Hospitals In Kuwait Research Articles

Prevalence and Predictors of Potentially Inappropriate Medications Among Patients Aged ≥65 Years on Hospital Admissions in Kuwait.

BackgroundPotentially inappropriate medications are major health concerns for patients aged ≥65 years. To investigate the prevalence of potentially inappropriate medications, Beer’s criteria can be used. We estimated the prevalence of potentially inappropriate medications prescription among patients aged ≥65 years admitted to Kuwait’s largest hospital and identified the predictors of prescribing a potentially inappropriate medication.MethodsA cross-sectional study was conducted retrospectively using inpatient records from the medical department at the Hospital in Kuwait from 1 January 2019 to 31 December 2019. The latest version of Beer’s criteria was used to identify potentially inappropriate medications in patients’ medical records. Data were analyzed descriptively to estimate the prevalence of potentially inappropriate medications and to describe participant characteristics. The predictors of potentially inappropriate medications prescribing were determined using binary logistic regression.ResultsA total of 423 medical records of patients were collected. The mean age of the patients admitted was 76 ± 7 years, and 222 of them (52.5%) were women. Upon hospital admission, potentially inappropriate medication was prevalent in 58.4% of patients. The most prevalent potentially inappropriate medications identified were proton pump inhibitors (27.3%), diuretics (21.5%), antipsychotic agents (9%), selective serotonin reuptake inhibitors (5%), and methyldopa (4%). Polypharmacy, Alzheimer’s disease, depression, irritable bowel syndrome, hypothyroidism, chronic kidney disease were predictors of potentially inappropriate medications prescription.ConclusionA high prevalence of potentially inappropriate medication prescription was observed among patients aged ≥65 years admitted to a hospital in Kuwait. The most likely predictor of potentially inappropriate medication prescription was polypharmacy.

Expert consensus for a national essential antidote list: E-Delphi method

Antidote stocking represents a major challenge to hospitals all over the world, including Kuwait. In order to assist hospitals to reduce costs and improve patient care, an essential antidote list can be used as an initial foundation for securing sufficient antidote availability at healthcare institutions. The aim of our study is to generate a nationally relevant essential antidote list for emergency care hospitals in Kuwait using the e-Delphi method by establishing consensus through a multidisciplinary expert group of healthcare providers. An electronic survey with 47 essential antidotes was developed. The e-Delphi method was used, with three rounds of voting, to determine expert consensus on an essential antidote list for hospitals in Kuwait. A purposive sample of healthcare professionals from governmental and private hospitals were selected for this study (n = 30). Consensus was gained if ≥75% of the expert panel agreed on the inclusion of the antidote, without any strong disagreements. Round 1 of the e-Delphi resulted in 41 antidotes reaching consensus and seven new antidotes suggested by the expert panel. Round 2 had two antidotes (out of seven newly suggested ones) reaching consensus. Round 3 was a confirmatory round, where the expert group agreed on their previous rounds’ opinions. This resulted in the development of an essential antidote list with 43 antidotes. The optimal approach for ensuring adequate availability of antidotes is continuous monitoring of local poisoning incidence and antidote requirements through collaborations between academic researchers and emergency care clinicians. The development of an essential antidote list, with expert consensus, is one of the initial steps in securing a foundation for appropriate provision of antidotes at all healthcare institutions. This is the first study that the authors are aware of that demonstrates that the e-Delphi technique can consolidate recommendations of experts in emergency medicine to provide a list of essential antidotes.

Lipid Profile Status amongst the Pilots of Kuwait Air Force

Introduction: Dyslipidemia has been established as one of the most important modifiable risk factors for cardiovascular diseases. Dyslipidemia is highly prevalent in the general population of Kuwait as well as in armed forces personnel. Objective: To assess the prevalence of dyslipidemia amongst the pilots of Kuwait Air Force. Materials and Methods: This descriptive cross-sectional study was carried out in Medical Directorate, Armed Forces Hospital Kuwait from July 2017 to June 2018. One hundred and twentysix Kuwaiti Air Force pilot were included in this study. Lipid profile [Total Cholesterol (TC), Triglyceride (TG), Low density lipoprotein cholesterol (LDL-C) and High density lipoprotein cholesterol (HDL-C)] were measured from fasting blood and were categorized based on the National Cholesterol Education Programme Adult Treatment Panel III criteria (NCEP-ATP III). Results: Mean (±SD) age of the 126 participants was 32.5±7.4 years. Among them 56.3% were current smoker. As per BMI (Body Mass Index) criteria 49.2% and 26.2% of the pilots were overweight and obese respectively. Most common lipid abnormality was high LDL-C (46%), followed by high TC (39.7%), low HDL-C 36.5%) and high TG (18.3%). Positive correlation between BMI and TG level and LDL-C level (r=0.273, p=0.001 & r=0.177, p=0.049 respectively) and negative correlation between BMI and HDL-C (r= -0.286, p=0.001) were found. BMI was found to be an independent predictive factor for dyslipidemia. Conclusions: Dyslipidemia and obesity was alarmingly high in the pilots of Kuwait Air Force and should be considered as a matter of medical concern. JAFMC Bangladesh. Vol 17, No 2 (December) 2021: 71-75

Outcomes of Mini-Percutaneous Nephrolithotomy in Children and Adolescents: A 10-Year Single-Centre Experience From Kuwait.

The current study retrospectively reviewed data for all children and adolescents who underwent mini-percutaneous nephrolithotomy (PCNL) at Ibn Sina Hospital and Sabah Al Ahmad Urology Centre in Kuwait over 10 years. Accordingly, the 40 patients underwent mini-PCNL. Among them, 21 patients (52.5%) had varying degrees of hydronephrosis, with mild to moderate severity accounting for nearly half of them, whereas six (15%) had multiple stones. The median operative time was 54.5 (43.3-64) minutes. Moreover, 11 patients needed flexible ureteroscopy (URS) and double-J (DJ) ureteric stent, and one patient required DJ ureteric stent only. None of the cases developed intraoperative bleeding. The median hospital stay of the included patients was three (2.3-4) days. Residual stone was observed in 11 patients (27.5%), with a median size of 3 (2 to 7) mm. The incidence of postoperative complications was 27.5% (n = 11 patients), with three patients experiencing postoperative bleeding (7.5%) and eight patients developing a fever (20%). All patients had mild postoperative pain. However, no leakage, sepsis, or pelvic injury occurred. None of the patients required revision. In conclusion, mini-PCNL was a safe and effective procedure in children and adolescents with renal stones.

MO296: Seasonal Variations in AKI Incidence and Outcomes

Abstract BACKGROUND AND AIMS Kuwait enjoys a cool winter but suffers a very hot summer. We aim to evaluate the relationship between weather temperature and acute kidney injury (AKI) incidence and outcome. METHOD We prospectively collected demographic (age, sex and nationality), clinical (CKD status, cause of AKI and comorbidities), management (fluids, diuretics, inotropes, ventilatory support and dialysis) and 30-day patients and kidney outcome data for all adult nephrology consultations for AKI in seven major public hospitals in Kuwait during January, February and March/2021 and compared them to those of June, July and August/2021. RESULTS A total of 2038 patients with AKI were enrolled (mean age: 64; males: 59%, Kuwaitis: 58%; mean eGFR: 66.5; mean initial Hgb: 106). Of the cohort, 42% had baseline eGFR < 60 (with a mean eGFR of 37, a mean age of 68 and a mean Hgb of 102 versus a mean eGFR of 88, a mean age of 59 and a mean Hgb of 109 for the group with baseline eGFR > 60). Higher percentage of AKI cases took place in cooler months (63% versus 37%). Patients with AKI in cooler months were significantly older (65 versus 59), with lower baseline eGFR (63 versus 72.5) and more comorbidities (DM, HTN, CAD). There was no difference between the two groups in the use of IV fluids (saline, bicarbonate, blood products, etc.) or IV diuretics (loop, thiazide or potassium-sparing); however, IV vasopressors were used more often in cooler months in cases of AKI. Mechanical ventilation was more frequently used in the summer cases (44% of summer AKI cases versus 40% of winter AKI cases) but not statistically significant. Dialysis was needed for 44% of the entire cohort, 56% of dialysis cases were in cooler months (31% of winter AKI cases) and 44% in summer months (40% of summer AKI cases). Dialysis modality was continuous in 85% of all cases. At 30 days, 36.5% of the total cohort died; 72% of them died while on dialysis. Larger proportion of deaths in AKI cases in cooler months (58% of total deaths or 33% of the winter AKI cases versus 42% of the total death or 42% of the summer AKI cases), with more deaths while on dialysis seen in cooler months too (56% versus 44% of deaths while on dialysis). However, lower rates of complete recovery from AKI were seen in summer cases (33% versus 67%), with a mean final eGFR of 57 for the winter AKI cases versus 41 for the summer AKI cases. CONCLUSION AKI is more common in the cooler months of the year affecting an older group of patients with more comorbidities, and is associated with higher usage of dialysis and higher rates of death, but probably better chances of kidney recovery in those who survive.

MO297: Acute Kidney Injury Among COVID-19 Positive Patients is Associated With Higher Mortality: Single Center Experience

BACKGROUND AND AIMSDespite the lungs are the major targets of COVID-19, other organs such as the kidneys are also affected. Renal complications of COVID-19 are not yet well studied. We aimed to study the prevalence of acute kidney injury (AKI) among positive COVID-19 cases that were managed in the intensive care unit (ICU) in a single isolation hospital during the pandemic, and to explore its impact on patient outcome.METHODThis retrospective study included 616 patients with COVID-19 who were managed in the ICU in a single isolation hospital in Kuwait during the pandemic, from February to December 2020. AKI was defined according to the serum creatinine criteria in the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Of the 616 patients, 40.2% developed AKI (group 1, n = 248) and were compared with the patients without AKI (group 2, n = 368).RESULTSMost of cases in the two groups were males (73% versus 70.7%), aged (60.8 ± 14 versus 51.7 ± 16 years), respectively. The two groups were comparable regarding chronic kidney disease (2% versus 0.8%) and chronic pulmonary disease. Other factors were significantly predominating among group 1 as diabetes mellitus (63.7 versus 40.5%), hypertension (74.2% versus 40.5%) and ischemic heart disease (26.2% versus 12.5%) (P < .05).Fever, cough, shortness of breath and dehydration were significantly more frequent presentations among patients of group 1, and had radiological findings that were synchronized with COVID-19 (89.5% versus 50.8%) (P < .05). Moreover, sepsis, volume depletion, shock, arrhythmias and ARDS predominated among the AKI group (P < .05). The number of cases who were managed by therapeutic anticoagulation was significantly higher in AKI patients (89.9% versus 51.9%); also, cases who received supportive vasopressors and convalescent plasma transfusion as well as steroid were significantly higher in the same group (P < .05). Other therapeutic modalities such as antivirals, tocilizumab and hydroxychloroquine were comparable in both groups.We found that acute respiratory failure requiring mechanical ventilation was significant among the AKI group (66.8% versus 29.4%), and the overall mortality rate was significantly higher in the same group (62.5% versus 32.8%).CONCLUSIONThe prevalence of AKI in patients with COVID-19 was 40.2%, and it was associated with poor prognosis among ICU COVID-19 positive cases.

Herpes zoster in the era of COVID 19: A prospective observational study to probe the association of herpes zoster with COVID 19 infection and vaccination.

Herpes zoster (HZ) is caused by reactivation of the latent varicella zoster virus (VZV) following decline in cell‐mediated immunity. All over the world, in the past couple of years, the Corona Virus 2019 (COVID‐19) has emerged as a viral cause of severe acute respiratory syndrome corona virus 2 (SARS‐CoV‐2) infection. Based on the current limited evidence, co‐infection of COVID‐19 with VZV or reactivation of VZV after COVID‐19 vaccination has been sporadically reported. All patients diagnosed with HZ, in Farwaniya Hospital in Kuwait, from March 2020 to July 2021, having either (A) a positive COVID‐19 polymerase chain reaction (PCR) test, or (B) been vaccinated against SARS‐CoV‐2 were enrolled in the study. All patients' demographic information, medical history, laboratory findings, and vaccination status was documented. All statistical analyses were performed using SPSS Statistics version 21.0 software. Twelve cases infected with COVID‐19 with a positive PCR (group 1) and five cases vaccinated against SARS‐CoV‐2 (group 2) were documented. Out of the 12 COVID‐19 infected patients (group 1), only two patients (16.67%) required hospitalization, while the remaining 10 patients had mild/moderate lymphopenia. Furthermore, amongst the 12 positive COVID‐19 cases, four patients with HZ were diagnosed within the first week of COVID‐19, while the remaining eight cases were diagnosed within 8 weeks of COVID‐19. Thoracic segments were affected in five cases (41.67%), cervical in one case (8.33%), cranial in two cases (16.67%), lumbar in three cases (25%) and sacral in one case (8.33%). In group 2, three patients presented with HZ within 4 weeks of having received the first dose of the vaccine and two patients after the second dose. Blood investigations for all five vaccinated patients did not show any abnormalities. Cervical segments were affected in two patients (40%), and cranial, thoracic, and lumbar segment in the remaining patients respectively (20%). Experts must be aware of the probable increased risk of HZ during the COVID 19 pandemic. We propose appropriate curative and preventive measures against HZ infection, including a systematic follow‐up of these patients to ensure that they stick to extreme safety measures till the diagnosis of COVID‐19 is omitted.

New precipitating factors for migraine during Covid-19 pandemic lockdown

Background: Lock down caused sudden lifestyle changes and represented a massive impact on human health. We aimed to report new migraine headache precipitating factors due to lifestyle changes during coronavirus disease 2019 (COVID-19) Pandemic lockdown. Methods: This cross-sectional survey included patients diagnosed with migraine based on The International Classification of Headache Disorders, 3rd edition (ICDH-3). During the lockdown, we submitted an online self-reported web-based questionnaire to patients already diagnosed with migraine and attending headache clinic at Ibn Sian Hospital in Kuwait. Questions explored different new precipitating factors of migraine headache attacks during COVID-19 pandemic lockdown compared to precipitating factors before lockdown. Results: A total of 340 migraine patients responded to online questionnaire. The mean age of them is 34.65 years. Females were predominant 79.1%. Majority of the cohort 85 % has more than one trigger of migraine headache attack. During pandemic, the common precipitating factors were smell of strong odors in 214 (62.9%), followed by certain food in 175 (51.8%), sleep disturbance in 120 (35.3%), emotional or mental stress in 80 (23.6%), caffeine in 80 (23.6%), flickers of light in 78 (22.9%), weather changes in 68(20%), smoking in 65 (19.12%), noise in 56 (16.5%), sun light exposure in 41 (12.1%), fasting/ hypoglycemia in 40 (11.7%), hormonal changes in 37 (10.6%), physical excretion/fatigue in 24 (7.1%), screen exposure in 20 (5.9%), and dehydration in 14 (4.1%) patients. Before pandemic, noises 200 (58.8%), flicker of light 180 (52.9%), weather changes 175 (51.5%), sun light 170 (50%), food 160 (48.5%) and 130 (38.2%) sleep deprivation were the most common precipitating factors of migraine. 40% did not report precipitating factors for migraine before lockdown. Conclusions: Change of habits during lock down exposed migraine patients to different precipitating factors. Strong odors, food, sleep disturbance and stress were the most common migraine headache precipitating factors during COVID-19 lockdown.

Late-onset Sepsis in Preterm Neonates is Associated with Higher Risks of Cerebellar Hemorrhage and Lower Motor Scores at Three Years of Age.

ObjectivesTo evaluate the impact of late-onset sepsis (LOS) in preterm infants on brain injury and neurodevelopmental outcomes at 36 months corrected age (CA).MethodsWe retrospectively analyzed the medical records of 203 preterm neonates of 24–32 weeks gestational age who were admitted between January and December 2017 at the neonatal intensive care unit (NICU) of a maternity hospital in Kuwait. The cases were stratified into no sepsis, early-onset sepsis (first onset of sepsis ≤ 72 hours postnatally), and LOS (> 72 hours postnatally). Brain injury was assessed from MRI records. Neurodevelopmental outcomes were evaluated at 36 months CA using Bayley-III scales of infant development.ResultsOut of 203 neonates, 16 had early-onset sepsis with Klebsiella pneumonia and group B streptococcus, and 93 developed LOS with K. pneumonia and gram-positive cocci in clusters. There were no group-wise differences in the prevalence of intraventricular hemorrhage (n = 68) or white matter injury (n = 42). However, higher cerebellar hemorrhage risk (adjusted odds ratio = 4.6 (1.3–18.6; p = 0.030) was observed in LOS group. At 36 months CA, infants in the LOS group were more likely to have lower motor, cognitive, and language composite scores. After adjusting for gestational age, birth weight, cerebellar hemorrhage, and white matter injury, the relationship between LOS and lower motor scores remained significant (adjusted β = –9.5, 95% CI: –16.4 to –2.7; p = 0.007), whereas the association with cognitive and language scores were no longer significant.ConclusionsLOS in preterm neonates significantly raises the risk of cerebellar hemorrhage and lower motor scores by three years of age.

Examining the Factors Influencing Orthopedic Physician's Decision to Purchase Medical Devices: Evidence from Kuwait.

PurposeIt is explanatory and descriptive research to explain the relationship among factors influencing the orthopedic physician’s decision of purchasing medical devices and equipment.MethodsQuantitative method will be used in this study as all heads of departments in MOH hospitals refused to make one-to-one interviews and suggested only questionnaires that will be high in confidentiality.ResultsFor the first question: What is the ranking of factors that influence orthopedic physician decision in purchasing medical devices and equipment in MOH hospitals in Kuwait? According to HB analysis, the most preferred attribute is implant review in a journal and the lowest preferred factor is product training. Moreover, Brand was the second preferred attribute followed by leader influence. Surprisingly, price came after all these attributes. Physicians ranked technical support and sponsorship in the fifth and sixth places. For the second question: How can marketing and sales management predict orthopedic physicians' decisions before designing product proposals? This will assist M&S department in creating proposals that satisfy orthopedic physicians through expecting their decisions on various alternatives.ConclusionThere is a good opportunity for all medical devices companies, after discussion with SMEs, either for growth or leaving stagnation phase. However, SMEs have no real understanding of what factors matter to the orthopedic physicians’ decision in purchasing medical devices and equipment. Thus, one of the goals of this research is to give M&S departments in medical devices companies with recommendations that will help them in forming attractive product offers to orthopedic physicians in MOH hospitals in Kuwait. Moreover, predicting the response from them in the future. In addition, four simulation scenarios have been conducted in this research to reach the best economic offer that maintains physicians attracted.

Exploring the Health Information Management System of Kuwait: Lessons and Opportunities

After studying the professional practices related to the management of medical records in Kuwaiti hospitals, it became utterly evident that there is inadequate understanding about maintaining the health information of patients. This dire situation is further compounded by the absence of official regulations established by the Ministry of Health for hospitals to effectively assess and manage medical records. Through this study, the researchers aimed to assess the medical records system in multiple healthcare settings in Kuwait, comprising government, private, and oil sectors. The study was carried out from May 2019 to July 2020 and used a self-developed, pilot-tested questionnaire measuring various aspects of the medical records management system. A total of 98 participants responded to the survey. The study results revealed that 43% of hospitals were using paper-based medical records, as compared to 53% that used both paper-based and electronic media. Moreover, 40% of hospitals in Kuwait did not adhere to the Ministry of Health policies regarding medical records disposition; instead, they developed their own hospital-based disposition policy. Moreover, the study findings showed that there were clear discrepancies in record retention policies among the participating hospitals, and the duration of record retention varied from 2 years, 5 years, 10 years, and more than 20 years across hospitals in Kuwait. In conclusion, national policies and guidelines need to be established to monitor the medical record systems in Kuwaiti hospitals to further enable better patient care and improve healthcare facilities. Furthermore, it has become indispensable to develop and maintain electronic health records as they constitute an integral part of modern healthcare.

POS-163 AKI IN RAMADAN: A PROSPECTIVE OBSERVATIONAL MULTI-CENTER STUDY

Fasting during Ramadan from dawn to sunset is one of the 5 pillars of Islam. Islamic lunar calendar is 11 days shorter than the Gregorian solar calendar, so the start of Ramadan changes every year and hours spent on fasting vary from 12 hours in Australia, to 21 hours in Sweden, with most countries have 11-16 hours of fasting on average. Patients with certain medical illness are exempted from fasting, however, many such patients partake in fasting. 1,2The long hours of fasting may be a risk factor for AKI in certain populations. We assess AKI in Ramadan of 2021, where the weather was moderately hot. Demographics, comorbidities, treatment, and 4 weeks outcome data for all nephrology consultation for AKI in four public hospitals in Kuwait during Ramadan of 2021 (13/April to 12/May/2021) prospectively collected and analyzed. We compare AKI in people fasting prior to admission to non-fasting. Total number of AKI cases during Ramadan was 158, 55% males, mean age 64, and 61% were Kuwaiti citizens. Community acquire cases were 15%. DM affected 75%, HTN 72%, and cardiac disease 25% of patients. Median baseline eGFR before AKI was 66.5. Baseline eGFR < 60 seen in 43%, and those compared to patients with eGFR > 60, had median baseline eGFR of 37.5 (vs 92), were older (69 vs 62), 87% had DM (vs 66%) and 87% had HTN (vs 61%). Cause of AKI was pre-renal / ischemic ATN in 69%, COVID-19 related in 17%. Many had more than one possible cause. IV fluids used in 76%, IV diuretics in 39%, IV vasopressors in 31%, and steroids in 21.5%. KRT needed in 27%. Volume overload and electrolytes / acid-base disorders were most common indication (21% and 19% respectively and 15% had more than one indication. Death within 30 days occurred in 11.4%. Of the total AKI cases, 24% were fasting before admission, with mean age of 56 (compared to 63 for non-fasting). No significant difference in baseline eGFR between fasting and non-fasting, nor in use of IV fluids, IV diuretics, or IV vasopressors. Dialysis needed in 21% of the fasting group, not significantly different from non-fasting group. Mortality rates were lower in the fasting group but not statistically significant (8% vs 12.5%). AKI affect both fasting and non-fasting population similarly, with no increased risk of need for dialysis or mortality.

Molecular characterisation of Candida auris isolates from immunocompromised patients in a tertiary-care hospital in Kuwait reveals a novel mutation in FKS1 conferring reduced susceptibility to echinocandins.

Candida auris is an emerging, potentially multidrug-resistant pathogen that exhibits clade-specific resistance to fluconazole and also develops resistance to echinocandins and amphotericin B easily. This study analysed 49 C auris isolates for alterations in hotspot-1 and hotspot-2 of FKS1 for the detection of mutations conferring reduced susceptibility to echinocandins. C auris isolates (n=49) obtained from 18 immunocompromised patients during June 2016-December 2018 were analysed. Antifungal susceptibility testing was performed by Etest and broth microdilution-based MICRONAUT-AM assay. Mutations in hotspot-1 and hotspot-2 regions of FKS1 were detected by PCR sequencing and fingerprinting of the isolates was done by short tandem repeat typing. The patients had multiple comorbidities/risk factors for Candida spp. infection including cancer/leukaemia/lymphoma/myeloma (n=16), arterial/central line (n=17), urinary catheter (n=17), mechanical ventilation (n=14) and major surgery (n=9) and received antifungal drugs as prophylaxis and/or empiric treatment. Seven patients developed C auris candidemia/breakthrough candidemia, nine patients had candiduria with/without candidemia and four patients developed surgical site/respiratory infection. Resistance to fluconazole and amphotericin B was detected in 44 and four isolates, respectively. Twelve C auris isolates from eight patients showed reduced susceptibility to echinocandins. Seven isolates contained hostspot-1 mutations and three isolates from a candidemia patient contained R1354H mutation in hotspot-2 of FKS1. Ten patients died, five were cured, two were lost to follow-up and treatment details for one patient were not available. Our findings describe development of a novel mutation in FKS1 conferring reduced susceptibility to echinocandins in one patient during treatment and unfavourable clinical outcome for many C auris-infected patients.

The effect of digital leadership on Kuwaiti hospitals’ employee performanc

The study aimed to identify the Impact of Digital Leadership on Kuwaiti hospitals’ employee performance by using a descriptive and analytical methodology. According to statistics provided to us by the Kuwaiti Ministry of Health, the study population consists of administrators in Kuwaiti hospitals, numbering 12006. A simple random sample commensurate with the study's objectives was drawn, numbering 372 administrators to distribute the study questionnaire to them, and 277 valid questionnaires were retrieved for analysis. It was also found that there is a statistically significant impact at the significance level (α≤0.05) of digital leadership with its dimensions (innovation, persuasion, and knowledge) on Kuwaiti hospitals' employees' performance. The researchers recommended that it is essential to strengthen the factors that lead to enhancing the concept of digital leadership under its essential elements in the work environment. as well as paying attention to the priorities of the impact of the digital leadership elements on the performance of employees in order to obtain a practical impact.

Attitude and Associated Factors Toward end of Life Care among Nurses Working in Kuwait Hospitals: A Cross-sectional Study

Objective:The current study assessed the attitude toward end of life (EOL) care among nurses working in Kuwait hospitals.Material and Methods:A descriptive, cross-sectional design was used to recruit 900 nurses from nine public, private and military hospitals in Kuwait. Data were collected using a self-administered questionnaire of the Frommelt Attitude Toward the Care of Dying questionnaire.Results:The results showed that nurses in Kuwait had a favourable and supportive attitude towards EOL care, mainly toward the families’ need for emotional support, care for the dying patients, involving the family in care, and accepting death. Further, attitude scores differed significantly based on nurses’ age, year of experience, education level, nationality, type of hospital, and place of work.Conclusion:Nurses working in Kuwait have a favourable attitude toward care for dying patients but an unfavourable perception toward making conversation with patients about death. Hence, providing appropriate awareness to nurses about death and dying in Kuwait might be a promising intervention to improve their attitude and sensitise the concept of death among them.

Nurses Turnover: Retention of the Staff

An extended literature review has been conducted about nurses’ turnover, and how to retain the staff by applying appropriate Human Resources theory in the healthcare organisation, to retain nurses and eliminate turnover. This is through exploring the Human Resource Management issue related to nurses’ high turnover and the reason which is behind to leave their hospitals in Kuwait. Also, the study will critically examine the working nature and the issue behind nurses’ turnover. In addition, motivational theories will be used in this paper and will apply some strategies that can be used to avert the causes of the problem, to ensure that nurses are retained within their organisations. Aim: To enhance employee loyalty to their organisations and effectively retain nurses’ staff in X organisation, with a particular reference to Human Resources Management. Methodology: Various literature, journals, articles, reports and books were reviewed to achieve the aim of this paper, specific consideration was given to the leadership. A relevant Human Resources Theory was applied with leadership support to retain nurses in the organisation and to reduce nurses’ turnover. Findings: Leaders are important to develop a considerable retention strategy within the organisation, by increasing the nurse’s loyalty and satisfaction through different techniques such as policy and guidelines, motivating through allowances and leave, further changing the system. Recommendations: To provide extensive training to the leaders to enhance their skills in managing the organisation and staff. To overcome the issues that interfere with nurses’ satisfaction and solve the issues to retain the nurses.

Identifying employees at high risk of diabetes among the medical staff of Jaber Al-Ahmed Armed Forces Hospital in Kuwait and screening them for diabetes

Background: Diabetes mellitus is one of the top diseases leading to morbidity and mortality in Kuwait. There is often a delay in diagnosing patients with type 2 diabetes due to the long asymptomatic pre-clinical stage and complications are commonly present at diagnosis. Screening can identify diabetics and treatment can be initiated earlier to prevent complications. Screening can detect pre-diabetics who may benefit from interventions to prevent or delay progression to diabetes. Objectives: The aim of this study is to estimate the prevalence of risk factors for diabetes in healthy employees and screen those with high risk for diabetes. Method: A cross-sectional study conducted in Jaber Al-Ahmed Hospital from October to November 2012. The Finnish questionnaire for diabetes risk assessment was used to categorize participants into different risk categories for diabetes. Participants considered to be at high risk were screened for diabetes using HbA1c. Results: 647 employees participated in the study. 70.6% of the participants were overweight or obese; more than half had a high waist circumference and 23% were smokers. Kuwaiti employees tended to have more risk compared to non- Kuwaitis (P&lt;0.001) with 27.6% of Kuwaitis belonging to the low risk group compared to 42.4% of the non-Kuwaitis. HbA1c testing showed that out of the 51 participants with high/very high risk, 6 (11.8%) were diabetics and 26 (51.0%) were pre-diabetics. Conclusion: Screening and a diabetic risk assessment for those at high risk should be part of the routine occupational health check program in the hospital.

Etiology and Antibiotic Susceptibility Patterns of Urinary Tract Infections in Children in a General Hospital in Kuwait: A 5-Year Retrospective Study

Objective: The aim of this study was to determine the bacterial profile and prevalence of antibiotic resistance patterns of uropathogens, as well as to evaluate the problem with extended-spectrum β-lactamases (ESBLs)-producing isolates, causing urinary tract infections (UTIs) in children in Al-Amiri Hospital, Kuwait, over a 5-year period. Materials and Methods: Significant isolates from symptomatic pediatric patients with UTIs from January 2017 to December 2021 were identified by conventional methods and by the VITEK 2 identification card system. Antimicrobial susceptibility testing was performed by the disk diffusion method for Gram-positive organisms and an automated VITEK 2 system for Gram-negative organisms. ESBL-producing Enterobacterales were detected by the double-disk diffusion method and VITEK 2 system. Results: Significant bacteriuria was detected in 13.7% of the 9,742 urine samples. Escherichia coli accounted for 67.3% of these, followed by Klebsiella pneumoniae (8.9%), Proteus spp. (5.7%), and Enterococcus spp. (7.4%), respectively. High resistance rates were observed among the Enterobacterales against ampicillin, cephalothin, nitrofurantoin, amoxicillin/clavulanic acid, and trimethoprim-sulfamethoxazole. The prevalence of ESBL-producing E. coli and K. pneumoniae was 26% and 55%, respectively. The most sensitive among the antibiotics tested for Gram-negative organisms were meropenem, amikacin, gentamicin, and piperacillin/tazobactam, while the antibiotics tested for Gram-positive organisms were vancomycin, ampicillin, linezolid, and nitrofurantoin. Conclusion: E. coli remains the most common uropathogen. A high percentage of uropathogens causing UTI in children were highly resistant to the first- and second-line antibiotics for the therapy of UTI. ESBL-producing bacteria were highly prevalent in children in our hospital. Local antibiograms should be used to assist with empirical UTI treatment.

Health Behavior Changes among Maternity Nurses during the COVID-19 Pandemic: A Cross-Sectional Study

Background: Maternity nurses are frontline health professionals in the COVID-19 pandemic who may confront life-altering challenges. Studies that evaluated the impact of COVID-19 on maternity nurses’ daily lifestyles are limited. Objective: The aim of this study was to examine the changes in health-enhancing behaviors, such as eating habits and lifestyle behaviors, during the COVID-19 pandemic among nurses working in a maternity hospital. Methods: This was a cross-sectional study that surveyed maternity nurses working in a major government maternity hospital in Kuwait. Data were collected between January and February 2021. Results: A total of 336 participants completed the questionnaire. Normal weight was perceived by 88 (26.2%) of the participants, while 56 (16.7%) had a Body Mass Index indicating obesity. Weight gain during the pandemic was reported by 128 (38.1%) participants and 91 (27.1%) of the sample gained one to three kilograms. The findings showed low adherence to the Mediterranean diet 5.3 ± 2.5 points. Sleep hours decreased significantly during the crisis, with 113 (33.6%) of participants sleeping 7 to 9 hours during the COVID-19 situation compared to 136 (40.5%) before the pandemic (p 2 = 7.621, P = 0.006), felt hungry between meals 37 (50.7%) (X2 = 6.505, p = 0.011), and who reported changes in their appetite (X2 = 17.129, p < 0.001). Conclusion: Maternity nurses revealed low adherence with the healthy diet, with almost a third of participants having self-reported weight gain. Further, the sleeping patterns and the practicing of physical activities were negatively affected by COVID-19 pandemic.

Herbal Use and Perceptions among Patients with Type 2 Diabetes Mellitus in Kuwait

Herbal medicine has become a popular treatment among patients with chronic diseases worldwide. Many patients with diabetes mellitus use herbal medicine without consulting their health professionals. The aim of this study was to assess the prevalence, pattern of use, and perceptions in type 2 diabetes patients using herbal medicine. It was conducted between 1st January 2019 and end of June 2019 diabetes clinic in Farwaniya Hospital in Kuwait. In this cross sectional quantitative study, 350 patients were asked to complete questionnaire administered by nurses. The study found that 30.6% of sample used herbal medicine—women more than men. Black cumin (habba soda) i.e. Nigella sativa was the most common herb used by diabetic patients. The study revealed that 70% of herbal medicine users had poor glycemic control (HbA1c ≥ 7%). Diabetic complications were greater in herbal users than in those receiving conventional therapy. The study also showed that 95.3% of herbal medicine users did not inform their treating doctors. Our conclusion was that herbal medicine users needed to increase their awareness and education about the risks and complications of herbal medicine.