Dr. Mohammed Sallam | International American University (original) (raw)

Papers by Dr. Mohammed Sallam

Research paper thumbnail of Challenges in Elucidating HIV Genetic Diversity in the Middle East and North Africa: A Review Based on a Systematic Search

Preprints.org, 2024

The extensive genetic diversity of HIV-1 represents a major challenge to public health interventi... more The extensive genetic diversity of HIV-1 represents a major challenge to public health interventions, treatment, and successful vaccine design. This challenge is particularly pronounced in the Middle East and North Africa (MENA) region, where limited data among other barriers preclude accurate characterization of HIV-1 genetic diversity. The objective of this review was to analyze studies conducted in the MENA region to delineate possible barriers that would hinder accurate depiction of HIV-1 genetic diversity in the MENA region. A systematic search of PubMed/MEDLINE and Google Scholar was conducted for published records on HIV-1 genetic diversity in English up till 1 October 2024 across 18 MENA countries. The pre-defined themes of challenges/barriers included limited sampling, data gaps, resource and infrastructure constraints, HIV-specific factors, and socio-cultural barriers. A total of 38 records were included in the final review, comprising original articles (55.3%), reviews (21.1%), and sequence notes (10.5%). Libya (15.8%), Morocco (13.2%), Saudi Arabia and MENA as a whole (10.5% for each) were the primary sources of the included records. Of the 23 records with original MENA HIV-1 sequences, the median number of sequences was 46 (range: 6–193). The identified barriers included (1) low sampling density; (2) limited clinical data (21.7% with no data, 60.9% partial data, and 17.4% with full data); (3) reliance solely on population sequencing and insufficient use of advanced sequencing technologies; (4) lack of comprehensive recombination analysis; (5) socio-cultural barriers including stigma with subsequent underreporting among at-risk groups. The barriers identified in this review can hinder the ability to map the genetic diversity of HIV-1 in the MENA. Poor characterization of HIV-1 genetic diversity in the MENA would hinder the efforts to optimize prevention strategies, monitor drug resistance, and develop MENA-specific treatment protocols. To overcome these challenges, investment in public health/research infrastructure, policy reforms to reduce stigma, and strengthened regional collaboration are recommended.

Research paper thumbnail of Addressing Drug Shortages at Mediclinic Parkview Hospital: A ‎Five-Year Study of ‎Challenges, Impact, and Strategies

Cureus, 2024

Background: Drug shortages have become a significant challenge globally, affecting healthcare del... more Background: Drug shortages have become a significant challenge globally, affecting healthcare delivery and patient outcomes. This study aimed to assess drug shortages’ prevalence, causes, and impact at a tertiary care hospital in Dubai, the United Arab Emirates (UAE), providing actionable insights for future mitigation strategies. Methods: A retrospective descriptive study was conducted at Mediclinic Parkview (MPAR) Hospital, part of Mediclinic Middle East (MCME), UAE. Data were collected from January 2019 to December 2023. Reported drug shortages were analyzed to assess their frequency, duration, causes, and management, with a focus on identifying trends and underlying factors. Results: Drug shortages peaked at 995 in 2020, particularly during the COVID-19 pandemic. The median time spent managing shortages reached 19.5 days per shortage in Q3 2020. Oral forms accounted for the highest frequency (n = 2231), representing 61% of all shortages, followed by topical forms (n = 414, 11%) and injection forms (n = 386, 10%). Most affected drugs were in the infectious disease (n = 547, 15%), cardiovascular (n = 387, 11%), and respiratory (n = 330, 9%) categories. Drug shortages were driven by regulatory issues and manufacturing delays (39%), unknown reasons (29%), and supply chain disruptions exacerbated by the pandemic (10%). A monopoly environment worsened the situation and limited sourcing flexibility, with 66% of shortages linked to zero supply competitors. Tirzepatide (n = 20) and oseltamivir (n = 18) were the drugs most frequently reported to be unavailable over the 60-month study interval. Regarding management efforts, 80% of the time was spent gathering information and communicating with the different stakeholders. The hospital’s response included contacting prescribers for alternatives and increased reliance on internal procurement and inter-pharmacy coordination. These shortages caused significant operational strain, with increased workloads and higher costs. Conclusion: The study highlighted the need for adopting proactive measures, improved strategies, enhanced communication, and better preparedness to address future drug shortages. Key actions involved investing in technology, strengthening supplier relationships, and advocating for policy reforms to mitigate risks and ensure continuity of care.

Research paper thumbnail of Generative Artificial Intelligence and Cybersecurity Risks: Implications for Healthcare Security Based on Real-life Incidents

Mesopotamian Journal of Artificial Intelligence in Healthcare, 2024

Background: The potential of generative artificial intelligence (genAI) tools, such as ChatGPT, i... more Background: The potential of generative artificial intelligence (genAI) tools, such as ChatGPT, is being increasingly explored in healthcare settings. However, the same tools also introduce significant cybersecurity risks that could compromise patient safety, data integrity, and institutional trust. This study aimed to examine real-world security breaches involving genAI and extrapolate their potential implications for healthcare settings. Methods: Using a systematic Google News search and a consensus-based approach among the authors, five high-profile genAI breaches were identified and analyzed. These cases included: (1) Data exposure in ChatGPT (OpenAI) due to an open-source library bug (March 2023); (2) Unauthorized data disclosure via Samsung’s (Samsung Group) use of ChatGPT (2023); (3) Logical vulnerabilities in Chevrolet (General Motors) AI-powered chatbot resulting in pricing errors (December 2023); (4) Prompt injection vulnerability in Vanna AI (Vanna AI, Inc.) which enabled remote code execution (2024); and (5) the deepfake technology used in a scam targeting the engineering firm Arup (Arup Group Limited), leading to fraudulent transactions (February 2024). Hypothetical healthcare scenarios were constructed based on the five cases, mapping their mechanisms to vulnerabilities in electronic health records (EHRs), clinical decision support systems (CDSS), and patient engagement platforms. Each case was analyzed using the Confidentiality, Integrity, and Availability (CIA) triad of information security to systematically identify vulnerabilities and propose actionable safeguards. Results: The analyzed cases of AI security breaches revealed significant risks to healthcare systems. Confidentiality violations included the potential exposure of sensitive patient records and billing information, extrapolated from incidents such as the ChatGPT data exposure and Samsung’s cases. These identified security breaches raised concerns about privacy violations, identity theft, and non-compliance with regulations such as Health Insurance Portability and Accountability Act (HIPAA). Integrity vulnerabilities were highlighted in Vanna AI's prompt injection flaw incident, with risks of altering patient records, compromising diagnostic algorithms, and misleading CDSS with erroneous recommendations. Similarly, logic errors identified in the Chevrolet case exposed potential risks of inaccurate billing, double-booked appointments, and flawed treatment plans within healthcare contexts. Availability disruptions, observed through system outages and operational suspensions following breaches like the ChatGPT and deepfake cases, can delay access to EHR systems or AI-driven CDSS. Such interruptions would directly impact patient care and create inefficiencies in administrative workflows. Conclusions: Generative AI presents a double-edged sword in healthcare, with transformative potential accompanied by substantial risks. Extrapolation of security breach cases in this study highlighted the urgent need for robust safeguards if genAI is implemented in healthcare settings. To address these vulnerabilities, healthcare institutions must implement strong security protocols, enforce strict data governance, and create AI-specific incident response plans. The balance between genAI-enabled innovation and protection of patient safety and data integrity trust requires proactive safety measures.

Research paper thumbnail of Current Developments in Malaria  Vaccination: A Concise Review on  Implementation, Challenges, and Future  Directions

Preprint, 2024

Malaria remains a persistent challenge in global health, disproportionately affecting populations... more Malaria remains a persistent challenge in global health, disproportionately affecting populations in endemic regions (e.g., sub-Saharan Africa). Despite decades of international collaborative efforts, this parasitic disease continues to claim hundreds of thousands of lives each year, with young children and pregnant women enduring the heaviest burden of malaria. The introduction of pre-erythrocytic malaria vaccines (RTS,S/AS01 and R21/Matrix-M), represents an important milestone in malaria control efforts with promising results from the erythrocytic vaccine RH5.1/Matrix-M in recent clinical trials. However, the approval of these vaccines is accompanied by significant challenges such as the limited efficacy, the complexity of multi-dose regimens, and numerous barriers to widespread implementation in resource-limited settings. This concise review provides an overview of the historical development and current status of malaria vaccines, tracking their milestones from initial scientific breakthroughs to the deployment of first-generation vaccines. The review also examines the complex challenges to broad malaria vaccination coverage, including logistical barriers, healthcare infrastructure effect, financial limitations, malaria vaccine hesitancy, among other obstacles in malaria-endemic regions. Additionally, we explore promising developments in malaria vaccination, such as next-generation candidates (e.g., mRNA-based vaccines), that hold the potential to offer improved efficacy, longer-lasting protection, and greater scalability. Finally, we emphasize the critical need to integrate malaria vaccination efforts with established malaria control interventions (e.g., insecticide-treated bed nets, vector control strategies, and anti-malarial drugs). Based on this review, we concluded that achieving sustained control of malaria morbidity and mortality will require strong global collaboration, sufficient funding, and continuous efforts to address inequities in access and delivery of malaria control measures including the malaria vaccines.

Research paper thumbnail of Cross-Linguistic Evaluation of Generative AI Models for  Diabetes and Endocrine Queries

Jordan Medical Journal, 2024

Background and Aims: Endocrine and metabolic disorders, including diabetes mellitus (DM), pose m... more Background and Aims: Endocrine and metabolic disorders, including diabetes
mellitus (DM), pose major global health challenges. Generative artificial
intelligence (genAI) models are increasingly used for patient self-help. This study
aimed to evaluate the performance of two genAI models, ChatGPT and Microsoft
Copilot, in addressing endocrine-related queries in English and Arabic.
Materials and Methods: This descriptive study adhered to the METRICS
checklist for genAI-based healthcare studies, comparing responses from
ChatGPT-4o and Microsoft Copilot to 20 endocrine-related queries in English and
Arabic (15 DM queries in addition to five endocrine queries). The responses were
evaluated using the CLEAR tool, which assessed completeness, accuracy, and
relevance/appropriateness. Three endocrinology experts independently evaluated
the genAI outputs.
Results: Per language and model, a total of 80 responses were assessed. Inter
rater reliability was high with Intraclass Correlation Coefficient=0.832.
ChatGPT-4o consistently outperformed Microsoft Copilot, earning 'Excellent'
ratings in English and ‘Very good’ in Arabic, while Microsoft Copilot achieved
‘Very good’ ratings in English and ‘Good’ to ‘Very good’ ratings in Arabic.
ChatGPT-4o surpassed Microsoft Copilot in completeness (4.38 vs. 3.36, p<.001,
Mann-Whitney U test (M-W)), accuracy (4.18 vs. 3.83, p=.014, M-W), and
relevance (4.44 vs. 3.82, p<.001, M-W). Performance varied significantly
between English and Arabic responses, with p<.001 for completeness, p=.001 for
accuracy, p=.012 for relevance, and p<.001 for the overall CLEAR score using
the M-W test. No statistically significant differences were found based on the
query topic.
Conclusions: ChatGPT-4o outperformed Microsoft Copilot in all CLEAR
components, but notable language-based disparities were evident. Addressing
these limitations is crucial to ensure equitable access to endocrine care for non
English-speaking patients.

Research paper thumbnail of Shifting the Scales: Tirzepatide's Breakthrough in Obesity Management

Curēus, May 18, 2024

Obesity is a complex and chronic condition that presents a significant global health challenge, r... more Obesity is a complex and chronic condition that presents a significant global health challenge, resulting in a wide range of health problems, such as heart disease, stroke, and diabetes, therefore diminishing the overall well-being of numerous individuals. Conventional treatment options often prove inadequate, providing temporary relief and frequent weight regain. However, a promising medication called tirzepatide has emerged and been approved by the FDA as a groundbreaking solution for managing obesity. Through its unique mechanism of action as a glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist, as well as its impressive results in clinical trials, tirzepatide has the potential to completely transform the current approach to treating obesity. This editorial provides a quick snap for the clinical implications of tirzepatide, its mechanism of action, effectiveness, safety record, and the challenges it faces, such as insurance coverage and drug shortages. It emphasizes the importance of an integrated treatment approach and highlights the necessity for continuous research and policy backing to enhance accessibility and advance public health outcomes related to weight management.

Research paper thumbnail of From Protection to Prevention: Redefining Vaccines in the Context of Antimicrobial Resistance

Curēus, May 18, 2024

Antimicrobial resistance (AMR) poses a significant threat to global health, compromising the effe... more Antimicrobial resistance (AMR) poses a significant threat to global health, compromising the effectiveness of treatments and increasing medical risks. In this crisis, the importance of vaccines in reducing AMR is being increasingly acknowledged, although not thoroughly explored. This literature review asserts that vaccines can significantly lessen the occurrence of infections, thereby reducing the need for antibiotics and limiting the emergence of resistance. Vaccines play a crucial role in antimicrobial stewardship programs by preventing diseases that would otherwise necessitate the use of antibiotics. Expanding vaccine coverage supports responsible usage of antimicrobials and aligns with global health priorities to maintain effective medical interventions. This review emphasizes the need for equitable funding and policy support for vaccine initiatives comparable to new antibiotics and diagnostic techniques. Moreover, it calls for more detailed investigations into vaccines' economic and health benefits in managing AMR, highlighting their potential as cost-effective solutions to this urgent health challenge. Through a careful analysis of existing literature, this review highlights the fundamental role of vaccines in transforming the landscape of AMR, shifting the focus from a protective approach to a preventive health strategy.

Research paper thumbnail of Enhancing Hospital Pharmacy Operations Through Lean and Six Sigma Strategies: A Systematic Review

Research paper thumbnail of Examining the Influence of Joint Commission International (JCI) Accreditation Surveys on Medication Safety Practices: A Cross-Sectional Study from Mediclinic Welcare Hospital in Dubai, UAE

Journal of Integrated Health, Oct 11, 2023

Research paper thumbnail of CLEAR: Pilot Testing of a Tool to Standardize Assessment of the Quality of Health Information Generated by Artificial Intelligence-Based Models

Artificial intelligence (AI)-based conversational models, such as ChatGPT, Microsoft Bing, and Go... more Artificial intelligence (AI)-based conversational models, such as ChatGPT, Microsoft Bing, and Google Bard, emerged as valuable sources of health information for the lay individuals. However, the accuracy of information provided by these AI models remains a significant concern. This pilot study aimed to test a new tool referred to as “CLEAR”, designed to assess the quality of health information delivered by AI-based models. Tool development involved a literature review on health information quality, followed by initial establishment of the CLEAR tool comprising five items that aimed to assess the following: completeness of content in response to the prompt, lack of false information, evidence support, appropriateness, and relevance of the generated content. Each item was scored on a 5-point Likert scale from excellent to poor. Content validity was checked by expert review of the initial items. Pilot testing involved 32 healthcare professionals using the CLEAR tool to assess content ...

Research paper thumbnail of Assessment of Artificial Intelligence ‎Credibility in Evidence-Based ‎Healthcare Management with “AERUS” Innovative Tool

Journal of Artificial Intelligence, Machine Learning and Data Science, Feb 19, 2024

Research paper thumbnail of Benchmarking Generative AI: A Call for Establishing a Comprehensive Framework and a Generative AIQ Test

Mesopotamian Journal of Artificial Intelligence in Healthcare, 2024

The introduction and rapid evolution of generative artificial intelligence (genAI) models necessi... more The introduction and rapid evolution of generative artificial intelligence (genAI) models necessitates a refined understanding for the concept of "intelligence". The genAI tools are known for its capability to produce complex, creative, and contextually relevant output. Nevertheless, the deployment of genAI models in healthcare should be accompanied appropriate and rigorous performance evaluation tools. In this rapid communication, we emphasizes the urgent need to develop a "Generative AIQ Test" as a novel tailored tool for comprehensive benchmarking of genAI models against multiple human-like intelligence attributes. A preliminary framework is proposed in this communication. This framework incorporates miscellaneous performance metrics including accuracy, diversity, novelty, and consistency. These metrics were considered critical in the evaluation of genAI models that might be utilized to generate diagnostic recommendations, treatment plans, and patient interaction suggestions. This communication also highlights the importance of orchestrated collaboration to construct robust and well-annotated benchmarking datasets to capture the complexity of diverse medical scenarios and patient demographics. This communication suggests an approach aiming to ensure that genAI models are effective, equitable, and transparent. To maximize the potential of genAI models in healthcare, it is important to establish rigorous, dynamic standards for its benchmarking. Consequently, this approach can help to improve clinical decision-making with enhancement in patient care, which will enhance the reliability of genAI applications in healthcare.

Research paper thumbnail of From Protection to Prevention: Redefining Vaccines in the Context of Antimicrobial Resistance

Cureus, 2024

Antimicrobial resistance (AMR) poses a significant threat to global health, compromising the effe... more Antimicrobial resistance (AMR) poses a significant threat to global health, compromising the effectiveness of treatments and increasing medical risks. In this crisis, the importance of vaccines in reducing AMR is being increasingly acknowledged, although not thoroughly explored. This literature review asserts that vaccines can significantly lessen the occurrence of infections, thereby reducing the need for antibiotics and limiting the emergence of resistance. Vaccines play a crucial role in antimicrobial stewardship programs by preventing diseases that would otherwise necessitate the use of antibiotics. Expanding vaccine coverage supports responsible usage of antimicrobials and aligns with global health priorities to maintain effective medical interventions. This review emphasizes the need for equitable funding and policy support for vaccine initiatives comparable to new antibiotics and diagnostic techniques. Moreover, it calls for more detailed investigations into vaccines' economic and health benefits in managing AMR, highlighting their potential as cost-effective solutions to this urgent health challenge. Through a careful analysis of existing literature, this review highlights the fundamental role of vaccines in transforming the landscape of AMR, shifting the focus from a protective approach to a preventive health strategy.

Research paper thumbnail of Shifting the Scales: Tirzepatide's Breakthrough in Obesity Management

Cureus, 2024

Obesity is a complex and chronic condition that presents a significant global health challenge, r... more Obesity is a complex and chronic condition that presents a significant global health challenge, resulting in a wide range of health problems, such as heart disease, stroke, and diabetes, therefore diminishing the overall well-being of numerous individuals. Conventional treatment options often prove inadequate, providing temporary relief and frequent weight regain. However, a promising medication called tirzepatide has emerged and been approved by the FDA as a groundbreaking solution for managing obesity. Through its unique mechanism of action as a glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist, as well as its impressive results in clinical trials, tirzepatide has the potential to completely transform the current approach to treating obesity. This editorial provides a quick snap for the clinical implications of tirzepatide, its mechanism of action, effectiveness, safety record, and the challenges it faces, such as insurance coverage and drug shortages. It emphasizes the importance of an integrated treatment approach and highlights the necessity for continuous research and policy backing to enhance accessibility and advance public health outcomes related to weight management.

Research paper thumbnail of The Role of Psychological Factors and Vaccine Conspiracy Beliefs in Influenza Vaccine Hesitancy and Uptake among Jordanian Healthcare Workers during the COVID-19 Pandemic

Vaccines

Vaccination to prevent influenza virus infection and to lessen its severity is recommended among ... more Vaccination to prevent influenza virus infection and to lessen its severity is recommended among healthcare workers (HCWs). Health professionals have a higher risk of exposure to viruses and could transmit the influenza virus to vulnerable patients who are prone to severe disease and mortality. The aim of the current study was to evaluate the levels of influenza vaccine acceptance and uptake as well as its determinants, among Jordanian HCWs over the last influenza season of 2021/2022. This study was based on a self-administered electronic survey that was distributed in March 2022. Psychological determinants of influenza vaccine acceptance and vaccine conspiracy beliefs were assessed using the previously validated 5C scale questionnaire (confidence, complacency, constraints, calculation and collective responsibility) and the vaccine conspiracy beliefs scale. The study sample comprised a total of 1218 HCWs: nurses (n = 412, 33.8%), physicians (n = 367, 30.1%), medical technicians (n =...

Research paper thumbnail of A Global Map of COVID-19 Vaccine Acceptance Rates per Country: An Updated Concise Narrative Review

Journal of Multidisciplinary Healthcare, 2022

The delay or refusal of vaccination, which defines vaccine hesitancy, is a major challenge to suc... more The delay or refusal of vaccination, which defines vaccine hesitancy, is a major challenge to successful control of COVID-19 epidemic. The huge number of publications addressing COVID-19 vaccine hesitancy necessitates periodic review to provide a concise summary of COVID-19 vaccine acceptance rates worldwide. In the current narrative review, data on COVID-19 vaccine acceptance rates were retrieved from surveys in 114 countries/ territories. In East and Southern Africa (n = 9), the highest COVID-19 vaccine acceptance rate was reported in Ethiopia (92%), while the lowest rate was reported in Zimbabwe (50%). In West/ Central Africa (n = 13), the highest rate was reported in Niger (93%), while the lowest rate was reported in Cameroon (15%). In Asia and the Pacific (n = 16), the highest rates were reported in Nepal and Vietnam (97%), while the lowest rate was reported in Hong Kong (42%). In Eastern Europe/Central Asia (n = 7), the highest rates were reported in Montenegro (69%) and Kazakhstan (64%), while the lowest rate was reported in Russia (30%). In Latin America and the Caribbean (n = 20), the highest rate was reported in Mexico (88%), while the lowest rate was reported in Haiti (43%). In the Middle East/North Africa (MENA, n = 22), the highest rate was reported in Tunisia (92%), while the lowest rate was reported in Iraq (13%). In Western/Central Europe and North America (n = 27), the highest rates were reported in Canada (91%) and Norway (89%), while the lowest rates were reported in Cyprus and Portugal (35%). COVID-19 vaccine acceptance rates ≥60% were seen in 72/114 countries/territories, compared to 42 countries/territories with rates between 13% and 59%. The phenomenon of COVID-19 vaccine hesitancy appeared more pronounced in the MENA, Europe and Central Asia, and Western/ Central Africa. More studies are recommended in Africa, Eastern Europe and Central Asia to address intentions of the general public to get COVID-19 vaccination.

Research paper thumbnail of Enhancing Hospital Pharmacy Operations Through Lean and Six Sigma Strategies: A Systematic Review

Cureus, 2024

Hospital pharmacies are integral to the healthcare system, and evaluating the factors influencing... more Hospital pharmacies are integral to the healthcare system, and evaluating the factors influencing their efficiency and service standards is imperative. This analysis offers global insights to assist in developing strategies for future enhancements. The objective is to identify the optimal Lean Six Sigma methodologies to improve workflow and quality of hospital pharmacy services. To the best of the author's knowledge, this research is believed to be the first in-depth analysis of Lean and Six Sigma in the hospital pharmacy domain, spanning 15 years from 2009 to 2023.

Research paper thumbnail of Improving Efficiency in Hospital Pharmacy Services: An Integrated Strategy Using the OCTAGON-P Framework and Lean 5S Management Practices

Cureus, 2024

Background Hospital pharmacy departments have a critical role in the healthcare system, as they a... more Background
Hospital pharmacy departments have a critical role in the healthcare system, as they aim to provide excellent patient services while also ensuring cost-effectiveness. Lean methodologies are well-known for improving efficiency and quality in various industries, but their impact on healthcare, particularly in hospital pharmacy settings, has not been thoroughly investigated.

Aim
This quality improvement (QI) study aimed to assess the impact of implementing the sort, set in order, shine, standardize, and sustain (5S) methodology using the innovative orientation, coordination, training, awareness, governance, observation, normalization, and promotion (OCTAGON-P) framework on the operations of Mediclinic Parkview Hospital (MPAR) Pharmacy in Dubai, UAE.

Methods
The QI project spanned a period of six weeks, from December 18th, 2023, to January 28th, 2024. Throughout this period, a new novel OCTAGON-P framework's eight crucial elements were methodically integrated. Simultaneously, an extensive preparation process encompassing the five stages of the 5S method was carried out.

Results
The findings indicated a notable enhancement in organization, orderliness, cleanliness, medication storage, and workspace standardization. The significant improvement of 217% in terms of organization highlighted the effectiveness of resource arrangement. The orderliness of the workspace saw an increase of 800%, indicating a transformation in the systematic organization. Additionally, cleanliness improved by 138%, demonstrating a significant advancement in maintaining a spotless environment. The standardization of processes experienced a boost of 300%, reflecting a solidified approach to consistent operational methods. These refinements resulted in an overall improvement of 90% from the initial baseline of 20% on the 5S checklist scores. Efficiency gains were observed, with outpatient medication retrieval times reduced by 50%, inpatient times by 40%, emergency prescription serving by 16.7%, and pediatric prescription serving by 11%. The inpatient medication return process saw a 67% improvement. Patient counseling time increased by 23.3%, indicating a more patient-centered approach. Prescription verification and medication expiry checks increased by 50% and 200%, respectively, enhancing the quality of care. Inventory management efficiency improved by 36%, and medication label printing time decreased by 70% with the additional label printers. Installing extra medication label printers was done through the OCTAGON-P framework, specifically in the "orientation" and "coordination" phases. These two initial phases focused on leadership's 5S orientation, management support, and securing additional resources. Therefore, the OCTAGON-P framework provided a structured approach that promoted continuous improvement and sustained lean practices.

Conclusion
This research study presented the remarkable effectiveness of the OCTAGON-P framework in structurally implementing the 5S methodology into hospital pharmacy operations. The findings underscored the potential of lean 5S to enhance and optimize operational efficiency and overall quality within the critical environment of hospital pharmacy settings. Consequently, these improvements can conclusively result in the provision of superior and enhanced patient care, which is truly fundamental and central to the mission and objectives of any healthcare institution.

Research paper thumbnail of A Preliminary Checklist (METRICS) to Standardize the Design and Reporting of Studies on Generative Artificial Intelligence-Based Models in Health Care Education and Practice: Development Study Involving a Literature Review

Interactive Journal of Medical Research, 2024

Background: Adherence to evidence-based practice is indispensable in health care. Recently, the u... more Background: Adherence to evidence-based practice is indispensable in health care. Recently, the utility of generative artificial intelligence (AI) models in health care has been evaluated extensively. However, the lack of consensus guidelines on the design and reporting of findings of these studies poses a challenge for the interpretation and synthesis of evidence. Objective: This study aimed to develop a preliminary checklist to standardize the reporting of generative AI-based studies in health care education and practice. Methods: A literature review was conducted in Scopus, PubMed, and Google Scholar. Published records with "ChatGPT," "Bing," or "Bard" in the title were retrieved. Careful examination of the methodologies employed in the included records was conducted to identify the common pertinent themes and the possible gaps in reporting. A panel discussion was held to establish a unified and thorough checklist for the reporting of AI studies in health care. The finalized checklist was used to evaluate the included records by 2 independent raters. Cohen κ was used as the method to evaluate the interrater reliability. Results: The final data set that formed the basis for pertinent theme identification and analysis comprised a total of 34 records. The finalized checklist included 9 pertinent themes collectively referred to as METRICS (Model, Evaluation, Timing, Range/Randomization, Individual factors, Count, and Specificity of prompts and language). Their details are as follows: (1) Model used and its exact settings; (2) Evaluation approach for the generated content; (3) Timing of testing the model; (4) Transparency of the data source; (5) Range of tested topics; (6) Randomization of selecting the queries; (7) Individual factors in selecting the queries and interrater reliability; (8) Count of queries executed to test the model; and (9) Specificity of the prompts and language used. The overall mean METRICS score was 3.0 (SD 0.58). The tested METRICS score was acceptable, with the range of Cohen κ of 0.558 to 0.962 (P<.001 for the 9 tested items). With classification per item, the highest average METRICS score was recorded for the "Model" item, followed by the "Specificity" item, while the lowest scores were recorded for the "Randomization" item (classified as suboptimal) and "Individual factors" item (classified as satisfactory). Conclusions: The METRICS checklist can facilitate the design of studies guiding researchers toward best practices in reporting results. The findings highlight the need for standardized reporting algorithms for generative AI-based studies in health care, considering the variability observed in methodologies and reporting. The proposed METRICS checklist could be a preliminary

Research paper thumbnail of Assessment of Artificial Intelligence Credibility in Evidence-Based Healthcare Management with "AERUS" Innovative Tool

Journal of Artificial Intelligence Machine Learning and Data Science, 2024

Background: Artificial Intelligence (AI) technologies have found applications across various aren... more Background: Artificial Intelligence (AI) technologies have found applications across various arenas, and Evidence-Based Management (EBMgt) is no exception. However, in this context, the careful assessment of AI outcomes becomes essential to confirm their credibility and ensure adherence to ethical standards. Mirroring recent similar explorations in the literature, this study introduced the "AERUS" tool, designed to evaluate AI trustworthiness in healthcare administration, focusing on five key areas: Accuracy, Efficiency, Reliability, Usability, and Security. Methods: The AERUS instrument evaluated AI's reliability in healthcare administration. It underwent minor revisions after an initial test with thirty healthcare administrators and internal consistency confirmation via Cronbach's alpha. The final version was tested on four AI models (ChatGPT 3.5, ChatGPT 4, Microsoft Bing, Google Bard) over six managerial topics, with evaluation by two raters using Cohen's kappa. Results: The refined AERUS tool assessed five areas: AI accuracy in management data, operational efficiency impact, decisionmaking reliability, user-friendliness for managers, and security protocol adherence. Initial testing with ten healthcare management statements showed high internal consistency (Cronbach's alpha of .911). Among six assessments, Microsoft Bing scored highest (mean 22.93, SD 1.11), followed by ChatGPT-4 (mean 22.00, SD 1.21), ChatGPT-3.5 (mean 20.00, SD 1.21), and Google Bard (mean 19.60, SD 1.22). Inter-rater agreement resulted in Cohen's kappa values ranging from 0.358 to 0.885 for the AI models. Conclusions and Recommendations: AERUS presents a supporting instrument for addressing AI credibility concerns in EBMgt, with recommendations for further research and widespread implementation to ensure the trustworthiness and reliability of AI in professional managerial decision-making.

Research paper thumbnail of Challenges in Elucidating HIV Genetic Diversity in the Middle East and North Africa: A Review Based on a Systematic Search

Preprints.org, 2024

The extensive genetic diversity of HIV-1 represents a major challenge to public health interventi... more The extensive genetic diversity of HIV-1 represents a major challenge to public health interventions, treatment, and successful vaccine design. This challenge is particularly pronounced in the Middle East and North Africa (MENA) region, where limited data among other barriers preclude accurate characterization of HIV-1 genetic diversity. The objective of this review was to analyze studies conducted in the MENA region to delineate possible barriers that would hinder accurate depiction of HIV-1 genetic diversity in the MENA region. A systematic search of PubMed/MEDLINE and Google Scholar was conducted for published records on HIV-1 genetic diversity in English up till 1 October 2024 across 18 MENA countries. The pre-defined themes of challenges/barriers included limited sampling, data gaps, resource and infrastructure constraints, HIV-specific factors, and socio-cultural barriers. A total of 38 records were included in the final review, comprising original articles (55.3%), reviews (21.1%), and sequence notes (10.5%). Libya (15.8%), Morocco (13.2%), Saudi Arabia and MENA as a whole (10.5% for each) were the primary sources of the included records. Of the 23 records with original MENA HIV-1 sequences, the median number of sequences was 46 (range: 6–193). The identified barriers included (1) low sampling density; (2) limited clinical data (21.7% with no data, 60.9% partial data, and 17.4% with full data); (3) reliance solely on population sequencing and insufficient use of advanced sequencing technologies; (4) lack of comprehensive recombination analysis; (5) socio-cultural barriers including stigma with subsequent underreporting among at-risk groups. The barriers identified in this review can hinder the ability to map the genetic diversity of HIV-1 in the MENA. Poor characterization of HIV-1 genetic diversity in the MENA would hinder the efforts to optimize prevention strategies, monitor drug resistance, and develop MENA-specific treatment protocols. To overcome these challenges, investment in public health/research infrastructure, policy reforms to reduce stigma, and strengthened regional collaboration are recommended.

Research paper thumbnail of Addressing Drug Shortages at Mediclinic Parkview Hospital: A ‎Five-Year Study of ‎Challenges, Impact, and Strategies

Cureus, 2024

Background: Drug shortages have become a significant challenge globally, affecting healthcare del... more Background: Drug shortages have become a significant challenge globally, affecting healthcare delivery and patient outcomes. This study aimed to assess drug shortages’ prevalence, causes, and impact at a tertiary care hospital in Dubai, the United Arab Emirates (UAE), providing actionable insights for future mitigation strategies. Methods: A retrospective descriptive study was conducted at Mediclinic Parkview (MPAR) Hospital, part of Mediclinic Middle East (MCME), UAE. Data were collected from January 2019 to December 2023. Reported drug shortages were analyzed to assess their frequency, duration, causes, and management, with a focus on identifying trends and underlying factors. Results: Drug shortages peaked at 995 in 2020, particularly during the COVID-19 pandemic. The median time spent managing shortages reached 19.5 days per shortage in Q3 2020. Oral forms accounted for the highest frequency (n = 2231), representing 61% of all shortages, followed by topical forms (n = 414, 11%) and injection forms (n = 386, 10%). Most affected drugs were in the infectious disease (n = 547, 15%), cardiovascular (n = 387, 11%), and respiratory (n = 330, 9%) categories. Drug shortages were driven by regulatory issues and manufacturing delays (39%), unknown reasons (29%), and supply chain disruptions exacerbated by the pandemic (10%). A monopoly environment worsened the situation and limited sourcing flexibility, with 66% of shortages linked to zero supply competitors. Tirzepatide (n = 20) and oseltamivir (n = 18) were the drugs most frequently reported to be unavailable over the 60-month study interval. Regarding management efforts, 80% of the time was spent gathering information and communicating with the different stakeholders. The hospital’s response included contacting prescribers for alternatives and increased reliance on internal procurement and inter-pharmacy coordination. These shortages caused significant operational strain, with increased workloads and higher costs. Conclusion: The study highlighted the need for adopting proactive measures, improved strategies, enhanced communication, and better preparedness to address future drug shortages. Key actions involved investing in technology, strengthening supplier relationships, and advocating for policy reforms to mitigate risks and ensure continuity of care.

Research paper thumbnail of Generative Artificial Intelligence and Cybersecurity Risks: Implications for Healthcare Security Based on Real-life Incidents

Mesopotamian Journal of Artificial Intelligence in Healthcare, 2024

Background: The potential of generative artificial intelligence (genAI) tools, such as ChatGPT, i... more Background: The potential of generative artificial intelligence (genAI) tools, such as ChatGPT, is being increasingly explored in healthcare settings. However, the same tools also introduce significant cybersecurity risks that could compromise patient safety, data integrity, and institutional trust. This study aimed to examine real-world security breaches involving genAI and extrapolate their potential implications for healthcare settings. Methods: Using a systematic Google News search and a consensus-based approach among the authors, five high-profile genAI breaches were identified and analyzed. These cases included: (1) Data exposure in ChatGPT (OpenAI) due to an open-source library bug (March 2023); (2) Unauthorized data disclosure via Samsung’s (Samsung Group) use of ChatGPT (2023); (3) Logical vulnerabilities in Chevrolet (General Motors) AI-powered chatbot resulting in pricing errors (December 2023); (4) Prompt injection vulnerability in Vanna AI (Vanna AI, Inc.) which enabled remote code execution (2024); and (5) the deepfake technology used in a scam targeting the engineering firm Arup (Arup Group Limited), leading to fraudulent transactions (February 2024). Hypothetical healthcare scenarios were constructed based on the five cases, mapping their mechanisms to vulnerabilities in electronic health records (EHRs), clinical decision support systems (CDSS), and patient engagement platforms. Each case was analyzed using the Confidentiality, Integrity, and Availability (CIA) triad of information security to systematically identify vulnerabilities and propose actionable safeguards. Results: The analyzed cases of AI security breaches revealed significant risks to healthcare systems. Confidentiality violations included the potential exposure of sensitive patient records and billing information, extrapolated from incidents such as the ChatGPT data exposure and Samsung’s cases. These identified security breaches raised concerns about privacy violations, identity theft, and non-compliance with regulations such as Health Insurance Portability and Accountability Act (HIPAA). Integrity vulnerabilities were highlighted in Vanna AI's prompt injection flaw incident, with risks of altering patient records, compromising diagnostic algorithms, and misleading CDSS with erroneous recommendations. Similarly, logic errors identified in the Chevrolet case exposed potential risks of inaccurate billing, double-booked appointments, and flawed treatment plans within healthcare contexts. Availability disruptions, observed through system outages and operational suspensions following breaches like the ChatGPT and deepfake cases, can delay access to EHR systems or AI-driven CDSS. Such interruptions would directly impact patient care and create inefficiencies in administrative workflows. Conclusions: Generative AI presents a double-edged sword in healthcare, with transformative potential accompanied by substantial risks. Extrapolation of security breach cases in this study highlighted the urgent need for robust safeguards if genAI is implemented in healthcare settings. To address these vulnerabilities, healthcare institutions must implement strong security protocols, enforce strict data governance, and create AI-specific incident response plans. The balance between genAI-enabled innovation and protection of patient safety and data integrity trust requires proactive safety measures.

Research paper thumbnail of Current Developments in Malaria  Vaccination: A Concise Review on  Implementation, Challenges, and Future  Directions

Preprint, 2024

Malaria remains a persistent challenge in global health, disproportionately affecting populations... more Malaria remains a persistent challenge in global health, disproportionately affecting populations in endemic regions (e.g., sub-Saharan Africa). Despite decades of international collaborative efforts, this parasitic disease continues to claim hundreds of thousands of lives each year, with young children and pregnant women enduring the heaviest burden of malaria. The introduction of pre-erythrocytic malaria vaccines (RTS,S/AS01 and R21/Matrix-M), represents an important milestone in malaria control efforts with promising results from the erythrocytic vaccine RH5.1/Matrix-M in recent clinical trials. However, the approval of these vaccines is accompanied by significant challenges such as the limited efficacy, the complexity of multi-dose regimens, and numerous barriers to widespread implementation in resource-limited settings. This concise review provides an overview of the historical development and current status of malaria vaccines, tracking their milestones from initial scientific breakthroughs to the deployment of first-generation vaccines. The review also examines the complex challenges to broad malaria vaccination coverage, including logistical barriers, healthcare infrastructure effect, financial limitations, malaria vaccine hesitancy, among other obstacles in malaria-endemic regions. Additionally, we explore promising developments in malaria vaccination, such as next-generation candidates (e.g., mRNA-based vaccines), that hold the potential to offer improved efficacy, longer-lasting protection, and greater scalability. Finally, we emphasize the critical need to integrate malaria vaccination efforts with established malaria control interventions (e.g., insecticide-treated bed nets, vector control strategies, and anti-malarial drugs). Based on this review, we concluded that achieving sustained control of malaria morbidity and mortality will require strong global collaboration, sufficient funding, and continuous efforts to address inequities in access and delivery of malaria control measures including the malaria vaccines.

Research paper thumbnail of Cross-Linguistic Evaluation of Generative AI Models for  Diabetes and Endocrine Queries

Jordan Medical Journal, 2024

Background and Aims: Endocrine and metabolic disorders, including diabetes mellitus (DM), pose m... more Background and Aims: Endocrine and metabolic disorders, including diabetes
mellitus (DM), pose major global health challenges. Generative artificial
intelligence (genAI) models are increasingly used for patient self-help. This study
aimed to evaluate the performance of two genAI models, ChatGPT and Microsoft
Copilot, in addressing endocrine-related queries in English and Arabic.
Materials and Methods: This descriptive study adhered to the METRICS
checklist for genAI-based healthcare studies, comparing responses from
ChatGPT-4o and Microsoft Copilot to 20 endocrine-related queries in English and
Arabic (15 DM queries in addition to five endocrine queries). The responses were
evaluated using the CLEAR tool, which assessed completeness, accuracy, and
relevance/appropriateness. Three endocrinology experts independently evaluated
the genAI outputs.
Results: Per language and model, a total of 80 responses were assessed. Inter
rater reliability was high with Intraclass Correlation Coefficient=0.832.
ChatGPT-4o consistently outperformed Microsoft Copilot, earning 'Excellent'
ratings in English and ‘Very good’ in Arabic, while Microsoft Copilot achieved
‘Very good’ ratings in English and ‘Good’ to ‘Very good’ ratings in Arabic.
ChatGPT-4o surpassed Microsoft Copilot in completeness (4.38 vs. 3.36, p<.001,
Mann-Whitney U test (M-W)), accuracy (4.18 vs. 3.83, p=.014, M-W), and
relevance (4.44 vs. 3.82, p<.001, M-W). Performance varied significantly
between English and Arabic responses, with p<.001 for completeness, p=.001 for
accuracy, p=.012 for relevance, and p<.001 for the overall CLEAR score using
the M-W test. No statistically significant differences were found based on the
query topic.
Conclusions: ChatGPT-4o outperformed Microsoft Copilot in all CLEAR
components, but notable language-based disparities were evident. Addressing
these limitations is crucial to ensure equitable access to endocrine care for non
English-speaking patients.

Research paper thumbnail of Shifting the Scales: Tirzepatide's Breakthrough in Obesity Management

Curēus, May 18, 2024

Obesity is a complex and chronic condition that presents a significant global health challenge, r... more Obesity is a complex and chronic condition that presents a significant global health challenge, resulting in a wide range of health problems, such as heart disease, stroke, and diabetes, therefore diminishing the overall well-being of numerous individuals. Conventional treatment options often prove inadequate, providing temporary relief and frequent weight regain. However, a promising medication called tirzepatide has emerged and been approved by the FDA as a groundbreaking solution for managing obesity. Through its unique mechanism of action as a glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist, as well as its impressive results in clinical trials, tirzepatide has the potential to completely transform the current approach to treating obesity. This editorial provides a quick snap for the clinical implications of tirzepatide, its mechanism of action, effectiveness, safety record, and the challenges it faces, such as insurance coverage and drug shortages. It emphasizes the importance of an integrated treatment approach and highlights the necessity for continuous research and policy backing to enhance accessibility and advance public health outcomes related to weight management.

Research paper thumbnail of From Protection to Prevention: Redefining Vaccines in the Context of Antimicrobial Resistance

Curēus, May 18, 2024

Antimicrobial resistance (AMR) poses a significant threat to global health, compromising the effe... more Antimicrobial resistance (AMR) poses a significant threat to global health, compromising the effectiveness of treatments and increasing medical risks. In this crisis, the importance of vaccines in reducing AMR is being increasingly acknowledged, although not thoroughly explored. This literature review asserts that vaccines can significantly lessen the occurrence of infections, thereby reducing the need for antibiotics and limiting the emergence of resistance. Vaccines play a crucial role in antimicrobial stewardship programs by preventing diseases that would otherwise necessitate the use of antibiotics. Expanding vaccine coverage supports responsible usage of antimicrobials and aligns with global health priorities to maintain effective medical interventions. This review emphasizes the need for equitable funding and policy support for vaccine initiatives comparable to new antibiotics and diagnostic techniques. Moreover, it calls for more detailed investigations into vaccines' economic and health benefits in managing AMR, highlighting their potential as cost-effective solutions to this urgent health challenge. Through a careful analysis of existing literature, this review highlights the fundamental role of vaccines in transforming the landscape of AMR, shifting the focus from a protective approach to a preventive health strategy.

Research paper thumbnail of Enhancing Hospital Pharmacy Operations Through Lean and Six Sigma Strategies: A Systematic Review

Research paper thumbnail of Examining the Influence of Joint Commission International (JCI) Accreditation Surveys on Medication Safety Practices: A Cross-Sectional Study from Mediclinic Welcare Hospital in Dubai, UAE

Journal of Integrated Health, Oct 11, 2023

Research paper thumbnail of CLEAR: Pilot Testing of a Tool to Standardize Assessment of the Quality of Health Information Generated by Artificial Intelligence-Based Models

Artificial intelligence (AI)-based conversational models, such as ChatGPT, Microsoft Bing, and Go... more Artificial intelligence (AI)-based conversational models, such as ChatGPT, Microsoft Bing, and Google Bard, emerged as valuable sources of health information for the lay individuals. However, the accuracy of information provided by these AI models remains a significant concern. This pilot study aimed to test a new tool referred to as “CLEAR”, designed to assess the quality of health information delivered by AI-based models. Tool development involved a literature review on health information quality, followed by initial establishment of the CLEAR tool comprising five items that aimed to assess the following: completeness of content in response to the prompt, lack of false information, evidence support, appropriateness, and relevance of the generated content. Each item was scored on a 5-point Likert scale from excellent to poor. Content validity was checked by expert review of the initial items. Pilot testing involved 32 healthcare professionals using the CLEAR tool to assess content ...

Research paper thumbnail of Assessment of Artificial Intelligence ‎Credibility in Evidence-Based ‎Healthcare Management with “AERUS” Innovative Tool

Journal of Artificial Intelligence, Machine Learning and Data Science, Feb 19, 2024

Research paper thumbnail of Benchmarking Generative AI: A Call for Establishing a Comprehensive Framework and a Generative AIQ Test

Mesopotamian Journal of Artificial Intelligence in Healthcare, 2024

The introduction and rapid evolution of generative artificial intelligence (genAI) models necessi... more The introduction and rapid evolution of generative artificial intelligence (genAI) models necessitates a refined understanding for the concept of "intelligence". The genAI tools are known for its capability to produce complex, creative, and contextually relevant output. Nevertheless, the deployment of genAI models in healthcare should be accompanied appropriate and rigorous performance evaluation tools. In this rapid communication, we emphasizes the urgent need to develop a "Generative AIQ Test" as a novel tailored tool for comprehensive benchmarking of genAI models against multiple human-like intelligence attributes. A preliminary framework is proposed in this communication. This framework incorporates miscellaneous performance metrics including accuracy, diversity, novelty, and consistency. These metrics were considered critical in the evaluation of genAI models that might be utilized to generate diagnostic recommendations, treatment plans, and patient interaction suggestions. This communication also highlights the importance of orchestrated collaboration to construct robust and well-annotated benchmarking datasets to capture the complexity of diverse medical scenarios and patient demographics. This communication suggests an approach aiming to ensure that genAI models are effective, equitable, and transparent. To maximize the potential of genAI models in healthcare, it is important to establish rigorous, dynamic standards for its benchmarking. Consequently, this approach can help to improve clinical decision-making with enhancement in patient care, which will enhance the reliability of genAI applications in healthcare.

Research paper thumbnail of From Protection to Prevention: Redefining Vaccines in the Context of Antimicrobial Resistance

Cureus, 2024

Antimicrobial resistance (AMR) poses a significant threat to global health, compromising the effe... more Antimicrobial resistance (AMR) poses a significant threat to global health, compromising the effectiveness of treatments and increasing medical risks. In this crisis, the importance of vaccines in reducing AMR is being increasingly acknowledged, although not thoroughly explored. This literature review asserts that vaccines can significantly lessen the occurrence of infections, thereby reducing the need for antibiotics and limiting the emergence of resistance. Vaccines play a crucial role in antimicrobial stewardship programs by preventing diseases that would otherwise necessitate the use of antibiotics. Expanding vaccine coverage supports responsible usage of antimicrobials and aligns with global health priorities to maintain effective medical interventions. This review emphasizes the need for equitable funding and policy support for vaccine initiatives comparable to new antibiotics and diagnostic techniques. Moreover, it calls for more detailed investigations into vaccines' economic and health benefits in managing AMR, highlighting their potential as cost-effective solutions to this urgent health challenge. Through a careful analysis of existing literature, this review highlights the fundamental role of vaccines in transforming the landscape of AMR, shifting the focus from a protective approach to a preventive health strategy.

Research paper thumbnail of Shifting the Scales: Tirzepatide's Breakthrough in Obesity Management

Cureus, 2024

Obesity is a complex and chronic condition that presents a significant global health challenge, r... more Obesity is a complex and chronic condition that presents a significant global health challenge, resulting in a wide range of health problems, such as heart disease, stroke, and diabetes, therefore diminishing the overall well-being of numerous individuals. Conventional treatment options often prove inadequate, providing temporary relief and frequent weight regain. However, a promising medication called tirzepatide has emerged and been approved by the FDA as a groundbreaking solution for managing obesity. Through its unique mechanism of action as a glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist, as well as its impressive results in clinical trials, tirzepatide has the potential to completely transform the current approach to treating obesity. This editorial provides a quick snap for the clinical implications of tirzepatide, its mechanism of action, effectiveness, safety record, and the challenges it faces, such as insurance coverage and drug shortages. It emphasizes the importance of an integrated treatment approach and highlights the necessity for continuous research and policy backing to enhance accessibility and advance public health outcomes related to weight management.

Research paper thumbnail of The Role of Psychological Factors and Vaccine Conspiracy Beliefs in Influenza Vaccine Hesitancy and Uptake among Jordanian Healthcare Workers during the COVID-19 Pandemic

Vaccines

Vaccination to prevent influenza virus infection and to lessen its severity is recommended among ... more Vaccination to prevent influenza virus infection and to lessen its severity is recommended among healthcare workers (HCWs). Health professionals have a higher risk of exposure to viruses and could transmit the influenza virus to vulnerable patients who are prone to severe disease and mortality. The aim of the current study was to evaluate the levels of influenza vaccine acceptance and uptake as well as its determinants, among Jordanian HCWs over the last influenza season of 2021/2022. This study was based on a self-administered electronic survey that was distributed in March 2022. Psychological determinants of influenza vaccine acceptance and vaccine conspiracy beliefs were assessed using the previously validated 5C scale questionnaire (confidence, complacency, constraints, calculation and collective responsibility) and the vaccine conspiracy beliefs scale. The study sample comprised a total of 1218 HCWs: nurses (n = 412, 33.8%), physicians (n = 367, 30.1%), medical technicians (n =...

Research paper thumbnail of A Global Map of COVID-19 Vaccine Acceptance Rates per Country: An Updated Concise Narrative Review

Journal of Multidisciplinary Healthcare, 2022

The delay or refusal of vaccination, which defines vaccine hesitancy, is a major challenge to suc... more The delay or refusal of vaccination, which defines vaccine hesitancy, is a major challenge to successful control of COVID-19 epidemic. The huge number of publications addressing COVID-19 vaccine hesitancy necessitates periodic review to provide a concise summary of COVID-19 vaccine acceptance rates worldwide. In the current narrative review, data on COVID-19 vaccine acceptance rates were retrieved from surveys in 114 countries/ territories. In East and Southern Africa (n = 9), the highest COVID-19 vaccine acceptance rate was reported in Ethiopia (92%), while the lowest rate was reported in Zimbabwe (50%). In West/ Central Africa (n = 13), the highest rate was reported in Niger (93%), while the lowest rate was reported in Cameroon (15%). In Asia and the Pacific (n = 16), the highest rates were reported in Nepal and Vietnam (97%), while the lowest rate was reported in Hong Kong (42%). In Eastern Europe/Central Asia (n = 7), the highest rates were reported in Montenegro (69%) and Kazakhstan (64%), while the lowest rate was reported in Russia (30%). In Latin America and the Caribbean (n = 20), the highest rate was reported in Mexico (88%), while the lowest rate was reported in Haiti (43%). In the Middle East/North Africa (MENA, n = 22), the highest rate was reported in Tunisia (92%), while the lowest rate was reported in Iraq (13%). In Western/Central Europe and North America (n = 27), the highest rates were reported in Canada (91%) and Norway (89%), while the lowest rates were reported in Cyprus and Portugal (35%). COVID-19 vaccine acceptance rates ≥60% were seen in 72/114 countries/territories, compared to 42 countries/territories with rates between 13% and 59%. The phenomenon of COVID-19 vaccine hesitancy appeared more pronounced in the MENA, Europe and Central Asia, and Western/ Central Africa. More studies are recommended in Africa, Eastern Europe and Central Asia to address intentions of the general public to get COVID-19 vaccination.

Research paper thumbnail of Enhancing Hospital Pharmacy Operations Through Lean and Six Sigma Strategies: A Systematic Review

Cureus, 2024

Hospital pharmacies are integral to the healthcare system, and evaluating the factors influencing... more Hospital pharmacies are integral to the healthcare system, and evaluating the factors influencing their efficiency and service standards is imperative. This analysis offers global insights to assist in developing strategies for future enhancements. The objective is to identify the optimal Lean Six Sigma methodologies to improve workflow and quality of hospital pharmacy services. To the best of the author's knowledge, this research is believed to be the first in-depth analysis of Lean and Six Sigma in the hospital pharmacy domain, spanning 15 years from 2009 to 2023.

Research paper thumbnail of Improving Efficiency in Hospital Pharmacy Services: An Integrated Strategy Using the OCTAGON-P Framework and Lean 5S Management Practices

Cureus, 2024

Background Hospital pharmacy departments have a critical role in the healthcare system, as they a... more Background
Hospital pharmacy departments have a critical role in the healthcare system, as they aim to provide excellent patient services while also ensuring cost-effectiveness. Lean methodologies are well-known for improving efficiency and quality in various industries, but their impact on healthcare, particularly in hospital pharmacy settings, has not been thoroughly investigated.

Aim
This quality improvement (QI) study aimed to assess the impact of implementing the sort, set in order, shine, standardize, and sustain (5S) methodology using the innovative orientation, coordination, training, awareness, governance, observation, normalization, and promotion (OCTAGON-P) framework on the operations of Mediclinic Parkview Hospital (MPAR) Pharmacy in Dubai, UAE.

Methods
The QI project spanned a period of six weeks, from December 18th, 2023, to January 28th, 2024. Throughout this period, a new novel OCTAGON-P framework's eight crucial elements were methodically integrated. Simultaneously, an extensive preparation process encompassing the five stages of the 5S method was carried out.

Results
The findings indicated a notable enhancement in organization, orderliness, cleanliness, medication storage, and workspace standardization. The significant improvement of 217% in terms of organization highlighted the effectiveness of resource arrangement. The orderliness of the workspace saw an increase of 800%, indicating a transformation in the systematic organization. Additionally, cleanliness improved by 138%, demonstrating a significant advancement in maintaining a spotless environment. The standardization of processes experienced a boost of 300%, reflecting a solidified approach to consistent operational methods. These refinements resulted in an overall improvement of 90% from the initial baseline of 20% on the 5S checklist scores. Efficiency gains were observed, with outpatient medication retrieval times reduced by 50%, inpatient times by 40%, emergency prescription serving by 16.7%, and pediatric prescription serving by 11%. The inpatient medication return process saw a 67% improvement. Patient counseling time increased by 23.3%, indicating a more patient-centered approach. Prescription verification and medication expiry checks increased by 50% and 200%, respectively, enhancing the quality of care. Inventory management efficiency improved by 36%, and medication label printing time decreased by 70% with the additional label printers. Installing extra medication label printers was done through the OCTAGON-P framework, specifically in the "orientation" and "coordination" phases. These two initial phases focused on leadership's 5S orientation, management support, and securing additional resources. Therefore, the OCTAGON-P framework provided a structured approach that promoted continuous improvement and sustained lean practices.

Conclusion
This research study presented the remarkable effectiveness of the OCTAGON-P framework in structurally implementing the 5S methodology into hospital pharmacy operations. The findings underscored the potential of lean 5S to enhance and optimize operational efficiency and overall quality within the critical environment of hospital pharmacy settings. Consequently, these improvements can conclusively result in the provision of superior and enhanced patient care, which is truly fundamental and central to the mission and objectives of any healthcare institution.

Research paper thumbnail of A Preliminary Checklist (METRICS) to Standardize the Design and Reporting of Studies on Generative Artificial Intelligence-Based Models in Health Care Education and Practice: Development Study Involving a Literature Review

Interactive Journal of Medical Research, 2024

Background: Adherence to evidence-based practice is indispensable in health care. Recently, the u... more Background: Adherence to evidence-based practice is indispensable in health care. Recently, the utility of generative artificial intelligence (AI) models in health care has been evaluated extensively. However, the lack of consensus guidelines on the design and reporting of findings of these studies poses a challenge for the interpretation and synthesis of evidence. Objective: This study aimed to develop a preliminary checklist to standardize the reporting of generative AI-based studies in health care education and practice. Methods: A literature review was conducted in Scopus, PubMed, and Google Scholar. Published records with "ChatGPT," "Bing," or "Bard" in the title were retrieved. Careful examination of the methodologies employed in the included records was conducted to identify the common pertinent themes and the possible gaps in reporting. A panel discussion was held to establish a unified and thorough checklist for the reporting of AI studies in health care. The finalized checklist was used to evaluate the included records by 2 independent raters. Cohen κ was used as the method to evaluate the interrater reliability. Results: The final data set that formed the basis for pertinent theme identification and analysis comprised a total of 34 records. The finalized checklist included 9 pertinent themes collectively referred to as METRICS (Model, Evaluation, Timing, Range/Randomization, Individual factors, Count, and Specificity of prompts and language). Their details are as follows: (1) Model used and its exact settings; (2) Evaluation approach for the generated content; (3) Timing of testing the model; (4) Transparency of the data source; (5) Range of tested topics; (6) Randomization of selecting the queries; (7) Individual factors in selecting the queries and interrater reliability; (8) Count of queries executed to test the model; and (9) Specificity of the prompts and language used. The overall mean METRICS score was 3.0 (SD 0.58). The tested METRICS score was acceptable, with the range of Cohen κ of 0.558 to 0.962 (P<.001 for the 9 tested items). With classification per item, the highest average METRICS score was recorded for the "Model" item, followed by the "Specificity" item, while the lowest scores were recorded for the "Randomization" item (classified as suboptimal) and "Individual factors" item (classified as satisfactory). Conclusions: The METRICS checklist can facilitate the design of studies guiding researchers toward best practices in reporting results. The findings highlight the need for standardized reporting algorithms for generative AI-based studies in health care, considering the variability observed in methodologies and reporting. The proposed METRICS checklist could be a preliminary

Research paper thumbnail of Assessment of Artificial Intelligence Credibility in Evidence-Based Healthcare Management with "AERUS" Innovative Tool

Journal of Artificial Intelligence Machine Learning and Data Science, 2024

Background: Artificial Intelligence (AI) technologies have found applications across various aren... more Background: Artificial Intelligence (AI) technologies have found applications across various arenas, and Evidence-Based Management (EBMgt) is no exception. However, in this context, the careful assessment of AI outcomes becomes essential to confirm their credibility and ensure adherence to ethical standards. Mirroring recent similar explorations in the literature, this study introduced the "AERUS" tool, designed to evaluate AI trustworthiness in healthcare administration, focusing on five key areas: Accuracy, Efficiency, Reliability, Usability, and Security. Methods: The AERUS instrument evaluated AI's reliability in healthcare administration. It underwent minor revisions after an initial test with thirty healthcare administrators and internal consistency confirmation via Cronbach's alpha. The final version was tested on four AI models (ChatGPT 3.5, ChatGPT 4, Microsoft Bing, Google Bard) over six managerial topics, with evaluation by two raters using Cohen's kappa. Results: The refined AERUS tool assessed five areas: AI accuracy in management data, operational efficiency impact, decisionmaking reliability, user-friendliness for managers, and security protocol adherence. Initial testing with ten healthcare management statements showed high internal consistency (Cronbach's alpha of .911). Among six assessments, Microsoft Bing scored highest (mean 22.93, SD 1.11), followed by ChatGPT-4 (mean 22.00, SD 1.21), ChatGPT-3.5 (mean 20.00, SD 1.21), and Google Bard (mean 19.60, SD 1.22). Inter-rater agreement resulted in Cohen's kappa values ranging from 0.358 to 0.885 for the AI models. Conclusions and Recommendations: AERUS presents a supporting instrument for addressing AI credibility concerns in EBMgt, with recommendations for further research and widespread implementation to ensure the trustworthiness and reliability of AI in professional managerial decision-making.

Research paper thumbnail of Hospital Pharmacy Operations Management: Synergizing Lean Efficiency and Six ‎Sigma ‎‎‎Precision for Optimal Service Quality – An Action Research From United ‎Arab Emirates

ProQuest ‎Dissertations & Theses Global, United States, 2024

The focus of this study was to examine how implementing Lean Six Sigma (LSS) ‎methodologies impac... more The focus of this study was to examine how implementing Lean Six Sigma (LSS) ‎methodologies impacted the Service Quality and effectiveness of the Pharmacy at Mediclinic ‎Parkview Hospital in Dubai, United Arab Emirates. The study employed the LSS DMAIC ‎‎(Define, Measure, Analyze, Improve, Control) method to identify inefficiencies and improve ‎overall performance statistical analyses and Sigma-level calculations. The implementation of ‎Lean Six Sigma methods led to an average increase of approximately 41.96% in performance ‎across six established Critical-to-Quality (CTQ) Key Performance Indicators (KPIs) within the ‎hospital pharmacy. The research utilized a validated questionnaire to examine how ‎demographic factors affect stakeholders' perceptions and challenges in implementing LSS ‎methodologies. Older adults faced more obstacles than their younger counterparts, with ‎noteable disparities observed across different fields of expertise education levels. This suggests ‎diverse experience with the implementation of LSS. Additionally, the study examined the ‎influence of DMAIC constructs on Service Quality using the SERVQUAL instrument across ‎various dimensions such as Tangibility, Reliability, Responsiveness, Assurance, and Empathy. ‎The findings revealed significant improvements across all models, indicated by p-values less ‎than 0.001, confirming the reliability of the results. Adjusted R-squared values ranging from ‎‎0.386 to 0.638 indicate that a substantial portion of service quality improvements can be ‎directly attributed to these methods. The “Improve” and “Control” constructs consistently ‎demonstrated positive effects, highlighting their critical role in enhancing service quality and ‎supporting the effective application of DMAIC in healthcare settings. This dissertation ‎enhances hospital pharmacy operations management through the Lean Six Sigma (LSS) ‎framework, emphasizing specialized training and customization of DMAIC elements to meet ‎healthcare service requirements.