Introduction:Medication errors have significant implications on patient safety. Error detection through an active management and effective reporting system discloses medication errors and encourages safe practices.Objectives:To improve patient safety through determining and reducing the major causes of medication errors (MEs), after applying tailored preventive strategies.Methodology:A pre-test, post-test study was conducted on all inpatients at a 177 bed hospital where all medication procedures in each ward were monitored by a clinical pharmacist. The patient files were reviewed, as well. Error reports were submitted to a hospital multidisciplinary committee to identify major causes of errors. Accordingly, corrective interventions that consisted of targeted training programs for nurses and physicians were conducted.Results:Medication errors were higher during ordering/prescription stage (38.1%), followed by administration phase (20.9%). About 45% of errors reached the patients: 43.5% were harmless and 1.4% harmful. 7.7% were potential errors and more than 47% could be prevented. After the intervention, error rates decreased from (6.7%) to (3.6%) (P≤0.001).Conclusion:The role of a ward based clinical pharmacist with a hospital multidisciplinary committee was effective in recognizing, designing and implementing tailored interventions for reduction of medication errors. A systematic approach is urgently needed to decrease organizational susceptibility to errors, through providing required resources to monitor, analyze and implement effective interventions.

Aim We aim to describe the pattern of response to treatment in a cohort of Egyptian lupus nephritis (LN) patients and to define variable prognostic factors. Methods We retrospectively analyzed records of 928 systemic lupus erythematosus (SLE) patients (898 females, 30 males) with biopsy-confirmed LN seen between 2006 and 2012 at Cairo University hospitals. Results Our study involved 928 SLE patients with a mean age of 26.25 ± 6.487 years, mean LN duration at time of renal biopsy 6.48 ± 4.27 months, mean SLEDAI 28.22 ± 11.7, and mean follow-up duration of 44.14 ± 17.34 months. Induction treatment achieved remission in 683 patients. Remission was achieved in all 32 patients with class II LN, compared to 651/896 (72.7%) patients in classes III, IV, and V. Induction by intravenous (IV) cyclophosphamide achieved response in 435/575 (75.7%) patients, while induction by mycophenolate mofetil (MMF) resulted in response in 216/321 (67.3%) patients ( p = 0.0068). Nephritic flares were least observed when MMF was used for maintenance (30/239 (12.6%) patients), compared to 71/365 patients (19.5%) ( p = 0.0266) when azathioprine (AZA) was used, and 22/79 patients (27.8%) ( p = 0.002) with IV cyclophosphamide. Class IV LN, high chronicity index, presence of crescents, and interstitial fibrosis in biopsies were all associated with chronic kidney disease (CKD) development eventually ( p < 0.001, p = 0.005, p = 0.012, and p = 0.031, respectively). By the end of the study duration, 305 (32.7%) patients had CKD. Logistic regression detected that high baseline serum creatinine, failure to achieve remission, hypertension, and nephritic flare were the main risk factors for poor renal outcome ( p < 0.001, p < 0.001, p = 0.004, and p < 0.001, respectively). The 5 years' mortality was 69 (7.4%) patients with sepsis being the main cause of death. Conclusion IV cyclophosphamide superseded as induction treatment, while MMF was the best maintenance treatment. High serum creatinine, hypertension, and nephritic flare were the main risk factors for poor renal outcome.

BACKGROUND: Self-medication is a practice with major global implications, especially with antibiotics intake. Self-medication among future health-care professionals could affect their way in prescribing medication in the future. AIM: This study was conducted to estimate the magnitude and the determinants of antibiotics self-medication practices and to describe the pattern of antibiotics abuse among undergraduate university students. METHODS: A cross-section study was conducted among 563 medical students from public and private universities in Cairo, Egypt, using a questionnaire. RESULTS: About 77.7% of the students used antibiotics without prescriptions with no statistical differences by age, sex, residence, or type of universities. More than half of the students (51.7%) do not know the effect of antibiotics abuse on microbial resistance. Most self-treated antibiotics were used to manage gastroenteritis symptoms (70%), respiratory symptoms (63%), and dental infections (36%), other causes such as headache or prophylactic reasons (21%). About 91.7% of the self-medicated students reported access to antibiotics from the pharmacy without a prescription and 71% of them mentioned discontinuation of a course of antibiotics at least once during the last year. About 81% of the students who do not know the effect of antibiotic abuse are self-medicated versus 75% of their counterpart who know and this difference is statistically significant. The multivariate analysis identified the residence as an independent predictor of their knowledge (area of residence = 1.6, 95% confidence interval [1.1–2.3]). CONCLUSION: The prevalence of self-medication with antibiotics among university students in Cairo is high. Our findings highlight the urgent need for tailored interventions to control this practice.

Background: Incident reporting system (IRS) deepens the understanding of the frequency of adverse events and near misses. Voluntary reporting is an essential step to improve patient safety. Objectives: The study aimed to apply an efficient and reliable system for incident reporting to enhance patient safety practices in pediatric intensive care units (PICUs). Methods: A quasi-experimental pretest-posttest study design was conducted to implement a voluntary anonymous IRS in PICUs. In-depth interviews were conducted with 16 health care personnel. A tailored educational program was provided to 73 health care personnel. A questionnaire was administered before and three months after the intervention to assess their attitude towards incident reporting. Results: The interviewed health care providers highlighted that no IRS was established in the PICUs and most of them never reported any event unless it was a sentinel event. They agreed that an IRS would be beneficial to PICUs. The average percentage of positive responses for "Frequency of error reporting' increased significantly from 23.8% to 42%. Communication problems, hygienic errors, therapeutic errors, and diagnostic errors accounted for 34%, 32%, 29%, and 5% of the reported potential errors, respectively. Conclusions: IRS implementation improves potential error reporting attitude and practice in PICUs.

Background This paper aims to document the numerous health innovations developed in response to the COVID-19 crisis in the Eastern Mediterranean Region (EMR) using a scoping review approach. Methods A literature search was conducted using PubMed, the Eastern Mediterranean Health Journal, the Index Medicus for EMR to identify peer-reviewed articles between December 2019 and November 2020 and WHO and ministries of health websites for grey literature. Following an initial review, full-text screening identified studies reporting on health innovations in response to the COVID-19 pandemic in the region. Results This review describes 82 health innovations reported from 20 countries across the region: 80% (n = 66) were digital and technology-based products and services including health care delivery (n = 25), public health informatics (n = 24) and prevention (n = 17); 20% (n = 16) were innovative processes including health care delivery (n = 8), educational programmes (n = 6) and community engagement (n = 2). Conclusion The speed with which these technologies were deployed in different contexts demonstrates their ease of adoption and manageability and thus can be considered as the most scalable. Strengthened frameworks to protect users’ privacy, documentation and evaluation of impact of innovations, and training of health care professionals are fundamental for promoting health innovations in the EMR.