To investigate factors affecting aminoglycoside clearance in adult patients with cystic fibrosis who received multiple courses of antibiotic therapy over a period of up to 15 years. Aminoglycoside concentration–time data and relevant clinical characteristics were collated from clinical pharmacokinetic databases established in Glasgow, Scotland and The Hague, The Netherlands. Data from Glasgow (1993–2009) were used for population model development; data from The Hague (2002–11) were used for model validation. NONMEM was used to determine structural and covariate models, with a particular focus on between-occasion variability and changes in aminoglycoside handling over multiple courses of therapy. The Glasgow dataset comprised 1075 courses of aminoglycoside therapy (96% tobramycin and 4% gentamicin) in 166 patients and included 2238 concentration measurements. The data were best described by a two-compartment model with creatinine clearance and height influencing aminoglycoside clearance, and height influencing volume of distribution. Between-subject and between-occasion variabilities in clearance were low, at 18% and 11%, respectively; between-subject variability was 12% for volume of distribution. Internal and external model validations were satisfactory. Multiple courses of therapy (ranging from 2 to 28 courses per patient) were not associated with any systematic changes in aminoglycoside clearance. Height was a better descriptor of aminoglycoside pharmacokinetics than weight in adult patients with cystic fibrosis. No changes in clearance were observed over time, even in patients who had received multiple courses of therapy over several years.

Background:There is a lack of data in the literature on the evaluation of tacrolimus (TAC) dosage regimen and monitoring after kidney transplantation (KT) in Kuwait. The aim of the present study was to evaluate TAC dosing in relation to the hospital protocol, the achievement of target TAC trough concentration (C₀), the prevalence of TAC side effects (SEs), namely, posttransplant diabetes mellitus (PTDM), denovo hypertension (HTN), and dyslipidemia, and factors associated with the occurrence of these SEs among KT recipients.Methods:A retrospective study was conducted among 298 KT recipients receiving TAC during the first year of PT. Descriptive and multivariate logistic regression analyses were used.Results:The initial TAC dosing as per the local hospital protocol was prescribed for 28.2% of patients. The proportion of patients who had C₀levels within the target range increased from 31.5 to 60.3% during week 1 through week 52. Among patients who did not have HTN, DM, or dyslipidemia before using TAC, 78.6, 35.2, and 51.9% of them were prescribed antihypertensive, antidiabetic, and antilipidemic medications during the follow-up period. Age of ≥40 years was significantly associated with the development ofde novoHTN, dyslipidemia, and PTDM (p< 0.05). High TAC trough concentration/daily dose (C₀/D) ratio was significantly associated with the development of PTDM (p< 0.05).Conclusion:Less than two-fifths of patients achieved target TAC C₀levels during the first month of PT. Side effects were more common in older patients. These findings warrant efforts to implement targeted multifaceted interventions to improve TAC prescribing and monitoring after KT.

Objective Structured Clinical Exams (OSCEs) can assess professional competencies in a structured manner and facilitate objective evaluation of clinical performance. With limited data from the Eastern Mediterranean region, this study aims to describe the development, implementation, and evaluation of OSCEs for final year pharmacy students in Kuwait. The study also aims to compare students' performance in two academic years (2015–2016 and 2016–2017). The design, implementation, and evaluation of the competency-based OSCE followed a 3-phase systematic evidence-based approach. The development phase involved establishing an OSCE working group to develop a blueprint and scoring rubrics and to organise assessors and standardised patient/physician training. The implementation phase involved conducting formative and summative OSCEs. The evaluation phase involved undertaking student and staff perception surveys. The overall students' OSCE scores for the academic years 2015–2016 and 2016–2017 were (median (interquartile range)) (71.6%, 32.2) and (60.0% (30.7)) and respectively (p < 0.0001). The average students' performance score was high in stations covering 'patient consultation and diagnosis' competency (71.4% (95% CI: 66.7–73.3)) and lower in stations covering 'monitoring of medicine therapy' competency (50.0% (95% CI: 33.3–66.7)). Students perceived stations covering 'monitoring medicines therapy' and 'assessment of medicine' as difficult. However, staff perceived stations related to 'patient consultation and diagnosis' competency as the easiest. Students reported that the OSCE was a positive experience as it provided them an opportunity to practice real life scenarios in a safe learning environment. The OSCE helped to identify the level of competency of students prior to graduation and areas to improve in the curriculum.

The development of competency frameworks serves as the foundation for the development of competency-based education. It is vital to develop a country-specific framework to address the specific needs of the local population for pharmacy services. This study aimed to describe the development process of a competency framework for undergraduate pharmacy education in Kuwait with a unique matrix structure. The process started with the development of guiding principles for curriculum revision and implementation, as well as the identification of global educational outcomes. This process was followed by: (A) a needs assessment with key stakeholders; (B) development of the initial competency framework; and (C) refinement of the framework. Qualitative data were thematically analyzed to identify the main competency domains that students need to perform the identified entrustable professional activities (EPAs). Five population needs were identified by the needs assessment, with 17 EPAs suggested to fulfill those needs. In addition, 11 competency domains were identified. The initial competency framework was created as a 3 × 8 matrix, with 3 professional and 8 transversal competency domains. Refinement of the framework resulted in the removal of redundancies and the development of a global behavior competency profile. The development of a matrix competency framework and associated EPAs for Kuwait serves as a foundation for preparing pharmacists to fulfill local population needs and expanding the scope of practice in the country.

To outline hospital pharmacy practices across the Gulf Cooperation Councils (GCC) countries’ hospitals. A modified survey questionnaire was prepared from the original 2019 American Society of Health-System Pharmacist (ASHP) survey questions. Survey details were discussed with some pharmacy directors for clarity and relevance. A list of hospitals were obtained from the Ministry of Health of each of the targeted GCC countries. A secure invitation link containing a survey questionnaire was sent to the participants directly. Sixty four hospitals responded to this survey. The overall response rate was 52%. About 47% of the surveyed hospitals considered their drug formularies as closed, and strict. Additionally, only 44% of hospitals compare the effectiveness of products, when taking formulary decisions for drug inclusion. Forty-four percent of hospitals have computerized prescriber order entry (CPOE / EHR) system functionality for formulary system management. At about 39.1% hospitals, pharmacists have the responsibility for managing medication therapies, majority were engaged in providing anticoagulation therapies. About 61% of hospital pharmacies in GCC countries receive medication orders electronically, through CPOE/EHR. Majority (66%) of the hospitals in GCC countries have an active Antimicrobial Stewardship Program (ASP) while only 40% of pharmacists have a key role in providing clinical support. About 57.8% of hospital pharmacy directors reported that pharmacists do not provide ambulatory care clinical pharmacy services in their hospitals. In GCC countries’ hospitals, there are major areas for improvement to patient care of which pharmacists are uniquely qualified as the medication experts to have the most meaningful outcomes in all of the domains of safe medication use, medication therapy management, antimicrobial stewardship program and participation in outpatient clinics.

Background: Therapeutic drug monitoring (TDM) helps ensure an efficient and safe therapeutic outcome. This study assessed physicians' and pharmacists' knowledge, confidence, and perception regarding clinical pharmacokinetics and TDM. Methods: A cross-sectional survey that used a self-administered questionnaire was used. A stratified random sample of 322 physicians and pharmacists across 3 Kuwait public hospitals was surveyed. Descriptive and comparative statistical analyses were performed during data analysis. A multivariate logistic regression model was used to identify factors associated with low levels of knowledge and confidence and negative perceptions among the subjects. Results: The response rate was 88%. Overall, the respondents' mean total knowledge score percentage was low (50.3%), with no significant difference between the physicians' and pharmacists' scores (P > 0.5); 60.4% of the participants (95% confidence interval: 54.9–65.6) felt confident when using TDM in their practice. Most participants expressed positive perceptions (90.1%; 95% confidence interval: 86.3–92.9) toward TDM. There was high agreement internally that pharmacists require some knowledge of TDM, should be asked by physicians in general for recommendations on the appropriate use of TDM, and should be able to provide relevant information regarding the appropriate use of TDM. Conclusions: Physicians and pharmacists in this study had high confidence in—and the positive perceptions of—TDM and its clinical implications. The present study's findings indicate an urgent need for professional education and training in clinical pharmacokinetics and TDM and its clinical implications through continuous professional development programs and its integration within the curricula of medical and pharmacy schools.