Post-Traumatic Stress Disorder (PTSD) Among Healthcare Workers of Tertiary Care Hospitals of Rawalpindi;Amid the COVID-19 Pandemic

Objective: To determine the prevalence of PTSD symptoms and its severity among HCWs, amid the COVID pandemic in a tertiary care setting. Study Design: Cross sectional analytic study. Place and Duration of Study: Pakistan Emirates Military Hospital, Rawalpindi Pakistan, from May to Aug 22. Methodology: The study was conducted on 173 healthcare workers of a tertiary care hospital. The sample size was calculated using the Rao-soft calculator. Validated questionnaires such as the Impact of Event Scale-Revised (IES-R) and PTSD Checklist Civilian Version (PCL-C) were used to collect the data. Data was entered and analyzed by using Statistical Package for Social Sciences (SPSS) version 26. Results: Out of 173 participants, majority of participants 90(52%) were male and single 103(63%). Mean age of the participating HCWs was 27(SD= 2.3). HCWs performing duties the in COVID-19 ward for one year were 66(38.2%) and majority were from Emergency medicine 61(35.3). Almost 150(86.71%) of HCWs did not experiencing any PTSD symptoms and those exhibiting a higher severity of symptoms were only 5(2.9%). There was no statistically significant difference in total and sub scales mean scores of IES-R among males and females (p=0.28). Conclusions: Our study concluded that prevalence of symptoms of PTSD was significantly low in Health Care Workers despite of the fact, majority of doctor participants were working in COVID-19 ward for one year. The symptoms were evident among healthcare professionals, however there was modest severity. © 2022, Army Medical College. All rights reserved.

Fuel subsidies to curb cost-push inflation: a case study of Pakistan to assess the impact of untargeted subsidies on fiscal space and current accounts

The rapid surge of global oil prices, on account of the pent-up demand after COVID-19 and the Russian-Ukraine war, has significantly contributed to the cost-push inflation as well as twin deficits, predominantly in developing economies. Motivated by the intention to curb the inflation, governments of several oil-dependent economies have rolled out fiscal measures to provide immediate relief to households through subsidizing the fuel component of the consumption basket. This paper provides a case study of Pakistan, wherein the effectiveness of untargeted gasoline and diesel subsidies has been gauged against alternative direct disbursement mechanisms. The analysis reveals that under the price-control based indirect subsidy disbursement mechanism, only 11% of the total domestic subsidies were directed to the poorest 40% of the households, whereas approximately 55% of the total subsidies were allocated to the 20% of the most liquid household segment. The case study analyzes the performance of alternative direct subsidy disbursement mechanisms which transpires into the potential fiscal savings of PKR 74.63 billion, while providing coverage to 40% of the lowest household segment. The study also evaluates the implication of the pass-through of the true prices on the national consumption of gasoline and diesel in the short-term, which reveals the sharp reduction of petroleum consumption in the total bill from 37% to 23%, thereby providing substantial relief to the current account balance. The finding provides key insights for economies to institutionalize the necessary social protection system and progressively transit to the direct subsidy disbursement mechanism while striving to contain the cost-push-based inflation triggered through the rapid movement of global oil prices. © 2022. The Author(s).

Classroom Management in Virtual Learning: A Perceptions Study with School Teachers in Qatar

The aim of the study is to analyze the issue of virtual classroom management throughout the COVID-19 pandemic using a case study approach in a descriptive analytical method. Participants in this study are 110 teachers currently engaged in preparatory and secondary schools in different parts of Qatar. The data collection instrument used was a 4 point Likert Scale based questionnaire targeted to elicit respondents' attitudes and opinions towards virtual classroom management, challenges faced in this, and the most suitable strategies to overcome these challenges. Descriptive statistics, frequencies, and percentages were used to analyze the data. Results based on the findings show three axes: teachers‟ challenges, beliefs, and attitudes. Findings indicate that teachers face difficulty in virtual classroom management and attribute the biggest challenge to their inability to check distractions in the home-based learning environment. Another significant finding is that classroom management is marginalized given the extremely limited teacher-student contact in the virtual education mode. Lastly, learner interaction is drastically stunted in virtual mode bringing the teachers to the conclusion that teaching in the physical mode is the only way to ensure classroom management. © 2022 by the authors.

Online Learning During COVID-19 Pandemic: L2 Learners' Perspectives

The current study was prompted by the sudden appearance of COVID-19 pandemicwhich changed the system of education globally. Successive students' perspectives were noticed in Saudi universities through adopting online platform to sustain the learning process. Therefore, this study is concerned with addressing the challenges that L2 learners face while accessing online learning platform and with its efficiency, motivationand their perspectives. This study employed an analytical research design. Data were collected via Saudi universities through a questionnaire. This study assigned to 128 L2 learners purposively sampled. Results reported that the majority of respondents admit the positivity of the online learning. However, challenges are still prevalent in accessing the apps and interacting successfully. The study proposes strategies to create safe, supportive and challenging learning environments through modifying new policies concerning online motivation, engaging students and developing them as learners along with periodic training for teachers on the different aspects of online education. Further, education policymakers, schools and universities should pay more attention for successive training to enhance instructors' technology and communicative competencies. Besides, innovative virtual teaching strategies are highly demanded for both instructors and L2 learners. Managing the classrooms virtually in pandemics needs more attention and polices to follow.

Accuracy and perceptions of teledentistry in KSA during the COVID-19 pandemic: A single-centre randomised controlled trial.

Objective: Teledentistry conveniently delivers dental care when in-person visits are restricted, such as during the COVID-19 pandemic. This study aimed to assess Saudi Arabian patients' accuracy, perceptions, knowledge, attitudes, and challenges regarding teledentistry used for diagnosis during the COVID-19 pandemic, as well as its accuracy, versus traditional dental visits. Methods: A single-blind, parallel-group randomised controlled trial design was used. The 70 participants were randomised equally into study and control groups. While the control group waited, the study group received teledentistry diagnoses which were compared with baseline clinical examinations retrieved from the UQU dental hospital, Makkah, KSA. After the intervention was completed, all participants answered a questionnaire. Results: There were no significant differences between the groups in knowledge or attitudes regarding teledentistry. However, study group participants had more favourable experiences with teledentistry. They reported good accuracy with diagnosis and recording of their chief complaints (74.3%), number of missing teeth (74.3%), number of filled teeth (71.4%), and oral hygiene status (65.7%). Additionally, moderate accuracy was reported on recording of health complaints (51.4%) and number of decayed teeth (40.?%). The number of decayed teeth and the decayed, missing, and filled teeth (DMF) index scores reported using teledentistry were significantly (p < 0.05) higher than reported in the baseline examinations. Conclusion: Teledentistry is widely accepted by patients and can be efficient for preliminary examinations, particularly during pandemic lockdowns or in more frequently occurring situations such as severe weather conditions, but subsequent clinical examination is necessary for maximally accurate diagnoses.

RESUSCITATION STATUS AND CHARACTERISTICS OF MUSLIM PATIENTS WHO DIE IN THE ICU: EXPERIENCE FROM A TERTIARY CARE CENTER

TOPIC: Palliative Care and End of Life Issues TYPE: Original Investigations PURPOSE: The end-of-life resuscitation status and therapeutic interventions in critically ill Muslim patients who succumb to their illness is not well reported. We describe our experience in such patients who were admitted to our tertiary care hospital Intensive Care Unit (ICU). METHODS: Our hospital is a tertiary care center accredited by Joint Commission International and Nurses Magnet Programs and runs active organ transplantation services. The patient population and treating ICU physicians are all Muslim. We collected twelve-month data from the year 2020 of patients who died in our ICU. Coronavirus Disease 2019 infected patients were treated separately and were not included in the study to give true reflection of the end-of-life care in Muslim patients under ordinary circumstances. Patient demographics, characteristics before and at ICU admission, cardiopulmonary resuscitation and DNAR details in ICU, and therapies administered in last 24 hours before death were recorded. Descriptive statistics were used to organize the collected data. Continuous variables were described as median with Interquartile Range Q1-Q3 (IQR), and categorical variables were described as number and percentages, as appropriate. RESULTS: 104 Muslim patients died during the study period. Their median age was 64 years and 51% were male. These patients had a median of 5 underlying comorbidities and a Charlson Comorbidity Index of 6 at baseline, highlighting their moribund status. 56% had underlying illness that would have qualified them for hospice before admission. Patients spent a median of 10 days (IQR 6-15) in the ward before ICU admission, had a high APACHE II score of 23 (IQR 20-33) and lactic acid of 3.7 (IQR 2.2-4.8) upon ICU admission. Their duration of mechanical ventilation (6 days;IQR 4-9), ICU stay (6 days;IQR 2-13) and hospital length of stay (10 days;IQR 6-15) were relatively long. 92% were "Full Code" at ICU admission and the status was changed to 'do-not-attempt resuscitation' (DNAR) in about 67% of the cohort before death. 42 patients had CPR done and 8 were made DNAR after one CPR. DNAR decision was made after median of 13 days (IQR 7-22 days) of hospital admission and 5 days (IQR 2.5-9 days) before death. DNAR discussions were led by Intensivists in 89% of the cases. Until the very end, patients in both groups were on tube feeds, underwent blood draws, had few limitations on therapy or withdrawal of care. There was hardly any involvement of Muslim chaplain and palliative care service. CONCLUSIONS: The concept of DNAR is accepted in Muslim patients even though decision is made near end of life. Many patients with terminal disease ended up in the ICU and role of hospice and palliative care needs to be increased in this population. CLINICAL IMPLICATIONS: DNAR is acceptable in Muslim patients, however, active mechanisms need to be developed to avoid terminal patients suffering undue ICU course at end of life. DISCLOSURES: No relevant relationships by Azhar Alharbi, source=Web Response No relevant relationships by Mohammed Alzahrani, source=Web Response No relevant relationships by MANSOR BINHASHR, source=Web Response No relevant relationships by Maryam Imran, source=Web Response No relevant relationships by Manahil Imran, source=Web Response No relevant relationships by Imran Khalid, source=Web Response No relevant relationships by Tabindeh Khalid, source=Web Response No relevant relationships by Murad Mawlawi, source=Web Response No relevant relationships by Nahid Mulla, source=Web Response No relevant relationships by Renad Nadhreen, source=Web Response No relevant relationships by Ahmed Qadah, source=Web Response No relevant relationships by Romaysaa Yamani, source=Web Response

Comparison of critical care healthcare workers emotional experience and coping strategies during middle east respiratory syndrome and COVID-19 outbreaks

Rationale Healthcare workers (HCWs) are at high risk of contracting both Middle East Respiratory Syndrome (MERS) and Coronavirus disease-2019 (Covid-19). Both diseases have their emotional toll on HCWs, but the difference of impact between the two remains unknown. Methods We administered a “MERS-Covid-19 Staff Questionnaire” to 80 HCWs, employed in critical care areas, who worked during both the 2014 MERS and Covid- 19 outbreaks in a tertiary care hospital in Jeddah, Saudi Arabia. The survey, adopted from our previously published study post MERS epidemic, consisted of 5 sections with 72 questions. Each question asked staff to compare their experience between the MERS and Covid-19 outbreak. The sections evaluated HCWs emotions, perceived stressors, factors that reduced their stress, coping strategies, and motivators for future outbreaks. Responses were scored on a scale from 0-3 and reported as mean and standard deviation. Student t-test was used to compare the difference in responses between the two outbreaks. Results Completed questionnaires were returned by 62 (78%) participants. In the assessment of HCWs “EMOTIONS”, the strongest feelings were similar in both outbreaks and included the ethical obligation of HCWs to keep working amidst tiring long hours and fear of personal safety (score>2/3;p>0.3). However, certain sentiments were stronger during Covid-19 pandemic, including discontent from disproportionately increased workload as compared to HCWs in low-risk areas and expectation of receiving extra compensation (mean score 1.7/3, p <0.02). When comparing “PERCEIVED STRESSORS”, Covid-19 was more distressing in various aspects. Not knowing when outbreak will end, stricter protective measure use at work and home, limitations on travel, heightened fear of getting infected in hospital or community and paranoia of touching surfaces, were all worse during Covid-19 (score>2/3;p<0.05). Social support, avoidance of disease transmission with protective measures and majority of patients recovering were major factors that “REDUCED STRESS” of HCWs similarly through both outbreaks (p>0.05). Some “COPING STRATEGIES” including staff being extra cautious of disease spread, minimizing of outdoor activities, and adopting relaxation measures mainly at home scored higher during Covid-19 (p<0.05). Availability of full protective gear, family support, quick cure or prevention for the disease and financial incentives were the predominant “MOTIVATORS” to uplift them in future outbreaks. Conclusion Both coronavirus outbreaks were emotionally draining for critical care HCWs. However, Covid-19 was more stressful and led to greater behavioral and protective adaptations in some respects. Further studies can focus on strategies to help HCWs emotional wellbeing based on our results.

Awareness of, Beliefs about, Practices of, and Barriers to Teledentistry among Dental Students and the Implications for Saudi Arabia Vision 2030 and Coronavirus Pandemic.

OBJECTIVES: Saudi Arabia launched multiple initiatives to overcome the problem of health-care access. The recent coronavirus pandemic created urgent demand to deal with the problem using nonconventional venues such as telehealth and teledentistry. This study aimed to investigate teledentistry knowledge, attitudes, and practices, and barriers to its use among dental students and teaching staff in Makkah province, Saudi Arabia. MATERIALS AND METHODS: A total of 314 dental students participated in this cross-sectional study. Data were collected using a validated self-reported questionnaire to measure teledentistry awareness, attitude, practices, and barriers to teledentistry. The study was approved by Umm Al-Qura University, Saudi Arabia. RESULTS: Only 17.2% were aware of the term "teledentistry." However, after it was explained, participants were able to correctly answer 25.16%-62.42% of items about teledentistry. A total of 67.83% would practice teledentistry, and 70.7% support using teledentistry on a national scale for Vision 2030. Only 25.16% used teledentistry before, but 56.05% did dental consultations via smartphone. The most common barriers were patient satisfaction requiring a dentist's physical presence, violation of patient privacy, and low levels of population education. CONCLUSION: Dental students seem to know little about teledentistry. However, they are open to learning and using it. It is encouraged to include the topic in continuing dental education, including how to use it during health disasters such as the coronavirus pandemic.