Health literacy in a high income Arab country: A nation-wide cross-sectional survey study.

INTRODUCTION: Health literacy is a powerful predictor of health outcomes, but remains a global challenge. There is a paucity of published data and limited understanding of the health literacy of patients in the Middle East. The purpose of this study was to assess the patient health literacy levels in the United Arab Emirates (UAE) and identify associated demographic characteristics. METHODS: A cross-sectional survey of adult patients attending public and private hospitals and primary care clinics was conducted across the UAE between January 2019 and May 2020. Chi-square test was used to analyze the association between health literacy and demographic variables. Ordinal regression was adopted to analyze the data for statistically significant independent variables. RESULTS: 2349 of 2971 patients responded (79% response rate). Slightly less than one-quarter (23.9%) of patients surveyed demonstrated adequate health literacy. Over a third of women respondents (31.7%) possessed adequate health literacy, as compared to only 13% of men surveyed (p<0.001). Participant age was significantly (p<0.001) associated with health literacy levels, with approximately 50% of participants above age 50 years (51-75 years) demonstrating inadequate health literacy. Education was also positively correlated with health literacy. Adequate health literacy levels were twofold higher (30.5%, p<0.001) in patients with high school education, as compared to patients without secondary education. CONCLUSIONS: The high proportion of patients with inadequate health literacy in our study confirms that the health literacy deficit is a challenge in the UAE. Targeted interventions are needed to improve health literacy, particularly for older individuals, to optimize healthcare utilization and improve individual and population health outcomes.

Effectiveness of BBIBP-CorV vaccine against severe outcomes of COVID-19 in Abu Dhabi, United Arab Emirates.

The effectiveness of the inactivated BBIBP-CorV vaccine against severe COVID-19 outcomes (hospitalization, critical care admission and death due to COVID-19) and its long-term effectiveness have not been well characterized among the general population. We conducted a retrospective cohort study using electronic health records of 3,147,869 adults, of which 1,099,886 vaccinated individuals were matched, in a 1:1 ratio to 1,099,886 unvaccinated persons. A Cox-proportional hazard model with time varying coefficients was used to assess the vaccine effectiveness adjusting for age, sex, comorbidity, ethnicity, and the calendar month of entry into the study. Our analysis showed that the effectiveness was 79.6% (95% CI, 77.7 to 81.3) against hospitalization, 86% (95% CI, 82.2 to 89.0) against critical care admission, and 84.1% (95% CI, 70.8 to 91.3) against death due to COVID-19. The effectiveness against these severe outcomes declined over time indicating the need for booster doses to increase protection against severe COVID-19 outcomes.

Impact of the COVID-19 Pandemic on a Physician Group's WhatsApp Chat: Qualitative Content Analysis.

BACKGROUND: Social media has emerged as an effective means of information sharing and community building among health professionals. The utility of these platforms is likely heightened during times of health system crises and global uncertainty. Studies have demonstrated that physicians' social media platforms serve to bridge the gap of information between on-the-ground experiences of health care workers and emerging knowledge. OBJECTIVE: The primary aim of this study was to characterize the use of a physician WhatsApp (WhatsApp LLC) group chat during the early months of the COVID-19 pandemic. METHODS: Through the lens of the social network theory, we performed a qualitative content analysis of the posts of a women physician WhatsApp group located in the United Arab Emirates between February 1, 2020, and May 31, 2020, that is, during the initial surge of COVID-19 cases. RESULTS: There were 6101 posts during the study period, which reflected a 2.6-fold increase in platform use when compared with platform use in the year prior. A total of 8 themes and 9 subthemes were described. The top 3 uses of the platform were requests for information (posts: 2818/6101, 46.2%), member support and promotion (posts: 988/6101, 16.2%), and information sharing (posts: 896/6101, 14.7%). A substantial proportion of posts were related to COVID-19 (2653/6101, 43.5%), with the most popular theme being requests for logistical (nonmedical) information. Among posts containing COVID-19-related medical information, it was notable that two-thirds (571/868, 65.8%) of these posts were from public mass media or unverified sources. CONCLUSIONS: Health crises can potentiate the use of social media platforms among physicians. This reflects physicians' tendency to turn to these platforms for information sharing and community building purposes. However, important questions remain regarding the accuracy and credibility of the information shared. Our findings suggest that the training of physicians in social media practices and information dissemination may be needed.

Intelligent Graduate Medical Education Dashboard (IGMED) to Enhance Trainee Oversight During the COVID-19 Pandemic.

BACKGROUND: Medical residents comprise a large, but unique, subset of the physician workforce. They serve as front-line staff, but are trainees, regulated by duty hour and supervision restrictions. Heightened oversight is necessary to ensure resident supervision and safety whilst mobilizing this important workforce during crisis. This manuscript describes the development and implementation of an institutional crisis dashboard to facilitate timely information gathering and decision-making regarding resident activities during the COVID-19 pandemic. OBJECTIVE: The purpose of the study was to develop an intelligent graduate medical education dashboard to centralize and integrate data to support accurate, timely decisions in several areas: (1) track redeployment; (2) ensure adherence to supervision and duty hour regulations; and (3) monitor infection control and safety measures. METHODS: The dashboard is a live Microsoft Excel database saved to a shared fileserver. All existing databases within the education department were reviewed to form a foundational template. A monitoring section provides at-a-glance information on trainee assignments. Embedded color-coded flags attached to specific responses immediately highlight areas of deficiency. RESULTS: The dashboard facilitated the efficient mobilization of trainees, while ensuring assignments followed education regulations. It allowed the education office to centralize and proactively arrange mass scrubs orders, facemask fitting, and personal protective equipment training. It was a monitoring system that enabled recognition of safety concerns in real-time, including identifying areas where residents were most exposed or infected. CONCLUSION: The dashboard improved the efficiency of crisis response, while prioritizing resident safety. It is feasible, low cost and easily accessible, even during Internet disruption. It can be used by hospitals worldwide, including low resource settings.

Post-infectious and post-acute sequelae of critically ill adults with COVID-19.

BACKGROUND: Data on the post-acute and post-infectious complications of patients who have recovered from severe coronavirus disease 2019 (COVID-19) are limited. While studies report that approximately 5-15% of COVID-19 hospitalized patients require intensive care and mechanical ventilation, a substantially higher number need non-invasive ventilation and are subject to prolonged hospitalizations, with long periods of immobility and isolation. The purpose of this study is to describe the post-infectious sequelae of severe viral illness and the post-acute complications of intensive care treatments in critically ill patients who have recovered from severe COVID-19 infection. METHODS: We performed a retrospective chart review of adult patients initially hospitalized with confirmed COVID-19 infection, who recovered and were transferred to a general medical ward or discharged home between March 15, 2020 and May 15, 2020, dates inclusive, after an intensive care unit (ICU) or high dependency unit (HDU) admission in a designated COVID-19 hospital in the United Arab Emirates. Demographic data, underlying comorbidities, treatment, complications, and outcomes were collected. Descriptive statistical analyses were performed. RESULTS: Of 71 patients transferred out of ICU (n = 38, 54%) and HDU (n = 33, 46%), mean age was 48 years (SD, 9.95); 96% men; 54% under age 50. Mean ICU stay was 12.4 days (SD, 5.29), HDU stay was 13.4 days (SD, 4.53). Pre-existing conditions were not significantly associated with developing post-acute complications (Odds Ratio [OR] 1.1, 95% confidence interval [CI] 0.41, 2.93, p = 1.00). Fifty nine percent of patients had complications; myopathy, swallowing impairments, and pressure ulcers were most common. Delirium and confusion were diagnosed in 18% (n = 13); all were admitted to the ICU and required mechanical ventilation. Of note, of all patients studied, 59.2% (n = 42/71) had at least 1 complication, 32.4% (n = 23) had at least 2 complications, and 19.7% (n = 14) suffered 3 or more sequelae. Complications were significantly more common in ICU patients (n = 33/38, 87%), compared to HDU patients (n = 9/33, 27%) (OR 17.6, 95% CI 5.23, 59.21, p <0.05). CONCLUSION: In a subset of critically ill patients who recovered from severe COVID-19 infection, there was considerable short-term post-infectious and post-acute disability. Long-term follow-up of COVID-19 survivors is warranted.

Rapid Development and Utilization of a Clinical Intelligence Dashboard for Frontline Clinicians to Optimize Critical Resources During Covid-19.

INTRODUCTION: The COVID-19 pandemic has created an unprecedented situation where sudden and prolonged surges of critically ill patients have disrupted healthcare systems worldwide A major concern for hospitals worldwide is how to best manage large numbers of COVID-19 infected and non-infected patients, while still maintaining high-quality clinical care. AIM: This manuscript describes the system development, collaborative efforts and the challenges encountered in developing an in-house clinical intelligence dashboard. METHODS: Through a longitudinal, interdepartmental collaboration, a COVID-19 clinical intelligence dashboard was created using Microsoft Power BI and Cerner Computer Language (CCL) to demonstrate clinical severity of patients and patient location in a single screen. A color-coding schema was applied to produce a red highlight for patients whose condition is deteriorating, whether due to increasing oxygen demand or worsening laboratory values. An additional function enabled users to drill down into the patient's clinical and laboratory parameters for the past 5 days, and ultimately to the respective patient chart for further assessment. RESULTS: The development of an in-house clinical intelligence dashboard is a feasible, effective tool to allow frontline clinicians to monitor patient status in multiple wards and proactively intervene as clinically necessary and transfer patients to the appropriate level of care. Comparing the 30 days before and 30 days after the implementation of the dashboard, the percentage of patients who required urgent intubation or cardiac resuscitation on the general medical ward, rather than a critical care setting, declined by over 50% (8 out of 34, 33% vs. 7 out of 55, 13%; two-tailed p < 0.05 by Fisher's exact test; OR 3.43; CI 1.07 to 10.95). CONCLUSION: The dashboard has enabled physicians to efficiently assess patient volumes and case severity to prioritize clinical care and appropriately allocate scarce resources. The dashboard can be replicated by developing healthcare systems that are continuing to grapple with the pandemic.

Optimizing Supportive Care in COVID-19 Patients: A Multidisciplinary Approach.

Within just a few months, SARS-CoV-2 has evolved from a virtually unknown pathogen to a leading cause of morbidity and mortality worldwide. As COVID-19 infection can affect multiple organ systems, treating many manifestations and complications requires clinical expertise across the healthcare professional spectrum. Therefore, interprofessional and multidisciplinary collaboration should form the cornerstone of every hospital's COVID-19 management approach. In this manuscript, we discuss the non-microbial management strategies for our COVID-19 inpatient population. Specifically, through an inter-professional and collaborative approach to care delivery, we provide rationale and guidance on prone positioning, oxygen strategies, early mobilization, identifying and treating co-infections, anticoagulation and ensuring appropriate psychological support for patients and their families. It is our hope that these recommendations help supporting clinician management decisions to best care for hospitalized COVID-19 patients in the region and worldwide.

Covid-19 pandemic research opportunity: Is the Middle East & North Africa (MENA) missing out?

BACKGROUND: The Covid-19 pandemic has caused fear and panic worldwide, forcing healthcare systems to disregard conventional practices and adopt innovation to contain the infection and death. Globally, there has been a rapid proliferation of research studies and clinical trials assessing risks, infectivity and treatment. METHODS: This review assesses the opportunities and challenges in the Middle East North Africa (MENA) region to engage in the conduct of high quality clinical trials during the Covid-19 pandemic. RESULTS: Opportunities are abundant for conducting clinical trials in MENA countries, including substantial cost savings, academic health centers, integrated health information systems, international accreditation, and international collaborations. Yet, the MENA region has missed out on opportunities to advance patient research during prior infectious disease outbreaks caused by the Severe Acute Respiratory Syndrome, Ebola, and the Middle East Respiratory Syndrome, as evidenced by the lack of concerted research and clinical trials from the region. A large vulnerable population, especially the poor expatriate work force, the current isolation of the health centers, and the lack of an expert network or field trained task force, all contribute to challenges preventing the formation of a pan Arab research enterprise for epidemics. CONCLUSION: Quality clinical research is critical during public health emergencies to identify treatments and solutions. The efficient conduct of clinical trials requires innovative strategies in research design, approval, and dissemination. Many countries in the MENA region have an opportunity to quickly ramp up research capacity and contribute significantly to the fight against the Covid-19 global threat.