Psychometric properties of the Arabic version of the confusion assessment method for the intensive care unit (CAM-ICU)

Abstract Background It is recommended that critically ill patients undergo routine delirium monitoring with a valid and reliable tool such as the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). However, the validity and reliability of the Arabic version of the CAM-ICU has not been investigated. Here, we test the validity and reliability of the Arabic CAM-ICU. Methods We conducted a psychometric study at ICUs in a tertiary-care hospital in Saudi Arabia. We recruited consecutive adult Arabic-speaking patients, who had stayed in the ICU for at least 24 hours, and had a Richmond Agitation-Sedation Scale (RASS) score ≥ − 2 at examination. Two well-trained examiners (ICU nurse and intensivist) independently assessed delirium in eligible patients with the Arabic CAM-ICU. Evaluations by the two examiners were compared with psychiatrist blind clinical assessment of delirium according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Subgroup analyses were conducted for age, invasive mechanical ventilation, and gender. Results We included 108 patients (mean age: 62.6 ± 17.6; male: 51.9%), of whom 37% were on invasive mechanical ventilation. Delirium was diagnosed in 63% of enrolled patients as per the psychiatrist clinical assessment. The Arabic CAM-ICU sensitivity was 74% (95% confidence interval [CI] = 0.63–0.84) and 56% (95%CI = 0.44–0.68) for the ICU nurse and intensivist, respectively. Specificity was 98% (95%CI = 0.93–1.0) and 92% (95%CI = 0.84–1.0), respectively. Sensitivity was greater for mechanically-ventilated patients, women, and those aged ≥65 years. Specificity was greater for those aged < 65 years, non-mechanically-ventilated patients and men. The median duration to complete the Arabic CAM-ICU was 2 min (interquartile range, 2–3) and 4.5 min (IQR, 3–5) for the ICU nurse and intensivist, respectively. Inter-rater reliability (kappa) was 0.66. Conclusions The Arabic CAM-ICU demonstrated acceptable reliability and validity to assess delirium in Arabic-speaking ICU patients

Introducing the comprehensive unit-based safety program for mechanically ventilated patients in Saudi Arabian intensive care units

Over the past decade, there have been major improvements to the care of mechanically ventilated patients (MVPs). Earlier initiatives used the concept of ventilator care bundles (sets of interventions), with a primary focus on reducing ventilator-associated pneumonia. However, recent evidence has led to a more comprehensive approach: The ABCDE bundle (Awakening and Breathing trial Coordination, Delirium management and Early mobilization). The approach of the Comprehensive Unit-based Safety Program (CUSP) was developed by patient safety researchers at the Johns Hopkins Hospital and is supported by the Agency for Healthcare Research and Quality to improve local safety cultures and to learn from defects by utilizing a validated structured framework. In August 2015, 17 Intensive Care Units (ICUs) (a total of 271 beds) in eight hospitals in the Kingdom of Saudi Arabia joined the CUSP for MVPs (CUSP 4 MVP) that was conducted in 235 ICUs in 169 US hospitals and led by the Johns Hopkins Armstrong Institute for Patient Safety and Quality. The CUSP 4 MVP project will set the stage for cooperation between multiple hospitals and thus strives to create a countrywide plan for the management of all MVPs in Saudi Arabia

Artificial intelligence-based fuzzy logic systems for predicting radiation protection awareness levels among university population

The present study aims to assess the knowledge level of radiation protection among individuals of Princess Nourah bint Abdulrahman University (PNU) using artificial intelligence baesd fuzzy logic system. This crosssectional study included 428 PNU participants. They were asked to fill in the online questionnaire, consisting of demographic data, education level, and radiation protection awareness. After informed consent was completed, a statistical package for the social sciences as well as fuzzy logic system was used for data analysis. The participant group consisted of 98.4% females, 96.3% individuals aged 18–28 years (the most common age group), 63.1% bachelor’s degree holders, and 65.7% medical participants. Specialty and radiation protection awareness exhibited significant association (P 0.05). PNU individuals in the medical field differed significantly (P > 0.05) with the non-medical individual in their knowledge of radiation protection. This study suggests that PNU individuals in the medical field have a reasonable awareness of radiation protection. However, the general knowledge of nonmedical individuals must be improved to raise awareness. Based on the obtained results by using fuzzy model, this study suggests that the tool can be used in the process of radiation protection awareness in other institutions and areas

Introducing the Comprehensive Unit-based Safety Program for mechanically ventilated patients in Saudi Arabian Intensive Care Units

Over the past decade, there have been major improvements to the care of mechanically ventilated patients (MVPs). Earlier initiatives used the concept of ventilator care bundles (sets of interventions), with a primary focus on reducing ventilator-associated pneumonia. However, recent evidence has led to a more comprehensive approach: The ABCDE bundle (Awakening and Breathing trial Coordination, Delirium management and Early mobilization). The approach of the Comprehensive Unit-based Safety Program (CUSP) was developed by patient safety researchers at the Johns Hopkins Hospital and is supported by the Agency for Healthcare Research and Quality to improve local safety cultures and to learn from defects by utilizing a validated structured framework. In August 2015, 17 Intensive Care Units (ICUs) (a total of 271 beds) in eight hospitals in the Kingdom of Saudi Arabia joined the CUSP for MVPs (CUSP 4 MVP) that was conducted in 235 ICUs in 169 US hospitals and led by the Johns Hopkins Armstrong Institute for Patient Safety and Quality. The CUSP 4 MVP project will set the stage for cooperation between multiple hospitals and thus strives to create a countrywide plan for the management of all MVPs in Saudi Arabia

Folic Acid Reinforces Maize Tolerance to Sodic-Alkaline Stress through Modulation of Growth, Biochemical and Molecular Mechanisms

The mechanism by which folic acid (FA) or its derivatives (folates) mediates plant tolerance to sodic-alkaline stress has not been clarified in previous literature. To apply sodic-alkaline stress, maize seedlings were irrigated with 50 mM of a combined solution (1:1) of sodic-alkaline salts (NaHCO3 and Na2CO3; pH 9.7). Maize seedlings under stressed and non-stressed conditions were sprayed with folic acid (FA) at 0 (distilled water as control), 0.05, 0.1, and 0.2 mM. Under sodic-alkaline stress, FA applied at 0.2 mM significantly improved shoot fresh weight (95%), chlorophyll (Chl a (41%), Chl b (57%), and total Chl (42%)), and carotenoids (27%) compared to the untreated plants, while root fresh weight was not affected compared to the untreated plants. This improvement was associated with a significant enhancement in the cell-membrane stability index (CMSI), relative water content (RWC), free amino acids (FAA), proline, soluble sugars, K, and Ca. In contrast, Na, Na/K ratio, H2O2, malondialdehyde (MDA), and methylglycoxal (MG) were significantly decreased. Moreover, seedlings treated with FA demonstrated significantly higher activities of antioxidant enzymes including superoxide dismutase (SOD), peroxidase (POX), catalase (CAT), and ascorbate peroxidase (APX) compared to the untreated plants. The molecular studies using RT-qPCR demonstrated that FA treatments, specifically at 0.2 mM, enhanced the K+/Na+ selectivity and the performance of photosynthesis under alkaline-stress conditions. These responses were observed through up-regulation of the expression of the high-affinity potassium-transporter protein (ZmHKT1), the major core protein of photosystem II (D2-Protein), and the activity of the first enzyme of carbon fixation cycle in C4 plants (PEP-case) by 74, 248, and 225% over the untreated plants, respectively. Conversely, there was a significant down-regulation in the expression ZmSOS1 and ZmNHX1 by 48.2 and 27.8%, respectively, compared to the untreated plants