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Introduction: Community pharmacists are often the first point of contact for the public, especially during pandemics. As outlined by the International Pharmaceutical Federation, community pharmacists have an important public health role during this Coronavirus Disease 2019 (COVID-19) public health emergency. We therefore investigated the current practices, response preparedness and professional development needs of community pharmacists in Qatar. Methodology: A descriptive cross-sectional online 38-item questionnaire-based survey constructed on evidence-based public health roles of pharmacists was conducted between 28 May and 18 June 2020. Questions related to current practices required responses on a 5-point Likert-type scale ranging from “always” to “never”. The questionnaire was evaluated for validity and the reliability analysis showed a Cronbach’s alpha coefficient of 0.921. Results: The response (n = 311) rate for the survey was 34.2%. More than 75% of pharmacists “always” encouraged and practiced hygiene and social distancing measures. On the other hand, the proportion of pharmacists “always” involved in patient assessment, education or providing information related to COVID-19 and application of evidence-based protocol ranged from 32 to 73%. The vast majority (87-96%) of pharmacists indicated that they needed professional development related to COVID-19. Overall, 77% of pharmacists either “strongly agreed” or “agreed” that they have all the necessary COVID-19 related emergency response preparedness and training. Country from which pharmacists obtained their first degree, and the type of pharmacy where they practice influenced their overall perception toward emergency response preparedness. Conclusions: Community pharmacists in Qatar are willing to receive additional training related to COVID-19 public health crisis despite being prepared to engage with patients.

Preterm birth (PTB) and early term birth (ETB) are associated with high risks of perinatal mortality and morbidity. While extreme to very PTBs have been extensively studied, studies on infants born at later stages of pregnancy, particularly late PTBs and ETBs, are lacking. In this study, we aimed to assess the incidence, risk factors, and feto-maternal outcomes of PTB and ETB births in Qatar. We examined 15,865 singleton live births using 12-month retrospective registry data from the PEARL-Peristat Study. PTB and ETB incidence rates were 8.8% and 33.7%, respectively. PTB and ETB in-hospital mortality rates were 16.9% and 0.2%, respectively. Advanced maternal age, pre-gestational diabetes mellitus (PGDM), assisted pregnancies, and preterm history independently predicted both PTB and ETB, whereas chromosomal and congenital abnormalities were found to be independent predictors of PTB but not ETB. All groups of PTB and ETB were significantly associated with low birth weight (LBW), large for gestational age (LGA) births, caesarean delivery, and neonatal intensive care unit (NICU)/or death of neonate in labor room (LR)/operation theatre (OT). On the other hand, all or some groups of PTB were significantly associated with small for gestational age (SGA) births, Apgar &lt, 7 at 1 and 5 minutes and in-hospital mortality. The findings of this study may serve as a basis for taking better clinical decisions with accurate assessment of risk factors, complications, and predictions of PTB and ETB.

Clinical pharmacy services have evolved rapidly and been developed largely to cover a wide range of patient care settings and therapeutic areas. However, clinical pharmacists' services in obstetrics and gynecology (OB/GYNE) setting are not commonly available in many developing countries. In addition, literature describing clinical pharmacists' role in OB/GYNE settings is limited. This chapter provides a general overview of pharmacists' role in OB/GYNE and outlines a case study of pharmacy services provided in an OB/GYNE setting in Qatar. The case study provides a description of the activities and responsibilities of the clinical pharmacist and highlights the challenges and opportunities in this setting. The current work retrospectively describes a 2-year period of clinical pharmacy service activities at the OB/GYNE Department at Women's Hospital (now Women's Wellness and Research Center) in Qatar. A narrative of the provided services is described through available resources, hospital website and electronic system, and pharmacy key informants. The estimated clinical pharmacist to bed ratio is 1 to 35-40 beds. Patient care-related activities such as medication review, patient education, and multidisciplinary rounds represent the main role of clinical pharmacists. Other nonclinical roles in which clinical pharmacists are actively involved include educational and research activities. Clinical pharmacists are challenged by the high turnover nature of the patient population, variable levels of case complexity, having patients in health transition states, and limited medication safety infrastructure. The clinical pharmacy services are limited to the inpatient setting, while documentation of activities done by clinical pharmacists needs to be enhanced. Providing clinical pharmacy services in the OB/GYNE field is a fruitful initiative in our setting. Having such a special patient population warrants the expansion of clinical pharmacy services in this clinical setting. 2021 Elsevier Inc. All rights reserved. Scopus

Background Abnormal fetal growth can be associated with factors during pregnancy and at postpartum. Objective In this study, we aimed to assess the incidence, risk factors, and feto-maternal outcomes associated with small-for-gestational age (SGA) and large-for-gestational age (LGA) infants. Methods We performed a population-based retrospective study on 14,641 singleton live births registered in the PEARL-Peristat Study between April 2017 and March 2018 in Qatar. We estimated the incidence and examined the risk factors and outcomes using univariate and multivariate analysis. Results SGA and LGA incidence rates were 6.0% and 15.6%, respectively. In-hospital mortality among SGA and LGA infants was 2.5% and 0.3%, respectively, while for NICU admission or death in labor room and operation theatre was 28.9% and 14.9% respectively. Preterm babies were more likely to be born SGA (aRR, 2.31; 95% CI, 1.45–3.57) but male infants (aRR, 0.57; 95% CI, 0.4–0.81), those born to parous (aRR 0.66; 95% CI, 0.45–0.93), or overweight (aRR, 0.64; 95% CI, 0.42–0.97) mothers were less likely to be born SGA. On the other hand, males (aRR, 1.82; 95% CI, 1.49–2.19), infants born to parous mothers (aRR 2.16; 95% CI, 1.63–2.82), or to mothers with gestational diabetes mellitus (aRR 1.36; 95% CI, 1.11–1.66), or pre-gestational diabetes mellitus (aRR 2.58; 95% CI, 1.8–3.47) were significantly more likely to be LGA. SGA infants were at high risk of in-hospital mortality (aRR, 226.56; 95% CI, 3.47–318.22), neonatal intensive care unit admission or death in labor room or operation theatre (aRR, 2.14 (1.36–3.22). Conclusion Monitoring should be coordinated to alleviate the risks of inappropriate fetal growth and the associated adverse consequences.

Background: Misoprostol is a synthetic prostaglandin E1 that induces cervical effacement and uterine contractions at all gestational ages, thus facilitating uterine evacuation and pregnancy termination. Successful medical evacuation of spontaneous miscarriage with minimal adverse effects can be performed using misoprostol-only regimen if given as indicated and if the administered dose, frequency of the dosage, and number of total doses are appropriate. Aim: To conduct a drug use evaluation by investigating indications, appropriateness of dosing, and clinical outcome of misoprostol-only regimen when used for medical evacuation of spontaneous miscarriage at the Women's Hospital in Doha, Qatar. Materials and methods: A retrospective descriptive drug use evaluation was conducted on women with spontaneous miscarriage who received misoprostol for medical evacuation during August 2013. The current practice at the Women's Hospital was compared with the recommendation from the World Health Organization (WHO). Patients were stratified into three groups based on weeks of amenorrhea. Results: A total of 107 patients received misoprostol during August 2013, of which 33 (31%) were included in the study. In these patients, the main indication for misoprostol use was missed miscarriage (54.5%). In the group of patients at ≤ 9 weeks of gestation, 80% received an initial dose of 800 μg, 80% received frequency within the WHO recommendation, and the majority had surgical evacuation (80%). In the group of patients at 10–12 weeks of gestation, more than 80% received an initial dose of 800 μg, 6% received frequency within the WHO recommendation, and more than 75% had successful medical evacuation. In the group of patients at 13–22 weeks of gestation, more than 80% received an initial dose of 400 μg, more than 80% received frequency within the WHO recommendation, and 54% had successful medical evacuation. Overall, more than 70% of the patients received ≤ 3 total doses of misoprostol and more than 60% had successful medical evacuation as a clinical outcome. Conclusions: Despite the current practice at the Women's Hospital not always being in accordance with the WHO recommendation, successful medical evacuation was achieved in most patients.

Doua AlSaad,1 Samah ElSalem,1 Palli Valapila Abdulrouf,1 Binny Thomas,1,2 Tayseer Alsaad,3 Afif Ahmed,1 Moza AlHail4 1Department of Pharmacy, Women’s Hospital, Hamad Medical Corporation, Doha, Qatar; 2Department of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, UK; 3Department of Pediatrics, Hamad General Hospital, 4Clinical Support Service Unit, Hamad Medical Corporation, Doha, Qatar Background: Breastfeeding is considered as gold standard for infant nutrition and should be interrupted only when a compelling indication exists. Certain medical conditions such as abortion, stillbirth, HIV infection, or infant galactosemia and certain medications such as chemotherapy necessitate lactation inhibition to protect the health of mother and infant. Drug use evaluation (DUE) studies are done to explore the current practice in a setting and help to identify areas in which further information and education may be needed by clinicians.Objective: The aim of this study was to conduct a DUE of cabergoline to assess indications for lactation inhibition, dosage regimen, and its safety.Method: A retrospective cross-sectional DUE study was conducted over a period of 4months from September 1, 2013, till December 31, 2013, at the Women’s Hospital, Qatar. All cabergoline prescriptions written for lactation inhibition within 10days of delivery or abortion were included in the study. A descriptive data analysis was undertaken.Results: Of the 85 patients included, stillbirth (50.6%) was considered as the main reason for lactation inhibition, followed by abortion (27.1%) and neonatal death (12.9%). The remaining 9.4% of the patients had live baby, and the majority of them were prescribed cabergoline for lactation inhibition because their maternal medical conditions required the use of drugs with insufficient safety data (n=6). Seventy-four percent of patients received cabergoline at accurate time and dose. However, 14% of the patients had preexisting hypertensive disorder and 58.3% of them were diagnosed as uncontrolled hypertension.Conclusion: The current DUE study found that cabergoline was mainly used to inhibit lactation for patients with stillbirth, abortion, and neonatal death. In mothers who use medications for other medical conditions, benefits and risks of breastfeeding should be carefully balanced before prescribing cabergoline. Current prescribing pattern can be further enhanced through informing health care providers regarding appropriate cabergoline dosage regimen and its safety in patients with uncontrolled hypertension. Keywords: lactation inhibition, cabergoline, drug use evaluation, breastfeeding inhibition

IntroductionA medication error can be defined as “any error occurring in the medication use process” and focuses on problems with the delivery of medication to a patient [1]. Medication errors are a complex and ongoing issue that are of concern in all health care institutions [1]. Such errors range in severity but have been associated with an increased mortality and morbidity rate, as well as resulting in significant health care cost for both adult and pediatric populations [2,3]. Evidence from the literature indicates that more complex medical problems in patients who require multiple medications are more likely to experience medication errors during their hospitalization [3,4]. Since the release of the report “To err is human” by the Institute of Medicine (IOM) in 1999, the importance of good patient safety management has become a major focus of many health care professionals throughout the world [2]. Neonates, as a population, do not appear at a particularly high risk of experiencing medication errors as the vast majorities are not born preterm and often do not require a significant number of medications within the first month of life. Premature newborns in the neonatal intensive care unit (NICU) however are much more vulnerable to medication errors as they often require many different medications, are of small size, are physiologically immature, and may be lacking in the abilities to compensate for the effects of such errors [5].MethodsA cross-sectional retrospective study investigating medication error reports submitted by healthcare professionals in an online database was completed. Medication error reports developed from January 1st of 2014 until April 14th of 2015 at a large, tertiary care NICU were reviewed. Medication error reporting within the hospital is policy driven and has migrated from a paper-based to a computer-based system that is accessible to all healthcare professionals. A data collection tool was developed based on three sources: literature review, National Coordinating Council for Medication Error Reporting and Prevention (NCC-MERP) classifications and a medication error sample report from the tertiary care hospital. This tool included demographics, personnel and practice event details including date and time, contributing factors, error category, and medications involved. Phase validation of the data collection tool was completed by study investigators and an external expert in medication error reporting. The modified version of the tool was then piloted using ten medication error reports completed by two investigators. Inconsistencies in data collection were discussed openly and final clarifications were made to the data collection tool. Data collection from all medication error reports were completed by two investigators. Medication errors reports included in this study were analyzed using Statistical Package for Social Sciences SPSS version 22. Frequencies were described using qualitative variables. Chi squared test was applied on categorical variables.ResultsDuring this study period, a total of 201 medication error reports were collected and reviewed. All errors were identified and reported by pharmacists. 51.8% of reports involved male patients. 27.4% of error reports developed from the NICU occurred in patients from birth to one day of age while 42.3% of error reports occurred in patients during the first week of life. The three most frequent categories of medication errors included wrong dose of medication (45.5%), wrong dosing frequency (31%) and documentation error (24%). Wrong frequencies were significantly associated with newborns on days 0–1 of life (p DiscussionSeveral studies have described the frequency and preventability of medication errors in the NICU [6]. This is the first study in Qatar that focuses on this area. We identified several deficiencies with the current error reporting system in that much of the demographic information useful for medication error reporting in neonates (ie. weight, gestational age, and diagnosis) are not necessary to complete the report. As only pharmacists completed all medication error reports it appears that education and training of other health care professionals may be needed to improve overall reporting. Reporters are also not anonymous which may contribute to underreporting. The most common medications involved in errors were antibiotics which is similar to existing studies [7]. Some limitations of this study included the inability to calculate the rate of errors occurring per patient or prescription as the total number of prescriptions written in the unit during this time was not available. Also, due to the retrospective nature of this study, there is the limitation of underrepresentation of medication errors as investigators were only able to describe medication errors that were reported through the online reporting system and did not use other sources for identifying medication errors in the unit.ConclusionBased on the reports generated through this online reporting system, medication errors that do occur in the NICU appear to be identified before they reach the patient. However, it is difficult to determine if underreporting does occur. Special care must be taken when selecting doses and frequencies of medications for patients in the NICU. Education and training on medication error reporting would likely have a positive influence on reporting by other health care professionals in the NICU.References[1] Bates DW, Boyle DL, Vander Vliet MB, Schneider J, Leape L. Relationship between medication errors and adverse drug events. J Gen Intern Med. 1995;10(4):199–205.[2] Kohn LT, Corrigan JM, Donaldson MS (Eds): Institute of Medicine Committee on Quality of Health Care in America: To Err is Human: Building a Safer Health System. Washington DC, National Academy Press, 2000.[3] Slonim AD, Tian J, Lafleur B, et al: Hospital reported medical errors in children. Pediatrics 2003; 111:617–621.[4] Slonim AD, Tian J, Lafleur B, et al: Patient characteristics associated with the occurrence of hospital-reported medical errors in children. Pediatr Res 2001; 49:A127.[5] Kanter DE, Turenne W, Slonim AD. Hospital-reported medical errors in premature neonates. Pediatr Crit Care Med 2004;5:119–23.[6] Santesteban E, Arenas S, Campino A. Medication errors in neonatal care: A systematic review of types of errors and effectiveness of preventive strategies. J Neonat Nurs 2015;21(5):200–8.[7] Jain S, Basu S, Parmar VR. Medication errors in neonates admitted in intensive care unit and emergency department. Indian J Med Sci. 2009;63:145–51.