Browsing by Author "Alqahtani, Saeed"

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An investigation of patients’ adherence to secondary preventive medications for stroke, and an exploration of the role of hospital pharmacists in the secondary prevention of stroke in the Kingdom of Saudi Arabia (KSA): A mixed method study
(Saudi Digital Library, 2022-11-18) Alqahtani, Saeed; Jalal, Zahraa; Mason, Julie; Paudyal, Vibhu
Background: A range of pharmacological treatments are supported by scientific data to lower the risk of stroke recurrence. However, it is known that non-adherence to secondary preventative medications is common amongst stroke patients, which negatively impacts patient outcomes. Understanding the factors that influence adherence and non-adherence can allow the development of interventions to promote adherence. In addition, evidence indicates that a variety of pharmacist interventions, particularly their role in increasing medication adherence among stroke patients, is able to enhance patient outcomes. This study aimed to investigate stroke patients’ adherence to secondary preventive medications and explore the role of the hospital pharmacists in secondary prevention and the management of stroke in the Kingdom of Saudi Arabia (KSA). Methods: A pragmatic, mixed-methods sequential exploratory study was conducted. Firstly, a systematic review and meta-analysis were performed based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to explore the role and outcomes of pharmacists’ interventions in relation to pharmaceutical care for the primary and secondary prevention of stroke. Secondly, a cross-sectional study was conducted with a convenient sample of Saudi stroke patients to measure patients’ adherence to medications prescribed for secondary prevention using a validated Arabic version of the Hill-Bone Medication Adherence Scale (HB-MAS) and multivariate linear regression. Following that, semi-structured interviews were conducted with a purposive sample of stroke patients who had been recruited in the previous cross-sectional study with the sub-optimal/optimal adherence groups. This qualitative study used the theoretical domains framework (TDF) and directed content analysis to explore the facilitators and barriers to medication adherence for the secondary prevention of stroke from the perspective of stroke patients. Finally, semi-structured interviews were performed with a purposive sample of Saudi hospital pharmacists to assess their experience and practice in the secondary prevention of stroke, with thematic analysis used to analyse the data. Results: The systematic review and meta-analysis included 31 studies; seven studies addressed the role of pharmacists in primary prevention and 24 in secondary prevention of stroke. The pharmacist interventions reported were diverse and often multifactorial. Overall, 20 studies reported statistically significant improvements in outcomes associated with medicines optimisation, risk factor modification, medicines adherence, and health-related quality of life (HRQoL) because of pharmacists’ input into patient care. Where measured, clinical outcomes in the secondary prevention of stroke (such as hospital readmission, thromboembolic events, and bleeding rates) were also improved. Importantly, meta-analysis of seven studies showed pharmacist intervention in emergency care significantly improved the odds of achieving thrombolytic therapy door to needle (DTN) times ≤45 minutes, odds ratio: 2.69 [95% confidence interval [CI]: 1.95-3.72]; p<0.001. The cross-sectional study showed that the level of stroke secondary preventive medications (SSPM) adherence was 72.3%, with a suboptimal adherence to SSPM. Males (224) showed suboptimal adherence (n= 170, 75.9%); more than females (119) (n=78, 65.5%), which was statistically significant (chi-square=4.15, p-value=.042). The average age was significantly higher in the group with suboptimal adherence (69.65 years) compared to the group with optimal adherence (64.33 years) and Mann–Whitney U (n optimal adherence=95, n suboptimal adherence=248) =2.165, p-value=0.03. Binary regression analysis revealed that per participant, the number of strokes (OR=1.779, 95% CI: 2.03 - 17.30, p-value=.001), and number of other medications used (OR=1.61, 95% CI: 1.26 - 2.05, p-value<.001) were significantly associated with suboptimal adherence. Numerous facilitators and barriers that influenced SSPM adherence were identified in the patient interview study. Fear of suffering another stroke, knowledge of SSPM, realisation of SSPM benefits in life expectancy and improving quality of life, family support, and establishing SSPM as a habit were identified as facilitators. On the contrary, SSPM barriers related to a lack of understanding regarding stroke and SSPM, forgetting to take medications, the ability for self-care and social influence, as well as certain religious beliefs. The pharmacist interview study found that most hospital pharmacists expressed good knowledge in regards to secondary stroke prevention. Additionally, most of the pharmacists recruited in the study were aware of the guidelines, such as the American Stroke Association (ASA) for the prevention and treatment of stroke. Some study participants stressed the need for adequate training and specialised stroke clinics within hospitals to effectively deal with stroke patients. Similarly, most of the participants outlined the lack of collaboration between the physicians. Many pharmacists were aware of their responsibility to improve patient medication adherence. Conclusion: This research study reveals certain factors that influence stroke patients’ adherence; and suggests possible solutions to increase stroke patients’ awareness of the importance of adhering to SSPM. Subsequently, the findings will provide future researchers and decision-makers with an extensive range of factors that might be considered when setting targets for interventions to improve adherence in the stroke population. Furthermore, this research can provide important recommendations regarding pharmacists and healthcare system roles in promoting medication adherence and seamless care of stroke patients.
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Assessment of Virtual Grid software for improving X-ray image quality and reducing radiation dose
(University of Exeter, 2024-06-25) Mohammad Sayed; Knapp, Karen; Fulford, Jon; Heales, Christine; Alqahtani, Saeed
Background and rationale: X-ray imaging is routinely used for diagnostic purposes. Scattered radiation from the patient is a major image degradation factor, as scattered X-rays appear as mislocated events and are undesirable since it increases the patient dose. The conventional method of reducing scattered radiation is an anti-scatter physical grid (PG) which is placed directly between the patient and the detector to remove or absorb scattered radiation whilst allowing primary x-ray radiation to pass to the image receptor, but this increases the dose and requires precise positioning and alignment. Recently, a new ‘Virtual Grid’ image processing software (VG) has been developed to correct for scattered X-rays and overcome some of the technical issues associated with grid devices. Objectives: This PhD project aims to assess the use and effectiveness of VG software on radiographs acquired without a physical grid in terms of image quality and the image quality and radiation dose in comparison to physical grid radiographs. Materials and methods: Initially a scoping review was conducted to identify and highlight published papers regarding X-ray scatter correction software for X-ray imaging. The Leeds model TOR CDR® phantom with polymethylmethacrylate image quality and an anatomical anthropomorphic PBU-50 whole-body phantom with added fabricated substitute layers of fat and lean tissue were experimentally assessed Clinically, retrospective clinical patient data was examined. These data were used to compare image quality and radiation dose of Gridless, VG software and PG approaches. Results: VG software resulted in an increase in image quality objectively and subjectively compared to raw gridless radiographs. However, PG images generally had higher image quality than VG software generated images, especially in clinical practice. The radiation dose in terms of DAP and the effective dose of Gridless with VG software procedures was lower than PG. VG software shows potential under some clinical conditions such as patients who are critically ill in bed or cannot stand, and when PG can be challenging or not appropriate for large body regions. Conclusion: This PhD project has demonstrated the potential of the VG software in terms of improving the image quality of the Gridless radiography. VG software promises to lower radiation dose levels in terms of DAP and effective dose compared to the conventional PG approach. This research contributes to research on the potential of scatter correction software in improving image quality and reducing radiation dose. However, it has limitations and further research is needed.
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Association of Nephrotoxicity with Non-adherence to Therapeutic Drug Monitoring Guidelines of Antibiotics B
(Saudi Digital Library, 2021) Abushomi, Hamidah Qasim; Alqahtani, Saeed
Purpose: The main objective of this study was to evaluate therapeutic drug monitoring services of antibiotics at King Saud University Medical City (KSUMC) and investigate the association between non-adherence to therapeutic drug monitoring (TDM) guidelines and development of adverse effect. Method: This was a retrospective study conducted using electronic health records (HER), included all hospitalized patients who received antibiotics (vancomycin, gentamicin, and amikacin) with requested TDM over a one-year. The adherence to the TDM guidelines was measured by reviewing all the following: appropriate indication, sampling time (based on medication), results reports, and clinical pharmacist intervention. Descriptive analysis was performed for all variables within the study. All information analysis was conducted using SPSS for Windows (Chicago, Inc.). Results: A total of 1179 patients who have TDM requests during 2017 were included in our study, of that 65 % were male. The TDM service was the most commonly requested for vancomycin 72%, followed by gentamycin and amikacin with almost 14%. Over 25% of the patients in this study have sepsis, 11% endocarditis and 10 % pneumonia. Upon assessment of the appropriateness of sampling times, we found that around 15% were withdrawn at the wrong time, and over 40% of the TDM services did not adhere to the guidelines. Although the physicians accepted most of the pharmacists’ intervention related to TDM service, the pharmacist did not provide any recommendation in more than onethird of the cases. Nephrotoxicity was the most common adverse reaction, and it is observed in 20% of the patients. We detected a significant negative association between nephrotoxicity and guideline adherence (OR = 1.47; p 0.014). Conclusion: A reliable TDM service depends on the collaboration between the health care teams, including; doctors, nurses, clinical pharmacists, and lab staff. TDM service offers a great opportunity in improving clinical practice, optimizing treatment outcomes and minimize drug-related problems like toxicity, and prolong hospitalization. Improving TDM, service in this hospital would result in avoiding unnecessary costs to the patient and the health care system
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Estimation of Phenytoin Pharmacokinetic Parameters in Epileptic Saudi Patients
(Saudi Digital Library, 2020) Alzaidi, Thuraya Abdullah Motlaq; Alqahtani, Saeed
Objective: The objective of this study is to determine the population pharmacokinetics of phenytoin in Saudi patients and to identify factors that explain variability. Method: A retrospective chart review was performed at King Saud University Medical City on patients who received oral and IV phenytoin. The population pharmacokinetic models were developed using Monolix 4.4. After development of the base model, we investigated several covariates including: age, gender, weight, and total daily dose, and liver functions tests. Results: The analysis included a total of 81 phenytoin plasma concentrations from 43 patients (70% male). Patients’ mean (±SD) age was 41 ± 18.7 years and body weight was 65.4 ± 17.7. The patients received a phenytoin total daily dose (TDD) of 330.5 ± 104.5mg/day, which resulted in trough concentration of 11.2 ± 10.3 mg/L. The data were sufficiently described by one compartment model with linear absorption and non-linear elimination processes. Average parameter estimates for phenytoin V, Vmax, and Km were 0.61 L/h/kg, 6.12 mg/kg/day, and 5.33 mg/L, respectively. The most significant covariates on phenytoin Vmax, and Km were patients’ age, body weight, and cotherapy with valproic acid. Conclusion: The population pharmacokinetic model of phenytoin in Saudi patients was established and significant covariates on the phenytoin model was recognized. This model showed the significant inter-individual variability between subjects. In addition, our findings showed that patients’ age, body weight, and cotherapy with VPA are the most significant covariates on phenytoin Vmax, and Km parameters. Further studies are required to understand the factors that may influence the pharmacokinetics of phenytoin and may assist in drug dosage decisions.
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Evaluating Storm water drainage Options for the urban area of Buraydah city
(Saudi Digital Library, 2017) Alhumaid, Mohammad Fahad Alrashed; Alqahtani, Saeed
Most of the regions in arid environment are facing problem of storm water drainage due to climate change and rapid urbanization. Saudi Arabia is one of the most important countries in arid environment. Qassim is a very important province. Most of its cities are facing the problem of storm water drainage. This thesis is an investigation of the storm water drainage options for drainage of storm water from Buraydah. The topography put Buraydah city in the critical situation because there is no natural storm drainage point for Buraydah city, as the mountains are forming a natural obstacle preventing the storm water to get it disposed-off to Wadi Al-Rumah. The ponding system with drainage pipe network is selected as solution for storm water drainage in Buraydah. This solution has some disadvantages like, the high cost of land expropriation, the high flooding risk of successive storm events and the high environmental risk. The thesis has considered all these factors in investigating the storm water management.
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