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National Prescribing Patterns of Psychotropic Medications in Older Adults in Oman
- Afaf Al-Shehhi, Maryam Al-Qamshooei, Laila Al-Kaabi, Mahera Al-Suqri, Yahya Al-Kalbani, Salim Al-Kasbi, Sumaia Al-Saadi, Asma Al-Farsi, Safiya Al-Busaidi, Latifa Al-Jahwari, Azza Al-Hinai, Manal Al-Balushi, Waleed Al-Shekaili, Hamed Al-Sinawi
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, p. S43
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Aims
High rate of psychotropic medications use in elderly people has been reported in the literature. Potentiality inappropriate prescriptions (PIPs) is very common as well. This issue has not been investigated in Oman previously. The aim of our study was to assess the patterns of psychotropic medications prescribed for older adults in the psychiatry clinics in Oman, screen for PIPs and plan for future actions to minimize inappropriate prescriptions.
MethodsThis is a cross sectional descriptive study using the information in patient's medical records. It was conducted in 12 health care institutions which equally represent all Governorates of Oman. All patients who aged ≥ 60 years old who attended psychiatry clinics from January 2019 to June 2021 and were prescribed psychotropic medications were included. All psychotropic drugs were evaluated including: antidepressants, antipsychotics, Mood stabilizers and hypnotics. STOPP criteria were applied to detect PIPs.
Results1409 patients (70%) out of 1995 elderly patients who attended the psychiatry clinics in the study period as a new case were prescribed psychotropic medications. Rate of polypharmacy in our study is 38.9%. The most common medications prescribed were risperidone (18.1%) from the antipsychotic category, citalopram (23%) from the antidepressant group and promethazine (30.1%) from the hypnotics group. Regarding the use of sedative medications,18.5% of the patients were prescribed a benzodiazepine and 35.6% of them were prescribed an antihistamine. When assessed the pattern of medications prescribed in healthy people compared to people with different categories of major medical morbidities, no differences were observed. We found 130 (9.3%) potentially inappropriate prescriptions in our study based on STOPP criteria which included use of long-acting benzodiazepine (Diazepam), prescription of anticholinergic medication to treat extrapyramidal side effects (procyclidine) and use of tricyclic antidepressants in specific categories of medical diseases.
ConclusionThe patterns of psychotropic prescriptions for older adults in the outpatient setting in Oman raise concerns about 2 main issues: psychotropic polypharmacy and high rate of benzodiazepines and antihistamines use. This warrants further investigation of these issues in separate studies to identify risk factors. We also recommend implementing certain actions to minimize inappropriate prescriptions including reviewing the availability of appropriate psychotropic medications for this age group in Oman, creating a national guideline for prescribing and providing continuous medical education to the physicians in the primary and secondary health care institutions regarding this aspect.
Experience of Treating Candida auris Cases at a General Hospital in Qatar
- Adila Shaukat, Feah Visan, Naser Al Ansari, Walid Al Wali, Manal Hamed, Ihab Elmadhoun, Hassan Mitwally, Edin Karic
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- Journal:
- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 1 / Issue S1 / July 2021
- Published online by Cambridge University Press:
- 29 July 2021, p. s62
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Background: So far, there have been no studies on Candida auris in Qatar. We describe the clinical spectrum and outcome of C. auris infection in patients admitted to a general hospital in Qatar. Methods: We conducted this descriptive observational study in a general hospital in Qatar. We have included all patients with C. auris infection and colonization admitted to a general hospital from December 2018 to August 2019. Results: We identified 13 patients with confirmed C. auris infection or colonization, of whom 5 cases represented an actual C. auris infection, while the remaining 8 cases were considered colonization. The mean age of the patients with infection was 76.6 years (SD, ±8.4), while the mean age of the patients with colonization was 66.4 years (SD, ±24.7). Among the individuals clinically infected with C. auris, 2 had urinary tract infections, 1 had candidemia, 1 acquired a soft-tissue infection, and 1 had a lower respiratory tract infection. All strains of C. auris were susceptible to echinocandins, flucytosine, and posaconazole while resistant to fluconazole and amphotericin B. Of the patients with C. auris infection who received systemic antifungal therapy, 3 (60%) died during antifungal therapy. Conclusions: Our study showed that C. auris can cause a wide variety of invasive infections, including bloodstream infection, urinary tract infection, skin infection, and lower respiratory tract infections, especially in critically ill patients. In addition, our isolates showed resistance to the most common antifungal agents such as fluconazole and amphotericin B.
Funding: No
Disclosures: None
First Candida auris Outbreak Experience in a Tertiary-Care General Hospital in Qatar, 2019
- Feah Visan, Naser Al Ansari, Walid Al Wali, Almunzer Zakaria, Omar Al Hasanat, Jenalyn Castro, Ghada Hudaib, Ubaid Ummer, Jameela Al Ajmi, Mildred Asuncion, Adila Shaukat, Manal Hamed
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, pp. s235-s236
- Print publication:
- October 2020
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Background:Candida auris is an invasive, multidrug-resistant pathogen that can cause outbreaks in hospitals. The mode of transmission is through contaminated hospital items such as fomites and staff interventions. The outbreak of Candida auris affecting 13 patients at the medical intensive care unit (MICU) and medical inpatient unit, either in the form of infection or colonization, is the first documented C. auris outbreak in the Qatar. Methods: The first case was identified in November 2018 in a patient colonized in the respiratory tract. Candida auris biweekly tests were conducted. The second to fourth cases were confirmed in the MICU admitted in the same room (room 2). The fifth case was identified incidentally and was not part of the screening in another ward (6 North Medical Inpatient Unit), and 4 weeks later, Candida auris was isolated from the urine and throat of a patient on this ward. The realization that case 5 was an index case changed the direction of the outbreak investigation, and expanded screening was started among the medical inpatients. When the IPC team identified cases 6–11 and 13, all had possible epidemiological links with case 5. Results: Our root-cause analysis suggests that the index case came from another general hospital. However, because no screening protocol has been established for Candida auris, interventions have not been in place to effectively prevent and control this organism. A strong collaborative outbreak team worked to end this outbreak using the following evidence-based IPC interventions: (1) patient screening and decolonization; (2) environmental screening; (3) enhanced environmental disinfection using peracetic acid wipes, 1% chlorine, and hydrogen peroxide vapor disinfection; (4) prophylactic contact precautions; (5) enhanced hand hygiene with bare below elbows protocol; and (6) a no white gown policy. Conclusions: The outbreak of Candida auris was declared to have nbeen terminated on August 22, 2019. Despite the long period involved in this outbreak, we succeeded in ending it through the concerted efforts of a multidisciplinary team utilizing the latest scientific evidence.
Funding: None
Disclosures: None