Recommendations to improve pharmacy practice research in the Middle Eastern Arab countries

The expansion of the pharmacist-led services has resulted in increased demand to have evidence in terms of necessity, efficacy, and cost. Evidence-based practice is crucial to provide the best patient health outcomes and pharmacy practice research can play a key role in this regard. This commentary provides a background of pharmacy practice research, and then, it highlights three key recommendations based on a systematic review of the literature. The systematic review of the literature on pharmacy practice research has been conducted in 12 Middle Eastern Arab Countries. The three key recommendations include (a) identification of research priorities by health authorities in each country; (b) pharmacy practice research culture to be nurtured and promoted with academic researchers and practitioners; and (c) shifting pharmacy practice research towards applied, interventional, and implementation studies

AB0104 CONCORDANCE BETWEEN THE PHYSICIAN’S AND THE PATIENT’S ASSESSMENT OF DISEASE ACTIVITY IN RHEUMATOID ARTHRITIS: RESULTS OF THE AUTODAS-MEAC STUDY AT ONE YEAR

Background:Involving the patients with rheumatoid arthritis (RA) in the assessment of their disease may increase their adherence to treatment, improve the disease outcomes and facilitate the application of telehealth. We previously reported an excellent concordance between the Disease Activity Score (DAS-28) performed by physicians and patients at the baseline visit of this prospective study (1).Objectives:To evaluate the persistence of the concordance between the physician’ and the patient’s assessment of disease activity in RA using DAS-28 after one year.Methods:At the baseline visit, patients with RA from 7 Middle Eastern Arab Countries (MEAC) were briefed about DAS-28 by their rheumatologist during a routine consultation and given smartphone access to a video in Arabic language explaining the performance of DAS-28. At 3, 6 and 12 months (± 3 months), the patients were asked to self-report DAS-28, blinded to the physician’s assessment. Concordance between the continuous DAS-28 at each visit was calculated using paired t-test numerically and the Bland-Altman method graphically. Agreement between physician- and patient-DAS categories (remission, low-, moderate- and high disease activity) was calculated at each visit using weighted kappa for category comparison. Weighted kappa of the different agreements were compared over time using their respective confidence intervals (CIs). Predictive factors of positive concordance between physician and patient-DAS were identified using binary logistic regression.Results:The study included 428 patients over a period of three years (2018 to 2020). The mean age of participants was 49.8 years, 82.5% were females, 44.3% had a university degree and the mean disease duration was 11.4 years.At baseline, the average patient-DAS was higher (4.06 (±1.52)) than the physician-DAS (3.97 (±1.52)). The mean difference was -0.09 [95%CI -0.14; -0.04] and most of the pairs were within the limit of agreement in the Bland-Altman graph, indicating a good concordance, particularly in cases of remission.During the study follow-up, 299 patients consulted for visit 2 (69.9% of the total population), 232 for visit 3 (54.2%) and 199 for visit 4 (46.5%). The weighted kappa was 0.80 [95%CI 0.76;0.85] at visit 1 and 0.79 [95%CI 0.72;0.88] at visit 4 (Figure 1 showing kappa for DAS-28, CDAI and SDAI as well). A minor numerical decrease in kappa was observed over time; however, the CIs were overlapping over the four visits and the agreement was considered stable, remaining in the excellent range. At visit 4, a positive concordance between the physician- and the patient-DAS was associated with the profession (lower in blue collar, p=0.001), the educational level (higher in high school and university, p=0.034) and the baseline physician’s DAS (higher in high disease activity, p=0.46).Conclusion:The agreement between the DAS-28 performed by the physician and by the patient was excellent at baseline and remained stable over one year. A positive concordance was associated with the profession, the educational level and the level of disease activity. The present study can help the rheumatologist make informed decisions about the patients who may be suitable for a remote evaluation of their disease activity, that can be of particular interest in the context of the COVID-19 pandemic.References:[1]Ziade N, Saad S, al Mashaleh M, et al. Perceptions of Patients with Rheumatoid Arthritis about Self-Assessment of Disease Activity after Watching an Educational Video: Qualitative Pilot Results from the Auto-DAS in Middle Eastern Arab Countries Study [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10).Acknowledgements:The authors would like to acknowledge the patients for participating in the study and the assistants/ students/ nurses who assisted in the data collection: Dr. Fatima Abdul Majeed Al Hawaj, M. Atef Ahmed, M. Mohammad Alhusamiah, Ms Raquel De Guzman, Ms Lina Razzouk.Disclosure of Interests:None declared

POS0275-HPR CONCORDANCE BETWEEN THE PHYSICIAN’S AND THE NURSE’S ASSESSMENT OF DISEASE ACTIVITY IN RHEUMATOID ARTHRITIS USING DAS-28, CDAI AND SDAI IN SEVEN MIDDLE EASTERN ARAB COUNTRIES

Background:Managing patients with chronic rheumatic diseases is increasingly relying on the collaboration of a multidisciplinary team, including the rheumatology nurse who can aid assessment of disease activity among other healthcare tasks.However, this practice, although common in Europe and North America, is still poorly implemented in the Middle eastern Arab countries (MEAC).Objectives:To evaluate the concordance between the physician’s and the nurse’s assessment of disease activity in patients with rheumatoid arthritis (RA) in the MEAC.Methods:During a routine patient visit to one of 9 rheumatology clinics located in 7 Middle Eastern Arab countries, the physician and the rheumatology nurse (who was already working in the clinic) performed the disease activity score 28 (DAS), Clinical Disease Activity Index (CDAI) and Simple Disease Activity Index (SDAI) in a blinded manner. The concordance regarding the 3 continuous scores was calculated using paired t-test. The agreement between physician- and nurse-DAS categories (remission, low, moderate and high disease activity) was calculated using weighted kappa for category comparison. Predictive factors of positive concordance between physician- and nurse-DAS were identified using binary logistic regression.Results:The study included 373 patients’ measurements over a period of two years (2018 to 2019). The mean age of the patients was 49.6 years (±28.2), 82.6% were females, and the mean disease duration was 11.3 years (±7.5).The mean physician-DAS was slightly higher (3.97 (±1.52)) than the nurse-DAS (3.90 (±1.54)) (p=0.002), with a mean difference of +0.08 [95%CI 0.03; 0.12] (Table 1). The difference in the DAS individual items, the CDAI and the SDAI were not statistically significant.Table 1.Comparison of the disease activity measures reported by the physician and by the nurse.PhysicianNursep-valueTotal Joint Count4.87 (2.26)5.02 (6.20)0.152Swollen Joint Count2.13 (3.88)2.15 (3.83)0.790Global Assessment3.30 (2.41)3.32 (2.43)0.702DAS-283.97 (1.52)3.90 (1.54)0.002CDAI14.26 (12.53)14.38 (12.59)0.515SDAI21.51 (23.57)21.61 (21.66)0.527When analyzing DAS as a categorical 4-items variable, the agreement between the physician and the nurse was present in 79.36% of the cases (weighted kappa was 0.77 [95%CI 0.73;0.83] which is considered as excellent, and was higher in patients with high disease activity (Figure 1).A positive concordance between the physician- and the nurse-DAS was associated with the country (higher in Egypt, p<0.001) and the status of higher disease activity (p<0.001).Conclusion:The agreement between the DAS-28 performed by the physician and by the nurse was excellent and was associated with the country and a higher disease activity. The present study confirms that the support of a trained nurse for evaluating disease activity in RA is feasible in the Arab countries and may save some valuable time in the clinic, whilst maintaining the quality of care for patients with RA.Figure 1.Agreement between physician- and nurse-DAS categoriesAcknowledgements:The authors would like to acknowledge the patients for participating in the study and the assistants/ students/ nurses who assisted in the data collection: Dr. Fatima Abdul Majeed Al Hawaj, M. Atef Ahmed, M. Mohammad Alhusamiah, Ms Raquel De Guzman, Ms Lina Razzouk.Disclosure of Interests:None declared

Cultural factors related to the decision of music education career choice in Jewish and Arab students in Israel

The decision to become a music educator can be influenced by the musical background of an individual, the cultural values, and by the perceived utilitarian value in terms of viable career option. This study was conducted among Jewish and Arab music-education students in Israel. The aim was to identify aspects related to choosing a career in music, particularly culturally shaped attitudes and perceptions. Cultural differences were examined using the Cultural Attitudes toward Music Experience and Education (CAMEE) questionnaire. Participants were 50 Israeli Jewish and Arab students who were enrolled in music education programs. Findings showed culturally related differences between participants’ musical upbringing. The Jewish students reported that they listened mainly to Western-style genres, played Western-type instruments, and studied Western music theory. The Arab students listened mainly to Middle Eastern Arab-style genres, played mainly music instruments that enable playing Arab music, and studied Middle Eastern Arab music theory. The Jewish students reported more experience with music and instrumental playing than their Arab peers. Motivation for teaching music included educational and ideological components for both groups, with Arab students reporting a higher level of utilitarian motivation

Partnering with Middle Eastern/Arab American and Latino Immigrant Communities to Increase Participation in Alzheimer’s Disease Research

Purpose: Recruitment and retention of US ethnic groups traditionally underrepresented in research continues to pose challenges. The Michigan Center for Contextual Factors in Alzheimer’s Disease (MCCFAD) engages with two underserved immigrant commu­nities in Michigan – Middle Eastern/Arab Americans in metro-Detroit and Latinos in the Grand Rapids area – to recruit and retain two Participant Resource Pools (PRP).Procedures: We adapt an existing commu­nity-based participatory research (CBPR) approach to recruit Middle Eastern/Arab American and Latino adults of all ages for Alzheimer’s disease and related dementia (ADRD) research. Using American Commu­nity Survey (2014-2018) data, we compare socio-demographic characteristics of Middle Eastern/Arab Americans and Latinos living in Michigan to our PRPs. Assessment tools and community advisory board feedback identified missteps and culturally sensitive solutions.Main Findings: In the first year of MCCFAD activities, 100 Middle Eastern/ Arab Americans and 117 Latinos joined the MCCFAD PRPs. Comparisons to state-level data showed that PRP participants were on average older and more likely to be female than the Middle Eastern/Arab American and Latino populations in Michigan. Further, Middle Eastern/Arab Americans in the PRP reported higher education levels while Latinos reported lower education levels than their respective statewide populations. Community partnerships/feedback identi­fied the importance of connecting with community leaders, attending to matters of within-group diversity, as well as language and semantics.Conclusion: Partnership with communities to develop culturally targeted and sensitive community health events can fill a signifi­cant gap in addressing ADRD health dispari­ties by establishing sustainable relationships to increase participation in ADRD research. Ethn Dis. 2020;30(Suppl 2):765-774; doi:10.18865/ed.30.S2.765

Isolated Congenital Supernumerary Nostril in an Adult Patient

The supernumerary nostril is a congenital accessory nostril, which is considered to be one of the rarest congenital nasal anomalies with an unknown etiology. We present the first case of a supernumerary nostril in an adult Saudi patient, which is the first such isolated case to be reported among the Middle Eastern Arab countries. An 18-year-old Saudi woman presented to the facial plastic clinic of King Fahad Medical City, Riyadh, with a complaint of an additional small left nasal opening since birth. She underwent circumferential surgical excision of the accessory nostril and its entire tract, following which the overlying skin was sutured. The patient appeared fine postoperatively with a satisfactory nasal appearance. In conclusion, patients with supernumerary nostrils should be thoroughly assessed to eliminate the presence of any other associated congenital anomalies. Early diagnosis and surgical management can facilitate a better reconstructive outcome.

Understanding 'Sectarianism'

‘Sectarianism’ is one of the most over-discussed yet under-analysed concepts in debates about the Middle East. Despite the deluge of commentary, there is no agreement on what ‘sectarianism’ is. Is it a social issue, one of dogmatic incompatibility, a historic one or one purely related to modern power politics? Is it something innately felt or politically imposed? Is it a product of modernity or its antithesis? Is it a function of the nation-state or its negation? This book seeks to move the study of modern sectarian dynamics beyond these analytically paralyzing dichotomies by shifting the focus away from the meaningless '-ism' towards the root: sectarian identity. How are Sunni and Shi'a identities imagined, experienced and negotiated and how do they relate to and interact with other identities? Looking at the modern history of the Arab world, Haddad seeks to understand sectarian identity not as a monochrome frame of identification but as a multi-layered concept that operates on several dimensions: doctrinal, subnational, national and transnational. Far from a uniquely Middle Eastern, Arab, or Islamic phenomenon, a better understanding of sectarian identity reveals that the many facets of sectarian relations that are misleadingly labelled "sectarianism" are echoed in intergroup relations worldwide.