Analysis of Nurses' Perceptions of Handover Practices: A Comparative Study in Different Medical Settings.

This article reports a comparative prospective study aimed to explore and compare nurses' perceptions of bedside clinical handover in 3 different settings (emergency unit, ICU, and medical ward). Results revealed that the participant nurses' perceptions varied significantly for different aspects of the handover process. Our data demonstrate department-specific variations in perceptions related to the adequacy, organization, relevance, availability of charts, use of charts for review, ease of following the information, and timeliness of the information.

Prevalence and impact of malnutrition on outcomes and mortality of under-five years children with pneumonia: a study from Upper Egypt.

Malnutrition has adverse impacts on under-five children with pneumonia. The purpose of this study was to address the prevalence and impact of malnutrition on under-five years children with pneumonia, admitted to a tertiary large children hospital in Upper Egypt. This study is a prospective case-control study. All under-five children diagnosed with pneumonia who were admitted to Assiut University Children's Hospital (AUCH) from January 1st to December 31st, 2021, were enrolled. Based on their nutritional assessment, the studied participants were classified into 2 groups: (1): Children with pneumonia and with nutritional deficiency considered as cases, and (2): Children with pneumonia and without nutritional deficiency considered as controls. Three hundred-fifty cases and 154 control subjects were enrolled, respectively. 93.4%, 31.1%, and 61.7% of the cases had underweight, stunting, and wasting, respectively. Among those cases, there were significant differences between survivors and non-survivors with regard to some clinicodemographic factors, laboratory parameters, and anthropometric parameters. Lack of compulsory vaccination, presence of sepsis, and blood transfusion (OR 2.874, 95% CI 0.048 - 2.988, p = 0.004, 2.627, 0.040 - 2.677, p = 0.009, and 4.108, 0.134 - 3.381, p < 0.001, respectively) were significant independent predictors for mortality among malnourished children with pneumonia.    Conclusion: Malnutrition has a high prevalence in under-five children with pneumonia in our locality. It has adverse effects on the outcomes and in-hospital mortality of those children. Lack of compulsory vaccination, presence of sepsis, and blood transfusion were significant independent predictors of mortality in malnourished children with pneumonia. Larger multicenter studies are warranted. What is Known: • Malnutrition has adverse impacts on under-five children with pneumonia. • Malnutrition could be a reason for in-hospital mortality among under-five children with pneumonia. What is New: • Malnutrition has a high prevalence in under-five children with pneumonia in Upper Egypt, with its adverse effects on the outcomes and mortality of those children. • Lack of vaccination, presence of sepsis, and blood transfusion are significant independent predictors of mortality in malnourished children with pneumonia in Upper Egypt.

Development of a Discharge Criteria Checklist for COVID-19 Patients From the Intensive Care Unit.

This study aims to develop and validate a checklist of discharge readiness criteria for COVID-19 patients from the intensive care unit (ICU). We conducted a Delphi design study. The degree of agreement among 7 experts had been evaluated using the content validity index (CVI) through a 4-point Likert scale. The instrument was validated with 17 items. All the experts rated all items as very relevant which scored the item-CVI 1, which validates all checklist items. Using the mean of all items, the scale-CVI was calculated, and it was 1. This meant validation of the checklist as a whole. With regard to the overall checklist evaluation, the mean expert proportion of the instrument was 1, and the S-CVI/UA was 1. This discharge criteria checklist improves transition of care for COVID-19 patients and can help nurses, doctors, and academics to discharge COVID-19 patients from the ICU safely.

Development and Validation of a Red Flag Prediction Model for Admission of COVID-19 Patients to the Intensive Care Unit.

We aimed to develop and validate a model for the criteria for admission of COVID-19 patients to the intensive care unit (ICU). A Delphi design study was conducted. The content validity index (CVI) was used to determine the degree of agreement among the experts to validate the content of the admission criteria tool. Eleven experts determined the validity. The evaluation was conducted using a 4-point rating scale. The accepted CVI value was 0.50 and more. The model was validated with 31 items in the 5 dimensions, with the item-CVI of 1, a face validity index of 1, and a scale-level content validity index (S-CVI) value of 1. We have developed and validated a red flag prediction model for ICU admission of COVID-19 patients. The accurate implementation of this model could improve the outcomes of those patients and possibly decrease mortality.

Can pregnancy aggravate the criticality of COVID-19 infection in obese asthmatic peripartum woman? A peripartum COVID-19 mortality case report.

As coronavirus disease 2019 (COVID-19) sweeps all over the world, Information about COVID-19 is evolving rapidly and interim guidance by multiple organisations is constantly being updated and expanded. Early with discovery of COVID 19, it was reported that pregnancy did affect the progress of the disease severity. Recently, Centres for Disease Control and Prevention (CDC) reported that pregnancy is a risk factors for COVID-19 severity. The current case report is presenting a peripartum COVID-19 positive mortality case.

Utility of a modified distress thermometer in screening COVID-19 patients for psychological distress: a prospective Egyptian study.

BACKGROUND: The National Comprehensive Cancer Network (NCCN) has adopted the distress thermometer (DT) as one of the best-known distress-screening instruments. We have adopted a modified version of the NCCN distress thermometer. We questioned if this modified DT (m-DT) could be utilized for measuring the prevalence of psychological distress among COVID-19 patients. METHODS: The prospective study included 2 phases; modification of the original DT and its associated problem list (PL), and evaluation of this m-DT in measuring the prevalence of psychological distress among COVID-19 patients. Egyptian adult subjects with suspected or confirmed cases of COVID-19 at 2 University Hospitals were enrolled. Binary logistic regression tests were carried out to explore the association between the m-DT cut-off scores of 4 and the clinical variables. RESULTS: One hundred sixty-nine (60.4%) patients experienced significant distress (m-DT cut off score ≥4). Logistic regression showed that occupation, presence of special habits, length of quarantine time, worry, cough, shortness of breath, and fever, were independent factors associated with significant distress in COVID-19 patients. CONCLUSION: With the modified distress thermometer (m-DT), 60% of Egyptian COVID-19 patients experienced significant distress. This distress was significantly related to age, marital status, occupation, presence or absence of special habits, and length of the quarantine time. With m-DT, the current study had identified worry, being a health-care worker, shortness of breath, fever, length of quarantine time, presence of special habits, and cough as independent factors associated with significant distress in COVID-19 patients. Further studies are warranted.

Accuracy and precision of pulse oximeter at different sensor locations in patients with heart failure.

BACKGROUND: Despite its wide use in clinical practice, few studies have assessed the role of pulse oximetry in patients with heart failure. We aimed to evaluate the accuracy and precision of the pulse oximeter in patients with heart failure and to determine this accuracy at three different sensor locations. METHODS: Comparison of pulse oximetry reading (SpO2) with arterial oxygen saturation (SaO2) was reported in 3 groups of patients with heart failure (HF); those with ejection fraction (EF) >40%, those with EF <40%, and those with acute HF (AHF) with ST and non-ST segment elevation acute myocardial infarction (STEMI and non-STEMI). RESULTS: A total of 235 patients and 90 control subjects were enrolled. There were significant differences in O2 saturation between control and patients' groups when O2 saturation is measured at the finger and toe, but not the ear probes; p=0.029, p=0.049, and 0.051, respectively. In HF with EF>40% and AHF with O2 saturations >90%, finger oximetry is the most accurate and reliable, while in HF with EF<40% and in patients with AHF with O2 saturations <90%, ear oximetry is the most accurate. CONCLUSION: Pulse oximetry is a reliable tool in assessing oxygen saturation in patients with heart failure of different severity. In HF with EF>40% and in AHF with O2 saturations >90%, finger oximetry is the most accurate and reliable, while in HF with EF<40% and in patients with AHF with O2 saturations <90%, ear oximetry is the most accurate. Further studies are warranted.

Changes in spirometric parameters with position in asymptomatic Egyptian young males with central obesity.

BACKGROUND: Central obesity is a chronic condition that can contribute to impairments in lung functions. Body position is an important technique that effectively restores and increases lung functions. We aimed to address the possible changes in spirometric parameters in asymptomatic overweight individuals with central obesity with a change in posture from sitting to supine in comparison to normal weight non-obese ones. METHODS: Enrolled subjects were healthy Egyptian males, aged between 20-45 years old, asymptomatic and nonsmokers. They underwent spirometry. The following parameters were measured; forced expiratory volume in one second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio, and forced expiratory flow (FEF)25-75%. They were classified into overweight with central obesity (n=40) and healthy control (n=40) groups based on their body mass index (BMI), weight-hip ratio (WHR), and waist circumference (WC). Spirometric parameters were compared between the 2 groups and in both setting and supine positions. RESULTS: The central obesity group showed significantly lower all spirometric parameters in comparison to the control one. All measured spirometric parameters had a significant reduction with supine position. There were negative correlations between both the WC and WHR and spirometric parameters. CONCLUSION: In this study of young Egyptian males, individuals with central obesity had reduced spirometric parameters in comparison to healthy ones. Change in position from sitting to supine has significant effects on spirometric parameters in both healthy middle age males with normal weight and those with overweight and central obesity. These results could have important clinical implications.

Value of modified Burns Wean Assessment Program scores in the respiratory intensive care unit: an Egyptian study.

BACKGROUND: There is no consensus on the most useful predictive indicator for weaning patients from mechanical ventilation (MV). We aimed to evaluate the utility of the modified Burns Wean Assessment Program (m-BWAP) in predicting the weaning success in patients with respiratory disorders admitted to the respiratory intensive care unit (RICU). METHODS: Patients with respiratory failure requiring MV for longer than 48 hours were included. They were weaned by pressure support ventilation and spontaneous breathing trails. Patients were divided into successful and unsuccessful weaning groups according to their outcomes. RESULTS: A total of 91 patients were enrolled. The majority had chronic obstructive pulmonary diseases (COPD): 40%, overlap syndrome (24%), and obesity hypoventilation syndrome (OHS): 15%. The successful group had significantly higher m-BWAP scores than that in the unsuccessful group (median 65; range 35 to 80 vs. median 45; range 30 to 65; p=0.000), with area under the curve (AUC) of 0.854; 95% CI 0.766 to 0.919), p<0.001. At cut-off value of ≥55, the sensitivity and specificity of m-BWAP to predict successful weaning were 73.77% and 84.85%, respectively. The AUC for m-BWAP was significantly higher than that for rapid shallow breathing index (RSBI). CONCLUSION: We conclude that m-BWAP scores represent a good predictor of weaning success among patients with chronic respiratory disorders in the RICU. The m-BWAP checklist has many factors that are closely related to the weaning outcomes of patients with chronic respiratory disorders. Further, large-scale, multicenter studies are warranted.

Outcomes of patients with Severe Acute Respiratory Infections (SARI) admitted to the intensive care unit: results from the Egyptian Surveillance Study 2010-2014.

BACKGROUND: Few data exist about respiratory viral infections in Egyptian patients. Hereby we describe the outcomes of hospitalized Egyptian patients with severe acute respiratory infections (SARI) admitted to the ICU. METHODS: A prospective study in which all hospitalized patients meeting the WHO case definition for SARI and admitted to the ICU, during the period 2010-2014, were enrolled. Samples were tested using RT-PCR for influenza A, B, respiratory syncytial virus (RSV), human metapneumovirus (hMPV), parainfluenza virus, adenovirus, bocavirus, enterovirus, and rhinovirus. Data were analyzed to study the clinical features of SARI-ICU patients and which pathogens are related to severe outcomes. Associated comorbidities were evaluated using Charlson Age-Comorbidity Index (CACI). RESULTS: Out of 1,075 patients with SARI, 219 (20.3%) were admitted to the ICU. The highest rates were reported for RSV (37%). SARI-ICU patients had higher rates of hospital stay, pneumonia, respiratory failure, ARDS, and mortality. Multivariate logistic regression analysis identified associated respiratory disorders (p=0.001), radiological abnormalities (p=0.023), and longer hospital stay (p=0.005) as risk factors for severe outcomes. CONCLUSIONS: This surveillance study showed that 20% of hospitalized Egyptian patients with viral SARI needed ICU admission. SARI-ICU patients had higher rates of hospital stay, pneumonia, respiratory failure, ARDS, and mortality. Higher comorbidity index scores, radiological abnormalities, and longer hospital stay are risk factors for severe outcomes in SARI-ICU patients in our locality.

Evaluation of pulmonary function changes in children with type 1 diabetes mellitus in Upper Egypt.

BACKGROUND: Diabetes mellitus is a leading cause of morbidity and mortality among children across the world and is responsible for a growing proportion of global healthcare expenditure. However, limited data are available on lung dysfunction in children with diabetes. AIM: The aim of this study was to evaluate the pulmonary function changes in children with type 1 diabetes mellitus (T1DM). METHODS: We studied 60 children with T1DM (mean age 10.5 ± 2.32 years; disease duration 2.45 ± 0.6 years, and 50 healthy control children (mean age 9.9 ± 2.5 years). Spirometry was performed for all individuals to measure forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC ratio, and peak expiratory flow rate (PEFR). Glycemic control was assessed on the basis of glycated hemoglobin (HbA1c), with HbA1c values <8% considered to indicate good glycemic control, and HbA1c values ⩾8% to indicate poor control. RESULTS: There was significant reduction in all spirometeric parameters in diabetic children in comparison with healthy control children. Children with poor glycemic control had significant impairment in lung functions compared with those with good glycemic control. CONCLUSIONS: T1DM in children leads to impairment of lung functions and this impairment increases with poor glycemic control.