Exploring Physicians' Views, Perceptions and Experiences about Broad-Spectrum Antimicrobial Prescribing in a Tertiary Care Hospital Riyadh, Saudi Arabia: A Qualitative Approach.
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SUBMITTER: Alsaleh NA
PROVIDER: S-EPMC8067237 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundThe term "telemedicine" refers to the use of communication technology to deliver health care remotely. The COVID-19 pandemic had substantial impacts on health care delivery from 2020 onward, and it was necessary to adapt high-quality care in a manner that limited the potential for viral exposure of both patients and health care workers. Physicians employed video, phone, and electronic written (e-consultation) visits, all of which provided quality of care comparable to that of face-to-face visits while reducing barriers of adopting telemedicine.ObjectiveThis study sought to assess physicians' perspectives and attitudes regarding the use of telemedicine in Riyadh hospitals during the COVID-19 pandemic. The main objects of assessment were as follows: (1) physicians' experience using telemedicine, (2) physicians' willingness to use telemedicine in the future, (3) physicians' perceptions of patient experiences, and (4) the influence of telemedicine on burnout.MethodsThis study employed SurveyMonkey to develop and distribute an anonymous 28-question cross-sectional survey among physicians across all specialty disciplines in Riyadh hospitals. A chi-square test was used to determine the level of association between variables, with significance set to P<.05.ResultsThe survey was distributed among 500 physicians who experienced telemedicine between October 2021 and December 2021. A total of 362 doctors were included, of whom 28.7% (n=104) were consultants, 30.4% (n=110) were specialists, and 40.9% (n=148) were residents. Male doctors formed the majority 56.1% (n=203), and female doctors accounted for 43.9% (n=159). Overall, 34% (n=228) agreed or somewhat agreed that the "quality of care during telemedicine is comparable with that of face-to-face visits." Approximately 70% (n=254) believed that telemedicine consultation is cost-effective. Regarding burnout, 4.1% (n=15), 7.5% (n=27), and 27.3% (n=99) of the doctors reported feeling burnout every day, a few times a week, and a few times per month, respectively.ConclusionsThe physicians had generally favorable attitudes toward telemedicine, believing that its quality of health care delivery is comparable to that of in-person care. However, further research is necessary to determine how physicians' attitudes toward telemedicine have changed since the pandemic and how this virtual technology can be used to improve physicians' professional and personal well-being.
| S-EPMC9278404 | biostudies-literature
Project description:PurposeDiabetic retinopathy (DR) is a serious cause of irreversible blindness and is the most common complication of diabetes. Annual fundus examination for diabetics aids in the prevention of blindness and allows intervening at a timely manner. As primary care physicians (PCP) are the main providers for diabetic care in Saudi Arabia, we aim to evaluate the current knowledge and awareness, and to assess practices among PCP regarding DR.MethodsWe conducted a cross-sectional study covering 46 randomly selected primary-care centers in Riyadh during October 2015. A Self-administered questionnaire was distributed to PCP containing 3 sections. The first section covered participants' demographics and professional background. The second section contained multiple-choice questions on knowledge related to diabetes and DR. The third section was to assess physicians' practices.ResultsA total of 216 PCPs completed the questionnaire. The mean overall knowledge score was 57 ± 14 out of 100. There was a significant difference in knowledge score between physicians who had obtained a subspecialty degree in family medicine compared to others (59 ± 14, 53.3 ± 14 respectively; P = 0.003). Only 19% of PCPs were aware of anti-vascular endothelial growth factor (VEGF) injections as a modality of treatment. A defect was found in the screening and follow-up of type 1 diabetics, and only 24% of physicians correctly referred patients with type 1 diabetes to an ophthalmologist.ConclusionOur study uncovered areas of defects in knowledge among PCP regarding DR. This needs to be addressed in future seminars and workshops with an emphasis on the proper ophthalmological screening and management of diabetic patients.
| S-EPMC5352944 | biostudies-literature
Project description:BackgroundNumerous surveys studied individuals' decision to receive COVID-19 vaccine but the motives behind accepting or refusing COVID-19 vaccines are not yet fully understood. We aimed to more qualitatively explore the views and perceptions toward COVID-19 vaccines in Saudi Arabia to provide recommendations to mitigate the vaccine hesitancy issue.MethodsOpen-ended interviews were conducted between October 2021-January 2022. The interview guide included questions about beliefs in vaccine efficacy and safety, and previous vaccination history. The interviews were audio-recorded, transcribed verbatim, and the content was analyzed using thematic analysis. Nineteen participants were interviewed.ResultsAll of the interviewees were vaccine acceptors; however, three participants were hesitant as they felt they were forced to receive it. Several themes emerged as the reasons to accept or refuse the vaccine. The key reasons behind vaccine acceptance were the sense of obligation to fulfill a governmental command, trust in the government decisions, vaccine availability, and the impact of family/friends. The main reason behind vaccine hesitancy was doubts regarding vaccine efficacy and safety and that vaccines were pre-invented, and the pandemic is made-up. Participants' sources of information included social media, official authorities, and family/friends.ConclusionFindings from this study show that the convenience of receiving the vaccine, the abundance of credible information from the Saudi authorities, and the positive influence of family/friends were among the major factors that encouraged the public in Saudi Arabia to get vaccinated against COVID-19. Such results may inform future policies regarding encouraging the public to receive vaccines in cases of pandemic.
| S-EPMC10165864 | biostudies-literature
Project description:BackgroundLimited reports addressing physicians' understanding of the various low-density lipoprotein cholesterol (LDL-C) targets/statin intensity required for treating the various dyslipidemia patient populations in Saudi Arabia are available. Therefore, the current study assessed the perceptions and beliefs of practicing clinicians in Saudi Arabia regarding the current practice for management of dyslipidemia and potential perceived barriers to adherence to lipid guidelines encountered in their regular clinical practice. Knowledge of different clinical practices and beliefs could have a positive impact on improving the quality of future care provided by physicians.MethodsA survey questionnaire was designed to assess physicians' familiarity, usage, and adherence to seven different international guidelines and used to evaluate the management of dyslipidemia, practice of patient treatment, and perceived obstacles to adhering to lipid guidelines related to specific patients, doctors, and practice issues.ResultsA total of 467 physicians were recruited for the study: (1) 57.2% were primary care physicians (PCPs) and (2) 42.8% were specialists. About 90.8% of them followed lipid guidelines of which the most common set were based on those by the American College of Cardiology/American Heart Association. The most utilized risk assessment tool was the atherosclerotic cardiovascular disease (ASCVD) risk calculator. About 60% of the physicians set an LDL-C target for their patients based on a combination of patients' risk factors and lipid profiles. In all, 42.1% of the physicians chose not to change existing therapy among patients with dyslipidemia to attain a non-high-density lipoprotein goal with controlled LDL-C level. Atorvastatin accounted for the greatest percentage of primary and secondary prevention choices (71.9% and 69.6%, respectively). Rosuvastatin was mostly preferred by physicians for patients with familial hypercholesterolemia. About two-thirds of the physicians (77.9%) prescribed statins to diabetic patients aged 40-75 years. Statin intolerance was encountered by 62.9% of the physicians in ≤ 10% of patients by 62.9%. Therapeutic strategies included switching to an alternative statin (40.1%) followed by reducing the statin dose (35.3%). Ezetimibe was prescribed by most physicians (77.9%) as an add-on to statin if the LDL-C target was not achieved. Fibrate was most preferred by physicians (62.7%) for hypertriglyceremia treatment followed by statins (28.7% of the physicians). Sixty-six percent reported not using proprotein convertase subtilisin/kexin type 9 serine protease inhibitors in their clinical practice due to unavailability at their institute (51.8%), high costs (26.3%), and/or lack of knowledge (20.6%). Perceived barriers to guideline adherence identified by physicians were lack of familiarity and knowledge of the guidelines, patient non-adherence, medication costs, and lack of timely follow-up appointments and educational tools. Multiple similarities and differences were observed after comparisons were made between specialists and PCPs in terms of guideline preference, clinical practice, and perceived barriers.ConclusionDifferent perceptions and attitudes among physicians in Saudi Arabia were found due to variable recommendations by international lipid guidelines. Perceived barriers that included the patient, physician, and practice were identified by physicians at multiple levels. Multiple challenges and different action gaps were observed when comparing specialists to PCPs. It is recommended that standardized practices be followed by clinicians in Saudi Arabia, and actions to address the outlined barriers are essential for optimizing health outcomes and ASCVD prevention.
| S-EPMC10495637 | biostudies-literature
Project description:Clinical pharmacists are responsible for guiding pharmacotherapy and ensuring medication safety along with other health-care providers. This study highlighted barriers that physicians and nurses encounter when interacting with clinical pharmacists. Twenty-seven physicians and nurses were randomly invited to participate in focus-group discussions. Five focus-group discussions were recorded and then transcribed, and the transcripts were reviewed and coded. Three major themes were identified, which were the role of clinical pharmacists, interprofessional communication, and competency. The greatest challenge reported in this study was lack of consistent understanding of the role of clinical pharmacists which to some extent caused communication deficiencies and affected the level of involvement with multidisciplinary teams. Despite that, majority of the participants perceived pharmacists as beneficial in optimizing pharmacotherapy and improving quality of care. Clinical pharmacy services are perceived positively in impacting quality of care as expressed by majority of the study participants. However, there is a lack of common understanding of the role of clinical pharmacists by other health-care providers.
| S-EPMC7774375 | biostudies-literature
Project description:IntroductionCongenital lobar overinflation (CLO) is a congenital overinflation of a pulmonary lobe. The treatment choice depends on the severity of its symptoms. Surgical intervention is indicated for patients with significant symptomatology, while a conservative approach is used to treat incidental and mildly symptomatic lesions. However, the conservative approach for children with mild symptoms is not very common among pulmonologist. Therefore, we evaluated this approach to treating mildly symptomatic children.MethodsThis retrospective study examined mildly symptomatic patients (n = 14) with a radiological diagnosis of CLO between June 2005 and August 2018 who were treated conservatively at KFSHRC in Riyadh. The participants' ages ranged between two days and four years, with follow-up period ranged from four months to 10 years.ResultsFourteen patients with CLO-who were 2 days to four years old and comprised 10 boys (71.4%) and four girls (28.6%)-were treated conservatively. All patients were symptomatic upon presentation, and their main clinical findings were tachypnea (85.7%) and dyspnea (78.6%). A single lobe was affected for ten patients (71.4%). Congenital cardiac anomalies founded in six patients (42.9%). Radiological image showed overinflation of all patients' affected lobes. Significant mediastinal displacement was observed among two patients (14.3%). During their follow-up periods, nine patients (64.3%) became asymptomatic, three (21.4%) showed improvement, and two (14.3%) remained symptomatic and underwent lobectomy.ConclusionsThe good outcomes for mildly symptomatic children with CLO in our series indicate that the conservative approach can be considered to treat these children at any age, along with close follow-up.
| S-EPMC8977909 | biostudies-literature
Project description:BackgroundAntimicrobial resistance (AMR) is presently considered an emergent major global public health concern and excessive and/or inappropriate use of broad-spectrum antimicrobials contribute to the development of AMR.ObjectiveTo evaluate the appropriateness of carbapenems and piperacillin-tazobactam use in a tertiary care hospital.MethodsA retrospective, observational, cross-sectional, drug-utilization study was conducted. The study included all adult hospitalized patients who had received at least one dose of the antimicrobials during their admission for the period between 1 January 2016 and 31 December 2017. The appropriateness of antimicrobial therapy was evaluated according to the Infectious Diseases Society of America (IDSA) guidelines with the consideration of the institutional antibiogram.ResultsOverall, 2731 patients received 5005 courses with one of the antimicrobials, for a total of 5045.9 defined daily doses (DDD) of imipenem-cilastatin, 6492.3 of meropenem and 15,595 of piperacillin-tazobactam (4.93, 6.34 and 15.24 DDD/100 bed days, respectively). The mean age of the patients who received either antimicrobial was 55.5 ± 20.3 years, with a 14-day average length of hospital stay. About half (52%) of the prescriptions were written for patients treated in the medical ward. Pneumonia (26.6%) and sepsis (24.9%) were the most common indication for the initiation of antimicrobial therapy. Of the assessed prescriptions, only 2787 (56.5%) were prescribed appropriately, with 2142 (43.5%) deemed inappropriate. The three most common reasons for inappropriate prescription were: the spectrum of activity was too broad (44.6%), followed by antimicrobial use without culture request (32.4%), and failure of suitable antimicrobial de-escalation (19.9%).ConclusionsThe study indicates that the overall rate of inappropriateness was high, emphasizing the need to develop initiatives to effectively improve broad-spectrum antimicrobial prescribing.
| S-EPMC7679439 | biostudies-literature
Project description:Background The occurrence of the COVID-19 pandemic in late December 2019 created a worldwide emergency. It affected most surgical subspecialties in many ways. Therefore, we aimed to quantitate the early effect of COVID-19 on elective and emergency orthopedic surgeries. Moreover, to identify the most affected orthopedic subspecialties during this crisis. Materials and methods Our study was conducted in a tertiary hospital in Saudi Arabia. We included all patients who underwent orthopedic procedures from January 1, 2020 - June 30, 2020, with the same period of 2019 for comparison. Emergency procedures were considered if a patient had an acute fracture, joint dislocation, compartment syndrome, infection, and infected non-union. Results The impact of procedure cancellation in the early COVID-19 phase was significant. Our department procedures decreased in the 2nd quarter of 2020 by 75.6% from the previous quarter of the same year and 61.1% from the 2nd quarter of 2019. No admission restrictions were made for oncology and trauma patients, though they had a reduction in their cases. The most affected subspecialties in our study were sports medicine, upper limb, arthroplasty, and pediatrics. Conclusion During the COVID-19 crisis, elective surgeries were held in our hospital and most of Saudi Arabia. Our cohort showed a significant decrease during this period. All subspecialties were affected by elective procedure cancellation, but some were affected more because of the elective nature of their operations, such as sports and upper limb, pediatric, and arthroplasty.
| S-EPMC9367174 | biostudies-literature
Project description:Background:Children diagnosed with autism spectrum disorder (ASD) have social and cognitive disabilities. For parents, these behaviors can lead to humiliation, social exclusion, and isolation. Stigma is a problem that not only may affect the individual with high functioning autism, but has the potential to extend to their family as well. Indeed, research indicates that the parents of children with disabilities (including ASD) commonly experience stigmatizing reactions from others. Aim of work:To determine the prevalence of self and enacted stigma among parents of ASD children from Riyadh, Saudi Arabia, and recognize possible risk factors and causes of stigmatization. Material and methods:An observational cross-sectional study involving the parents of ASD children from Riyadh, Saudi Arabia. About 163 participants were included from the Centre for Autism Research (CFAR) at King Faisal Specialist Hospital & Research Centre (KFSH & RC) in Riyadh. The primary material used for data collection was a five-point scale questionnaire developed by the investigator. The questionnaire consisted closed ended questions related to the participants' demographic data, autistic child, family life, resources, and social experiences as a parent. The collected data were analyzed using descriptive statistics and appropriate statistical analysis, using Statistical package for the social sciences (SPSS), version 22. The level of significance was P value?<?.05. Results:The findings of this work indicated that 55 (33.7%) of the parents scored more than 3 in answering questions related to felt stigma; 82 (50.3%) were fathers. On the other hand, 108 (66.3%) did not feel stigmatized being a parent of autistic child. Forty-two (25.8%) of the parents scored more than 3 in answering questions related to enacted stigma, whereas 121 (74.2%) did not face enacted stigmatization being a parent of autistic child. There was a strong tendency for mothers (41, 75%) to feel more self- and enacted stigmatized than fathers (P?<?.05). Moreover, the gender of the autistic child, consanguinity, severity of the ASD, and the monthly income of the family showed no significant difference in the parents who scored more than 3 for felt- or enacted stigmatization (P?>?.05). Conclusion:Among participated parents of children with ASD in Riyadh, Saudi Arabia, 33.7% of them experienced stigmatization, and mothers felt more self- and enacted stigmatized when compared to fathers. Public awareness among people in Saudi Arabia have been increased and, thus, negative stigmatization has decreased among parents in the country. A high level of felt stigma suggests the need for psychological intervention for the family to help cope with this new situation. A higher level of enacted stigma suggests the need for their rights (individuals with ASD) and increased awareness in the society. It is recommended that further research is needed in different centers in Riyadh and other regions of Saudi Arabia to investigate the prevalence of stigma in parents of autistic children.
| S-EPMC7568054 | biostudies-literature
Project description:To investigate a cluster of Middle East respiratory syndrome (MERS) cases in a women-only dormitory in Riyadh, Saudi Arabia, in October 2015, we collected epidemiologic information, nasopharyngeal/oropharyngeal swab samples, and blood samples from 828 residents during November 2015 and December 2015-January 2016. We found confirmed infection for 19 (8 by reverse transcription PCR and 11 by serologic testing). Infection attack rates varied (2.7%-32.3%) by dormitory building. No deaths occurred. Independent risk factors for infection were direct contact with a confirmed case-patient and sharing a room with a confirmed case-patient; a protective factor was having an air conditioner in the bedroom. For 9 women from whom a second serum sample was collected, antibodies remained detectable at titers >1:20 by pseudoparticle neutralization tests (n = 8) and 90% plaque-reduction neutralization tests (n = 2). In closed high-contact settings, MERS coronavirus was highly infectious and pathogenicity was relatively low.
| S-EPMC6759265 | biostudies-literature