Perceived responsibility for mechanical ventilation and weaning decisions in intensive care units in the Kingdom of Saudi Arabia

Background: Optimizing patient outcomes and reducing complications require constant monitoring and effective collaboration among critical care professionals. The aim of the present study was to describe the perceptions of physician directors, respiratory therapist managers and nurse managers regarding the key roles, responsibilities and clinical decision-making related to mechanical ventilation and weaning in adult Intensive Care Units (ICUs) in the Kingdom of Saudi Arabia (KSA). Methods: A multi-centre, cross-sectional self-administered survey was sent to physician directors, respiratory therapist managers and nurse managers of 39 adult ICUs at governmental tertiary referral hospitals in 13 administrative regions of the KSA. The participants were advised to discuss the survey with the frontline bedside staff to gather feedback from the physicians, respiratory therapists and nurses themselves on key mechanical ventilation and weaning decisions in their units. We performed T-test and non-parametric Mann-Whitney U tests to test the physicians, respiratory therapists, and nurses’ autonomy and influence scores, collaborative or single decisions among the professionals. Moreover, logistic regressions were performed to examine organizational variables associated with collaborative decision-making. Results: The response rate was 67% (14/21) from physician directors, 84% (22/26) from respiratory therapist managers and 37% (11/30) from nurse managers. Physician directors and respiratory therapist managers agreed to collaborate significantly in most of the key decisions with limited nurses’ involvement (P<0.01). We also found that physician directors were perceived to have greater autonomy and influence in ventilation and waning decision-making with a mean of 8.29 (SD±1.49), and 8.50 (SD±1.40), respectively. Conclusion: The key decision-making was implemented mainly by physicians and respiratory therapists in collaboration. Nurses had limited involvement. Physician directors perceived higher autonomy and influence in ventilatory and weaning decision-making than respiratory therapist managers and nurse managers. A critical care unit’s capacity to deliver effective and safe patient care may be improved by increasing nurses’ participation and acknowledging the role of respiratory therapists in clinical decision-making regarding mechanical ventilation and weaning

Effect of Conventional and Electronic Cigarettes Smoking on the Color Stability and Translucency of Tooth Colored Restorative Materials: An In Vitro Analysis

This in vitro study compared the effects of conventional and electronic cigarettes on the aesthetics (color stability and translucency) of two types of composite resins: micro and nano-hybrid. Methods: A total of 120 specimens from two different composite materials Filtek Z250 XT (Nano-hybrid, 3M) and Filtek Z250 (Micro-hybrid, 3M) were divided into four groups (n = 30); shade A2 was used. The samples were exposed to conventional and electronic cigarette smoke via a custom made chamber device. The color values and measurements were recorded using a spectrophotometer before and after the exposure. The color and translucency were evaluated using the three-dimensional CIE Lab. Results: There was a significant change in the color (&Delta;E) and the translucency parameter (TP) in all of the specimens exposed to electronic cigarettes and conventional cigarettes. The results showed that the highest &Delta;E mean is for the nano-hybrid composite exposed to conventional cigarettes with 1.74 &Delta;E while the same material is 0.64 under the electronic cigarettes and the difference is significant with (p &lt; 0.05). The micro-hybrid composite data showed less changes in color under both exposures with 0.85 &Delta;E mean under the conventional cigarette smoke and 0.48 under the electronic cigarette smoke with (p &lt; 0.004). Conclusions: The conventional cigarette smoke has more effect on the color stability of the composite resins than electronic cigarettes. From a clinical point of view, the effect of smoke exposure on the tested specimens&rsquo; color, for the time duration to which the specimens were exposed, were moderate (&Delta;E &lt; 2). The micro-hybrid composites showed better color stability as compared to the nano-hybrid composites