In order to enhance the quality use of and to promote the practice of generic medicines in Qatar, an educational program should be implemented. A national generic medicine policy and guidelines are warranted in the State of Qatar.

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Background Coronavirus disease 2019 (COVID-19) pandemic created unprecedented pressures on healthcare systems and led to the widespread adoption of telepharmacy services, a practice that was not previously established in the state of Qatar. Objective The -study aimed to explore clinical pharmacists’ (CPs) perspectives and experiences in utilizing telepharmacy for the provision of pharmaceutical care during the COVID-19 pandemic. Methods A descriptive, qualitative approach using face-to-face focus group (FG) discussions was used. CPs across Hamad Medical Corporation (HMC) were purposively invited to participate in the study. FG discussions were audio-recorded, transcribed verbatim, and validated. Transcripts were analyzed using inductive thematic analysis. Recruitment continued until a saturation point was achieved. Results We conducted five focus groups that included 23 CPs and led to seven themes. Overall, CPs reported inadequate preparedness for the practice of telepharmacy, which they perceived as challenging. The primary perceived benefits of telepharmacy were decreased infection exposure risk, improved quality of care, improved patients’ satisfaction, and enhanced workplace efficiency and productivity. The main highlighted risks of telepharmacy were related to threatened patient confidentiality, missed pharmaceutical care opportunities, and negatively impacted professional rapport with other healthcare providers; and the major perceived challenges were low digital health literacy, complex illnesses and medication regimens, lack of standardized protocols, and inadequacy of resources and cultural resistance for virtual care. Participants recommended standardization and training, resource allocation, and proper service promotion as potential facilitators of telepharmacy practice. Conclusion The current study revealed that despite perceived barriers, pharmacists identified several benefits of telepharmacy and recommended potential facilitators that should be used to integrate and sustain the practice of telepharmacy in the future. Future studies should investigate the impact of telepharmacy on clinical pharmacy interventions and patient outcomes.

Objective The aim of the study was to assess the quality of the recently published European clinical practice guidelines for the management of dyslipidaemias, utilizing the refined Appraisal of Guidelines for Research & Evaluation tool. Method The 2019 European Society of Cardiology and European Atherosclerosis Society Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk was appraised and scored for methodological rigour and transparency by 5 independent appraisers using a validated tool. Key findings The guideline scored highest in the domains that evaluated editorial independence (100%) and clarity of presentation (98.6%) and lowest in the domains that addressed stakeholder involvement (55.56%) and rigour of development (63%). Overall the quality of the guideline was high, and all reviewers recommended its use in practice. Conclusion The guideline’s overall quality was judged to be high, and all appraisers recommended its use in practice without modifications.

Background Coronavirus disease (COVID-19) is associated with significant morbidity and mortality. This study aimed to explore the early predictors of intensive care unit (ICU) admission and in-hospital mortality among patients diagnosed with COVID-19. Methods This was a case-control study of adult patients with confirmed COVID-19. Cases were defined as patients admitted to ICU during the period February 29 - May 29, 2020. For each case enrolled, one control was matched by age and gender. Results A total of 1560 patients with confirmed COVID-19 were included. Each group included 780 patients with a predominant male gender (89.7%) and a median age of 49 years (interquartile range = 18). Predictors independently associated with ICU admission were cardiovascular disease (CVD) (adjusted odds ratio (aOR)=1.64, 95% confidence interval (CI): 1.16 - 2.32, p=0.005), diabetes (aOR=1.52, 95% CI: 1.08 - 2.13, p= 0.016), obesity (aOR=1.46, 95% CI: 1.03-2.08, p= 0.034), lymphopenia (aOR=2.69, 95% CI: 1.80-4.02, p< 0.001), high aspartate aminotransferase (AST) (aOR= 2.59, 95% CI: 1.53-4.36, p< 0.001), high ferritin (aOR=1.96, 95% CI: 1.40-2.74, p< 0.001), high C-reactive protein (CRP) (aOR=4.09, 95% CI: 2.81-5.96, p< 0.001), and dyspnea (aOR=2.50, 95% CI: 1.77-3.54, p< 0.001). Similarly, significant predictors of mortality included CVD (aOR=2.16, 95% CI: 1.32- 3.53, p=0.002), diabetes (aOR=1.77, 95% CI: 1.07-2.90, p=0.025), cancer (aOR=4.65, 95% CI: 1.50-14.42, p= 0.008), lymphopenia (aOR=2.34, 95% CI: 1.45-3.78, p= 0.001), and high AST (aOR= 1.89, 95% CI: 1.04-3.43, p=0.036). Risk Factors for ICU admission among patients with COVID-19 (N=1560) Conclusion Having CVD, diabetes, lymphopenia, and increased AST were independent predictors for both ICU admission and in-hospital mortality in patients with COVID-19. In addition, obesity, high ferritin, and CRP levels were associated with increased risk of ICU admission, while cancer was strongly associated with in-hospital mortality. Early identification and monitoring of patients at risk is essential in planning the level of care needed to prevent delay in medical intervention. Disclosures Adel Abou-Ali, PharmD, PhD, Astellas Pharma Global Development, Inc. (Employee)

Smoking is one of the leading causes of preventable death worldwide. Several pharmacological therapies have been established over the years to aid in smoking cessation, including Varenicline, a partial nicotine agonist. Neuropsychiatric adverse events have been reported in patients treated with Varenicline. Here, we present a case of first-episode psychosis in the context of Varenicline therapy. The patient's chart was retrospectively reviewed for relevant medical and psychiatric history, in addition to the use of current or past medications. Routine laboratory investigations and brain imaging were performed. The Naranjo Adverse Drug Reaction Probability Scale was also done independently by two physicians involved in the patient's treatment.He was admitted for psychotic symptoms elicited in the context of a probable adverse reaction to Varenicline. The current evidence linking Varenicline to psychosis remains controversial. Speculatively, there could be a link between Varenicline, which supposedly increases dopamine levels in the prefrontal cortex through the mesolimbic pathways, and psychotic symptoms. It is therefore beneficial to be cognizant, in a clinical setting, of the possibility of the emergence of these symptoms with Varenicline therapy.

Endogenous bacterial endophthalmitis results from bacterial seeding of the eye during bacteremia. A diagnosis of endogenous bacterial endophthalmitis requires clinical findings such as vitritis or hypopyon along with positive blood cultures. Serratia marcescens is the second most common pathogen causing hospital‐acquired ocular infections. This report describes a case of endogenous bacterial endophthalmitis caused by S. marcescens in an older adult with end‐stage renal disease (ESRD) on peritoneal dialysis, who had late‐onset pleural empyema secondary to coronary artery bypass grafting (CABG). A 61‐year‐old gentleman presented with a two‐day history of cloudy vision, black floaters, pain, swelling, and gradual vision loss in his right eye. There was no history of trauma, ocular surgeries, or previous similar episodes. He had myocardial infarction treated with CABG 3 months back. Examination showed a 3 mm hypopyon in the anterior chamber. He had classic signs of endophthalmitis with positive blood cultures for S. marcescens. He was treated with high‐dose intravenous meropenem and intravitreal ceftazidime without vitrectomy. Endophthalmitis progressed to complete vision loss in his right eye, requiring evisceration. Endophthalmitis caused by S. marcescens is rare, but long‐term outcomes can be severe, causing complete vision loss in about 60% of the patients. It is usually hospital‐acquired, and the source can be late‐onset empyema several months after cardiac surgery, in an immunocompromised patient. Systemic antibiotics should be supplemented with intravitreal agents with or without pars plana vitrectomy.

fatal consequences. Missing dependent and independent controls regarding concentration and identity pose a risk for patient safety. Purpose We developed a concept for a two-stage quality control of the infusion solutions. Drug identity and concentration can be checked onsite after preparation using a combined UVand Raman spectrometer (UV-Raman). This is complemented by an independent method using liquid chromatography coupled to UV detection (HPLC-UV). Material and methods Methods for the analysis of seven cytostatic drugs and two monoclonal antibodies were developed and validated on an i-QCRx UV-Raman system (B and W Tek Europe GmbH, Lübeck, Germany) and on an Agilent 1200 series HPLC-UV system (Agilent Technologies, Waldbronn, Germany). Sample transport and preparation were evaluated to ensure valid results. In a pilot study we analysed samples from different pharmacies in both systems. Results Method development and validation were successful for the investigated compounds in both systems. HPLC-UV is more sensitive than UV-Raman. However, due to the content of the preparations, real samples had to be diluted before applying HPLC-UV analysis. Sensitivity of the UV-Raman spectrometer fits to the required concentration range without further dilution. All methods showed reproducible results, UV-Raman varied by 0.44% in a repeated analysis (n=3) of 5-fluorouracil, while HPLC-UV varied by 0.14%. Results of the investigated samples were also equivalent. In a sample containing paclitaxel with a target concentration of 0.72 mg/mL we determined 0.73 mg/mL (101%) using UV-Raman and 0.69 mg/mL (96%) using HPLC-UV, for example. Conclusion UV-Raman and HPLC-UV are suitable for determining the content of patient-individual preparations, both with individual assets and drawbacks. The study showed that the two-stage control concept is appropriate to ensure a highquality level for patient-individual preparations.