Barriers to implementation of clinical research in the state of Qatar : a managerial perspective

Clinical research helps in improving patient care and quality of life through translation of findings from basic research (laboratory based) into actual benefit to patients. The huge advancements in the field of clinical research are accompanied by increase in demand for infrastructure, funding and regulations to ensure the safe conduct of research. There are many barriers faced by researchers around the world that affect the initiation and progress of their clinical research projects and eventually lead to wastage of effort and resources. Many studies in literature assessed these barriers from the researchers’ perspective. Nevertheless, the aim of this study was to identify the barriers as seen by research managers in Qatar. The study also had a retrospective aspect where the database of funded projects was analyzed for frequency of suspensions and terminations and if they were related to the identified barriers. Five research managers from different research institutions in Qatar were interviewed for their opinion about the barriers to conducting clinical research in Qatar. The interviews were recorded, transcribed and a thematic analysis model was applied to generate common themes. The major barriers identified could be categorized into four major themes – scientific / professional, financial, administrative and regulatory. A retrospective analysis of the grants awarded to Hamad Medical Corporation (HMC) confirmed that most reasons for the suspensions and terminations were related to these barriers. We believe that this study provided very important insight into the barriers faced by researchers in Qatar. The outcomes will be communicated to the policy makers in Qatar to focus on addressing these issues for a better utilization of the available resources and infrastructure to support clinical research in Qatar. The study also paves the way for a future study where barriers will be assessed by the researchers

Factors Associated with Family Consent to Organ Donation in Qatar: Results from a Household Survey

Background: Family consent and organ donors rates are colinear to each other. The low consent rate can be influenced by socioeconomic and behavioral factors in the population. This study aimed to assess the influence of sociodemographic and behavioral factors on family consent for organ donation in the household population.Subjects dan Method: This is a secondary data analysis of the cross-sectional research design of 1044 household participants conducted in Qatar on organ donation between October and November 2016. A two-stage systematic random sampling was applied to collect data. The dependent variable was family consent. The independent variables were demographic and behavioral factors such as knowledge, attitude, intention, and beliefs about organ donation. Data were collected using household survey Questionnaire and analyzed using Student t-tests (unpaired), chi-square tests, and multivariate logistic regression analysis. C-statistics were applied to see discriminate accuracy of the developed regression model for family consent.Results: Knowledge (aOR= 1.63; 95%CI= 0.55 to 4.80; p= 0.380), behavioral belief (aOR= 1.11; 95%CI= 0.77 to 1.61; p= 0.580), heard organ donation (aOR= 1.12; 95%CI= 0.71 to 1.76; p= 0.630), registered for organ donation (aOR= 1.11; 95%CI= 0.50 to 2.46; p= 0.800), donated any organ/ blood/tissue (aOR= 1.63; 95%CI= 0.55 to 4.80; p= 0.380) can increased with family consent for organ donation registration. But, it’s not significantly statistic. Attitude (aOR= 1.73; 95%CI= 1.28 to 2.34; p= 0.001), control belief (aOR= 0.74; 95%CI= 0.55 to 0.99; p= 0.050), and Intention (aOR= 7.50; 95%CI= 4.04 to 13.92; p= 0.001) can increased with family consent for organ donation registration and the results were statistically significant.Conclusion: Attitude, control belief, and intention can increase family consent for organ donation registration. Keywords: Family consent, intention, attitude, knowledge, organ donation. Correspondence:Rajvir Singh. Cardiology Research Center, Heart Hospital, Hamad Medical Corporation (HMC), Doha, Qatar, Post Box: 3050; email: [email protected]. Mobile: 97455897044

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

An Assessment of Clinical Research Self-Efficacy among Researchers at the Largest Healthcare Institute in Qatar: Recommendations and Future Actions

OBJECTIVES Clinical research professionals must be equipped with adequate training in sound scientific methods and appropriate ethics. In this study, we aimed to assess the current clinical research self-efficacy of researchers at Hamad Medical Corporation (HMC). We also evaluated the effects of training courses on researchers’ self-efficacy. METHODS Utilizing a cross-sectional design, we used the shortened Clinical Research Appraisal Inventory (CRAI-12) through an online survey to assess the current clinical research self-efficacy of 600 researchers at HMC, Doha, Qatar. After conducting descriptive analyses, unpaired t test and ANOVA were used to determine significant mean percentages between variables. Pearson correlation coefficients were also calculated to measure the association among the interval variables. All tests were 2-sided, and significance was defined as P  5), reflecting higher self-efficacy for the topics covered in CRAI. Gender differences were significant across all factors, with males reporting higher levels of self-assessed efficacy and in clinical research. Other factors such as higher education degrees and previous (external) clinical research training were also associated with higher self-reported clinical research efficacy. CONCLUSIONS The findings of this study indicate that researchers at HMC possess high clinical research self-efficacy overall, but lower self-efficacy in securing funding. Gender and education level positively influence self-efficacy across CRAI factors. Notably, clinical research training boosts self-efficacy, especially when obtained outside HMC. In conclusion, healthcare providers are strongly encouraged to engage in effective clinical research training courses, both within and outside of their healthcare institutions, to improve their clinical research efficacy and enhance clinical practice

Factors Associated with Family Consent to Organ Donation in Qatar: Results from a Household Survey

Background: Family consent and organ donors rates are co-linear to each other. The low consent rate can be influenced by socioeconomic and behavioral factors in the population. This study aimed to assess the influence of sociodemographic and behavioral factors on family consent for organ donation in the household population. Subjects dan Method: This is a secondary data analysis of the cross-sectional research design of 1044 household participants conducted in Qatar on organ donation between October and November 2016. A two-stage systematic random sampling was applied to collect data. The dependent variable was family consent. The independent variables were demographic and behavioral factors such as knowledge, attitude, intention, and beliefs about organ donation. Data were collected using household survey Questionnaire and analysed using Student t-tests (unpaired), chi-square tests, and multivariate logistic regression analysis. C-statistics was applied to see discriminate accury of the developed regression model for family consent. Results: Attitude (aOR= 1.73; 95%CI= 1.28 to 2.34; p= 0.001) and Intention (aOR= 7.50; 95%CI= 4.04 to 13.92; p= 0.001) factors were significantly associated to family consent to increase organ donation registration whereas; control belief (aOR= 0.74; 95%CI= 0.55 to 0.99; p= 0.050) was negatively associated to family consent. Knowledge (aOR= 1.63; 95%CI= 0.55 to 4.80; p= 0.380), behavioral belief (aOR= 1.11; 95%CI= 0.77 to 1.61; p= 0.580), heard organ donation (aOR= 1.12; 95%CI= 0.71 to 1.76; p= 0.630), registered for organ donation (aOR= 1.11; 95%CI= 0.50 to 2.46; p= 0.800), and donated any organ/blood/tissue (aOR= 1.63; 95%CI= 0.55 to 4.80; p= 0.380) factors were not statistically significant to family consent to increase organ donation registration. Conclusion: Attitude and intention can increase family consent to organ donation registration. Keywords: Family consent, intention, attitude, knowledge, organ donation. Correspondence