FreshRSS

🔒
❌ Acerca de FreshRSS
Hay nuevos artículos disponibles. Pincha para refrescar la página.
AnteayerTus fuentes RSS

Incidence of critical events in the post-anesthesia care unit at a resource-limited setting in Debre Markos, Northwest Ethiopia

by Abebaw Misganaw, Alaye Debas Ayenew, Netsanet Temesgen Ayenew, Enyew Fenta Mengistu, Baye Ashenef, Samrawit Nega Shiferaw, Getamesay Demelash Simegn

Background

Surgery and anesthesia can disrupt normal physiological function through surgical stress and residual anesthetic effects, increasing the risk of post-anesthetic complications, known as critical incidents. This study aimed to determine the incidence of critical events in the post-anesthesia care unit at Debre Markos Comprehensive Specialized Hospital, Ethiopia.

Methods

An institution-based prospective cross-sectional study was conducted from June 1, 2024, to September 30, 2024. The sample size was determined by a single proportion formula using a prevalence of 50% and a 5% margin of error at the 95% confidence interval. The data was analyzed using SPSS version 22 for windows. Analysis was conducted using bivariable and multivariable logistic regression as needed.

Result

Of the 422 patients, 160 (37.9%) experienced one or more critical events, with a total of 214 complications recorded. The most common critical events that occurred in the PACU were cardiovascular-related events (42%) and respiratory & airway related incidents (20%). BMI, duration of anesthesia, intraoperative complications, patient handover, PACU staff training, and ASA physical status were significantly associated with the occurrence of critical events. The odds of critical events were higher among underweight (AOR = 3.71; 95% CI: 1.27–10.79) and overweight patients (AOR = 3.05; 95% CI: 1.28–7.24). Anesthesia duration of 1–2 hours (AOR = 2.01; 95% CI: 1.06–3.81) and >2 hours (AOR = 4.11; 95% CI: 1.59–10.66) also increased the risk. Patients with intraoperative complications had higher odds of critical events (AOR = 3.52; 95% CI: 1.88–6.58), as did those without proper handover (AOR = 3.92; 95% CI: 2.11–7.25). Increasing ASA class was associated with higher risk ASA II (AOR = 2.59; 95% CI: 1.11–6.07), ASA III (AOR = 2.86; 95% CI: 1.20–6.86), and ASA IV (AOR = 11.75; 95% CI: 2.76–50.03). Additionally, patients cared for by PACU nurses without prior PACU training were more likely to develop complications (AOR = 3.15; 95% CI: 1.73–5.72).

Conclusion

Approximately 38% of patients experienced ≥1 critical event, mainly cardiovascular and respiratory complications. Patients who had intraoperative complications, ASA 2 to ASA 4 status, under/overweight, and those who received anesthesia for a prolonged duration were relatively at higher risk of developing critical events. There was a long time to stay in the PACU for those patients who experienced critical events.

Trajectories of Nursing Care During the Critical and Intensive Phases After Coronary Artery Bypass Graft Surgery: A Retrospective Observational Study

ABSTRACT

Aim

To examine the trajectories of nursing care during the critical and intensive phases after coronary artery bypass graft surgery, using standardised electronic nursing records.

Design

Retrospective observational study.

Methods

The electronic nursing records of 122 patients who underwent coronary artery bypass graft from a tertiary hospital were collected between September 2021 and September 2023. Among the 287,360 extracted nursing statements, the 427 most frequent statements were mapped to SNOMED CT. Nursing data were categorised into pre- and postoperative phases, and a heatmap was used to visualise daily nursing care trends during the first 8 days post-surgery.

Results

In total, 287,360 nursing statements were extracted and semantically mapped, with 90.9% linked to pre-coordinated SNOMED CT concepts. The results showed that in the acute postoperative phase, clinical priorities included respiratory management and surgical drain care. As recovery progressed, priorities expanded to include pressure injury prevention, safety monitoring, and effective interdisciplinary communication.

Conclusions

The analysis using standardised nursing records identified dynamic care patterns after coronary artery bypass graft surgery and supports the development of disease-specific, evidence-based nursing practice guidelines.

Implications for the Profession and/or Patient Care

Support for evidence-based nursing care for patients undergoing coronary artery bypass graft surgery.

Impact

This study addressed the limited development of nursing-focused clinical practice guidelines by demonstrating how real-world nursing data can be leveraged to develop disease-specific, evidence-based guidance. By mapping electronic nursing records to international standard terminology, the study advanced a methodological approach for systematically capturing and analysing nursing care trajectories over time. The findings reveal dynamic patterns of nursing interventions during postoperative care and provide empirical support for developing standardised, data-driven nursing guidelines, ultimately strengthening evidence-based practice in acute and critical care settings.

Reporting Method

Strengthening the Reporting of Observational Studies in Epidemiology guidelines.

Patient or Public Contribution

This study did not include patient or public involvement in its design, conduct, or reporting.

Development and validation of a risk prediction model for chronic kidney disease among adult hypertensive patients having follow-up at University of Gondar Comprehensive Specialised Hospital, Ethiopia: a retrospective cohort study

Por: Tilahun · A. D. · Limenih · M. A. · Muluneh · A. G. · Hailu · W. · Anlay · D. Z. · Liyew · B. · Muche · A. A.
Objective

Chronic kidney disease (CKD) arises due to uncontrolled hypertension (HTN). HTN significantly increases the risk of complications in vital organs, mainly the kidneys. If hypertensive individuals receive early intervention, the majority of these complications and deaths from CKD can be avoided. Having a clinically applicable tool to predict the future risk of those complications can prevent early disability and premature mortality. However, to this day, there is a lack of a validated risk prediction model specifically designed for CKD of hypertensive patients in Ethiopia. We aimed to develop a risk prediction model for CKD among hypertensive patients at the University of Gondar Comprehensive Specialised Hospital (UoGCSH), Ethiopia.

Study design

A retrospective follow-up study was conducted from 1 January 2012 to 30 December 2021. The Least Absolute Shrinkage and Selection Operator regression methods were used to select predictors. The performance of the models was assessed using the Area Under the Curve and calibration plots. The internal validity of the model was evaluated using bootstrapping methods, and the model was presented as a nomogram. Decision curve analysis was conducted to assess the net benefit of the prediction model in clinical and public health contexts.

Setting

Data from patients’ medical records were collected via the Kobo Toolbox in the UoGCSH.

Participant

We followed a total of 1120 Patients diagnosed with HTN.

Results

The incidence of CKD among adult hypertensive patients was 19.82% (95% CI 17.59% to 22.26%). In the multivariable logistic regression analysis, age, residency, baseline blood pressure status, type of HTN, family history of HTN, baseline serum creatinine levels, proteinuria at baseline and dyslipidaemia were identified as statistically significant predictors of CKD. The nomogram demonstrated a discriminatory power of 91.98% (95% CI 90.09% to 93.88%) and a calibration p value of 0.327. The sensitivity and specificity of the prediction model were 80.63% (95% CI 74.81% to 85.61%) and 87.97% (95% CI 85.66% to 90.03%), respectively. The developed nomogram has a greater net benefit than using the treat-all or treat-none strategies when the threshold probability of the patient is increased.

Conclusion

The nomogram demonstrated excellent discrimination and calibration in identifying hypertensive patients at high risk of CKD. This predictive model offers clinicians a valuable tool for early identification of high-risk individuals, enabling timely interventions, personalised counselling and optimised management through close monitoring to prevent disease progression.

Epidemiology and disease burden of connective tissue disease-associated interstitial lung disease (CTD-ILD) in Asia: a systematic review and meta-analysis protocol

Por: Chua · F. · Subramaniam · S. · Lai · W. H. · Tan · S. H. · Yean · H. R. A. · Kho · S. S. · Yew · J. S. Y. · Hong · H. C. · Ng · C. C. M. · Sirol Aflah · S. S. · Mohd Zaidi · N. A. · Ong · V. H. · Chai · G. T. · Ang · S. H. · Maamor · H. · Muhamad · N. A.
Introduction

Interstitial lung diseases (ILD) associated with an underlying connective tissue disease (CTD), also known as a systemic autoimmune rheumatic disease or SARD, are chronic conditions with a tendency to progress. CTD-ILDs are increasingly diagnosed and pose an important global health challenge. This systematic review aims to provide an overarching evaluation of their epidemiology and disease burden in Asia. In this review, the term CTD-ILD will be used to denote all major forms of ILD arising in the context of a SARD.

Methods and analysis

This systematic review will adhere to the standards of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, including a flow diagram to depict the process by four independent reviewers that will assess titles and abstracts against the following predetermined criteria. A systematic review of the literature search published from 2000 to 2024 will be conducted using five electronic databases including PubMed/MEDLINE, Scopus, EMBASE, Cochrane Library and Web of Science. Publications that meet the inclusion criteria of this review will be subjected to a full-text review to extract relevant data. Collated data will be analysed and organised into categories based on the expected outcome and objectives. The quality of published evidence, including heterogeneity across studies, will be checked against PRISMA checklists and assessed by Newcastle-Ottawa Scale.

Ethics and dissemination

Ethics approval is not applicable for this study since no original data will be collected. The findings of this review will be disseminated through a peer-reviewed publication in a scientific journal and conference communications, with the aim of contributing insights to the field by identifying research gaps and informing clinical practice.

PROSPERO registration number

The protocol of this systematic review is registered with the National Medical & Research Register (ID-24–03600-GUB) and International Prospective Register of Systematic Reviews PROSPERO (CRD420251037095).

Type I hybrid effectiveness-implementation randomised controlled trial to address intergenerational impact of war trauma and resilience among second-generation refugee children in the USA: Resettled Refugee Families for Healing (RRF4H) study protocol

Por: Tutlam · N. T. · Liyew · T. W. · Betancourt · T. S. · Powell · B. J. · Guo · S. · McKay · M. · Ssewamala · F. M.
Introduction

Children from refugee families resettled in the USA face higher risks of serious mental health challenges compared with their native-born peers. Research shows that refugee youth in high-income countries frequently suffer from trauma-associated disorders such as post-traumatic stress disorder (PTSD), depression and anxiety. The high prevalence of trauma-associated mental health problems among these youth may be attributed to their own trauma exposure, especially if born in conflict zones, and post-resettlement challenges like poverty, acculturation difficulties, racism and discrimination. However, they may also suffer from the effects of intergenerational trauma, where parental war trauma impacts them. This study aims to adapt and test an intervention addressing intergenerational trauma-related emotional and behavioural health outcomes among US-born children of refugee parents in Omaha and Lincoln, Nebraska.

Methods and analysis

This is a two-arm cluster randomised type I hybrid effectiveness-implementation trial. Guided by the Social Action and Family Systems theories and applying them to the intergenerational transmission of trauma framework, the combination intervention consists of family strengthening model delivered through multiple family groups+peer mentoring programme called TeenAge Health Consultants (TAHC) adapted for delivery in virtual environment (Virtual TAHC). A total of 154 US-born adolescents of parent resettled as refugees (77 per study arm), ages 14–17 and at least one biological parent per youth (dyads) will be recruited from four comparable communities utilising community-based participatory research approach and randomised to usual care or intervention group. The intervention will be implemented for up to 16 weeks, with assessments at baseline, after intervention completion and 6 months follow-up. To determine study feasibility, we will use binary metrics of participant enrolment of 70% or more and retention of 80% or more at 12 months. To assess study acceptability, we will determine participant satisfaction with the study based on the Client Satisfaction Questionnaire (CSQ-8). To maximise rigour, our analyses will follow an intention-to-treat (ITT) approach. For primary inferential analyses, we will fit two-level generalised linear mixed models to continuous primary outcomes. The models will include fixed effects for study arm, time and their interaction terms. We will perform time-averaged comparisons of post-baseline repeatedly measured observations across study arms to examine intervention effects over the duration of the postintervention study period. To delineate barriers and facilitators to implementation and implementation strategies, we will apply a more integrative approach, using both inductive and deductive approaches guided by the grounded theory and integrative theory that combines both deductive and inductive approaches. Finally, we will integrate findings from the quantitative and qualitative analysis to provide additional explanation and context for our quantitative findings.

Ethics and dissemination

Voluntary written informed assent and consent will be obtained from all participants, adolescents and their parents, respectively. All study procedures received approval from Washington University in St. Louis Institutional Review Board (IRB #202307081).

Study findings will be disseminated through publications in scientific journals and presentations at national and international conferences. We also plan to provide community education about the study through a dissemination conference at the end of the study.

Trial registration number

NCT06176638.

The Development and Impact of a Respiratory Patient Care Mobile Application on Nursing Students

Por: Kim · Hyewon
imageThis study aimed to develop a virtual experiential application for respiratory patient care and evaluate its impact on nursing students' knowledge, self-efficacy, clinical practice anxiety, and performance confidence. This application with gamification elements was developed following a structured approach encompassing assessment, design, development, implementation, and evaluation. The experimental group consisted of 21 third-year university students who engaged with the application multiple times a day for 1 week; the control group, comprising 21 students, received traditional prelearning. Data were collected 1 week before and immediately before the clinical practice commencement, from March 7 to 24, 2023, using an online survey. Nursing knowledge, self-efficacy, clinical practice anxiety, and performance confidence were evaluated. Significant improvements were observed in the experimental group's knowledge of respiratory patient care, self-efficacy, clinical practice anxiety, and performance confidence. The application proved to be an effective learning resource and assisted students in implementing the nursing process to enhance patient conditions; it highlighted nursing educators' necessity in developing and evaluating educational content. The developed application was effective in enhancing student nurses' competence and confidence, affecting nursing education and patient care.

The Impact of Artificial Intelligence-Assisted Learning on Nursing Students' Ethical Decision-making and Clinical Reasoning in Pediatric Care: A Quasi-Experimental Study

imageThe integration of artificial intelligence such as ChatGPT into educational frameworks marks a pivotal transformation in teaching. This quasi-experimental study, conducted in September 2023, aimed to evaluate the effects of artificial intelligence–assisted learning on nursing students' ethical decision-making and clinical reasoning. A total of 99 nursing students enrolled in a pediatric nursing course were randomly divided into two groups: an experimental group that utilized ChatGPT and a control group that used traditional textbooks. The Mann-Whitney U test was employed to assess differences between the groups in two primary outcomes: (a) ethical standards, focusing on the understanding and applying ethical principles, and (b) nursing processes, emphasizing critical thinking skills and integrating evidence-based knowledge. The control group outperformed the experimental group in ethical standards and demonstrated better clinical reasoning in nursing processes. Reflective essays revealed that the experimental group reported lower reliability but higher time efficiency. Despite artificial intelligence's ability to offer diverse perspectives, the findings highlight that educators must supplement artificial intelligence technology with strategies that enhance critical thinking, careful data selection, and source verification. This study suggests a hybrid educational approach combining artificial intelligence with traditional learning methods to bolster nursing students' decision-making processes and clinical reasoning skills.
❌