Effect of prosocial voice and structural empowerment on patient safety culture moderated by self-monitor and mediated by psychological empowerment at Saudi public hospitals

The culture of patient safety has attracted more intention of researchers and healthcare decision makers to create safe environment for the patient. Therefore, through literature review there are theoretical gaps that have to be examined. Consequently, to contribute to the literature, the objectives of this research are to assess patient safety culture (PSC), structural empowerment (SE), to examine the relationship between structural empowerment (SE) and patient safety culture (PSC), to examine the relationship between prosocial voice (PSV) and patient safety culture (PSC), to examine the interaction between prosocial voice (PSV) and patient safety culture (PSC) moderated by self-monitoring (SM), and to examine the interaction between structural empowerment (SE) and patient safety culture (PSC) mediated by psychological empowerment (PE), in the Saudi Public Hospitals. Towards this end, this study has developed the proposed model based on the Structural Process Outcome (SPO) Theory. To examine the proposed model, the quantitative survey questionnaire research approach was followed where 3810 questionnaires were distributed, out of which 2117 were returned and only 1793 were usable ones. By using hierarchical regression and correlation analysis through SPSS, those data were analyzed. The results show that there was moderate level of patient safety culture and structural empowerment among public hospitals in Saudi Arabia. So, there are areas for improving dimensions of patient safety culture and structural empowerment. Additionally, there was significant relation between structural empowerment and patient safety culture. On the other hand, there was no significant relation between prosocial voice and patient safety culture at public hospital in Saudi Arabia. Furthermore, there is no significant moderating effect of self-monitoring and there is no mediating effect of psychological empowerment. Besides providing suggestions for future research, this study provides several recommendations for leaders of public hospital in Saudi Arabia

A study of positive exponential consensus on DeGroot model

A nonlinear consensus model is assigned to resolve the consensus problem of multi-agent systems (MAS). Other studies have constructed consensus systems based on low-complexity computation linear equations or complex nonlinear equations. Linear equations are less efficient in reaching a consensus due to their slow computation process, where nonlinear equations are more efficient. The three major challenges in designing nonlinear consensus equations are: building a system of nonlinear equations that have solution, easy to calculate, and less time consuming. This study aims to create a consensus system that is nonlinear and easy to calculate. According to our survey, the DeGroot model (DGM) of 1974 is a linear model and the first effect consensus model with a flexible computation process for finite nodes. We examine if raising the exponential level for the initial cases of agents allows the system to achieve a consensus and move the DGM to a nonlinear level. The results show that by raising the exponent, the DGM is able to reach a consensus. The consensus of the DGM reaches a certain positive value that depends on the initial states of the agents and the transition matrix, whereas the consensus of the proposed exponential DGM (EDGM) reaches zero with a flexible and unrestricted matrix. Moreover, EDGM is a nonlinear model and reaches the consensus faster than the DGM linear model. The results are supported by theoretical evidence and numerical analysis

Management of Major Trauma and the Role of Interventional Radiology

This study aimed at exploring the management of major trauma and analyzing the role of interventional radiology for major trauma patients. As there are no prospective randomized controlled trials of interventional radiology in major trauma. Therefore, this review aims to summarize the evidence supporting the use of interventional radiological techniques in the management of major trauma. The study concluded that interventional radiology has become an essential part of the modern trauma unit. Roles in pelvic haemorrhage and aortic injury are now well established and have contributed to improving patient survival and reducing long-term morbidity

Prevalence and etiology of community-acquired pneumonia in immunocompromised patients

Background. The correct management of immunocompromised patients with pneumonia is debated. We evaluated the prevalence, risk factors, and characteristics of immunocompromised patients coming from the community with pneumonia. Methods. We conducted a secondary analysis of an international, multicenter study enrolling adult patients coming from the community with pneumonia and hospitalized in 222 hospitals in 54 countries worldwide. Risk factors for immunocompromise included AIDS, aplastic anemia, asplenia, hematological cancer, chemotherapy, neutropenia, biological drug use, lung transplantation, chronic steroid use, and solid tumor. Results. At least 1 risk factor for immunocompromise was recorded in 18% of the 3702 patients enrolled. The prevalences of risk factors significantly differed across continents and countries, with chronic steroid use (45%), hematological cancer (25%), and chemotherapy (22%) the most common. Among immunocompromised patients, community-acquired pneumonia (CAP) pathogens were the most frequently identified, and prevalences did not differ from those in immunocompetent patients. Risk factors for immunocompromise were independently associated with neither Pseudomonas aeruginosa nor non\u2013community-acquired bacteria. Specific risk factors were independently associated with fungal infections (odds ratio for AIDS and hematological cancer, 15.10 and 4.65, respectively; both P = .001), mycobacterial infections (AIDS; P = .006), and viral infections other than influenza (hematological cancer, 5.49; P < .001). Conclusions. Our findings could be considered by clinicians in prescribing empiric antibiotic therapy for CAP in immunocompromised patients. Patients with AIDS and hematological cancer admitted with CAP may have higher prevalences of fungi, mycobacteria, and noninfluenza viruses

Microbiological testing of adults hospitalised with community-acquired pneumonia: An international study

This study aimed to describe real-life microbiological testing of adults hospitalised with community-acquired pneumonia (CAP) and to assess concordance with the 2007 Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) and 2011 European Respiratory Society (ERS) CAP guidelines. This was a cohort study based on the Global Initiative for Methicillin-resistant Staphylococcus aureus Pneumonia (GLIMP) database, which contains point-prevalence data on adults hospitalised with CAP across 54 countries during 2015. In total, 3702 patients were included. Testing was performed in 3217 patients, and included blood culture (71.1%), sputum culture (61.8%), Legionella urinary antigen test (30.1%), pneumococcal urinary antigen test (30.0%), viral testing (14.9%), acute-phase serology (8.8%), bronchoalveolar lavage culture (8.4%) and pleural fluid culture (3.2%). A pathogen was detected in 1173 (36.5%) patients. Testing attitudes varied significantly according to geography and disease severity. Testing was concordant with IDSA/ATS and ERS guidelines in 16.7% and 23.9% of patients, respectively. IDSA/ATS concordance was higher in Europe than in North America (21.5% versus 9.8%; p&lt;0.01), while ERS concordance was higher in North America than in Europe (33.5% versus 19.5%; p&lt;0.01). Testing practices of adults hospitalised with CAP varied significantly by geography and disease severity. There was a wide discordance between real-life testing practices and IDSA/ATS/ERS guideline recommendations

Atypical pathogens in hospitalized patients with community-acquired pneumonia: A worldwide perspective

Background: Empirical antibiotic coverage for atypical pathogens in community-acquired pneumonia (CAP) has long been debated, mainly because of a lack of epidemiological data. We aimed to assess both testing for atypical pathogens and their prevalence in hospitalized patients with CAP worldwide, especially in relation with disease severity. Methods: A secondary analysis of the GLIMP database, an international, multicentre, point-prevalence study of adult patients admitted for CAP in 222 hospitals across 6 continents in 2015, was performed. The study evaluated frequency of testing for atypical pathogens, including L. pneumophila, M. pneumoniae, C. pneumoniae, and their prevalence. Risk factors for testing and prevalence for atypical pathogens were assessed through univariate analysis. Results: Among 3702 CAP patients 1250 (33.8%) underwent at least one test for atypical pathogens. Testing varies greatly among countries and its frequency was higher in Europe than elsewhere (46.0% vs. 12.7%, respectively, p &lt; 0.0001). Detection of L. pneumophila urinary antigen was the most common test performed worldwide (32.0%). Patients with severe CAP were less likely to be tested for both atypical pathogens considered together (30.5% vs. 35.0%, p = 0.009) and specifically for legionellosis (28.3% vs. 33.5%, p = 0.003) than the rest of the population. Similarly, L. pneumophila testing was lower in ICU patients. At least one atypical pathogen was isolated in 62 patients (4.7%), including M. pneumoniae (26/251 patients, 10.3%), L. pneumophila (30/1186 patients, 2.5%), and C. pneumoniae (8/228 patients, 3.5%). Patients with CAP due to atypical pathogens were significantly younger, showed less cardiovascular, renal, and metabolic comorbidities in comparison to adult patients hospitalized due to non-atypical pathogen CAP. Conclusions: Testing for atypical pathogens in patients admitted for CAP in poorly standardized in real life and does not mirror atypical prevalence in different settings. Further evidence on the impact of atypical pathogens, expecially in the low-income countries, is needed to guidelines implementation

Burden and risk factors for Pseudomonas aeruginosa community-acquired pneumonia:a Multinational Point Prevalence Study of Hospitalised Patients

Pseudornonas aeruginosa is a challenging bacterium to treat due to its intrinsic resistance to the antibiotics used most frequently in patients with community-acquired pneumonia (CAP). Data about the global burden and risk factors associated with P. aeruginosa-CAP are limited. We assessed the multinational burden and specific risk factors associated with P. aeruginosa-CAP. We enrolled 3193 patients in 54 countries with confirmed diagnosis of CAP who underwent microbiological testing at admission. Prevalence was calculated according to the identification of P. aeruginosa. Logistic regression analysis was used to identify risk factors for antibiotic-susceptible and antibiotic-resistant P. aeruginosa-CAP. The prevalence of P. aeruginosa and antibiotic-resistant P. aeruginosa-CAP was 4.2% and 2.0%, respectively. The rate of P. aeruginosa CAP in patients with prior infection/colonisation due to P. aeruginosa and at least one of the three independently associated chronic lung diseases (i.e. tracheostomy, bronchiectasis and/or very severe chronic obstructive pulmonary disease) was 67%. In contrast, the rate of P. aeruginosa-CAP was 2% in patients without prior P. aeruginosa infection/colonisation and none of the selected chronic lung diseases. The multinational prevalence of P. aeruginosa-CAP is low. The risk factors identified in this study may guide healthcare professionals in deciding empirical antibiotic coverage for CAP patients