Inhaled Nitric Oxide for Clinical Management of COVID-19: A Systematic Review and Meta-Analysis

Background: Severe COVID-19 is associated with hypoxemia and acute respiratory distress syndrome (ARDS), which may predispose multiorgan failure and death. Inhaled nitric oxide (iNO) is a clinical vasodilator used in the management of acute respiratory distress syndrome (ARDS). This study evaluated the response rate to iNO in patients with COVID-19-ARDS. Method: We searched Medline and Embase databases in May 2022, and data on the use of iNO in the treatment of ARDS in COVID-19 patients were synthesized from studies that satisfied predefined inclusion criteria. A systematic synthesis of data was performed followed by meta-analysis. We performed the funnel plot and leave-one-out sensitivity test on the included studies to assess publication bias and possible exaggerated effect size. We compared the effect size of the studies from the Unites States with those from other countries and performed meta-regression to assess the effect of age, year of publication, and concomitant vasodilator use on the effect size. Results: A total of 17 studies (including 712 COVID-19 patients) were included in this systematic review of which 8 studies (involving 265 COVID-19 patients) were subjected to meta-analysis. The overall response rate was 66% (95% CI, 47–84%) with significantly high between-studies heterogeneity (I2 = 94%, p < 0.001). The funnel plot showed publication bias, although the sensitivity test using leave-one-out analysis showed that removing any of the study does not remove the significance of the result. The response rate was higher in the Unites States, and meta-regression showed that age, year of publication, and use of concomitant vasodilators did not influence the response rate to iNO. Conclusion: iNO therapy is valuable in the treatment of hypoxemia in COVID-19 patients and may improve systemic oxygenation in patients with COVID-19-ARDS. Future studies should investigate the mechanism of the activity of iNO in COVID-19 patients to provide insight into the unexplored potential of iNO in general ARDS

Physicians’ attitudes, beliefs and barriers to a pulmonary rehabilitation for COPD patients in Saudi Arabia: a cross-sectional study

This study aimed to assess physicians’ attitudes toward delivering pulmonary rehabilitation (PR) to chronic obstructive pulmonary disease (COPD) patients and identify factors and barriers that might influence referral decisions. Between September 2021 and January 2022, a cross-sectional online survey was distributed to all physicians in Saudi Arabia. A total of 502 physicians completed the online survey, of which 62.0% (n = 312) were male. General physicians accounted for 51.2%, while internal-medicine specialists and pulmonologists accounted for 26.9% and 6.6%, respectively. Only 146 (29%) physicians had referred COPD patients to a PR program. The difference in referral rates between all specialties (p = 0.011) was statistically significant. Physicians with more years of experience were more likely to refer COPD patients to PR (p < 0.001). Moreover, a home-based PR program was preferred by 379 physicians (75.5%), and 448 (89.2%) perceived smoking cessation as an essential component of PR. Availability of PR centers (69%) was the most common barrier for not referring patients to PR. The overall referral rate was low among all physicians, owing to a lack of PR centers and trained staff. Home-based delivery was the preferred method of delivering PR, with smoking cessation as an essential component

Healthcare providers’ attitudes, beliefs and barriers to pulmonary rehabilitation for patients with chronic obstructive pulmonary disease in Saudi Arabia: a cross-sectional study

Objectives: To assess the attitude of healthcare providers (HCPs) towards the delivering of pulmonary rehabilitation (PR) to patients with chronic obstructive pulmonary disease (COPD) and identify factors and barriers that might influence referral. Design: A cross-sectional online survey consisting of nine multiple-choice questions. Settings: Saudi Arabia. Participants: 980 HCPs including nurses, respiratory therapists (RT) and physiotherapists. Primary outcome measures: HCPs attitudes towards and expectations of the delivery of PR to COPD patients and the identification of factors and barriers that might influence referral in Saudi Arabia. Results: Overall, 980 HCPs, 53.1% of whom were men, completed the survey. Nurses accounted for 40.1% of the total sample size, and RTs and physiotherapists accounted for 32.1% and 16.5%, respectively. The majority of HCPs strongly agreed that PR would improve exercise capacity 589 (60.1%), health-related quality of life 571 (58.3%), and disease self-management in patients with COPD 589 (60.1%). Moreover, the in-hospital supervised PR programme was the preferred method of delivering PR, according to 374 (38.16%) HCPs. Around 85% of HCPs perceived information about COPD, followed by smoking cessation 787 (80.3%) as essential components of PR besides the exercise component. The most common patient-related factor that strongly influenced referral decisions was ‘mobility affected by breathlessness’ (64%), while the ‘availability of PR centres’ (61%), the ‘lack of trained HCPs’ (52%) and the ‘lack of authority to refer patients’ (44%) were the most common barriers to referral. Conclusion: PR is perceived as an effective management strategy for patients with COPD. A supervised hospital-based programme is the preferred method of delivering PR, with information about COPD and smoking cessation considered essential components of PR besides the exercise component. A lack of PR centres, well-trained staff and the authority to refer patients were major barriers to referring patients with COPD. Further research is needed to confirm HCP perceptions of patient-related barriers

ConectCat : aplicación web : fiestas locales y otros servicios y puntos de interés en Cataluña

Aplicación web basada en mapas interactivos y timeline. Permite visualizar las fiestas locales así como otros servicios y puntos de interés de Cataluña

Cross-cultural adaptation and validation of the Arabic version of the Physical Activity Scale for the Elderly among community-dwelling older adults in Saudi Arabia

Ayidh M Alqarni,1,2 Vishal Vennu,1 Sulaiman A Alshammari,3 Saad M Bindawas1 1Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia; 2Department of Physical Therapy, King Abdullah Hospital, Bisha, Saudi Arabia; 3Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia Purpose: Older adults are the fastest growing population group worldwide. Regular physical activity (PA) is reported to reduce the risk of health conditions and improve personal well-being. Few validated instruments can be used to measure the PA levels among older adults in Saudi Arabia. The Physical Activity Scale for the Elderly (PASE) is used worldwide for evaluating the PA levels of the elderly in epidemiological studies. However, this scale has not been translated into Arabic. This study aimed to cross-culturally adapt the PASE into Arabic language and evaluate its reliability and validity among community-dwelling older adults in Saudi Arabia. Patients and methods: This study was a cross-sectional one following Beaton guidelines to translate and perform cultural adaptation, as well as test the reliability and validity of the PASE Arabic version (PASE-A). Elderly (N=74) people from both genders, who lived in a community dwelling in Riyadh city, were selected from several primary health care centers. The study used Cronbach&rsquo;s alpha coefficient to assess the internal consistency reliability, while intraclass correlation coefficient (ICC2,1) was used for test&ndash;retest reliability and the Spearman&rsquo;s rank correlation coefficient (r) was used to evaluate the correlation among PASE-A and grip strength, Timed Up and Go test, body mass index, and fat percentage. Results: Out of 74 older adults, 59 (79.7%) completed the PASE-A questionnaire twice. The internal consistency of the PASE-A components was good (Cronbach&rsquo;s alpha 0.70&ndash;0.75), and the reliability of the components was excellent (ICC2,1 0.90&ndash;0.98). A higher PASE-A score was associated with higher grip strength (r=0.28, p=0.05) and with shorter Timed Up and Go test times (r=-0.45, p=0.01). Conclusion: The PASE-A version was easy, understandable, and relevant for Saudi older adults&rsquo; culture. This scale was a reliable and valid tool for evaluating and assessing the PA level among community-dwelling older adults in Saudi Arabia. Keywords: physical activity, elderly, psychometric, PASE, Saudi Arabia, reliability, cross-sectional study, psychometri

Response [by M Melloh and T Barz to Alqarni, AM; Schneiders, AG; Hendrick, PA "Clinical tests to diagnose lumbar segmental instability: A" in Journal of Orthopaedic and Sports Physical Therapy, Mar 2011, 41 (3) pp.130-140]

Letters to the Editor-in-Chief of JOSPT as follows: ‘Structural LSI Can Occur in the Absence of Functional LSI’ and Authors' Respons

Adherence to diabetes medication among diabetic patients in the Bisha governorate of Saudi Arabia &ndash; a cross-sectional survey [Corrigendum]

Alqarni AM, Alrahbeni T, Al Qarni A, Al Qarni HM. Patient&nbsp;Prefer Adherence. 2019;13:63&ndash;71. On page 65, &ldquo;Data collection&rdquo; section, second paragraph,&nbsp;should read from &ldquo;The MGLS was used to assess patient&nbsp;adherence to diabetic medications with permission from the&nbsp;scale owner. The composite four items in this adherence&nbsp;scale were: &ldquo;Q1: Do you ever forget to take your diabetic&nbsp;medication?&rdquo;; &ldquo;Q2: Do you ever have problems remembering&nbsp;to take your diabetic medication?&rdquo;; &hellip;&rdquo; to &ldquo;The MGLS&nbsp;was used to assess patient adherence to diabetic medications&nbsp;which is in the public domain. The composite four items in&nbsp;this adherence scale were: &ldquo;Q1: Do you ever forget to take&nbsp;your diabetic medication?&rdquo;; &ldquo;Q2: Are you careless at times&nbsp;about taking your diabetic medication?&rdquo;;&hellip;&rdquo;&nbsp; Read the original articl

Adherence to diabetes medication among diabetic patients in the Bisha governorate of Saudi Arabia &ndash; a cross-sectional survey

Abdullah M Alqarni,1,2 Tahani Alrahbeni,2 Ayidh Al Qarni,3,4 Hassan M Al Qarni1,2 1Clinical Pharmacy Department, Bisha Health Affairs, Ministry of Health, Bisha, Saudi Arabia; 2Department of Pharmacy and Allied Sciences, Riyadh Elm University, Riyadh, Saudi Arabia; 3Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia; 4Department of Physical Therapy, King Abdullah Hospital, Bisha Health Affairs, Ministry of Health, Bisha, Saudi Arabia Background: Patients&rsquo; non-adherence to diabetes medication is associated with poor glycemic control and suboptimal benefits from their prescribed medication, which can lead to worsening of medical condition, development of comorbidities, reduced quality of life, elevated health care costs, and increased mortality.Objective: This study aimed to assess medication adherence among patients with diabetes and associated factors in Bisha primary health care centers (PHCCs) in Saudi Arabia.Patients and methods: A cross-sectional study was conducted with a sample of 375 type 1 and 2 Saudi diabetic patients attending PHCCs under the Health Affairs of the Bisha governorate. The participants were aged 18 years and above, and had been taking diabetes medications for at least 3 months. Pregnant women, patients with mental illnesses, and those who were not willing to participate were excluded. Adherence to diabetes medications was measured using the four-item Morisky Green Levine Medication Adherence Scale (MGLS). All participants completed a self-report questionnaire including sociodemographic and clinical variables. Univariate and multivariate analyses were carried out using SPSS version 22.Results: Of all the respondents, 134 (35.7%), 161 (42.9%), and 80 (21.4%), patients had high (MGLS score 0), intermediate (MGLS score 1 or 2), and low adherence (MGLS score&nbsp;&ge;3), respectively. Factors associated with the level of adherence in univariate analysis were occupational status (P=0.037), current medication (P&lt;0.001), glycated hemoglobin (A1c) (P&lt;0.001), and number of associated comorbidities (P&lt;0.001). In multivariable analyses, A1c &lt;7 (P&lt;0.001) and no associated comorbidities (P&lt;0.003) variables remained significantly associated with adherence.Conclusion: The level of adherence to medication in diabetes mellitus patients in the Bisha PHCCs was found to be suboptimal. The findings point toward the need for better management of primary health care providers&rsquo; approaches to individual patients, by taking into account their medication adherence levels. Better identification of patients&rsquo; level of adherence remains essential for successful diabetes treatment. Keywords: diabetes mellitus, medication adherence, patients with diabetes, A1c, Bisha, Saudi Arabi

Psychological Resilience, Anxiety, and Well-Being of Health Care Providers During the COVID-19 Pandemic

Amani M AlQarni,1 Abdelaziz Elfaki,2 Moataza M Abdel Wahab,1 Yasser Aljehani,3 Auday A ALKhunaizi,4 Sharifah A Othman,5 Reem A AlShamlan2 1Family and Community Medicine Department, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 2Psychiatry Department, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 3Department of Surgery, King Fahd Hospital of the University, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia; 4Emergency Department, Qatif Central Hospital, Qatif, Saudi Arabia; 5Obstetrics and Gynaecology Department, King Fahd Hospital of the University, Dammam, Saudi ArabiaCorrespondence: Reem A AlShamlan; Amani M AlQarni, Tel +966536353448 ; +966591775751, Email [email protected]; [email protected]: On the frontlines of the pandemic, healthcare providers (HCPs) are overworked, anxious, and fearful. Yet, despite all the fear and anxiety, the facilitation of protective resilience and psychological well-being has become crucial to ensure that minimal intangible psychological losses are incurred due to the pandemic.Aim: The present study aimed to examine the psychological resiliency, state anxiety, trait anxiety, and psychological well-being of frontline HCPs during the COVID-19 and to determine the association among resiliency, state-trait anxiety, and psychological well-being and their links with demographic and workplace factors.Design and Settings: A cross-sectional study concerning frontline HCPs was conducted at two of the largest hospitals in the eastern province of Saudi Arabia.Results: A significant inverse correlation was determined between resilience and state anxiety (r=− 0.417, p< 0.05) and between resilience and trait anxiety (r=− 0.536, p< 0.05). Likewise, a positive intermediate correlation between resilience and the age of the individual (r=0.263, p< 0.05) and a weak positive correlation with years of experience (r=0.211, p< 0.05) were established. Also, the resilience score of volunteer workers (50.9) was lower than that of regular staff (66.8) (p=0.028).Conclusion: Resilience is a crucial factor affecting the training of individuals, which will further promote their work output and mental health capacity, thus improving their overall concept of survival in adversity.Keywords: psychological distress, anxiety, resilience, well-being, COVID-19 pandemic, health care provider

Knowledge and practice of using airway pressure release ventilation mode in ARDS patients: a survey of physicians

Background: Limited data is available on awareness and clinical management of the airway pressure release ventilation (APRV) mode of ventilation for acute respiratory distress syndrome (ARDS) patients among physicians who work at in adult critical areas. This study aimed to assess the knowledge and current practice of using APRV mode with ARDS patients and identify barriers to not using this mode of ventilation among physicians who work in adult critical areas in Saudi Arabia. Methods: Between November 2022 and April 2023, a cross-sectional online survey was disseminated to physicians who work in adult critical areas in Saudi Arabia. The characteristics of the respondents were analyzed using descriptive statistics. Percentages and frequencies were used to report categorical variables. Results: Overall, 498 physicians responded to the online survey. All responders (498, 100 %) reported that APRV is indicated in patients with ARDS, but 260 (52.2 %) did not know if there was an institutionally approved APRV protocol. Prone positioning was the highest recommended intervention by 164 (33.0 %) when a conventional MV failed to improve oxygenation in patients with ARDS. 136 (27.3 %) responders stated that the P-high should be set equal to the plateau pressure on a conventional ventilator while 198 (39.8 %) said that P-low should be 0 cmH2O. Almost half of (229, 46.0 %) responders stated that the T-high should be set between 4 and 6 s, while 286 (57.4 %) said that the T-low should be set at 0.4–0.8 s. The maximum allowed tidal volume during the release phase should be 4–6 ml/kg. Moreover, just over half (257, 51.6 %) believed that the maximum allowed P-high setting should be 35 cmH2O. One third of the responders (171, 34.3 %) stated that when weaning patients with ARDS while in APRV mode, the P-high should be reduced gradually to reach a target of 10 cmH2O. However, 284 (36.9 %) thought that the T-high should be gradually increased to reach a target of 10 s. Most responders (331, 66.5 %) felt that the criteria to switch the patient to CPAP would be to have an FiO2 ≤ 0.4, P-high ≤10 cm H2O, and T-high ≥10 s. Lack of training has been the most common barrier to not using APRV by 388 (77.9 %). Conclusion: There is a lack of consensus on the use of APRV mode, probably due to several barriers. While there were some agreements on the management of ventilation and oxygenation, there were variations in the selection of the initial setting of APRV. Education, training, and the presence of standardized protocols may help to provide better management