Few studies have looked at how SARS-CoV-2 affects pulmonary function, exercise capacity, and health-related quality of life over time. The purpose of this study was to evaluate these characteristics in post COVID-19 subjects 1 year after recovery. The study included two groups. The case group included post COVID-19 subjects who had recovered after a year, and the control group included healthy participants who had never tested positive for COVID-19. The study screened 90 participants, 42 of whom met the eligibility criteria. The findings revealed that the majority of post COVID-19 subjects had relatively normal lung function 1-year post-recovery. A significant reduction in DLCO (B/P%) was observed in the case group vs. control. The exercise capacity test revealed a clinically significant difference in distance walked and a significant difference in the dyspnea post-walk test in the case group compared to the control group. The case group's health-related quality of life domain scores were significantly affected in terms of energy/fatigue, general health, and physical function. The post COVID-19 subjects were shown to have well-preserved lung function after 1 year. However, some degree of impairment in diffusion capacity, exercise capacity, and health-related quality of life remained.

BackgroundHealthcare systems can potentially improve their safety, quality of service, and performance efficiency with a cost reduction, through the introduction and implementation of healthcare information management systems. This study aims to examine the frequency of miscoding errors in principal and secondary diagnoses, exploring demographic and coder-related factors contributing to these errors through the use of the QuadraMed system. The study also investigates the association of coding errors with patient safety and service quality to estimate the potential financial implications resulting from these inaccuracies in the healthcare system. MethodsThis analytical cross-sectional retrospective study was conducted at a local hospital in Najran, Saudi Arabia, from July 2021 to February 2022 using the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) coding system. The costing and financial data were collected from the reimbursement department for eligible 750 patient cases in terms of payment mode, services availed, and length of stay. The financial claims were evaluated to estimate the impact on the quality of service and patient safety. The reimbursement amount was calculated based on codes. The data were analyzed using SPSS and the odds ratio was calculated to estimate the risk of major coding errors in different departments. ResultsPrimary codes 240 (32%) and 40 (5.3) secondary codes were reviewed and percentages and inaccuracies were calculated after recording. The percentage of inaccurate medical codes in principal diagnosis was 57(26.8%) and the percentage of inaccurate medical codes in secondary diagnosis was 21 (9.9%). The primary diagnostic codes have more coding errors with a total number of 240 (32%) coding errors with a moderate level of agreement between the original coder and independent coder with a kappa value of 0.462. The identified recording was done by the independent coder, and the secondary diagnostic code showed 40 (5.3%) cases, with a poor kappa value of 0.128. The results showed the highest number of primary diagnostic codes was among surgery clinics 79 (63.2%). The highest number of secondary diagnostic codes were reported among consultant clinics 12 (9.6%) ConclusionsThe study concludes that the identification of miscoding in the healthy population has a financial impact on the healthcare organization's infrastructure.

Objective This study aims to assess beliefs about asthma controller medications among parents of Saudi Arabian children with asthma and the association between these beliefs and medication adherence using the Necessity-Concerns Framework. Methods A cross-sectional survey was provided to parents of children with asthma when they brought their children to routine appointments at local public clinics between May 16 and July 10, 2018. Participants electronically filled out validated Arabic versions of the Medication Adherence Reported Scale (MARS) and Beliefs About Medications Questionnaire (BMQ). Descriptive statistics were used to characterize the study participants, while hierarchical linear regression analysis assessed associations between parental beliefs about controller medications and medication adherence. Results A total of 381 parents of children with asthma completed the study survey. The vast majority (89%) of study participants were non-adherent to their children’s prescribed medications while only 11% were adherent. Additionally, our study revealed a significantly positive association between adherence and parents’ beliefs in the necessity of the medication (p < .001), with concerns about the adverse effects of medication being negatively associated with parental adherence. A higher mean score for medication adherence was reported among the ambivalent groups compared to the accepting, indifferent, and skeptical groups. Conclusions Medication adherence among parents of children with asthma was relatively low. In addition, necessity beliefs were significantly associated with parental adherence to controller medications for their children with asthma. Further studies are warranted to investigate potential factors contributing to poor parental adherence and develop tailored interventions that support parental medication adherence for their asthmatic children.

BackgroundLimited data is available on awareness and clinical management of the airway pressure release ventilation (APRV) mode of ventilation for acute respiratory distress syndrome (ARDS) patients among physicians who work at in adult critical areas. This study aimed to assess the knowledge and current practice of using APRV mode with ARDS patients and identify barriers to not using this mode of ventilation among physicians who work in adult critical areas in Saudi Arabia. MethodsBetween November 2022 and April 2023, a cross-sectional online survey was disseminated to physicians who work in adult critical areas in Saudi Arabia. The characteristics of the respondents were analyzed using descriptive statistics. Percentages and frequencies were used to report categorical variables. ResultsOverall, 498 physicians responded to the online survey. All responders (498, 100 %) reported that APRV is indicated in patients with ARDS, but 260 (52.2 %) did not know if there was an institutionally approved APRV protocol. Prone positioning was the highest recommended intervention by 164 (33.0 %) when a conventional MV failed to improve oxygenation in patients with ARDS. 136 (27.3 %) responders stated that the P-high should be set equal to the plateau pressure on a conventional ventilator while 198 (39.8 %) said that P-low should be 0 cmH2O. Almost half of (229, 46.0 %) responders stated that the T-high should be set between 4 and 6 s, while 286 (57.4 %) said that the T-low should be set at 0.4–0.8 s. The maximum allowed tidal volume during the release phase should be 4–6 ml/kg. Moreover, just over half (257, 51.6 %) believed that the maximum allowed P-high setting should be 35 cmH2O. One third of the responders (171, 34.3 %) stated that when weaning patients with ARDS while in APRV mode, the P-high should be reduced gradually to reach a target of 10 cmH2O. However, 284 (36.9 %) thought that the T-high should be gradually increased to reach a target of 10 s. Most responders (331, 66.5 %) felt that the criteria to switch the patient to CPAP would be to have an FiO2 ≤ 0.4, P-high ≤10 cm H2O, and T-high ≥10 s. Lack of training has been the most common barrier to not using APRV by 388 (77.9 %). ConclusionThere is a lack of consensus on the use of APRV mode, probably due to several barriers. While there were some agreements on the management of ventilation and oxygenation, there were variations in the selection of the initial setting of APRV. Education, training, and the presence of standardized protocols may help to provide better management.

ObjectiveTo investigate the prevalence of intensive care unit (ICU) admission and its predictors among hospitalized chronic obstructive pulmonary disease (COPD) patients.MethodsAn observational retrospective study was conducted. All patients with a confirmed diagnosis of COPD according to the GOLD guidelines between 28 and 2020 and 1 March 2023 at Al-Noor Specialist Hospital were included in this study. Patients were excluded if a preemptive diagnosis of COPD was made clinically without spirometry evidence of fixed airflow limitation. Descriptive results were presented as frequency (percentage) for categorical variables and mean (SD) for continuous variables and to estimate prevalence of ICU admission. Predictors of ICU admission among hospitalized COPD patients were determined using logistic regression analysis. A SPSS (Statistical Package for the Social Sciences) version 25 was used to perform all statistical analysis.ResultsA total of 705 patients with COPD were included in this study. The mean age was 65.4 (25.3) years. Around 12.4% of the hospitalized patients were admitted to the ICD. Logistic regression analysis identified that older age (OR; 1.92, (1.41–2.62)), smoking (OR; 1.60 (1.17–2.19)), and having specific comorbidities (Hypertension (OR; 1.98 (1.45–2.71)), Diabetes mellitus (OR; 1.42 (1.04–1.93)), GERD (OR; 2.81 (1.99–3.96)), Ischemic heart disease (OR; 3.22 (2.19–4.75)), Obstructive sleep apnea syndrome (OR; 2.14 (1.38–3.33)), stroke (OR; 4.51 (2.20–9.26))) were predictors of ICU admissions among patients with COPD.ConclusionsOur study found that a step-up approach to inpatient COPD management requires admission to the ICU in 12.4%, for which age, smoking status, cardiovascular, and stroke were important predictors. Further clinical research is needed to provide a validated model that can be incorporated into clinical practice to monitor this patient population during their admission and identify at-risk individuals for early transfer to higher acuity settings and intensive care units.

AimAnti IL5/anti-IL5R biologics are highly effective in asthma by targeting eosinophilic inflammation and reducing exacerbations, but their effects on lung function are less clear. The aim of the study was to explore whether a novel lung function index, σlnCL, provided by a new technique, computed cardiopulmonography (CCP), is modified following treatment with these biologic therapies in patients with severe type-2 high asthma. σlnCL measures inhomogeneity (unevenness) in lung tissue inflation/deflation and is a sensitive index of small-airways disease.MethodsThis was an observational study at a tertiary asthma clinic. Fifty-four patients with type- 2 high asthma were evaluated at baseline and following their 4th biologic injection with an anti-IL5 or anti-IL5R agent 3 or 4 months later, respectively. Assessments included CCP (as described in [1]) and standard spirometry, both pre- and post-bronchodilation with salbutamol, and measurements of blood eosinophil count (BEC), FeNO and ACQ5.ResultsBiologic therapy significantly improved both FEV1%pred and σlnCL (p<0.01 and p<0.005, respectively), as did bronchodilation (p<0.001 for both), regardless of the specific biologic used (linear mixed-effects modelling). When considering BEC, FeNO, and ACQ5 as predictors in the models, BEC and ACQ5 significantly influenced FEV1%pred (F-ratio 22.7 and 22.6, respectively, both p<0.001). However, only BEC strongly affected σlnCL values (F-ratio 34.1, p<0.001), while ACQ5 had a weaker effect (F-ratio 5.4, p<0.05). FeNO did not show statistical significance.The change in post-bronchodilator σlnCL following biologics followed a bimodal distribution (Akaike information criterion). Patients responding with a fall in σlnCL also had a significant increase in FEV1%pred compared to those without σlnCL changes (t-test, 13.1% vs. -1.6%, p<0.001, figure 1). S94 Figure 1‘σlnCL Responders’, i.e. patients who exhibited a decrease in σlnCL (standard deviation for the natural logarithm of standardized lung compliance) following their fourth biologic injection (B) also experienced a significant improvement in FEV1%pred (forced expiratory volume in one second as a percentage of predicted) compared to ‘σlnCL Non- Responders’, i.e. those who did not show the changes in σlnCL, (A)ConclusionsCCP categorized patients into two groups: responders and non-responders to biologics in terms of lung function changes. Although the effectiveness of anti-IL5 therapy may not rely on direct lung function changes, a subgroup of patients experienced early and significant lung function improvement. Additionally, our findings revealed a strong association between σlnCL and systemic eosinophilic inflammation levels (BEC) in type-2 high asthma, both at baseline and after biologic treatment.ReferenceMagor-Elliot, et al. 2022. doi:10.1152/japplphysiol.00436.2022Please refer to page A286 for declarations of interest related to this abstract.

Abstract Objective In line with global trends, growing number of educational institutions in Saudi Arabia are developing their curricula based on the feedback and suggestions from their students to help improve the quality of teaching. This study aims to assess the differences in learning style preferences among female nursing students of Saudi Arabia. Methods This cross-sectional study included 124 female nursing students who were asked to answer the culturally adapted Arabic version of visual, aural/auditory, read/write, and kinesthetic (VARK) survey. Data were analyzed with SPSS, version 23. The Wilks' lambda or multivariate analysis (MANOVA) was used to determine the relationship between the participants' learning preferences, sociodemographic characteristics, and year of study. Results Nursing students who had visual learning preferences had a significantly different learning style as compared to those who preferred aural and kinesthetic learning (p &lt; 0.001). On the contrary, there was not enough evidence to conclude that the same was true for students who preferred to read/write. Conclusions Further research is required to explore the relationship between learning style preferences and learning outcomes with the inclusion of a larger sample size and representatives of two genders, males and females. The findings of the current research provide the foundation for adaptive learning by identifying the individual preferences in learning among the nursing students.