The rate of ward to intensive care transfer and its predictors among hospitalized COPD patients, a retrospective study in a local tertiary center in Saudi Arabia

OBJECTIVE

To investigate the prevalence of intensive care unit (ICU) admission and its predictors among hospitalized chronic obstructive pulmonary disease (COPD) patients.

METHODS

An observational retrospective study was conducted. All patients with a confirmed diagnosis of COPD according to the GOLD guidelines between 28 and 2020 and 1 March 2023 at Al-Noor Specialist Hospital were included in this study. Patients were excluded if a preemptive diagnosis of COPD was made clinically without spirometry evidence of fixed airflow limitation. Descriptive results were presented as frequency (percentage) for categorical variables and mean (SD) for continuous variables and to estimate prevalence of ICU admission. Predictors of ICU admission among hospitalized COPD patients were determined using logistic regression analysis. A SPSS (Statistical Package for the Social Sciences) version 25 was used to perform all statistical analysis.

RESULTS

A total of 705 patients with COPD were included in this study. The mean age was 65.4 (25.3) years. Around 12.4% of the hospitalized patients were admitted to the ICD. Logistic regression analysis identified that older age (OR; 1.92, (1.41-2.62)), smoking (OR; 1.60 (1.17-2.19)), and having specific comorbidities (Hypertension (OR; 1.98 (1.45-2.71)), Diabetes mellitus (OR; 1.42 (1.04-1.93)), GERD (OR; 2.81 (1.99-3.96)), Ischemic heart disease (OR; 3.22 (2.19-4.75)), Obstructive sleep apnea syndrome (OR; 2.14 (1.38-3.33)), stroke (OR; 4.51 (2.20-9.26))) were predictors of ICU admissions among patients with COPD.

CONCLUSIONS

Our study found that a step-up approach to inpatient COPD management requires admission to the ICU in 12.4%, for which age, smoking status, cardiovascular, and stroke were important predictors. Further clinical research is needed to provide a validated model that can be incorporated into clinical practice to monitor this patient population during their admission and identify at-risk individuals for early transfer to higher acuity settings and intensive care units.

Medication prescription profile and hospital admission related to medication administration errors in England and Wales: an ecological study

OBJECTIVE

To explore the correlation between prescribing rate of medications and hospital admissions related to medications administration errors in England and Wales during the time from 1999 to 2020.

DESIGN

An ecological study.

SETTING

A population-based study using hospital admission data that are publicly available in the UK. Data in this study were extracted from the Hospital Episode Statistics database in England and the Patient Episode Database in Wales from Wales. The Prescription Cost Analysis database was used to extract the prescription data.

PARTICIPANTS

Patients who were hospitalised all National Health Service (NHS) trusts and any independent sector funded by NHS trusts.

PRIMARY OUTCOME MEASURE

Hospitalisation rates related to medication administration errors and its associated prescriptions.

RESULTS

The annual rate of hospital admissions related to medication administration errors increased by 32.0% (from 184.21 (95% CI 183.0 to 185.4) in 1999 to 243.18 (95% CI 241.9 to 244.4) in 2020 per 100 000 persons. The most common three indications of hospital admissions were T39 (non-opioid analgesics, antipyretics and antirheumatics), T43 (psychotropic drugs), T42 (antiepileptic, sedative-hypnotic and antiparkinsonism drugs). The age group 15-59 years had the highest number of hospital admissions (83.4%). Women contributed to 59.1% of the total number of hospital admissions. Admission rate among men increased by 16.7%. Among women, the admission rate increased by 44.6%.

CONCLUSION

Admission rates due to medication administration errors increased markedly in the past decade. This increase was correlated with an increase in the prescription rate of several therapeutic classes. Patients taking non-opioid analgesics, antipyretics and antirheumatics, psychiatric medications, antiepileptic, sedative-hypnotic and antiparkinsonism drugs should have their recommended (and administered) doses closely monitored. They should be followed up on a regular basis to ensure that they are taking their medications as prescribed.

Nomophobia among university students in five Arab countries in the Middle East: prevalence and risk factors

BACKGROUND

Excessive use of mobile phones leading to development of symptoms suggestive of dependence syndrome with teenagers are far more likely to become dependent on mobile phones as compared to adults. COVID-19 pandemic has had an impact on the mental health of several groups in society, especially university students. This study aimed to explore the prevalence of mobile phone dependence among university students and its associated factors.

METHODS

Between September 2021 and January 2022, a cross-sectional study was conducted at universities in Jordan, Lebanon, Egypt, Bahrain, and Saudi Arabia utilizing an online and paper-based self-administered questionnaire. We employed a previously developed questionnaire by Aggarwal et al. RESULTS: A total of 5,720 university students were involved in this study (Egypt = 2813, Saudi Arabia = 1509, Jordan = 766, Lebanon = 432, and Bahrain = 200). The mean estimated daily time spent on using mobile phone was 186.4 (94.4) minutes. The highest mobile dependence score was observed for the university students from Egypt and the lowest mobile dependence score was observed for the university students from Lebanon. The most common dependence criteria across the study sample was impaired control (55.6%) and the least common one was harmful use (25.1%). Females and those reported having anxiety problem or using a treatment for anxiety were at higher risk of developing mobile phone dependence by 15% and 75%, respectively.

CONCLUSION

Mobile phone dependence is common among university students in Arab countries in the Middle East region. Future studies exploring useful interventions to decrease mobile phone dependence are warranted.

Real World Adherence to and Persistence With Oral Oncolytics in Multiple Myeloma: A Systematic Review and Meta-analysis

INTRODUCTION

Oral oncolytic treatments (OOTs) have improved the prognosis of patients with multiple myeloma (MM). However, the effectiveness of these therapies is undermined by poor adherence. We aimed to characterize the real-world adherence to, and persistence with, OOTs for MM.

MATERIALS AND METHODS

MEDLINE, EMBASE, and the International Pharmaceutical abstracts databases were searched for relevant observational studies published in English up to November 21, 2021. This was supplemented by manual searches of abstracts from the annual meetings of the American Society of Hematology, the American Society for Clinical Oncology, and the European Hematology Association as well as screening the references of included articles. Random-effects meta-analysis was performed.

RESULTS

Following screening of 11,557 articles, 19 studies involving 27,129 patients in 8 countries (France, the US, Germany, Italy, the UK, Brazil, South Korea, and Belgium) prescribed OOTs (lenalidomide, thalidomide, pomalidomide, panobinostat, ixazomib, and melphalan) for MM were included. The overall pooled proportion of adherent patients was 67.9% (95% confidence interval [CI]: 57.1%-77.8%). The pooled proportion of adherent patients was higher in self-reported questionnaire-based studies compared to those using prescription/dispensing data (81.6% vs. 61.0%; P-value for difference = .08). Across 5 studies involving 15,363 patients, a pooled proportion of 35.8% (95% CI: 22.0-50.9) discontinued treatment. Factors reported to be associated with nonadherence included increasing age, higher comorbidity, polypharmacy, and a lack of social support.

CONCLUSION

In patients with MM, adherence to and persistence with OOTs remains suboptimal. To achieve desired clinical outcomes, interventions to improve adherence and minimize discontinuation may be warranted.

The safety and efficacy of the use of oral anticoagulant medications in patients with diabetes mellitus: A systematic review

Aims

Diabetes mellitus (DM) and atrial fibrillation (AF) commonly co-exist. Oral anticoagulants (OACs) are widely used in patients with DM. This review aims to summarise the available literature on the safety (hypoglycaemia or bleeding) and efficacy (stroke or systemic embolism) of the use of OACs in patients with DM.

Methods

We searched the Medline, the Excerpta Medica dataBASE (Embase) and Cochrane databases up to the 10th of December 2020. The search strategy was conducted using both keywords and MeSH terms. We included randomised controlled trials (RCTs) and observational studies that reported on the safety and efficacy of the use of OACs in patients with diabetes from all age groups. Study selection, data extraction and quality assessment were conducted independently by two reviewers.

Results

A total of 3,976 articles were identified through the search process, of which seven studies met the inclusion criteria of the systematic review: four observational studies and three studies that were randomised controlled trials, with a total of 703,855 patients. Two observational studies reported that the use of warfarin was associated with a higher risk of hypoglycaemic events, specifically with sulfonylurea. One observational study and three randomised controlled trials reported that the use of warfarin compared to other oral anticoagulants was associated with a higher risk of bleeding. In addition, three randomised controlled trials reported that the use of warfarin compared to other oral anticoagulants was associated with a lower risk of stroke or systemic embolism.

Conclusions

This systematic review found that DOACs had a better efficacy outcome and safer clinical outcomes in comparison to warfarin in patients with diabetes.

Utilization of drug information resources among community pharmacists in Jordan: A cross-sectional study

BACKGROUND

Pharmacists are considered to be important sources of drug information (DI) for patients and other healthcare providers. This study aims to examine the characteristics of DI utilization for practicing pharmacists in Jordan and identify the main barriers that impede their ability to utilize them.

METHOD

A cross-sectional study using an online survey was conducted in Jordan between the 27th of November 2020 and 18th of January 2021. Our questionnaire was constructed to explore pharmacists' utilization patterns of DI resources, the types of DI resources they use and barriers impeding them.

RESULTS

A total of 1875 pharmacists participated in this study. Only one-fifth of the participating pharmacists reported that they referred to DI databases. The most commonly reported databases/websites were Drugs.com, Jordan FDA, and Medscape. The most commonly reported paper-based resources were Drugs in Jordan, Step up pharmacy, and British Pharmacopeia. The most commonly used mobile applications were Drugs.com, Medscape and Lexicomp. 44% of the pharmacists reported that they use DI resources fewer than five times per week and more than half of them (60.7%, n = 1138) reported that the day-shift was the shift that allowed them more time to use DI resources. Lack of time was the most common barrier (53.2%) that restricted the ability of pharmacists to use DI resources.

CONCLUSION

Using electronic resources is still deficient and far from optimum and interventions to improve the pharmacists' utilization of electronic drug databases are required. Universities and various pharmaceutical bodies are advised to train pharmacists on using DI databases.

Knowledge and awareness of the general population and healthcare providers about retinoblastoma: It is time to know the glow

Retinoblastoma is the most frequent primary intraocular tumour in childhood. Early detection of retinoblastoma is the key to successful management with a higher chance of survival. This study aims to assess the knowledge of the general population and healthcare providers about retinoblastoma in term of presentation, risk factors, timing for diagnosis, and complications. A cross-sectional study using an online survey was conducted in three Arab countries (Jordan, Saudi Arabia, and Iraq) between 28 August and 16 September 2020. The questionnaire tool was constructed based on an extensive literature review to explore the study's aim and objectives. Logistic regression was used to identify predictors of better knowledge about retinoblastoma. A total of 3676 participants were involved in the study (Jordan = 2654, Saudi Arabia = 604, and Iraq = 418). The average retinoblastoma knowledge score for the whole study population was 6.25 (SD = 4.12) out of 21, representing 29.8% (out of the maximum possible total score). Participants aged above 50 years old, married individuals, those with a secondary education level, those who work as professionals in industry, those who have more than four children, and those who reported that they were not in direct contact with a large number of children were less likely to be knowledgeable about retinoblastoma presentation, risk factors, the timing for diagnosis, and complications (P < .05). Early detection is the cornerstone for decreasing morbidity and mortality among children with retinoblastoma. However, the awareness and knowledge about retinoblastoma are very limited in our study population. Efforts should be directed at increasing awareness of both the general population and healthcare providers regarding retinoblastoma. Policymakers are responsible for improving knowledge and awareness about retinoblastoma to facilitate early detection of the disease by conducting awareness campaigns in addition to improve screening skills of healthcare providers and providing them with proper screening and diagnostic tools.

Dexamethasone and diclofenac intramuscular mixture injection and risk of death: A case series study

Diclofenac and dexamethasone injection mixture could be associated with fatal cardiovascular events, further studies are warrantied to explore the safety of this injection mixture and explore the genetic role of it.