Background: Communities of practices (CoPs) are a process in which workers interact and acquire knowledge from each other at the workplace. This informal knowledge in the workplace can assist professionals to become active knowledge builders with sufficient autonomy regarding specific knowledge or skills required. In addition, this approach that supports informal learning facilitates learning among nurses in the workplace. A cross-sectional descriptive design study was conducted to discover facilitators and barriers that affect the implementation of a CoPs approach. The results show that CoPs seemingly provides a forum for sharing on the job, allowing for successful transition and retention. This and other findings can help in improving and facilitating this approach widely among nurses at the workplace. Purpose: This study explored CoP among medical and surgical nurses at King Khalid Hospital in Jeddah, Saudi Arabia. It also presents the facilitators and barriers in implementing the CoPs approach. Study Design: A cross-sectional descriptive design was used. Sixty-seven medical-surgical nurses were conveniently sampled at a military hospital in Jeddah, Saudi Arabia. Data were collected using a structured, validated questionnaire. Methodology: Descriptive and inferential statistics were used for data analysis and were presented in frequencies, percentages, and P values. Results: A total of 62 nurses, mostly females, participated in this study. The mean age of respondents was 30.95 years, and N = 52 (83.9%) had a bachelor's degree in nursing, with N = 26 (41.9%) having between 5 and 10 years of experience in nursing. Most respondents (82.3%) had a clear understanding of what a CoP is. Most respondents N = 40 (64.5%) agreed that they wished to share their knowledge within the community. The top facilitators of a CoP as expressed by respondents were: to deliver solutions for daily problems N = 49 (79%) followed by N = 41 (66.1%) of respondents agreeing that CoP transfer best practices and results in the development of new knowledge N = 30 (48.4%). The most common barrier to a CoP identified within this study was lack of time as expressed by most participants N = 46 (74.2%), followed by a lack of confidence, N = 36 (58.1%) and a fear of not sharing correct information N = 31 (50%). Conclusion: This study described the facilitators and barriers of CoPs. Furthermore, the study highlighted the critique of CoP from the literature. Despite this critique, CoPs are found to provide a forum for sharing on the job, allowing for successful transition and retention.
{"title":"Exploring communities of practice among medical-surgical nurses at King Khalid Hospital in Jeddah, Saudi Arabia","authors":"S. Alsayed, Jennifer de Beer, Tahani Uyoni","doi":"10.4103/sccj.sccj_18_19","DOIUrl":"https://doi.org/10.4103/sccj.sccj_18_19","url":null,"abstract":"Background: Communities of practices (CoPs) are a process in which workers interact and acquire knowledge from each other at the workplace. This informal knowledge in the workplace can assist professionals to become active knowledge builders with sufficient autonomy regarding specific knowledge or skills required. In addition, this approach that supports informal learning facilitates learning among nurses in the workplace. A cross-sectional descriptive design study was conducted to discover facilitators and barriers that affect the implementation of a CoPs approach. The results show that CoPs seemingly provides a forum for sharing on the job, allowing for successful transition and retention. This and other findings can help in improving and facilitating this approach widely among nurses at the workplace. Purpose: This study explored CoP among medical and surgical nurses at King Khalid Hospital in Jeddah, Saudi Arabia. It also presents the facilitators and barriers in implementing the CoPs approach. Study Design: A cross-sectional descriptive design was used. Sixty-seven medical-surgical nurses were conveniently sampled at a military hospital in Jeddah, Saudi Arabia. Data were collected using a structured, validated questionnaire. Methodology: Descriptive and inferential statistics were used for data analysis and were presented in frequencies, percentages, and P values. Results: A total of 62 nurses, mostly females, participated in this study. The mean age of respondents was 30.95 years, and N = 52 (83.9%) had a bachelor's degree in nursing, with N = 26 (41.9%) having between 5 and 10 years of experience in nursing. Most respondents (82.3%) had a clear understanding of what a CoP is. Most respondents N = 40 (64.5%) agreed that they wished to share their knowledge within the community. The top facilitators of a CoP as expressed by respondents were: to deliver solutions for daily problems N = 49 (79%) followed by N = 41 (66.1%) of respondents agreeing that CoP transfer best practices and results in the development of new knowledge N = 30 (48.4%). The most common barrier to a CoP identified within this study was lack of time as expressed by most participants N = 46 (74.2%), followed by a lack of confidence, N = 36 (58.1%) and a fear of not sharing correct information N = 31 (50%). Conclusion: This study described the facilitators and barriers of CoPs. Furthermore, the study highlighted the critique of CoP from the literature. Despite this critique, CoPs are found to provide a forum for sharing on the job, allowing for successful transition and retention.","PeriodicalId":345799,"journal":{"name":"Saudi Critical Care Journal","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132390235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: Patient-ventilator asynchrony (PVA) commonly occurs in critically ill patients, and it is connected with poor health outcomes. To prevent PVA, respiratory therapists (RTs) must have sufficient knowledge regarding respiratory physiology and mechanics and have the ability to understand ventilator graphics and patient signs and symptoms. However, little is known of the respiratory care practitioner's knowledge about PVA. The aim of this study is to assess the ability of RTs to identify and manage PVAs based on their years of experience, previous training, and characteristics of their clinical setting. Methodology: A study questionnaire was developed to examine the knowledge of RTs to identify PVA. This pilot survey was reviewed and tested by selected experts in the respiratory care field for appropriateness of questions and accuracy of the content. The final survey consisted of 33 items. This include six items on the respondent's demographic information, four on the previous PVA education, eight on the workplace policy and five ventilator screenshot to measure RTs' knowledge on waveform interpretation. Each screenshot had two open text questions asking about the possible causes and solutions for the identified asynchrony. Data were collected and managed using Qualtrics. Exploratory analysis using descriptive statistics was used to analyze the data. Results: A total of 118 recorded responses were received, and 79 participants completed the full survey. Overall, the ability to identify asynchronies on ventilator graph screenshots was poor. Only two RTs (1.7%) correctly detected all five types of asynchrony, whereas 14 (11.8%) identified four asynchronies, 31 (26.1%) recognized three asynchronies, 24 (20.2%) detected two asynchronies, 12 (10.1%) identified only one asynchrony, and 36 (30.3%) did not recognize any asynchronies. No statistically significant differences regarding previous training, years of experience, and work characteristics were observed. Conclusions: The overall knowledge regarding the identification of PVA among RTs is poor. Previous training, years of experience, and work characteristics were not an indicator to correctly identify PVAs.
{"title":"Patient-Ventilator asynchrony: Surveying the Knowledge of respiratory therapists in Saudi Arabia","authors":"A. Mohammed","doi":"10.4103/sccj.sccj_20_19","DOIUrl":"https://doi.org/10.4103/sccj.sccj_20_19","url":null,"abstract":"Objective: Patient-ventilator asynchrony (PVA) commonly occurs in critically ill patients, and it is connected with poor health outcomes. To prevent PVA, respiratory therapists (RTs) must have sufficient knowledge regarding respiratory physiology and mechanics and have the ability to understand ventilator graphics and patient signs and symptoms. However, little is known of the respiratory care practitioner's knowledge about PVA. The aim of this study is to assess the ability of RTs to identify and manage PVAs based on their years of experience, previous training, and characteristics of their clinical setting. Methodology: A study questionnaire was developed to examine the knowledge of RTs to identify PVA. This pilot survey was reviewed and tested by selected experts in the respiratory care field for appropriateness of questions and accuracy of the content. The final survey consisted of 33 items. This include six items on the respondent's demographic information, four on the previous PVA education, eight on the workplace policy and five ventilator screenshot to measure RTs' knowledge on waveform interpretation. Each screenshot had two open text questions asking about the possible causes and solutions for the identified asynchrony. Data were collected and managed using Qualtrics. Exploratory analysis using descriptive statistics was used to analyze the data. Results: A total of 118 recorded responses were received, and 79 participants completed the full survey. Overall, the ability to identify asynchronies on ventilator graph screenshots was poor. Only two RTs (1.7%) correctly detected all five types of asynchrony, whereas 14 (11.8%) identified four asynchronies, 31 (26.1%) recognized three asynchronies, 24 (20.2%) detected two asynchronies, 12 (10.1%) identified only one asynchrony, and 36 (30.3%) did not recognize any asynchronies. No statistically significant differences regarding previous training, years of experience, and work characteristics were observed. Conclusions: The overall knowledge regarding the identification of PVA among RTs is poor. Previous training, years of experience, and work characteristics were not an indicator to correctly identify PVAs.","PeriodicalId":345799,"journal":{"name":"Saudi Critical Care Journal","volume":"86 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115862562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. Siddharth, S. Gupta, S. Satpathy, S. Agarwala, R. Lodha
Introduction: Organization of intensive care units (ICUs) have a bearing on the quality of care rendered and outcome of care. Hence, this study was conducted with the aim to examine various ICUs for compliance against the different structural and organizational parameters prescribed by the standard national and international guidelines. Methodology: A descriptive and observational study was conducted from June 2011 to September 2012 in neonatal surgery ICU (NSICU), pediatric ICU, and medicine ICU (MICU) at a tertiary care teaching hospital of Northern India. Structural and organizational aspects of each ICU were studied against the Indian and international guidelines prescribed by concerned scientific organizations/bodies. These guidelines were selected in consultation with the domain experts. All parameters were assigned equal weightage, and scoring was done by assigning a score of 0, 5, and 10 to noncompliance, partial compliance, and compliance, respectively. Data were collected through direct observations, perusing hospital records, and unstructured interview of key informants. Results: NSICU assessment against the two international guidelines revealed the adherence of 42.52% and 37.80% toward different structural and organizational parameters. Similarly, low compliance to organizational and structural parameters were observed in pediatric (national –52.38% and international –49.39%) and MICUs (national –50.52% and international –39.01%). All the three ICUs under study have been created by carving out space from their respective inpatient admission area owing to patient care requirements, hence, does not score well against the structural/spatial parameters. Conclusion: Overall, low compliance of all three ICUs was observed when compared against the prescribed guidelines for organizational and structural parameters.
{"title":"Structure and organization of intensive care units in a tertiary care hospital of north India: A comparative study against national and international guidelines","authors":"V. Siddharth, S. Gupta, S. Satpathy, S. Agarwala, R. Lodha","doi":"10.4103/sccj.sccj_16_18","DOIUrl":"https://doi.org/10.4103/sccj.sccj_16_18","url":null,"abstract":"Introduction: Organization of intensive care units (ICUs) have a bearing on the quality of care rendered and outcome of care. Hence, this study was conducted with the aim to examine various ICUs for compliance against the different structural and organizational parameters prescribed by the standard national and international guidelines. Methodology: A descriptive and observational study was conducted from June 2011 to September 2012 in neonatal surgery ICU (NSICU), pediatric ICU, and medicine ICU (MICU) at a tertiary care teaching hospital of Northern India. Structural and organizational aspects of each ICU were studied against the Indian and international guidelines prescribed by concerned scientific organizations/bodies. These guidelines were selected in consultation with the domain experts. All parameters were assigned equal weightage, and scoring was done by assigning a score of 0, 5, and 10 to noncompliance, partial compliance, and compliance, respectively. Data were collected through direct observations, perusing hospital records, and unstructured interview of key informants. Results: NSICU assessment against the two international guidelines revealed the adherence of 42.52% and 37.80% toward different structural and organizational parameters. Similarly, low compliance to organizational and structural parameters were observed in pediatric (national –52.38% and international –49.39%) and MICUs (national –50.52% and international –39.01%). All the three ICUs under study have been created by carving out space from their respective inpatient admission area owing to patient care requirements, hence, does not score well against the structural/spatial parameters. Conclusion: Overall, low compliance of all three ICUs was observed when compared against the prescribed guidelines for organizational and structural parameters.","PeriodicalId":345799,"journal":{"name":"Saudi Critical Care Journal","volume":"57 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125506921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: A mechanical ventilator (MV) is one of the most important devices in critical care units. Improper ventilator settings may adversely affect patients' health. The objective of this study is to evaluate the accuracy of volume, pressure, and flow delivered by the ventilators in clinical settings. Materials and Methods: Thirty randomly chosen MVs from four randomly selected main hospitals in the eastern province of Saudi Arabia were included in this study. All types of modern intensive care unit ventilators brands along with all versions were targeted. Pressure, volume, and flow were evaluated at two levels by using Fluke Biomedical VT PLUS HF Gas Flow Analyzer. Results: High-pressure mean was 28.7 ± 4.9 cm H2O and low-pressure mean was 14.6 ± 1.3 cm H2O. 95% limits of agreement (LA95%) between the measured and setting in high pressure was −0.74–2.86 cm H2O and −0.114–0.84 cm H2O in low pressure. The mean of volume measurements was 676.9 ± 45.5 ml in high setting and 342.9 ± 24 ml in low setting. In high volume setting, LA95%of 104.76–138.05 ml, wherein low volume LA95%of 47.7–65.3 ml. High flow mean was 53.4 ± 4.6 lpm with LA95%of 3.3–6.8 lpm and low flow mean was 36 ± 3.7 lpm with LA95%of 1.87–4.6 lpm. Conclusion: The present data reveal that MVs in clinical settings have some variations in their performance. The delivered flow and volume might not be accurate as it might be anticipated. These differences should be considered while their use in critically ill patients.
背景:机械呼吸机(MV)是重症监护病房最重要的设备之一。不适当的呼吸机设置可能会对患者的健康产生不利影响。本研究的目的是评估临床环境中呼吸机提供的体积、压力和流量的准确性。材料与方法:从沙特阿拉伯东部省份随机选取的四家主要医院随机选取30名mv。所有类型的现代重症监护病房呼吸机品牌以及所有版本的目标。采用Fluke Biomedical VT PLUS HF气体流量分析仪对压力、体积和流量进行两个水平的评估。结果:高压平均28.7±4.9 cm H2O，低压平均14.6±1.3 cm H2O。在高压下，测量值与设定值之间的95%一致限(LA95%)为−0.74-2.86 cm H2O，在低压下为−0.114-0.84 cm H2O。平均容积测量值高设置为676.9±45.5 ml，低设置为342.9±24 ml。高流量时la95%为104.76 ~ 138.05 ml，低流量时la95%为47.7 ~ 65.3 ml，高流量平均值为53.4±4.6 lpm, la95%为3.3 ~ 6.8 lpm，低流量平均值为36±3.7 lpm, la95%为1.87 ~ 4.6 lpm。结论:目前的数据显示，在临床设置的mv有一些差异的表现。交付的流量和体积可能不像预期的那样准确。在重症患者中使用时应考虑到这些差异。
{"title":"Evaluation of mechanical ventilators' accuracy in clinical settings: A quality control study","authors":"H. Al-Otaibi, K. Ansari, F. Farooqi","doi":"10.4103/sccj.sccj_21_19","DOIUrl":"https://doi.org/10.4103/sccj.sccj_21_19","url":null,"abstract":"Background: A mechanical ventilator (MV) is one of the most important devices in critical care units. Improper ventilator settings may adversely affect patients' health. The objective of this study is to evaluate the accuracy of volume, pressure, and flow delivered by the ventilators in clinical settings. Materials and Methods: Thirty randomly chosen MVs from four randomly selected main hospitals in the eastern province of Saudi Arabia were included in this study. All types of modern intensive care unit ventilators brands along with all versions were targeted. Pressure, volume, and flow were evaluated at two levels by using Fluke Biomedical VT PLUS HF Gas Flow Analyzer. Results: High-pressure mean was 28.7 ± 4.9 cm H2O and low-pressure mean was 14.6 ± 1.3 cm H2O. 95% limits of agreement (LA95%) between the measured and setting in high pressure was −0.74–2.86 cm H2O and −0.114–0.84 cm H2O in low pressure. The mean of volume measurements was 676.9 ± 45.5 ml in high setting and 342.9 ± 24 ml in low setting. In high volume setting, LA95%of 104.76–138.05 ml, wherein low volume LA95%of 47.7–65.3 ml. High flow mean was 53.4 ± 4.6 lpm with LA95%of 3.3–6.8 lpm and low flow mean was 36 ± 3.7 lpm with LA95%of 1.87–4.6 lpm. Conclusion: The present data reveal that MVs in clinical settings have some variations in their performance. The delivered flow and volume might not be accurate as it might be anticipated. These differences should be considered while their use in critically ill patients.","PeriodicalId":345799,"journal":{"name":"Saudi Critical Care Journal","volume":"143 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117172593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The incidence of myasthenia gravis (MG) is around 15–20/100,000. It can present as respiratory failure known as a myasthenic crisis in old age individuals. This can be precipitated by some underlying processes such as sepsis. As most patients with cor pulmonale are associated with type 2 respiratory failure and some degree of muscle fatigue, in this scenario, the other causes of neuromuscular weakness such as MG can be missed. We report the case of an 80-year-old male known case of type 2 diabetes, hypertension, cor pulmonale, and sepsis who presented with generalized weakness and respiratory failure as the first symptom of MG. As there is limited literature available on MG in cor pulmonale, we aimed to report this study.
{"title":"Presentation of myasthenia gravis crisis in a critically ill patient of corpulmonale","authors":"S. Singla","doi":"10.4103/sccj.sccj_19_19","DOIUrl":"https://doi.org/10.4103/sccj.sccj_19_19","url":null,"abstract":"The incidence of myasthenia gravis (MG) is around 15–20/100,000. It can present as respiratory failure known as a myasthenic crisis in old age individuals. This can be precipitated by some underlying processes such as sepsis. As most patients with cor pulmonale are associated with type 2 respiratory failure and some degree of muscle fatigue, in this scenario, the other causes of neuromuscular weakness such as MG can be missed. We report the case of an 80-year-old male known case of type 2 diabetes, hypertension, cor pulmonale, and sepsis who presented with generalized weakness and respiratory failure as the first symptom of MG. As there is limited literature available on MG in cor pulmonale, we aimed to report this study.","PeriodicalId":345799,"journal":{"name":"Saudi Critical Care Journal","volume":"57 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126015608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
How to cite this article: Arabi YM, Alsolamy SJ, Al-Dawood A. Should pneumatic compression be used in conjunction with pharmacologic venous thromboprophylaxis: Lessons from the PREVENT trial. Saudi Crit Care J 2019;3:95-8. Pneumatic compression is a widely used method for venous thromboprophylaxis in conjunction with pharmacologic thromboprophylaxis (unfractionated heparin [UFH] and low molecular-weight heparin [LMWH]) among patients admitted to the intensive care units (ICUs). Recently, the Pneumatic Compression for Preventing Venous Thromboembolism (PREVENT) trial (clinicaltrials.gov identifier: NCT02040103, Current controlled trials ISRCTN44653506) was published.[1] The PREVENT trial, a multicenter randomized controlled study, assessed whether adjunctive pneumatic compression in critically ill patients receiving pharmacologic thromboprophylaxis would result in lower incidence of proximal lower limb deep vein thrombosis (DVT) than pharmacologic thromboprophylaxis alone.
{"title":"Should pneumatic compression be used in conjunction with pharmacologic venous thromboprophylaxis: Lessons from the PREVENT trial","authors":"Y. Arabi, S. Alsolamy, A. Al-Dawood","doi":"10.4103/sccj.sccj_15_19","DOIUrl":"https://doi.org/10.4103/sccj.sccj_15_19","url":null,"abstract":"How to cite this article: Arabi YM, Alsolamy SJ, Al-Dawood A. Should pneumatic compression be used in conjunction with pharmacologic venous thromboprophylaxis: Lessons from the PREVENT trial. Saudi Crit Care J 2019;3:95-8. Pneumatic compression is a widely used method for venous thromboprophylaxis in conjunction with pharmacologic thromboprophylaxis (unfractionated heparin [UFH] and low molecular-weight heparin [LMWH]) among patients admitted to the intensive care units (ICUs). Recently, the Pneumatic Compression for Preventing Venous Thromboembolism (PREVENT) trial (clinicaltrials.gov identifier: NCT02040103, Current controlled trials ISRCTN44653506) was published.[1] The PREVENT trial, a multicenter randomized controlled study, assessed whether adjunctive pneumatic compression in critically ill patients receiving pharmacologic thromboprophylaxis would result in lower incidence of proximal lower limb deep vein thrombosis (DVT) than pharmacologic thromboprophylaxis alone.","PeriodicalId":345799,"journal":{"name":"Saudi Critical Care Journal","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125614476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hani S Lababidi, Abrar Alajlani, A. Alasmari, Wajed Alshammeri, Wejdan Suwayyid, A. Bahnassy
Background: Many cancer patients need admission to intensive care unit (ICU). It is important to identify patients who will benefit most from ICU care. Objective: The current study aimed to identify the clinical features associated with outcomes and factors predicting ICU mortality of cancer patients at a tertiary care hospital in Riyadh, Saudi Arabia. Materials and Methods: This was a single-center, retrospective study of all adult patients with either hematological or solid cancer admitted to ICU between January 2017 and June 2018 at King Fahad Medical City, Riyadh, Saudi Arabia. Collected data included: patients' demographics, type of cancer, diagnosis, stage of disease, number of organs failure, reason for ICU admission, severity scores (Acute Physiology and Chronic Health Evaluation [APACHE] II, and Sepsis-related Organ Failure Assessment [SOFA] score), code status, interventions in the ICU, and outcomes. Results: A total of 108 cancer patients were admitted 128 times to ICU during the specified study period. Overall, mortality rate was 57% with standardized mortality rate according to the APACHE II of 0.75. Associative mortality included: vasopressor agents odds ratio (OR) = 3.44, cardiopulmonary resuscitation (CPR) before ICU admission OR = 3.35, presence of sepsis OR = 2.64, and need for invasive ventilatory support OR = 2.16. A total of 46 patients (43%) had hematological malignancies, whereas 62 (57%) had solid organ malignancies. Septic shock ranked first (44%) as the main reason for ICU admission. The mortality rate among hematological and solid organ cancer patients were 52% and 61%, respectively. The code status was do not resuscitate (DNR) in 55 patients (51%), 22% of the DNR patients were survivors. Twelve patients (22%) were DNR before ICU admission, whereas 43 (78%) were made DNR during their ICU stay. Most of ICU mortalities for both groups occurred within the first 20 days of ICU admission. Conclusion: Cancer patients admitted to ICU has high mortality rates; however, this does not preclude aggressive treatment for some. Factors associated with mortality include vasopressors, CPR, sepsis, and mechanical ventilation. Change of code status to DNR during ICU stay is common.
{"title":"The characteristics and outcomes of oncology patients in intensive care unit in a tertiary care hospital in Saudi Arabia","authors":"Hani S Lababidi, Abrar Alajlani, A. Alasmari, Wajed Alshammeri, Wejdan Suwayyid, A. Bahnassy","doi":"10.4103/sccj.sccj_17_19","DOIUrl":"https://doi.org/10.4103/sccj.sccj_17_19","url":null,"abstract":"Background: Many cancer patients need admission to intensive care unit (ICU). It is important to identify patients who will benefit most from ICU care. Objective: The current study aimed to identify the clinical features associated with outcomes and factors predicting ICU mortality of cancer patients at a tertiary care hospital in Riyadh, Saudi Arabia. Materials and Methods: This was a single-center, retrospective study of all adult patients with either hematological or solid cancer admitted to ICU between January 2017 and June 2018 at King Fahad Medical City, Riyadh, Saudi Arabia. Collected data included: patients' demographics, type of cancer, diagnosis, stage of disease, number of organs failure, reason for ICU admission, severity scores (Acute Physiology and Chronic Health Evaluation [APACHE] II, and Sepsis-related Organ Failure Assessment [SOFA] score), code status, interventions in the ICU, and outcomes. Results: A total of 108 cancer patients were admitted 128 times to ICU during the specified study period. Overall, mortality rate was 57% with standardized mortality rate according to the APACHE II of 0.75. Associative mortality included: vasopressor agents odds ratio (OR) = 3.44, cardiopulmonary resuscitation (CPR) before ICU admission OR = 3.35, presence of sepsis OR = 2.64, and need for invasive ventilatory support OR = 2.16. A total of 46 patients (43%) had hematological malignancies, whereas 62 (57%) had solid organ malignancies. Septic shock ranked first (44%) as the main reason for ICU admission. The mortality rate among hematological and solid organ cancer patients were 52% and 61%, respectively. The code status was do not resuscitate (DNR) in 55 patients (51%), 22% of the DNR patients were survivors. Twelve patients (22%) were DNR before ICU admission, whereas 43 (78%) were made DNR during their ICU stay. Most of ICU mortalities for both groups occurred within the first 20 days of ICU admission. Conclusion: Cancer patients admitted to ICU has high mortality rates; however, this does not preclude aggressive treatment for some. Factors associated with mortality include vasopressors, CPR, sepsis, and mechanical ventilation. Change of code status to DNR during ICU stay is common.","PeriodicalId":345799,"journal":{"name":"Saudi Critical Care Journal","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131973147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Gill, U. Rathi, Charmila Choudhary, Aravind Guledagudd
Central line insertion is a commonly performed procedure in the intensive care unit. Although technical difficulty is moderate, experience decreases the failure rate. Central vein catheter (CVC) insertion is associated with various complications such as pneumothorax and arterial puncture, but rare possibilities such as coiling of catheter can still occur and every intensivist should be cautious about it. Chest X-ray remains the gold standard to confirm the course and position of CVC and should be correlated with clinical findings. We report a case where CVC insertion was associated with coiling and led to occlusion of the proximal port.
{"title":"Hairpin coiling of central line catheter: Pinch-off syndrome?","authors":"R. Gill, U. Rathi, Charmila Choudhary, Aravind Guledagudd","doi":"10.4103/sccj.sccj_13_19","DOIUrl":"https://doi.org/10.4103/sccj.sccj_13_19","url":null,"abstract":"Central line insertion is a commonly performed procedure in the intensive care unit. Although technical difficulty is moderate, experience decreases the failure rate. Central vein catheter (CVC) insertion is associated with various complications such as pneumothorax and arterial puncture, but rare possibilities such as coiling of catheter can still occur and every intensivist should be cautious about it. Chest X-ray remains the gold standard to confirm the course and position of CVC and should be correlated with clinical findings. We report a case where CVC insertion was associated with coiling and led to occlusion of the proximal port.","PeriodicalId":345799,"journal":{"name":"Saudi Critical Care Journal","volume":"107 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115695493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bassam Basaffar, Nasser Aloitibi, Rashed S Alzahrani, Omar Felimban, Khalid Algethami, A. Alshehri
Background: Sepsis is a life-threatening condition existing worldwide and is frequently known as the “hidden killer” because it is a time-sensitive illness, like myocardial infarction and cardiac arrest; therefore, prehospital providers must have adequate knowledge about it. Aim: The aim was to measure the knowledge and perception of sepsis among emergency medical service (EMS) providers to assure better patient prognosis. Methodology: A cross-sectional paper-based questionnaire survey comprising 15 questions, divided into three sections, was conducted at Makkah Saudi Red Crescent Authority to evaluate their knowledge related to the signs and symptoms of sepsis in particular and management and perception of sepsis in general. The responses received were categorized according to the specialties considering P < 0.05 as statistically significant. Results: The total number of study participants was 102; 26 participants were excluded because they did not meet the inclusion criteria. Among the remaining 76 participants, 64.5% were technicians and 35.5% were specialists. The most common age group was 25 ± 5 years which composed 46.1% of the total participants, and the highest years of experience was between 6 and 10 years which composed 47.4% of the total participants. According to a 5-point Likert scale, there was an adequate level of EMS provider perception on the knowledge of sepsis. Nearly 55.6% of the specialists knew the three stages of sepsis better than technicians (40.8%). Both the technicians and specialists had poor knowledge regarding hypothermia (technicians 20.4% and specialists 25.9%) as a sign of sepsis, in addition to administering intravenous antibiotics (technicians 28.6% and specialists 14.8%) as a management modality. On the other hand, both had enough knowledge regarding the other signs and symptoms with an average of 72.8% and the management of sepsis with an average of 72%. Conclusion: Overall, all participants had a good level of knowledge related to sepsis. However, the participants lack knowledge on administering antibiotics and hypothermia; moreover, their attitude and willingness toward recognizing and managing septic patients is unknown. Hence, it is recommended that further research may be undertaken to measure it at a larger scale and efforts be made to educate the providers certainly on the knowledge they lack of.
{"title":"Emergency medical service providers' knowledge and perception of sepsis at Makkah Saudi Red Crescent Authority","authors":"Bassam Basaffar, Nasser Aloitibi, Rashed S Alzahrani, Omar Felimban, Khalid Algethami, A. Alshehri","doi":"10.4103/sccj.sccj_14_19","DOIUrl":"https://doi.org/10.4103/sccj.sccj_14_19","url":null,"abstract":"Background: Sepsis is a life-threatening condition existing worldwide and is frequently known as the “hidden killer” because it is a time-sensitive illness, like myocardial infarction and cardiac arrest; therefore, prehospital providers must have adequate knowledge about it. Aim: The aim was to measure the knowledge and perception of sepsis among emergency medical service (EMS) providers to assure better patient prognosis. Methodology: A cross-sectional paper-based questionnaire survey comprising 15 questions, divided into three sections, was conducted at Makkah Saudi Red Crescent Authority to evaluate their knowledge related to the signs and symptoms of sepsis in particular and management and perception of sepsis in general. The responses received were categorized according to the specialties considering P < 0.05 as statistically significant. Results: The total number of study participants was 102; 26 participants were excluded because they did not meet the inclusion criteria. Among the remaining 76 participants, 64.5% were technicians and 35.5% were specialists. The most common age group was 25 ± 5 years which composed 46.1% of the total participants, and the highest years of experience was between 6 and 10 years which composed 47.4% of the total participants. According to a 5-point Likert scale, there was an adequate level of EMS provider perception on the knowledge of sepsis. Nearly 55.6% of the specialists knew the three stages of sepsis better than technicians (40.8%). Both the technicians and specialists had poor knowledge regarding hypothermia (technicians 20.4% and specialists 25.9%) as a sign of sepsis, in addition to administering intravenous antibiotics (technicians 28.6% and specialists 14.8%) as a management modality. On the other hand, both had enough knowledge regarding the other signs and symptoms with an average of 72.8% and the management of sepsis with an average of 72%. Conclusion: Overall, all participants had a good level of knowledge related to sepsis. However, the participants lack knowledge on administering antibiotics and hypothermia; moreover, their attitude and willingness toward recognizing and managing septic patients is unknown. Hence, it is recommended that further research may be undertaken to measure it at a larger scale and efforts be made to educate the providers certainly on the knowledge they lack of.","PeriodicalId":345799,"journal":{"name":"Saudi Critical Care Journal","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121033226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Saudi registered nurses (RNs) currently comprise 30% of Saudi Arabia's nursing workforce, and turnover/attrition rates remain problematic. No studies exploring Saudi RNs' experiences of acute care work and/or the factors that influence their decision to continue working were located. Purpose: To construct an insightful understanding of the acute care workplace experiences of female Saudi RNs and factors affecting retention. Methods: Snowball sampling was used to recruit 26 female acute care Saudi RNs who were interviewed about their workplace experiences. A constructivist grounded theory approach was used to code and categorize data to construct a shared understanding reflective of the experiences of participants and the researcher as both constructing the meanings given. Results: Shared understandings of patients' culture, religion, and language were assisting Saudi RNs to feel competent in making a unique contribution to patient care. Although participants reported negative impacts from some workplace policies, they were able to create their own identity and to find their own place by creating a career identity as Saudi-Muslim nurses. Successfully creating this unique nursing identity enhanced their motivation, work commitment, and competence; however, difficulties were encountered in accommodating work conditions and working as a minority group within a workplace largely staffed by foreign nurses. Conclusion: Saudi nurses' acute care workplace experiences were found to be complex and challenging and significantly affected by the lack of supportive policies designed to help them to keep working clinically. Implications for Nursing Policy: Workplace retention of Saudi RNs is an organizational issue that needs wide discussion to enable continuing clinical work of Saudi female nurses.
{"title":"Exploring acute care workplace experiences of Saudi female nurses: Creating career identity","authors":"S. Alsayed, S. West","doi":"10.4103/sccj.sccj_11_19","DOIUrl":"https://doi.org/10.4103/sccj.sccj_11_19","url":null,"abstract":"Background: Saudi registered nurses (RNs) currently comprise 30% of Saudi Arabia's nursing workforce, and turnover/attrition rates remain problematic. No studies exploring Saudi RNs' experiences of acute care work and/or the factors that influence their decision to continue working were located. Purpose: To construct an insightful understanding of the acute care workplace experiences of female Saudi RNs and factors affecting retention. Methods: Snowball sampling was used to recruit 26 female acute care Saudi RNs who were interviewed about their workplace experiences. A constructivist grounded theory approach was used to code and categorize data to construct a shared understanding reflective of the experiences of participants and the researcher as both constructing the meanings given. Results: Shared understandings of patients' culture, religion, and language were assisting Saudi RNs to feel competent in making a unique contribution to patient care. Although participants reported negative impacts from some workplace policies, they were able to create their own identity and to find their own place by creating a career identity as Saudi-Muslim nurses. Successfully creating this unique nursing identity enhanced their motivation, work commitment, and competence; however, difficulties were encountered in accommodating work conditions and working as a minority group within a workplace largely staffed by foreign nurses. Conclusion: Saudi nurses' acute care workplace experiences were found to be complex and challenging and significantly affected by the lack of supportive policies designed to help them to keep working clinically. Implications for Nursing Policy: Workplace retention of Saudi RNs is an organizational issue that needs wide discussion to enable continuing clinical work of Saudi female nurses.","PeriodicalId":345799,"journal":{"name":"Saudi Critical Care Journal","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115075850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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