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Factors influencing self-care management in adult hemodialysis patients: An integrative review
Background: End-stage renal disease (ESRD) poses a significant health challenge with hemodialysis (HD) being the most prevalent therapy. Patients undergoing HD must comply with a strict therapeutic regimen including dietary control fluid restriction and medication adherence. Successful disease management and improved outcomes rely on patients’ involvement and participation in their care.
Aim: To identify the factors that hinder or facilitate self-care management (SCM) in HD patients.
Methodology: This review followed Whittemore and Knafl’s integrative review framework. A comprehensive literature search of articles published between 2017 and 2022 was conducted in CINAHL Medline and PubMed using the keywords end-stage renal disease hemodialysis self-care management self-care and self-management. This search yielded 21 suitable articles for review.
Results: SCM is influenced by three main factors: facilitators barriers and outcomes. Facilitators of SCM include self-care management interventions patient knowledge socio-demographic factors family support healthcare professionals peer support and psychological factors. Barriers encompass psychological and physical conditions. Outcomes include both physiological and psychological aspects.
Conclusion: Understanding the factors influencing SCM in HD patients is vital for developing reliable and effective self-care strategies and interventions to enhance both physical and psychological outcomes.
Opening Statement
The World Health Organisation estimates that climate change since the 1970s is already responsible for 140000 deaths annually. The uncertainties of climate change raise the possibility that it will bring disaster on a global scale but also that its impact might be delayed provided that we take decisive action now. Most of the negative consequences will be felt in the earth's mid-latitudes already the poorest parts of the world where secondary effects such as economic disruption disease famine and war will be experienced most acutely.
Climate change is caused by humans and all indicators tend to show that it is going to get worse hence the need for decisive timely and sustained global political action. These are the expectations with which we host the Doha Climate Change Conference 2012 as part of the 18th session of the Conference of the Parties to the UNFCCC (United Nations Framework Convention on Climate Change).
We hope that through this journal our different religious traditions can guide us at this crucial time in human history in developing a common discourse inspired by their ancient wisdom. May it teach us how to relate to the environment and to our fellow humans who in other countries and in future times will be affected by the economic decisions we make in our own countries at this present time. Our hope is that our religious traditions can remind us to look beyond selfishness greed and apathy in making economic decisions informed by ethical principles. May we learn how to walk the earth with humility like the founders of the various religions did and to leave the earth in a better condition than that in which we inherited it from our forefathers.
بيان افتتاح
تقدر منظمة الصحة العالمية أن ظاهرة التغير المناخي كانت سببا منذ ١٩٧۰ في وفاة ١٤۰۰۰۰ حالة سنويا. التوقعات المحتملة للآثار الناجمة عن تغير المناخ تشير إلى احتمال وقوع كارثة على نطاق عالمي، ولكن، في الوقت ذاته يمكن أيضا تأخير تلك الآثار، شريطة أن تتخذ إجراءات حاسمة من الآن. ومن المتوقع أن تظهر معظم الآثار السلبية في خطوط العرض المتوسطة للأرض، والتي تعد بالفعل أفقر مناطق العالم، وهي أساسا تعيش تحت المعاناة الشديدة من جراء الاضطرابات الاقتصادية، من ناحية، والمجاعة والأمراض والحروب، من ناحية أخرى. وظاهرة التغير المناخي تعد نتيجة لأفعال البشر، وجميع المؤشرات تميل إلى إظهار أنه سوف تزداد سوءا في السنوات المقبلة، وبالتالي بات من الضروري اتخاذ إجراءات حاسمة في الوقت المناسب، ووضع سياسة شاملة ومستدامة لهذا الهدف. ففي هذا الصدد، ستستضيف الدوحة مؤتمر الدوحة لتغير المناخ عام ٢۰١٢، كجزء من الدورة ١٨ لمؤتمر الأطراف في اتفاقية تغير المناخ (اتفاقية الأمم المتحدة الإطارية بشأن تغير المناخ). و في هذا الإطار تسعى مجلة أديان والتي يصدرها مركز الدوحة الدولي لحوار الأديان، في نشر وعي بيئي بإشراك نخبة من المختصين في مجال التقاليد الدينية المختلفة لإثراء موضوع البيئة من المنظور الديني ونأمل من خلال هذ الطرح، أن نصل إلى إرشادات نافعة وإسهامات، علها تضيف جديدا في الوعي البيئي العالمي، في هذه المرحلة الحاسمة من تاريخ البشرية. كما أنه من المهم أن ندرك بأن القرارات الاقتصادية التي نتخذها اليوم سوف تكون لها آثار سلبية عميقة في مستقبل البشرية جمعاء؛ لأن الكرة الأرضية أضحت قرية واحدة. أملنا أن تقاليدنا الدينية ستساعدنا في إدراك المخاطر التي تحدق بنا جراء نتيجة الآثار السلبية على البيئة من حولنا. ولذا وجب علينا بأن نتعاون لمواجهة هذه التحديات ونتخطى السلوكيات السلبية من الجشع والأنانية واللامبالاة، وأن نأخذ بعين الاعتبار المبادئ الأخلاقية الدينية الرامية لحماية الإنسان وإسعاده أساسا، في اتخاذنا للقرارات الاقتصادية التي تتعلق في مستقبلنا البيئِيِّ. وخلاصة الأمر، إن هذه الأخلاق ترشدنا بأن نتواضع للناس ونتعامل برفق مع البيئة التي هي جزء من حياتنا، مقتدين بذلك بمؤسسي الديانات المختلفة. وكما ورثناها من أجدادنا، أن نورث الأرض للأجيال القادمة، وهي أفضل حالا مما هي عليه اليوم.
Exergame: A Gamelike Exercise to Improve Motor Functions and Physical Activities in Diabetic Patients Undergoing Hemodialysis
Background: Balance mobility falls and foot problems are serious detriments for the diabetic patients undergoing hemodialysis (HD) treatment. In addition the HD process often leaves them too fatigued to engage in any physical activity or daily exercise further deteriorating their motor functions. Exercise would be effective for this population. However due to the time availability post-dialysis fatigue as well as limitation of transportation to exercise facility the conventional exercise is impractical. Objective: We are developing an interactive foot and ankle exercise game that can be played during HD sessions to improve mobility and balance as well as reduce foot problems. In this study we examined the feasibility and effectiveness of this innovative wearable sensor based non-weight bearing exercise (Exergame) to improve daily physical activity in diabetic patients undergoing HD treatment. Methods: Thirty-three diabetic subjects receiving HD treatment were recruited and randomized into an intervention group (IG: n = 15 age = 62.2 ± 7.6 years BMI = 29.1 ± 6.1 kg/m2) and a control group (CG: n = 18 age = 66.6 ± 8.7 years BMI = 32.5 ± 9.0 kg/m2). Both groups underwent a 4-week ankle and foot exercise program (30 minutes per session two sessions per week) during HD process. The IG received exercise via the Exergame program which uses wearable sensors attached on subject's feet. The subject's 3-dementional ankle and foot movements were visualized in real-time on a computer screen placed in front of him/her. The subject played some game-like tasks by moving and rotating the foot and ankle. The difficulty level of the task was gradually increased depends on ability of the subject (like a game) from a simple flexion-extension movement to more complex movements including medial-lateral movement with different range of motion. The CG received traditional foot and ankle exercise without technology. Daily physical activity data was assessed for 48 hours (day and night) at baseline and post 4-week exercise using a validated wearable sensor (PAMSysTM). Daily physical activity was quantified by duration spent in each main posture (i.e. lying sitting standing and walking) and activities (e.g. postural transition sedentary behavior etc). Results: All IG subjects achieved to complete all exercise tasks indicating the feasibility of the Exergame platform. No adverse event or difficulty were reported indicating practicality of the exercise program. None subject in the IG was dropped out during the 4-week exercise program. Low dropout rate may indicate acceptability of the proposed Exergame platform. At the end of intervention subjects in the IG were more active than subjects in the CG. In summary the IG performed 53% more posture transitions to walking (Cohen's d effect size = 0.5) and 39% more posture transitions between sitting and walking (d = 0.5) when compared to the CG. Subjects in the IG also had significant less sedentary behavior than subjects in the CG. In summary subjects in the IG spent 5% less time on sitting and lying (p = 0.049 d = 0.7) as well as 47% more time on standing and walking (p = 0.049 d = 0.7) when compared to subjects in the CG. Conclusions: This study demonstrated feasibility acceptability and effectiveness of an innovative Exergame program to improve daily physical activity in diabetic patients undergoing HD treatment. The key innovation of the proposed intervention is its practicality to be done during HD process which could address the limitations of prior exercise interventions in HD patients for example the low adherence of therapeutic exercise. Further studies should be addressed to confirm the observation with larger sample sizes.
GameBased NonWeight Bearing Exercise to Improve Postural Balance in Diabetic Patients Underjoining Hemodialysis
Background: Poor balance falls and foot problems are serious detriments for the diabetic patients due to the obesity and diabetic foot ulcer. In addition for the diabetic patients undergoing hemodialysis (HD) treatment the HD process often leaves them too fatigued to engage in any physical activity or daily exercise further deteriorating their motor functions and increasing risk of falling. Exercise would be effective for this population. However due to the time availability post-dialysis fatigue as well as limitation of transportation to exercise facility the conventional exercise for this population is impractical. Objective: We are developing an interactive foot and ankle exercise game that can be played during HD sessions to improve foot region blood flow as well as reduce foot problems. In this study we examined the feasibility and effectiveness of this innovative wearable sensor based non-weight bearing exercise (Exergame) to improve postural balance in diabetic patients undergoing HD treatment. Methods: Sixty diabetic subjects receiving HD treatment were recruited and randomized into an intervention group (IG: n = 29 age = 63.3 ± 7.9 years BMI = 31.2 ± 6.5 kg/m2 female = 41%) and a control group (CG: n = 31 age = 66.5 ± 10.7 years BMI = 32.3 ± 8.2 kg/m2 female = 55%). Both groups underwent a 4-week ankle and foot exercise program (30 minutes per session two sessions per week) during HD process. The IG received exercise via the Exergame program which uses wearable sensors attached on subject's feet. The subject's 3-dementional ankle and foot movements were visualized in real-time on a computer screen placed in front of him/her. The subject performed some game-like tasks by moving and rotating the foot and ankle. The difficulty level of the task was gradually increased depending on ability of the subject (like a game) from a simple flexion-extension movement to more complex movements including medial-lateral movement with different range of motion. The CG received traditional foot and ankle exercise without any technology. Postural balance was assessed in the semi-tandem test. Balance tests were performed at baseline and conclusion of the program under both eyes-open and eyes-closed conditions. Balance parameters included ankle sway and hip sway in anterior-posterior (AP) direction (degree) medial-lateral (ML) direction (degree) as well as in area (degree2). Results: All IG subjects achieved to complete all exercise tasks indicating the feasibility of the Exergame platform. No adverse event or difficulty were reported indicating practicality of the exercise program. None subject in the IG was dropped out during the 4-week exercise program. Low dropout rate may indicate acceptability of the proposed Exergame platform. Under eyes-open condition the IG had significant ankle sway reduction in the AP direction (Cohens’ d effect size = 0.55 p = 0.037) when comparing with the CG. At conclusion the AP direction ankle sway reduced 18% in the IG while in the CG it increased 58%. More significant improvements of postural balance were observed under eyes-closed condition. When comparing with the CG the IG had significant ankle and hip sway reductions in both AP and ML directions as well as in area (p < 0.050). The highest effect size contrasting changes between the IG and CG was also observed for ankle sway in ML direction (Cohens’ d effect size = 0.76 p = 0.005). Conclusions: This study demonstrated feasibility acceptability and effectiveness of an innovative Exergame program to improve postural balance in diabetic patients undergoing HD treatment. The key innovation of the proposed intervention is its practicality to be done during HD process which could address the limitations of prior exercise interventions in HD patients for example the low adherence of therapeutic exercise.
Mortality of dialysis patients in Qatar: A retrospective epidemiologic study
Background: End-stage kidney disease (ESKD) patients on maintenance renal replacement therapy (RRT) have far lower life spans than those of the general population. No previous studies have been performed to assess the mortality of dialysis patients in the State of Qatar. We designed this study to assess the mortality of dialysis patients in Qatar and the impact of dialysis modality.
Methods: All chronic ambulatory dialysis patients (both on hemodialysis (HD) and peritoneal dialysis (PD) between 2014 and 2016) were included in the study whereas patients undergoing dialysis for less than 3 months were excluded. We reviewed patients’ demographics comorbidities and general laboratory investigations through our electronic record system and collected and analyzed them. We identified patients who died during that period and compared them to those who survived. We performed a subanalysis for HD versus PD patients who died.
Results: The total number of deceased dialysis patients was 164 with an overall crude mortality rate of 6.4%. They were significantly older than those who survived (p = 0.0001). The mortality rate was significantly higher in female than in male patients (51.2% and 38.9% respectively) (p = 0.004) but significantly lower in PD than HD patients (1.36% PD; 5.0% HD; p = 0.007). It was also significantly higher in natives than in the expats (60.3% and 39.6% respectively) (p = 0.0008); however no significant differences were noted between deceased natives and expats in most demographic and laboratory characteristics. The most common cause of patient death was CVD (62 patients 37.8%) followed by sepsis (44 patients 26.8%). Diabetes cerebrovascular accident and dyslipidemia were more common in HD deceased patients than in PD patients (80.6% 47% and 59% respectively in HD patients vs 68.5% 42% and 31% respectively in PD patients). Albumin and potassium levels in deceased PD patients were significantly lower than in HD patients (p = 0.001).
Conclusion: Our study found that the high-risk population had a significant mortality which was higher in HD than PD patients. This is the first study to look at these outcomes in Qatar. We identified multiple mortality associated factors such as comorbid conditions and old age. We believe that improving treatment and close monitoring for comorbid conditions in the dialysis population might improve survival.
Utilizing diabetes mellitus risk assessment tool in screening of hemodialysis patients at risk of diabetes mellitus
Background: Hamad General Hospital is the main provider of hemodialysis (HD) in Qatar for approximately 650 patients per year. Over 60% of these patients have Diabetes Mellitus (DM) and 55% of them suffer from end stage renal disease (ESRD). 2% of ESRD patients develop DM after their first year of dialysis1. The aims of this quality improvement study were early DM detection risk factors modifications and reduction of diabetes complications in our patients. Methods: A risk assessment tool was adapted to identify the risk level of HD patients to develop DM2. They were screened to determine their risk score across 8 categories. Six categories (gender history of gestational diabetes family history of high blood pressure diabetes physical activity and smoking) were scored 0 to 1 age was scored 0 to 3 and relationship between weight and height scored 1 to 3. (Overall score range: 1-12). Patients were classified into two groups: a low-risk group (score < 5) and a high-risk group (score ≥ 5)3. Patients were referred to different medical specialties for further management according to the risk factor and a lifestyle modification management plan was set individually. Results: 189 non-diabetic dialysis patients were screened in the first quarter of 2020 their mean age was 51 years-old and 69% were male. Forty-three percent of patients were found to be at high risk of developing DM. The most important risk factors were family history (55%) obesity (40%) age >60 years (32%) low physical activity (14%) and smoking (11%) (Figure 1). Thirty-seven percent of patients were referred to the obesity clinic 10% to the smoking cessation clinic 5% to physiotherapy and 100% of patients were referred to the multidisciplinary care (Figure 2). Conclusion: Screening for diabetes is pivotal for early detection and risk factor modification in dialysis patients. We recommend quarterly data assessment and evaluation so patients can be managed according to the findings.
Effects of novel anemia nurse manager program on hemodialysis: a retrospective study from Qatar
Introduction: Anemia management in dialysis is challenging. Keeping hemoglobin levels within a tight range is difficult. A new program (anemia nurse manager [ANM]) was started for better anemia management. This study aimed to compare traditional anemia management with the new ANM model regarding the achievement of better hemoglobin targets (range 10–12 g/dL) avoidance of extreme hemoglobin levels ( < 9 or >13 g/dL) and evaluation of the cost-effectiveness of the new model.
Methods: This retrospective observational study compared traditional anemia management with management involving our new ANM model. Patients on hemodialysis in all ambulatory dialysis clinics in Qatar were included. The study included three phases: phase 1 (observation): June 2015 to August 2015 460 patients; phase 2 (pilot): September 2015 to May 2016 211 patients; and phase 3 (expansion in two phases): June 2016 to February 2017 and October 2017 to June 2018 610 patients. Hemoglobin iron saturation and ferritin were evaluated according to the protocol.
Results: In this study 55% of the patients achieved the target hemoglobin in phase 1 compared with 75% in phase 2 (p = 0.0007). The hemoglobin level within the target range was sustained at 72% ± 5% of patients in phase 3. The achievement rate of the target hemoglobin level increased from 56% (May 2015) to 72% (July 2018) (p < 0.001). The proportion of patients with extreme hemoglobin declined from 10.7% in phase 1 to 6.4% in phase 2 and sustained at 8% afterward. Reducing the doses of erythropoietin stimulating agents owing to the use of the ANM model saved costs by approximately 11%.
Conclusions: The ANM model was able to achieve and maintain hemoglobin levels within the target range and decrease extreme hemoglobin levels. These outcomes improved patient care by avoiding high hemoglobin (increase thrombosis cancer recurrence stroke and death) and low hemoglobin (weakness poor quality of life and need for transfusion) levels. The ANM model was cost effective even after including the salaries of nurses. This model can be considered in other aspects of patient care in dialysis.
Dialysis and advanced chronic kidney disease population Free from Hepatitis C virus infection: A safe nephrology approach
Background: One of the most prevalent viruses among dialysis patients is Hepatitis C as it affects 8.4% of the dialysis patients in Qatar1. It causes serious complications including end-stage liver disease. There is no available vaccine to protect against the transmission of the Hepatitis C virus (HCV). However antiviral drugs lead to precious benefits including reducing the risk of morbidity/mortality increasing life expectancy and eventually nominating them for kidney transplant2.
The Qatar National Plan for HCV control by 2020 was launched in December 2014. In 2017 the World Health Organization accepted to support the development and implementation of national multispectral policies and strategies for its prevention and control in Qatar3. The treatment of HCV in dialysis patients has been a challenge since its launch in 2020. Methods: This is a single-center cohort study including a retrospective collection of data from 70 dialysis patients infected with Hepatitis C virus. 44 of them were treated with Ombitasvir 12.5 mg Paritaprevir 75 mg and Ritonavir 50 mg over 12 weeks and 12-week follow up period. As per all guidelines of the American Association for the Study of Liver Disease (AASLD) the European Association for the Study of the Liver (EASL) and the Asian Pacific Association for the Study of the Liver (APASL) sustained virological response indicates a patient has cured. Results: From the 70 HCV-positive patients the 44 patients who received the 12-week treatments were cured (Figure 1). During the treatment phase their biochemical values were normal (Figure 2). Conclusion: The outcome of the first phase treatment of Hepatitis C in dialysis patients is highly effective. Moreover the successful HCV antiviral treatment will decrease the risk of infection transmission within dialysis patients and reduce the occurrence of complications occurring after kidney transplantation.
Determinants of vaccine adherence among non-dialysis chronic kidney disease patients in Qatar
Introduction: Chronic kidney disease (CKD) is a global health problem. Reduced innate and adaptive immunological responses predispose CKD patients to infections. Despite the clinical and epidemiological importance of CKD and the great value of vaccination as a prophylactic measure the utilization of recommended vaccines in Qatar has not yet been evaluated.
Methods: We conducted a cross-sectional study to estimate the level of influenza pneumococcal and hepatitis B vaccination and the predictors of adherence to these recommended vaccines among non-dialysis CKD patients receiving renal ambulatory care in Qatar from 1 September 2020 to 30 April 2021. Complete vaccination was defined as receiving the three vaccines and partial vaccination was defined as receiving one or two vaccines. The full and partial vaccination predictors were assessed using multivariate logistic regression and reported as odds ratio (OR) with p<0.05 indicating statistical significance.
Results: 416 non-dialysis CKD patients were included in our analysis. 73% were males; the mean age was 56 ± 15 years. More than 50% of the patients were from the Middle East followed by 36% from Asia. Most patients had concurrent hypertension concurrent diabetes mellitus and were stage V CKD. Only 12% of the patients were fully vaccinated while 73% received partial vaccination. The predictors of vaccination included age gender Asian origin employment living conditions concurrent medical conditions CKD stage allergy to medications and use of injectable medications. Only stage V CKD positively predicted adherence to full and partial vaccinations in non-dialysis CKD patients.
Conclusion: There is very low adherence to the recommended vaccines in CKD patients with a prevalence of complete vaccination of 12% only. Increased public awareness about the importance of vaccination in CKD may improve the adherence rates among these patients in Qatar.
Cardiovascular calcification in hemodialysis patients: A Qatar-based prevalence and risk factors study
Background: Patients with end-stage kidney disease on hemodialysis (HD) have an increased risk of death due to the high prevalence of cardiovascular disease. Vascular calcification (VC) is predictive of cardiovascular disease and mortality. We conducted a study to evaluate the prevalence and risk factors for VC in dialysis patients in Qatar.
Methods: This is a retrospective nationwide study including all chronic ambulatory dialysis patients in Qatar from 2020 to 2022. We used our national electronic medical record to track demographics clinical characteristics comorbidities laboratory values and diagnostic data for each patient. Calcifications were assessed by echocardiography (routinely done for all our dialysis population per national protocol) computed tomography X-ray and ultrasound. The study protocol was approved by the local medical research ethics committee (MRC-01-20-377).
Results: 842 HD patients were included in this study. Vascular calcifications (VC) were prevalent in 52.6% of patients. The main site of VC was Mitral valve calcifications in 55.5% of patients. Patients with VC were significantly older and had more prevalence of diabetes mellitus (p = 0.001 and p = 0.006 respectively). There was no statistically significant difference between patients with calcifications and patients without calcifications regarding serum calcium phosphorus and PTH level. In multivariate analysis age and diabetes significantly increased the risk factor for calcification (95% CI 1.033–1.065 p < 0.0001 and 95% CI 1.128–2.272 p < 0001 respectively). Moreover higher vitamin D levels and higher doses of IV Alfacalcidol were significant risk factors for calcifications (95% CI 1.005–1.030 p < 0.007 and 95% CI 1.092–1.270 p < 0.0001 respectively).
Conclusion: Our study found that vascular calcification was widespread among our dialysis population in Qatar. Implementing the practice of echocardiography in dialysis patients was extremely helpful and the most productive in detecting vascular calcification. Diabetes mellitus almost doubles the risk for vascular calcifications in dialysis patients. These results are beneficial in identifying risk factors for vascular calcification which can help stratify dialysis patients’ risk of cardiovascular disease and optimize prevention efforts.
National response to the COVID-19 Omicron variant crisis in the ambulatory hemodialysis service in the State of Qatar
The coronavirus disease (COVID-19) pandemic has had a significant worldwide impact since its emergence in 2019. End-stage kidney disease patients have been among the most vulnerable population affected and have a higher risk of acquiring infection and developing more severe disease. We have encountered three major COVID-19 waves in Qatar and they have required different strategies to overcome. The most recent wave was due to the Omicron variant characterized by higher transmissibility. The monthly incidence of COVID-19 infection during the Omicron wave in patients with end-stage renal disease peaked at 256 patients compared to 35 and 39 patients during the first and second waves respectively. In addition more than one-third of our dialysis staff became infected during this wave. Unlike the previous two waves COVID-19 due to the Omicron variant was less severe with only 5% of hemodialysis patients requiring admission to the intensive care unit compared to 25% during the previous waves. The Omicron variant wave resulted in a crisis in our country due to the high number of non-hospitalized COVID-19 hemodialysis patients and the severe staff shortage. Several measures were taken to overcome the crisis such as designating one facility to dialyze all COVID-19 ambulatory patients reducing dialysis sessions to 3 hours and introducing a fourth dialysis shift.
This article describes the challenges we faced in the ambulatory hemodialysis service during the Omicron wave and the measures taken in the COVID-19 and non-COVID-19 designated facilities to combat the crisis.
Challenges to improve the Coronavirus disease 2019 (COVID-19) Immunization among dialysis population in Hamad General Hospital in the Nephrology Division, Hamad Medical Corporation, Doha, State of Qatar
Background: Hamad General Hospital (HGH) Nephrology Department is the main provider for dialysis services in Qatar serving almost 900 patients. The introduction of the COVID-19 vaccination is a crucial step in protecting End Stage Renal Disease (ESRD) patients who are vulnerable and prone to infections due to their immunocompromised status.1 They are at high risk because they are unable to practice adequate safe physical distancing as the majority of them are dependent on others due to age and the medical condition.
During the first wave of the COVID 19 pandemic the mortality rate was 20-30% among the dialysis population.2 Several challenges were faced since February 2020 to manage and control COVID-19 infection in dialysis units. Vaccination is the most important preventive measure in facing COVID-19. Hence a multidisciplinary team was formulated in March 2020 aiming to raise the patients and staff awareness of the importance of COVID-19 vaccination. Methods: The assessment of dialysis patients’ knowledge and educational needs was done by conducting multidisciplinary focus group activities providing educational materials in many languages education through hospital TV channels WhatsApp group activities with patient educators and direct education during physicians’ monthly dialysis assessment. Monitoring the compliance rate was done by monthly data collection and targeting non-compliant groups. Results: After the implementation of COVID-19 immunization strategic plan by the end of June 2021 75% (666 patients) out of 884 dialysis patients were vaccinated (Figure 1). The current vaccination update for over 16-year-old in Qatar is 62.8% 3. Moreover COVID-19 positive patients were properly managed since the beginning of 2020 by following Ministry of Public Health (MOPH) guidelines to control the spread among the dialysis population and the successful initiation of COVID-19 vaccination program (Figure 2). Conclusion: Continuous educational activities and awareness campaigns have increased COVID-19 immunization percentage among the dialysis population and probably contributed to saving lives.
Impact of COVID-19 on dialysis patients: Reported experience in Qatar
Background: Patient-centered care is a concept focussing on meeting the specific health needs of patients as expressed by them. Patients Reported Experience Measures (PREM) is another concept associated with patient-centered care. PREM surveys capture information about the healthcare experience as perceived by patients.1 Its importance lies in the incorporation of patient feedback into the clinical decisions and service evolution.2 Dialysis patients play an important role in their treatment and their voice matters to provide proper care. PREM was first conducted in 2019 in our dialysis unit. In 2020 the COVID-19 impacted dialysis services and resulted in many challenges including staff shortage and deployment. Yet the patients’ feedback was evaluated continuously and compared with previous years before the pandemic. Methods: A validated questionnaire from the National Health Service in London was used.3 It consisted of 7 questions covering demographics dialysis options patient portal patient's relationship with the staff teamwork and traveling abroad. The survey involved 317 randomly selected patients who have been at least one year on dialysis. A comparison between 2019 and 2020 results was conducted using the chi-square test. Results: A drop in patients’ experience was observed in many survey components like education on dialysis medication side effects access to the patient portal access to physicians and nurses from home (Figure 2). However in other areas some positive experiences remained unchanged like communication and knowledge among the staff.:Conclusion: Patients’ reported experience helps in the evaluation of health services. After exploring dialysis patients’ experiences it was possible to identify what is going well and how COVID-19 impacted the patients’ perspectives. The PREM survey conducted in this work showed a significant decline in many parameters likely attributed to COVID-19 consequences including the staff shortages.
Time-Series Forecasting of Hemodialysis Population in the State of Qatar by 2030
Background: There are few statistics on dialysis-dependent individuals with end-stage kidney disease (ESKD) in Qatar. Having access to this information can aid in better understanding the dialysis development model aiding higher-level services in future planning. In order to give data for creating preventive efforts we thus propose a time-series with a definitive endogenous model to predict ESKD patients requiring dialysis.
Methods: In this study we used four mathematical equations linear exponential logarithmic decimal and polynomial regression to make predictions using historical data from 2012 to 2021. These equations were evaluated based on time-series analysis and their prediction performance was assessed using the mean absolute percentage error (MAPE) coefficient of determination (R2) and mean absolute deviation (MAD). Because it remained largely steady for the population at risk of ESKD in this investigation we did not consider the population growth factor to be changeable. (FIFA World Cup 2022 preparation workforce associated growth was in healthy and young workers that did not influence ESKD prevalence).
Result: The polynomial has a high R2 of 0.99 and is consequently the best match for the prevalence dialysis data according to numerical findings. Thus the MAPE is 2.28 and the MAD is 9.87% revealing a small prediction error with good accuracy and variability. The polynomial algorithm is the simplest and best-calculated projection model according to these results. The number of dialysis patients in Qatar is anticipated to increase to 1037 (95% CI 974–1126) in 2022 1245 (95% CI 911–1518) in 2025 and 1611 (95% CI 1378–1954) in 2030 with a 5.67% average yearly percentage change between 2022 and 2030.
Conclusion: Our research offers straightforward and precise mathematical models for predicting the number of patients in Qatar who will require dialysis in the future. We discovered that the polynomial technique outperformed other methods. Future planning for the need for dialysis services can benefit from this forecasting.
Medical research production in native languages: A descriptive analysis of PubMed database
Introduction: Language barriers in medicine can hinder effective communication comprehension and patient care. While English has emerged as the dominant language in global medicine the importance of native languages should not be overlooked. This article aims to examine the extent of publishing in native languages by analyzing the PubMed database literature to gain further insights into the usage of native languages in medicine and medical research.
Methods: In December 2023 a comprehensive examination of the PubMed literature was conducted for each of the 55 registered languages. We searched for records published in each language (e.g. German[lang]) by applying language filters. Ethnologue provided data on the number of worldwide native speakers for each language facilitating a comparative analysis.
Results: By December 2023 PubMed contained over 36 million publications with 86.5% of them published in English. German French and Russian came after English with over 700 thousand publications each. Among the languages analyzed fourteen had fewer than 50 publications nineteen had fewer than 100 twenty-two had fewer than 500 and twenty-five had fewer than one thousand publications. European languages were well-represented with thousands of publications each while widely spoken languages such as Hindi and Arabic had limited representation.
Conclusion: The production of medical research in native languages reflects the attention given to native languages in medicine and medical education within each country. It is crucial to provide due attention to these language-related issues and explore strategies for including native languages in medicine to bridge the gaps in language and medicine.