Nurses' Perceptions of Patient Safety Culture in Intensive Care Units: A Cross-Sectional Study

BACKGROUND: Patient safety culture is a relatively new focus where little is known about its current status in Egypt’s teaching hospitals, mainly intensive care units (ICUs). Therefore, the authors of this study attempted to assess the patient safety culture dimensions from the nurses’ perspective. METHODS: An exploratory cross-sectional study was conducted in two ICUs (pediatric ICU and adult ICU) at the University Hospital over 3 months from October till December 2018. Sixty nurses were interviewed using the Hospital Survey on Patient Safety Culture. RESULTS: The current study findings revealed an average positive response to individual items ranging from 6% to 51%. The “Organizational learning†dimension had the highest average percent positive patient safety dimension score (51%) among all respondents, while the “Frequency of events reported†dimension had the lowest one (6%). No statistically significant difference was reported between the pediatric and adult ICUs for all mean scores except for the “Non-punitive response to error†dimension which was reported to be greater in the pediatric intensive care unit (PICU) compared to adult ICU (P < 0.005). The overall patient safety grade was rated acceptable by 47.5% of the interviewed nurses. CONCLUSION: The current study shows that patient safety is fragile in ICUs, and more effort is recommended to increase the awareness of health care providers. Also, hospital managers need to enhance the performance and practices of patient safety within a non-punitive reporting environment

Hospital Preparedness for Critical Care during COVID-19 Pandemic: Exploratory Cross-sectional Study

AIM: The researchers conducted the study to assess intensive care units (ICUs) preparedness in Cairo University Hospitals to deal efficiently and effectively with COVID-19 upcoming waves. METHODS: An exploratory cross-sectional study was conducted at Cairo University Intensive Care Units 6 pediatric ICUs, and 2 adult ICUs in the period from the end of February to the first week of March, 2020; almost 2 weeks after the appearance of the first case of COVID-19 in Egypt by hand-delivered questionnaire method with one of the ICU staff members who were available and have time to take part in the study. WHO checklist for hospital readiness was used; this checklist based on current knowledge and available evidence on the COVID-19 pandemic for WHO’s Regional Office for the Eastern Mediterranean Region. The WHO has developed the checklist to help hospital managers prepare for COVID-19 patient management by optimizing each hospital’s capacities. The list composed of 10 key components: (1) Leadership and coordination; (2) operational support, logistics and supply management; (3) information; (4) communication; (5) human resources; (6) continuity of essential services and surge capacity; (7) rapid identification; (8) diagnosis; (9) isolation and case management; and (10) infection prevention and control. RESULTS: The overall preparedness in both pediatric and adult ICUs was 54%. Overall, adult ICUs were more prepared than pediatric ICUs, especially in communication; continuity of essential services and surge capacity; rapid identification; diagnosis; isolation; and case management. Both of them were comparable regarding operational support, logistics and supply management; human resources; and infection prevention and control, while information component was lower in both types but reached critical values 10% in adult ones. CONCLUSION: The current study demonstrated the intermediate readiness of ICUs at initial outbreak; further assessment during different phases of pandemic is required. Continues education of HCWs and active communication should be established

Avaliação em Duas Fases do Laboratório Remoto em Engenharia, VISIR, na Universidade Al-Quds da Palestina

Os laboratórios de ciência e engenharia desempenham um papel fundamental na demonstração de conceitos e princípios, bem como na melhoria das competências técnicas. Com a introdução de laboratórios remotos foi possível partilhar dispositivos, equipamento e instrumentação entre universidades. Mais, eles evitam restrições de tempo e espaço, sendo capazes de se adaptar ao ritmo próprio de cada estudante, no caso do tempo passado no laboratório não ter sido suficiente. Neste artigo é descrito um estudo empírico, dividido em duas fases de avaliação. Na primeira fase foi avaliada a flexibilidade de aplicação do laboratório remoto em engenharia VISIR na faculdade de engenharia na Universidade de Al-Quds em Jerusalém, Palestina. Durante esta fase foi ainda avaliada a aceitação desta tecnologia, pelos estudantes, quando em interação com os laboratórios tradicionais. Na segunda fase deste estudo, que decor rerá em 2014/15, será realizada uma aprofundada análise comparativa de forma a caracterizar o VISIR perante as restantes modalidades de laboratórios de engenharia, os práticos/presenciais e os de simulação. Estas três formas de laboratório são comparadas através de testes experimentais, tendo em atenção os critérios de avaliação definidos para os laboratórios de ensino de engenharia e de acordo com os objetivos fundamentais dos cursos, nomeadamente, as taxas de retenção e de satisfação dos estudantes, bem como do seu desempenho.info:eu-repo/semantics/publishedVersio

A Two-Stage Assessment of the Remote Engineering Lab VISIR at Al-Quds University in Palestine

Engineering labs are an essential part in engineering education since they provide practical knowledge for students, illustrate concepts and principles, and improve technical skills. Remote labs allow devices, equipment and instrumentations to be shared with other universities. Additionally, they relax time and space constraints, and are capable of being adapted to the pace of each student in case there was insufficient time in the laboratory. This paper describes an empirical study, which embeds two stages of assessment. In the first stage, we are concerned with finding out the level of flexibility when applying the engineering remote lab VISIR as a contemporary remote lab technology in the engineering faculty at Al-Quds University in Jerusalem in Palestine, and whether the engineering students will accept such technology to interact with in their future lab courses or not. In the second stage of the assessment study, a more in-depth comparative analysis will be carried out in order to have a categorization of VISIR in the landscape of the engineering labs such as hands-on and simulations. The three lab approaches will be compared with each other by means of an experimental testing based on assessment criteria that are in accordance with the fundamental course objectives of engineering instructional labs: student’s retention rate and satisfaction survey, as well as their performance.info:eu-repo/semantics/publishedVersio

Intraoperative endomanometric laparoscopic Nissen fundoplication improves postoperative outcomes in large sliding hiatus hernia with severe gastroesophageal reflux disease. A retrospective cohort study

Background: Laparoscopic Nissen Fundoplication (LNF) is the gold standard surgical intervention for gastroesophageal reflux disease (GERD). LNF can be followed by recurrent symptoms or complications affecting patient satisfaction. The aim of this study is to assess the value of the intraoperative endomanometric evaluation of esophagogastric competence and pressure combined with LNF in patients with large sliding hiatus hernia (> 5 cm) with severe GERD (DeMeester score >100). Materials and methods: This is a retrospective, multicenter cohort study. Baseline characteristics, postoperative dysphagia and gas bloat syndrome, recurrent symptoms, and satisfaction were collected from a prospectively maintained database. Outcomes analyzed included recurrent reflux symptoms, postoperative side effects, and satisfaction with surgery. Results: 360 patients were stratified into endomanometric LNF (180 patients, LNF+) and LNF alone (180 patients, LNF). Recurrent heartburn (3.9% vs. 8.3%) and recurrent regurgitation (2.2% vs. 5%) showed a lower incidence in the LNF+ group (P=0.012). Postoperative score III recurrent heartburn and score III regurgitations occurred in 0% vs. 3.3% and 0% vs. 2.8% cases in the LNF+ and LNF groups, respectively (P=0.005). Postoperative persistent dysphagia and gas bloat syndrome occurred in 1.75% vs. 5.6% and 0% vs. 3.9% of patients (P=0.001). Score III postoperative persistent dysphagia was 0% vs. 2.8% in the two groups (P=0.007). There was no redo surgery for dysphagia after LNF+. Patient satisfaction at the end of the study was 93.3% vs. 86.7% in both cohorts, respectively (P=0.05). Conclusions: Intraoperative high-resolution manometry (HRM) and endoscopic were feasible in all patients, and the outcomes were favorable from an effectiveness and safety standpoint

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe