Patient Care During Ramadan: A Narrative Review.

This year's article on health information technology (HIT) illustrates the use of digital technology to prevent and treat diabetes by enabling consumer engagement, behavior change, and impact analytics. It provides a snapshot of current thinking about digital technology's capabilities and capacity to deliver personalized interventions at scale. Early results are promising. A growing number of digital programs are clinically proven to improve health and lower the cost of care. And pioneering health-care organizations are offering these programs to members and patients as part of their new models for value-based care. Their success will drive other organizations—payers, providers, and employers—to make similar investments in health. In the modern health-care world, experts agree that “value” will be created by enabling health, not just delivering care. With today's epidemic of diabetes, patients who use digital health technologies can benefit greatly from both short-term health improvements and long-term health self-management. The foundations have been laid with evidence-based programs. Now, more health-care organizations must embrace this population management strategy for health. As adoption increases, the next technology challenge will arise: consumer engagement at scale. This engagement will be digital: content-rich programs filled with social support to activate, educate, and engage consumers. Most of the articles included in this and prior ATTD Yearbook articles address the specifics of digital interventions once the person enrolls. But before enrollment, consumers must engage. And to engage consumers, one must understand their reasons for engaging and their expectations for results. These insights fall into the realm of digital marketing, rather than the domain of clinical programs. Using a multidisciplinary approach, digital engagement will be the next variable to solve in the equation for scalable digital health. Not for a lack of trying, we have been unable to find noteworthy articles presenting best practices for consumer engagement from outreach to enrollment. But the future looks quite bright for the science of marketing digital health interventions. Increasingly, “big data” is providing scientists, innovators, entrepreneurs, educators, health-care providers, and administrators with the insights they need to predict consumer interests and personalize experiences throughout the entire behavior change process—from outreach to outcomes. Over the coming year, we will continue to search the health-care landscape to bring more innovations in digital health and diabetes prevention, from consumer engagement to population impact.

Pharmacology, Toxicology and Biomedical Reports,2019,5,2,65-68.DOI:10.5530/PTB.2019.5.11Published:July 2019Type:Review ArticleAuthors:Yousef Ahmed Alomi, Mohammed Abdulaziz Altuwaijri, Mohsen Huraybie Alshammari, and Nouf Hameed Al-Muallad Author(s) affiliations:Yousef Ahmed Alomi*, General Administration of Pharmaceutical Care, Ministry of Health, Riyadh, SAUDI ARABIA. Mohammed Abdulaziz Altuwaijri, ENT Consultant, King Saud Medical City, Riyadh, SAUDI ARABIA. Mohsen Huraybie Alshammari, Hail Maternaty and Childern Hospital, Ministry of Health, Hail, SAUDI ARABIA. Nouf Hameed Al-Muallad, Ibn Sina College Hospital, Jeddah, SAUDI ARABIA. Abstract:Objectives: To review the intake of antibiotics and fasting during the holy month of Ramadan. Methods: In this study, we performed an extensive search of 50 databases following the Saudi Digital Library search engine. We included meta-analysis, randomized controlled studies and observational studies published in English language with human study only for update May 2017. The search terms included Ramadan, fasting, medication, therapy, type of disease and medication based on therapeutic class. The list of antibiotic medication and switch from regular days to Ramadan days based on literature search revealed comparative safety studies, efficacy studies and cost of type of medication for each disease studies and national or international evidence-based guidelines of switching short half-life to long halflife. All parenteral dosage form of medication were excluded from study. All medications should be listed in the Ministry of Health drug formulary. Results: A total of 710 studies were obtained after an extensive search with specific terms. Of those, 104 studies were duplicate studies and 606 were considered for further evaluation. After evaluation, we obtained 30 studies which discussed about the antibiotics and Ramadan. Of these 30 studies, only 2 studies were found to be appropriate for further revision. Among the two, one study was an observational study regarding the pattern of prescribing antibiotics during the holy month of Ramadan. The second study was about the systemic review on the safety of fasting and several infectious diseases. The suggested draft of list of antibiotic switch from regular days to the holy Ramadan days was explored in this review. Conclusion: The investigations about antibiotics intake during fasting not found. The studies of antibiotic during the holy month of Ramadan is required during legal registrations at all Muslim countries. Antibiotics switch therapy during fasting is highly recommended at all Muslim patients in the world. Keywords:Antibiotics, Fasting, Literature, Ramadan, ReviewView:PDF (190.51 KB) PDF PDF Images Table 1: The antibiotic studies conducted during the holy month of Ramadan.

BACKGROUND AND OBJECTIVES:Twelve “good death” principles have been identified that apply to Westerners. This study aimed to review the TFHCOP good death perception to determine its validity for Muslim patients and health care providers, and to identify and describe other components of the Muslim good death perspective.SUBJECTS AND METHODS:Participants included 284 Muslims of both genders with different nationalities and careers. We used a 12-question questionnaire based on the 12 principles of the TFHCOP good death definition, followed by face-to-face interviews. We used descriptive statistics to analyze questionnaire responses. However, for new themes, we used a grounded theory approach with a “constant comparisons” method.RESULT:On average, each participant agreed on eight principles of the questionnaire. Dignity, privacy, spiritual and emotional support, access to hospice care, ability to issue advance directives, and to have time to say goodbye were the top priorities. Participants identified three main domains. The first domain was related to faith and belief. The second domain included some principles related to self-esteem and person>s image to friends and family. The third domain was related to satisfaction about family security after the death of the patient. Professional role distinctions were more pronounced than were gender or nationality differences.CONCLUSION:Several aspects of «good death,» as perceived by Western communities, are not recognized as being important by many Muslim patients and health care providers. Furthermore, our study introduced three novel components of good death in Muslim society.

Historically, oral intake for women during labor has been limited to nothing by mouth or clear liquids only. These restrictions are based on the risk of aspiration during or after the administration of general anesthesia. While aspiration can be life threatening, older methods of anesthesia are rarely used in current intrapartum care, and evidence is inconclusive that withholding oral nutrition reduces the risk of gastric aspiration. Additionally, withholding oral nutrition may result in the development of ketosis and may potentially contribute to a woman's stress and dissatisfaction with the birth experience. The purpose of this Clinical Bulletin is to review the evidence related to this practice and provide recommendations to promote informed, shared decision making regarding oral intake during labor with women at low risk for gastric aspiration.

There are an estimated 3.5 million Muslims in North America. During the holy month of Ramadan, healthy adult Muslims are to fast from predawn to after sunset. While there are exemptions for older and sick adults, many adults with diabetes fast during Ramadan. However, there are risks associated with fasting and specific management considerations for patients with diabetes. We evaluated provider practices and knowledge regarding the management of patients with diabetes who fast during Ramadan. A 15-question quality improvement survey based on a literature review and the American Diabetes Association guidelines was developed and offered to providers at the outpatient primary care and geriatric clinics at an inner-city hospital in New York City. Forty-five providers completed the survey. Most respondents did not ask their Muslim patients with diabetes if they were fasting during the previous Ramadan. Knowledge of fasting practices during Ramadan was variable, and most felt uncomfortable managing patients with diabetes during Ramadan. There is room for improvement in educating providers about specific cultural and medical issues regarding fasting for patients with diabetes during Ramadan.

IntroductionSickle cell disease is a genetic disorder that frequently presents with vaso-occlusive crisis (VOC). Most patients with sickle cell disease in Qatar are Muslims; hence, they practice intermittent fasting during the holy month of Ramadan. However, there is a paucity of literature describing the effect of intermittent fasting on the occurrence of severe VOC. As a result, there is a lack of guidelines or standardized protocols that can help physicians advise patients with sickle cell disease who wish to practice intermittent fasting. Therefore, this study's aim was to investigate the effect of intermittent fasting on the clinical and hematological parameters of individuals with sickle cell disease.MethodsWe conducted a retrospective study for 52 Muslim patients with sickle cell disease in Qatar aged ≥18 years who were confirmed to be fasting during the holy month of Ramadan during any of the years 2019–2021. The difference in the occurrence of severe VOC, hemolytic crisis, and other clinical, hematological, and metabolic parameters were studied one month before, during, and one month after the intermittent fasting of Ramadan using the patient's medical records. Mean (sd), median (IQR), and frequency (%) described the data. One-way with repeated measures ANOVA with a Greenhouse-Geisser correction and Friedman tests (*) were used at alpha level 0.05.ResultsThe study participants' (mean±sd) age was (31.1±9.2) years, 51.9% were males, and 48.1% were females. Roughly seventy percent of the participants were of Arab ethnicity, while the rest were either African or Asian. Most of the patients were homozygotes (SS) (90.4%). The median number of severe VOC (P = 0.7) and hemolytic crisis (P = 0.5) was not found to be significantly different before, during, or after Ramadan. Significant differences, however, were found in platelet count (P = 0.003), reticulocyte count (P < 0.001), and creatinine level (P = 0.038) with intermittent fasting.DiscussionIn this preliminary study, intermittent fasting does not seem to influence the rate of occurrence of severe vaso-occlusive crisis or hemolytic crisis in patients with sickle cell disease; however, it was found to be associated with differences in platelet count, reticulocytes count, and creatinine level. The statistical and clinical significance of these findings needs to be confirmed in studies with a larger sample size.

PROTOCOL: Education Support Services for Improving School Engagement and Academic Performance of Children and Adolescents with a Chronic Health Condition: A Systematic Review

AimThe impact of a stoma on the health related quality of life (HRQoL) in patients is irrespective of faith. Muslim patients report lower quality of life and spiritual well‐being following stoma surgery as compared to others. This critical review aims to improve awareness of Islamic practices and HRQoL outcomes in this cohort of patients amongst healthcare professionals.MethodAn extensive non‐systematic search of EMBASE, MEDLINE and Google Scholar was performed for original research articles pertaining to health related quality of life (HRQoL), stoma care and impact on religious practice in Muslim patients. A narrative synthesis of extracted data was performed and presented using basic thematic analysis.ResultsThe findings from the 10 original articles, including 954 participants, were identified. Perceptions of cleanliness emerged as a concern to Muslim patients with stomas as it is core to the performance of prayer. Muslim patients with stomas are known to avoid or reduce participation in prayers due to perceived inferior hygiene and fear of leakage. The consensus opinion from Islamic scholars is that they can pray normally, attend mosque and perform the Hajj pilgrimage. Stoma patients may fast in the holy month of Ramadan provided it is medically safe. Evidence suggests religion‐specific counselling can reduce the detrimental effect on HRQoL of Muslim patients following stoma‐forming surgery and increases engagement in social aspects of life.ConclusionsIt is important for patients, family members and healthcare professionals to understand the practical and religious implications of stomas on these patients for appropriate guidance and counselling.

The daytime fasting of Ramadan is observed annually by millions of adult Muslims all over the world. Some may have mild, moderate or severe medical conditions. They may seek advice on feasibility and safety of fasting and/or their management. Physicians ought to have a working knowledge about the religious rules of Ramadan fast and their medical implications. In this article we present a concise summary of the proceedings of a series of symposia. Their objectives were to review the effects of Ramadan fasting on the health of Muslim patients with various chronic medical conditions and to propose practical management strategies. An initial introductory Islamic perspective on fasting to set the scene for the following presentations. The religious rulings excluding patients with acute and chronic medical conditions from fasting were highlighted. The roles of the medical professional in guiding patients on best ways to make informed decisions to fast and feast safely were stressed. Available evidence from published literature and clinical practice was reviewed and practical guidance covering the major body systems was given. Generally speaking, fasting in Ramadan is possible for most stable chronically ill patients under medical supervision. The effect of fasting on health issues should be explained to patients well ahead of starting the holy month. Counseling patients about their use of medications as well as their suitability to undertake the fast is a major step in health care for Muslim patients. Available observations cover a spectrum of chronic medical conditions affecting various body systems. These include renal, hematological cardiac, neurological, rheumatologic, gastroenterological, endocrine conditions and drug therapy during Ramadan. Changes in the parameters of clinical functions in healthy people and in non-renal patients were minimal, insignificant and remained within the normal range. Patients on hemodialysis could fast safely on nondialysis days. Stable renal transplant recipients do not seem to sustain any risk from fasting after the first year. No evidence of increased risk of renal stones and colic was found during Ramadan. No consistent rise in cardiac events was observed during Ramadan. Hypertension needs special treatment manipulations. Headache and risk of seizures are two neurological conditions with relevance to fasting. These can be managed by simple medical measures. Peptic acid disease complications may increase by the long fasting, however treatment with peptic disease medications reduces the risks. Hematological conditions influenced by dehydration such as sickle disease are better managed by adequate hydration particularly under stressful circumstances. Rheumatological conditions can be managed by usual therapies during Ramadan. Diabetes received most attention from the medical profession for obvious reasons. Several expert statements were published. Where the risk of hypoglycemia or hyperglycemia is increased many would advise against fasting. Patients controlled by simple regimens with low risk of hypoglycemia may be able to fast safely. Changes in medication aim at adjusting the amount and timing of the drug administration to match calorie intake thus preventing hypoglycemia in the daytime and hyperglycemia after sunset. In conclusion, management of the medical patients during Ramadan represents a special challenge to patients alike. Taking on this challenge is an opportunity to test the cultural-competence of health services.

The era of telehealth pharmacy practice

Intermittent fasting is an increasingly popular dieting technique with many well-studied benefits, such as permitting weight loss in obese patients, lowering low-density lipoprotein cholesterol (LDL-C) levels and triglyceride levels, and optimizing circadian rhythms. A special type of intermittent fasting occurs during Ramadan, when Muslims worldwide fast daily from dawn to sunset for a month. Ramadan fasting has demonstrated several health benefits, including improving the gut microbiome, modifying gut hormone levels, and lowering proinflammatory markers such as cytokines and blood lipids. Although fasting has many health benefits, fasting during Ramadan may aggravate chronic medical conditions. We aim to review the literature devoted to Ramadan fasting and its effects on Muslim patients with gastrointestinal (GI) disorders, such as Inflammatory bowel disease (IBD), peptic ulcer disease (PUD), upper GI bleeding (UGIB), gastroesophageal reflux disease (GERD), and liver conditions. We will discuss recommendations for diet and medication compliance during Ramadan in the recommended pre-Ramadan counseling sessions. In this study, we used PubMed to research journals using the key terms "Ramadan," "intermittent fasting," and "gastrointestinal diseases." The current literature studying the impact of Ramadan on gastrointestinal disorders shows that patients with IBD have a minimal risk of disease exacerbation, although older men with ulcerative colitis (UC) were more prone to exacerbation during fasting. Patients with duodenal ulcers were at a higher risk of hemorrhage after Ramadan fasting. Although with mixed results, studies show patients with liver disease demonstrated improvements in liver enzymes, cholesterol, and bilirubin after Ramadan. Physicians should offer pre-Ramadan counseling to educate patients on the risks of fasting and encourage shared decision-making. To facilitate more definitive discussions between the physician and a Muslim patient, clinicians should seek a deeper understanding of how Ramadan fasting affects certain health conditions and offer accommodations, such as diet and medication adjustments.

Background & Objective: Islamic fasting is observed by millions of Muslims across the world during the holy month of Ramadan and other specific days of the lunar year. Fasting Muslims abstain from eating and drinking from dawn until sunset. Depending on season and geographical location, Muslims maintain fasting for approximately 13-18 hours per day. The present study aimed to review the benefits of Islamic fasting.Materials and Methods: This literature review was conducted via searching in databases like Medline, PubMed, PMC, Google Scholar, ScienceDirect, and reference lists of relevant articles using keywords like health benefits, Islamic fasting, intermittent fasting, alternate-day fasting, time-restricted feeding, and Ramadan intermittent fasting.Results: Islamic fasting could be considered as intermittent fasting as it is similar to alternate-day fasting and time-restricted feeding. Intermittent fasting is associated with numerous health benefits.Conclusion: According to this review, some of the main health benefits of Islamic fasting include weight loss, attenuation of metabolic markers (e.g., insulin resistance, blood glucose, and blood pressure), improved lipid profile, prevention of chronic problems (e.g., obesity, diabetes, cardiovascular diseases, and cancer), protection against neurodegeneration, and diminished inflammation.Keywords: Health Benefits, Ramadan Fasting, Islamic Fasting, Intermittent Fasting, Alternate-day Fasting, Time-restricted Feeding

Background Patients who follow a specific religion may experience specific moral conflicts when interacting with the health care system. Health care providers’ awareness of and sensitivity to such issues can be beneficial to patients and increase the quality of care they receive. The aims of this study were to investigate (1) which potential ethical issues were considered to be relevant to Muslim patients and (2) to examine if these assessments varied between Muslim non-medical, Muslim medical, and non-Muslim medical students. Methods An online questionnaire with n = 205 students from different universities in Zurich, Switzerland was conducted. The questionnaire contained a list of ethical issues of presumed relevance to Muslim patients, which had been compiled based on a literature search and an expert consultation. Results Muslim non-medical students considered 33% of the ethical issues as morally problematic to Muslim patients. In contrast, Muslim medical students regarded 19%, and non-Muslim medical students 14%, of the issues as morally problematic. All three groups identified female circumcision and abortion as problematic for Muslim patients. Muslim non-medical students additionally highlighted access to a prayer room and to a professional Muslim chaplain as important to them. Conclusions There are different ideas about which issues are of moral relevance to Muslim patients. Further studies investigating Muslim patients’ views and the extent to which these views matched with health care providers’ assessments of ethical issues relevant to their Muslim patients, are needed to provide a robust empirical basis for culturally sensitive, patient-oriented clinical care.

Introduction: Millions of Muslims across the world observe Islamic fasting during the holy month of Ramadan, as well as the other specific dates in the lunar calendar year. While fasting during this month, Muslims refrain from eating or drinking from dawn to dusk. Islamic fasting is similar to alternate day fasting (ADF) since it incorporates an average of 12 hours of fasting and 12 hours of feasting periods. This present review study is aimed to find out the common adverse health effects associated with Islamic fasting and the preventive measures to be followed to avoid them. Methods: The literature was reviewed through searching in databases such as PubMed, Google Scholar, and reference lists to identify the related articles. Results: Many health benefits have been attributed to Islamic fasting, including the reduced risk of cardiovascular diseases, diabetes, cancer, hypertension, and asthma. On the other hand, some studies have mentioned a few health problems associated with Islamic fasting, such as headaches, heartburn, constipation, dehydration, decreased sleep quality, and anemia, which may occur in some fasting individuals during Ramadan. Conclusion: Islamic fasting could be beneficial for health if it is performed correctly. During Ramadan, fasting individuals are advised to adhere to a balanced diet that contains sufficient portions of fruits and vegetables, whole grains, pulses, meat, fish, milk, and dairy products. Moreover, fasting individuals must drink adequate fluids, such as water, fresh fruit juices, and soups, in order to prevent the possible adverse health effects associated with Islamic fasting.

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