Mohammed M. Alsultan

BACKGROUND: The potentially inappropriate medications (PIMs) are a list of drugs that should be avoided or used with caution in geriatric patients. Therefore, the aim of this study was to explore the prevalence of PIMs use and potential risk factors in geriatric patients with diabetes mellitus (DM) and hypertension (HTN). MATERIALS AND METHODS: This cross-sectional study was conducted between June 1, 2023, and October 31, 2024. Data were obtained from the outpatient clinics of elderly people aged 65 years and older. The 2023 updated Beers Criteria, developed by the American Geriatrics Society, was used to determine the use of PIMs among persons aged ≥65 years. The prevalence of PIMs was based on ≥1 PIM prescription divided by the total number of patients. Data analyzed using SPSS; Chi-square test, independent samples t-test, and logistic regression analysis were performed. RESULTS: The entire sample included 198 patients with DM and HTN; 58.6% of the study participants showed PIM use. The most frequently prescribed classes of PIMs that should be avoided were gastrointestinal agents ( n = 136). The multivariable logistic regression showed a considerably higher risk of PIMs in females (adjusted odds ratio [AOR] = 2.59, 95% confidence interval [CI]: 1.20–5.60), people with genitourinary diseases (AOR = 3.88, 95% CI: 1.53–9.87), and polypharmacy (AOR = 1.09, 95% CI: 1.05–1.13). The most frequently used PIM that should be avoided was proton-pump inhibitors (97.8%). In contrast, the PIM that should be used with caution was dapagliflozin (99.0%). CONCLUSIONS: The prevalence of PIMs was high in geriatric patients with DM and HTN. In addition, the predictors that could significantly affect the PIMs were female gender, comorbid genitourinary disease, and polypharmacy. Thus, the results of this study could help healthcare providers improve safe prescribing for geriatric patients diagnosed with DM and HTN.

Background/Objectives: Diabetes mellitus is a common chronic disease that may lead to multimorbidity and high drug use. Therefore, this study aims to examine the prevalence of polypharmacy and hyperpolypharmacy among adult patients diagnosed with type 2 diabetes mellitus (T2DM) with its associated factors. Methods: This is a retrospective cross-sectional study conducted from 1 May 2023 to 31 October 2024. The outcomes in our study were polypharmacy (from five to nine drugs) and hyperpolypharmacy (≥10 drugs). Baseline and demographic characteristics, along with multinomial logistic regression, were used to analyze the data. Results: The total number of patients with T2DM was 2435. The prevalence rate of polypharmacy was 46.98%, while hyperpolypharmacy was 24.27%. Older age was significantly associated with a higher risk of polypharmacy [OR = 1.031, 95% (1.022–1.040)] and hyperpolypharmacy [OR = 1.037, 95% (1.026–1.049)]. In addition, patients with higher levels of hemoglobin A1c showed a significantly higher risk of polypharmacy and hyperpolypharmacy ([OR = 1.162, 95% (1.105–1.221)] and [OR = 1.284, 95% (1.209–1.364)], respectively). The comorbidities that increased the odds of hyperpolypharmacy were hypertension [OR = 2.136, 95% (1.449–3.148)], pulmonary disease [OR = 2.375, 95% (1.292–4.367)], mental disorders [OR = 6.269; 95% (3.284–11.964], and congestive heart failure [OR = 8.014, 95% (2.768–23.200)]. Conclusions: The prevalence of polypharmacy and hyperpolypharmacy is high in patients with T2DM. The predictors that may play a significant role in increasing the risk of hyperpolypharmacy are the poor control of HbA1c and the coexistence of comorbidities. Providing proper prescribing of patients’ therapy plans can improve individuals’ health outcomes. Therefore, this study highlights the important role of primary care physicians in coordinating care, along with clinical pharmacists, in the identification of polypharmacy.

Artificial intelligence (AI) is gaining recognition for its ability to enhance patient outcomes in healthcare. Therefore, integrating AI into the undergraduate curriculum is essential to equip students with foundational knowledge before graduation. This study investigated the knowledge and perceptions of AI education among undergraduate healthcare students. This cross-sectional study targeted students from various health colleges in Saudi Arabia and was conducted from January 1, 2024, to April 30, 2024. Data were collected using a validated questionnaire comprising three sections: demographics, knowledge, and perceptions of AI. We utilized a convenience sampling technique to distribute the survey. Descriptive analysis was performed to assess the baseline characteristics, and a multivariable logistic regression model was used to identify the covariates that significantly influence knowledge scores. A total of 303 students participated in our study, including 142 pharmacy and 161 non-pharmacy students. Non-pharmacy students demonstrated significantly greater knowledge of AI than pharmacy students (p = 0.0084). Positive perceptions of AI were more prevalent than negative perceptions among all participants (p = 0.0062). Pharmacy and non-pharmacy students held significantly different knowledge of advanced AI skills (p = 0.0019) and the importance of AI applications (p = 0.0259). Additionally, there were significant differences in perceptions regarding the belief that AI-powered medical devices would help healthcare providers reduce medical errors (p = 0.0279). Healthcare students recognize the benefit of AI in enhancing patient outcomes but lack practical knowledge of its medical applications. They believe integrating AI education into their curriculum is essential for acquiring skills before graduation. Therefore, enhancing AI training may foster innovation, enhance patient outcomes, and align with the evolving demands of the healthcare sector.

Workplace violence (WPV) is a prevailing global concern among healthcare providers (HCPs). Pharmacists may be more vulnerable to WPV than other HCPs due to being the most trusted, approachable, and accessible healthcare workers. However, in Saudi Arabia, there is little research on violence in the workplace among pharmacists working in different sectors. This is a cross-sectional survey study. An online survey was adopted from previous studies and distributed to a convenience sample of pharmacists by email and social media using a link to a web-based survey platform in QuestionPro. SPSS 28 was used for analysis. Logistic regression was employed to assess the association between WPV exposure and the participants’ characteristics. Three hundred and nineteen pharmacists participated in the study. A total of 156 (48.9%) reported exposure to workplace violence. Most participants had experienced verbal abuse (39.7%). Most offenders were male (84.6%), and aged 21–45 years (66.7%). Common causes included lack of a penalty (13.3%), and absence of reporting systems (11.4%). Seventy-eight percent of participants reported that the violence affected them negatively, leading to hopelessness (19.7%), and decreased work performance and productivity (15.1%). Logistic regression indicated that working as a staff (OR: 3.165; 95% CI 1.118–8.96, p = 0.030), working evening or night shift (OR: 2.4456; 95% CI 1.340–4.503, p = 0.004), and lacking procedure for reporting the violence (OR: 0.412; 95% CI 0.236–0.717, p = 0.002) were more likely to be victim of workplace violence than their counterparts. In Saudi Arabia, the risk of WPV events occurrence among pharmacists is high. The findings can guide the creation of appropriate policies, actions, and safety procedures to prevent and address WPV against pharmacists.

Background: Metabolic bariatric surgery (MBS) is an effective and relatively safe intervention for managing obesity. This study aimed to evaluate the cost-utility of MBS compared with the standard treatment—lifestyle modification plus liraglutide—in the Kingdom of Saudi Arabia (KSA). Methods: A Markov model was developed to estimate the lifetime costs and outcomes of MBS. Costs and outcomes were discounted at an annual rate of 3%. The analysis was conducted from societal and healthcare system perspectives, using a willingness-to-pay (WTP) threshold of one to three times the gross domestic product (GDP) per capita per quality-adjusted life years (QALY) gained. Direct medical and nonmedical costs were obtained from hospital records and patient surveys, respectively. Transitional probabilities and utility values were obtained from published literature and primary data collection in the KSA. One-way and probabilistic sensitivity analyses were performed to assess parameter uncertainty. Results: Over a lifetime horizon, MBS yielded 0.38 incremental QALY and US$ 11,975 (Saudi Riyal [SAR] 44,905; purchasing power parity [PPP] 23,911) incremental costs, leading to an incremental cost-effectiveness ratio (ICER) of US$ 31,909 (SAR 119,660; PPP 63,717) per QALY gained from a societal perspective and US$ 36,353 (SAR 136,324); PPP 72,590) from a healthcare system perspective. The model was most sensitive to the discount rates of costs and outcomes and the direct medical costs associated with MBS. At a WTP threshold of one GDP per capita (US$ 30,436; SAR 114,135; PPP 60,775), the standard treatment had a 63% probability of being cost-effective. However, at a threshold of approximately 1.8 GDP per capita (US$ 56,000; SAR 210,000; PPP 111,821), MBS was cost-effective in 100% of the iterations. Conclusion: MBS is a cost-effective intervention compared with standard treatment in the context of the KSA. Efforts should be made to expand earlier and equitable access to MBS for individuals with a BMI > 40 kg/m² without comorbidities across the country.

Background: Poor medication literacy may lead to serious health risks. Nevertheless, very little research has examined medication literacy in Saudi Arabia. Thus, this study assessed medication literacy and factors associated with poor medication literacy. Methods: A descriptive, cross-sectional study was conducted, with eligibility criteria including individuals aged ≥ 18 years, speaking Arabic or English, and residing in Saudi Arabia. Eligible participants completed an online, self-administered survey disseminated through social media platforms over a two-month period. Horvat’s Medication Literacy Assessment Questionnaire was employed. The analysis used regression in SPSS version 29 to identify predictors of medication literacy. Results: A total of 815 participants were included. Most were female (75.7%), aged 18– 24 years (50.1%), and held undergraduate degree (47%). The median (IQR) medication literacy score, assessed using Horvat’s Medication Literacy Assessment Questionnaire (score range: 0– 29), was 22.0 (18– 24). Results showed a relatively poor level of medication literacy, with 50% of participants scoring below the average of correct answers. Most problems were found in items related to dosing, requiring understanding information from longer texts and numerical skills. Other issues included refills, drug use in pregnancy, storage and disposal, expiration date, adverse effects, drug interactions, missed doses, label understanding, tablet splitting, and duration of therapy. Multiple linear regression revealed significant predictors. Lower educational levels were associated with reduced scores (β = − 1.765, p = 0.009 for high school or below; β = − 5.872, p = 0.016 for diploma). Smaller households were associated with higher scores (β = 1.252, p = 0.031 for 1– 4 members; β = 1.255, p = 0.021 for 5– 8 members). Prescription medications use (β = 2.375, p < 0.001) and less frequent pharmacists consultation (β = 3.602, p = 0.001) were positively associated with higher scores. Conclusion: Medication literacy among study participants requires improvement, especially in areas involving dosing instructions and numerical understanding. Targeted interventions are necessary for those with inadequate literacy levels.

Therapeutic drug monitoring (TDM) is key to optimizing vancomycin therapy, as accurate sampling timing ensures valid drug levels and supports safe, effective clinical decisions. This study aimed to assess the timing accuracy of blood draws for vancomycin TDM, evaluate its clinical implications, and identify predictors of timing errors. A cross-sectional study was conducted at King Saud University Medical City, involving 103 patients from October 2023 to December 2023. The primary outcome was adherence to the blood sampling timing guidelines. Secondary outcomes included clinical cure rates, acute kidney injury incidence, and in-hospital mortality. Of the analyzed samples, 80.6% were improperly timed. Clinical cure rates were significantly higher among patients with correctly timed samples (75%) compared to those with incorrectly timed samples (57.83%). Timely sampling improved cure rates for pulmonary and skin infections (85.71%), while improper timing reduced them to 72.22% and 62.5%, respectively. Improper timing was linked to higher in-hospital mortality (30.12%) and acute kidney injury (15.66%). Multivariate analysis revealed that bacteremia significantly reduced the likelihood of clinical cure (odds ratio = 0.387, 95% confidence interval [0.160, 0.933], P = .035), while 3 times daily dosing significantly increased the odds of correctly timed samples (odds ratio = 5.1, 95% confidence interval [1.125, 23.11], P = .035). This study highlights the critical role of accurate timing in vancomycin TDM for achieving favorable patient outcomes and reducing adverse events. Strengthened institutional protocols and targeted training programs are essential to improve adherence to sampling guidelines and enhance patient safety.

Background: Prescribing errors present a critical concern in practice where junior doctors initiate the majority of prescriptions. Objective: The study aimed to evaluate the impact of pharmacist-led educational intervention provided to undergraduate medical students on the appropriateness and self-perceived readiness to prescribe medications. Methods: This pharmacist-led pre-and-post-intervention study included female undergraduate medical students enrolled in the prescription practice course between Oct 19 and Nov 15 2022, at King Fahad University Hospital in the eastern region of Saudi Arabia. The course involved three main domains: a pre-module assessment, formal training in the principles of prescription writing, and a post-module assessment. The pre-module assessment was designed to assess the students’ ability to write a prescription for a given patient scenario. After that, formal training in the principles of prescription writing was conducted, which highlighted the elements of prescription writing based on World Health Organization (WHO) guidelines for good prescription. Finally, the post-module assessment was utilized to evaluate the knowledge the students gained during the session, asking them to re-write a prescription for the same patient scenario. Results: This study assessed one hundred twenty-four students before and after writing the prescription course. The mean score and standard deviation before the course were 8.65±2.362, and they significantly improved after the course. Their mean score after the course was 14.2±0.988 (P-value <0.001). Conclusion: The pharmacist-led prescription writing intervention for undergraduate medical students has improved their skills, knowledge, and confidence. Thus, this supports incorporating prescription writing into undergraduate medical students’ education with pharmacist involvement.

BACKGROUND Herbal medicine is commonly used in Saudi Arabia, and is widely viewed as natural and safe. However, its use among transplant recipients poses risks due to interactions with immunosuppressive therapies. This study explores herbal medicine use, knowledge, and attitudes among Saudi transplant recipients. MATERIAL AND METHODS A cross-sectional study of 203 transplant recipients from multiple clinics in Saudi Arabia was conducted using a structured questionnaire to assess demographics, herbal supplement use, awareness of risks, and attitudes. Statistical analyses compared users and non-users of herbal supplements. RESULTS Post-transplant herbal supplement use decreased significantly (44.3% to 19.2%, p=0.0001). Many relied on unreliable sources like friends or the internet, and 54.24% of reported supplements posed interaction risks with immunosuppressive drugs. Participants aware of these risks were significantly less likely to use herbal supplements (15% vs 88%, p=0.0007). Alarmingly, 81.1% received no pre-transplant education, and 70.4% received no post-transplant care, despite 81% desiring guidance from healthcare providers. CONCLUSIONS Herbal supplement use among transplant recipients in Saudi Arabia is prevalent and risky due to potential drug interactions. Most patients lack education about these risks, underscoring the need for improved healthcare education.

Objective: To examine the prevalence of potentially inappropriate medications (PIMs) prescribed among older patients diagnosed with psychiatric diseases and to identify associated factors.Methods: This cross-sectional study was conducted among older patients who visited outpatient clinics in Saudi Arabia between June 1st, 2019, and May 31st, 2023. PIMs use was estimated using the updated 2019 American Geriatric Society (AGS) Beers criteria. Data were analyzed using chi-square or Fisher's exact test for categorical variables and t-test for continuous variables to compare patients with and without PIMs. In addition, the Pearson correlation test was performed between the total number of prescriptions and the number of PIMs. Multivariable logistic regression analysis was used to explore PIMs. Statistical significance was set at p < 0.05.Results: Our study included 306 patients with psychiatric diseases, with 156 (50.98%) in the PIMs group and 150 (49.02%) in the non-PIMs group. There was a considerable positive correlation between the total number of prescriptions and the number of PIMs (r = 0.76; p < 0.0001). The adjusted logistic regression analysis revealed a significantly higher risk of PIMs use in individuals with psychiatric diseases and comorbid neurological diseases compared to those without [adjusted odds ratio (AOR) = 2.48, 95% CI [1.15–5.32]]. In contrast, the risk of PIMs use was not significantly greater for older individuals with psychiatric diseases and comorbid hypertension {AOR = 1.67, 95% CI [(0.79–3.54)]}, diabetes mellitus {AOR = 1.25, 95% CI [(0.66–2.34)]}, or pulmonary disease {AOR = 2.34, 95% CI [(0.69–7.96)]}.Conclusion: This study highlighted the elevated number of PIMs in older adults with psychiatric diseases in the outpatient setting, particularly those with comorbid neurological diseases. Therefore, clinical pharmacists may play a crucial role in improving the outcomes of patients diagnosed with psychiatric illnesses. Finally, future studies should examine additional strategies to reduce the use of PIMs in this population.