Antimicrobial Resistance (AMR) is a major global concern, negatively impacting public health outcomes (1-5), patient safety (3,6-8) and poses enormous burden on economic development and security (8-16). Internationally, data suggests, at any given time, approximately one-third of the hospitalized patients and over two-thirds of critically ill patients are prescribed antimicrobials and more than half of these prescribed antimicrobials are deemed inappropriate (5,17,18).

Adverse Drug Reactions (ADRs) are major global concern, adversely impacting patient safety and health outcomes. ADRs cause significant morbidity and mortality among hospitalised patients, causing greater length of hospital stay, increased healthcare costs and patient dissatisfaction to the treatments. Pharmacovigilance (PV), a process of detecting, monitoring and preventing drug-related harm, plays a vital role to ensure patient safety. ADR reporting is the cornerstone of PV. PV practices in Qatar are relatively new and are evolving rapidly. The purpose of this article is to explore the medication safety practices (notably ADR reporting) at the largest academic healthcare center in Qatar. The article further provides evidence on how information related to ADRs are generated and interpreted. Furthermore, it describes how a designated center for monitoring medication safety activities was established at the largest healthcare provider in Qatar.

BackgroundOver 4.2 million confirmed cases and more than 285,000 deaths, COVID-19 pandemic continues to harm significant number of people worldwide. Several studies have reported the impact of COVID-19 in general population, however, there is scarcity of information related to pharmacological management, maternal and perinatal outcomes during the pandemic. Altered physiological, anatomical and immunological response during pregnancy makes it more susceptible to infections. Furthermore, during pregnancy, a woman undergoes multiple interactions with the health care system that increases her chance of getting infected, therefore managing pregnant population presents a unique challenge. Research Question(s)This systematic review seeks to answer the following questions in relation to COVID-19,What are the different clinical characteristics presented in maternal and perinatal population?What are the different maternal and perinatal outcome measures reported?What are the distinct therapeutic interventions reported to treat Covid-19?Is it safe to use ‘medications’ used in the treatment of COVID-19 during antenatal, perinatal, postnatal and breastfeeding?Method The search will follow a comprehensive, sequential three step search strategy. Several databases relevant to COVID-19 and its impact on pregnancy including Medline, CINAHL, LitCovid etc. will be searched from the inception of the disease until the completion of data collection. The quality of this search strategy will be assessed using Peer Review of Electronic Search Strategies Evidence-Based Checklist (PRESS EBC). An eligibility form will be developed for a transparent screening and inclusion/exclusion of studies. All studies will be sent to Refworks and abstraction will be independently performed by two researchers. Risk of bias will be assessed using Cochrane Risk of Bias tool for randomized controlled trials, Newcastle–Ottawa Quality Assessment Scale for non-randomized studies and for case reports Murad et al tool will be used. Decision to conduct metanalysis will be based on several factors including homogeneity and outcome measures reported, otherwise a narrative synthesis will be deemed appropriate. Discussion This systematic review will summarise the existing data on effect of COVID-19 on maternal and perinatal population. Furthermore, to the best of our knowledge, this is the first systematic review addressing therapeutic management and safety of medicines to treat COVID-19 during pregnancy and breastfeeding.Systematic review registrationProspero (CRD42020181163)

BackgroundMaternal health refers to the health of women pre-pregnancy, during pregnancy, childbirth and postpartum. Pregnancy is a state of altered physiology and medication use during this period is remarkably challenging. For various reasons medication use during pregnancy cannot be completely avoided however, due to altered drug pharmacokinetics and crossing of placenta many of these drugs could significantly still harm the growing fetus. Pharmacists are medication experts with great knowledge of pharmacology, pharmacokinetics and are trained to apply evidence based clinical knowledge. Although pharmacists are having great potential to modify and optimize drug therapy in pregnancy, current evidence demonstrates they do not actively provide this care and are least interested in doing so.ObjectiveThe primary objective of the study was to determine the knowledge, perception, attitude and experience of pharmacist in Qatar regarding risk benefits ratio, concerns, advice, and source of information about drug use in pregnancy and secondary objective aimed to correlate knowledge with different variables.MethodsA prospective cross sectional questionnaire based study was conducted by Women's Hospital pharmacy department for 3 months in 2010 (June – August). A 23-item self-completed anonymous questionnaire was distributed to 400 licensed pharmacists in Qatar including community pharmacists, hospital pharmacists, Primary Health Centers (PHC) and pharmacists working in polyclinics. Five pharmacists from women's hospital were selected to distribute and collect the questionnaire. A convenient sampling technique was used. All licensed pharmacist were included while pharmacy technicians were excluded. Pilot study was conducted on 30 pharmacists (16 community and 14 hospital pharmacists), were almost consistent in terms of answering, except for two questions (concerning knowledge and pharmacists confidence levels while dealing with physicians) which were modified accordingly. The questionnaire was classified into 4 sections: 1) Section 1, about their practice 2) Section 2, about knowledge and perception of medication use in pregnancy 3) Section 3, about pharmacist's level of confidence while dealing with patient and physician 4) Section 4, about source of drug information and certain general statements regarding their beliefs Data was analyzed by SPSS version 17. Descriptive statistics was applied for all the collected variables. Knowledge level of each respondent is determined by ranking their answers based on a scale developed with maximum 28 scores. To see association between Knowledge levels and variables, χ2 test was used. P value 0.05 was considered as statistical significant. The study conformed to the ethical principles of Hamad Medical Corporation Research center. Descriptive statistics was applied for all the collected variables.ResultsAn overall response rate of 51.75% (207/400) was obtained, and majority (54.1%) of whom were males. The highest percentages of respondents were practicing hospital pharmacists (46.8%), followed by community pharmacist (35.3%) whereas only 13% responded from primary healthcare centers. Most of them had a bachelors' degree (95.7%) in pharmacy. More than 50% of pharmacists responded to have no continuous education or received any CE points in last 12 months. 66% of these respondents reasoned work related issues (time, workload) for not attending these educational activities. 86% of the respondents were aware of the risk and benefits associated with the medication use in pregnancy. Majority (64.7%) of pharmacist possessed ‘average knowledge levels’, 34.3% with ‘good knowledge’ very few (1%) had ‘very good knowledge’. Only 33.3% were comfortable giving advices/counselling to pregnant women. Approximately 89% (strongly agree 39.6% and agree 49.8%) respondents believed they were competent enough to inform pregnant population about their medication where as 1.5% disagreed (strongly disagree 0.5% plus 1% disagree) and around 9% being unsure. Respondents with experience of 5 years and above had better knowledge levels than others. There was a significant positive association between respondents having Continuous Educational activities and their knowledge levels. Respondents who were very comfortable and somewhat comfortable (69.4%) were more knowledgeable than those uncomfortable and somewhat uncomfortable (10.6%). Knowledge of respondents who contacted prescribers with an alternative medication was 79.6% compared to ones who contacted prescribers without an alternative 8.3%. Respondents who agreed and strongly agreed that they were confident enough to advice both physicians (87%) and pregnant patients (91.3%) were more knowledgeable than others.ConclusionOur study provided a baseline data regarding knowledge, perception and experience of pharmacist in Qatar regarding drug use in pregnancy. With majority of respondents lacking educational activities, there is an urgent need to stress on the importance of continuous pharmacy education tailored to meet the requirements of specialized areas. Pharmacist should be aware of medications used during pregnancy and should be familiar regarding risks and benefits of the medication used and to provide appropriate drug related information to pregnant women and healthcare professionals taking care of pregnant women.

Introduction Few qualitative studies have explored determinants of antimicrobial prescribing behaviour in hospitals, and none has made reference to behavioural theories. An understanding of these determinants is required for the successful development and implementation of behaviour change interventions (BCIs) in this area. Aim To explore the determinants of clinicians’ antimicrobial prescribing behaviour, using the Theoretical Domains Framework (TDF; a framework of behavioural theories). Methods This work was part of a multi-phase explanatory, sequential mixed methods PhD programme of research. This qualitative part involved semi-structured, online (video) interviews via a videoconferencing software programme (Zoom) with clinicians (doctors and pharmacists) based in 12 Hamad Medical Corporation hospitals in Qatar. Clinicians were sampled purposively in strata of gender, profession, years of experience and area of practice. The interview schedule was developed based on a review of published literature (1), previous findings of quantitative research (2) and the TDF to ensure comprehensive coverage of key determinants (including barriers and facilitators) related to clinicians’ antimicrobial prescribing behaviour. Interviews were conducted from December 2020 to February 2021, audio-recorded, transcribed and independently analysed by two research team members using the TDF as an initial coding framework. Results Data saturation was achieved after interviewing eight doctors and eight pharmacists from a range of areas of practices and with a variety of experiences. A number of themes, linked to ten TDF domains, were identified as determinants of antimicrobial prescribing behaviour and these determinants were interrelated. In-depth analysis identified several barriers and facilitators that may contribute to inappropriate or appropriate antimicrobial prescribing. Main barriers identified were around hospital guidelines and electronic system deficiencies (environmental context and resources), gaps in the knowledge in relation to guidelines and appropriate prescribing (knowledge), restricted roles/responsibilities of microbiologists and pharmacists (professional role and identity), uncomfortable antimicrobial prescribing decisions (memory, attention and decision processes), as well as professional hierarchies and poor multidisciplinary teamworking/relationships (social influences). “Sometimes, the barrier would be the ego of senior doctors who refuse our evidence-based recommendation and depend on their clinical judgement or experience” (Pharmacist 470, Cardiology). Key facilitators highlighted included guidelines compliance goals and intentions, and the beliefs of consequences of appropriate or inappropriate prescribing. Further education and training sessions, and some changes to guidelines, including accessibility were also considered essential. “We need to seriously consider getting an antibiotic guidelines app which is downloaded to clinicians’ mobile phones. The mobile app is handy, you can access it anytime even at the patient’s bedside” (Doctor 514, Microbiology). Conclusion This qualitative study, using a theoretically based approach, has identified that antimicrobial prescribing in hospitals is a complex process influenced by a broad range of behavioural determinants that described specific barriers and facilitators. The in-depth understanding of this complexity provided by this phase of the research may contribute to the design and development of theoretically based BCIs to improve clinicians’ antimicrobial prescribing. Limitations include data collected with online interviews due to the Covid-19 restrictions. This may have excluded some clinicians who did not feel comfortable with or have access to the technology required. References (1) Talkhan H, Stewart D, Mcintosh T, Ziglam H, Abdulrouf P, Al-Hail M et al. The use of theory in the development and evaluation of behaviour change interventions to improve antimicrobial prescribing: a systematic review. Journal of Antimicrobial Chemotherapy. 2020;75(9):2394-2410. (2) Talkhan H, Stewart D, McIntosh T, Ziglam H, Abdulrouf P, Al-Hail M et al. Using the Theoretical Domains Framework to investigate clinicians’ behavioural determinants of antimicrobial prescribing in Qatar. International Journal of Pharmacy Practice. 2021;29(1):i20-i22.

Introduction Poisoning is a major public health issue and a leading cause of admission to the emergency department (ED) worldwide. There is paucity of data describing epidemiology, outcomes, and cost of acute poisoning. Up-to-date information about poisoning pattern is imperative for accurate diagnosis and effective management. This study therefore investigates the epidemiology, poison pattern and associated cost of acute poisoning in Qatar. Method A retrospective review of electronic health records of 397 patients admitted due to poisoning at the ED from January 2015 - December 2019. Demographic characteristics, incidence, clinical characteristics, cause of exposure, outcomes, and cost associated with acute poisoning were included. Frequency and percentages were calculated for categorical variable and mean and SD for continuous variables, relation between sociodemographic characters and poisoning profile was assessed using Chi-square. P-value less than 0.5 was considered statistically significant. A micro-costing approach using the cost of each resource was applied for the cost calculations. Result The incidence of acute poisoning was found to be 178 patients per 100,000 patients. Females (56%), and children below 14 years (44.3%) accounted for the largest proportion. The majority of the exposures were accidental and therapeutic agents (64.2%) were the most common toxic agents. The mean length of stay in the hospital was found to be 1.84 ± 0.81 and most patients (76.6) were discharged within the first 8 hours of the ED admission. A statistically significant difference was found between age groups and type of toxins (χ2 = 23.3, p < 0.001), cause and route of exposure (χ2 = 42.2, p < 0.001) and length of stay (χ2 = 113.16, p < 0.001). Admission to intensive care units had the highest cost expenditure (USD 326,008) while general wards accounted for the least (USD 57,709). Conclusion The study demonstrates unintentional poisoning due to pharmacological agents was common among infants and children. The findings of this study will assist in the development of educational and preventative programs to minimise the exposure to toxic agents. Further studies exploring the impact of medical toxicology services, potential risk factors and post discharge monitoring of poisoning are highly warranted.