Raniah Aljadeed

Background/Objectives: Ketamine use in emergency departments is expanding for the management of agitation, procedural sedation, and rapid sequence intubation. We aim to describe the indications and characteristics of ketamine administration in emergency department patients in Saudi Arabia through retrospective chart review. Methods: This was a single-center, retrospective chart review conducted at an academic medical center. The study population included patients who received intravenous (IV) or intramuscular (IM) ketamine in the emergency department between 1 January 2023, and 31 December 2024. Patients younger than 18 years of age or those who were pregnant were excluded. Results: A total of 192 patients were included. The median ketamine dose was 50 mg (a total range of 20–240 mg). Procedural sedation was the primary indication (79%), followed by pain management (12.5%), rapid sequence intubation (4.7%), and agitation (2.1%). Nearly all patients (99.5%) received ketamine intravenously, and 83.9% received it in conjunction with other medications. For procedural sedation, ketofol was the most common combination therapy, accounting for 83.6% of combination cases. No procedural failures, need for additional sedatives, or redosing within an hour were reported for procedural sedation. For pain management, ketamine was predominantly administered for musculoskeletal pain (50%) and was most often used as monotherapy (58.3%). Notably, no documented adverse effects were observed post ketamine administration across all indications. Conclusions: Among patients who received ketamine in emergency departments in Saudi Arabia, its administration was frequent, particularly for procedural sedation and acute pain management. In this study we found no adverse events or procedural failures were documented. Further research is warranted to validate these findings.

The American College of Clinical Pharmacy (ACCP) first described the role and history of the pharmacist as principal investigator (PI) in 2000. An update was published in 2010, citing evidence from NIH and the ClinicalTrials.gov registry that showed an increase in the number of individuals with a Pharm.D. degree engaging in pharmacist‐directed research. The 2025 ACCP Publications Committee was charged with providing an update to the 2010 paper. Key findings include a substantial increase in the total amount of federal funding awarded to schools of pharmacy (SoP) between 2011 and 2023, a modest increase in the number of pharmacists receiving federal grants when comparing 2010 with 2024, and evidence of pharmacist leadership and engagement in Clinical and Translational Science Award networks and service on national grant review panels. It remains challenging, however, to ascertain accurate and reliable data on pharmacists serving in PI roles because of the limitations of currently available data sources. This is especially true for pharmacist PIs who receive non‐federal funding. Future opportunities include a continued emphasis on training programs to prepare pharmacists for PI roles, greater institutional support (e.g., research infrastructure, mentoring programs) for pharmacists serving in PI roles, better promotion of research career tracks to Pharm.D. students and trainees, enhanced efforts at SoP to pursue institutional training grants, and more collaborative efforts across professional organizations to advocate for pharmacist‐scientists. An urgent call to action is necessary to ensure the future growth and success of pharmacist‐directed research.

Background: Status epilepticus (SE) is a medical emergency that requires immediate care and is associated with substantial mortality and morbidity. Current guidelines recommend benzodiazepines (BZDs), regardless of the type of SE, as an initial treatment. Despite established guidelines, BZD underdosing remains common in clinical practice. This study aimed to the objective of this study was to assess BZD doses in patients administered to the ED with SE and evaluate patient outcomes in relation to BZD dosing adequacy.Methods: We conducted a single-center retrospective study of adult patients (≥18 years) who presented to the ED with SE and received BZDs from January 2021 to January 2024. Primary outcome was percent of SE patients admitted to our institution who received inadequate doses of BZDs. Secondary outcomes included ICU admission rates, need for endotracheal intubation, duration of mechanical ventilation, Glasgow Coma Scale (GCS) at discharge administration of second-line antiseizure medications, and in-hospital mortality. Demographic data, treatment details, and outcomes were collected and analyzed.Results: Among 196 adult patients included, only 17% (n = 34) received an adequate first dose of BZDs. Pre-hospital BZD administration occurred in 5% of cases. Lorazepam was most frequently administered (65%), followed by midazolam (20%) and diazepam (15%). Inadequate dosing rates were 77.2% for lorazepam, 90.0% for midazolam, and 96.6% for diazepam. Following first dose of BZE, the overall need for endotracheal intubation rate was 8.7% and in-hospital mortality at 3.1% across the entire cohort, with no significant differences between the 2 groups (p = 0.166; p = 0.279). The overall need for endotracheal intubation rate was 8.9%, with no statistically significant difference observed between the groups (p = 0.167). For patients requiring mechanical ventilation, the mean duration was 4 days (p = 0.988). Notably, inadequate total BZD dosing was significantly associated with increased in-hospital mortality (4.2% vs. 0%, p = 0.010).Conclusion: BZD underdosing in SE management remains widespread, with only 17% of patients receiving guideline-adherent initial doses. Although our study did not demonstrate significant differences in clinical outcomes based on dosing adequacy, implementation of institution-specific protocols and focused educational initiatives on weight-based BZD administration may improve guideline adherence in SE management.

Intravenous push (IVP) administration of anti-seizure medications is becoming increasingly popular among emergency departments. IVP administration eliminates the need for compounding and preparation by the pharmacy department, as well as the need to gather infusion materials or set up a patient’s tubing and pump, all of which translate to faster drug administration. This is important given the time-sensitive nature of status epilepticus treatment. This review will discuss several anti-seizure medications, including phenytoin, fosphenytoin, valproic acid, levetiracetam, brivaracetam and lacosamide, for which evidence supports the safe and efficacious use of IV push administration.

Continuing education (CE) is an essential requirement for pharmacy professionals to stay abreast with the evolving knowledge and skills of the practice and meet the regulatory mandate. The purpose of this research is to assess factors affecting the satisfaction of pharmacists and pharmacy technicians towards CE practices in Saudi Arabia. A self-administered survey instrument was developed following an extensive literature search. The questionnaire consisted of three sections: participants’ demographics, data on CE activities over the past year and overall satisfaction, and statements of barriers (14 items) and facilitators (12 items) for participation in CE activities (scored on a 5-point Likert scale (5 = always, 1 = never)). The survey was piloted and then distributed as a link through the Saudi Commission for Health Specialties and Saudi Pharmaceutical Society (SPS) between Jan 2018 and Feb 2019. Data was available on 398 pharmacists and 40 pharmacy technicians (completion rate was 55 %). The majority were practitioners, male, working in a hospital setting and had more than five years of practice experience. Half of the participants were from the Central Region and about one-third were non-Saudi. Only a quarter of the participants were satisfied/very satisfied with the current CE practices in Saudi Arabia. Job constraints (62.7 %), cost (55.9 %), schedule of CE activities (55.4 %), lack of information on CE opportunities (53 %) and professional burnout (49.7 %) were the top barriers. There was a significant level of dissatisfaction among pharmacy technicians when compared to pharmacists (p = 0.003), as well as among Saudi pharmacists when compared to non-Saudi pharmacists (p = 0.002). Lack of relevant CE activities (p = 0.05), lack of quality activities (p = 0.002), lack of recognition (p = 0.013) and lack of internet access (p = 0.006) were significantly more barriers for pharmacy technicians compared to pharmacists. The most identified facilitators to engage in CE activities were a personal desire to learn (78.4 %), the requirement to maintain a professional license (73.8 %) and relaxation provided by learning (58.5 %) and networking opportunities (53.4 %). The majority of the participants preferred conferences or interactive workshops, short CE over half a day or less, and the topic of disease management/drug therapy. The findings of the study highlight the need for a partnership strategy that includes various stakeholders to improve CE program quality and accessibility that supports and promotes the professional development of pharmacists and pharmacy technicians in Saudi Arabia. It also underscores the importance of meeting the preferences of pharmacy practitioners when designing CE programs and aligning such activities with their practices.

Investigating pharmacovigilance (PV) practices among oncology healthcare providers (HCPs) is crucial for patient safety in oncology settings. This study aimed to assess the awareness, attitudes, and practices towards PV and identify barriers to effective adverse drug reaction (ADR) reporting for HCPs working in oncology-related settings. Employing a cross-sectional survey design, we collected data from 65 HCPs, focusing on their experiences with ADR reporting, education on ADR management, and familiarity with PV protocols. The results showed that about half of the responders were pharmacists. Around 58.9% of the respondents reported ADRs internally, and 76.9% had received some form of ADR-related education. However, only 38.5% were aware of formal ADR review procedures. Methotrexate and paclitaxel emerged as the drugs most frequently associated with ADRs. The complexity of cancer treatments was among the common reasons for the low reporting of ADRs by the study participants. The findings highlight the need for enhanced PV education and standardized reporting mechanisms to improve oncology care. We conclude that reinforcing PV training and streamlining ADR-reporting processes are critical to optimizing patient outcomes and safety in oncology, advocating for targeted educational interventions and the development of unified PV guidelines.

All health care professionals have a responsibility to integrate current evidence‐based medicine into their clinical practice to ensure the best possible patient care. Clinical practice guidelines (CPGs) play a major role in helping clinicians identify when and how to implement evidence into routine clinical practice to improve patient outcomes. The primary intent of CPGs is to benefit patients by improving the quality of care; however, CPGs also improve efficiency and effectiveness within the health care system. The process used to develop CPGs is important to ensure the recommendations are trustworthy, based on the highest‐quality evidence, and free of significant conflicts of interest. The National Academy of Medicine (NAM) published guidance on best practices for developing CPGs in 1990 and again in 2011. Additional guidance is provided by various reporting checklists for CPGs, such as the Appraisal of Guidelines for Research & Evaluation (AGREE) II and Reporting Items for Practice Guidelines in Healthcare (RIGHT) instruments. However, analyses of published CPGs show inconsistent application of these best practices. This paper discusses the benefits of CPGs, reviews the guideline development process, discusses limitations in this process and in applying CPGs to patient care, identifies opportunities for improvement, provides considerations for educating learners and other health care professionals about CPGs, and examines the role of pharmacists in CPG development, dissemination, and implementation.

The Saudi Pharmacist Licensure Examination (SPLE) has been mandated by the Saudi Commission for Health Specialties (SCFHS) for three and a half years; however, colleges of pharmacy and/or pharmacy organizations in Saudi Arabia have yet to implement a comprehensive review program to help prospective graduates to succeed. The aim of this study was to assess the impact of an integrated program designed to enhance students’ performance on the SPLE. A cross-sectional study was conducted to determine the impact of integrating SPLE review activities (clinical review quizzes (CRQs), disease state presentations (DSPs), a Capstone OSCE, and a mock SPLE) on students’ SPLE results and perceptions of their SPLE preparation and performance. Student scores from the review activities were analyzed and an anonymous, voluntary survey was used to assess the impact of these activities on student readiness levels and performance on the SPLE. A total of 127 Doctor of Pharmacy (Pharm.D.) students were included in the study. The average scores for the mock SPLE, DSPs, and Capstone OSCE were (55.8% ± 8.55), (91.3% ± 7.17), and (95.2% ± 6.90), respectively. Approximately 50% of the students responded to the survey. Most students had taken and passed the SPLE on the first attempt (94.6%) with an average score of 635.7 ± 39.4 (∼79%). Over 60% and 70% of students recommended the SPLE CRQs activity and the DSP activity, respectively. With respect to mock SPLE, 60.9% believed that it provided an idea of what to expect on the SPLE and 54.7% recommended to add the Capstone OSCE into the curriculum. Overall, the majority of students would recommend these activities be incorporated in the college of pharmacy curriculum in order to better prepare pharmacy graduates for the SPLE. Prospective graduates from Saudi universities may benefit from college of pharmacy-organized SPLE reviews. Based on this study’s findings, a comprehensive review course including a mock SPLE and disease state presentations is recommended. In addition, SPLE review lectures, CRQs, and a Capstone OSCE may provide additional benefit.