Respiratory Ward Research Articles

A Rare Cause of Black Pleural Effusion

A 64-year-old man was admitted to the respiratory ward with a 2-week history of progressive dyspnea. He had lost 5 kg in body weight during the previous 2 months. He had a mild dry cough, but he denied a history of fever, or night sweats. One year previously, he had undergone spleen and pancreatic tail resection in a local hospital because of abdominal trauma. He reported no history of hypertension, diabetes, or hyperlipidemia, and he had no personal or family history of cancer; however, he had a >40-year history of smoking.

The impact of pharmacist-led antimicrobial stewardship program on antibiotic use in a county-level tertiary general hospital in China: A retrospective study using difference-in-differences design.

BackgroundInappropriate use of antibiotics has become a major driver for the spread of antimicrobial resistance globally, particularly common in China. Antimicrobial stewardship programs are effective in optimizing antimicrobial use and decreasing the emergence of multi-drug-resistant organisms, and the pharmacist has performed a leading role in this program.ObjectiveTo evaluate the impact of antimicrobial stewardship programs driven by pharmacists on antibiotic consumption and costs and the appropriateness of antibiotic use.MethodsA single-center retrospective quasi-experimental design was conducted in two independent hepatobiliary surgery wards and two independent respiratory wards in a county-level tertiary general hospital in Jiangsu, China. Each intervention group was served with antimicrobial stewardship programs with prescriptions audit and feedback, antibiotics restriction, education, and training. The propensity score matching method was employed to balance confounding variables between the intervention group and control group, and a difference-in-differences analysis was used to evaluate the impact of antimicrobial stewardship programs. The primary outcome was measured by scores of rationality evaluation of antibiotics.ResultsThe DID results demonstrated that the implementation of the antimicrobial stewardship programs was associated with a reduction in the average length of hospital stay (coefficient = −3.234, p = 0.006), DDDs per patient (coefficient = −2.352, p = 0.047), and hospitalization costs (coefficient = −7745.818, p = 0.005) in the hepatobiliary surgery ward, while it was associated with a decrease in DDDs per patient (coefficient = −3.948, p = 0.029), defined daily doses per patient day (coefficient = −0.215, p = 0.048), and antibiotic costs (coefficient = −935.087, p = 0.014) in the respiratory ward. The program was also associated with a decrease in rationality evaluation scores (p < 0.001) in two wards.ConclusionThe result reveals that the implementation of the antimicrobial stewardship programs is effective in reducing the length of hospital stay, decreasing antibiotics consumption and costs, and improving the appropriateness of antimicrobial use such as decreasing irrational use of cephalosporins, reducing combinations, and improving timely conversion. However, great attention ought to be paid to the improper use of broad-spectrum antibiotics. The government is responsible for providing sustainable formal education for pharmacists, and more funding and staff support to promote antimicrobial stewardship programs.

Hospital preparedness for COVID-19 at a base level hospital in Galle District, Sri Lanka

COVID-19 is a contagious respiratory illness caused by SARS-CoV-2. As such, it is challenging to maintain the safety of healthcare workers while delivering care to patients during the COVID-19 pandemic. The health sector has thus implemented various strategies to enhance hospital preparedness and ensure safety. The aim of this study is then to assess the hospital’s preparedness for COVID-19 at a base hospital in Galle District, to ensure safety. A descriptive cross-sectional study was conducted among medical officers and nursing officers in Galle district. A self-administered questionnaire and an observational checklist were used to collect data. Response rate was 90.52%. Majority were female 88.8% (n=221). Majority of the participants were between 30-39 years of age (n=144 %). Study sample consisted of 62 (24%) medical officers and 196 (76%) nursing officers and the majority (n=152, 58.9%) had more than 10 years of work experience. Furthermore, the majority 81.4% (n=210) were aware of updates about guidelines and circulars regarding COVID-19 issued by the Ministry of Health. Frequent hand washing was practiced by 96.9% (n=250) while social distancing was not practiced by a considerable number of participants (n=77, 29.8%). 90.7% (n=234) participants were not exposed to training on outbreak management. A considerable proportion was not confident about the correct practice of donning and doffing (n=60, 23.2%). The absence of a dedicated respiratory ward and a separate venue at emergency treatment unit to manage patients with respiratory symptoms were noted. There were deficiencies of adherence to social distancing, training, self-confidence and physical arrangement of hospital. Ergo, it is noted that implementing training programs on outbreak response and building trust between the institution and staff on safety will improve the preparedness in future outbreaks.

Antimicrobial susceptibility and genotyping of microorganisms isolated from sputum culture of children with cystic fibrosis in an Iranian referral children's hospital.

Chronic bacterial infections of the airways are present in most patients with cystic fibrosis (CF). Although most pathogens are acquired from the environment, there is great evidence of patient-to-patient transmission. Therefore, evaluating the genetic variation of strains isolated from CF patients is recommended for the purpose of examining hospital infection. The aim of this study was to determine the antibiotic susceptibility pattern and genotyping of Staphylococcus aureus and Pseudomonas aeruginosa strains isolated from sputum samples of children with CF referred to asingle pediatric CF center in Tehran, Iran. In this cross-sectional study, the antimicrobial susceptibility profiles of strains isolated from patients with CF during 1year were determined. Pseudomonas aeruginosa and S.aureus isolates were genotyped using the random amplified polymorphic DNA polymerase chain reaction method and were analyzed using GelComparII software. Of 534patients with CF, 384 had negative sputum cultures (72%), and 94strains of P.aeruginosa (18%) and 53strains of S.aureus (10%) were isolated. The mean age of the patients was 8.22 ± 5.7years (range, 2months to 18years). The P.aeruginosa strains showed high sensitivity to ceftazidime (96%), piperacillin/tazobactam (96%), and imipenem (94%). All strains of S.aureus were susceptible to vancomycin, and 13% of the strains were methicillin-resistant S.aureus. High resistance to penicillin (92%) and erythromycin (88.5%) were reported. The results of P.aeruginosa genotyping revealed that there were six major clusters in this hospital. Also, based on the analysis of genotyping results, S.aureus strains were obtained from five clusters, most of which were located in cluster B1 (34isolates, 64%). The results of this study show the possibility of strains being transferred from one part of the hospital to another (especially from the respiratory ward to other areas). Hence, high attention should be paid to the basic methods of preventing infection.

COVID-19 Serosurvey of Frontline Healthcare Workers in Western Australia

We aimed to study COVID-19 infection in healthcare workers (HCWs) during the first wave in a setting of low community incidence prior to HCW vaccination. We performed a cross-sectional study of frontline HCWs in two tertiary hospitals in Western Australia with questionnaire and testing for SARS-CoV-2 IgG antibodies, using a screening assay followed by confirmatory assays for initial reactive results. 799 Frontline HCWs were enrolled in the study, working in the emergency department (n = 194, 24.2%), ICU (n = 176, 22.0%), respiratory ward (n = 20, 2.5%), COVID clinic (n = 37, 4.6%), and theatre (n = 222, 28%). 189 (23.6%) were doctors, 327 (41.0%) nurses, and 283 (35.4%) other. Contact with a known COVID-19-positive patient occurred at work for 337 (42.1%), and outside work for 10 (1.2%). Four were diagnosed with COVID-19 by PCR, acquired overseas in two cases and related to healthcare work in two cases (one acquired from a colleague and one possibly acquired from patient contact in the healthcare setting). Nine HCWs had reactive screening serology, and three had confirmed positive IgG (these three were PCR-positive cases). Infection control procedures in the setting of low community incidence were effective at preventing HCW acquisition of COVID-19 infection.

Association Between Low Serum Creatinine and Mortality in Patients With Severe Chronic Obstructive Pulmonary Disease.

Introduction: Muscle mass may be a better predictor of mortality than BMI in chronic obstructive pulmonary disease (COPD). Serum creatinine depends on muscle mass and renal function; low values may predict higher mortality.Objective: To determine whether there is an association between low serum creatinine and mortality in severe COPD.Methods: This is a retrospective study of serum creatinine values at admission and within the last year before admission. Outcomes measured were mortality at 30 days and one year after admission in patients with acute type 2 respiratory failure secondary to COPD, who were admitted over a one-year period to a respiratory ward (N = 130). The statistics were calculated using the chi-squared test.Results: There appears to be a significant relationship between the one-year pre-admission creatinine values and mortality at one year (p = 0.0003).Conclusions: The relationship with mortality appears to be stronger with pre-admission creatinine values rather than the admission values and appears to predict the patients at the highest risk of mortality one year after admission.

Determinants of the health care service choices of long-term mechanical ventilation patients: Applying andersen's behavioral model.

AimsThe number of ventilator-dependent patients is rapidly increasing globally. As a result, long-term mechanical ventilation (LTMV) patients face the choice of receiving health care in respiratory care wards (RCWs) rather than at home. In this study, we applied Andersen’s behavioral theoretical model (ABM) to investigate the determinants of the health care service decisions of patients receiving LTMV.MethodsA cross-sectional research design and cluster random sampling were used to select 365 participants from nine RCWs and eight home care facilities in northern Taiwan. Data were collected in face-to-face interviews using a structured questionnaire.ResultsOf the predisposing factors, advanced age and an education level of at least junior high school influenced the choice to use RCW services. Being married, living with extended family, and medium or higher socioeconomic status were associated with the decision to use home care services. Of the enabling factors, patients with more caregivers, those whose family caregivers held strong beliefs about providing care, and those who perceived greater social support from health care providers were more likely to choose home care services. Of the need factors examined, poor cognitive function and higher dependence on assistance for activities of daily living (ADL) increased the probability of patients choosing RCW services. Hierarchical logistic regression analysis indicated that our final model accounted for 44.8% of the observed variance in health care service choice.ConclusionsABM enables an improved understanding of the health care service choices of LTMV patients. Our findings also highlight the importance of rigorously assessing patient needs and helping patients choose the most appropriate health care service.

Antibiotic resistance of airborne bacterial populations in a hospital environment.

Bacteria in a hospital environment potentially cause hospital-acquired infections (HAIs), particularly in immunocompromised individuals. Treatments of HAIs with antibiotics, however, are ineffective due to the emergence of antibiotic-resistant bacteria (ARB). This study aims to identify airborne bacteria in a tertiary hospital in Malaysia and screen for their resistance to commonly used broad-spectrum antibiotics. Airborne bacteria were sampled using active sampling at the respiratory ward (RW), physician clinic (PC) and emergency department (ED). Physical parameters of the areas were recorded, following the Industry Code of Practice on Indoor Air Quality 2010 (ICOP IAQ 2010). Bacterial identification was based on morphological and biochemical tests. Antibiotic resistance screening was carried out using the Kirby-Bauer disk diffusion method. Results showed that the highest bacterial population was found in the highest density occupancy area, PC (1024 ± 54CFU/m3), and exceeded the acceptable limit. Micrococcus spp., Staphylococcus aureus, α- and β-Streptococcus spp., Bacillus spp. and Clostridium spp. colonies were identified at the sampling locations. The antibiotic resistance screening showed a vast percentage of resistance amongst the bacterial colonies, with resistance to ampicillin observed as the highest percentage (Micrococcus spp.: 95.2%, S. aureus: 100%, Streptococcus spp.: 75%, Bacillus spp.: 100% and Clostridium spp.: 100%). This study provides awareness to healthcare practitioners and the public on the status of the emergence of ARB in a hospital environment. Early detection of bacterial populations and good management of hospital environments are important prevention measures for HAI.

Development and assessment of an educational intervention to improve the recognition of frailty on an acute care respiratory ward

BackgroundFrailty is a robust predictor of poor outcomes among patients with chronic obstructive pulmonary disease yet is not measured in routine practice. We determined barriers and facilitators to measuring frailty...

Accuracy of Transthoracic Ultrasound in the Diagnosis of Different Pleural and Pulmonary Diseases: Zagazig University Experience

Recently, there is an increase application of chest ultrasound to evaluate and monitor pleuropulmonary diseases. Computed tomography (CT) is the gold standard for most different lung pathologies with limitations. This study aims to assess the effectiveness of Chest Ultrasound compared to Computed Tomography in diagnosis of different pleuropulmonary disorders and to define the rules of chest ultrasound in pulmonary medicine. This study was conducted upon randomly selected 110 patients with different pleuropulmonary disorders who were admitted to the respiratory ward and ICU, Zagazig University Hospitals, from April 2018 to April 2020. All patients with abnormal chest X. ray opacities were evaluated for complete history taking, full clinical examination, laboratory investigations, then Chest US was performed on the first day of admission then CT was done as a gold standard for the final diagnosis then results of both Chest US and CT were compared. Compared to CT, Chest US had sensitivity (95.8%) for free pleural effusion diagnosis, specificity (90.3%), and (92.7%) accuracy; for pneumonia, (90.9%), (96.1%), and (94.5%) respectively, while pneumothorax had (81.8%), (98%), and (96.3%) accuracy, respectively; for pulmonary edema, (89.5%), (97.8%), and (96.4%) accuracy, respectively. The US plays a valuable role in the diagnosis of different pleuropulmonary diseases and can be used as the first routine radiological modality in both ward &amp; ICU.

Early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary diseaseon general respiratory wards

Background- Chronic Obstructive Pulmonary disease (COPD) as defined by Global Initiative for Obstructive Lung Disease (GOLD) is a common preventable and treatable disease, is characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases. Objectives-To evaluate outcome of NIV in terms ofTime for reversion of pH to normal, Duration of NIV, Hospital stay, Failure of NIV, Mortality and to compare the effect of noninvasive mechanical ventilation (NIV) in severelyacidotic (pH &lt; 7.25) with mildly acidotic (pH 7.25–7.35) patients with acute hypercapnic chronic obstructive lung disease (COPD) Methods-This is a prospective observational study of COPD patients with acute Type 2 respiratory failure initiated on NIV conducted in Christian Medical College, Vellore, Tamil Nadu. The study was conducted in the Department of Pulmonary Medicine, Christian Medical College, Vellore.Assuming the mean as 12h (SD=6h), the sample size is Hence it is decided to sample 25 mild acidosis and 25 severe acidosis cases for this study. In the present study, 53 patients were recruited from April 2017 to June 2018.

Antibiotic-resistant bacteria contamination in the air of different departments in hospital

To investigate the contamination of antibiotic-resistant bacteria in air of different departments in hospital. From 2018.07 to 2021.06, 191 samples of the air-conditioning filter dust in three hospitals were collected. Antibiotic-resistant bacteria were isolated from the accumulated dust. The drug sensitivity test was conducted for Staphylococcus aureus, Acinetobacter baumannii and Enterobacteriaceae. A total of 119 samples were detected antibiotic-resistant bacteria from 191 samples, and the detection rate was 62.30%. The detection rate of different departments from high to low was surgical ward(68.29%) &gt;intensive care unit(ICU)(59.62%) &gt;medical ward(57.92%). A total of 362 strains of antimicribial-resistant organisms were isolated, mainly were Acinetobacter(28.73%), Pseudomonas(22.10%), Bacillus(22.10%), Staphylococcus(9.12%), etc. Among them, 72 strains of target organisms were detected, and the detection rate was 19.89%(72/362), the detection rate of different target bacteria from high to low was Acinetobacter baumannii(12.71%)&gt;Enterobacteriaceae(4.72%)&gt;Staphylococcus aureus(2.76%)(P&lt;0.05). The drug sensitivity test showed that 41 strains of antimicribial-resistant organisms were detected, and the detection rate was 56.94%(41/72), including carbapenem-resistant Acinetobacter baumannii(CR-ABA), methicillin-resistant Staphylococcus aureus(MRSA), carbapenem-resistant Enterobacteriaceae(CRE), etc.24 strains of multidrug-resistant organisms(MDROs) were detected and the detection rate was 58.54%(24/41). The detection rate of different departments from high to low was ICU(80.00%)&gt;medical ward(60.00%)&gt;surgical ward(46.15%). There was contaminated by Acinetobacter baumannii, Staphylococcus aureus, Enterobacteriaceae in the air of hospitals, some of them were MDROs, mainly were detected in neurological ward, respiratory medical ward, hyroid and breast surgery ward, neurosurgery ward, cardiothoracic surgery ward, gallideulous surgical ICU and general ICU.

Evaluating Post-discharge Thromboembolic Events in Patients With COVID-19

Background: COVID-19 is associated with a high rate of thromboembolic events in hospitalized patients, but it is unclear whether this risk remains high after discharge. This study aimed to evaluate the association of underlying factors with post-discharge thrombolytic events in COVID-19 patients and the association of thrombolytic events with subsequent mortality and ischemic heart disease. Methods: In this study, eligible patients with COVID-19 who were admitted to the respiratory ward of Loghman Hakim Hospital, Tehran, Iran, followed up for about 3 months after discharge to record any thromboembolic events. Patients who reported postdischarge thromboembolic events were confirmed based on their diagnostic tests. The Chi-square test was used to evaluate the association between thromboembolic events and qualitative parameters, and an independent t-test was used to evaluate their association with quantitative parameters. Logistic regression analysis was performed to assess the association between independent variables and the composite outcome. Results: Thromboembolic events were diagnosed in 35 patients (5.04%), including Myocardial Infarction (MI) in 17 patients (2.44%), venous thromboembolism in 10 patients (1.44%), and ischemic stroke in 8 patients (1.15%). None of the 26 patients who received thromboprophylaxis had thromboembolic events. During follow-up, 22 patients (3.17%) died, of whom, 10 patients (43.47%) had thromboembolic events. Thromboembolic events were not associated with sedentary life and oxygen (O2) dependency after discharge (P value of 0.40 and 0.098, respectively). Regression analyses showed that thromboembolic events were significantly associated with ischemic heart disease and mortality (P=0.007 and P&lt;0.001, respectively). Conclusion: Our findings support a high rate of post-hospitalization thromboembolic events in COVID-19 patients; however, it needs more large-scale trials.

Stress on caregivers providing prolonged mechanical ventilation patient care in different facilities: A cross-sectional study.

Taiwan has implemented an integrated prospective payment program (IPP) for prolonged mechanical ventilation (PMV) patients that consists of four stages of care: intensive care unit (ICU), respiratory care center (RCC), respiratory care ward (RCW), and respiratory home care (RHC). We aimed to investigate the life impact on family caregivers of PMV patients opting for a payment program and compared different care units. A total of 610 questionnaires were recalled. Statistical analyses were conducted by using the chi-square test and multivariate logistic regression model. The results indicated no associations between caregivers' stress levels and opting for a payment program. Participants in the non-IPP group spent less time with friends and family owing to caregiver responsibilities. The results of the family domain show that the RHC group (OR = 2.54) had worsened family relationships compared with the ICU group; however, there was less psychological stress in the RCC (OR = 0.54) and RCW (OR = 0.16) groups than in the ICU group. In the social domain, RHC interviewees experienced reduced friend and family interactivity (OR = 2.18) and community or religious activities (OR = 2.06) than the ICU group. The RCW group felt that leisure and work time had less effect (OR = 0.37 and 0.41) than the ICU group. Furthermore, RCW interviewees (OR = 0.43) were less influenced by the reduced family income than the ICU group in the economic domain. RHC family caregivers had the highest level of stress, whereas family caregivers in the RCW group had the lowest level of stress.

Efficacy and feasibility of awake proning in patients with COVID-19-related acute hypoxemic respiratory failure: an observational, prospective study.

IntroductionMost of COVID-19 patients present with hypoxemic respiratory failure. Proning is one of the management options proven to improve oxygenation and reduce mortality in non-COVID-19-related acute respiratory distress syndrome. As a response to COVID-19 pandemic surge, a dedicated COVID-19 respiratory ward for the management of mild to moderate ARDS patients who require oxygen therapy, non-invasive ventilation (NIV), or high-flow nasal cannula (HFNC) was established. We adopted a policy of early awake proning in such patients.AimsTo determine the physiological changes, improvement in oxygenation, the need for intubation, alongside with the duration, tolerance, and adverse effects of awake proning. Study design and methodsSingle-center, prospective observational cohort study. All awake, non-intubated, spontaneously breathing patients with COVID-19, and hypoxemic acute respiratory failure requiring oxygen supplementation, NIV, or HFResultsFifty patients were enrolled. There was a significant improvement in oxygenation when turning the patients from supine to prone position with mean PFR was 85 (SD 13.76) in supine position which increased to 124 (SD 34.08) in prone position with substantial increase in mean PFR 1-h post proning to 138 (SD 28.01) and P-value 0.0001. Prone positioning was feasible in 41 (82%) patients (mean duration 8.5 (SD 3.13) h), and 38 (76%) patients reported that it was well tolerated.ConclusionAwake proning was feasible, tolerable, and effective in improving oxygenation in patients with COVID-19-related pneumonia and acute hypoxemic respiratory failure in this prospective study.

Cross-cultural translation and psychometric properties of the Persian version Manchester respiratory activities of daily living questionnaire (MRADLQ-P)

PurposeThe present study was an attempt to investigate cross-cultural adaptability and evaluate the psychometric properties of the Persian version of the Manchester respiratory activities of daily living questionnaire ((MRADLQ-P).Patients and methodsIn a cross-sectional study, we selected 260 patients with severe respiratory diseases who needed to be admitted to the respiratory wards of this city hospital. The process of cultural localization of the questionnaire was performed based on a standard and valid process. Psychometric properties of the instrument were confirmed based on face and content validity assessments, convergent validity, discriminative validity and internal consistency. Data collected by demographic questionnaire, MRADL questionnaire and work ability index. Data were analyzed by SPSS 22 using descriptive statistics (mean and standard deviation), Spearman correlation coefficient, Cronbach's alpha coefficient, and Mann–Whitney test.ResultsThe mean age of participants was 48.8 ± 20.1 years. 176 (71.5%) were male. face content validity including content validity index (CVI) was 0.82 and content validity ratio and it was good. The questionnaire was measured at the same time as the work ability index, which Mann–Whitney test showed that the questionnaire has good differential power. Cronbach's alpha coefficient of 0.9 indicates a very good reliability of the questionnaire.ConclusionThe results show that intercultural psychometrics of MRADL questionnaire has good validity, reliability, and differential power that can be a good tool for use in future studies. Also, the translation of this checklist included translation into the target language, backward translation of the Persian versions into the original language, and comparisons and ambiguities to obtain a final and acceptable version.

A nosocomial salmonellosis outbreak caused by blaOXA-48–carrying, extensively drug-resistant Salmonella enterica serovar Goldcoast in a hospital respiratory care ward in Taiwan

A nosocomial salmonellosis outbreak caused by Salmonella enterica serovar Goldcoast occurred in a respiratory care ward (RCW) of a hospital in central Taiwan between December 24, 2020, and January 21, 2021. Ten isolates recovered from 10 RCW residents were resistant to extended-spectrum cephalosporins. The resistance mechanism needs to be investigated. Whole-genome sequencing and antimicrobial susceptibility testing were conducted to determine the genetic resistance determinants and the phenotypic resistance in the isolates. Each of the 10 outbreak isolates harbored an IncHI2 plasmid that carried 15 antimicrobial resistance genes aac(3)-IId, aadA22, aph(3')-Ia, aph(6)-Id, arr-2, blaCTX-M-55, blaLAP-2, blaTEM-1, dfrA14, floR, lnu(F), qnrS13, sul2, sul3, tet(A), an efflux pump regulatory gene ramAp and an IncL plasmid carried a blaOXA-48. The outbreak strains were expected to be resistant to numerous antimicrobials, including aminoglycosides, b-lactams /inhibitors, tetracycline, rifamycin, lincosamide, sulfonamides, trimethoprim, phenicols, fluoroquinolones, and carbapenems. Two outbreak isolates displayed higher minimum inhibitory concentrations than the other eight isolates to cefmetazole and carbapenems, which was linked to a deficiency of a major facilitator superfamily transporter in the two isolates. The carbapenem-resistant outbreak strains could have been derived from extensively drug-resistant S. enterica Goldcoast strains, which have been a major pathogen in Taiwan since 2018, through the acquisition of a blaOXA-48-carrying plasmid. Special efforts are needed in Taiwan to monitor the spread of extremely resistant strains.

Correlation of ICU Nurses' Cognitive Level with Their Attitude and Behavior toward the Prevention of Ventilator-Associated Pneumonia.

Objective To analyze the correlation of ICU nurses' cognitive level with their attitude and behavior toward the prevention of ventilator-associated pneumonia (VAP). Methods A total of 90 ICU nurses working in the adult internal medicine ICU, adult surgery ICU, subacute respiratory care ward, etc. from January 2018 to June 2019 were chosen as the subjects to carry out questionnaire survey with the cognition scale, and the correlation analysis on their cognitive level, attitude, and behavior toward the prevention of VAP was conducted. Results The linear fitting analysis finding showed that the cognitive level presented a positive correlation with the attitude score and behavior score (R2 = 0.668, 0.734). Conclusion Improving ICU nurses' cognitive level, attitude, and behavior toward preventing VAP is conducive to the upgrade of their quality of nursing services. In addition, the ICU nurses' cognitive level is positively correlated with their attitude and behavior.

Clinical Profile of COVID-19 Illness in Children—Experience from Tertiary Care Hospitals

Objective: Assessing detailed clinical profile as well as outcome in severe acute respiratory infection coronavirus infectious disease 2 (SARS-CoV-2) infected children. Methods: This is a retrospective study undertaken at pediatric departments of tertiary care hospitals of Lahore, Rawalpindi and Mirpur AJK for the period of three months from July 2021 to September 2021. The clinical characteristics data as well as result of children under 18 years infected with COVID-19 were reviewed as well as analyzed. Results: In total 2919 children that were suspected to be COVID-19 infected were verified for COVID-19 virus in flu emergency (n = 1744), severe acute respiratory infection ward (n = 825) and non-COVID (n = 350). From these studies, 8.73% children tested positive for COVID-19 infection. Of the positive cases, 56.47% were managed for outpatients and 59% needed admission. Most children admitted had critical illness owing to malnutrition and other comorbidities. Conclusions: Children of any age group are vulnerable to COVID-19 with minor male preponderance. Amongst infected, 2/3rd were asymptomatic or mildly symptomatic and needed outpatient management as well as home isolation. The adverse consequences were commonly observed in infants as well as children under 10 years of age with undernourishment and comorbidity. Keywords: COVID-19, Pandemic, Comorbidities, Respiratory infection

Exploring the impact of pulse oximeter selection within the COVID-19 home-use pulse oximetry pathways

BackgroundDuring the COVID-19 pandemic, portable pulse oximeters were issued to some patients to permit home monitoring and alleviate pressure on inpatient wards. Concerns were raised about the accuracy of these...