Awareness, Knowledge, Attitude, and Skills (AKAS) of Telemedicine and Its Use by Primary Healthcare Providers.

Background: This study aimed to determine the rate of telemedicine (TM) use and the levels of awareness, knowledge, attitude, and skills of TM among primary healthcare (PHC) providers. Methods: In a cross-sectional study, 104 PHC providers were subjected to a validated AKAS scale via Survey Monkey. The tool consists of 4 parameters that users can respond to using a 4-point Likert scale to assess their awareness (12 statements), knowledge (11 statements), attitude (11 statements), and skills (13 statements) on TM. Total and percentage mean scores (PMS) were calculated for each parameter. Participants were categorized in each parameter into three categories: low (≤ 49% score), average (50-70% score), and high (≥ 71% score) levels. The association of AKAS levels with personal characteristics and TM use was investigated. The significance was set at p<0.05. Results: One-half of participants (51%) reported current use of TM, and two-thirds (63.5%) reported a high level of AKAS, with a PMS of 72.9±14.7, 95% CI: 70.1-75.7. There were significant associations between the following: years of experience and levels of knowledge (Χ2LT = 6.77, p= 0.009) and skills (Χ2LT = 4.85, p = 0.028), respectively; and total household income and levels of skills (Χ2LT = 6.91, p= 0.009). The rate of TM use was significantly associated with awareness levels (Χ2LT = 6.14, p = 0.013). Lack of training ranked as the first barrier (45.5%), followed by connection problems and tools' unavailability (35.1% each). The participants recommended providing TM training (41.1%) and stabilization of connection and networking signals (30.1%). Conclusion: Despite their high level of TM awareness, the rate of TM use by PHC providers is less than satisfactory. Establishing standardized TM training and supporting the network signals are recommended. A large-scale study on the impact of TM integration with PHC services is necessary.

Physicians' Examination and Referral Practices on Orthodontic Problems Among 6-12-Year-Old Children in Saudi Arabia.

Background: Physicians are more likely to examine children than dentists; thus, they may have a significant role in detecting oral and dentofacial problems. This study aimed to determine the rate and comprehensiveness of examinations, the rate and quality of referral practices, and the predictors of referral practice of physicians regarding orthodontic problems among children. Methods: In a multi-center cross-sectional study, a total of 518 physicians in Saudi Arabia were subjected to an e-questionnaire of four sections: (1) Physicians' demographic and work-related characteristics; (2) Physicians' comprehensiveness of oral and orthodontic examinations; (3) Physicians' referral practices to orthodontists and reasons considered for referral; and (4) Physicians' sources of orthodontic education. Logistic regression analysis was applied to identify the significant predictors of referral practice. The significance was set at p < 0.05. Results: Most physicians reported partial oral (78.5%) and orthodontic (72.2%) examinations, while the full examination was reported by only 12% and 2.5% of physicians, respectively. Referral to orthodontists was practiced by most of the physicians (83.8%), yet for the majority of them, the quality of referral was poor (40.3%) or fair (46.1%), with only 13.6% who practiced quality referral. Dental development issues (53.3%) and functional issues (51.5%) were reported as the main reasons for referral, followed by family/patient request (42.9%), dental alignment (42.5%), oral respiratory issues (32.4%), and finally jaw relation (26.1%). Referral practice was predicted by the comprehensive oral (OR = 2.37, p = 0.007) and orthodontic (OR = 4.26, p < 0.001) examinations, number of patients seen by the physician (OR = 1.58, p = 0.007), and level of training (OR = 1.88, p = 0.03). Conclusion: Although most physicians reported high rates of examination and referral practices on orthodontic problems among children in Saudi Arabia, only a small portion showed comprehensive examinations and quality referral practice. Including dental courses in medical curricula and improving oral and orthodontic examination guidelines for physicians are recommended.

Awareness and Predictors of the Use of Bioinformatics in Genome Research in Saudi Arabia.

Background: With the advances in genomics research, many countries still need more bioinformatics skills. This study aimed to assess the levels of awareness of bioinformatics and predictors of its use in genomics research among scientists in Saudi Arabia. Methods: In a cross-sectional survey, 309 scientists of different biological and biomedical specialties were subjected to a previously validated e-questionnaire to collect data on (1) Knowledge about bioinformatics programming languages and tools, (2) Attitude toward acceptance of bioinformatics resources in genome-related research, and (3) The pattern of information-seeking to online bioinformatics resources. Logistic regression analysis was applied to identify the predictors of using bioinformatics in research. Significance was set at p<0.05. Results: More than one-half (248, 56.4%) of all scientists reported a lack of bioinformatics knowledge. Most participants had a neutral attitude toward bioinformatics (295, 95.4%). The barriers facing acceptance of bioinformatics tools reported were; lack of training (210, 67.9%), insufficient support (180, 58.2%), and complexity of software (138, 44.6%). The limited experience was reported in; having one or more bioinformatics tools (98, 31.7%), using a supercomputer in their research inside (44, 14.2%) and outside Saudi Arabia (55, 17.8%), the need for developing a program to solve a biological problem (129, 41.7%), working in one or more fields of bioinformatics (93, 30.1%), using web applications (112, 36.2%), and using programming languages (102, 33.0%). Significant predictors of conducting genomics research were; younger scientists (p=0.039), Ph.D. education (p=0.003), more than five years of experience (p<0.05), previous training (p<0.001), and higher bioinformatics knowledge scores (p<0.001). Conclusion: The study revealed a short knowledge, a neutral attitude, a lack of resources, and limited use of bioinformatics resources in genomics research. Education and training during each education level and during the job is recommended. Cloud-based resources may help scientists do research using publicly available Omics data. Further studies are necessary to evaluate collaboration among bioinformatics software developers and biologists.

The Outcome of Sacrocolpopexy/Sacrohysteropexy for Patients with Pelvic Organ Prolapse and Predictors of Anatomical Failure.

Background: Pelvic organ prolapse (POP) is a medical condition that profoundly impacts women's quality of life. Unfortunately, the literature lacks long-term predictors and risk factors for its recurrence. This study aims to assess the efficacy and safety of Sacrocolpopexy/Sacrohysteropexy and to identify the predictors of recurrence in a Saudi setting. Methods: In a retrospective cohort study, all patients who underwent Sacrocolpopexy (n=144) and Sacrohysteropexy (n=56) between 2009-2021 were followed up. Electronic medical records were examined to collect data on the following: Patient characteristics [age, parity, BMI, and past medical and surgical history], prolapse-related characteristics/symptoms, Surgery-related characteristics [type and approach of surgery, mesh type, and concomitant surgery], and Outcome characteristics. Postoperative anatomical success and failure rates were determined according to the Baden-Walker classification. Logistic regression analysis was applied to identify the predictors of overall anatomical failure of Sacrocolpopexy. Significance was considered at p<0.05. Results: Success rates of 96.8%, 99.4%, and 85.2% were detected in the anterior, apical, and posterior vaginal prolapse, respectively, with an overall success rate of 83.1%. The overall failure rate was 15.9%, with an incidence density of 5.98 per 100 women-years. The onset of failure in 27 failure cases ranged from 40 days to 11.5 years postoperative. After adjustment for the possible potential confounders, older age (OR=1.06, 95% CI:1.01‒1.13, p=0.03) and the presence of diabetes (OR=4.93, 95% CI:1.33‒18.33, p=0.02) were the only significant predictors of operation failure. As for complications, six cases (3.6%) required reoperation, two cases (1.2%) had a bowel obstruction two and seven years after surgery, and one patient (0.6%) had vaginal mesh exposure. Conclusion: The outcomes of Sacrocolpopexy/Sacrohysteropexy in our study are comparable to those in previous studies. Diabetes and elder age at the time of the surgery played a role in predicting recurrence. Sacrocolpopexy has a long-term profile of safety and efficacy. These findings could be key to stratifying surgical plans for pelvic organ prolapse cases.

Epidemiology of postoperative spinal wound infection in the Middle East and North Africa (MENA) region.

Background: Despite the extensive literature on postoperative spinal wound infection, yet to our knowledge, there is no previous study containing combined data from several sites in the Middle East and North Africa (MENA) region. This study aimed to estimate the incidence of surgical site infection (SSI) following spine surgeries, its associated factors, and management. Methods: In a retrospective cohort study, medical records of all patients ≥18 years of age who underwent spine surgery at 6 tertiary referral centers in the MENA region between January 2014 to December 2019 (n=5,872) were examined to collect data on the following: (1) Patient's characteristics, (2) Disease characteristics, (3) Spine surgery approach, and (4) Characteristics of Postoperative SSI. The determinants of postoperative SSI were identified using logistic regression analysis. Receiver operating characteristic (ROC) curve was applied to identify the cut-off of the length of stay in the hospital postoperatively till the infection is likely to occur. Significance was set at p<.05. Results: The overall incidence of SSI was 4.2% (95% CI: 3.72-4.77), in the form of deep (46.4%), superficial (43.1%), dehiscence (9.3%), and organ space (1.2%) infections. After adjusting for all possible confounders, significant predictors of postoperative SSI were; diabetes (OR=2.12, p<.001), smoking (OR=1.66, p=.002), revision surgery (OR=2.20, p<.001), open surgery (OR=2.73, p<.001), perioperative blood transfusion (OR=1.45, p=.033), ASA class III(OR=2.08, p=.002), and ≥4 days length of stay "LOS" (OR= 1.71, p=.001). A cut-off of 4 days was the optimum LOS above which postoperative SSI is more likely to occur, with 0.70 sensitivity, 0.47 specificity, and 0.61 area under the curve. Conclusions: This is the first study that highlighted the incidence of postoperative SSI in spine surgery in the MENA region. Incidence figures are comparable to figures in different areas of the world. Identifying predictors of SSI might help high­risk patients benefit from more intensive wound management.

Assessment of concerns about vaccination among recovered COVID-19 patients in Saudi Arabia.

Background: Vaccine hesitancy re-emerged as a critical public health issue during the COVID-19 pandemic. Aims: This study assessed the concerns of recovered COVID-19 patients about vaccination and the predictors of vaccine hesitancy. Methods: This was a cross-sectional study of 319 adult patients who recovered from COVID-19 in Saudi Arabia. It was conducted during 1 May to 1 October 2020 at King Abdulaziz Medical City, Riyadh. Each participant was interviewed 6-12 months post-recovery using the vaccination attitude examination scale. Data were collected on COVID-19 illness severity, sociodemographic characteristics, history of chronic disease, and post-COVID-19 vaccination. Level of vaccination concern was assessed based on the percentage mean score (PMS). Results: Most (85.3%) of the patients who recovered from COVID-19 expressed moderate overall concern (PMS = 68.96%) about vaccination. Concern was highest for mistrust in vaccine benefits (PMS = 90.28%), followed by natural immunity preference (PMS = 81.33%) and worries about the vaccine side-effects (PMS = 60.29%). Concern over commercial profiteering was low (PMS = 43.92%). The overall PMS for concern about vaccination was significantly higher among patients aged 45+ years (t = 3.12, P = 0.002) and among those who had experienced severe COVID-19 illness (t = 1.96, P = 0.05). Conclusion: Overall concern about vaccination was high, and specific concerns were prevalent. Patient education on how the vaccine protects against reinfection should be targeted at COVID-19 patients before being discharged from hospital.

Impact of a Video-Based Educational Intervention on the Levels of Knowledge and Concerns about COVID-19 Vaccination.

BACKGROUND: The hesitancy to receive the COVID-19 vaccine plays a role in delaying the current global and national COVID-19 management strategies. Evidence has highlighted the importance of examining the public's concerns and knowledge about COVID-19 vaccines in sustaining public prevention of the further spread of the virus worldwide. This study aimed to assess the impact of a video-based educational session on the Saudi public's levels of knowledge and concerns about the COVID-19 vaccination. METHODS: In a double-blind, randomized posttest-only control group study design, 508 Saudis were randomized to an experimental group (n = 253) and a control group (n = 255). The experimental group was exposed to a video-based educational session, while the control group was not. Then both groups were subjected to a validated questionnaire to assess their level of knowledge and concerns about the vaccine. RESULTS: In comparison to the control group, the experimental group showed a significantly lower proportion of overall high concern (0.4% vs. 5.5%, p < 0.001) and a higher proportion of overall good knowledge (74.2% vs. 55.7%, p < 0.001). After adjustment for possible confounders, the experimental group showed a significantly lower percent mean score of overall concern (45.0% vs. 65.0%, p < 0.001) and a higher percent mean score of overall knowledge (74.2% vs. 55.7%, p < 0.001) than the control group. CONCLUSIONS: The video-based educational intervention positively impacted the levels of knowledge and concerns about COVID-19 vaccination among the experimental group. These interventions safeguard against the rumors and misconceptions about COVID-19 vaccinations. Further studies on the impacts of such interventions on vaccine uptake are recommended.

Prevalence of Obesity among Children and Adolescents in Saudi Arabia: A Multicenter Population-Based Study.

Background: Childhood obesity has increased in Saudi Arabia over the past few decades. However, a representative burden of obesity remains unclear, as most studies had relied on small samples and/or used international growth references, which may have resulted in over-or underestimations of prevalence. Objective: The study aimed to determine the prevalence of obesity among children and adolescents in Saudi Arabia using the Saudi growth chart. Methods: This population-based retrospective study included children and adolescents aged 2-19 years who visited any facility within the National Guard Health System (5 hospitals and 24 primary care centers) across Saudi Arabia between 2016 and 2021. The Saudi growth reference for children and adolescents was used for classification. Those with body mass index ≥95th percentile were considered as obese and ≥85th to <95th percentile as overweight. Chi-square tests were used to compare frequencies across groups. Results: A total of 351,195 children and adolescents were included, of which 337,316 (96%) were Saudis. Overall, about one-fifth of the population was overweight (11.2%) or obese (9.4%). The prevalence of obesity was highest among children aged 2-6 years (12.3%), and it was higher among boys (10.4%) than girls (8.3%). In terms of region, the prevalence of obesity among Saudis was highest in the Central and Eastern regions (9.9% for both). Conclusion: The findings highlight an urgent need for national interventions to focus on the upstream determinants of childhood obesity and to improve healthy options for children and adolescents in terms of food and physical activities.

Utility of patient information leaflet and perceived impact of its use on medication adherence.

BACKGROUND: Although patients frequently use patient information leaflets (PILs) to obtain information about medicine, their confidence in using it may be diminished after reading it. This study aimed to assess the public perception of PIL's quality and the perceived impact of its use on medication adherence. METHODS: A community-based cross-sectional study of 1,138 adult individuals in Saudi Arabia, April-May 2020, was conducted via Survey Monkey using an anonymous validated e-questionnaire. Data were collected on personal characteristics, PIL readership and preferences, perception towards PIL quality and impact of its use on taking medication, and reasons for not reading PIL. In addition, logistic regression analysis was performed to identify the significant predictors of reading PIL. Significance was considered at p < 0.05. RESULTS: Nearly all participants (91.1%) reported reading PIL. The more read PIL's sections were directions of use (52.7%) and side effects (30.3%). Female gender (OR = 5.64, 95%CI: 3.53,9.02), age over 40 years (OR = 2.80, 95%CI: 1.69,4.64), and secondary education or more (OR = 1.74, 95%CI: 1.06,2.85) were the significant predictors of reading PIL. The majority of PIL readers reported their preference for verbal information (65.8%), hard copy presentation (77%), adding graphics (71.1%), and concise content of PIL (68.8%). In addition, most participants reported PIL always/usually adds to their knowledge of medicines (70.6%) and said that PIL reading positively impacted their medication adherence (64.9%). For only 8.8%, PIL reading negatively impacted their adherence, primarily because of reading information on medicine's side effects and complications (74.4%). More than one-half of participants perceived the PIL quality as good/excellent in terms of; font size (51.3%), language comprehensiveness (64.9%), paper quality (68.0%), and general appearance (64.9%). Getting sufficient information from doctors and pharmacists was the main reason for not reading the PIL (59.2%). Most participants (92.5%) agreed on standardizing how information is displayed in the PIL among all PILs of all companies. CONCLUSION: PIL is read by nearly all the study sample, especially females, older, and educated subjects. It was perceived as beneficial in upgrading medication adherence. Effective designing of PILs should focus on patients' literacy level and age. Standardization of the PIL structure in all pharmaceutical companies is recommended.

Impact of Patient-Centered and Self-Care Education on Diabetes Control in a Family Practice Setting in Saudi Arabia.

Background: Diabetes mellitus is a chronic and complex medical disease that leads to significant morbidity and mortality. Patient-centered diabetes education that emphasizes active patient involvement, self, and shared care constitutes a substantial and essential component of the comprehensive diabetes management approach. Objectives: To assess the impact of patient-centered diabetes education sessions on the prescribed treatment plan in controlling diabetes and other related cardiovascular risk factors. Methods: In a pre-experimental pretest-posttest one group study design, all referred patients with type 2 diabetes (T2DM) to the diabetes educator clinic (n = 130 patients) during the period of 6 months from January to July 2021 were subjected to multiple and consecutive patient-centered diabetes education sessions, based on the framework published by the Association of Diabetes Care and Education Specialties (ADCES), in addition to their usual treatment plan. Demographic, social, and biological data were obtained at the baseline, three months, and six months after the intervention. Nonparametric Friedman and Cochran's Q tests for related samples were applied to examine the impact of this educational intervention on glycosylated hemoglobin (HbA1c) and other associated cardiovascular risks. The results of 130 patients with T2DM showed a significant reduction of mean systolic blood pressure "SBP" (p = 0.015), glycosylated hemoglobin (HbA1c) (p < 0.001), fasting blood sugar "FBS" (p < 0.001), total cholesterol (p < 0.001), low-density lipoprotein (p < 0.001), and triglyceride (p < 0.001), and significant rise of mean high-density lipoprotein (p = 0.011). At three and six months after the intervention, 43% and 58% of patients showed improved HbA1c levels. The mean HbA1c was reduced from 10.2% at the beginning of the study to 8.7% (p < 0.001) after six months. Moreover, a significant reduction in the prevalence of obesity (p = 0.018), high FBS (p = 0.011), and high SBP (p = 0.022) was detected. Conclusions: This study showed a considerable positive impact of diabetes education and patient-centered care on optimizing glycemic and other cardiovascular risk control. The needs of certain patients with T2DM should be addressed individually to achieve the best possible outcomes. Further research is needed to explore the long-term benefits of this intervention.

Clinical characteristics and outcome of Covid-19 illness and predictors of in-hospital mortality in Saudi Arabia.

BACKGROUND: Patients' race and ethnicity may play a role in mortality from Covid-19. Studies in China, the US, and Europe have been conducted on the predictors of Covid-19 mortality, yet in the EMR countries, such studies are scarce. Therefore, we aimed to describe the hospitalization rate, ICU-admission, and in-hospital mortality of Covid-19 and predictors of in-hospital mortality in Saudi Arabia. METHODS: E-medical records were examined for all Covid-19 patients diagnosed in five tertiary hospitals affiliated with the Saudi-National Guard-Health Affairs during March 21, 2020, and September 12, 2021, based on a positive SARS-CoV-2 RT-PCR test, (n = 35,284). Data were collected on patients' characteristics, comorbidities, laboratory findings, hospitalization, ICU admission, and in-hospital and overall mortality. Logestic regressions were used to identify the independent predictors of in-hospital mortality. The best laboratory parameters cut-off values to predict in-hospital mortality were identified using the area under the receiver operating characteristic curve (AUC). Significance was considered at p < 0.05. RESULTS: Of all 35,284 Covid-19 patients, 81.8% were adults and 21.7% were hospitalized. Compared to non-hospitalized patients, hospitalized patients were more of female gender (52.1% versus 47.3%, p < 0.001) and had higher mean age (p < 0.001), higher mean BMI (p < 0.001), and higher rates of: diabetes (p < 0.001), hypertension (p < 0.001), ischemic heart disease (p < 0.001), cancer (p < 0.001), COPD (p < 0.001) and asthma (p = 0.011). The study showed 3.1% overall case-fatality, 20.3% ICU admission rate, and 9.7% in-hospital mortality. Predictors of in-hospital mortality among adult patients were; patients' age ≥ 70 years (OR = 6.93, 95% CI 1.94-24.79), ischemic heart disease (OR = 1.80, 95% CI 1.05-3.09), ICU admission (OR = 24.38, 95% CI 15.64-38.01), abnormal C-reactive protein "CRP" (OR = 1.85, 95% CI 1.08-3.16), abnormal D-dimer (OR = 1.96, 95% CI 1.15-3.36), lymphopenia (OR = 2.76, 95% CI 2.03-3.3.76), high neutrophil count (OR = 2.10, 95% CI 1.54-2.87), and abnormal procalcitonin (OR = 3.33, 95% CI 1.88-5.90). The best laboratory parameters cut-off values to predict in-hospital mortality were CRP > 72.25 mg/L (AUC = 0.64), D-dimer > 1125 µg/L (AUC = 0.75), neutrophils count > 5,745 × 10^9/L (AUC = 0.70), lymphocytic count < 1.10 × 10^9/L (AUC = 0.72), and procalcitonin > 0.18 ng/mL (AUC = 0.76). CONCLUSIONS: Rates of hospitalization, ICU-admission, in-hospital mortality and overall case fatality were nearly comparable to the rates in western countries. Early interventions are necessary for high-risk Covid-19 patients, especially elderly patients and those with cardiac diseases.

Awareness and Attitude of Physicians on the Role of Dentists in the Management of Obstructive Sleep Apnea.

Background: Efforts to evaluate physicians' awareness and attitude toward dentists' comprehensive role in OSA management are relatively negligible. Therefore, this study aimed to assess physicians' awareness and attitude toward the role of dentists in OSA management in Saudi Arabia. Methods: In a multi-center cross-sectional study, a total of 358 physicians in Saudi Arabia were subjected to an e-questionnaire composed of three sections: (1) physicians' demographic data, (2) physicians' general and specific knowledge of OSA and its management [using 29 factual statements to be responded by "True, False, or I don't know" responses], and (3) physicians' attitude towards dentists' role in OSA management [using 12 attitude statements to be responded by a Likert scale of "Never, Rarely, Sometimes, Usually, Always" responses]. A scoring system was applied for both knowledge and attitude, total and percentage mean scores (PMS) were calculated, and knowledge and attitude levels were categorized accordingly. Predictors of correct knowledge and favorable attitude were identified using multiple regression analyses. Results: Physicians had an overall average knowledge level (PMS = 56% ± 19.4%), with 35.5% and 5.9% reporting good general and specific knowledge levels, respectively (χ2 = 143.0, p < 0.001). Physicians had an overall neutral attitude level (PMS = 64.4% ± 17.5%), with about one-half reporting a neutral attitude level (48.9%) and only one-fourth reporting a positive attitude level (27.7%). Higher levels of knowledge were a significant predictor of favorable attitudes (t = 5.71, p < 0.001). Higher training levels were a significant predictor of correct knowledge (t = 3.60, p < 0.001) and favorable attitude (t = 3.15, p = 0.002). Conclusions: Physicians showed insufficient knowledge about OSA and a less than favorable attitude towards dentists' role in its management. Enhancing medical curricula and clinical protocols and guidelines on the dentists' role in OSA management is recommended.

Epidemiology of Work-Related Neck Pain Among Spine Surgeons.

STUDY DESIGN: Cross-sectional survey. OBJECTIVES: This study aimed to investigate work-related neck pain among AO spine surgeons in different regions by estimating its prevalence, predictors, consequences, and management methods. METHODS: A cross-sectional survey of 411 spine surgeon members of AO spine was conducted during March-May 2021, using the Modified Nordic Questionnaire and the Neck Disability Index. Data on neck pain experience during the last 12 months and its consequences and risk factors were collected. Logistic regression analysis was done to identify significant predictors of neck pain. Significance was set at P < .05. RESULTS: The 1-year neck pain was experienced by 66.7% of surgeons. According to the Neck Disability Index, more than one-half (52.8%) experienced disability due to neck pain of mild (45.5%), moderate (6.5%), and severe (.8%) grades. Neck pain was responsible for stopping work in 17.5% of surgeons, with a median of 3.5 (IQR, 2-7.8) days off work. One-half of the participants (56.3%) were treated by medical care, 31.5% by physiotherapy, and 16.5% requested rest days and sick leave. Physical stress (P < .001) and non-exercising (P = .04) were the significant predictors of neck pain. CONCLUSION: The 12-month prevalence of neck pain was high among spine surgeons, with an impact on activities of daily living, mainly of a mild degree, reported by one-half of surgeons. Physical stress was the only significant predictor, while sports practice was a protective factor against neck pain. Medication was the primary management adopted-an increased focus on pain prevention through improved workplace ergonomics and sports activity programs is recommended.

Accuracy of Antibiotic Allergy Documentation and the Validity of Physicians' Decision in a Pediatric Tertiary Care Setting.

BACKGROUND: Patients allergic to antibiotics are at higher risk of receiving treatment with a broader spectrum, more harmful, and expensive agents. The aims of this study were (1) to assess the quality of documentation of antibiotics allergies in the electronic medical records (EMR) in a Pediatric tertiary care setting, and (2) to determine the validity of physicians' decision to hold antibiotics prescriptions. METHODS: This is a retrospective cohort study at King Abdullah Specialized Children Hospital, Riyadh, Saudi Arabia. A review of the EMR and all Adverse Drug Reaction (ADR) reports of pediatric patients 1-14 years old, with a documented allergy to antibiotics from June 2016 until June 2019. The quality of documentation of antibiotics allergy was assessed based on the presence of four parameters: 1) allergy alert notification, 2) allergy severity classification, 3) setting notes, and 4) symptoms' description. In addition, all physicians' reports of allergy to antibiotics were cross-classified according to their corresponding ADR reports, and the validity of physicians' documentation of allergy was assessed. RESULTS: Of a total of 105 Pediatric patients' EMR, documentation of antibiotics allergy was available in 98 (93.3%), with the presence of symptoms description (83%), allergy notes (87%), severity (67%), and signs of alert (50.8%). Overall documentation quality was good for only 23.5% of patients, while it was poor for 35.7%. Physicians' documentation of antibiotics allergy was 0.82 sensitive [with 0.18 risk of allergy] and 0.60 specific [with 0.40 unnecessary restrictions of prescriptions]. Of all children with possible/actual allergies, only 38.9% were referred to the immunology clinic. CONCLUSION: The quality of documentation of antibiotic allergy in children and the validity of physicians' decisions are less than satisfactory. Therefore, improving communications between all healthcare providers regarding patients' allergy status and follow-up for further assessment of the reaction is recommended to improve patient care.

Epidemiology of work-related lower back pain among rehabilitation professionals in Saudi Arabia.

BACKGROUND: Occupational and physical therapists are at risk of musculoskeletal pain and injuries possibly due to their work-related activities, posture and affected body mechanics. AIMS: To investigate the epidemiology of lower back pain among rehabilitation professionals. METHODS: A cross-sectional survey of 259 physical and occupational therapists in rehabilitation centres in Saudi Arabia was conducted during July-August 2019, using the Modified Nordic Questionnaire. Data on different measures of lower back pain, and its consequences and risk factors were collected. Logistic regression analysis was done to identify significant predictors of lower back pain. RESULTS: Rehabilitation professionals experienced 73.7% 1-year lower back pain prevalence, 52.5% intense pain that lasted ≥ 1 day, 22.4% chronic lower back pain, 23.9% sick-leave-seeking lower back pain and 18.5% medical-care-seeking lower back pain. Difficult/impossible activities of daily living in standing up (45.5%), employment (44.0%), climbing stairs (33.9%), walking (33.0%), sitting (29.3%), sleeping and travel (29.8% each), awakening (23.0%), social life (26.2%), and personal care (15.7%) were reported. Lower back pain was responsible for stopping work in 32.5% of participants, with a mean 1.38 (±2.96) days off work during the last year. One half of participants (50.3%) were treated by physiotherapy, 25.1% by medical care, and 39.3% requested rest days and/or sick leave. Physical stress and < 10 years' experience were significant predictors of lower back pain. CONCLUSION: Prevalence of lower back pain was high among rehabilitation professionals, with a high impact on activities of daily living. Physiotherapy was the main management adopted. Educational programmes are necessary to teach proper use of body mechanics, and sports activity programmes to reduce the risk of lower back pain and arrange for proper rest periods.

Behavior Responses and Attitude of the Public to COVID-19 Pandemic During Movement Restrictions in Saudi Arabia.

BACKGROUND: The behavior of the general public and the adoption of precautionary measures during a pandemic determine the fate of the country in the absence of any specific cure. This study aimed to determine the public attitude and behavior responses to the COVID-19 pandemic in Saudi Arabia during movement restrictions, and the predictors of behavioral responses. METHODS: A community-based cross-sectional study of 2470 adult individuals in Saudi Arabia, 17-29 April 2020 was conducted via Survey Monkey, using an anonymous validated e-questionnaire. Data were collected on demographic characteristics, COVID-19-related attitudes, and behavioral responses in terms of; precautionary measures, preparedness, and self-quarantine activities, to be responded to by 4-point Likert scales. Multiple linear regression analyses were performed to identify the significant predictors of compliance with different behaviors. Significance was considered at p<0.05. RESULTS: Participants reported positive attitudes towards governmental actions (95%), self-hygiene (93.2%), social distancing (97.1%) and choice of healthy food (89.6%), and negative attitudes towards the current worldwide situation of the pandemic (81.0%) and hearing someone tested positive (77.8%) or died from COVID-19 (83.7%). High rates of compliance to behavior were reported by only 55.8% of participants in terms of precautionary measures (71.3%), preparedness (38.4%), and self-quarantine activities (46.1%). After adjusting for all possible confounders, the total attitude score was a significant predictor of the total scores of precautionary measures (t=12.01, p<0.001), preparedness (t=9.29, p<0.001), self-quarantine activities (t=12.05, p<0.001), and overall behavior response (t=14.09, p<0.001). Other significant predictors of higher overall behavior response scores were female gender (t=7.22, p<0.001) and non-Saudi nationality (t=3.40, p<0.001). CONCLUSION: This study provides baseline data on the behavioral response to the national COVID-19 pandemic in Saudi Arabia. The levels of compliance to behavior response and attitude to COVID-19 pandemic were less than satisfactory. Socio-demographics influence public behavior and protective health measures. COVID-19 awareness programs are recommended.

Diagnostic Accuracy of D-Dimer Testing and the Revised Geneva Score in the Prediction of Pulmonary Embolism.

BACKGROUND: Pulmonary embolism (PE) diagnosis can sometimes be challenging due to the disease having nonspecific signs and symptoms at the time of presentation. The present study aimed to evaluate the validity of the D-dimer in combination with the revised Geneva score (RGS) in the prediction of pulmonary embolism. PATIENTS AND METHODS: This is a retrospective study of 2010 patients with suspected PE who had undergone both D-dimer testing followed by chest CT angiography (CTPA), irrespective of the D-dimer test results, at King Abdulaziz Medical City, Riyadh, Saudi Arabia, over 3 years, from Jan. 2016 to Jan. 2019. The predictive accuracy of D-dimer, adjusted D-dimer, and RGS was calculated. The receiver operating characteristic "ROC" curve was applied to allocate the optimum RGS cutoff for PE prediction. RESULTS: The overall prevalence of PE was 16%. It was 0%, 25.8%, and 88.9% in low, intermediate, and high clinical probability categories of RGS, respectively. Both conventional and age-adjusted D-dimer thresholds showed significant level of agreement (kappa=0.81, p<0.001), high sensitivity (94% and 92.8%), high negative predictive value "NPV" (91.2% and 91.4%), low specificity (12.3% and 15.3%), and low positive predictive value "PPV" (17.5% and 17.8%), respectively. Combination of the age-adjusted D-dimer threshold and RGS at a cut-off of 5 points would provide 100% sensitivity and 61.7% specificity 34.1% PPV, 100% NPV, and 0.87 area under the curve "AUC". At an RGS cutoff <5 points, PE could have been ruled out in more than one-half (1036, 51.5%) of all suspected cases, and would have saved the cost of CTPA. CONCLUSION: Conventional and age-adjusted D-dimer tests showed high levels of agreement in the prediction of PE, high sensitivity, and low specificity. RGS has a good performance in PE prediction. Using the revised Geneva score alone rules out PE for more than one-half of all suspected without further imaging.

Perception and attitude of healthcare workers in Saudi Arabia with regard to Covid-19 pandemic and potential associated predictors.

BACKGROUND: Healthcare workers (HCWs) face considerable mental and physical stress caring for patients with Covid-19. They are at higher risk of acquiring and transmitting this virus. This study aims to assess perception and attitude of HCWs in Saudi Arabia with regard to Covid-19, and to identify potential associated predictors. METHODS: In a cross-sectional study, HCWs at three tertiary hospitals in Saudi Arabia were surveyed via email with an anonymous link, by a concern scale about Covid-19 pandemic during 15-30 April, 2020. Concerns of disease severity, governmental efforts to contain it and disease outcomes were assessed using 32 concern statements in five distinct domains. Multiple regression analysis was used to identify predictors of high concern scores. RESULTS: A total of 844 HCW responded to the survey. Their average age was 40.4 ± 9.5 years, 40.3% were nurses, 58.2% had direct patient contact, and 77.3% were living with others. The majority of participants (72.1%) had overall concern scores of 55 or less out of a maximum score of 96 points, with an overall mean score of 48.5 ± 12.8 reflecting moderate level of concern. Three-fourth of respondents felt at risk of contracting Covid-19 infection at work, 69.1% felt threatened if a colleague contracted Covid-19, 69.9% felt obliged to care for patients infected with Covid-19 while 27.7% did not feel safe at work using the standard precautions available. Nearly all HCWs believed that the government should isolate patients with Covid-19 in specialized hospitals (92.9%), agreed with travel restriction to and/or from areas affected by Covid-19 (94.7%) and felt safe the government implemented curfew and movement restriction periods (93.6%). Predictors of high concern scores were; HCWs of Saudi nationality (p < 0.001), younger age (p = 0.003), undergraduate education (p = 0.044), living with others (p = 0.003) working in the western region (p = 0.003) and direct contact with patients (p = 0.018). CONCLUSIONS: This study highlights the high concern among HCWs about Covid-19 and identifies the predictors of those with highest concern levels. To minimize the potential negative impact of those concerns on the performance of HCWs during pandemics, measures are necessary to enhance their protection and to minimize the psychological effect of the perceived risk of infection.

Efficacy of scopolamine transdermal patch in children with sialorrhea in a pediatric tertiary care hospital.

BACKGROUND: Drooling is common in children with neurological disorders, but its management is very challenging, Scopolamine transdermal patch (STP) appears to be useful in controlling drooling, although it is not approved for this indication and there are limited clinical studies about its effectiveness. This study aimed (1) to assess the impact of STP use on the severity of drooling and on the frequency of emergency department (ED) and hospital readmission (RA) visits related to drooling, and (2) to determine the level of family satisfaction with STP when used in children with neurological disorders. METHODS: This is a retrospective cohort study of all pediatric patients aged 3-14 years, with non-progressive neurodevelopmental disability, who used STP for more than one year during the period between April 2015 and July 2018 (n = 44). Data on demographics, clinical status, comorbidities, STP dose and duration, other medications, ED and RA visits were collected. Follow-up phone-call interviews with parents/caregivers were performed using a parent-reported frequency and severity rating scale of sialorrhea. Absolute and relative risk reductions were calculated to assess the impact of STP on ED and RA visits. Significance was considered at p-value of ≤ 0.05. RESULTS: STP use showed significant reduction in severity of drooling (p < 0.001), wiping of the child's mouth (p < 0.001), bibs or clothing changes (p < 0.001), choking and aspiration of saliva (p = 0.001). The Relative Risk Reduction of the drooling-related ED and RA visits were 86% and 67% respectively. Nearly two-thirds (60%) of caregivers were satisfied with using STP. CONCLUSIONS: This is the first study of its kind done in Saudi Arabia demonstrating favorable impact of STP use by children on the consequences associated with drooling and with the frequency of ER and RA visits due to drooling. Development of a medication use protocol is recommended to standardize STP treatment in order to optimize its effectiveness. This study serves as baseline information for future prospective interventional studies.