Use of virtual reality exercises in disaster preparedness training: A scoping review.

Background: The scope and number of disasters have increased over the years. This has called for more robust disaster preparedness training and plans. The use of virtual reality exercises in addition to tabletop exercises is considered a new approach to the preparation of disaster preparedness plans. Virtual reality exercises are being developed to either replace or complement current traditional approaches to disaster preparedness training. Objectives: To review and summarize the current existing literature regarding the effectiveness, advantages and limitations of using virtual reality exercises in disaster preparedness as a complementary/replacement mechanism for real-time drills and tabletop exercises. Methods: In this scoping review, we searched PubMed, Cochrane, EMBASE, PLOS, and Google Scholar for research publications involving virtual reality exercises in disaster training from 2008 to 2022 using "AND" and "OR" operators for the keywords "disaster," "preparedness," "virtual reality," and "tabletop." From a total of 333 articles that resulted in our search and were then evaluated by the authors, 55 articles were finally included in this review. Results: Virtual reality exercises are found to be better in the formulation of disaster preparedness plans compared to tabletop exercises. Virtual reality exercises can be used as the primary means of creating a real-life-like experience in disaster preparedness training and proved at least as better complementary to tabletop exercises. Virtual reality exercises have many advantages over traditional real-life or tabletop exercises and are more cost-effective, but some drawbacks are still identified. Conclusion: The advantages of virtual reality exercises are remarkable and underline their benefits and uses versus costs. We highly encourage decision-makers and institutions dealing in disaster preparedness to adopt using virtual reality exercises in training for disaster preparedness.

Cost-Savings Associated with Multi-Disciplinary Team Approach for Reducing Macrovascular and Microvascular Complications in Patients with Type 2 Diabetes: A Predictive Model.

Purpose: This study aims to predict the expected cost savings associated with implementing a multidisciplinary team (MDT) approach to reduce macrovascular and microvascular complications among patients with type 2 diabetes mellitus (T2DM). Methods: This economic evaluation study was conducted in Riyadh First Health Cluster, Saudi Arabia as a predictive model conceptualized by the authors based on models used in previous studies, particularly the CORE Diabetes Model. Our model was designed based on 1) the level of glycemic control among 24,755 T2DM patients served by MDTs; 2) the expected incidence of diabetes-related complications without intervention; 3) the predicted risk reduction of developing diabetes-related complications with MDTs. Costs of complications and cost savings were then calculated and expressed as mean incremental annual cost savings adjusted for a 1% reduction in HbA1c, and a 10 mmHg reduction in systolic blood pressure (SBP). Results: Along with the expected reduction in all diabetes-related complications, the average incremental cost savings per diabetic patient is predicted to be ($38,878) with approximately ($11,108) in the year of complication onset and ($27,770) over the subsequent post-index 10-years. On adjustment of cost savings, the average incremental cost savings are predicted to be ($22,869) for each 1% reduction in HbA1c per diabetic patient and ($27,770) for every 10 mmHg reduction in SBP per diabetic patient. Conclusion: MDT as a model of care is effective in glycemic control among T2DM patients with a predicted significant reduction of all diabetes-related complications and in turn, a predicted significant cost savings.

Effectiveness of Case Manager Led Multi-Disciplinary Team Approach on Glycemic Control Amongst T2DM Patients in Primary Care in Riyadh: A Retrospective Follow-Up Study.

OBJECTIVES: Our study aims to assess the effectiveness of implementing a case manager-led Multidisciplinary Team approach in the primary healthcare setting on improving glycemic control and reducing cardiovascular risks for T2DM patients over a 6-month period. METHODS: This retrospective record-based follow-up study was carried out on 3060 uncontrolled T2DM patients in primary healthcare centers in Riyadh First Health Cluster over a period of 6 months. The patient records are investigated and analyzed, including demographic characteristics and measurements of Hemoglobin A1c (HbA1c), Low-Density Lipoprotein Cholesterol (LDL-C), total cholesterol, and BP levels at enrollment and after 6 months of Multi-Disciplinary Team follow-up. The changes in the study variables and their correlations to each other are tested using Statistical Package for the Social Sciences software. RESULTS: At enrollment, our patients were characterized by poor glycemic control (HbAIC > 8%). Most of them have high body weight with a mean BMI of (31.2 ± 1.7), and nearly two-thirds are either hypertensive or have dyslipidemia (43.4% and 47.3% respectively). After 6 months of MDT follow-up, there is a significant improvement in glycemic control among 1971 patients (64.4%), with a reduction in the mean level of different outcomes relative to baseline HbA1c (-15%, P < .001), total cholesterol (-9.0%, P < .001), LDL-C (-11.0%, P < .001), systolic BP (-7.7%, P < .001), and diastolic BP (-10.5%, P < .001). The improved glycemic control showed a significant positive correlation with the number of MDT visits but negatively correlated with BMI and the number of comorbidities. In addition, the improvements in secondary outcomes were positively and significantly correlated with such improvements in glycemic control. CONCLUSION: Case-manager-led MDT approach significantly improves glycemic control and significantly improves control over dyslipidemia and hypertension, reducing cardiovascular risks, and unfavorable events among such diabetic patients. We highly recommend developing more MDTs, training case managers, and rigorously evaluating the MDT approach.

Assessment of Primary Health Care Specialized Reference Clinics in Riyadh First Health Cluster: Outcome, Cost-Effectiveness and Patient Satisfaction.

Purpose: The objectives of the study are to assess the outcome and cost-effectiveness of specialized reference clinics (SRCs) in primary health care centers (PHCCs) of Riyadh First Health Cluster (RFHC), then to estimate the patient satisfaction among clients utilizing such SRCs. Patients and Methods: This facility-based study was conducted in Riyadh city, Saudi Arabia among six PHCCs in RFHC that contain SRCs. Records of all patients utilizing SRCs and their referral information were studied along two years. An in-depth interview was conducted with health care providers in SRCs. Cost analysis was calculated by the financial support group within RFHC. Also, a randomly selected 400 subjects utilizing SRCs were asked to fill patient satisfaction questionnaire. Results: Over two years, a total number of 55,084 patients utilized SRCs among different specialties. Most of these patients (86.7%) had full medical service within PHC-SRCs with no need for referral to hospitals. SRCs are significantly effective in decreasing the burden on hospitals in most specialties (p < 0.001). This effectiveness is significantly increased during the 2nd year of service. The time spent until appointment is significantly reduced from an average of six weeks in hospitals to an average of one week in SRCs. SRCs are very cost-effective as they reduced referrals to hospitals by 86.7% among 55,084 patients who utilized SRCs over two years, saving total costs of about 14.08 million Saudi Riyals (3.75 million US dollars). Most of the specialties are cost-effective except for urology and general surgery clinics, which are not cost-effective. Patient satisfaction is high regarding all service domains. The overall patient satisfaction score increased from 71.4% in the 1st year up to 73.2% in the second year. Conclusion: PHC-SRCs are cost-effective health services and their creation is reasonable and beneficial in terms of reducing costs of health care delivery, reducing the burden on hospitals, and improving patient satisfaction.

Preventive Behaviors Towards Covid-19 Pandemic Among Healthcare Providers in Saudi Arabia Using the Protection Motivation Theory.

PURPOSE: The main objectives of the study are firstly to measure the COVID-19 preventive health behaviors related among health care providers (HCPs), then to identify the determinants of such behavior using the protection motivation theory (PMT). PATIENTS AND METHODS: An online cross-sectional survey, containing closed-ended questions, was distributed among healthcare professionals including physicians, pharmacists, technicians, and nurses. It consisted of questions assessing socio-demographic and occupational characteristics, in addition to questions from the modified PMT that has been tailored for the COVID-19 pandemic through five sub-constructs: perceived severity and perceived vulnerability, response efficacy, self-efficacy, response costs, and behavioral intention. RESULTS: A total of 385 HCPs have participated in the study with a mean age of 40.08±8.2 years; the majority was Saudi, married, and having children. There was a significant association between intention to comply with COVID-19 preventive behavior and being females, nurses, having training in Infection prevention and control (IPC) measures, and availability of personal protective equipment (PPE) during work time (p≤0.01). Other demographic variables, working experience, the status of being in the workforce during the pandemic COVID-19 in Saudi Arabia did not have a significant effect on the intention of HCPs to comply with COVID-19 preventive behavior. The vast majority 85.7% of HCPs answered "always" regarding the behavioral intention of HCPs to comply with COVID-19 preventive behavior. There was a significant positive correlation between COVID-19 behavioral intention and other constructs of PMT model, including perceived severity (r=0.272) perceived vulnerability (r= 0.248), self-efficacy (r=0.218), response-efficacy (r=0.167), and response-cost (r=0.13). Gender, availability of PPE, and self-efficacy had a significant prediction of COVID-19 behavioral intentions (P <0.05) with a predicted increase of 0.56, 0.37, and 0.12, respectively, in the mean of the intention score. Self-efficacy was the highest significant predictor of the behavior (p=0.008). CONCLUSION: Females' gender, nurses, having training in IPC measures, and availability of PPE during work time have a significant association with intention to comply with COVID-19 preventive behavior. The present study coping appraisal particularly self-efficacy predicted the COVID-19 pandemic protection motivation and preventive behavior more than threat appraisal. Therefore, future training programs must consider the level of self-efficacy of HCPS, and increase their knowledge regarding the effectiveness of recommendation strategies to perform protective measures against the COVID-19.