Factors Affecting Validity of Arterial Blood Gases Results among Critically Ill Patients: Nursing Perspectives

Arterial blood gases  sampling is one of the most common laboratory tests in intensive care units and   might be corrupted by pre-analytical factors that influence the validity of results. Arterial blood gases are valuable only if obtained properly and measured carefully. Corrupted factors in arterial blood gas sampling change significantly the results and adversely affect patient-care decisions when the magnitude of the error is clinically important  .Therefore the nurses’ role is very important to control these factors. The aim of this study is to assess the different pre- analytical factors affecting ABGs results’ validity among critically ill patients at Cairo University Hospitals. The following research questions were formulated Q1: What do critical care nurses know about the different factors that can affect ABG results’ validity? , Q2: What are the different practices performed by critical care nurses in relation to ABG results’ validity?  And Q3: What are the additional pre-analytical factors that might affect the ABG results?. A descriptive exploratory research design was utilized in this study.  A sample of convenience of 68 bed side nurses were recruited from three  intensive care units affiliated to Cairo University Hospitals which are; Surgical ICU, medical ICU , and Neurological ICU.  Three tools were utilized to collect data; ABGs nurses’ knowledge questionnaire that consists of two sections, the first section included Socio-demographic data and  the second section constituted 17 questions that covered factors affecting ABGs’ results, ABG withdrawal technique, and indications, and complications of sampling related questions. The second tool was ABGs observational checklist including arterial sampling practices through two main different methods; direct puncturing from radial or femoral sites   and indirect puncturing from arterial line and finally assessment of pre-analytical factors that may affect validity of ABG results. Findings of the study showed that the all the studied subjects (100%) demonstrated unsatisfactory knowledge and practical level in relation to ABG sampling and controlling the different factors that might affect ABG results’ validity.  Moreover, There were no significant statistical difference between knowledge scores   regarding educational level (F=2.73; P=0.07), working area (F=1.07;P=0.34), and gender (F=1.096;P=0.29) among the studied subjects. Results of the current study indicated a real gap between nurses' knowledge and practices as compared to the evidence based guidelines of American Association for Respiratory Care in management of ABG sampling. The current study recommends an enrichment of critical care nurses’ knowledge and practices related to this essential procedure in addition to consideration of the different corrupting factors by hospital authorities to keep with the related evidence based guide lines that will be great benefits for patient, hospital, and all health professionals. Key words: validity of Arterial blood gases' results, pre-analytical factors affecting

Pre COVID-19 usage of smartphones and medical applications among medical students

Background: To determine awareness of medical students that utilize smartphone and their familiarity of medical applications.Methods: The questionnaire-based descriptive study was conducted in December 2019 and comprised medical students of first year and second year of the CMH Kharian Medical College, Kharian, and Nawaz Sharif Medical College, Gujrat, Gujranwala Medical College, Gujranwala and Mohi-ud-Din Islamic Medical College, Mirpur. Questionnaires were distributed in the classrooms and were filled by the students anonymously. SPSS 20 was used for statistical analysis.Results: Among the 770 medical students in the study, 747 (97%) had smartphones and 23 (3%) were using simple cell phones. Overall, 362 (47%) of the smart phone users were using some medical apps. Besides, 223 (29%) were aware of the medical apps but were not using them. Also, 655 (85%) students were not using any type of medical text eBooks through their phone, and only 115 (15%) had relevant text eBooks in their phones.Conclusions: A very low awareness among medical college students exists regarding smartphones as a gadget for improving medical knowledge

Cerebrovascular Stroke Recurrence among Critically Ill Patients at a Selected University Hospital in Egypt

Cerebrovascular stroke (CVS) is a fatal disease. Literature review cited that, CVS recurrence is more devastating than the first attack. The risk of recurrent CVS is up to 15 times greater than the risk of CVS and is attributed to insufficient control of risk factors and non compliance with medical advice. So that, identification of risk factors of recurrence is an important role of the critical care nurses, plays an essential role in the prevention of further stroke. Aim: to study the risk factors, frequency and severity of recurrent cerebrovascular stroke among adult critically ill patients admitted to intensive care units. Research questions: Q1- What are the risk factors of recurrent cerebrovascular stroke among critically ill patients at a selected university hospital? Q2- What are the intervals of recurrence from the first attack of cerebrovascular stroke? Q3- What is the frequency of recurrent cerebrovascular stroke attacks among critically ill patients?  Q4-What is the severity rate of recurrent cerebrovascular stroke among critically ill patients?. A descriptive exploratory research design was utilized in the current study. The study was conducted at different CVS intensive care units at a selected University Hospital. A sample of convenience including all adult patients admitted to the ICU with recurrent CVS over a period of six months (80 patients) was included. Three tools were used for data collection: socio-demographic and medical data sheet, CVS risks factors assessment sheet, and the National Institutes of Health Stroke Scale (NIHSS). Results: The majority of the studied group admitted with the first recurrence of CVS, had different chronic illnesses such as hypertension (100%) & diabetes mellitus (95%). The duration of CVS recurrence ranged from two - < five years among 30% of the studied group. 36.25% of the studied group admitted with severe degree of CVS with a mean severity score of (X = 19.17 + SD = 1.255). Conclusions: uncontrollable risk factors (old age, male gender, marriage); life style risk factors (smoking, obesity, low income); chronic medical diseases (old CVS, hypertension, diabetes mellitus, ischemic heart disease,  myocardial infarction, heart failure,… etc ); noncompliance with prescribed drugs of chronic illnesses, abnormal laboratory investigations (high cholesterol, triglyceride, low density lipoprotein) represented the common risk factors and contributed to recurrent cerebrovascular stroke with different severity. Key words: Cerebrovascular stroke, recurrence, critically ill patients, risk factors, severity

Evaluation of the role of gracilis free flap in reconstruction of orofacial defects

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Effect of Earplugs and Eye Mask on Sleep Quality Among Patients with Acute Coronary Syndrome at Assiut University Hospital

Background: Sleep disturbance can cause multiple negative cardiovascular effects among patients with Acute Coronary Syndrome (ACS). Aim: this study carried out to investigate effect of earplugs and eye mask on sleep quality among patients with ACS. Design: a quasi-experimental design. Setting: Coronary Care Unit at Assiut University Hospital. Subjects: Convenience sampling of 60 male and female adult patients were assigned randomly to two equal groups (30 each). Tools: Four tools were utilized to collect data of study, which were: Tool I Acute Coronary Syndrome patient assessment sheet Tool II: Factors affecting sleep quality among patients with ACS during night Tool III: 0–10 Numeric Pain Rating Scale Tool IV: ST Mary’s Hospital Sleep Questionnaire (SMHSQ). Methods: Researcher assessed factors affecting sleep quality during night as base line data and on daily basis for 3 consecutive days. Then, earplugs and eye mask were placed for study group between 7:10 PM. On morning, sleep quality was assessed for study and control groups by using (SMHSQ) between 7:8 AM. Results: Finding of this study supported stated research hypotheses with statistical significant difference between study and control groups regarding total mean of sleep quality score during 1st and 2nd nights of intervention (P=0.000**, P= 0.014*) respectively as well as some of environmental factors affecting sleep quality with P. value < 0.05. Conclusion Earplugs, eye mask significantly improve sleep quality of patients with ACS. Therefore, offering earplugs and eye mask as a part of routine nursing practice for all ACS patients is highly recommended.                                                                                        Key words: earplugs and eye mask, sleep quality, acute coronary syndrome patient

Intensive Care Nurses’ Knowledge & Practices regarding Infection Control Standard Precautions at a Selected Egyptian Cancer Hospital

Critical care nurses are the health care professionals who have the obligation to protect critically ill patients against infection especially those who are immune compromised, in order to enhance their recovery, prevent deterioration in their health, and achieve high quality nursing care. Therefore critical care nurses should have sound knowledge and strict adherence to infection control standard precautions. Aim of the study: to assess nurses' knowledge and evaluate their practice regarding infection control standard precautions. Research design: A descriptive research design was utilized in this study. Sample: A sample of convenience including 77 ICU nurses was recruited in the current study.  Setting: The study was carried out at the Intensive Care of a selected Cancer Hospital in Egypt. Tools of data collection: Two tools were developed, tested for clarity and feasibility, and then used to collect data pertinent to the current: a- Structured Interview Questionnaire to assess nurses' knowledge regarding infection control standard precautions. b-Nurses’ Performance Observational Checklist to evaluate nurses' practice / utilization of infection control standard precautions. Results: the current study revealed that, approximately two thirds (63.6%) of the studied sample had unsatisfactory knowledge level (<75%) with a mean total knowledge score of 102.5 + 13.7. However, more than half (57.1%) of the studied sample had satisfactory performance level (>75%) with a mean total performance scores of 77.3+4.4. Negative significant correlations were found between: mean knowledge scores, and age; mean knowledge scores and years of experience (r = -.323 & r = -.325 at P < 0.004 respectively); between mean practice scores and age; and mean practice scores and years of experience (r = -.235 & r =-.291 at P < 0.39, 0.010 respectively). However, positive correlations were found between mean knowledge scores and mean practice scores; age and years of experience (r = 0.318 & 0.794 at P < 0.005 & 0.000 respectively). Conclusion: Based on findings of the current study, it can be concluded that inspite of having satisfactory performance level regarding infection control standard precautions, critical care nurses had unsatisfactory knowledge level. Recommendation: updating knowledge and performance of ICU nurses through continuing in-service educational programs; emphasizing the importance of following the latest evidence-based practices of infection control in continuing education / training programs; strict observation of nurses’ performance/ utilization of infection control standard precautions and correction of poor practices by the infection control team are required; and providing training programs for  newly joined ICU nurses about infection control standard precautions and at regular intervals. Key Words: Infection control (IC), Standard precautions (SP), Intensive care unit (ICU), Knowledge, Practice

Pulmonary placental transmogrification associated with adenocarcinoma of the lung: a case report with a comprehensive review of the literature

Pulmonary placental transmogrification (PT) is a rare entity with less than 40 cases reported in the literature. Most reported cases are associated with either bullous emphysema or with pulmonary fibrochondromatous hamartomas. We present only the second case of PT associated with adenocarcinoma of the lung. A 67-year-old female with multiple chronic medical ailments presented with shortness of breath and was found to have a 6-cm mass in the upper lobe of her right lung. A computed tomography (CT) guided core biopsy was performed that showed a well-differentiated adenocarcinoma. Interestingly the normal lung tissue showed placental villous architecture. A unique feature of our case is that the diagnosis was made on a needle core biopsy, unlike all the other cases in the literature. We also provide a comprehensive review of this rare entit

Impact of a Designed Nursing Intervention Protocol about Preoperative Liver transplantation Care on Patients’ Outcomes at A University Hospital in Egypt

Background: Literature review cited that, Liver transplantation is now considered as the gold standard for treatment of patients with end-stage liver diseases and early liver tumors in cirrhotic livers. Patient education is vital to the safety and success of a transplant. Aim: the aim is to assess the impact of a designed nursing intervention protocol about preoperative liver transplantation care on patient’s outcomes as indicated by: patients` knowledge & practice mean scores, and complications developed. To fulfill the aim of this study, the following hypothesis was formulated: patients undergoing liver transplantation who will be exposed to the designed nursing intervention protocol about preoperative liver transplantation care will show better outcomes. Material and Methods: A convenient sample of 14 adult male and female patients admitted to Liver Transplant Unit at El Manial University Hospital were included, three of them were died with an attrition rate of 21.4%. Four tools were formulated to collect data pertinent to the study. 1- Sociodemographic and medical data sheet; 2- Pre/Post knowledge assessment questionnaire sheet, 3- Observational checklists, & 4- Complications assessment sheet. Structured interview, reviewing medical records, direct observation and physical examination were utilized for data collection. Results: a  significant statistical difference was found in relation to the total and subtotal mean knowledge and practice scores during different assessment periods  with P values (0.00 for both); as well, 45.5 %  of patients developed respiratory complications (pleural effusion) compared to 53.8 % of their correspondence who developed respiratory complications (pleural effusion, chest infection, and others), in addition, 9.1% of the studied subjects developed  rejection, and ascites as compared to (1.9 %, 5.7%) of their correspondence over the last consecutive three years respectively. Conclusion: Liver transplantation patients showed a positive improvement in their knowledge and practice in relation to breathing, coughing, & using respirometer exercises and range of motion. Replication of this study on a larger sample selected from different geographical areas is highly recommended. Key wards: liver transplantation, designed nursing intervention protocol, preoperative liver transplantation care, knowledge, complications, and patient`s outcome