antimicrobial stewardship teaching into their curriculum. Learning objectives for the elective courses focused on guidelines issued by the Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA), antimicrobial stewardship literature appraisal and principal application. The most used teaching strategy was didactic lectures, followed by case studies. Active-learning approaches like simulators, problem-based learning, and presentations were also used but to a lesser extent. Summary. Antimicrobial stewardship curricular reform may be influenced by the timing of the course, teaching approaches, and performance assessment of students. Antimicrobial stewardship learning should be a required of all pharmacy students. The scarcity of scholarly activity in the teaching of and assessment of learning in antimicrobial stewardship suggests that curricular planning should be guided by national or international organizations to ensure pharmacy students learn such important material., (© 2021 American Association of Colleges of Pharmacy.)

Objectives: Antimicrobial resistance is a worldwide public health issue that requires emergent action. Antimicrobial stewardship programs (ASPs) have been proposed as a strategy to minimise resistance. Although ASPs were implemented in governmental hospitals in Qatar since 2015, a formal evaluation of these programs has not been conducted. We aimed to assess the status of ASPs in Qatar and to identify strengths, weaknesses, opportunities and challenges (SWOC) to further enhance ASPs within Hamad Medical Corporation (HMC)., Methods: Lead stakeholders of ASPs in HMC filled a questionnaire adapted from the 2019 Centers for Disease Control Prevention checklist for ASPs. Notes were taken by research team to assist in formulating a SWOC analysis., Key Findings: All hospitals (12/12) had an infectious diseases physician and pharmacist designated as an ASP leader (major strength identified). Almost all hospitals lack a financial statement and information technology resources to support ASPs (major weaknesses identified). Nine hospitals had an antibiotic pre-authorisation policy and adopted a prospective audit with feedback strategy. Among hospitals surveyed, 11 hospitals tracked antibiotic use by measuring the defined daily dose, and only four hospitals tracked rates of Clostridioides difficile infection. Qatar's rich economy supports the allocation of financial resources and budgeting to improve ASPs despite the increased emergence of resistant organisms and the limited resources currently available to expand ASPs across the country's healthcare settings., Conclusions: Although ASPs were implemented in all governmental hospitals in Qatar, national efforts and more resources are needed to further develop and improve these programs., (© The Author(s) 2020. Published by Oxford University Press on behalf of Royal Pharmaceutical Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Statement: A phenomenon is occurring in international settings where the language of program delivery and assessment does not match the primary language of practice. It is unknown whether determining competence in English disadvantages students for practice in non-English settings. As such, we conducted a pilot study to determine student performance and perceptions after completion of two Objective Structured Clinical Examinations (OSCEs) examinations, one conducted in English and one conducted in Arabic within an Arabic-speaking Middle Eastern setting. Twenty-two students completed both OSCEs. Overall scores were similar but student rankings differed. Students were more confident performing in Arabic, felt that the Arabic examination was more reflective of practice, and believed that use of Arabic OSCEs can promote better patient care. Findings support the notion that student success may be influenced by language of assessment and that we may need to rethink how we determine assessment validity in these emerging international education settings.

Objectives: To critically appraise published international clinical practice guidelines (CPGs) for management of febrile neutropenia in adult patients with cancer and to determine opportunities for improved development and reporting., Methods: A literature search identified CPGs for adult cancer patients with febrile neutropenia. Four independent assessors evaluated each included CPG according to the Appraisal of Guidelines for Research and Evaluation II instrument. Standardized scores were calculated for each guideline and polled collectively. Reliability of assessment was determined using a two-way random model intraclass correlation coefficients., Key Findings: Eight CPGs were independently evaluated by four assessors. Collectively, the highest scoring domain was editorial independence (83.3), followed by clarity of presentation (55.4), scope and purpose (53.4), stakeholder involvement (53.1), rigour of development (52.7) and applicability (47.8). Overall assessments ranged from 28.6 to 96.4 of 100 possible points. Three (37.5%) guidelines were recommended for use without alterations, two (25%) guidelines were recommended with alterations, and three (37.5%) guidelines were not recommended for implementation into practice. Reliability varied between guidelines with intraclass correlation coefficients ranging from 0.41 to 0.82., Conclusions: Clinical practice guidelines for febrile neutropenia in adult patients with cancer were moderately rated with a 37.5% of guidelines being recommended for use in practice. Guideline developers should focus on improving CPG applicability and rigour in the development and reporting processes. Critical appraisal of guidelines should become a standard practice prior to implementation into clinical settings., (© 2017 Royal Pharmaceutical Society.)

Background and Purpose: Adaption of active learning strategies into new cultures and contexts requires careful consideration to maximize effectiveness and meet intended objectives. The aim of this paper was to describe the adaption and implementation of problem-based learning (PBL) within a pharmacy curriculum in a Middle Eastern context., Educational Activity and Setting: PBL was implemented into the curriculum at Qatar University in 2014 and expanded in subsequent years to include differing courses and contexts. The process was blueprinted to align with international accreditation standards. A SWOC (Strengths, Weaknesses, Opportunities, Challenges) analysis was completed to identify cultural and contextual facilitators and barriers regarding implementation and achievement of target outcomes., Findings: Strengths included novelty, enhancement of learning, engagement, and accreditation alignment. Weaknesses included student preparation and buy in, facilitation inconsistency, and logistical support. Opportunities included expansion, departmental support, timing, and congruency with practice skills. Challenges included student resistance, departmental engagement, assessment, expansion, and cultural norms in teaching and learning., Discussion and Summary: PBL provided benefit but also presented many cultural and contextual challenges of adaption from Western settings. Future work should focus addressing these cultural factors, to promote effectiveness of PBL as an active learning strategy., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Meropenem is a carbapenem antibiotic that exhibits time-dependent bactericidal activity, traditionally dosed intravenously at 1 g every 8 h. In order to maximize its pharmacodynamic activity and reduce costs, an alternative regimen employed by many institutions is 500 mg every 6 h. The objective of this review was to summarize and evaluate published literature comparing clinical outcomes associated with these two meropenem dosing regimens. The literature was searched up to October 2016 using the MEDLINE, EMBASE, and Google Scholar databases. Three retrospective cohort studies were identified that compared clinical outcomes in general infectious disease patients (two studies) and patients with febrile neutropenia (one study). All studies reported no difference in clinical outcomes (clinical success, time to defervescence, sign or symptom resolution, length of stay, mortality, need for other antibiotics, and seizure rates). One study reported reduced economic costs with the alternative dosing. Interpretation of findings was primarily limited by small sample sizes and generalizability. Based on the data reviewed, the alternative dosing regimen of meropenem 500 mg intravenously every 6 h could be considered a therapeutic option. Future studies are needed to confirm the findings of this review, especially in high-risk populations such as immunocompromised patients or those with severe infections.

Background: Professional responsibilities are guided by laws and ethics that must be introduced and mastered within pharmaceutical sciences training. Instructional design to teaching typically introduces concepts in a traditional didactic approach and requires student memorization prior to application within practice settings. Additionally, many centers rely on best practices from abroad, due to lack of locally published laws and guidance documents. Objectives: The aim of this paper was to summarize and critically evaluate a professional skills laboratory designed to enhance learning through diversity in instructional methods relating to pharmacy law and best practices regarding narcotics, controlled medications, and benzodiazepines. Setting: This study took place within the Professional Skills Laboratory at the College of Pharmacy at Qatar University. Method: A total of 25 students participated in a redesigned laboratory session administered by a faculty member, clinical lecturer, teaching assistant, and a professional skills laboratory technician. The laboratory consisted of eight independent stations that students rotated during the 3-h session. Stations were highly interactive in nature and were designed using non-traditional approaches such as charades, role-plays, and reflective drawings. All stations attempted to have students relate learned concepts to practice within Qatar. Main outcome measures: Student perceptions of the laboratory were measured on a post-questionnaire and were summarized descriptively. Using reflection and consensus techniques, two faculty members completed a SWOC (Strengths, Weaknesses, Opportunities, and Challenges) analysis in preparation for future cycles. Results: 100% (25/25) of students somewhat or strongly agreed that their knowledge regarding laws and best practices increased and that their learning experience was enhanced by a mixed-methods approach. A total of 96% (24/25) of students stated that the mixed-methods instructional approach should be continued in the future. The SWOC analysis identified the mixed methods approach and student feedback as strengths and opportunities, while resource shortages and lack of impact assessment were identified as weaknesses and challenges. Conclusion: Creative redesign of instructional methods pertaining to law and best practices was effective to achieve positive student perceptions regarding instructional methods and learning. Future cycles should include rigorous assessment methods to evaluate impact on student learning and practice.

Seizures are common complications for patients with brain tumors. No clear evidence exists regarding the use of antiepileptic agents for prophylactic use yet newer agents are being favoured in many clinical settings. The objective of this systematic review was to determine the efficacy of levetiracetam for preventing seizures in patients with brain tumors. A literature search was completed using the databases PubMed (1948 to December 2015), EMBASE (1980 to December 2015), Cochrane Database of Systematic Reviews, and Google Scholar. Studies were included if they reported seizure frequency data pertaining to levetiracetam use in patients with brain tumors as either monotherapy or as an add on agent. The literature search produced 21 articles (3 randomized controlled trials, seven prospective observational studies, and 11 retrospective observational studies). All studies were found to be at high risk of bias. Overall, studies show levetiracetam decreased seizure frequency in brain tumor patients with or without craniotomy. Safety outcomes were also favourable. As such, levetiracetam appears effective for reducing seizures in patients with brain tumors and may be considered a first-line agent. However, there is an urgent need for more high quality prospective data assessing levetiracetam and other antiepileptic drugs in this population.

Introduction: The authors' objective was to study the anatomical and functional results of an original construct using the Cotrel-Dubousset instrumentation., Material and Methods: This construct is called "Modular construct" or "2 H.S.-1 S.H." fits up two vertebrae above the fracture and a single below. So if the fracture is situated on the L1 level, a supra-laminar hook is set up on each side of T11, and two pedicular screws in T12 (2 H.S.). In the same way, a pedicular screw and an infra-laminar hook are set up on each side of L2 (1.S.H.). Two transverse bars connect together the right and the left rod. This retrospective work is based on the study of 24 patients who had a Thoraco-lumbar burst fracture according to Denis'classification, who were operated on in our Department, and started again to walk without external contention. All the patients had a postero-lateral bone graft. There were no [corrected] anterior arthrodesis performed. The average follow up was 4 years. This series was compared with a concomitant series of miscellaneous constructs realized by the same operators with the C.D. instrumentation., Results: The average regional kyphosis angles went from 16.9 degrees in pre-operative to 3.9 degrees in post-operative, and 8 degrees at the maximum follow up. The average vertebral kyphosis angles went from 18 degrees in pre-operative to 3.8 degrees in post-operative, and 6.3 degrees at the maximum follow up. The miscellaneous constructs had poorer results. There were two severe infections, one early the other late., Discussion: These results compared with the literature show that the 2 H.S.-1 S.H. construct is a competitive one. We think that its mechanical qualities arise from adding systematically hooks at the ends of the construct. These hooks protect the screws during flexion and from pull out constraints.