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.

Methylprednisolone Treatment Versus Standard Supportive Care for Adult COVID-19 Mechanically Ventilated, Acute Respiratory Distress Syndrome Patients.

A myriad of symptoms presented by severely ill mechanically ventilated COVID-19 patients has added pressure on the caregivers to explore therapeutic options. Systemic steroids have been reported to therapeutically benefit patients, with elevated inflammatory markers, during the severe acute respiratory syndrome, and the Middle East respiratory syndrome outbreak. COVID-19 disease is characterized by inflammation of the respiratory system and acute respiratory distress syndrome. Given the lack of specific treatment for COVID-19, the current study aimed to evaluate the therapeutic benefit of methylprednisolone as an add-on treatment for mechanically ventilated hospitalized COVID-19 patients with severe COVID pneumonia. Data were collected retrospectively from the electronic patient medical records, and interrater reliability was determined to limit selection bias. Descriptive and inferential statistical methods were used to analyze the data. The variables were cross-tabulated with the clinical outcome, and the chi-square test was used to determine the association between the outcomes and other independent variables. Sixty-one percent (43/70) of the COVID-19 ARDS patients received standard supportive care, and the remainder were administered, methylprednisolone (minimum 40 mg daily to a maximum 40 mg q 6 h). A 28-day all-cause mortality rate, in the methylprednisolone group, was 18% (5/27, p < 0.01) significantly lower, compared to the group receiving standard supportive care (51%, 22/43). The median number of days, for the hospital length of stay (18 days), ICU length of stay (9.5 days), and the number of days intubated (6 days) for the methylprednisolone-treated group, was significantly lower (p < 0.01) when compared with the standard supportive care group. Methylprednisolone treatment also reduced the C-reactive protein levels, compared to the standard care group on day 7. Our results strengthen the evidence for the role of steroids in reducing mortality, ICU length of stay, and ventilator days in mechanically ventilated COVID-19 patients with respiratory distress syndrome.

Assessment of mortality from COVID-19 in a multicultural multi-ethnic patient population.

BACKGROUND: Studies indicate that ethnicity and socioeconomic disparity are significant facilitators for COVID-19 mortality. The United Arab Emirates, distinctly has a population of almost 12% citizens and the rest, immigrants, are mainly unskilled labourers. The disparate socio-economic structure, crowded housing conditions, and multi-ethnic population offer a unique set of challenges in COVID-19 management. METHODS: Patient characteristics, comorbidities, and clinical outcomes data from the electronic patient medical records were retrospectively extracted from the hospital information system of the two designated public COVID-19 referral hospitals. Chi-square test, logistic regression, and odds ratio were used to analyse the variables. RESULTS: From, the total of 3072 patients, less than one-fifth were females; the Asian population (71.2%);followed by Middle Eastern Arabs (23.3%) were the most infected by the virus. Diabetes Mellitus (26.8%), hypertension (25.7%) and heart disease (9.6%) were the most prevalent comorbidities observed among COVID-19 patients. Kidney disease as comorbidity significantly diminished the survival rates (Crude OR 9.6, 95% CI (5.6-16.6), p < 0.001) and (Adjusted OR 5.7 95% CI (3.0 - 10.8), p < 0.001), as compared to those patients without kidney disease. Similarly, the higher age of patients between 51 and 65 years, significantly decreased the odds for survival (Crude OR 14.1 95% CI (3.4-58.4), p < 0.001) and (Adjusted OR 12.3 95% CI (2.9 - 52.4), p < 0.001). Patient age beyond 66 years, further significantly decreased the odds for survival (Crude OR 36.1 95% CI (8.5-154.1), p < 0.001), and (Adjusted OR 26.6 95% CI (5.7 - 123.8), p < 0.001). CONCLUSION: Our study indicates that older ages above 51 years and kidney disease increased mortality significantly in COVID-19 patients. Ethnicity was not significantly associated with mortality in the UAE population. Our findings are important in the management of the COVID-19 disease in the region with similar economic, social, cultural, and ethnic backgrounds.

Epidemiological characteristics of children with coronavirus at a joint commission-accredited hospital in the United Arab Emirates.

OBJECTIVES: Our aim was to identify the epidemiological characteristics and transmission patterns of coronavirus (COVID-19) among pediatric patients in the multicultural and multiethnic city of Al Ain in the United Arab Emirates (UAE). METHOD: A retrospective study was conducted by abstracting data from the electronic medical records of pediatric patients with COVID-19 from two major public hospitals in Al Ain. The data of patients from birth through 16 years of the cases with COVID-19 confirmed by reverse transcription-polymerase chain reaction were obtained. In addition to the epidemiological characteristics, transmission patterns, comorbidities, index cases, travel history, and coinfection with other viruses were analyzed. Cohen's kappa was used to assess interrater reliability and descriptive data. Chi-square test was used to assess significant differences between the variables and was conducted using Statistical Product and Service Solutions software. RESULTS: We identified 298 (150 males, 148 females) laboratory-confirmed cases. The patients' median age was 7 years. Of these, 50% had parents who also tested positive. Most patients (86.9%) were healthy without any known medical problems. The coinfection rate was ~2%. CONCLUSION: The epidemiological characteristics of children with COVID-19 in Al Ain are similar to those observed internationally. Children of all ages appeared to be susceptible to COVID-19 and no significant sex or ethnicity differences were detected. Furthermore, this study provides strong evidence of human-to-human transmission.

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.

Case fatality rates of COVID-19 across the globe: are the current draconian measures justified?

Aim: The current study assessed the case fatality rate (CFR) across different income level countries of the world, and the virulence pattern of COVID-19, against the backdrop of panic and uncertainty faced by many governments, who are trying to impose draconian containment measures to control the outbreak. Subjects and Methods: Data on confirmed cases and number of deaths due to coronavirus infection were retrieved from the WHO as on 30 March 2020, and examined for the various income level countries, per the World Bank criteria. The CFR was calculated country-wise and estimated for the various groups such as low, lower-middle, upper-middle, and high-income, and the data was analyzed. Results: The overall CFR for the high income countries was 5.0%, compared with a CFR of 2.8% for low-income countries. The upper-middle-income countries showed a CFR of 4.3%, while the lower-middle-income countries stood at 3.7%. The results from our study predict that the maximum CFR in high-income countries will be contained at approximately 5% (95% CI). The CFR for the low, lower-middle, and upper-middle-income countries will range between 2.8 and 4.3% (95% CI). Conclusion: COVID-19, irrespective of its transmissibility, produces a lower CFR compared with that of SARS-Cov and MERS-Cov, although COVID-19 has infected eight times more countries than MERS-Cov and SARS-Cov, and caused a higher number of deaths. The nation-wide lockdown measures to prevent the spread of the virus may be reconsidered, given the hardships for the population and their impact on the economic system.

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.