Teaching Hospitals In Egypt Research Articles

Physicians’ perceptions and response to the role of clinical pharmacists in a teaching hospital in Egypt

Physicians’ perceptions and response to the role of clinical pharmacists in a teaching hospital in Egypt

A multicentre survey of asthma-related quality-of-life and treatment in Egypt during the COVID-19 pandemic

Background: Asthma is a common chronic noncommunicable disease which can impair the health-related quality-of-life (HRQOL) of patients. Aims: To investigate treatment-related experiences and HRQOL of asthma patients in Egypt during the COVID-19 pandemic. Methods: A multicentre cross-sectional study was conducted from 21 July to 17 December 2020 in 3 teaching hospitals in Egypt among a convenience sample of asthma patients. We used socioeconomic and clinical variables, perceived threat level of COVID-19, experiences before and during COVID-19, the Asthma Control Questionnaire (ACQ), and the mini Asthma Quality of Life Questionnaire (mini-AQLQ) to collect data. Results: Among the 200 respondents (66.0% male; mean age 40.2 years), 80.0% had uncontrolled asthma. The greatest impairment to HRQOL was due to limitation of activity. Females reported a higher level of perceived threat from COVID-19 (Chi squared = –2.33, P = 0.02). Before the pandemic, more patients visited the clinician when they had symptoms but did so more regularly during the pandemic. Over 75% could not differentiate between asthma and COVID-19 symptoms. Perceived uncontrolled asthma and poor compliance with treatment were significantly associated with impairment of HRQOL (P < 0.05) before COVID-19. Conclusion: The COVID-19 pandemic improved some asthma-related health behaviours, but limitations in HRQOL were still evident. Uncontrolled asthma is a key factor for HRQOL and should remain a focus for all patients.

Effects of manual hyperinflation with rib cage compression and endotracheal suctioning on arterial blood gas parameters in mechanically ventilated patients at a university hospital, Egypt

BackgroundManual hyperinflation and expiratory rib cage compression are methods of chest physiotherapy. They are commonly applied but their value and their early utilization managing mechanically ventilated remain questionable. The purpose of the study was to investigate the effects of manual hyperinflation with rib cage compression and endotracheal suctioning on arterial blood gas parameters in mechanically ventilated patients.ResultsSeventy mechanically ventilated patients at a teaching hospital in Egypt were assigned to the clinical trial study. The age of more than half of the studied samples ranged between 60 and 69 years with a mean age of 53.64 ± 16.44 years. Initially, the ABG parameters were assessed. Then, the patients were exposed to manual hyperinflation for 5 min and 20 min external expiratory chest compression followed by endotracheal suctioning. Later, ABG parameters were assessed again and compared to the initial one. The findings revealed significant differences in ABG parameters before and after completion of MHI and ERCC and ETT suctioning in relation to PaO2 (t = 3.892) and SaO2 (t= 5.904). Also, it showed significant improvement in PaO2 and SaO2 after the completion of interventions, while no significant differences were found in other ABG parameters. This study was registered retrospectively with an ISRCTN number 39983 on 5/6/2021.ConclusionApplying manual hyperinflation with rib cage compression and endotracheal suctioning improved mainly the arterial oxygenation parameters in mechanically ventilated patients despite no significant changes observed in other ABG parameters.

Workplace violence among nurses and physicians in a tertiary teaching hospital in Egypt

Abstract Background Workplace violence (WPV) has been recognized as a major occupational hazard worldwide. Healthcare professions are particularly at a higher risk of WPV. Reported magnitude of WPV represents only the tip of an iceberg. The consequences of WPV in healthcare sector are dramatic; it affects the wellbeing of healthcare professions as well as the quality of the delivered service. Objective The study aimed to measure the magnitude of WPV, to identify factors associated with WPV among nurses and physicians working in a tertiary teaching hospital in Egypt. Methodology A descriptive cross-sectional study was conducted. A total of 114 physicians and 128 nurses were interviewed about exposure to WPV within the previous 12 months. Results The study found a high magnitude of WPV; nearly three fourth of physicians and nurses experienced violence in the workplace within the past 12 months. Female physicians experienced WPV more commonly compared to male physicians. There was a statistically significant association between type of patient nurses commonly cared for and experiencing WPV. Conclusion and Recommendations WPV among healthcare professions is an increasing problem that needs to be addressed. Increasing awareness of the problem among healthcare professions as well as the general public is warranted. Violence prevention program with a zero-tolerance policy is warranted.

Missed nursing care, non-nursing tasks, staffing adequacy, and job satisfaction among nurses in a teaching hospital in Egypt

BackgroundMissed nursing care (MNC) has been linked to patient harm in a growing body of literature. However, this issue is still not adequately investigated in developing countries. The aim of the study is to measure the extent of missed nursing care, to identify its types, and to determine factors contributing to missed nursing care.MethodsA cross-sectional design was used. The study was conducted among 50 units at 1762-beds teaching Hospital in Alexandria that employs 1211 nurses in inpatient areas. A sample of 553 nurses were interviewed using the MISSCARE and the N4CAST survey. The MISSCARE survey measured the amount of missed nursing care (MNC) that was experienced on the last worked shift by each nurse. The N4CAST survey was used to collect data about level of non-nursing work carried out by nurses and the nurses’ job satisfaction.ResultsThe overall mean score for the missed nursing care was 2.26 ± 0.96 out of 5, with highest mean score attributed to “Planning” and lowest mean score attributed to “Assessment and Vital Signs” (2.64 and 1.96, respectively). Missed nursing care was significantly associated with number of patients admitted and cared for in the last shift and perceived staffing adequacy. Almost all non-nursing care tasks and most of satisfaction elements showed negative weak correlation with overall missed nursing care.ConclusionMissed Nursing Care is common in study hospital which may endanger patient safety. MNC Missed Nursing Care is positively associated with nursing adequacy. There is no association between MNC and neither nurses’ job satisfaction nor non-nursing tasks. Nursing leaders should monitor missed nursing care and the environmental and staffing conditions associated with it in order to design strategies to reduce such phenomena.

Chronic lung sepsis in a sample of Egyptian patients with type II diabetes mellitus

Background/aim Chronic lung sepsis is one of the major causes of chronic respiratory symptoms such as chronic cough and pus formation. It has received very little attention over recent decades. In addition, failure of its characterization in immunocompromised patients such as diabetics has led to under-recognition and lack of early management. Patients and methods In this study, 61 patients with symptoms and signs of chronic lung disease were enrolled from Ahmed Maher Teaching Hospital in Egypt. Of them, 32 fulfilling the criteria of chronic lung sepsis were classified into two groups: diabetic (17 patients) and nondiabetic (15 patients). All of the patients were subjected to detailed medical history, thorough clinical examination, laboratory investigations, sputum culture and sensitivity, and high-resolution computed tomography of the chest. Results A total of 23 cases were diagnosed as bronchiectasis, four cases were diagnosed as lung abscess, two cases were pyopneumothorax, whereas there was one case each of infected cyst, empyema, and infected emphysematous bullous. Sputum culture showed that gram-negative organisms were more evident in the diabetic group. The management of cases of chronic lung sepsis showed the use of double or triple antimicrobial therapy in the diabetic group. Conclusion Targeting good control of pneumonia in patients with type II diabetes mellitus using double or triple antimicrobial therapy is essential to inhibit the progression of pulmonary infections to chronic lung sepsis.

Genomic Insights into a Colistin-Resistant Uropathogenic Escherichia coli Strain of O23:H4-ST641 Lineage Harboring mcr-1.1 on a Conjugative IncHI2 Plasmid from Egypt

The reintroduction of colistin, a last-resort antibiotic for multidrug-resistant pathogens, resulted in the global spread of plasmid-mediated mobile colistin resistance (mcr) genes. Our study investigated the occurrence of colistin resistance among Escherichia coli isolated from patients with urinary tract infections admitted to a teaching hospital in Egypt. Out of 67 isolates, three isolates were colistin-resistant, having a minimum inhibitory concentration of 4 µg/mL and possessing the mcr-1 gene. A double mechanism of colistin resistance was detected; production of mcr-1 along with amino acid substitution in PmrB (E123D and Y358N) and PmrA (G144S). Broth mating experiments inferred that mcr-1 was positioned on conjugative plasmids. Whole-genome sequencing of EC13049 indicated that the isolate belonged to O23:H4-ST641 lineage and to phylogroup D. The mcr-1-bearing plasmid corresponded to IncHI2 type with a notable similarity to other E. coli plasmids previously recovered from Egypt. The unbanned use of colistin in the Egyptian agriculture sector might have created a potential reservoir for the mcr-1 gene in food-producing animals that spread to humans. More proactive regulations must be implemented to prevent further dissemination of this resistance. This is the first characterization of mcr-1-carrying IncHI2:ST4 plasmid recovered from E. coli of a clinical source in Egypt.

P0597TRAINING IS NOT ENOUGH: RESISTANCE TO THE APPLICATION OF THE AGREED CRITERIA (KDIGO) FOR THE DIAGNOSIS OF ACUTE KIDNEY INJURY IN INTENSIVE CARE UNITS IN EGYPT

Abstract Background and Aims Acute kidney injury (AKI) is one of the most serious complications of patients admitted to intensive care units (ICUs). It is associated with high short- and long-term mortality and resource utilization. The definition of AKI has been established by the KDIGO guidelines based on changes in serum creatinine, urine output or both. However, in clinical practice physicians may ignore the standard criteria and rely on clinical judgement. We therefore aimed to assess the degree of physicians’ compliance with the KDIGO guidelines in diagnosis of AKI. Method We collected data (demographic, clinical, and biochemical) in a multicenter prospective cohort study from all adults admitted to ICUs (10 surgical and 8 medical) units at Alexandria University Teaching Hospitals from February 1st, 2016 till August 1st, 2016. Alexandria Teaching Hospitals cover four governorates of Northern Egypt and serve approximately 14 million people. Doctors were preliminarily instructed to apply KDIGO criteria for the diagnosis of AKI. Personal and clinical experience data were collected from the treating physicians. We followed patients for thirty days from study entry until discharge, death or study end. Written informed consent was obtained from all participants. AKI was defined and classified based on KDIGO 2012 criteria. In parallel, we registered the actual clinical diagnosis made by the treating physicians. We used frequencies and means for qualitative and quantitative variables as appropriate. Results The study included 532 patients who were on average 46 year old (±18), 41.7% were males, 23.5% with smoking, 23.1% had diabetes, 34.8%, were hypertensive, 11.3 % with pre-existing chronic kidney disease, and 30.1% had cardiovascular diseases. There were 140 physicians responsible for treating the enrolled subjects, with mean age 30 ±3 years, 57% were males, 20% were nephrologists, and the median years of experience was 3 years (inter-quartile range: 2-4years). The AKI incidence was 62.2% according to KDIGO criteria versus 49.9% based on the clinical diagnosis of treating physicians. Among those not reported to have AKI by the treating physicians; 19.1% were in stage 1, 26.4% in stage 2, and 12.9% in stage 3 AKI based on KDIGO. About 24% of patients who had AKI at ICU admission and 15% of those who developed AKI after ICU admission were not appropriately identified as AKI patients according to the physicians. There was a significant association between the physician speciality (nephrology vs other specialties) and the correct AKI diagnosis based on KDIGO criteria (X2=47.06, p<0.001). Conclusion To streamline a correct and timely identification of AKI, treating physicians in ICUs at a large hospital in North Africa, like the Alexandria University Teaching Hospitals in Egypt, need well focused training and knowledge verification post training on KDIGO guidelines for identifying AKI patients. Implementation of electronic alerts could help in proper diagnosis and management.

Genetic analysis of carbapenemase-producing Gram-negative bacteria isolated from a university teaching hospital in Egypt

A total of 65 non-replicate Gram-negative bacterial strains were recovered from clinical specimens between April and September 2014 at a University Hospital in Egypt. This collection was screened by PCR for carbapenemase-encoding genes, 16S rRNA methylases, and colistin resistance genes (mcr-1–mcr-8). Twenty-two strains (22/65, 33.8%) were positive for carbapenemase-encoding genes [13 NDM-1-producers (four Escherichia coli, two Klebsiella pneumoniae, and seven Providencia stuartii), two E. coli co-carrying NDM-5 and OXA-181, and seven Pseudomonas aeruginosa (three VIM-2, four VIM-24) strains]. The 16S rRNA methylase RmtC was detected in 12 NDM-1-producers for the first time in Egypt; no mcr genes were detected. A self-transmissible A/C plasmid was found to carry blaNDM-1 in all NDM-1-producing strains. NDM-5 and OXA-181 were located on an untypeable and IncX3 plasmid, respectively. Additionally, Enterobacterial repetitive intergenic consensus (ERIC)-PCR revealed five clonally related P. stuartii isolates collected over a 1.5-month period. Thirteen carbapenemase-producing strains were isolated from burn patients who are at a high risk of developing infections and require special medical care. To our knowledge, this is the first report of NDM-1-producing-P. stuartii strains in an African burn unit, NDM-1- and RmtC-positive non-lactose fermenting E. coli globally, VIM-24-producing P. aeruginosa in Africa, and 16S RMTase rmtC-NDM-1-producers in Egypt. This work highlights the detection of different carbapenemase-producing bacterial strains within an Egyptian teaching hospital compromising the effectiveness of carbapenems and urgently asking the Egyptian medical authorities for implementation of antimicrobial surveillance plans and infection control policies to early detect and to effectively halt the rapid spread of these superbugs.

A robust medical image retrieval system based on wavelet optimization and adaptive block truncation coding

This paper presents a proposed method for medical image retrieval in order to search in a database for an image that is similar to a query image. The proposed Medical Image Retrieval System (MIRS) consists of two phases; enrollment phase and querying phase. In enrollment phase, the Discrete Wavelet Transform (DWT) coefficients are computed from every incoming image. Four wavelet types; Haar, Daubechies, Coiflet, and Symlet wavelets with different decomposition levels have been tested and compared in order to determine the most suitable wavelet type for the retrieval approach. Then, the Block Truncation Codes (BTCs) are extracted from the wavelet coefficients. To make the proposed image retrieval system robust, the BTC is adaptive by dividing the image into sub-blocks using one of four different scanning methods; raster, zigzag, Morton or Hilbert scanning. Finally, the extracted codes are stored as features vectors database. In querying phase, the BTCs are extracted from the wavelet coefficients of the query image. The similarity measurement between the features vector of the query images and the features vectors stored in the features vectors database is carried out using 8 different distance metrics to select the most suitable one. The proposed MIRS has been tested with a medical image database consists of 7500 CT brain images collected from a teaching hospital in Egypt. The results demonstrated that the proposed approach gives good results with extracting the BTCs with Morton scanning from the DB2 DWT. Moreover, Manhattan distance achieved the best similarity measurement results. The performance of the proposed MIRS has been compared with the published medical image retrieval approaches for VIA-ELCAP and Kvasir databases. The results indicated that, the proposed MIRS is robust and efficient for different medical image databases due to the advantages of dividing the image into blocks and each block can be retrieved separately according to its variance.

Assessment of the appropriateness of meningitis management and drug utilisation: a prospective audit for implementing an antimicrobial stewardship program

AbstractBackgroundBacterial and viral meningitis are two life‐threatening diseases that pose a socioeconomic burden on many developing countries such as Egypt. Inappropriate management is the main factor contributing to this burden.AimAssess the appropriateness of management of bacterial and viral meningitis in accordance with the Infectious Diseases Society of America guidelines and to evaluate the drugs used.MethodsA prospective observational audit study was conducted in a teaching hospital in Egypt to evaluate the appropriateness of meningitis management as part of implementing a proposed institutional antibiotic stewardship program. Fifty‐eight patients met the inclusion criteria. A threshold between 90 and 100% was considered to measure the appropriateness as according to the World Health Organization drug use evaluation guidelines.ResultsViral meningitis affected more than 60% of patients. The empirical regimen consisted primarily of penicillin, ceftriaxone and dexamethasone. The mean duration of the first antimicrobial and antiviral doses were 1.55h and 19–22h respectively. Non‐compliance with standard practice guidelines due to wrong regimen selection was detected in more than 60% of patients. Fewer than 10% of patients received the correct dexamethasone regimen and fewer than 20% of patients had a follow‐up lumbar puncture. The mean length of stay was 9–12 days. Non‐compliance with guidelines resulted in extra charges for more than 70% of patients.ConclusionsOverall compliance with standard practice guidelines was below the proposed thresholds and misuse of drugs, especially antibiotics, was obvious. Institutional antimicrobial stewardship programs are essential to improve the quality of care and to limit medication misuse.

Comparison of Dental Treatment Performed under General Anesthesia between Healthy Children and Children with Special Needs at a Teaching Hospital in Egypt

BACKGROUND: The evaluation of dental treatment under general anesthesia (GA) in healthy children and children with special health care needs (SHCN) should take into consideration; firstly, the different dental treatment needs according to the disability condition (scope of disability) and secondly, the limitation of the treatment. Aim of the study: This retrospective study aims at comparing the different dental treatment modalities performed under general anesthesia for healthy children, on one side, and those with special health needs, on the other. The Study was carried out at Unit for Dental Treatment of Healthy Children and Children with Special Needs, Faculty of Dentistry’ Teaching Hospital, Cairo University, in 2017 and 2018.Method: This retrospective study was approved by the Research Ethics Committee, Faculty of Dentistry, Cairo University. Data was retrieved from the files of the pediatric patients, aged from 1 to 18 years old, who received dental treatment under GA, between January 2017 to December 2018, at this Unit. Patients with special needs, with either mental or physical disability, were assigned as Group A, while the healthy patients were assigned as Group B. The two Groups were compared for: the treatment modalities of operative restorations, pulp therapy, anterior and posterior crowns, fissure sealants, dental prophylaxis, and extractions of teeth. The number of repeated admissions for dental treatment under GA was also included in the Study.Results: The total number of children who had dental treatment under GA in the years 2017 and 2018 was 2276. Number of children with SHCN was 553 (24.3%), while the number of healthy children was 1723 (75.7%). Group A showed significantly higher mean age (7.04) than Group B (4.27), (P-value <0.001). Group A showed a higher percentage of previous admissions for dental treatment under GA (13.4%), than group B (0.6%) (P-value <0.001). The most frequent disability was cerebral palsy (41.2%), followed by autism (17.7%), then mental retardation (15.2%). For primary dentition, Group A showed significantly higher prevalence of extractions for molars and incisors than Group B (P-value <0.001, effect size = 0.159 and P-value <0.001, effect size = 0.150, respectively), and higher prevalence of glass ionomer (GI) fillings for molars than Group B. Group A showed significantly lower prevalence of: composite fillings, GI fillings for incisors, pulpotomies, pulpectomies, and crowns. There was no statistically significant difference in amalgam filling treatments and fissure sealant applications between the two Groups. For permanent dentition, Group A showed significantly higher prevalence of amalgam fillings, composite fillings and crowns for molars than Group B. In addition, Group A showed significantly higher prevalence of dental prophylaxis than Group B.Conclusions: The use of radical treatment as extraction of extensive decayed teeth in children with SHCN is observed in this Study. The use of crowns to protect the teeth even without pulp therapy is demonstrable in the treatment pattern revealed in this Study. A special attention should be directed toward preventive procedures such as dental prophylaxis, fissure sealants and topical fluoride application. Education of parents/caregivers is needed to implement and supervise the proper oral hygiene measures for the children with SHCN.

Carbetocin versus oxytocin in prevention of postpartum hemorrhage in late preterm twin pregnancy following cesarean section: a prospective clinical study

Objective The objective of this study was to compare effectiveness and safety of carbetocin versus oxytocin infusion in prevention of postpartum hemorrhage (PPH) in women with late preterm twin pregnancy undergoing cesarean section. Patients and methods A prospective clinical study was conducted from June 2014 to August 2015 in Shibin El-Kom and Benha Teaching Hospitals in Egypt that enrolled 175 women with late preterm twin pregnancy undergoing cesarean section. Carbetocin group (n = 90) as a single intravenous bolus was compared with oxytocin (n = 85) 10 IU as six infusions as soon as the second twin was delivered, and the outcomes were compared. Results The mean blood loss during cesarean section was higher in oxytocin group as compared with carbetocin (685 ± 350 vs. 782.8 ± 370 ml, P > 0.05). The incident of primary PPH (>1000 ml) in cesarean delivery was lower in carbetocin group versus oxytocin group (3.33 vs. 11.76%, P 0.05). The need for another uterotonic agents in carbetocin was lower than in oxytocin (23.33 vs. 35.29%, P Conclusion This study found that carbetocin was an acceptable option with reduction of PPH compared with oxytocin in late preterm twin pregnancy undergoing cesarean section, and both had similar safety profile with minor hemodynamic effect.

The effectiveness of clinical pathway-directed care on hospitalisation-related outcomes in patients with severe traumatic brain injury: A quasi-experimental study.

To compare the effectiveness of clinical pathway-directed care to usual care on hospitalisation-related outcomes in patients with severe traumatic brain injury (STBI). Severe traumatic brain injury is a major cause of disability and mortality in young adults. Clinical pathways endeavour to bring evidence and clinical practice closer together to foster the delivery of best practice and to improve patient outcomes. Quasi-experimental study. The study was conducted in a trauma intensive care unit of a large teaching hospital in Egypt. Patients aged 18-60years with a diagnosis of STBI, a Glasgow Coma Scale score between 3-8 and a nonpenetrating head injury were consecutively assigned to 15days of care. The outcomes assessed were complications related to hospitalisation, clinical variances, length of intensive care unit (ICU) stay, ICU readmission rate and patient/family satisfaction. Sixty participants completed the study (30 in each arm). Apart from age, there were no significant differences between groups in baseline characteristics. The clinical pathway group demonstrated statistically significantly fewer cases of hospitalisation-related complications on day 15, and a significantly shorter length of ICU stay, lower ICU readmission rate and a high level of patient/family satisfaction when compared with the usual care group. The effect of the intervention on fever, pressure ulceration, hyperglycaemia and readmission to the ICU was no longer statistically significant after controlling for age. The findings of the current study suggest that the implementation of a clinical pathway for patients with severe TBI may be helpful in improving the patient experience as well as some hospitalisation-related outcomes. The provision of clinical pathway-directed care in a trauma ICU may offer benefits to the patient, family and institution beyond that provided by usual care.

Diagnostic accuracy of serum miR-122 and miR-199a in women with endometriosis.

To evaluate the value of serum microRNA-122 (miR-122) and miR-199a as reliable noninvasive biomarkers in the diagnosis of endometriosis. During 2015-2016, at a teaching hospital in Egypt, a prospective cohort study was conducted on 45 women with pelvic endometriosis and 35 women who underwent laparoscopy for pelvic pain but were not diagnosed with endometriosis. Blood and peritoneal fluid (PF) samples were collected; interleukin-6 (IL-6) was detected by enzyme-linked immunosorbent assay and miR-122 and miR-199a expression was measured by quantitative real-time polymerase chain reaction. The serum and PF levels of IL-6, miR-122, and miR-199a were significantly higher in women with endometriosis than in controls (P<0.001 for all comparisons). Serum miR-122 expression was positively correlated with serum IL-6 (r=0.597), PF IL-6 (r=0.603), PF miR-122 (r=0.934), serum miR-199a (r=0.727), and PF miR-199a (r=0.653). Serum miR-199a expression was positively correlated with serum IL-6 (r=0.677), PF IL-6 (r=0.678), PF miR-122 (r=0.744), and PF miR-199a (r=0.932). Serum miR-122 and miR-199a had a sensitivity of 95.6% and 100.0%, and a specificity of 91.4% and 100%, respectively, for the detection of endometriosis. Serum miR-122 and miR-199a were significantly increased in endometriosis, indicating that these microRNAs might serve as biomarkers for the diagnosis ofendometriosis.

Job Engagement as a Mediator of the Relationship between Organizational Agility and Organizational Performance: A Study on Teaching Hospitals in Egypt

Purpose: The purpose of this study is to examine the moderating significant role of Job Engagement (JE) in the relationship between Organizational Agility (OA) and Organizational Performance (OP).Research Design/Methodology: To assess positive OA, refer to (OA Questionnaire, Jaworski and Kohli 1993), JE (JE Questionnaire, Rich et al., 2010) and OP (OP Questionnaire, Darroch, 2003; Pathirage, et al., 2007; and Chen &amp; Mohamed, 2007). The data of the study was collected from 310 employees at Teaching Hospitals in Egypt. Out of the 357 questionnaires that were distributed to employees at Teaching Hospitals in Egypt, 310 usable questionnaires were returned, a response rate of 86%. Multiple Regression Analysis (MRA) was used to confirm the research hypotheses.Findings: The research has found that there is significant relationship between OA, JE and OP at Teaching Hospitals in Egypt. JE significantly influenced OA and OP. The finding reveals that OA affects OP through JE. Accordingly, the study provided a set of recommendations including the necessity to pay more attention to OA as a key source for organizations to enhance the competitive advantage which is of prime significance for OP through JE.Practical implications: This research helps boost scientific research, particularly in terms of testing the model content, as well as studying the study variables and the factors affecting them. In addition, it pointed to the need for organizations to practice OA in order to be able to meet contemporary intense competition, as this trend is to play an important role in enhancing JE.Originality/value: This research dealt with OA in terms of its concept and dimensions, in addition to dealing with the role of OA in promoting JE at Teaching Hospitals in Egypt.

Organizational Silence: Its Destroying Role of Organizational Citizenship Behavior

&lt;p&gt;Purpose: The purpose of this research is to identify the types of Organizational Silence (OS) and its effects on Organizational Citizenship Behavior (OCB) at Teaching Hospitals in Egypt.&lt;/p&gt;&lt;p&gt;Design/methodology/approach: To assess OS, refer to (OS questionnaire, Schechtman, 2008; Brinsfield, 2009), and OCB (OCB questionnaire Podsakoff, 1990; Konovsky &amp;amp; Pugh, 1994; and Konovsky &amp;amp; Organ, 1996). Out of the 357 questionnaires that were distributed to employees, 315 usable questionnaires were returned, a response rate of 88%. Multiple Regression Analysis (MRA) was used to confirm the research hypotheses.&lt;/p&gt;&lt;p&gt;Findings: The research has found that there is significant relationship between OS and OCB. Also, the research has found that OS directly affects OCB. In other words, OS is one of the biggest barriers to OCB at Teaching Hospitals in Egypt.&lt;/p&gt;&lt;p&gt;Practical implications: This research pointed to the need for organizations to adopt a culture which encourages and urges employees to speak in the labor issues and the non-silence in order for the administration to be able to realize these issues and try to solve them first hand in order to prevent their aggravation.&lt;/p&gt;&lt;p&gt;Originality/value: Silence climate has an impact on the ability of organizations to detect errors and learn. Therefore, organizational effectiveness is negatively affected. This research aims to measure the effect of OS on OCB. Based on the findings of this research, some important implications are discussed.&lt;/p&gt;

DRUG CLASSES PROFILE AMONG ELDERLY PATIENTS ADMITTED TO GERIATRIC UNIT

Background Elderly people have a higher prevalence of chronic illness, disability and dependency and are more likely to be on medication than younger people. They are often taking several drugs at once to treat concomitant disease processes. Aim To identify and classify different types of drugs and comorbid diseases encountered among hospitalized elderly patients. Methods Data were prospectively collected from 320 patients aged ≥ 65 hospitalized at the Department of Geriatrics and Gerontology at a university teaching hospital in Egypt among 17 month study period. Patient’s medical profiles were studied carefully for identification and classification of different types of drugs and comorbid diseases encountered among hospitalized elderly patients. Results There were different types of comorbid diseases encountered among the patients, with a median of five per patient and a range of 1-11 per patient. The most common medical disorders among the studied patients were hypertension (52.8%), diabetes (42.5%) and chronic liver diseases (40.3%). The total number of medications prescribed was 2985; median number of medications per patient was nine (range 2-20). The most commonly prescribed medications were antacids and peptic ulcer medications (78.1%), antiplatelet and anticoagulants (77.2%) and antibiotics (68.1%). While the less frequently prescribed drugs were skeletal muscle relaxant (0.6%) and antifungal drugs (0.3%). Conclusion Results of the current study have reported the presence of poly-pharmacy and poly-morbidity among this Egyptian elderly patient’s profile.

Job Attitudes as a Mediator of the Relationship between Organizational Cynicism and Organizational Citizenship Behavior: An Applied Study on Teaching Hospital in Egypt

Study Objectives: The purpose of this investigation is to determine the mediating significant role of job attitudes (job satisfaction and organizational commitment) in the relationship between organizational cynicism and Organizational Citizenship Behavior (OCB). Research Design/Methodology: A survey-based descriptive research design is used. The study was carried on at Teaching Hospitals in Egypt. About 357 survey questionnaires were distributed by employing diverse modes of communication such as in person and post. Multiple follow-ups yielded 315 statistically usable questionnaires. Stepwise regression analysis was used to confirm the research hypotheses.Results: The findings of the study indicated that there is a significant negative correlation between organizational cynicism, job satisfaction, organizational commitment and OCB. In addition to that, job satisfaction and organizational commitment have the advantage of increasing OCB. Research limitations/implications: The main subject of the study were all categories of employees at Teaching Hospitals in Egypt. Self-reported measures were used to measure organizational cynicism, job satisfaction, organizational commitment and OCB. Practical implications: Considering the importance of employees’ organizational commitment and their effects on effectiveness of Teaching Hospitals, and policy makers should take necessary measures for the optimal provision of intrinsic and extrinsic job rewards to make their core workforce highly satisfied and committed.Originality/value: The relevant literature shows that organizational cynicism, job attitudes, and OCB are under-researched in the public sector in Egypt. So, the current investigation has contributed to improve the understanding of this significant issue. Besides, the study findings are discussed in perspective of practical implications in public sector hospitals in Egypt.

Examining the Relationship between Organizational Cynicism and Organizational Change: A Study from Egyptian Context

Organizational cynicism and change are two intertwined phenomena which constitute an important subject matter in organizational behavior literature. One of the main causes of organizational cynicism is organizational change. Drawing on the literature review, there are some studies regarding organizational cynicism and organizational change. In Egypt, limited research has been conducted, but the present study attempts to find out whether there is a relationship between organizational cynicism and change. This study was conducted at Teaching Hospitals in Egypt. It is the first empirical work ever done so far in the field of organizational cynicism and its relation with organizational change. The evaluative attitudes of the employees towards organizational cynicism and change are investigate. The relationship between organizational cynicism and change will be illustrated. Three groups of employees were examined. Three hundred and fifty seven questionnaires were distributed and 300 usable questionnaires were returned, a response rate of 84%. The results reveal that there are differences among the three groups of employees regarding their evaluative attitudes towards organizational cynicism and change. Besides, the attitudes toward organizational cynicism and change are related. Hence, recommendations include the necessity to pay more attention to organizational cynicism as a common phenomenon in organizations. Finally, the implications of this study are discussed.