Telemedicine in the Kingdom of Saudi Arabia: The feasibility of delivering parent-mediated early intervention targeting social communication in autism.

Background: Evidence on the effectiveness of telemedicine in coaching parents of autistic children on naturalistic developmental early interventions (EI) is limited and conducted in Western countries. In the Saudi context, little is known about EI services and the feasibility of telemedicine in coaching parents. Aims: 1) Examine the literature on the effectiveness of telemedicine in coaching parents to implement naturalistic developmental EI on child's social communication; 2) Investigate parents' and speech and language therapists' (SLTs) perceptions of EI and describe community-based practice with the aim of enhancing it, and 3) Investigate the feasibility of telemedicine to deliver community-based practice in coaching parents. Methods: A rapid review evaluated intervention characteristics, outcomes, and research quality in nine studies. Action research employed semi-structured interviews with six parents' and four SLTs' investigated the second aim. A sample of 47 parents completed the survey investigating telemedicine acceptability and intention to use. Finally, eleven parent-child dyads participated in a pre-post feasibility study investigating telemedicine's implementation, usability, and acceptability. Results: Review findings suggest insufficient evidence for the effectiveness of telemedicine on child's social communication. Action research showed that SLTs' EI practice was one-toone, therapist-implemented or hybrid, with no consistent parent training. SLTs' reported engaging parents in EI was challenging. Findings showed parents have mixed views about the service. Parents reported raising autistic children was effortful, and parents wanted more support. The surveys revealed high telemedicine acceptability, usability, and intention to use. In the feasibility study, parents showed low-moderate fidelity scores for full achievement and scored moderate-high for partial achievement of strategies. No significant treatment difference was observed in children's social communication. Conclusions: More high-quality research is required to examine the effectiveness of telemedicine applications on child's social communication in community-based settings to support access and continuity of therapy in EI services

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population