Major Government Hospitals Research Articles

Clinical and safety outcomes of decompressive surgery for patients with degenerative lumbar spine disease in the Gaza Strip: a prosective study.

A significant number of patients with degenerative lumbar spine disease (DSD) require decompressive surgery. Disparities in surgical care exist between different countries and regions. This study reports on the clinical and safety outcomes of lumbar decompressive surgery performed in the Gaza Strip, a poor and underserved area with a fragile healthcare system. Patients with DSD were prospectively followed up after undergoing lumbar decompressive surgery at two major governmental hospitals in the Gaza Strip between October 2019 and March 2020. Outcomes were assessed using the Core Outcome Measure Index (COMI-back) and the Oswestry Disability Index (ODI), measured both before and three months after surgery. Surgical complication rates were also evaluated. A paired t-test was performed to explore the significance of differences in the mean pre- and postoperative scores for each COMI variable and the ODI item. Sixty-six patients were included, consisting of 41 (62.1 %) males and 25 (37.9 %) females, with a mean age of 61.02 ± 11.4 years. The total COMI-back score decreased from 27.3 ± 6 to 10.3 ± 10 postoperatively (p < 0.0001). A decrease of 15.15 points was also noted between the mean ODI scores before and after surgery (p < 0.0001). Similar significant decreases were observed across all COMI-back and ODI items. The three-month global outcome indicated that the operation benefited 47 patients (71.2 %). Likewise, 39 (59 %) and 19 (28.7 %) reported being "highly satisfied" or "satisfied" with the overall state of their back/leg symptoms, respectively. Eight (12.1 %) patients experienced a postoperative complication: six (9.5 %) had wound infections, one (1.5 %) sustained a dural tear, one (1.5 %) experienced a CSF leak, and one (1.5 %) needed reoperation. The mean hospital stay was 2 days ± 1.3 days. The study shows a significant improvement across all outcome parameters from baseline to the three-month postoperative follow-up, with rates of surgical complications and hospital stays comparable to global averages.

Evaluating MRI and CT scan scheduling workflows: A retrospective analysis

Background and objectiveEffective management of MRI and CT scan scheduling workflows is crucial in healthcare settings to ensure timely diagnosis and treatment. This study aims to analyze the scheduling workflows for MRI and CT scans in two major government hospitals in Saudi Arabia by assessing the time intervals from physician request to exam execution. MethodsA retrospective study was conducted using data from January 1, 2017 to December 31, 2022. The study included all patients who underwent MRI or CT scans at the selected hospitals. The following three main intervals were analyzed: Days from Request to Appointment (DRA), Days from Appointment to Scheduled (DAS), and Days from Scheduled to Performed (DSP). ResultsThe CT scans had a mean DRA of 2.67 days (SD = 18.13) and a mean DAS of 5.25 days (SD = 20.19). The DSP for both scans was less than one day, indicating that scans are typically performed on the same day they are scheduled. The MRI scans showed a mean DRA of 11.10 days and a DAS of 20.25 days, with a similarly quick DSP. Overall, CT scans had shorter and less variable waiting times than MRI scans. The study also noted a significant drop in scans during the COVID-19 pandemic, followed by a gradual return to normal volumes. ConclusionThe MRI scans typically experience longer and more variable durations compared to CT scans. Employing timestamps has proven effective in breaking down these waiting periods into distinct stages to provide a clear view of delays. This detailed analysis provides actionable insights for targeting key issues, guiding decisions to improve scheduling efficiency and ultimately reduce patient waiting times.

Cleft lip and palate and periconception COVID-19 infection in five arab countries.

Little is known about factors associated with the severity of cleft lip with or without cleft palate (CL/P) especially during the COVID-19 pandemic with its dramatic changes. The aim of this multi-national study is to measure the association between CL/P severity, COVID-19 infection, and fear of COVID-19 in five Arab countries. This cross-sectional study took place in major governmental hospitals in five Arab countries from November 2020 to April 2023. Participants were infants born with CL/P and their mothers who were in their 1st trimester during the COVID-19 pandemic. Clinical examination was carried out, and CL/P cases were grouped according to phenotype: cleft lip and palate (CLP) versus cleft lip (CL), cleft extension (incomplete versus complete), and site (unilateral versus bilateral) to assess severity. Information on maternal COVID-19 infection and fear of COVID-19 were gathered. The study recruited 273 CL/P infants. Maternal COVID-19 infection during one-month pre-gestation and 1st trimester was significantly associated with higher odds of CL/P severity (AOR = 2.707; P = 0.002) than mothers without the COVID-19 infection. Using supplements during pregnancy showed a protective effect (AOR = 0.573; P = 0.065). Mothers infected with COVID-19 before and during pregnancy had more than twofold higher odds of having an infant with a more severe CL/P phenotype.

Assessment of antibiotic prescribing pattern and cost for hospitalized patients: A study from Palestine.

One of the largest problems facing the world today is the morbidity and mortality caused by antibiotic resistance in bacterial infections. A major factor in antimicrobial resistance (AMR) is the irrational use of antibiotics. The objective of this study was to assess the prescribing pattern and cost of antibiotics in two major governmental hospitals in the West Bank of Palestine. A retrospective cohort study was conducted on 428 inpatient prescriptions containing antibiotics from two major governmental hospitals, they were evaluated by some drug use indicators. The cost of antibiotics in these prescriptions was calculated based on the local cost. Descriptive statistics were performed using IBM-SPSS version 21. The mean ± SD number of drugs per prescription (NDPP) was 6.72 ± 4.37. Of these medicines, 38.9% were antibiotics. The mean ± SD number of antibiotics per prescription (NAPP) was 2.61 ± 1.54. The average ± SD cost per prescription (CPP) was 392 ± 744 USD. The average ± SD antibiotic cost per prescription (ACPP) was 276 ± 553 USD. The most commonly prescribed antibiotics were ceftriaxone (52.8%), metronidazole (24.8%), and vancomycin (21.0%). About 19% of the antibiotics were prescribed for intra-abdominal infections; followed by 16% used as prophylactics to prevent infections. Almost all antibiotics prescribed were administered intravenously (IV) 94.63%. In general, the average duration of antibiotic therapy was 7.33 ± 8.19 days. The study indicated that the number of antibiotics per prescription was statistically different between the hospitals (p = 0.022), and it was also affected by other variables like the diagnosis (p = 0.006), the duration of hospitalization (p < 0.001), and the NDPP (p < 0.001). The most commonly prescribed antibiotics and the cost of antibiotics per prescription were significantly different between the two hospitals (p < 0.001); The cost was much higher in the Palestinian Medical Complex. The practice of prescribing antibiotics in Palestine's public hospitals may be unnecessary and expensive. This has to be improved through education, adherence to recommendations, yearly immunization, and stewardship programs; intra-abdominal infections were the most commonly seen infection in inpatients and ceftriaxone was the most frequently administered antibiotic.

Knowledge of ICU nurses toward prevention of ventilator associated pneumonia at public hospitals in Najran, Saudi Arabia

Objective: To assess the level of knowledge among Intensive Care Unit nurses regarding Ventilator-associated pneumonia prevention at Najran Hospital in Najran City, Saudi Arabia. Methodology: This descriptive cross-sectional study was conducted among Intensive Care Unit nurses at Najran Hospital using stratified random sampling from four major government hospitals. Data were collected from 1st February to 30th April 2019, through structured questionnaires from 147 nurses. Descriptive and inferential statistics were applied using SPSS version 21. Results: The participants were primarily female (54%), married (50.6%), with a mean age of 28.4±4.2 years. A significant proportion (55.2%), had 1-3 years of Intensive Care Unit experience and the majority held diploma degrees (65.5%). More than half received Intensive Care Unit training (51.7%) and 81.6% had not undergone specific Ventilator-associated pneumonia prevention training. Only 5.7% of Intensive Care Unit nurses demonstrated good knowledge of Ventilator-associated pneumonia prevention, 57.5% exhibited moderate knowledge, and 36.8% had poor knowledge. No significant associations were found between knowledge levels and Intensive Care Unit training, gender, or years of experience (p&gt;0.05). However, a significant correlation was observed between the level of education and knowledge of Ventilator-associated pneumonia prevention (p=0.001). Conclusion: The study highlights substantial knowledge gaps among Intensive Care Unit nurses concerning Ventilator-associated pneumonia prevention, with the majority demonstrating inadequate knowledge. Urgent interventions are required to enhance the understanding of Ventilator-associated pneumonia prevention among Intensive Care Unit nursing staff.

Delay in Care Seeking for Menstrual Regulation

In Bangladesh menstrual regulation (MR) services are available at all major government and private hospitals, and even at government primary health care facilities. In spite of wide availability, women who do not use menstrual regulation services from proper facilities may resort to induce unsafe abortion by non-medical or untrained health workers in unhygienic condition. Worldwide, nearly 1 in 10 pregnancies end in unsafe abortion and World Health Organization (WHO) estimates that 18 out of 20 unsafe abortions takes place in developing countries. Induced abortion leading to complication such as bleeding, infection injuries and even death, these deaths could be prevented if women had an access to safe abortion facilities. This cross sectional study was carried out among fifty two women from family planning unit of Institute of Child and Mother Health (ICMH), Dhaka from December 2009 to May 2010. The purpose of this study was to identify the factors for delay in care seeking of menstrual regulation (MR). The data were collected by using the pretested questionnaires and cases were selected from the women who came for seeking care of MR after 10 weeks of amenorrhoea. Duration of amenorrhoea was confirmed by taking history and in some cases by ultrasonography. After incorporation of the socio-demographic data; factors or reasons of delay in MR were found due to personal, social, service and family related events. The mean age of respondents was 22.14 years. About 75% of the respondents were housewives and 79% were illiterate. The mean age of marriage 19.5 years. Regarding husband’s educational level of the respondent, more than one-third (37%) was class I – V, others one-third (33%) was above the primary level rest of the husbands were higher secondary and above. More than two-third (70%) of the respondents delivered 1 to 3 live children and used oral contraceptive pills. Most of the (87%) of women gave right answer about MR and most of them (85%) had knowledge about adverse effect of MR. Nearly two-third (65%) came to know about MR form relatives/neighbors, where one-fourth (25%) from health workers and rest them from mass media/ others. Most of the (87%) respondents answered correctly about advantages of MR, however, 60% did not know about the proper time of performing MR after cessation of menstruation. Most of the respondents (85%) knew about the side effects of MR; among them more than one-third (37%) told excessive bleeding was adverse effects of MR, however 33%, 8%, 6% and rest 4% told pain, sterility, perforation and infection respectively were the adverse effects of MR. Three-fifth (60%) of the patients didn't know about the right time of pursue care for MR and 63% of them were unaware about legal aspects of MR that they have right to seek MR. More than half of the respondents (56%) stated the reasons for the delay due to their personal problem where, 19%, 15% and 10% of them were specified the reasons as social factor, service related reason and family conflict respectively. Among the respondents of personal reason for delaying MR, more than half of them (52%) took oral tablets for abortion at home, 41% failed to understand their amenorrhoea and only 7% were unaware about service facility for MR. Regarding familial reasons for delay of MR, 60% pointed out the security problem and remaining 40% told about resistance by husband/others or absence of husband in the houses. The main (70%) social reasons of delaying MR was due to spiritual bindings and 30% was due to public disgrace. Service facility related reasons for delaying MR were treatment cost (62%), distance of facility (25%) and substandard services (13%). The study findings suggested that women had good knowledge about MR even they made delay due to unawareness of their legal rights, personal issues, social and service related causes. Strengthening of reproductive health services through community clinic at community level with available awareness building program on MR may minimize the delay for care seeking of MR among women. Bangladesh Med J. 2022 May; 51(2): 37-44

Healthcare Workers' Assessment of a Visual Triage System (VTS).

Overcrowding and extended waiting times in the emergency department (ED) can pose a significant risk of COVID-19 transmission from patients to healthy individuals. In 2017, the Saudi Ministry of Health (MOH) introduced a visual triage system (VTS) with scoring to notify healthcare workers (HCWs) in EDs about the Middle East respiratory syndrome coronavirus (MERS-CoV) infection risk. During the COVID-19 pandemic, the MOH employed a VTS to classify patients according to their potential risk of COVID-19 infection upon their admission to the ED. Suspected patients were then directed along specific pathways to reduce their contact with healthy individuals. This study assessed HCWs' satisfaction with the VTS in the ED of two major government hospitals within the Riyadh region. Additionally, it assessed HCWs' perceptions of VTS effectiveness. This study used a cross-sectional, observational design and relied on surveys for data collection. A total of 127 participants completed the survey, of which 87 (68.5%) were based in the EDs of the two hospitals. Among the ED participants, 18.1% expressed satisfaction with the VTS, 46.4% were neutral, and 33.1% reported dissatisfaction. ED participants provided feedback on the system's effectiveness, with 24.1% finding it effective, 66.7% considering it somewhat effective, and 9.2% deeming it ineffective. Of the total (127) study participants (70.1%) reported that the HCWs required better training to effectively implement the VTS infection control plans for suspected cases. Fewer than half of the participants (35.4%) deemed the time spent by VTS personnel to identify COVID-19 cases to be reasonable, whereas 22% found it too short and 27.6% considered it too long. Of the total 127 participants, 63% reported that language differences between patients and HCWs constituted barriers to the effective application of the VTS. Our study findings indicated that most ED participants had a neutral outlook on their satisfaction with the VTS and a neutral perspective on the effectiveness of VTS, viewing it as only somewhat effective. Reported weaknesses and key obstacles to the successful implementation of the VTS included language barriers. and insufficient training for HCWs, andunclear VTS pathways. The reported strengths of the VTS included its effectiveness in reducing crowds and identification of COVID-19 patients.

The ABCDE approach: Evaluation of adherence in a low-income country

BackgroundEarly recognition and initial treatment of trauma patients prevents deterioration and buys time for making a definitive diagnosis. The “Airway, Breathing, Circulation, Disability and Exposure” (ABCDE) approach should be used whenever an injury is suspected. It provides quick identification and management of life-threatening problems. Still, there is limited knowledge regarding adherence to the ABCDE approach. This research aims to assess the adherence of the trauma team members to the ABCDE approach in the management of major trauma patients and the factors affecting it. MethodThe study is a cross-sectional hospital-based study conducted in the trauma and resuscitation rooms of major governmental hospitals in Khartoum in the period from Jan.30, 2022, to Mar.29, 2022. It was done among the medical staff dealing with major trauma cases. Data were collected by observation using a modified standardized checklist for assessing the ABCDE approach and via a self-administered questionnaire for identifying the factors affecting adherence. Total coverage of all major trauma cases resuscitation (n = 50) was done. Also, a sample size of 158 medical staff was covered for the questionnaire. The data was analyzed in Statistical Package for the Social Science (SPSS) V.23. ResultsThe mean percentage of adherence to the ABCDE approach was 37.9 % (SD 15.44). When the ABCDE sequence was not followed, the ACB was the commonest sequence. Also, adherence had no significant relation with any patient or staff-related factor. The main present obstacles to adherence to the ABCDE approach were overcrowding in the room and unprepared facilities. While the major present facilitator was the clinical experience. ConclusionThe adherence rate was low, but initiation of the ABCDE approach was rapid. The factors participating in low adherence rates were usually facility or population-based factors. We recommend further studies, further training and embedment of guidelines, and the provision of larger trauma rooms with adequate supplies.

Insomnia among Intensive Care Unit Nurses in the United Arab Emirates and its Association to Work Productivity and Quality of Life

Background: A healthy workforce is essential for sustainable healthcare systems, disease control, and the provision of quality and safe healthcare services. Insomnia is a common problem among critical care nurses attributed to the hard nature of their work, long and irregular shifts, high levels of stress and tension, and exposure to traumatic situations associated with critical care environments. These issues compromise their professional and personal lives, have financial consequences for health organizations, and may reduce the quality of care provided to patients. Aim: To assess the prevalence of insomnia among ICU nurses and determine its impact on their Quality of Life (QoL) and work productivity. Methods: This cross-sectional study involved 430 ICU nurses working in three major governmental hospitals in the United Arab Emirates. Nurses were selected via convenient sampling. Data collected included nurses’ demographic characteristics, insomnia levels using the Athens Insomnia Scale, work productivity using the workability index, and QoL using the World Health Organization Quality of Life Scale-Brief questionnaire Results: Approximately 237 (55%) of participants reported moderate to severe levels of insomnia, and 195 (45.3%) had moderate productivity levels. However, the majority of participants reported low QoL levels in physical, psychological, social, and environmental QoL domains (61.4%, 60.2%, 47.2%, and 70.5%), respectively. Bivariate correlations demonstrated a significant negative relationship; correlation coefficient of -0.517, between participants' insomnia levels and work productivity levels. Additionally, significant negative relationships were found between insomnia levels and the QoL domains, with correlation coefficients of -0.629, -0.568, -0.469, and -0.485, respectively. Conclusion: This study found that insomnia has a negative relationship with ICU nurses’ work productivity and QoL. This may impact care delivery patient care and safety.Regular counseling sessions, better working hours, less overtime, and a better work-life balance may contribute to increased productivity and improved QoL among ICU nurses in the UAE.

A machine learning approach to predict the parameters of COVID‐19 severity to improve the diagnosis protocol in Oman

The purpose of this study is to utilize a Machine Learning-based methodology for predicting the key parameters contributing to severe COVID-19 cases among patients in Oman. To carry out the investigation, a comprehensive dataset of patient information, encompassing a range of blood parameters, was acquired from major government hospitals in Oman. Diverse machine learning algorithms were deployed to uncover underlying trends within the acquired dataset. The outcomes of this research delineated the determinants of severe cases into two categories: non-blood-related parameters and blood-related parameters. Among non-blood-related factors, advanced age, gender, and the presence of chronic kidney disease emerged as risk factors contributing to unfavorable prognoses, particularly in elderly patients. In the realm of blood parameters, male patients with blood types O-positive and A-positive exhibited heightened susceptibility to severe illness compared to their female counterparts. Additionally, deviations in Hemoglobin levels, Mean Cell Volume, and Eosinophil counts were identified as drivers of poor prognoses among elderly patients. The implications of these research findings extend to aiding healthcare decision-makers in quantifying the associated risks, health benefits, and cost-effectiveness pertaining to COVID-19. Furthermore, the acquired insights can empower decision-makers to refine the management of COVID-19, expediting treatment protocols and minimizing the risk of mortality. Interestingly, the study unveiled a correlation linking blood type to disease progression. A notable finding indicated that a staggering 96.5% of patients succumbed to the disease even when their blood sodium levels remained in the standard range of 136–145 mmol/L. These insights hold immense value for healthcare institution decision-makers, allowing a more in-depth evaluation of the risks, health benefits, and the cost-effectiveness related to COVID-19. Consequently, the findings offer a guiding light for implementing pivotal measures, optimizing treatment protocols, and substantially reducing mortality risks associated with the virus.

Perceived Relationship Between Horizontal Violence and Patient Safety Culture Among Nurses.

Despite the value of undertaking patient safety culture, its association with horizontal violence in nursing workplace is still understudied. This study aimed to investigate the association between the perceived patient safety culture and its relationship with horizontal violence among nurses working in Jordan. A cross-sectional correlational design was used. Nurses working in major governmental hospitals in Jordan were conveniently recruited to complete an online self-administered questionnaire, which included the following tools: Hospital Survey on Patient Safety Culture and Negative Behaviours in Healthcare (NBHC) Survey. The survey was designed to measure attitudes and perceptions on patient safety culture at multiple levels of a healthcare organization with ten dimensions. The Negative Behaviours in Healthcare (NBHC) survey was developed as an adaptation of the Lateral Violence in Nursing Survey (LVNS) with 25 items and two open-ended questions. A total of 330 nurses responded to the questionnaire. Nurses moderately perceived patient safety culture (HSOPS mean = 3.5, SD = 1.1). Low incidence of horizontal violence was claimed (mean = 2.1, SD = 1.1). However, it was associated with moderate negative correlation with patient safety culture (r = -0.53, p < 0.001). Regression model revealed that patient safety culture explained an additional 53% of the variance of horizontal violence after controlling the effects of age and length of clinical experience (R-square change: 0.560, SE: 19.7, P: 0.001, CI: 1.21-1.57). Despite its low incidence, patient safety culture was found influential to the horizontal violence based on the perspectives of nurses in Jordan. Patient safety culture can be incorporated with other factors that contribute to the development of horizontal violence in nursing workplace.

Viral etiologies of lower respiratory tract infections in children < 5 years of age in Addis Ababa, Ethiopia: a prospective case–control study

BackgroundLower respiratory tract infections (LRTIs) are a major cause of morbidity and mortality in children worldwide and disproportionally affect Sub-Saharan Africa. Despite the heaviest burden of LRIs in Ethiopia, to date, no published studies have reported a comprehensive viral etiology of LRTIs among children in Ethiopia. The objective of this study was to determine and estimate the etiological contribution of respiratory viruses to LRTIs in < 5 years children in Ethiopia.MethodsA prospective case–control study was conducted from September 2019 to May 2022 in two major governmental hospitals, St. Paul Hospital Millennium Medical College and ALERT Hospital in Addis Ababa, Ethiopia. Nasopharyngeal/oropharyngeal samples and socio-demographic and clinical information were collected from children under 5 years. A one-step Multiplex real-time PCR (Allplex™ Respiratory Panel Assays 1–3) was done to detect respiratory viruses. STATA software version 17 was used for the data analysis. We computed the odds ratio (OR), the attributable fraction among exposed (AFE) and the population attributable fraction (PAF) to measure the association of the detected viruses with LRTIs.ResultsOverall, 210 LRTIs cases and 210 non-LRTI controls were included in the study. The likelihood of detecting one or more viruses from NP/OP was higher among cases than controls (83.8% vs. 50.3%, p = 0.004). The multivariate logistic regression showed a significantly higher detection rate for RSV A (OR: 14.6, 95% CI 4.1–52.3), RSV B (OR: 8.1, 95% CI 2.3–29.1), influenza A virus (OR: 5.8, 95% CI 1.5–22.9), and PIV 1 (OR: 4.3, 95% CI 1.1–16.4), among cases when compared with controls. The overall AFE and PAF for RSV A were (93.2% and 17.3%), RSV B (87.7% and 10.4%) and Influenza A virus (82.8% and 6.3%), respectively. The mean CT values were significantly lower for only RSV B detected in the case groups as compared with the mean CT values of RSV B detected in the control group (p = 0.01).ConclusionsRSV, Influenza A and PIV 1 viruses were significantly associated with LRTIs in < 5 years children in Addis Ababa, Ethiopia. Therefore, we underscore the importance of developing prevention strategies for these viruses in Ethiopia and support the importance of developing and introducing an effective vaccine against these viruses.

Molecular characterization and epidemiology of methicillin-resistant Staphylococcus aureus isolated from clinical samples in Sokoto, Nigeria

Objectives: Methicillin-resistant Staphylococcus aureus (MRSA) is a major public health threat and a cause of hospital-acquired and community-acquired infections. This study was undertaken to investigate antimicrobial resistance pattern, the genetic lineage, presence of S. aureus protein A (SPA) gene, and staphylococcal chromosomal cassette mec (SCC mec) types of MRSA isolated from clinical samples sent for microbiological test in major government hospitals in Sokoto. Material and Methods: A total of 90 S. aureus MRSA isolates were collected and confirmed using standard microbiological techniques. Antibiotic susceptibility testing was done using the disk diffusion method; mecA detection and sequencing were carried out. Phylogenetic reconstruction was also done using the molecular evolutionary genetics analysis X software and phylogeny tree constructed by Neighbor-Joining method. SCC mec typing and SPA detection were also done. Results: Of the 90 S. aureus isolates, 42 were found to be MRSA using the cefoxitin disk diffusion, the most potent antibiotic against them was quinupristin/dalfopristin with 83.3% followed by rifampicin with 81.0% and 6 clindamycin with a 71.4%. With 78.6% of the isolates showing resistance to the fluoroquinolone antibiotic ciprofloxacin, tetracycline and gentamicin came in second and third, with 64.3% and 61.9% of isolates showing resistance, respectively. Most of the MRSA isolates were resistant to more than three antibiotics. Polymerase chain reaction showed 36 (85.7%) harbored the mecA gene and of the 36 mecA positive isolates, phylogenetic reconstruction of representative MRSA sequences showed that MRSA sequences in this study clustered in two closest clades suggesting a possible horizontal transfer. Of the 36 isolates, 23 were SCC mec type I, ten were type IV, and three were non-typeable, while the SPA gene was detected in all the isolates amplified. Conclusion: The use of phenotypic and molecular methods in this study provided useful information on antibiotic resistance profile, epidemiology, and molecular characteristics of MRSA isolates in Sokoto Nigeria. The information provided could help in monitoring the evolution of MRSA strains in Nigeria over time.

Risk factors for SARS-CoV-2 infection among health workers in India: a case control study.

COVID-19 was declared as a Public Health Emergency of International Concern on 30th January 2020. Compared to the general population, healthcare workers and their families have been identified to be at a higher risk of getting infected with COVID-19. Therefore, it is crucial to understand the risk factors responsible for the transmission of SARS-CoV-2 infection among health workers in different hospital settings and to describe the range of clinical presentations of SARS-CoV-2 infection among them. A nested case-control study was conducted among healthcare workers who were involved in the care of COVID-19 cases for assessing the risk factors associated with it. To get a holistic perspective, the study was conducted in 19 different hospitals from across 7 states (Kerala, Tamil Nadu, Andhra Pradesh, Karnataka, Maharashtra, Gujarat, and Rajasthan) of India covering the major government and private hospitals that were actively involved in COVID-19 patient care. The study participants who were not vaccinated were enrolled using the incidence density sampling technique from December 2020 to December 2021. A total of 973 health workers consisting of 345 cases and 628 controls were recruited for the study. The mean age of the participants was observed to be 31.17 ± 8.5 years, with 56.3% of them being females. On multivariate analysis, the factors that were found to be significantly associated with SARS-CoV-2 were age of more than 31 years (adjusted odds ratio [aOR] 1.407 [95% CI 1.53-1.880]; p = 0.021), male gender (aOR 1.342 [95% CI 1.019-1.768]; p = 0.036), practical mode of IPC training on personal protective equipment (aOR 1. 1.935 [95% CI 1.148-3.260]; p = 0.013), direct exposure to COVID-19 patient (aOR 1.413 [95% CI 1.006-1.985]; p = 0.046), presence of diabetes mellitus (aOR 2.895 [95% CI 1.079-7.770]; p = 0.035) and those received prophylactic treatment for COVID-19 in the last 14 days (aOR 1.866 [95% CI 0.201-2.901]; p = 0.006). The study was able to highlight the need for having a separate hospital infection control department that implements IPC programs regularly. The study also emphasizes the need for developing policies that address the occupational hazards faced by health workers.

Caught in the Crossfire: How Work-Family Conflict Affects the Lives of Married Nurses in India

Purpose- This research aimed to examine the nature of the relationship between work and life among married nurses in Jammu and Kashmir, IndiaDesign/Methodology- A questionnaire with measures for work-family conflict, life satisfaction, and family satisfaction was administered. The nodal agency, Government Medical College (GMC), provided the researcher with a list of nurses and their marital statuses. A sample of 253 nurses was analyzed using simple random sampling from a list of potential 527 nurses. These 253 respondents worked at five major government hospitals. In addition to the work-family measures, questions on age, work experience, job grade, and family type were askedFindings- The results revealed a significant relationship between work and family conflict with both life satisfaction as well as family satisfaction. In both cases, the time-based, and strain-based conflict scored higher than the behavior-based conflict in influencing family and life satisfaction negativelyPractical Implications- The results highlight the need for organizational support for nurses, which can be in the form of flexible work schedules, and other time-saving techniques. Given that nurturing responsibilities are shouldered by women in India not only monetary but non-monetary benefits should be availed to the nurses to alleviate their work-family conflict.

Congenital Craniofacial Anomalies amongst Neonates at Major Government Hospital in Bengaluru: A Cross-Sectional Study

Introduction: Craniofacial anomalies (CFAs) are a manifold group of malformations in the growth of the head and face. Congenital anomalies are the major cause for pregnancy termination, infant mortality as well as childhood morbidity. The occurrence of congenital CFAs in the Indian population remains unlashed. Objectives: The objective of the study is to assess the frequency of incidence and types of CFAs and also their association with maternal risk factors. Materials and Methods: A cross-sectional survey was conducted on the mothers/babies delivered for 60 days at Vanivilas Hospital, Bengaluru. The anomalies were broadly classified as major and minor, further by structure as cranial, oral, nasal, auricular, and ocular. Data were analyzed to determine the association of these anomalies with mother’s age, gestational age, gender, and weight of the baby. Results: Out of 2251 deliveries, 158 were dead of which 12 (7.6%) had major CFAs. About 0.8% of major anomalies and 3.0% of minor anomalies occurred. The most common major craniofacial anomaly observed was anencephaly. In minor anomalies, anomalies of the oral cavity included gingival cyst, tongue-tie, epulis, and natal teeth. Mothers with age &gt;35 years and gestational age &lt;37 weeks had higher risk for major CFAs. Conclusions: This study provides baseline information for future prevention and better management of patients likely to have babies with congenital major and minor CFAs.

Physical Access Related User-Friendliness of Sexual and Reproductive Health Services for Women With Disabilities in Various Hospitals in a City in North India: An Integrated Qualitative and Quantitative Study.

Access to optimum health care services is vital for every woman. Women with disabilities (WWD), in particular, face multiple discrimination and social exclusion on this issue. The objective of the study was to evaluate the user-friendliness of sexual and reproductive health (SRH) services in terms of the physical access to health facilities in various hospitals in a city in north India. This cross-sectional evaluation study was conducted during 2013-2017 in five purposively selected major government hospitals in a city in north India. A disabled friendliness evaluation tool was used to analyze the barriers to physical access in terms of approach to SRHcare facilities. Data analysis was done through MicrosoftExcel (Microsoft, Redmond, WA, USA) and content analysis. Results: Overall, 270 respondents aged 15 years and above with at least 40% disability were interviewed for the study. Lack of access to SRH care in hospitals (infrastructure/equipment/communication/transport) was the main barrier (46.36%) reported by WWD. Most of the hospitals lacked any special provisions for people with disability (PWD). Proper ramps, stairs, toilets, etc. were not present in hospitals as denoted by their verbatim responses. All the hospitals scored low on access to sexual and reproductive health services for WWD.

Emergency Physicians' Awareness of Medico-Legal Case Management: A Cross-Sectional Study from Saudi Arabia.

Emergency department physicians often encounter medico-legal cases when patients initially present to the hospital, and thus there is a strong need for them to have robust medico-legal management and reporting knowledge. To assess the awareness of emergency department physicians of two major hospitals in the Eastern Province of Saudi Arabia in managing medico-legal cases. This descriptive cross-sectional survey-based study included all adult and pediatric emergency physicians working at King Fahd Hospital of the University and King Fahd Specialist Hospital, two major government hospitals in the Eastern Province of Saudi Arabia. The questionnaire included questions about demographic information, the workload in the emergency department, previous medico-legal training, and information about physicians' perspectives regarding medico-legal situations. A total of 85 physicians completed the questionnaire, with most being Saudis (78.8%) and consultants (44.7%). Most participants (84.7%) immediately notified the police authority through the official procedure on suspicion of a case being criminal. However, only 28.2% of the participants were aware of how to complete the medico-legal report, and the majority (82.4%) had not received any specific training or attended specific courses in writing medico-legal reports. Most participants (91.8%) expressed the need for additional medico-legal case training programs, with continuous education (29.4%) being the preferred mode. In addition, 60% of the consultants were dissatisfied with the current medico-legal reporting and management workflow in their hospital. About half of the participants did not obtain photographs in medico-legal cases and did not know if their workplace provided a protocol for collecting evidentiary material such as clothes, swabs, bullets, remnants of foreign bodies, etc. The results of the present study indicate the necessity to consider periodical continuing medical education programs and workshops for emergency department physicians in the Eastern Province of Saudi Arabia to help them in appropriately handling medico-legal cases.

The profile of Saudi male nursing workforce: A cross-sectional study

This study aims to determine the profile of the Saudi male nursing workforce that influences tenure in their job and their intentions in staying on the job or leaving their job. This research used the quantitative-comparative approach employing 361 nurses as participants from the three major government hospitals namely, King Faisal Specialist Hospital and Research Center, King Abdulaziz Medical City, and King Fahad Medical Center in Riyadh city, Kingdom of Saudi Arabia. Results showed that nurses in the workforce perceived the lack of promotion opportunities as the main reason for leaving the nursing profession (3.92±.952) and the reason for becoming a nurse wanted to help others cope with illness (4.68). There is a significant difference found in age to reasons (F=11.51; p&lt;001) opinion of becoming a nurse (F=6.73; p&lt;001), highest qualification on their reasons for leaving the nursing profession (F=11.8; p&lt;.001) but not on the opinion of nurses (F=.690; p&gt;.502). Moreover, the years of experience of the nurses were found significant to reasons (F=5.085; p&lt;.002) and opinion (F=4.89; p&lt;.002). Regarding the position held, there found significant differences in reasons for leaving (F=9.05; p&lt;.001) and their opinion about becoming a nurse (F=11.81; p&lt;.001). Concerning marital status there found significant differences in their reasons for leaving the nursing profession (t=5.779; p&gt;.290) and their opinion (t=1.39; p&gt;.573). Meanwhile, the number of dependents found no significant difference in their reasons (t=2.248; p&gt;0.38) and opinion (t=.820; p&gt;.366). Continuous skill development and career progression opportunities for male nurses contribute to job satisfaction and, as a result, it will be the key to gaining greater autonomy for Saudi Arabia's nurses.

Point prevalence survey of antibiotic utilization in secondary care hospital in the United Arab Emirates.

The present study was carried out to identify and report the pattern of antibiotics prescribing to determine the adherence to the international empirical and therapeutic guidelines of antibiotic use. A point prevalence survey took place at a selected date of January 26, 2020, in which data collection was performed to all the patients present in the hospital who used at least one systemic antibiotic agent as an inpatient from 00:00 am until midnight of that day. This was performed using European Surveillance of Antimicrobial Consumption (ESAC - audit tool). The participated hospital in this point prevalence study represents a major government hospital in the UAE. Descriptive statistics were used and results were expressed using standard statistical methods. Out of the 125 hospitalized patients, a total of 41 (32.8%) patients were included in the survey and treated with different trends of antibiotics on the date point prevalence survey. The total number prescribed antibiotics was 54 with a higher percentage of treatment indication (70.4%), compared to prophylaxis indication (29.6%). The combinations of penicillin's win in being the most commonly used agents by a percent of 31.5%, including the use of Amoxicillin-clavulanic acid by 22.2% and Piperacillin-tazobactam with 9.3%. The compliance with local/international guidelines accounts for 78.0% of the treated & prophylaxis patients. Considerable results have been obtained which can assure the quality improvement of the antibiotic use in the studied hospital.