The Reality of Businesses to Consumers E-Commerce in Jordan: A Study of the Jordanian Industrial Companies from the Perspective of Employees

This study aims to identifying the scope of e- commerce employment among businesses and costumers. So, the present study aims at achieving the following goals: 1- Gaining knowledge concerning e-commerce, its characteristics, forms and requirements. 2- Identifying the scope of e-commerce at the Jordanian market, and awareness concerning e-commerce among individuals and firms. 3- Determining the degree of success of e-commerce usage on the operations and the value of companies and individuals from the perspective of employees at those companies. The researcher found a number of recommendations based on the results of the study, 1- Conducting similar studies examining the factors affecting the application and adoption of e- commerce among Jordan firms, based on different years in which the required methods for encouraging e- commerce. 2- Approving laws and legislations which regulate e- commerce among the firms which adopt e- commerce. 3- The necessity of awareness and guidance provision for the employees at the e- commerce firms and their customers concerning the importance of e- commerce and employing its capacities which may yield great benefits for the firm and the customer if applied appropriately, supported by relevant regulations and laws. 4- providing training courses for the employees at the firms in order to create an environment which is suitable for, and aware of e- commerce. Keywords: E-Commerce, Businesses, Jordanian Industrial Companies , Perspective of Employee

Critically ill patients with diabetes and Middle East respiratory syndrome:a multi-center observational study

Background: Diabetes is a risk factor for infection with coronaviruses. This study describes the demographic, clinical data, and outcomes of critically ill patients with diabetes and Middle East Respiratory Syndrome (MERS).Methods: This retrospective cohort study was conducted at 14 hospitals in Saudi Arabia (September 2012–January 2018). We compared the demographic characteristics, underlying medical conditions, presenting symptoms andsigns, management and clinical course, and outcomes of critically ill patients with MERS who had diabetes compared to those with no diabetes. Multivariable logistic regression analysis was performed to determine ifdiabetes was an independent predictor of 90-day mortality.Results: Of the 350 critically ill patients with MERS, 171 (48.9%) had diabetes. Patients with diabetes were more likely to be older, and have comorbid conditions, compared to patients with no diabetes. They were more likely topresent with respiratory failure requiring intubation, vasopressors, and corticosteroids. The median time to clearance of MERS-CoV RNA was similar (23 days (Q1, Q3: 17, 36) in patients with diabetes and 21.0 days (Q1, Q3: 10, 33) in patients with no diabetes). Mortality at 90 days was higher in patients with diabetes (78.9% versus 54.7%, p <0.0001). Multivariable regression analysis showed that diabetes was an independent risk factor for 90-day mortality(odds ratio, 2.09; 95% confidence interval, 1.18–3.72).Conclusions: Half of the critically ill patients with MERS have diabetes; which is associated with more severe disease. Diabetes is an independent predictor of mortality among critically patients with MERS

Critically ill patients with diabetes and Middle East respiratory syndrome:a multi-center observational study

Background: Diabetes is a risk factor for infection with coronaviruses. This study describes the demographic, clinical data, and outcomes of critically ill patients with diabetes and Middle East Respiratory Syndrome (MERS).Methods: This retrospective cohort study was conducted at 14 hospitals in Saudi Arabia (September 2012–January 2018). We compared the demographic characteristics, underlying medical conditions, presenting symptoms andsigns, management and clinical course, and outcomes of critically ill patients with MERS who had diabetes compared to those with no diabetes. Multivariable logistic regression analysis was performed to determine ifdiabetes was an independent predictor of 90-day mortality.Results: Of the 350 critically ill patients with MERS, 171 (48.9%) had diabetes. Patients with diabetes were more likely to be older, and have comorbid conditions, compared to patients with no diabetes. They were more likely topresent with respiratory failure requiring intubation, vasopressors, and corticosteroids. The median time to clearance of MERS-CoV RNA was similar (23 days (Q1, Q3: 17, 36) in patients with diabetes and 21.0 days (Q1, Q3: 10, 33) in patients with no diabetes). Mortality at 90 days was higher in patients with diabetes (78.9% versus 54.7%, p <0.0001). Multivariable regression analysis showed that diabetes was an independent risk factor for 90-day mortality(odds ratio, 2.09; 95% confidence interval, 1.18–3.72).Conclusions: Half of the critically ill patients with MERS have diabetes; which is associated with more severe disease. Diabetes is an independent predictor of mortality among critically patients with MERS

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)

Permissive Underfeeding or Standard Enteral Feeding in Critically Ill Adults

BACKGROUND The appropriate caloric goal for critically ill adults is unclear. We evaluated the effect of restriction of nonprotein calories (permissive underfeeding), as compared with standard enteral feeding, on 90-day mortality among critically ill adults, with maintenance of the full recommended amount of protein in both groups. METHODS At seven centers, we randomly assigned 894 critically ill adults with a medical, surgical, or trauma admission category to permissive underfeeding (40 to 60% of calculated caloric requirements) or standard enteral feeding (70 to 100%) for up to 14 days while maintaining a similar protein intake in the two groups. The primary outcome was 90-day mortality. RESULTS Baseline characteristics were similar in the two groups; 96.8% of the patients were receiving mechanical ventilation. During the intervention period, the permissiveunderfeeding group received fewer mean (±SD) calories than did the standardfeeding group (835±297 kcal per day vs. 1299±467 kcal per day, P&lt;0.001; 46±14% vs. 71±22% of caloric requirements, P&lt;0.001). Protein intake was similar in the two groups (57±24 g per day and 59±25 g per day, respectively; P = 0.29). The 90-day mortality was similar: 121 of 445 patients (27.2%) in the permissive-underfeeding group and 127 of 440 patients (28.9%) in the standard-feeding group died (relative risk with permissive underfeeding, 0.94; 95% confidence interval [CI], 0.76 to 1.16; P = 0.58). No serious adverse events were reported; there were no significant between-group differences with respect to feeding intolerance, diarrhea, infections acquired in the intensive care unit (ICU), or ICU or hospital length of stay. CONCLUSIONS Enteral feeding to deliver a moderate amount of nonprotein calories to critically ill adults was not associated with lower mortality than that associated with planned delivery of a full amount of nonprotein calories. 2399 Permissive Underfeeding in Critically Ill Adults N utritional support is an essential component of the care of critically ill adults. 1 Achieving caloric targets has been recommended with the premise that attenuating malnutrition and protein catabolism, which are associated with increased morbidity and mortality, will improve outcomes. 2 Observational studies examining various doses of enteral feeding have yielded conflicting results. 11 Conversely, caloric restriction may be beneficial; it has been shown to prolong life span in several species, 12-14 promote mammalian cell survival, 24 Such findings prompt the question of whether moderate caloric restriction while protein intake is preserved would improve the outcomes in critically ill adults. In a single-center, randomized, controlled trial of moderate caloric intake (60 to 70% of the estimated caloric requirement) versus standard caloric intake (90 to 100%), with maintenance of the full targeted protein intake in both groups, we observed that the lower caloric intake was associated with a reduction in in-hospital mortality, which was a secondary end point. Me thods Study Design The Permissive Underfeeding versus Target Enteral Feeding in Adult Critically Ill Patients (PermiT) trial was an unblinded, pragmatic, randomized, controlled trial conducted at seven tertiary care centers in Saudi Arabia and Canada between November 2009 and September 2014. The institutional review board at each participating center approved the study. Written informed consent was obtained from all the patients or their legal representatives. The study was sponsored by the King Abdullah International Medical Research Center, Riyadh, Saudi Arabia, and the investigators designed, managed, and analyzed the study independently. Patients were eligible for the trial if they were fed enterally within 48 hours after ICU admission. Inclusion and exclusion criteria are listed in Interventions Enrolled patients were randomly assigned to the permissive-underfeeding group or the standardfeeding group with the use of opaque, sealed, sequentially numbered envelopes. The randomization list was computer-generated. Randomization was performed in random permuted blocks and was stratified according to center. The feeding strategy was unblinded because of the need for adjustment of the nutritional support according to feeding tolerance and gastric residual volumes. ICU dietitians estimated patients&apos; standard caloric requirements using the equation 2400 T h e ne w e ngl a nd jou r na l o f m e dicine University (the Penn State equation) for mechanically ventilated patients who had a body-mass index (BMI; the weight in kilograms divided by the square of the height in meters) of less than 30 and using the 1992 Ireton-Jones equation for mechanically ventilated patients who had a BMI of 30 or higher and for spontaneously breathing patients 26-28 The caloric goal was 40 to 60% of caloric requirements in the permissive-underfeeding group and 70 to 100% of caloric requirements in the standard-feeding group. We set the caloric goal in the permissive-underfeeding group at a lower level than we did in the earlier trial, Cointerventions Protein requirements were calculated at 1.2 to 1.5 g per kilogram of body weight per day, in accordance with clinical practice guidelines. 1 To ensure that enteral protein and volume delivery in the permissive-underfeeding group would be similar to those in the standard-feeding group, the permissive-underfeeding group received additional protein (Beneprotein, Nestlé Nutrition) and normal saline or water at a dose of 2 ml per kilogram every 4 hours unless otherwise specified by the clinical team. Data Collection At baseline, we collected data on patient demographics, diabetes history, admission category (medical, surgical, or trauma), Acute Physiology and Chronic Health Evaluation (APACHE) II score, Daily during the intervention period, we obtained nutritional data (total calories and calories from enteral feeding, propofol, intravenous dextrose, and parenteral nutrition), laboratory data (levels of blood glucose, hemoglobin, creatinine, potassium, magnesium, and phosphate), and information on insulin dose, fluid intake and output, use of prokinetic agents, stool frequency and consistency, and duration of interruption in feeding. On a weekly basis, we recorded body weight; levels of lipids, prealbumin, and transferrin; and 24-hour urinary nitrogen excretion. We also recorded the use of selected medications during the ICU stay. Information on the monitoring of serious adverse events is provided in Outcomes The primary outcome was 90-day all-cause mortality. Secondary outcomes included mortality in the ICU, 28-day mortality, in-hospital mortality, 180-day mortality, and serial SOFA scores. Tertiary outcomes included days free from mechanical ventilation, ICU-free days, hospital length of stay, hypoglycemia, hypokalemia, hypomagnesemia, hypophosphatemia, transfusions of packed ), feeding intolerance (vomiting, abdominal distention, or a gastric residual volume of more than 200 ml), and diarrhea. Statistical Analysis On the basis of the findings of our previous randomized, controlled trial, For serial measurements, we tested the change over time and the difference between the two groups over time using a repeated-measures analysis of variance, with no imputation for missing values. The primary outcome was compared between the two study groups in the following prespecified subgroups: nonsurgical patients versus surgical patients, patients with diabetes versus patients without diabetes, patients with an APACHE II score of 18 or lower versus those with a score higher than 18, patients with a specific admission diagnosis (severe sepsis or traumatic brain injury) versus patients without either of those diagnoses, patients using vasopressors at baseline versus those not using them, and patients with a blood glucose level of no more than the median value at randomization versus those with a level higher than the median value. Tests were two-sided and at the 5% significance level. For serial measurements, we used a Bonferroni correction to account for multiple comparisons. To account for alpha spending by the interim analyses, we used the O&apos;Brien-Fleming method. A final P value of less than 0.045 was considered to indicate statistical significance for the primary outcome. Analyses were performed with the use of SAS software, version 9.2 (SAS Institute). R esult s Patients A total of 894 patients underwent randomization Interventions and Cointerventions Throughout the intervention period, patients in the permissive-underfeeding group had a lower caloric intake than did patients in the standardfeeding group Outcomes Mortality The 90-day mortality (primary end point) was 27.2% (121 of 445 patients) in the permissiveunderfeeding group and 28.9% (127 of 440 patients) in the standard-feeding group (relative risk, 0.94; 95% confidence interval [CI], 0.76 to 1.16; P = 0.58) ( 2402 T h e ne w e ngl a nd jou r na l o f m e dicine ence in the probability of survival between the two groups (P = 0.43 by the log-rank test) Other End Points Serial SOFA scores, nitrogen balance, body weight, and levels of C-reactive protein, prealbumin, creatinine, bilirubin, partial pressure of arterial carbon dioxide, hemoglobin, lipids, potassium, magnesium, phosphate, transferrin, and urinary nitrogen excretion did not differ significantly between the two groups ( 2404 T h e ne w e ngl a nd jou r na l o f m e dicine days did not differ significantly between the two group

Critically ill healthcare workers with the middle east respiratory syndrome (MERS): A multicenter study.

BACKGROUND:Middle East Respiratory Syndrome Coronavirus (MERS-CoV) leads to healthcare-associated transmission to patients and healthcare workers with potentially fatal outcomes. AIM:We aimed to describe the clinical course and functional outcomes of critically ill healthcare workers (HCWs) with MERS. METHODS:Data on HCWs was extracted from a multi-center retrospective cohort study on 330 critically ill patients with MERS admitted between (9/2012-9/2015). Baseline demographics, interventions and outcomes were recorded and compared between survivors and non-survivors. Survivors were approached with questionnaires to elucidate their functional outcomes using Karnofsky Performance Status Scale. FINDINGS:Thirty-Two HCWs met the inclusion criteria. Comorbidities were recorded in 34% (11/32) HCW. Death resulted in 8/32 (25%) HCWs including all 5 HCWs with chronic renal impairment at baseline. Non-surviving HCW had lower PaO2/FiO2 ratios 63.5 (57, 116.2) vs 148 (84, 194.3), p = 0.043, and received more ECMO therapy compared to survivors, 9/32 (28%) vs 4/24 (16.7%) respectively (p = 0.02).Thirteen of the surviving (13/24) HCWs responded to the questionnaire. Two HCWs confirmed functional limitations. Median number of days from hospital discharge until the questionnaires were filled was 580 (95% CI 568, 723.5) days. CONCLUSION:Approximately 10% of critically ill patients with MERS were HCWs. Hospital mortality rate was substantial (25%). Patients with chronic renal impairment represented a particularly high-risk group that should receive extra caution during suspected or confirmed MERS cases clinical care assignment and during outbreaks. Long-term repercussions of critical illness due to MERS on HCWs in particular, and patients in general, remain unknown and should be investigated in larger studies

Permissive underfeeding versus target enteral feeding in adult critically ill patients (PermiT Trial): a study protocol of a multicenter randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Nutritional support is an essential part of the management of critically ill patients. However, optimal caloric intake has not been systematically evaluated. We aim to compare two strategies of enteral feeding: permissive underfeeding versus target feeding.</p> <p>Method/Design</p> <p>This is an international multi-center randomized controlled trial in critically ill medical- surgical adult patients. Using a centralized allocation, 862 patients will be randomized to permissive underfeeding or target feeding. Patients in the permissive group receive 50% (acceptable range is 40% to 60%) of the calculated caloric requirement, while those in the targeted group receive 100% (acceptable range 70% to 100%) of the calculated caloric requirement. The primary outcome is 90-day all-cause mortality. Secondary outcomes include ICU and hospital mortality, 28-day, and 180-day mortality as well as health care-associated infections, organ failure, and length of stay in the ICU and hospital. The trial has 80% power to detect an 8% absolute reduction in 90-day mortality assuming a baseline risk of death of 25% at an alpha level of 0.05.</p> <p>Discussion</p> <p>Patient recruitment started in November 2009 and is currently active in five centers. The Data Monitoring Committee advised continuation of the trial after the first interim analysis. The study is expected to finish by November 2013.</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN68144998</p