Quality of Life of Children Receiving Permanent Renal Dialysis in Gaza Strip

This study aims to evaluate the quality of Life in children (ages between 3-16 years) receiving permanent renal dialysis in Gaza strip. The design of this study is case-control. All cases in Gaza strip were included in the study (15cases) and compared with the control group (45 individuals without the disease) that were selected accordance to the cases sex, age, living places, monthly income and the relationship between parents. The study sample was interviewed by the researchers and completed the developed questionnaire, which focused on quality of life and included five domains, these domains are Physical health, Psychological health, Social relationships, Environment health and Personal safety. Validity and reliability of the instrument were tested and the total instrument reliability test (Cronbach's Alpha) was 0.74, while by Split half methods was 0.94. The study revealed statistically significant difference (< 0.001) between cases and control in all study domains except the environmental health domain. The educational achievement deteriorated significantly as a result of impairment of physical health, psychological health and social relationships. Also, the study revealed that the altered levels of serum electrolytes secondary to renal failure and dialysis are responsible for signs and symptoms that the patients experience. The study domains did not show statistically significant difference when compared by sex, age, living places, monthly income and the relationship between parents. The study also revealed that there was a bad need to pay more attention when caring and dealing with dialyzed patients. Special food supplementation should

Flow and Distribution of Water in Fractional Wettability Unsaturated Porous Media

In recent years, interest in fluid flow and transport in the unsaturated zone has gained more attention, due to growing concerns that the quality of the subsurface environment is adversely affected by agricultural, industrial, and municipal activities. The wettability properties (e.g., water repellency) of soil in the unsaturated zone play an important role in determining fluid movement and ultimate distributions. A number of studies have shown that preferential flow and spatially variable moisture content is likely to occur in water repellant soils. Development of appropriate constitutive relations for numerical modeling becomes even more difficult in systems that contain water repellant soils. First, flow through fractionally-wet systems often follows preferential flow paths. Preferential flow can result in fast and deep infiltration of water and may impact solute and colloid/virus transport and plant growth. Second, it is difficult to incorporate pore- and centimeter-scale processes that result in irregular water flow and distribution during and following drainage. The resulting small-scale heterogeneities may impact subsequent infiltration and evaporation/volatilization processes. In this research, mm- and cm-scale capillary pressure¡Vwater content experiments and computed x-ray microtomography (CMT) were used to obtain quantitative data describing drainage and the irreducible water distribution in fractionally-wet systems. The findings from this research showed that wettability and pore-size distribution affected the capillary pressure-water content relationship in uniform and well-graded sand. As expected, an increase in the fractional wettability caused a decrease in the air entry pressure for all the sands tested. As the fractionally wettability increased, the slope of the capillary pressure-water content became steeper for the uniform sands and shallower for the well-graded sand. Comparison of mm- and cm-scale drainage capillary pressure-water content experiments showed that columns designed for CMT experiments can be used for low values of fractional wettability (less than 25%). CMT was successfully used to image the heterogeneous distribution of water during and following drainage; water content values obtained from the images when combined with the corresponding capillary pressure head values matched the laboratory experimental data. Finally, CMT was shown to be a highly effective technique to quantitatively characterize ƒÝm-scale grain, pore, and fluid properties

Implementing Quantitative Techniques to Improve Decision Making in Construction Projects: A Case Study

This research aims to evaluate the effectiveness of implementing quantitative techniques to improve decision making in construction projects by using time- and cost-oriented failure mode and effect analysis and Monte Carlo simulation. This research is limited to the project schedule and risk management of one phase of construction project to build a new automated warehouse in Hungary. The results show that there are 80% and 100% chances that the duration and cost of the construction project phase will increase due to the uncertainty and individual risks associated with the construction project activities respectively

Risk factors for dyslipidemia among hypertensive patients attending the laboratory of the european Gaza hospital:case control study

Dyslipidemia is a worldwide health problem that is rising steadily. The purpose of this study is to identify risk factors that may lead to dyslipidemia in hypertensive patients, which in turn may contribute to the preparation of preventive programs to decrease mortality and morbidity from hypertension and dyslipidemia. The design of the study was casecontrol, which is practical and economical design for studying risk factors. The study sample consisted of 237 participants, divided into three groups (case group included 79 hypertensive patients with dyslipidemia, control group included 79 hypertensive patients without dyslipidemia and 79 normal persons). Participants were selected from European Gaza Hospital (EGH) during the period from January 1st 2009 to December 31st 2010. The study instrument consisted of Sociodemographic characteristics, history of smoking, physical activity, compliance to diet and lipid profile. The lipid profiles were analyzed by spectrophotometer at EGH medical laboratory. The study results showed that risk factors for dyslipidemia included; obesity (Chi square = 18.775; P = 0.001), low level of education (Chi square = 19.50; P = 0.012), non compliance to diet (Chi square = 6.723; P = 0.035) and not working or being retired (Chi square = 13.484; P 0.001). In conclusion, the results highlighted serious issues that need special programs at primary and secondary levels to reduce and modify the risk factors of dyslipidemia. Clients with the identified risk factors need more attention and follow up to reduce the chance of developing dyslipidemia.Dyslipidemia is a worldwide health problem that is rising steadily. The purpose of this study is to identify risk factors that may lead to dyslipidemia in hypertensive patients, which in turn may contribute to the preparation of preventive programs to decrease mortality and morbidity from hypertension and dyslipidemia. The design of the study was casecontrol, which is practical and economical design for studying risk factors. The study sample consisted of 237 participants, divided into three groups (case group included 79 hypertensive patients with dyslipidemia, control group included 79 hypertensive patients without dyslipidemia and 79 normal persons). Participants were selected from European Gaza Hospital (EGH) during the period from January 1st 2009 to December 31st 2010. The study instrument consisted of Sociodemographic characteristics, history of smoking, physical activity, compliance to diet and lipid profile. The lipid profiles were analyzed by spectrophotometer at EGH medical laboratory. The study results showed that risk factors for dyslipidemia included; obesity (Chi square = 18.775; P = 0.001), low level of education (Chi square = 19.50; P = 0.012), non compliance to diet (Chi square = 6.723; P = 0.035) and not working or being retired (Chi square = 13.484; P 0.001). In conclusion, the results highlighted serious issues that need special programs at primary and secondary levels to reduce and modify the risk factors of dyslipidemia. Clients with the identified risk factors need more attention and follow up to reduce the chance of developing dyslipidemia

The incidence of MRSA infections in the United States: is a more comprehensive tracking system needed?

A review of epidemiological studies on the incidence of MRSA infections overtime was performed along with an analysis of data available for download from Hospital Compare (https://data.medicare.gov/data/hospital-compare). We found the estimations of the incidence of MRSA infections varied widely depending upon the type of population studied, the types of infections captured and in the definitions and terminology used to describe the results. We could not find definitive evidence that the incidence of MRSA infections in U.S. community or facilities is decreasing significantly. Of concern are recent data reported to the National Healthcare Safety Network (NHSN) on MRSA bloodstream infections which indicate that by the end of 2015 there had been little change in the average facility Standardized Infection Ratio (0.988), compared to a 2010-2011 baseline and is significantly increased compared to the previous year. This is in contradistinction to the recent Veterans Administration study which reported over an 80% reduction in MRSA infections. However, this discrepancy may be due to the inability to reconcile the baselines of the two data sets; and the observed increase may be artifactual due to aberrations in the NHSN tracking system. Our review supports the need for implementation of a comprehensive tracking and monitoring system involving all types of healthcare facilities for multi-drug resistant organisms, along with concomitant funding for both staff and infrastructure. Without such a system, determining the effectiveness of interventions such as antibiotic stewardship and chlorhexidine bathing will be hindered

Patient satisfaction in home health care

Aims and objectives. To assess the current use of patient satisfaction measures in home health care and to examine the reliability and validity of current measures of patient satisfaction in home health care. Background. Patient satisfaction has been one of the widely used measures in home health care as an indicator of quality of care. A few efforts have been made to develop psychometrically sound patient satisfaction scales for use in home health care. Design. A critical review of the literature. Methods. Electronic databases were systematically searched to identify the studies or publications that measured and addressed patient satisfaction and its measurement in home health care. Results. The review of the literature showed that patient satisfaction measures have been used in the evaluation of care programmes including rehabilitation programmes, discharge and home follow‐up programmes, care process and

View point: gaps in the current guidelines for the prevention of Methicillin-resistant Staphylococcus aureus surgical site infections

The authors advocate the addition of two preventative strategies to the current United State’s guidelines for the prevention of surgical site infections. It is known that Staphylococcus aureus, including Methicillin-resistant Staphylococcus aureus (MRSA), carriers are at a higher risk for the development of infections and they can easily transmit the organism. The carriage rate of Staph. aureus in the general population approximates 33%. The CDC estimates the carriage rate of MRSA in the United States is approximately 2%. The first strategy is preoperative screening of surgical patients for Staph. aureus, including MRSA. This recommendation is based upon the growing literature which shows a benefit in both prevention of infections and guidance in preoperative antibiotic selection. The second is performing MRSA active surveillance screening on healthcare workers. The carriage rate of MRSA in healthcare workers approximates 5% and there are concerns of transmission of this pathogen to patients. MRSA decolonization of healthcare workers has been reported to approach a success rate of 90%. Healthcare workers colonized with dangerous pathogens, including MRSA, should be assigned to non-patient contact work areas. In addition, there needs to be implemented a safety net for both the worker’s economic security and healthcare. Finally, a reporting system for the healthcare worker acquisition and infections with dangerous pathogens needs to be implemented. These recommendations are needed because Staph. aureus including MRSA is endemic in the United States. Policies regarding endemic pathogens which are to be implemented only upon the occurrence of a facility defined “outbreak” have to be questioned, since absence of infections does not mean absence of transmission. Optimizing these policies will require further research but until then we should error on the side of patient safety

The Use of Surveillance and Preventative Measures for Methicillin-resistant Staphylococcus Aureus Infections in Surgical Patients

The Agency for Healthcare Research & Quality (AHRQ) found that Methicillin-resistant Staphylococcus aureus (MRSA) is associated with up to 375,000 infections and 23,000 deaths in the United States. It is a major cause of surgical site infections, with a higher mortality and longer duration of care than Methicillin-sensitive Staphylococcus aureus. A multifactorial bundled approach is needed to control this epidemic, with single interventions unlikely to have a significant impact on attenuating MRSA infection rates.Active surveillance has been studied in a wide range of surgical patients, including surgical intensive care and non-intensive care units; cardiac, vascular, orthopedic, obstetric, head and neck cancer and gastrostomy patients. There is sufficient evidence demonstrating a beneficial effect of surveillance and eradication prior to surgery to recommend its use on an expanded basis.Studies on MRSA surveillance in surgical patients that were published over the last 10 years were reviewed. In at least five of these studies, the MRSA colonization status of patients was reported to be a factor in preoperative antibiotic selection, with the modification of treatment regiments including the switching to vancomycin or teicoplanin in MRSA positive preoperative patients. Several authors also used decolonization protocols on all preoperative patients but used surveillance to determine the duration of the decolonization.Universal decolonization of all patients, regardless of MRSA status has been advocated as an alternative prevention protocol in which surveillance is not utilized. Concern exists regarding antimicrobial stewardship. The daily and universal use of intranasal antibiotics and/or antiseptic washes may encourage the promotion of bacterial resistance and provide a competitive advantage to other more lethal organisms.Decolonization protocols which indiscriminately neutralize all bacteria may not be the best approach. If a patient\u27s microbiome is markedly challenged with antimicrobials, rebuilding it with replacement commensal bacteria may become a future therapy.Preoperative MRSA surveillance allows the selection of appropriate prophylactic antibiotics, the use of extended decolonization protocols in positive patients, and provides needed data for epidemiological studies

Staff Developed IP Program Increases Antimicrobial Stewardship and Decreases HAIs Rates

The burden of Hospital Associated Infections (HAIs) in intensive care units is extremely high and cannot be overemphasized, with more than one third ofa all HAIs being acquired in intensive care units. This study firstly aimed to involving the health care team in identifying causes of HAIs and antibiotic use, then involving the health care team in developing activities and interventions to improve the quality of health care in the intensive care unit (ICU) at Ranteesy Pediatric Hospital (RPH). The research team then evaluated the effectiveness of these interventions. The study design is Quasi experimental (pre and post-test), all the staff who worked in the intensive care unit were involved in this study. The three phases of the project: assessing the preexisting stage, development and implementation of the interventions, and evaluating its effectiveness after 12 months. The researchers used many quality assessment tools to help identifying, collecting, displaying, monitoring, and improving the quality of health care. These tools are Brainstorming, self-administered questionnaire, check list, flow charts, fish bone analysis, Pareto chart, trend chart, and run chart. Result revealed that lack of knowledge; supervision and experience were the mostly perceived causes of HAI in the ICU. Post intervention tests showed statistical significant improvement and a decrease in the rate of HAIs in comparison to the pre-test, and the mean of positive cultures (blood, sputum, urine, wounds or CSF) decreased from 76% to 42%, used of antibiotics vials per week decreased from 130 to 92 vials, and the average hospital stay days from (8-10) to (5-8). The study findings supported the need for health educational programs about infection control and prevention, and monitoring staff performance at RPH ICU in order to reduce the rate of HAIs and antibiotic use. KEYWORDS: hospital associated infections prevention, infection prevention in pediatric ICU, infection control pediatric ICU, quality improvement pediatric ICU, prevention of HAIs.The burden of Hospital Associated Infections (HAIs) in intensive care units is extremely high and cannot be overemphasized, with more than one third ofa all HAIs being acquired in intensive care units. This study firstly aimed to involving the health care team in identifying causes of HAIs and antibiotic use, then involving the health care team in developing activities and interventions to improve the quality of health care in the intensive care unit (ICU) at Ranteesy Pediatric Hospital (RPH). The research team then evaluated the effectiveness of these interventions. The study design is Quasi experimental (pre and post-test), all the staff who worked in the intensive care unit were involved in this study. The three phases of the project: assessing the preexisting stage, development and implementation of the interventions, and evaluating its effectiveness after 12 months. The researchers used many quality assessment tools to help identifying, collecting, displaying, monitoring, and improving the quality of health care. These tools are Brainstorming, self-administered questionnaire, check list, flow charts, fish bone analysis, Pareto chart, trend chart, and run chart. Result revealed that lack of knowledge; supervision and experience were the mostly perceived causes of HAI in the ICU. Post intervention tests showed statistical significant improvement and a decrease in the rate of HAIs in comparison to the pre-test, and the mean of positive cultures (blood, sputum, urine, wounds or CSF) decreased from 76% to 42%, used of antibiotics vials per week decreased from 130 to 92 vials, and the average hospital stay days from (8-10) to (5-8). The study findings supported the need for health educational programs about infection control and prevention, and monitoring staff performance at RPH ICU in order to reduce the rate of HAIs and antibiotic use. KEYWORDS: hospital associated infections prevention, infection prevention in pediatric ICU, infection control pediatric ICU, quality improvement pediatric ICU, prevention of HAIs

Staff-developed infection prevention program decreases health care–associated infection rates in pediatric critical care

BACKGROUND Health care–associated infections are an international problem that occurs in an estimated 10% of all hospital admissions globally. 3 Health care–associated infections not only increase morbidity and mortality in patients but also cause a considerable economic burden on health care. 4 According to the Centers for Disease Control and Prevention, the incidence of HAI is 1.7 million infections and 99 000 deaths per year. 1 Health care–associated infections cost an estimated $28 billion to$33 billion each year. 1 The mean prevalence of HAI in Europe is 7.1 per 100 patients. In England,£ 1000 million annually is budgeted by the National Health Service for HAI. 5 In Canada, the incidence of HAI is greater than 220 000 per year and results in 8500 to 12 000 deaths; the direct costs of HAI are estimated at $1 billion annually. 6 Health care–associated infections cost Thai hospitals 10% of their annual