Clinical Wards Research Articles

MM-358 An Indication of Treating Multiple Myeloma in a Developing Country: A Retrospective Analysis of a Single-Center Experience, “Part I Descriptive Epidemiology”

In the last decade, the treatment of multiple myeloma (MM) has had a great improvement by the addition of multiple drugs with different mechanisms of action to the already present armamentarium of conventional chemotherapy and stem cell transplant, including proteasome inhibitors, immunomodulatory drugs, monoclonal antibodies, CAR-T cell therapy, and bispecifics, which impact the disease course and progression. However, the question remains about the ideal use of the treatment modalities, especially in low-budget settings. To assess the demographic data of patients with MM, plasma cell leukemia (PCL), and plasmacytoma on follow-up at Oncology Center Mansoura University (OCMU). This is a retrospective study about the demographic data of patients with MM, PCL, and plasmacytoma treated in OCMU in the period between 1-1-2006 and 1-1-2020 (15 years). OCMU is an academic institutional practice acting as a referral center and providing multidisciplinary tertiary care for hematology and oncology patients in the delta region in Egypt. Patients with MM, PCL, and plasmacytoma treated in OCMU in the period between 1-1-2006 and 1-1-2020 (15 years) who were in follow-up in our outpatient clinic or internal ward and are registered in our electronic database. We had 771 cases (745 MM, 9 PCL, and 27 plasmacytoma) registered in our database during this period. Patients underwent history taking, clinical examination, and myeloma workup to reach the diagnosis as per the International Myeloma Working Group consensus criteria. Report the demographic data of our patients regarding age, sex, and disease type. The cases were divided as 96% MM, 1% PCL, and 3% plasmacytoma with a male to female ratio of 1.3:1 (1.2:1 MM, 1.25:1 PCL, and 1.7:1 plasmacytoma). As for the age at diagnosis, the median was 55.8 years (53 [35.9-71.3] MM, 59.2 [38-69.7] PCL, and 55.2 [24.1-75.3] plasmacytoma). MM accounts for 1.8% of all cancers and 18% of hematologic malignancies in the USA, but more data are required about the incidence and prevalence in the Middle East and developing countries and its ethnic association among these populations.

Prediction of prognosis and outcome of patients with pulmonary embolism in the emergency department using early warning scores and qSOFA score.

ObjectiveTo determine the prediction ability of the National Early Warning Score (NEWS), National Early Warning Score 2 (NEWS2), and quick Sequential Organ Failure Assessment (qSOFA) score for the prognosis of pulmonary embolism (PE) in the emergency department.MethodsThis retrospective study involved 245 patients with PE. The NEWS, NEWS2, and qSOFA scores were compared according to the hospitalization clinic (ward vs. intensive care unit), hospitalization length (<10 vs. >10 days), severity of embolism (massive vs. submassive), and outcome (discharged vs. died).ResultsThe areas under the curve of the NEWS, NEWS2, and qSOFA score for 1-week mortality were 0.854 (sensitivity, 78%; specificity, 73%; cutoff, 7.5; confidence interval, 0.807–0.902), 0.870 (sensitivity, 83%; specificity, 73%; cutoff, 5.5; confidence interval, 0.825–0.915), and 0.789 (sensitivity, 83%; specificity, 51%; cutoff, 0.5; confidence interval, 0.720–0.858), respectively.ConclusionThe NEWS2 more accurately predicts 1-week mortality than do the NEWS and qSOFA score in patients with PE.

Prevalence of Insomnia among Emergency Doctors and their Physiological Link with Serum Melatonin: Key to Better Sleep among Doctors of LUMHS

Background: As a consequence of the epidemic, health care workers have been subjected to unusual levels of stress, anxiety, and sleep issues. Chronic insomnia is usually linked to circadian rhythm abnormalities. Insomnia is a frequent indication of a lack of serum melatonin. Objective: To detect the prevalence of Insomnia among doctors at LUMHS and their physiological role with regard to serum melatonin levels. Methodology: This cross-sectional study was conducted involving 116 doctors, out of which male 48(41.3%) and female 68 (58.6%), working in all clinical wards of Liaquat University of Medical &amp; Health Sciences, Jamshoro / Hyderabad from August 2021 to February 2022. Each patient's demographic information was collected. Serum Melatonin levels in the blood were measured using an ELISA KIT. Along with (Insomnia severity index) questioner was filled out by each participant. SPSS version 26 was used to analyze the collected data. Results: This study found that physicians' sleep and wake cycles are disrupted owing to their long, stressful working hours, out of 116 participants, 42.68 percent experienced insomnia. Regardless of age, gender, or BMI, Insomnia was shown to be co- related with a lower blood melatonin level (r value=-.585**, p=0.001). Conclusion: The findings of this investigation are in line with our hypothesis that reduced serum Melatonin levels in insomniacs lead to delayed signal transduction, causing circadian oscillator system anomalies. We have found that insomnia among doctors shows significant variations in relation to department, sex, designation, and working hours. Further addressing it requires molecular studies. Keywords: Insomnia, Prevalence, Serum Melatonin, sleep disturbance

Experiences of the clinical learning environment in peer learning: A mixed method study from bachelor students’ and main preceptors’ perspectives

There is a lack of clinical placements for bachelor nursing students (BNS). Due to this, stringent educational models for clinical practice need to be developed. The aim was to describe bachelor nursing students’ and main preceptors’ experiences of the clinical learning environment during peer learning. This mixed method study was based on a joint project between the Karlstad University and the Region Värmland, Sweden, where peer learning was launched in two geriatric clinical education wards. A total of 23 bachelor nursing student and four main preceptors participated. The data were collected in parallel, qualitative data through focus group interviews and reflective journals, and quantitative data with the CLES + T scale between November 2017 and February 2018. A directed content analysis of all results was performed. The COREQ Checklist was used. The student–patient and the student–main preceptor relationships were important for the students’ development. The students described the educational atmosphere as comfortable and safe and that the staff were knowledgeable about them. Peer learning with close interaction between patients and all staff can create authenticity, which in turn drives the BNSs’ professional development. All staff should be involved in the supervision of the students and include them as members of the nursing team.

P025 A study on candiduria in neonates and infants from a tertiary care center, North India.

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PMObjective Candida albicans is the major cause of fungal UTI in neonates and infants but nowadays incidence of other species of Candida is also increasing, and these are mostly multidrug resistant. It is, therefore, important to determine the causative Candida species in fungal UTI for appropriate management. This study was undertaken to determine the Candida species distribution in UTI along with susceptibility patterns and outcomes in infants and neonates admitted to various wards and intensive care units (ICUs) of our hospital. The incidence rate of candiduria in ICUs was also assessed.MethodUrine samples were collected from infants and neonates presented in pediatric and neonatal ICUs and clinical wards with a clinical suspicion of candiduria. Infants at risk of invasive candidiasis were also included in the study. Identification of Candida species was done by Gram's staining, germ tube test, chlamydospore formation on corn meal agar, color of colonies on CHROMagar, and confirmed by Matrix Assisted Laser Desorption-Time of Flight (MALDI-TOF). Antifungal susceptibility was performed by using the Broth microdilution method as per the latest CLSI guidelines (M27-A3/M27-S4).ResultUrine samples were received from 219 infants, and Candida was isolated from samples from 52 infants (isolation rate 23.75%), of which 30 were admitted to pediatric or neonatal ICU and 22 in the wards. The incidence rate of candiduria in ICU was 3.25%. Candida albicans was the most frequently isolated species from the samples of infants in the wards (13/22 ie, 59%), while Candida tropicalis was most frequently isolated from samples of infants in the ICUs (13/30 ie, 43.34%). Candida glabrata was the least commonly isolated species and was only encountered in the ICU. The species distribution of isolates is given in Table 1. There was no discrepancy between the results of conventional methods of identification and MALDI-TOF.Antifungal susceptibility was performed for 18 randomly selected isolates. All were found to be susceptible to caspofungin, micafungin, itraconazole, voriconazole, fluconazole, and amphotericin B. MIC distribution for various isolates is given in Table 2.ConclusionHigh index of suspicion of candiduria is necessary for early diagnosis of fungal UTI and initiation of antifungal treatment, especially in critically ill infants requiring intensive care. Species other than C. albicans are also encountered more frequently nowadays and these species often have higher MICs for commonly used antifungal drugs, which may lead to delayed or failed response to routine antifungal therapy and necessitate prolonged use and or higher doses of antifungals. Identification of Candida isolates at species level along with analysis of the susceptibility patterns is therefore important for successful outcomes in candiduria in neonates and infants.

Association between germ-line HLA and immune-related adverse events.

BackgroundIn recent years, significant progress has been made in immune checkpoint inhibitors (ICIs). However, accompanied by remarkable efficacy, a growing number of immune-related adverse events (irAEs) also arose. The mechanism of irAEs remains unclear. Previous studies indicated a positive association between specific human leukocyte antigen (HLA) variants and irAEs. Therefore, we planned and initiated a large cohort study aiming to uncover the relationship between irAEs and divergent HLA types.MethodsWe screened all patients who have been treated in the clinical research ward, Cancer Hospital of the Chinese Academy of Medical Sciences. All participants were diagnosed with malignant tumors with complete AE follow-up data in the original electronic medical records. Sequencing libraries were generated using a customized panel, and four-digit formatted HLA alleles were extracted for further analysis. Association analysis was performed between HLA variants and different irAEs. We introduced two external reference groups and a non-irAE control group within the study cohort to control the type I error. We also explored the relationship between the zygosity of HLA genes, the evolutionary divergence of HLA class I genotype (HED), and irAEs.Results530 participants received at least two doses of ICIs. The median follow-up time was 10.3 months. 97% of patients received anti-PD-1/PD-L1 treatment. The occurrence of overall irAEs showed no significant difference between the HLA homozygous group and the HLA heterozygous group. We did not find any significant association between irAEs and HED. We found that some HLA types are associated with irAEs of different organs and detected a significant association between HLA-DRB3*01:01 and thrombocytopenia (OR 3.48 (1.19,9.42), p = 0.011), HLA-DPB1*04:02 and hypokalemia/hyponatremia (OR 3.44 (1.24,9.1), p = 0.009), leukopenia (OR 2.1 (0.92,4.8), p = 0.037), anemia (OR 2.33 (1.0,5.41), p = 0.026), HLA-A*26:01 and bilirubin elevation (OR 2.67 (0.92,8.31), p = 0.037).ConclusionsIrAEs in specific organs and tissues may be associated with certain HLA types, while HLA heterogeneity has no significant influence on the happening of irAEs. More research is needed to explore the role of germline genetic changes in the risk assessment of irAEs.

A Five-Year Retrospective Study on Fractured Orbital Walls: A Spearman Correlation Analysis

Objective: The purpose of this study is to find propotion of fractured orbital walls in the maxillofacial trauma cases and its associated maxillofacial fracture treated in the Oral Maxillofacial Clinic Oral Maxillofacial ward and operation theatre of Hospital USM in Kelantan, Malaysia. Materials and methods: From July 2013 to June 2018, records of patients who sustained maxillofacial fractures and presented them to the Accident and Emergency Department, Oral Maxillofacial Clinic, Hospital USM were reviewed, recorded, and analyzed. There are 294 patients whose data has been collected because they met the inclusion criteria. Each patient with a complete medical record was reviewed. Data were collected under the variables: Zygomatic Complex, Zygomatic Arch, Nasal, Maxillary Sinus, Le Fort I, Le Fort II, Le Fort III, Orbital Wall, Alveolar Process, Symphysis of Mandible, Condyle of Mandible, Ramus of Mandible, Maxillary Bone and Mandibular Bone of maxillofacial fracture. The fractured orbital walls in these cases was reviewed. At the first stage, all the selected variables will be screened for their important clinical point of view. The SPSS software version 26.0 was used to determine all possible factors contributing to orbital wall fracture. Results: This was a retrospective cross-sectional analysis of the medical records of 294 patients with maxillofacial fracture treated in the Oral Maxillofacial Clinic and Oral Maxillofacial ward, Hospital USM. There were 228 (77.3%) men and 66 (22.4%) women included in this study. The most common age range is 11-20 years (39.8%), 21-30 years (26.2%). Maxillary Bone Fracture (0.371; p &lt;0.05), Maxillary Sinus Fracture (0.180; p &lt;0.05), Zygomatic Arch Fracture (0.127; p &lt;0.05) were found to be the most affected site, which had a positive correlation with an orbital fracture of the maxillofacial trauma cases. A path analysis based on the Spearman correlation was developed by taking into account significant correlations at the level of 0.05. Conclusion: Using the matrix spearman correlation, multiple response analysis (MRA), path analysis, we discovered a clear connection between orbital wall fracture and several other factors. This discovery will aid in the understanding of the most common fracture and the causes of orbital wall fracture in maxillofacial trauma. The Zygomatic Arch Fracture, Maxillary Sinus Fracture, and Maxillary Bone Fracture were found to have a significant relationship with the orbital wall when the significance level was set at 0.05. Bangladesh Journal of Medical Science Vol. 21 No. 04 October’22 Page : 744-750

An audit of sharps injuries in clinical skills simulation wards at a UK university

Background/Aims Healthcare students are at high risk of sharps injuries, which can negatively impact their confidence and wellbeing. This study audited three clinical skills simulation wards at a UK university to determine the incidence of sharps injuries in this educational setting. Methods An audit of sharps injuries sustained in three clinical skills simulation wards was conducted, including data from 2008–2016. The authors developed an audit tool to collect data on the number of incidents that occurred, the type of individual involved and the nature of the incident. Results were analysed to compare the incidence of general injuries and sharps injuries among healthcare students and staff. Results A total of 46 incidents were recorded across the three wards during the 8-year period. Sharps injuries were by far the most common type of injury, comprising 69.6% of recorded incidents, followed by fainting at 19.6%. The highest proportion of general injuries (56.5%) and sharps injuries (59.4%) occurred among nursing students. However, the association between incidents and type of individual involved was not statistically significant Conclusions Sharps injuries were the most common type of incident in the clinical skills simulation wards, with student nurses being at highest risk. Intervention is needed to improve safety in this educational setting, including sharps handling training, with greater focus on existing regulations.

Clinician Estimates of Frailty Compared to Formal Frailty Assessment in Adults With Heart Failure: A Cross-Sectional Analysis.

Frailty assessment is recommended for patients with heart failure. Despite the availability of instruments to assess frailty, there are no clear recommendations regarding the optimal instrument to use in a heart failure context. This ambiguity combined with a lack of education and resources, often leads clinicians to rely on subjective estimates of frailty, such as 'the end-of-the-bed' or 'eyeball' test. To examine the association between clinician-estimated frailty and formal frailty assessment in adults with heart failure. Cross-sectional analysis of the FRAilty MEasurement in Heart Failure (FRAME-HF) study. (1) Adults aged ≥18 years in the outpatient heart failure clinic and cardiology ward; (2) and cardiovascular clinicians (nurses, physicians, and allied-health professionals). Following participant recruitment, cardiovascular clinicians were asked to rate the participant's frailty status based on their routine clinical assessment as either: frail, pre-frail, or non-frail, which was then compared to a formal frailty assessment using a modified version of the Frailty Phenotype. The association between clinician-estimated frailty and formal frailty assessment were examined using a weighted Kappa statistic and Spearman's correlation coefficient. A total of 75 patients and 39 clinicians were recruited, producing 194 paired frailty assessments. Mean age of the patients was 54 (±13) years. Correlation of pooled clinician-estimated frailty to formal frailty was fair (0.52, p=0.00). Correlation was highest between allied-health estimated frailty and formal frailty (0.70, p=0.00). Agreement between pooled clinician-estimated frailty and formal frailty was fair (0.33) and was highest between allied health-estimated frailty and formal frailty (0.45). Subjective clinician-estimated frailty is not a reliable replacement for formal frailty assessment in adults with heart failure, underscoring the need for assessment using a valid and reliable instrument.

Pulsed electromagnetic fields for the management of knee osteoarthritis: multicentre, randomised, controlled, non-inferiority trial protocol

IntroductionPulsed electromagnetic field (PEMF) is an available treatment for knee osteoarthritis (KOA), which is the most common cause of pain and disability. Nonetheless, whether the clinical effects are like that...

Clinical and Evolutionary Features of SARS-CoV-2 Infection (COVID-19) in Children, a Romanian Perspective.

Background: Given the potential for additional development to clarify a better knowledge of generally influence of COVID-19 upon the pediatric population, the clinical symptoms of SARS-CoV-2 infection in children and adolescents are still being explored. Morbidity in children is characterized by a variable clinical course. Our study’s goal was to compare clinical aspects of 230 pediatric patients who analyzed positive for SARS-CoV-2 and were hospitalized between April 2020 and March 2022. Methods: This retrospective study aimed to compare the clinical characteristics of coronavirus disease 2019, (COVID-19) in two groups of pediatric patients hospitalized in the infectious disease clinical ward IX at the National Institute for Infectious Diseases “Prof. Dr. Matei Bals,” Bucharest, Romania. Clinical characteristics of 88 patients (first group), admitted between April–December 2020 were compared with the second group of 142 children admitted between July 2021 and March 2022. Results: Of 230 children, the median age was 4.5 years, and 53.9% were male. Fever (82.17%) and sore throat (66%) were the most common initial symptoms. Rhinorrhea (42%), cough (34%) and diarrhea (41.74%), with abdominal pain (26%) were also reported in a considerable number of cases. 88 (36.21%) patients (first group) were admitted during the second wave in Romania, mostly aged <5 years old, and experienced digestive manifestations like fever (p = 0.001), and diarrhea (p = 0.004). The second group experienced different clinical signs when compared with the first group, with higher temperature and increased respiratory symptoms analogous to persons who suffer acute respiratory viral infections. The proportion in the second group increased by 23.48% from the first group, and the 0–4 age group for both groups had symptoms for a median interval of 5 days; age (0–4-years old) and length of stay were both proportionally inversely and required longer hospitalization (5 days), for the first group. During study time, the fully vaccinated children for 5–12 years old were 10%, and for 13–18 years old, 14.35% respective. We report two Pediatric Inflammatory Multisystem Syndrome (PIMS) in the second group, with favorable evolution under treatment. Comorbidities (obesity and oncological diseases) were reported in both groups and are risk factors for complications appearing (p < 0.001). All pediatric cases admitted to our clinic evolved favorably and no death was recorded. Conclusions: Clinical characteristics of pediatric patients with COVID-19 are age-related. In the first group, 85.29% of 0–4 years old children experienced digestive symptoms, whereas in the second group 83.78% underwent mild and moderate respiratory symptoms for the 5–12 age range. The potential effects of COVID-19 infection in children older than 5 years should encourage caregivers to vaccinate and improve the prognosis among pediatric patients at risk.

An Evaluation of the Impact of COVID-19 on Cardiovascular Surgery

Introduction: We aimed to describe the impact of COVID-19 among the patients who had cardiac surgery, with particular emphasis on pulmonary complications and 30-day mortality. Patients and Methods: From March 2020 to June 2021, a total of 2267 patients underwent cardiovascular surgery at Koşuyolu High Specialization Training and Research Hospital.. Patients who tested SARSCoV-2-positive by PCR perioperatively (seven days before or 30 days after surgery), despite testing negative at admission, were included. The primary endpoint of the study was 30-day mortality following surgery. The secondary endpoint was the development of pulmonary complications including acute respiratory distress syndrome (ARDS) or respiratory failure, which were defined according to the Berlin definition, and the need for mechanical ventilation for &gt;48 h after the operation or the need for re-intubation after extubation. Results: Eleven patients out of 2267 (0.48%) had a positive PCR test for COVID-19. In the postoperative period, seven patients were diagnosed with COVID-19 in the clinical wards, of whom three patients were readmitted to the ICU. Nine patients had radiological pulmonary involvement. Five patients (45.5%) developed ARDS within four to seven days after a positive PCR test. Eight patients (72.7%) developed respiratory failure and required re-intubation, of whom two could not be extubated. Five patients (45.5%) died within 30 days, and seven (63.6) died during their hospital stay. Conclusion: COVID-19 has a severe negative impact on the postoperative course of cardiac surgery patients in terms of cardiovascular outcomes, pulmonary complications, and mortality. Given the dramatic impact of COVID-19 infection on postoperative outcomes, it appears that deferring cardiovascular surgeries may be more suitable if COVID-19 positivity is detected.

Algorithmic insights of camera-based respiratory motion extraction

Objective. Measuring the respiratory signal from a video based on body motion has been proposed and recently matured in products for contactless health monitoring. The core algorithm for this application is the measurement of tiny chest/abdominal motions induced by respiration (i.e. capturing sub-pixel displacement caused by subtle motion between subsequent video frames), and the fundamental challenge is motion sensitivity. Though prior art reported on the validation with real human subjects, there is no thorough or rigorous benchmark to quantify the sensitivities and boundary conditions of motion-based core respiratory algorithms. Approach. A set-up was designed with a fully-controllable physical phantom to investigate the essence of core algorithms, together with a mathematical model incorporating two motion estimation strategies and three spatial representations, leading to six algorithmic combinations for respiratory signal extraction. Their promises and limitations are discussed and clarified through the phantom benchmark. Main results. With the variation of phantom motion intensity between 0.5 mm and 8 mm, the recommended approach obtains an average precision, recall, coverage and MAE of 88.1%, 91.8%, 95.5% and 2.1 bpm in the day-light condition, and 81.7%, 90.0%, 93.9% and 4.4 bpm in the night condition. Significance. The insights gained in this paper are intended to improve the understanding and applications of camera-based respiration measurement in health monitoring. The limitations of this study stem from the used physical phantom that does not consider human factors like body shape, sleeping posture, respiratory diseases, etc., and the investigated scenario is focused on sleep monitoring, not including scenarios with a sitting or standing patient like in clinical ward and triage.

The meaning of CPR in the life-world of hospital: perspectives of patients who witnessed CPR and healthcare professionals.

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): Resuscitation Council (UK) Background Cardiopulmonary resuscitation (CPR) in hospital is a stressful experience for patients who witness it and for the healthcare professionals involved. Limited evidence and guidance exist regarding the experience of witnessing a fellow patient’s CPR. Informed by a systematic review [1] and a multi-stakeholder consultation [2], the WATCH (Witnessing an Attempt of CPR in Hospital) study has explored the lived experiences of hospital patients and healthcare professionals on patient-witnessed CPR with the primary aim of understanding the impact of such an experience [3]. Purpose The purpose of this study was to understand the meaning of CPR in the context of the hospital life-world of patients who witness CPR and of healthcare professionals. Methods The WATCH study used a qualitative descriptive phenomenological design. The lived experiences of 16 witnessing patients admitted to nine clinical wards and of 20 healthcare professionals involved in CPR were explored through in-depth interviews and focus groups conducted in one hospital in the UK. Results Three themes were developed from analysis indicating that, despite a shared understanding of CPR as part of hospital life and as a potential result of emergencies, patients and healthcare professionals had different perspectives of hospital CPR. 1) Unfamiliarity vs Exposure: although patients were aware of CPR, witnessing CPR was often unexpected and traumatic, as many had not experienced it before. Instead, healthcare professionals with previous knowledge and expertise, held an emotional distance and focused on the clinical tasks of CPR. 2) Fiction vs Reality: healthcare professionals considered patients to have unrealistic expectations of CPR, often uninformed and influenced by distorted portrayal of CPR to the lay public through television. Patients acknowledged that witnessing hospital CPR helped their understanding of the reality of it, which differed from their initial idea. 3) Life vs Death: Patients felt disturbed by the presence of a dead body in their room after CPR, whilst daily activities of hospital life were carried out, highlighting a contrast between life and death in the same environment. Finally, healthcare professionals reflected on the meaning of performing CPR as a process to help the ones witnessing it to face and accept the reality of death. Conclusion The WATCH study highlighted that patients and healthcare professionals hold different perspectives of CPR in hospital. Awareness of different perspectives of hospital CPR will help healthcare professionals initiate CPR conversations with hospital patients. Education and accurate information should be offered to hospital patients around CPR to have realistic expectations. Further work is required to guide and support clinical practice around patient-witnessed CPR in hospital.

Effect of a Pharmacy-based Centralized Intravenous Admixture Service on the Prevalence of Medication Errors: A Before-and-After Study.

Intravenous admixture preparation errors (IAPEs) may lead to patient harm. The primary aim of this study was to assess the effect of a pharmacy-based centralized intravenous admixture service (CIVAS) on IAPEs. We conducted a before-and-after study in 3 clinical wards before CIVAS implementation and in the CIVAS unit 18 months after implementation. Intravenous admixture preparation error data were collected by disguised observation. The primary outcome was the proportion of admixtures with 1 or more IAPEs. Secondary outcomes were the type and potential severity of IAPEs, noncompliance to hygiene procedures, and nursing staff satisfaction with the CIVAS. The primary outcome was analyzed using a multivariable mixed-effects logistic regression model. One or more IAPEs were identified in 14 of 543 admixtures (2.6%) in the CIVAS unit and in 148 of 282 admixtures (52.5%) in the clinical wards (odds ratio, 0.02; 95% confidence interval, 0.004-0.05). The most common IAPE types were wrong solvent or diluent (n = 95) and wrong volume of infusion fluid (n = 45). No potentially harmful IAPEs occurred in the CIVAS unit as opposed to 22 (7.8%) in the clinical wards. Disinfection procedures were better adhered to in the CIVAS unit. Overall nurse satisfaction with the CIVAS increased from a median of 70 (n = 166) 5 months after intervention to 77 (n = 115) 18 months after intervention ( P < 0.001) on a 100-point scale. Centralized intravenous admixture service performed notably better than the clinical wards with regard to IAPEs and noncompliance to hygiene procedures. Nurses were satisfied with the CIVAS. Hence, the implementation of CIVAS is an important strategy to improve medication safety in hospitals.

Factors Affecting Nursing Students Learning in Clinical from Student Viewpoint at Taif University

Introduction: Clinical practice is important because it allows students to apply their theoretical knowledge in a real environment, develop psychomotor skills, observe and adapt the professional role. In clinical practice, many factors may affect students’ learning. These factors are listed as These factors are listed as students related issues, clinical instructor related issues and clinical environment related issues. In order to plan an effective learning, it is essential to specify these factors and organize them in a way that will support the students’ learning. This research will discuss these factors in detail. Aim: The research aims was assessing the factors affecting nursing student learning in clinical practice Method: Descriptive cross-sectional community-based study was conducted at the University of Taif in the Kingdom of Saudi Arabia. The duration of the study spanned from August 2021- June 2022, the questionnaire was sent to participants via electronic links on Mobile phones, Results: the study consists of 218 participants, most of them from the fourth year , numbered 92, third year was 54, then the second year was number 41 and finally the first was 31 and most of them are females (62.8%) , 151 student did not have diseases (69.1% ) While 49 students had vision impairment (23.3%), Majority of the nursing students 128(58.7%) choosing nursing as a opportunity , the Majority 169 nursing Student agreed that worried about making mistakes in clinical placement while 96 students was said the characteristics of instructor is difficult and 86 students complain the instructor is more interested in their appearance more than their education , half the students 112 student They said there is a difference between theory and practical training and 73 students they said they needed more time for hospital training , the was statistic significant association between student related factors and A grade point average (p.v =.084) and also the was significant statistic association between Clinical related factors and A grade point average (p.v =.091) Conclusions: It is clear that all themes mentioned by the students play an important role in student learning and nursing education in general. Learning of students in clinical placements is affected by factors originating from themselves, the instructor and clinical wards. Readiness of students, personal and professional characteristics of instructor and attitudes of staff towards students in placements have importance on learning of students. Recommendation: Practical training is very important in the educational process. We recommend increasing the hours of practical training, link practice with the theoretical part and use modern methods in training Keywords: Clinical practice, Nursing Students, Learning, Student Viewpoint and Taif University

Women’s Choice of Immediate Postpartum Reversible Contraceptives Visiting a Tertiary Hospital of Nepal

Introduction: Long-acting reversible contraceptives (LARC, Intrauterine contraceptives devices and Implants) stand on 1st regards to safety and effectiveness. It is an easily accessible variety for spacing birth as well as preventing unintended pregnancy soon after childbirth in Nepal due to free supply by the Government under safe motherhood program of Reproductive health policy. Despite free supply, LARC is not routinely implemented in practice among immediate post-partum lady as single approach contraceptives concern to unintended pregnancy due to unmet need. To find out the choice of LARC by antenatal and immediate postpartum women after delivery. Methods: A descriptive cross-sectional study was conducted among 200 women in antenatal clinic and obstetric ward of College of Medical Science and Teaching Hospital using non probability convince sampling technique. Ethical approval was taken form Institutional Review Committee of College of Medical Sciences and Teaching Hospital and data was analyzed using descriptive statistical tools in SPSS. Results: Twenty eight percent of antenatal and 42% of postnatal women had induced abortion for unintended pregnancy in past. All women had knowledge about modern method of contraception but only 47 percent antenatal and 58 percent postnatal women adopted contraception in past. Implant was chosen by 44% antenatal and 46% postnatal women; whereas IUCD was chosen by 45% antenatal and postnatal women as LARC. Jadelle was the choice of LARC in both group due to its convenient duration (5 years) for birth spacing and its safety profile during breastfeeding. Twenty women refuse for LARC in immediate postpartum period. Conclusions: Single approach immediate postpartum LARC in is chosen by women who had induced abortion for unintended pregnancy in past for its long action, convenience during breast feeding and reliability. Maximum antenatal women prefer IUCD compared to Implants among postnatal women. Keywords: Copper T; Immediate post-partum; Jadelle; long-acting reversible contraceptives; Puerperium; Unintended pregnancy.

Evaluation and prioritization of occupational safety and health risks of Shahid Sadoughi Hospital in Yazd in 2019

Introduction: Today, it is essential to pay attention to the opportunities and threats in health services, especially in hospitals, to identify and evaluate the existing risks and manage them in these centers. Hospital risk management is a program to reduce the occurrence and prevalence of preventable accidents and is of great economic, human and moral importance in the hospital environment. This study aimed to evaluate and prioritize the occupational safety and health risks of the staff of Shahid Sadoughi Hospital in Yazd in 2019&#x0D; Methods and material: : The present study is descriptive-cross-sectional. In the first step, the main risks in clinical, laboratory, facilities, radiology, and administrative departments were identified. Based on FMEA logic, three severity, probability, and vulnerability indicators were identified for each risk. Then, prioritization criteria were determined, and ANP prioritized the risks.&#x0D; Results: According to infectious disease experts with a risk of 0.86 in the clinical ward, inhalation of Barisek chemical vapor 1.17 in the laboratory, radiation of the device with a risk of 0.64 in imaging, infectious disease with a risk of 0.33 and 1.3 in order of priority The first were in the administrative and facilities department.&#x0D; Conclusion: The results showed that the hospital management should adopt special management programs to control infectious diseases with a staff health approach. Control measures should be set with priority risks. The difference in the obtained risk numbers indicated the different priorities of implementing risk management programs in each ward of Shahid Sadoughi Hospital.

Mother’s burden form caring of their children with leukemia in Al-Basrah Province/ Iraq

Objectives: to assess the severity of the burdens practiced by Mothers for their children with leukemia in Al-Basrah Province and find out the association between severity of the burden and demographic characteristics. Methodology: A cross-sectional descriptive study consisting of (105) mothers who have children under eighteen years were selected in oncology &amp; hematology clinic and leukemia ward (B) were interviewed at Al.Basrah children specialist hospital from 9 July 2021 to 20 October 2021. Result: Findings of the study revealed that (85.1 %) of the mothers expressed sever care burden. Conclusion: The study concluded that mothers overall responses were sever at care burden.

Mother’s coping strategies in caring for their children with leukemia in Al-Basrah Province/ Iraq

Background: Leukemia is a cancer of the white blood cells that affects people of all ages. In the spleen, bone marrow, and lymph tissue, immature WBCs (blast cells) proliferate at a rapid rate. The cells are aberrant and unable to combat infection efficiently. As a result of the large number of aberrant cells that grow and are released into the peripheral circulation, they tend to concentrate in bodily tissues and organs, especially when circulation is slow. Objectives: to assess coping strategies among mothers of children with leukemia in Al-Basrah province and find out the association between coping strategies and demographic characteristics. Methodology: A cross-sectional descriptive study consisting of (105) mothers who have children under eighteen years were selected in oncology &amp; hematology clinic and leukemia ward (B) were interviewed at Al.Basrah children specialist hospital from 9 July 2021 to 20 October 2021. Result: the mostly of (89.5%) mother’s coping strategies of children with leukemia expressed moderate coping Conclusion: The study concluded that the overall assessment of mother’s coping strategies of children with leukemia is moderate coping