Preparedness, Risk Perception, Concerns and Risk Acceptance among Hospital Healthcare Workers (HCWs) in facing the emerging new Corona Virus (COVID-19) Outbreak in Najran Hospitals, Saudi Arabia, at the early phase of the pandemic (Preprint)

BACKGROUND Coronavirus disease 2019 (COVID-19) pandemic extended to reach most countries in the globe during a few months. The preparedness of healthcare institutions and healthcare workers is crucial for applying effective prevention and control measures. OBJECTIVE This study aimed to assess HCWs and institutional preparedness in facing the new emerging coronavirus (COVID-19) infection at the early phase of the pandemic, and to explore HCWs' risk perception, concerns, and risk acceptance. METHODS A cross-sectional survey was conducted among hospital HCWs in the main hospitals, in Najran city, southwestern Saudi Arabia, at the early phase of the pandemic, during March-April, 2020. RESULTS Overall, 563 completed questionnaires were received (382; 67.9% from KKH and 181; 32.1% from NNH). The majority were females (78.6%), nurses constituted (74.7%). The age range of the participants was 20-63 years, with the mean age of physicians 36.5±9.15 years and 31.8±7.48 years for nurses. Among participants, 65.8% attended training program/s for COVID-19 infection, of whom 69.9% were satisfied with this training. Almost all (97.4%) of the participants reported reading the official circulars assigned for guidelines, case definition and, infection control measures regarding COVID-19 infection, 97.1% received basic infection control training, 98.9% checked for the best-fitted size of N95 mask, and 89.4% were influenza vaccinated. Of the participants, 82.6% reported that they have sufficient knowledge about t COVID-19 pandemic, 82.0% being confident that they can protect themselves and their patients when dealing with COVID-19 cases, 92.9% reported that they understand the risk of COVID-19 infection for patients and healthcare staff and 83.2% reported agreement of accepting the risk of getting the infection being a part of their job. The study participants attained a 20.26±2.60 knowledge score on a scale of 26 maximum points (77.9%), of them 74.5% attained 20 points or more (>75%) indicating good working knowledge about the COVID-19 pandemic. Exploring the participants’ perception about the preparedness of their institutions towards the COVID-19 pandemic, 70.8% agreed that institutional precautionary measures to COVID-19 in the workplace are sufficient, 71.6% agreed that all personal protective equipment (PPE) are provided and always available in the workplace, and 90.6% mentioned that the staff in their institutions have had adequate training. Exploring risk perception and the affective aspect of the pandemic on HCWs, 79.0%, 35.2%, 64.2% of the participants felt that they, their families, and the Najran community are at high risk of getting an infection with the COVID-19 virus respectively, and 54.7% and 55.1% were concerned about their personal and family health respectively. CONCLUSIONS Findings revealed good knowledge about the COVID-19 pandemic among HCWs in Najran hospitals, Saudi Arabia. Concerns and worries were expressed regard working with the highly infectious COVID-19 patients. Participants appreciated important aspects of institutional preparedness. Experience gained from the previous MERS-CoV outbreak may explain good knowledge, risk acceptance, self-efficacy, and good and rapid institutional preparedness at the early stage of the pandemic.

The landscape of antibiotic usage among COVID-19 patients in the early phase of pandemic: a Malaysian national perspective

Background During the early phase of the COVID-19 pandemic, antibiotic usage among COVID-19 patients was noted to be high in many countries. The objective of this study was to determine the prevalence of antibiotic usage and factors affecting antibiotic usage among COVID-19 patients during the early phase of the COVID-19 pandemic in Malaysia. Methods This was a cross-sectional study that involved reviewing medical records of COVID-19 Malaysian patients aged 12 and above who were diagnosed with COVID-19 and received treatment in 18 COVID-19 hospitals from February to April 2020. A minimum sample of 375 patients was required. A binary logistic regression analysis was performed to determine factors associated with antibiotic usage. Variables with p < 0.05 were considered statistically significant. Results A total of 4043 cases were included for analysis. The majority of the patients (87.6%) were non-smokers, male (65.0%), and had at least one comorbidity (37.0%). The median age was 35 years (IQR: 38). The prevalence of antibiotic usage was 17.1%, with 5.5% of them being prescribed with two or more types of antibiotics. The most frequent antibiotics prescribed were amoxicillin/clavulanic acid (37.8%), ceftriaxone (12.3%), piperacillin/tazobactam (13.3%), azithromycin (8.3%), and meropenem (7.0%). Male patients (adjusted OR 1.53), who had a comorbidity (adjusted OR 1.36), associated with more severe stage of COVID-19 (adjusted OR 6.50–37.06), out-of-normal range inflammatory blood parameters for neutrophils, lymphocytes, and C-reactive protein (adjusted OR 2.04–3.93), corticosteroid use (adjusted OR 3.05), and ICU/HDU admission (adjusted OR 2.73) had higher odds of antibiotic use. Conclusions The prevalence of antibiotic usage in the early phase of the COVID-19 pandemic was low, with amoxicillin/clavulanic acid as the most common antibiotic of choice. The study showed that clinicians rationalized antibiotic usage based on clinical assessment, supported by relevant laboratory parameters.

Weight Change during the Early Phase of Convalescent Rehabilitation after Stroke as a Predictor of Functional Recovery: A Retrospective Cohort Study

It has been reported that weight gain at discharge compared with admission is associated with improved activities of daily living in convalescent rehabilitation (CR) patients with low body mass index. Here, we investigated whether weight maintenance or gain during the early phase of CR after stroke correlates with a better functional recovery in patients with a wide range of BMI values. We conducted this retrospective cohort study in a CR ward of our hospital and included adult stroke patients admitted to the ward from January 2014 to December 2018. After ~1 month of hospitalization, the patients were classified into weight loss and weight maintenance or gain (WMG) groups based on the Global Leadership Initiative on Malnutrition criteria for weight. We adopted the motor functional independence measure (FIM) gain as the primary outcome. The motor FIM gain tended to be greater in the WMG group but without statistical significance. However, multiple regression analysis showed that WMG was significantly and positively associated with motor FIM gain. In conclusion, weight maintenance or gain in patients during the early phase of CR after stroke may be considered as a predictor of their functional recovery, and nutritional management to prevent weight loss immediately after the start of rehabilitation would contribute to this.

Dynamics of Donor-Derived Cell-Free DNA at the Early Phase After Pediatric Kidney Transplantation: A Prospective Cohort Study

Background: Donor-derived cell-free DNA (ddcfDNA) has been suggested as an indicator of allograft injury in adult and pediatric kidney transplantation (KTx). However, the dynamics of ddcfDNA in pediatric KTx have not been investigated. In addition, it has not been demonstrated whether donor-recipient (D/R) size mismatch affect ddcfDNA level.Methods: Pediatric KTx recipients with a single donor kidney were enrolled and followed up for 1 year. ddcfDNA, calculated as a fraction (%) in the recipient plasma, was examined longitudinally within 3 months post-transplant. D/R size mismatch degree was described as D/R height ratio. The 33rd percentile of D/R height ratio (0.70) was used as the cut-off to divide the patients into low donor-recipient height ratio group (&lt;0.70) and high donor-recipient height ratio group (≥0.70). The dynamics of ddcfDNA were analyzed and the impact factors were explored. Stable ddcfDNA was defined as the first lowest ddcfDNA. ddcfDNA flare-up was defined as a remarkable elevation by a proportion of &gt;30% from stable value with a peak value &gt;1% during elevation.Results: Twenty-one clinically stable recipients were enrolled. The median D/R height ratio was 0.83 (0.62–0.88). It took a median of 8 days for ddcfDNA to drop from day 1 and reach a stable value of 0.67% (0.46–0.73%). Nevertheless, 61.5% patients presented ddcfDNA&gt;1% at day 30. Besides, 81.0% (17/21) of patients experienced elevated ddcfDNA and 47.6% (10/21) met the standard of ddcfDNA flare-up. Donor-recipient height ratio was an independent risk factor for ddcfDNA flare-up (odds ratio = 0.469 per 0.1, 95% CI 0.237–0.925, p = 0.029) and low donor-recipient height ratio (&lt;0.70) was found to increase the risk of flare-up occurrence (odds ratio = 15.00, 95% CI 1.342–167.638, p = 0.028).Conclusions: ddcfDNA rebounds in many stable pediatric KTx recipients without rejection. This may be induced by significant D/R size mismatch and may affect its diagnostic performance at the early phase after pediatric KTx in children.