Nurses' Perceptions of Patient Safety Culture in Intensive Care Units: A Cross-Sectional Study

BACKGROUND: Patient safety culture is a relatively new focus where little is known about its current status in Egypt’s teaching hospitals, mainly intensive care units (ICUs). Therefore, the authors of this study attempted to assess the patient safety culture dimensions from the nurses’ perspective. METHODS: An exploratory cross-sectional study was conducted in two ICUs (pediatric ICU and adult ICU) at the University Hospital over 3 months from October till December 2018. Sixty nurses were interviewed using the Hospital Survey on Patient Safety Culture. RESULTS: The current study findings revealed an average positive response to individual items ranging from 6% to 51%. The “Organizational learning†dimension had the highest average percent positive patient safety dimension score (51%) among all respondents, while the “Frequency of events reported†dimension had the lowest one (6%). No statistically significant difference was reported between the pediatric and adult ICUs for all mean scores except for the “Non-punitive response to error†dimension which was reported to be greater in the pediatric intensive care unit (PICU) compared to adult ICU (P < 0.005). The overall patient safety grade was rated acceptable by 47.5% of the interviewed nurses. CONCLUSION: The current study shows that patient safety is fragile in ICUs, and more effort is recommended to increase the awareness of health care providers. Also, hospital managers need to enhance the performance and practices of patient safety within a non-punitive reporting environment

Dietary regimens for chronic hepatic diseases: advice and compliance

Background: Nutrition is coming to the fore as a major determinant of chronic diseases, and scientific evidence supports this view. The link between diet and chronic liver disease is an important area of study, as it could help reduce the suffering and the economic burden caused by liver disease. The study aimed to assess the current dietary guidelines of chronic hepatic disease patients and to determine their compliance and that of service providers to following these guidelines.Methods: A cross sectional descriptive study was conducted in the inpatient section of one of Cairo’s University hospitals in Egypt for a duration of 12 months. Interviewing questionnaires were used to collect the required data from 60 patients and 20 service providers. The objective of the study was adequately explained to participants and their consensus was obtained with assured confidentiality.Results: The majority of patients (73.5%) received dietary advice from hospital physicians only or in conjunction with their private physician. The advice was given orally by 100% of hospital physicians though only by 21% of private physicians which could have negatively affected patients’ compliance. About 60 % of the patients claimed to be compliant with the dietary regimens prescribed. Non compliance was related to lack of supportive measures  52.2%) or to negative patient attitude (48.8%). Hospital meals were not satisfactory neither to the service providers nor to clients. Hospital physicians did not properly prescriberegimens for reasons related to insufficient knowledge (66.7%), patients' attitudes (20%) and patients’ overload (13.3%).Conclusions: A standardized comprehensive set of dietary guidelines for different liver disease patientsshould be developed and communicated to service providers so as to promote compliance amongst patients

Hospital Preparedness for Critical Care during COVID-19 Pandemic: Exploratory Cross-sectional Study

AIM: The researchers conducted the study to assess intensive care units (ICUs) preparedness in Cairo University Hospitals to deal efficiently and effectively with COVID-19 upcoming waves. METHODS: An exploratory cross-sectional study was conducted at Cairo University Intensive Care Units 6 pediatric ICUs, and 2 adult ICUs in the period from the end of February to the first week of March, 2020; almost 2 weeks after the appearance of the first case of COVID-19 in Egypt by hand-delivered questionnaire method with one of the ICU staff members who were available and have time to take part in the study. WHO checklist for hospital readiness was used; this checklist based on current knowledge and available evidence on the COVID-19 pandemic for WHO’s Regional Office for the Eastern Mediterranean Region. The WHO has developed the checklist to help hospital managers prepare for COVID-19 patient management by optimizing each hospital’s capacities. The list composed of 10 key components: (1) Leadership and coordination; (2) operational support, logistics and supply management; (3) information; (4) communication; (5) human resources; (6) continuity of essential services and surge capacity; (7) rapid identification; (8) diagnosis; (9) isolation and case management; and (10) infection prevention and control. RESULTS: The overall preparedness in both pediatric and adult ICUs was 54%. Overall, adult ICUs were more prepared than pediatric ICUs, especially in communication; continuity of essential services and surge capacity; rapid identification; diagnosis; isolation; and case management. Both of them were comparable regarding operational support, logistics and supply management; human resources; and infection prevention and control, while information component was lower in both types but reached critical values 10% in adult ones. CONCLUSION: The current study demonstrated the intermediate readiness of ICUs at initial outbreak; further assessment during different phases of pandemic is required. Continues education of HCWs and active communication should be established

Avaliação em Duas Fases do Laboratório Remoto em Engenharia, VISIR, na Universidade Al-Quds da Palestina

Os laboratórios de ciência e engenharia desempenham um papel fundamental na demonstração de conceitos e princípios, bem como na melhoria das competências técnicas. Com a introdução de laboratórios remotos foi possível partilhar dispositivos, equipamento e instrumentação entre universidades. Mais, eles evitam restrições de tempo e espaço, sendo capazes de se adaptar ao ritmo próprio de cada estudante, no caso do tempo passado no laboratório não ter sido suficiente. Neste artigo é descrito um estudo empírico, dividido em duas fases de avaliação. Na primeira fase foi avaliada a flexibilidade de aplicação do laboratório remoto em engenharia VISIR na faculdade de engenharia na Universidade de Al-Quds em Jerusalém, Palestina. Durante esta fase foi ainda avaliada a aceitação desta tecnologia, pelos estudantes, quando em interação com os laboratórios tradicionais. Na segunda fase deste estudo, que decor rerá em 2014/15, será realizada uma aprofundada análise comparativa de forma a caracterizar o VISIR perante as restantes modalidades de laboratórios de engenharia, os práticos/presenciais e os de simulação. Estas três formas de laboratório são comparadas através de testes experimentais, tendo em atenção os critérios de avaliação definidos para os laboratórios de ensino de engenharia e de acordo com os objetivos fundamentais dos cursos, nomeadamente, as taxas de retenção e de satisfação dos estudantes, bem como do seu desempenho.info:eu-repo/semantics/publishedVersio

A Two-Stage Assessment of the Remote Engineering Lab VISIR at Al-Quds University in Palestine

Engineering labs are an essential part in engineering education since they provide practical knowledge for students, illustrate concepts and principles, and improve technical skills. Remote labs allow devices, equipment and instrumentations to be shared with other universities. Additionally, they relax time and space constraints, and are capable of being adapted to the pace of each student in case there was insufficient time in the laboratory. This paper describes an empirical study, which embeds two stages of assessment. In the first stage, we are concerned with finding out the level of flexibility when applying the engineering remote lab VISIR as a contemporary remote lab technology in the engineering faculty at Al-Quds University in Jerusalem in Palestine, and whether the engineering students will accept such technology to interact with in their future lab courses or not. In the second stage of the assessment study, a more in-depth comparative analysis will be carried out in order to have a categorization of VISIR in the landscape of the engineering labs such as hands-on and simulations. The three lab approaches will be compared with each other by means of an experimental testing based on assessment criteria that are in accordance with the fundamental course objectives of engineering instructional labs: student’s retention rate and satisfaction survey, as well as their performance.info:eu-repo/semantics/publishedVersio

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Side-specific factors for intraoperative hemodynamic instability in laparoscopic adrenalectomy for pheochromocytoma: a comparative study

Background: Adrenalectomy for pheochromocytoma (PHEO) is challenging because of the high risk of intraoperative hemodynamic instability (HDI). This study aimed to compare the incidence and risk factors of intraoperative HDI between laparoscopic left adrenalectomy (LLA) and laparoscopic right adrenalectomy (LRA). Methods: We retrospectively analyzed two hundred and seventy-one patients aged &gt; 18 years with unilateral benign PHEO of any size who underwent transperitoneal laparoscopic adrenalectomy at our hospitals between September 2016 and September 2023. Patients were divided into LRA (N = 122) and LLA (N = 149) groups. Univariate and multivariate logistic regression analyses were used to predict intraoperative HDI. In multivariate analysis for the prediction of HDI, right-sided PHEO, PHEO size, preoperative comorbidities, and preoperative systolic blood pressure were included. Results: Intraoperative HDI was significantly higher in the LRA group than in the LLA (27% vs. 9.4%, p &lt; 0.001). In the multivariate regression analysis, right-sided tumours showed a higher risk of intraoperative HDI (odds ratio [OR] 5.625, 95% confidence interval [CI], 1.147–27.577, p = 0.033). The tumor size (OR 11.019, 95% CI 3.996–30.38, p &lt; 0.001), presence of preoperative comorbidities [diabetes mellitus, hypertension, and coronary heart disease] (OR 7.918, 95% CI 1.323–47.412, p = 0.023), and preoperative systolic blood pressure (OR 1.265, 95% CI 1.07–1.495, p = 0.006) were associated with a higher risk of HDI in both LRA and LLA, with no superiority of one side over the other. Conclusion: LRA was associated with a significantly higher intraoperative HDI than LLA. Right-sided PHEO was a risk factor for intraoperative HDI

Intraoperative endomanometric laparoscopic Nissen fundoplication improves postoperative outcomes in large sliding hiatus hernia with severe gastroesophageal reflux disease. A retrospective cohort study

Background: Laparoscopic Nissen Fundoplication (LNF) is the gold standard surgical intervention for gastroesophageal reflux disease (GERD). LNF can be followed by recurrent symptoms or complications affecting patient satisfaction. The aim of this study is to assess the value of the intraoperative endomanometric evaluation of esophagogastric competence and pressure combined with LNF in patients with large sliding hiatus hernia (&gt; 5&nbsp;cm) with severe GERD (DeMeester score &gt;100). Materials and methods: This is a retrospective, multicenter cohort study. Baseline characteristics, postoperative dysphagia and gas bloat syndrome, recurrent symptoms, and satisfaction were collected from a prospectively maintained database. Outcomes analyzed included recurrent reflux symptoms, postoperative side effects, and satisfaction with surgery. Results: 360 patients were stratified into endomanometric LNF (180 patients, LNF+) and LNF alone (180 patients, LNF). Recurrent heartburn (3.9% vs. 8.3%) and recurrent regurgitation (2.2% vs. 5%) showed a lower incidence in the LNF+ group (P=0.012). Postoperative score III recurrent heartburn and score III regurgitations occurred in 0% vs. 3.3% and 0% vs. 2.8% cases in the LNF+ and LNF groups, respectively (P=0.005). Postoperative persistent dysphagia and gas bloat syndrome occurred in 1.75% vs. 5.6% and 0% vs. 3.9% of patients (P=0.001). Score III postoperative persistent dysphagia was 0% vs. 2.8% in the two groups (P=0.007). There was no redo surgery for dysphagia after LNF+. Patient satisfaction at the end of the study was 93.3% vs. 86.7% in both cohorts, respectively (P=0.05). Conclusions: Intraoperative high-resolution manometry (HRM) and endoscopic were feasible in all patients, and the outcomes were favorable from an effectiveness and safety standpoint

Comparative study of laparoscopic ventral mesh rectopexy versus perineal stapler resection for external full-thickness rectal prolapse in elderly patients: enhanced outcomes and reduced recurrence rates—a retrospective cohort study

Background: In elderly patients with external full-thickness rectal prolapse (EFTRP), the exact differences in postoperative recurrence and functional outcomes between laparoscopic ventral mesh rectopexy (LVMR) and perineal stapler resection (PSR) have not yet been investigated. Methods: We conducted a retrospective multicenter study on 330 elderly patients divided into LVMR group (n = 250) and PSR (n = 80) from April 2012 to April 2019. Patients were evaluated before and after surgery by Wexner incontinence scale, Altomare constipation scale, and patient satisfaction questionnaire. The primary outcomes were incidence and risk factors for EFTRP recurrence. Secondary outcomes were postoperative incontinence, constipation, and patient satisfaction. Results: LVMR was associated with fewer postoperative complications (p &lt; 0.001), lower prolapse recurrence (p &lt; 0.001), lower Wexner incontinence score (p = 0.03), and lower Altomare’s score (p = 0.047). Furthermore, LVMR demonstrated a significantly higher surgery–recurrence interval (p &lt; 0.001), incontinence improvement (p = 0.019), and patient satisfaction (p &lt; 0.001) than PSR. Three and 13 patients developed new symptoms in LVMR and PSR, respectively. The predictors for prolapse recurrence were LVMR (associated with 93% risk reduction of recurrence, OR 0.067, 95% CI 0.03–0.347, p = 0.001), symptom duration (prolonged duration was associated with an increased risk of recurrence, OR 1.131, 95% CI 1.036–1.236, p = 0.006), and length of prolapse (increased length was associated with a high recurrence risk (OR = 1.407, 95% CI = 1.197–1.655, p &lt; 0.001). Conclusions: LVMR is safe for EFTRP treatment in elderly patients with low recurrence, and improved postoperative functional outcomes