Assessing the Anxiety and Knowledge about Monkeypox Virus: A Cross-Sectional Cohort Study

Introduction Recent cases of human monkeypox virus (MPXV) infections have raised global health concerns, as sporadic instances have occurred in various regions, prompting investigations into the potential for increased transmission. This underscores the importance of effective communication strategies in addressing the emerging challenges associated with this viral ailment. The study was conducted to understand public anxiety and knowledge related to MPXV infection, particularly in the context of emerging infectious diseases. Our aims included assessing anxiety levels and knowledge about monkeypox infection among the Saudi population, as well as their willingness to receive vaccinations if available. Methods A cross-sectional cohort study among the adult Saudi population was conducted. A questionnaire with four sections, including demographic data and disease knowledge, comprised optimized questions of the standard generalized anxiety disorder assessment (GAD-7) as well as questions related to acceptance of getting the vaccine if it could be afforded. Results Out of a total of 5298 participants, 927 (17.5%) showed different degrees of GAD-7 anxiety. Females showed a significantly higher rate of anxiety (487/2189, 22.2%) than males (440/3109, 14.2%). People aged 46 to 55 and >55 years old showed significantly higher rates of anxiety (30.7% and 27.2%). There is an overall decrease in knowledge and awareness about the MPXV. Interestingly, 59% of the participants admitted that they would get the MPXV vaccine if it were made available. There was a positive correlation between the anxiety level and the response of people toward the MPXV vaccine if it were available. Conclusion Our study underscores a significant level of anxiety and a notable lack of awareness concerning MPXV infection. Although a substantial number of participants expressed their willingness to receive an MPXV vaccine, our findings emphasize the pressing need for improved public education and awareness campaigns to alleviate anxiety levels and enhance understanding of this infectious disease. This effort is crucial for mitigating health concerns and facilitating well-informed decision-making among the Saudi population.

Impact of a national collaborative project to improve the care of mechanically ventilated patients

This prospective quasi-experimental study from the NASAM (National Approach to Standardize and Improve Mechanical Ventilation) collaborative assessed the impact of evidence-based practices including subglottic suctioning, daily assessment for spontaneous awakening trial (SAT), spontaneous breathing trial (SBT), head of bed elevation, and avoidance of neuromuscular blockers unless otherwise indicated. The study outcomes included VAE (primary) and intensive care unit (ICU) mortality. Changes in daily care process measures and outcomes were evaluated using repeated measures mixed modeling. The results were reported as incident rate ratio (IRR) for each additional month with 95% confidence interval (CI). A comprehensive program that included education on evidence-based practices for optimal care of mechanically ventilated patients with real-time benchmarking of daily care process measures to drive improvement in forty-two ICUs from 26 hospitals in Saudi Arabia (>27,000 days of observation). Compliance with subglottic suctioning, SAT and SBT increased monthly during the project by 3.5%, 2.1% and 1.9%, respectively (IRR 1.035, 95%CI 1.007-1.064, p = 0.0148; 1.021, 95% CI 1.010-1.032, p = 0.0003; and 1.019, 95%CI 1.009-1.029, p = 0.0001, respectively). The use of neuromuscular blockers decreased monthly by 2.5% (IRR 0.975, 95%CI 0.953-0.998, p = 0.0341). The compliance with head of bed elevation was high at baseline and did not change over time. Based on data for 83153 ventilator days, VAE rate was 15.2/1000 ventilator day (95%CI 12.6-18.1) at baseline and did not change during the project (IRR 1.019, 95%CI 0.985-1.053, p = 0.2812). Based on data for 8523 patients; the mortality was 30.4% (95%CI 27.4-33.6) at baseline, and decreased monthly during the project by 1.6% (IRR 0.984, 95%CI 0.973-0.996, p = 0.0067). A national quality improvement collaborative was associated with improvements in daily care processes. These changes were associated with a reduction in mortality but not VAEs. Registration The study is registered in clinicaltrials.gov (NCT03790150).

Tobacco smoking and depressive symptoms among male medical students in Al-Baha University

Background:

Smoking is a psychosocial problem regarding its causes mainly. In primary health care units, depression is the most common problem that affects the whole body and arises with physical, emotional, and cognitive symptoms. This study aimed to determine the prevalence rate of tobacco smoking and depressive symptoms among male medical students of Albaha university. Also, to investigate the association between tobacco smoking and depressive symptoms among male medical students of Albaha university.

Method:

A cross-sectional study was conducted on All the male medical students in the all-academic year levels of Al-Baha medical college using a self-administrated questionnaire.

Results:

Two hundred and eight medical students completed the study. About half of the participants (49.5%) weren't smokers. More than two-thirds (69.5%) started smoking in the first academic year. Our statistical analysis results reported; a significant correlation regarding the marital status (P-value = 0.000). The abnormality was significantly higher among current smokers (P-value = 0.013) and markedly lower among nonsmokers (P-value = 0.004). Regarding types of smoking, cigarette smokers were seriously depressed (P-value = 0.000).

Conclusion:

There is a relationship between smoking and depressive state among medical students. Researches must be conducted to explain this relation of depression symptoms with tobacco and not to increase the prevalence of smoking by helping students quit smoking.

Anticoagulation Control of Warfarin in Pharmacist-Led Clinics Versus Physician-Led Clinics: A Prospective Observational Study

Purpose

Warfarin is an affordable drug used for numerous indications, and still a favorable choice for patients with a history of bleeding from direct oral anticoagulants or presence of valvular heart diseases. However, warfarin requires regular international normalized ratio (INR) monitoring for safety and efficacy. Warfarin’s efficacy and safety is correlated with actual time spent within the therapeutic INR. Time in therapeutic range (TTR) is an estimate that measures the percentage of actual time spent within the therapeutic INR. Our aim was to investigate differences in anticoagulation control of warfarin using TTR between pharmacists and other health-care providers.

Methods

This prospective observational study was conducted in an ambulatory-care setting of a tertiary hospital to compare anticoagulation management using TTR between clinics run by pharmacists versus other health-care providers.

Results

A total of 62 patients were enrolled: 33 in the pharmacist-led clinic and 29 in the physician-led clinic. TTR levels were statistically higher among patients in the pharmacist-led clinic than than the physician-led clinic (87.27%±3.82% and 52.48%±5.49%, respectively; p<0.001). For 27 patients followed retrospectively by physicians and prospectively by clinical pharmacists, TTR was statistically higher during clinical pharmacists’ care (91.70%±2.93% versus 61.39%±5.11%, respectively; p<0.001). During the study, approximately 82% of patients reached their target INR in the pharmacist-led clinic compared to 24% in the physician-led clinic.

Conclusion

The findings of our study found that patients followed in the pharmacist-led clinic had higher TTR levels than those followed in the physician-led clinic.

National Approach to Standardize and Improve Mechanical Ventilation

NASAM (National Approach to Standardize and Improve Mechanical Ventilation) is a national collaborative quality improvement project in Saudi Arabia. It aims to improve the care of mechanically ventilated patients by implementing evidence-based practices with the goal of reducing the rate of ventilator-associated events and therefore reducing mortality, mechanical ventilation duration and intensive care unit (ICU) length of stay. The project plans to extend the implementation to a total of 100 ICUs in collaboration with multiple health systems across the country. As of March 22, 2019, a total of 78 ICUs have registered from 6 different health sectors, 48 hospitals, and 27 cities. The leadership support in all health sectors for NASAM speaks of the commitment to improve the care of mechanically ventilated patients across the kingdom.

The burden perceived by informal caregivers of the elderly in Saudi Arabia

OBJECTIVES:

The objective of this study was to discover the characteristics of informal caregivers of elderly patients; to determine the socioeconomic, psychological, and physical consequences facing informal caregivers; and to measure their burdens and needs.

MATERIALS AND METHODS:

This study was a cross-sectional survey of informal caregivers of elderly patients. Participants were recruited from different hospitals and primary care clinics in Riyadh, Saudi Arabia. For an intended sample size of 384 caregivers, a multistage sampling was used. A self-administered questionnaire was used to collect data. Data analysis included student's t-test and ANOVA to test for statistical significance.

RESULTS:

The study included 315 caregivers of elderly patients. Over half of the elderly patients were female (55.9%) and over 70 years old (65.7%); about 31% had chronic diseases or disabilities, which represented the majority of health problems reported by the elderly population. Most of the caregivers were family members (87.9%), young (43.8%), female (52.7%), unemployed (54.6%), and unmarried (58.1%). Most caregivers suffered from musculoskeletal problems (78.1%). The mean Zarit Burden Interview score was 31.3, which indicated a moderate burden. More than half of caregivers requested blood pressure (55.6%) and blood sugar measuring devices (53%). Three quarters (74.9%) of the caregivers wanted educational training to cope with emergencies. Most caregivers expressed a need for frequent healthcare for themselves (58.4%) and a home health visit service (72.9%) to support them in the care of their elderly.

CONCLUSIONS AND RECOMMENDATIONS:

Mobilization of resources in locations where these carers of the elderly live are greatly needed. In addition, health authorities should provide devices and essential training to manage the common problems and emergencies that informal caregivers have to deal with. Moreover, caregivers need follow-up supervision by a home visit team. Further studies are required to guide the implementation of the above advice.