Exploring the lived experience of Arab male patients on intermittent catheterization after spinal cord injury: A phenomenological study.

BACKGROUND: Intermittent catheterization (IC) has been identified as one of the critical techniques used by spinal cord injury (SCI) patients to cope with emptying the bladder, despite several problems impeding this procedure. AIM: The study aimed accordingly to explore the lived experience of Arab male patients on IC after their SCI. DESIGN: This study was carried out by using a descriptive qualitative approach with a phenomenological analysis of data. METHODS: A qualitative study was carried out on 10 Arab male patients from the Rehabilitation Hospital at King Fahad Medical City (KFMC), Riyadh, Saudi Arabia who were utilizing intermittent catheters following SCI. The interviews were analysed using Husserl's phenomenology and the Colaizzi method of data analysis. RESULTS: Two major themes and six sub-themes were identified from exploring the patients experience. These themes are as follows: Theme 1: The Way to IC; with two sub-themes: (i) 'service provided and acceptance' and (ii) 'educational experience'; Theme 2: Lifestyle and self-adaptation; with four sub-themes: (i) 'Flexibility and freedom', (ii) 'Physical access to the community', (iii) 'Traveling' and (iv) 'Work and Social life balance'. CONCLUSION: It is evident that using an intermittent catheter among patients with SCI influenced almost all aspects of the participant's life, including their social lives and body image appearance.

Insights into pressure injury prevention: Assessing the knowledge, attitudes, and practices of Palestinian nursing students.

AIM: To assess the knowledge, attitudes, and practices of Palestinian nursing students towards pressure injury prevention. MATERIALS AND METHODS: A descriptive cross-sectional study was conducted with 455 nursing students recruited from Arab American University-Palestine, employing a total population sample. Data collection forms include socio-demographic information, the Pressure Ulcer Knowledge Assessment Tool, Attitude towards Pressure Ulcer Prevention Instrument and Pressure Injury Preventive Practices scale. RESULTS: The study found that students had a mean knowledge score of 54% (14.04/26), a positive attitude score of 75.8% (39.42/52), and demonstrated a fair level of practice 75.3% (30.12/40). Significant differences were observed in the Knowledge, Attitude, and Practice total scores, linked to academic year, clinical experience, and the number of attended departments during clinical training (p < 0.001). Additionally, weak but significant positive relationships were found between practice and attitude scores (r = 0.303, p < 0.001), practice and knowledge score (r = 0.211, p < 0.001), and a moderate positive significant relationship between knowledge and attitude scores (r = 0.567, p < 0.001). CONCLUSION: The study revealed insufficient knowledge, positive attitudes, and somewhat unsafe practices among nursing students regarding pressure injury prevention. It highlights the need for specific revisions in the nursing curriculum. Improvements can be achieved through detailed coverage in classrooms and laboratories, integrating simulation methods. Additionally, ensuring that students gain adequate experiences in clinical units, with a specific emphasis on pressure injury prevention, is crucial for improving students' capability and contribute to better pressure injury management.

Reversible Cross-linked Thermoresponsive Polycaprolactone Micelles for Enhanced Stability and Controlled Release.

Thermoresponsive amphiphilic poly(ε-caprolactone)s (PCL)s are excellent candidates for drug delivery due to their biodegradability, biocompatibility, and controlled release. However, the thermoresponsivity of modified PCL can often lead to premature drug release because their lower critical solution temperature (LCST) is close to physiological temperature conditions. To address this issue, we developed a novel approach that involves functionalizing redox-responsive lipoic acid to the hydrophobic block of PCL. Lipoic acid has disulfide bonds that undergo reversible cross-linking after encapsulating the drug. Herein, we synthesized an ether-linked propargyl-substituted PCL as the hydrophobic block of an amphiphilic copolymer along with unsubstituted PCL. The propargyl group was used to attach lipoic acid through a postpolymerization modification reaction. The hydrophilic block is composed of an ether-linked, thermoresponsive tri(ethylene glycol)-substituted PCL. Anticancer drug doxorubicin (DOX) was encapsulated within the core of the micelles and induced cross-linking in the presence of a reducing agent, dithiothreitol. The developed micelles are thermodynamically stable and demonstrated thermoresponsivity with an LCST value of 37.5 °C but shifted to 40.5 °C after cross-linking. The stability and release of both uncross-linked (LA-PCL) and cross-linked (CLA-PCL) micelles were studied at physiological temperatures. The results indicated that CLA-PCL was stable, and only 35% release was observed after 46 h at 37 °C while LA-PCL released more than 70% drug at the same condition. Furthermore, CLA-PCL was able to release a higher amount of DOX in the presence of glutathione and above the LCST condition (42 °C). Cytotoxicity experiments revealed that CLA-PCL micelles are more toxic toward MDA-MB-231 breast cancer cells at 42 °C than at 37 °C, which supported the thermoresponsive release of the drug. These results indicate that the use of reversible cross-linking is a great approach toward synthesizing stable thermoresponsive micelles with reduced premature drug leakage.

Prevalence, severity, and characteristics of medical device related pressure injuries in adult intensive care patients: A prospective observational study.

This study was intended to determine the characteristics of Medical Related Pressure Injury (MDRPI) in adult intensive care patients. MDRIs are recognized as significant and complex health problems among hospitalized patients. Underestimated true scale of the problem is evident because the systematic clinical evaluation of MDRPI occurrence is not part of routine skin assessment among intensive care patients. A prospective approach was used to obtain data of MDRPIs with two weeks follow up to monitor the prevention and treatment strategies. Participants were 329 adult patients from three large referral and teaching centres in Jordan. Data were collected using a screening form that included demographic and clinical characteristics, and a list of medical devices. The primary outcome for this study was MDRPI and defined as a pressure injury (PI) found on the skin or mucous membrane with a medical device in use at the location of the injury (EPUAP, 2019). The patients with MDRPI were followed up for 2 weeks for prevention and treatment strategies. Prevalence of MDRPI was 5.01% (15/299) with 41 injuries, 27/41 (65.8%) were skin injuries and 14/41(34.2%) were mucosal. Most mucous membrane MDRPIs were at mouth/lips and caused by ET tube and meatal orifice caused by foley catheter. Skin MDRPIs were at the nose and caused by NG tube and hands by peripheral intravenous line and arms caused by blood pressure cuff. Inadequate prevention was provided on daily care as only 177 prevention and treatment interventions were provided over 2 weeks for 15 patients. As a growing problem among Jordanian adults in intensive care, MDRPI required the need for effective prevention. About one-thirds of MDRPIs were mucosal, a finding not previously reported, indicating the need to include mucous membrane assessment with skin assessment when a medical device such as NG and ET tubes or foley catheters are in use. Prevention and treatment interventions provided to patients with MDRPIs were not systematic and based on routine care with no clear guidelines. A consensus has yet to be reached suggesting the need to establish effective prevention strategies for medical device-related pressure injuries. Future research is recommended to follow up MDRPI prevention and treatment strategies among patients in ICU. We suggest to continue studying the prevalence of MDRPIs and monitoring the location, prevention and treatment of both skin and mucosal MDRPIs.

Extended Endonasal Endoscopic (EEE) Surgery with Almost No Use of Adjuvant Radiotherapy for Juvenile Nasopharyngeal Angiofibroma (JNA).

Background and Objectives: Juvenile nasopharyngeal angiofibroma (JNA) is an angiomatous hamartoma of the nasal cavity. It is a benign but locally aggressive vascular tumor of the nasopharynx affecting adolescent males. Many surgical procedures are in practice, but the extended endonasal endoscopic (EEE) approach for JNAs is a suitable and effective technique. Materials and Methods: Fifteen adolescent patients having JNA who underwent extended endonasal endoscopic (EEE) surgery from January 2010 to January 2022 were studied retrospectively. Patients having residual and recurrent JNAs and those who underwent surgery other than EEE were excluded. Results: The average age of the patients was 18.3 years of age. A total of six patients (40%) each had stage V and IV while three patients (20%) had stage III JNAs. Gross total removal was achieved in eight (53.3%) patients and seven (43.7%) had partial removal. There was no per or postoperative mortality. All the patients had at least 3 years of postoperative follow-up and during follow-ups, seven patients were found to have residual tumors, and two had recurrences. Discussion: During the last decades, the endoscopic approach for the resection of JNAs has gained increasing popularity due to its obvious advantages over transfacial approaches. The magnified and angled field of view "behind the corner" helping in a more complete inspection for the resection and shorter hospitalization time makes it a better choice than the other approaches. Conclusions: Endoscopy is an excellent approach for primary JNA. It allows well visualization and precise removal of the angiofibroma. An endoscopic multiangle, multicorridor skull base approach including Denker's anteromedial maxillotomy is suitable and preferable for the resection of extensive JNAs.

N protein-based ultrasensitive SARS-CoV-2 antibody detection in seconds via 3D nanoprinted, microarchitected array electrodes.

Rapid detection of antibodies to SARS-CoV-2 is critical for COVID-19 diagnostics, epidemiological research, and studies related to vaccine evaluation. It is known that the nucleocapsid (N) is the most abundant protein of SARS-CoV-2 and can serve as an excellent biomarker due to its strong immunogenicity. This paper reports a rapid and ultrasensitive 3D biosensor for quantification of COVID-19 antibodies in seconds via electrochemical transduction. This sensor consists of an array of three-dimensional micro-length-scale electrode architecture that is fabricated by aerosol jet 3D printing, which is an additive manufacturing technique. The micropillar array is coated with N proteins via an intermediate layer of nano-graphene and is integrated into a microfluidic channel to complete an electrochemical cell that uses antibody-antigen interaction to detect the antibodies to the N protein. Due to the structural innovation in the electrode geometry, the sensing is achieved in seconds, and the sensor shows an excellent limit of detection of 13 fm and an optimal detection range of 100 fm to 1 nm. Furthermore, the sensor can be regenerated at least 10 times, which reduces the cost per test. This work provides a powerful platform for rapid screening of antibodies to SARS-CoV-2 after infection or vaccination.

In-hospital mortality in SARS-CoV-2 stratified by gamma-glutamyl transferase levels.

BACKGROUND: This study investigates in-hospital mortality amongst patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its relation to serum levels of gamma-glutamyl transferase (GGT). METHODS: Patients were stratified according to serum levels of gamma-glutamyl transferase (GGT) (GGT<50 IU/L or GGT≥50 IU/L). RESULTS: A total of 802 participants were considered, amongst whom 486 had GGT<50 IU/L and a mean age of 48.1 (16.5) years, whilst 316 had GGT≥50 IU/L and a mean age of 53.8 (14.7) years. The chief sources of SARS-CoV-2 transmission were contact (366, 45.7%) and community (320, 40%). Most patients with GGT≥50 IU/L had either pneumonia (247, 78.2%) or acute respiratory distress syndrome (ARDS) (85, 26.9%), whilst those with GGT<50 IU/L had hypertension (141, 29%) or diabetes mellitus (DM) (147, 30.2%). Mortality was higher amongst patients with GGT≥50 IU/L (54, 17.1%) than amongst those with GGT<50 IU/L (29, 5.9%). More patients with GGT≥50 required high (83, 27.6%) or low (104, 34.6%) levels of oxygen, whereas most of those with GGT<50 had no requirement of oxygen (306, 71.2%). Multivariable logistic regression analysis indicated that GGT≥50 IU/L (odds ratio [OR]: 2.02, 95% confidence interval [CI]: 1.20-3.45, p=0.009), age (OR: 1.05, 95% CI: 1.03-1.07, p<0.001), hypertension (OR: 2.06, 95% CI: 1.19-3.63, p=0.011), methylprednisolone (OR: 2.96, 95% CI: 1.74-5.01, p<0.001) and fever (OR: 2.03, 95% CI: 1.15-3.68, p=0.016) were significant predictors of all-cause cumulative mortality. A Cox proportional hazards regression model (B = -0.68, SE =0.24, HR =0.51, p = 0.004) showed that patients with GGT<50 IU/L had a 0.51-times lower risk of all-cause cumulative mortality than patients with GGT≥50 IU/L. CONCLUSION: Higher levels of serum GGT were found to be an independent predictor of in-hospital mortality.

Systematic review and meta-analysis: Prevalence of hypertension among adolescents in the Arab countries.

PROBLEM: Hypertension (HTN) is one of the non-communicable diseases which prevalence is rising in both developed and developing countries. There is a scarcity of data on the prevalence of HTN in Arab countries. This review outlines what is currently known about prevalence and risk factors of HTN in adolescence in Arab world. ELIGIBILITY CRITERIA: A systematic review and meta-analysis were conducted using PubMed, Cochrane Library, Scopus, CINAHL, Science Direct, and Google Scholar databases from 2011 to 2021. SAMPLE: Fourteen studies from 9 Arab countries met inclusion criteria. Studies included a total of 777 adolescents with HTN and 2147 adolescents with pre-HTN. RESULTS: The overall prevalence of HTN among adolescents in the Arab World was estimated at 12.6% (95CI 0.083-0.176), while pre-HTN was 13.9% (95CI 0.084-0205). Overweight and obesity resemble the higher risk of developing hypertension. Family history, high consumption of salt, smoking and low physical activity also increase the risk of HTN. The development of adolescent HTN can be predicted through anthropometric measurements such as Body Mass Index (BMI), wrist circumferences, and high waist circumference. CONCLUSION: The prevalence of HTN among adolescents in the Arab world was significant, ranging from 4 to 26%. The heterogeneity between studies was high. IMPLICATION: Local governments and policymakers must consider strengthening regulations to address environmental risk factors and improve public awareness about risk factors to HTN. A combined use of nurse- and patient targeted educational interventions could also help in reducing the burden of HTN in this population.

Biological Efficacy of Compounds from Stingless Honey and Sting Honey against Two Pathogenic Bacteria: An In Vitro and In Silico Study.

Honey inhibits bacterial growth due to the high sugar concentration, hydrogen peroxide generation, and proteinaceous compounds present in it. In this study, the antibacterial activity of stingless and sting honey against foodborne pathogenic bacteria isolated from spoiled milk samples was examined. The isolated bacterial strains were confirmed as Bacillus cereus and Listeriamonocytogenes through morphological, biochemical, and 16 s RNA analysis. Physiochemical characterizations of the honey samples revealed that both of the honey samples had an acidic pH, low water content, moderate reducing sugar content, and higher proline content. Through the disc diffusion method, the antibacterial activities of the samples were assayed and better results were observed for the 50 mg/disc honey. Both stingless and sting honey showed the most positive efficacy against Bacillus cereus. Therefore, an in silico study was conducted against this bacterium with some common compounds of honey. From several retrieved constituents of stingless and sting honey, 2,4-dihydroxy-2,5-dimethyl 3(2H)-furan-3-one (furan) and 4H-pyran-4-one,2,3-dihydro of both samples and beta.-D-glucopyranose from the stingless revealed high ligand-protein binding efficiencies for the target protein (6d5z, hemolysin II). The root-mean-square deviation, solvent-accessible surface area, the radius of gyration, root-mean-square fluctuations, and hydrogen bonds were used to ensure the binding stability of the docked complexes in the atomistic simulation and confirmed their stability. The combined effort of wet and dry lab-based work support, to some extent, that the antimicrobial properties of honey have great potential for application in medicine as well as in the food industries.

Medication Identification Device to Reduce Medication Errors in Nursing Homes: A Controlled Pilot Study.

A controlled pilot study was performed to evaluate implementation of a medication identification device intended to reduce errors in nursing homes. Naïve observation was used for data collection of medication errors on an intervention unit using the device and a control unit, along with field notes describing observation details. Ten staff were observed administering medications to 70 residents over the study time-frame. Of the 9,099 medication administrations observed (n = 4,588 intervention; n = 4,511 control), 1,068 (12%) errors were identified. The intervention unit had fewer non-time errors versus the control unit, including dose (n = 21 vs. n = 59; p < 0.01), drug (n = 4 vs. n = 21; p <0.01), route (n = 0 vs. n = 4; p < 0.01), and given without order (n = 1 vs. n = 8; p < 0.01). However, time errors were higher on the intervention unit and were often due to late start and interruptions. Non-time errors were due to reliance on memory and nursing judgment. A combination of technology and staff dedicated solely to medication administration likely affected error rate differences. [Journal of Gerontological Nursing, 48(4), 5-11.].

Risk Factors for Mortality in Patients with COVID-19: The Kuwait Experience.

OBJECTIVES: To describe the baseline characteristics and to evaluate the risk factors for in-hospital mortality in patients admitted to hospitals with coronavirus disease (COVID-19) in Kuwait. SUBJECTS AND METHODS: This retrospective cohort study analyzed data of patients admitted to two hospitals in Kuwait with COVID-19. The outcome was assessed by using multivariable analysis of factors affecting survival and mortality. RESULTS: In 962 patients, the case fatality ratio was 9.04%. The mean age of nonsurvivors was 63.5 ± 14.8 years, and most deaths occurred in males (80.5%). For the whole sample, the source of transmission was significantly related to mortality and the median duration of in-hospital stay was 15 days (interquartile range: 2-52 days). In patients with high oxygen requirements, the case fatality rate was 96.6%. Multivariable analysis identified age, hypertension, cardiovascular disease (CVD), and dyspnea on presentation as independent risk factors for COVID-19 mortality. CONCLUSIONS: The mortality rate was higher in older patients with comorbidities such as hypertension and CVD. Early recognition of high-risk patients may help to improve care and reduce mortality.

Cross-sectional study of Middle East respiratory syndrome coronavirus in humans and dromedary camels in Diyala, Iraq.

BACKGROUND: Middle East respiratory syndrome (MERS) is a zoonotic viral disease transmitted from dromedaries to humans. To date, more than 1500 cases of MERS have been reported and 80% of all cases have occurred in the Kingdom of Saudi Arabia (KSA). This cross-sectional study was carried out to figure out the rate of infection among humans and dromedary camels and to explore the risk factors. METHODS: This study was conducted in Diyala Province, Iraq for the period from August 2017 to October 2018. Human subjects included 90 participants; 34 (37.8%) were females and 56 (62.2%) were males. Additionally, 90 dromedary camels were also included, 50 (55.6%) males and 40 (44.4%) females. Serum samples from subjects were collected and tested for the presence of anti-MERS-coronavirus (CoV) immunoglobulin g (IgG). RESULTS: The results revealed that 46 (51.1%) of human subjects were positive for anti-MERS-CoV IgG, (95% confidence interval (CI) for the prevalence rate 40.9-61.3) with a mean titer of anti-MERS-CoV IgG antibodies (Ab) of 81.2 U/mL. The anti-MERS-CoV IgG positivity rate was insignificantly higher, but the mean of anti-MERS-CoV IgG titer was significantly higher among females (p = 0.12 and p < 0.004, respectively). Furthermore, the anti-MERS-CoV IgG positivity rate and Ab titer were significantly higher among those people who visited KSA for Hajj or Umrah (p < 0.001 and p < 0.001, respectively). In camels, 81 (90.0%) were positive for anti-MERS-CoV IgG, (95% CI for the prevalence rate 82.5-94.9), with a mean titer of 99.8 U/mL. DISCUSSION: The MERS-CoV infection rate was high among both Iraqi humans and dromedary camels. Further confirmatory studies are needed, and setting up of national precaution program is essential.

In-hospital mortality in SARS-CoV-2 stratified by serum 25-hydroxy-vitamin D levels: A retrospective study.

This study is done to estimаte in-hоsрitаl mоrtаlity in раtients with severe асute resрirаtоry syndrоme соrоnаvirus 2 (SАRS-СоV-2) strаtified by Vitamin-D (Vit-D) levels. Раtients were strаtified ассоrding tо by serum 25-hydroxy-vitamin D (25(OH)Vit-D) levels intо twо grоuрs, that is, 25(OH)Vit-D less thаn 40 nmol/L аnd 25(OH)Vit-D greаter thаn 40 nmol/L. А tоtаl оf 231 раtients were inсluded. Оf these, 120 (50.2%) оf the раtients hаd 25(OH)Vit-D levels greаter thаn 40 nmol/L. The meаn аge wаs 49 ± 17 yeаrs, аnd 67% оf the раtients were mаles. The mediаn length оf оverаll hоsрitаl stаy wаs 18 [6; 53] dаys. The remаining 119 (49.8%) раtients hаd а 25(OH)Vit-D less thаn 40 nmol/L. Vitamin D levels were seen as deficient in 63% of patients, insufficient in 25% and normal in 12%. Оverаll mоrtаlity wаs 17 раtients (7.1%) but statistically not signifiсаnt among the grоuрs (p = 0.986). The Kарlаn-Meier survivаl аnаlysis shоwed no significance based on an alpha of 0.05, LL = 0.36, df = 1, p = 0.548, indicating Vitamin_D_Levels was not able to adequately predict the hazard of Mortality. In this study, serum 25(OH)Vit-D levels were found have no significance in terms of predicting the in-hоsрitаl mortality in раtients with SАRS-СоV-2.

A comparative assessment of information recall and comprehension between conventional leaflets and an animated video in adolescent patients undergoing fixed orthodontic treatment: A single-center, randomized controlled trial.

INTRODUCTION: The objective of this 2-arm parallel trial was to investigate the recall and comprehension of the information of orthodontic patients undergoing fixed orthodontic treatment using either the verbal explanation supported with the British Orthodontic Society (BOS) leaflet or 3-dimensional (3D) animated content. METHODS: Patients aged 12-18 years, with no relevant medical history or learning and reading difficulties, who were to undergo orthodontic treatment, were randomized to receive information about fixed orthodontic treatment, using either verbal explanation supported with the BOS leaflet or 3D animated content on the basis of the BOS leaflet. Randomization was performed by block randomization; block size of 4 was used, from which 6 blocks with 6 different sequences (AABB, ABBA, ABAB, BBAA, BAAB, BABA). The blinded author asked patients a series of open-ended questions. The primary outcome measure was the total score of the questions. An independent 2 sample t test was conducted to determine if there was a statistical difference in total questions score between the conventional method (verbal and leaflet) and the 3D animation at the time of consent taking (T0) and again 1 year later (T1). The secondary outcome measure was the time spent by the clinician delivering the information to the patient. RESULTS: Thirty-two patients were randomized into each group. After 1 year, 1 patient was lost in each group. At the time of consent, the conventional group scored 79.1 ± 18.4 compared with 76.4 ± 12.8 for the 3D animation group with no statistically significant difference (95% confidence interval, -11.0 to 5.3), (P = 0.492). One year later, again, there was no statistically significant difference (P = 0.639) between the conventional group (75.6 ± 12.3) and the 3D animation group (74.4 ± 9.0) (95% confidence interval, -7.0 to 4.4). The average exposure time to the educational intervention in the conventional group was 8.5 minutes more than the 3D animation group. CONCLUSIONS: The use of 3D animation or verbal and leaflet information is relatively equivalent in transferring knowledge to the orthodontic patient. The use of a 3D animated video reduces the clinician time needed in the clinic to deliver information to the patients and also allows multiple views and better suits the younger generation. Patients undergoing short- or long-term orthodontic treatment do not recall root damage as a risk of orthodontic treatment, which requires special attention from the orthodontist to reinforce this information. REGISTRATION: This trial was not registered. PROTOCOL: The protocol was not published before trial commencement.

A systematic review of population pharmacokinetic analyses of digoxin in the paediatric population.

This is a PROSPERO registered systematic review (CRD42018105207), conducted to summarize the available knowledge regarding the population pharmacokinetics of digoxin in paediatrics and to identify the sources of variability in its disposition. PubMed, ISI Web of Science, SCOPUS and Science Direct databases were searched from inception to January 2019. All paediatric population pharmacokinetic studies of digoxin that utilized the nonlinear mixed-effect modelling approach were incorporated in this review, and data were synthesized descriptively. After application of the inclusion-exclusion criteria 8 studies were included. Most studies described digoxin pharmacokinetics as a 1-compartment model with only 1 study describing its pharmacokinetics as 2-compartments. Age was an important predictor of clearance in studies involving neonates or infants, other predictors of clearance were weight, height, serum creatinine, coadministration of spironolactone and presence of congestive heart failure. Congestive heart failure was also associated with an increased volume of distribution in 1 study. The estimated value of apparent clearance in a typical individual standardized by mean weight ranged between 0.24 and 0.56 L/h/kg, the interindividual variability in clearance ranged between 7.0 and 35.1%. Half of the studies evaluated the performance of their developed models via external evaluation. In conclusion, substantial predictors of digoxin pharmacokinetics in the paediatric population in addition to model characteristics and evaluation techniques are presented. For clinicians, clearance could be predicted using age especially in neonates or infants, weight, height, serum creatinine, coadministration of medications and disease status. For future researchers, designing pharmacokinetic studies that allow 2-compartment modelling and linking pharmacokinetics with pharmacodynamics is recommended.

The burden of laboratory-confirmed influenza infection in Lebanon between 2008 and 2016: a single tertiary care center experience.

BACKGROUND: Influenza is a major cause of morbidity and mortality worldwide. Following the 2009 pandemic, there was widened interest in studying influenza burden in all regions. However, since data from the World Health Organization (WHO) Middle East and North Africa (MENA) region remain limited, we aimed to contribute to the understanding of influenza burden in Lebanon. METHODS: A retrospective chart review extending over a period of 8 seasons from Jan 1st, 2008 till June 30th, 2016 at a tertiary care center in Beirut was performed. All cases confirmed to have influenza based on rapid antigen detection or/and polymerase chain reaction on a respiratory sample were included for analysis. Data on epidemiology, clinical presentation, complications, antiviral use and mortality were collected for analysis. RESULTS: A total of 1829 cases of laboratory-confirmed influenza were identified. Average annual positivity rate was 14% (positive tests over total requested). Both influenza A and B co-circulated in each season with predominance of influenza A. Influenza virus started circulating in December and peaked in January and February. The age group of 19-50 years accounted for the largest proportion of cases (22.5%) followed by the age group of 5-19 years (18%). Pneumonia was the most common complication reported in 33% of cases. Mortality reached 3.8%. The two extremes of age (< 2 years and ≥ 65 years) were associated with a more severe course of disease, hospitalization, intensive care unit (ICU) admission, complications, and mortality rate. Of all the identified cases, 26% were hospitalized. Moderate-to-severe disease was more likely in influenza B cases but no difference in mortality was reported between the two types. Antivirals were prescribed in 68.8% and antibiotics in 41% of cases. There seemed to be an increasing trend in the number of diagnosed and hospitalized cases over the years of the study. CONCLUSION: Patients with laboratory-confirmed influenza at our center had a high rate of hospitalization and mortality. A population based prospective surveillance study is needed to better estimate the burden of Influenza in Lebanon that would help formulate a policy on influenza control.

Forecasting Content and Stage in a Nursing Home Information Technology Maturity Instrument Using a Delphi Method.

Health information technology capabilities in some healthcare sectors, such as nursing homes, are not well understood because measures for information technology uptake have not been fully developed, tested, validated, or measured consistently. The paper provides a report of the development and testing of a new instrument measuring nursing home information technology maturity and stage of maturity. Methods incorporated a four round Delphi panel composed of 31 nursing home experts from across the nation who reported the highest levels of information technology sophistication in a separate national survey. Experts recommended 183 content items for 27 different content areas specifying the measure of information technology maturity. Additionally, experts ranked each of the 183 content items using an IT maturity instrument containing seven stages (stages 0-6) of information technology maturity. The majority of content items (40% (n = 74)) were associated with information technology maturity stage 4, corresponding to facilities with external connectivity capability. Over 11% of the content items were at the highest maturity stage (Stage 5 and 6). Content areas with content items at the highest stage of maturity are reflected in nursing homes that have technology available for residents or their representatives and used extensively in resident care. An instrument to assess nursing home IT maturity and stage of maturity has important implications for understanding health service delivery systems, regulatory efforts, patient safety and quality of care.

Correction to: Forecasting Content and Stage in a Nursing Home Information Technology Maturity Instrument Using a Delphi Method.

The original article unfortunately contained a mistake.

Exploring the lived experience of Jordanian male nurses: A phenomenological study.

BACKGROUND: Human beings have an inbuilt desire to care and nurture others. In some professions such as nursing, women are perceived as privileged in relation to these traits, and women are in the majority in the nursing profession. The Gender theory suggests that men should adapt to feminine traits and nature in order to fit in the nursing profession. However, there is a paucity of literature in relation to Arab male nurses' experience in nursing. PURPOSE: The purpose of this study was to explore the Jordanian male nurses' experiences of their career within their Arabic community. METHODS: A hermeneutic phenomenological approach, underpinned by VanManen's perspective was used. Twenty-two Jordanian male nurses were approached from four hospitals in Jordan. Four focus groups comprising 5-6 interviewees in each were used. The focus groups were audio-recorded and transcribed verbatim. The data were analyzed using Van Manen's hermeneutic approach and themes extracted from the Arabic version were compared critically with the analysis of the English version to develop the meaning of the narratives. DISCUSSION: Three major themes emerged from the data: (i) personal gains; (ii) masculinity; (iii) and cultural influences. Whilst male nurses recognized nursing is a female dominant profession, they viewed themselves as more independent in decision making and more productive than their female counterparts. Significantly, the participants described nursing as a means of fulfilling their spiritual needs and thus a personal gain. The interviewees linked their masculinity to resilience and endurance. Participants described that men in nursing face some social constraints within the Arab community. CONCLUSION: The study findings partly supported the fact that nursing in Jordan is a predominantly female profession which lends support to the gender theory in which Jordanian male nurses experienced a social bias and disadvantages by Arabic culture stereotypes of a male nurse. Although nursing is still a feminine career, the findings of this study raise awareness that gender role stereotype might not hold a strong stance in relation to nursing and that could be attributed to elements such as economic and payment status.

[Congenital Retinal Dystrophies: Combining Ophthalmological Techniques to Improve the Read-out]. / Hereditäre Netzhautdystrophien: Kombination ophthalmologischer Methoden zur Optimierung des Readout.

An early diagnosis, differential diagnosis and possible decision about therapeutic interventions has considerable consequences for the personal and social life of patients affected with inherited retinal dystrophies (IRD). For the ophthalmologist, the clinical heterogeneity interferes with a simple diagnostic approach. The present review suggests a structured clinical approach for the ophthalmological diagnosis of IRD and discusses the relevance of different methods for diagnosis, differential diagnosis and the evaluation of progression. A detailed history should be followed by non-invasive retinal imaging. An early diagnosis prior to visible fundus alterations is facilitated by combining optical coherence tomography, fundus and near-infrared autofluorescence. Spectral reflectance photography, OCT angiography and fluorescence lifetime imaging ophthalmoscopy are helpful in the early diagnosis of specific IRD. If retinal imaging is not sufficient for a diagnosis the multifocal electroretinogram is useful for early diagnosis and full-field electroretinogram for differential diagnosis of IRD. Patients should be referred to specialised IRD-centres for differential diagnosis and possible treatment.