Psychological Responses Among Healthcare Workers Providing Care for Patients with COVID-19: A Web-Based Cross-Sectional Survey in Riyadh, Saudi Arabia.

Introduction: Coronavirus disease (COVID-19) is a pandemic of international concern that has caused significant physical and psychological health challenges to healthcare workers worldwide. This study aimed to assess and evaluate the psychological responses of healthcare workers who provided hands-on care for patients with COVID-19 at King Fahad Medical City (KFMC), Riyadh, Saudi Arabia, as it was converted to a dedicated COVID-19 hospital during the pandemic. Methods: This study used a descriptive cross-sectional design to recruit 500 participants at KFMC between April 10 and May 5, 2020. This study used the 21-item Depression, Anxiety, and Stress Scale (DASS-21) to assess the psychological responses among the study participants. Results: The findings of this study showed that of 500 respondents, 304 (60.9%) reported having depressive symptoms, 281 (56.3%), 318 (63.3%) having stress and anxiety symptoms. Moreover, 250 participants (50%) who lived with their families reported severe stress and anxiety. However, the results of our study indicated that healthcare workers were committed to providing care to COVID-19 patients. Conclusions: Depression, anxiety, and stress symptoms were highly prevalent among healthcare workers at KFMC. Therefore, there is an urgent need for psychological interventions to identify healthcare workers with heavy psychological burdens.

Nurses experience of caring for patients with COVID-19: A phenomenological study.

Introduction: COVID-19 has impacted all dimensions of life and imposed serious threat on humankind. Background: In Jordan, understanding how nurses experienced providing care for patients with COVID-19 offers a framework of knowledge about similar situations within the context of Arabic culture. Aim: To explore nurses' experience with providing hands-on care to patients with active COVID-19 infection in an Arabic society. Methods: A descriptive phenomenological study interviewed 10 nurses through a purposive sampling approach until data saturation was reached. The research site was hospital designated to receive patients with active COVID-19 infection. Semi-structured interviews were used to collect the data. Findings: Three themes were generated from the data: the impact of the COVID-19 outbreak on nurses' health; unfamiliar work and social environments; and conforming to professional standards. Discussion: There are specific risks to the physical and mental wellbeing of nurses who provide hands-on care to patients with COVID-19 in an Arabic society. Implication for nursing and health policy: Health care institutions should consider establishing programs that promote nurses' wellbeing and support their productivity in a crisis. A danger pay allowance should be considered for nurses during extraordinary circumstances, such as pandemics.

Nurses experience of caring for patients with COVID-19: A phenomenological study

Introduction COVID-19 has impacted all dimensions of life and imposed serious threat on humankind. Background In Jordan, understanding how nurses experienced providing care for patients with COVID-19 offers a framework of knowledge about similar situations within the context of Arabic culture. Aim To explore nurses' experience with providing hands-on care to patients with active COVID-19 infection in an Arabic society. Methods A descriptive phenomenological study interviewed 10 nurses through a purposive sampling approach until data saturation was reached. The research site was hospital designated to receive patients with active COVID-19 infection. Semi-structured interviews were used to collect the data. Findings Three themes were generated from the data: the impact of the COVID-19 outbreak on nurses' health;unfamiliar work and social environments;and conforming to professional standards. Discussion There are specific risks to the physical and mental wellbeing of nurses who provide hands-on care to patients with COVID-19 in an Arabic society. Implication for nursing and health policy Health care institutions should consider establishing programs that promote nurses' wellbeing and support their productivity in a crisis. A danger pay allowance should be considered for nurses during extraordinary circumstances, such as pandemics.

Impact of one-stop clinic on the clearance of COVID-19 surgical backlog

Objective: During the COVID-19 pandemic, there was a significant decrease in the number of operated elective cases due to the shutdown procedures. This situation created a substantial surgical backlog. Several visits are generally necessary before a surgical decision making and booking the surgery time. Improving patient access by creating “one-stop” clinics might help decrease the number of visits before the surgery. This study investigated the effect of one-stop clinic application as a new care model on COVID-19 surgical backlog clearance. Methods: We conducted a quasi-experimental, interrupted time-series, pretest-posttest study design in the northern areas of Saudi Arabia. The study outcomes were the number of surgeries and the time elapsed from the first seen day to the booked room day. Results: A total of 358 surgeries were included. Of them, 107 (29.9%) surgeries were performed before initiation of the one-stop clinic and 251 (70.1%) after initiation. The median (quartile Q1, Q3) time elapsed from the first seen day until the booked OR day post-one-stop clinic was 10 (6-17), which was significantly lower than pre-one-stop clinic 20 (11-33), P < 0.0001. Conclusion: One-stop clinics shortened the period between first visit and booking in the operating room. One-stop clinics may alleviate the surgical backlog resulting from the COVID-19 crisis. [ FROM AUTHOR] Copyright of Journal of Health Sciences (Qassim University) is the property of Journal of Health Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Assigning green hospitals during the COVID-19 pandemic assure continuous and safe resumption of surgical services.

BACKGROUND: Coronavirus 19 pandemic impacted the health system with more pressure on the critical areas, leading to direct manpower working in the Operating Room to help treat this new problem by postponing elective surgical cases and affecting some urgent ones. However, elective surgical services start to recover by establishing one or more hospitals that deal with COVID-19 free patients (green hospital) in each area with a dedicated one to treat COVID19 cases. Our research shows if this model's application assures safe and continued recovery of surgical services to reach the level before the pandemic. This study aimed to explore if assigning a green hospital to assure safe and continuous resumption of surgical services during a pandemic. METHODS: This study used a multicenter, national, quasi-experimental, post-test-only control group design. All hospitals assigned at least one hospital as a green hospital (COVID-19 free hospital) in the northern areas of Saudi Arabia were included in the study. We also included Riyadh's large tertiary care hospital as a control none green hospital. We reported the number of surgical backlog in each city, the number of surgical cases performed, the percentage of OR utilization in each city and the percentage of COVID-19 cases to the number of ICU bed cases in each city. RESULTS: This study included green hospitals in five cities in the northern area of Saudi Arabia. Besides, we included one none large green hospital in Riyadh city as a control group. The median of weekly procedures in green hospitals was 101 (99, 109.5) in Alqurayat, 233 (194, 237) in Tabuk, 180 (162, 199) in Haill, 108 (90, 120) in Al Jawf and 257 (155, 313) in Northern Borders. The median of weekly procedures in the control hospital was 245 (215, 259). Green hospitals contributed to reducing the surgical backlog by a median percentage of 74% (38, 108) in Alqurayat, 25% (21, 26) in Tabuk, 8% (7, 9) in Haill, 81% (54, 91) in Al Jawf and 78% (72, 88) in Northern Borders. While in the control hospital was 8% (8, 9). CONCLUSION: Implementing elective surgeries in green hospitals contributes to a continuous resumption of surgical services during the COVID-19 pandemic.

Bullous pemphigoid after second dose of mRNA- (Pfizer-BioNTech) Covid-19 vaccine: A case report.

INTRODUCTION AND IMPORTANCE: Messenger RNA vaccines, commonly known as mRNA vaccines, are the first COVID-19 vaccines that have been authorized and licensed in the United States. Two mRNA vaccines, BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna) are available. Mass vaccination remains the most critical way to halt the spread of the COVID pandemic. The most common adverse effects of the COVID vaccines are headache, muscular soreness, weariness, redness, swelling, and tenderness at the injection site. The dermatological adverse effects of mRNA vaccines, on the other hand, are little understood. We present a case of bullous fixed medication eruption following delivery of the second dose of Pfizer's Covid-19 vaccination. CASE PRESENTATION: We discuss the case of a 78-year-old man who went to the Emergency Department at King Fahad Medical City in Riyadh, Saudi Arabia, with numerous bullae throughout his extremities one day after receiving the second dosage of Pfizer Covid-19 vaccine. The bullae began three days before his presentation, and they were preceded by intense pruritus and urticated plaques. A skin biopsy was performed which revealed IgG (+1), IgM (+1), and C3 (+1) staining of the basement membrane. Another punch skin biopsy taken from an intact bulla was suboptimal compressing of dermal tissue only, revealing modest perivascular lymphocytic infiltrative and scattered eosinophils. This pathological picture with superficial perivascular inflammatory dermatitis, and the presence of eosinophils suggests drug-induced bullous pemphigoid. The patient was treated with topical and systemic corticosteroids, fusidic acid cream, and emollients after a confirmed diagnosis of bullous pemphigoid was obtained. He was hospitalized for 3 weeks as a case of severe sepsis due to a skin infection, and he was started initially on empiric antibiotics with piperacillin-tazobactam plus vancomycin that was later upgraded to meropenem and vancomycin based on the results of the blood and wound cultures. The patient suffered a pulmonary embolism on the second day of hospitalization and was placed on a heparin infusion that could potentially contribute to his death one month after discharge from our hospital. CLINICAL DISCUSSION: Bullous pemphigoid is the most frequent autoimmune bullous disease. It occurs in the elderly. The cause of this disease is unknown, although it sometimes can be triggered by taking certain medications. Two case reports have also revealed bullous pemphigoid eruption following immunization. One case report reported a 78-year-old lady with diabetes and Alzheimer's disease who developed tense bullae on her face and torso after getting the second dosage of the Pfizer-BioNTech COVID-19 Vaccine. Another case study described a 77-year-old male patient who developed generalized pruritis and bullae on erythematous bases one day after receiving the AstraZeneca COVID-19 vaccination. This new-onset bullous pemphigoid phenomenon has also been observed with other vaccinations such as rabies and swine flu. CONCLUSION: Although uncommon, several dermatological side reactions like bullous eruptions have been reported following the mRNA Pfizer Covid-19 vaccination. According to this case report, Bullous pemphigoid might be caused by the mRNA- (Pfizer) Covid-19 Vaccine.

Enhancing palliative care occupancy and efficiency: a quality improvement project that uses a healthcare pathway for service integration and policy development.

This article described our experience in implementing a quality improvement project to overcome the bed overcapacity problem at a comprehensive cancer centre in a tertiary care centre. We formed a multidisciplinary team including a representative from patient and family support (six members), hospice care and home care services (four members), multidisciplinary team development (four members) and the national lead. The primary responsibility of the formulated team was implementing measures to optimise and manage patient flow. We used the plan-do-study-act cycle to engage all stakeholders from all service layers, test some interventions in simplified pilots and develop a more detailed plan and business case for further implementation and roll-out, which was used as a problem-solving approach in our project for refining a process or implementing changes. As a result, we observed a significant reduction in bed capacity from 35% in 2017 to 13.8% in 2018. While the original length of stay (LOS) was 28 days, the average LOS was 19 days in 2017 (including the time before and after the intervention), 10.8 days in 2018 (after the intervention was implemented), 10.1 days in 2019 and 16 days in 2020. The increase in 2020 parameters was caused by the COVID-19 pandemic, since many patients did not enrol in our new care model. Using a systematic care delivery approach by a multidisciplinary team improves significantly reduced bed occupancy and reduces LOS for palliative care patients.