Health Sciences

Permanent URI for this community

https://hdl.handle.net/20.500.11888/18806

Browse

Now showing 1 - 20 of 23

BACTERIOLOGIC PROFILE AND ANTIBIOTIC SUSCEPTIBILITY PATTERN OF SEPTICEMIA IN NEONATAL INTENSIVE CARE UNITS, PALESTINE (2019-2021)
(2022-12-29) Bayan Asem Mohammad Ibrahim
Background: Neonatal sepsis (NS) is a public health concern worldwide because of its high morbidity and mortality, in addition to the growing resistance towards World Health Organization (WHO) recommended empiric regimens. The aim of this study is to evaluate the matching status of WHO empiric antibiotic regimens with the causative pathogens of NS at three tertiary care hospitals in Palestine. Methods: This is a retrospective study where records of neonates with suspected NS admitted to neonatal intensive care units of three tertiary care units in the period of January 2019 to December 2021 were extracted from the Ministry of Health electronic database. Univariate analysis and multivariate logistic regressions were performed for factors associated with culture-proven NS, generating odds ratios and confidence intervals. Results: Out of 6090 suspected cases of NS, 884 (14.5%) cases had positive blood cultures. The prevalence rate of NS was 9 per 1000 live births and 4 per 1000 live births for early-onset sepsis, with an overall mortality prevalence of (17.2%). The predominantly isolated organisms were 499/884 (56.4%) Coagulase-negative Staphylococcus (CoNS), 119/884 (13.5%) Klebsiella pneumonia, and 66/884 (7.5%) Streptococcus spp. Moreover, most of the isolated bacteria (79.6%) didn’t match any of the WHO empiric regimens and the probability of matching for both WHO regimens among EOS was found 2.4 times the matching probability among LOS by doing multiple logistic regressions. (21.6%) of the Isolated bacteria (excluding CoNS) were multi-drug resistant (MDROs). Antibiotic susceptibility for Gram-negative bacteria was high among amikacin (63%), meropenem (70%), piperacillin-tazobactam (65.6%), and colistin (100%). Alternately, it was low for ampicillin (7.1%), cefotaxime (21.8%), and ceftazidime (29%). On the other hand, Gram-positive bacteria were sensitive to vancomycin (99.8%), and (81%) of Gram-positive other than Staphylococcus spp. were sensitive to ampicillin. Conclusions: The culture-proven NS prevalence rate is 10 folds the rate of high-income countries, and the majority of isolated pathogens were resistant to empiric WHO regimens. Hence, a careful review of empiric treatment for NS is warranted. Moreover, strict infection control and antimicrobial stewardship programs should be implemented to slow down the emergence of resistant organisms among the neonatal population. Keywords: Aantibiotic susceptibility; Empiric regimens; Neonatal sepsis; Prevalence rate of NS.
EFFECTIVENESS OF QUALITY HEALTHCARE SERVICES FROM A PATIENT PERSPECTIVE: A HOSPITAL BASED CASE STUDY
(2023-02-13) Ahmad Nidal Ahmad Rashid
Abstract This study aims to identify the effectiveness of quality healthcare services from a patient perspective: a hospital based case-study. To achieve the objectives of the study and answer its hypotheses the researcher used the descriptive analytical approach which is based on the study of the problem, a method that does not stop at collecting information. The research instrument used to collect data was the questionnaire: The sample of the study consists of (365) patients in governmental hospitals (Rafidia Hospital and the Ittihad Hospital) and private (Arab Specialist Hospital and Nablus Specialist Hospital) in Nablus Governorate. Results show that the degree of tangibility factor practice, that 80% of the participants have agreed on considering it as one of the factors of the effectiveness of healthcare services quality from patient perspective to the extent that its degree has been very high. Hence, 67.9% of the participants agreed on considering the degree of reliability factor practice as one of effectiveness healthcare services quality factors from patient perspective that its degree has been "high". Also, 65.6% of the participants have agreed on considering the degree of empathy factor practice as one of effectiveness healthcare services quality factors from patient perspective that its degree has been "high". Furthermore, 72% of the participant considered the degree of responsiveness factor practice as one of effectiveness healthcare services quality factors from patient perspective that its degree reaches "high". Thus, 66.4% of the participants have agreed that the degree of assurance factor practice as one of effectiveness healthcare services quality factors from patient perspective reaching "high" degree. Finally, 70.8% of the participants have agreed that the degree of doctor’s skills from patient perspective indicating a "high" degree. In addition, the results of Pearson correlation test of the hypotheses shows that doctors skills in dealing with patients is jointly affected quality healthcare services factors including tangibility, reliability, empathy, responsiveness, and assurance. Based on the results of the previous study, the researcher recommends a set of recommendations, which focus on developing assessment tool for patients to detect the healthcare services quality, arranging training courses for doctors to train them to help patients during their treatment in hospitals, and providing a fully organized structure that illustrate the main criteria for healthcare services quality. Keywords: Effectiveness; Hospitals; Nablus city; Patients; Quality healthcare services
RADIOLOGY DEPARTMENT: A POTENTIAL SOURCE OF MULTIDRUG-RESISTANT MICROORGANISMS, A CROSS-SECTIONAL STUDY AT TERTIARY CARE HOSPITAL, PALESTINE
(2023-03-22) Zena Mohammad Saleem Odeh
Globally, healthcare facilities face a great challenge in the form of hospital-acquired infections (HAIs). Aside from the morbidity and mortality they cause, these illnesses are also extremely costly. Research on infection transmission in the medical area has been considerable, but not so much in the radiology department. This study aims to identify the presence of multidrug-resistant (MDR) microbes on surfaces that are frequently touched in Computed Tomography (CT), Magnetic Resonance Imaging (MRI), Ultrasound (US), plain X-ray examination rooms, and portable radiography that are susceptible to contamination, as well as to investigate the potential dangers of contracting MDR organisms to patients and healthcare providers. In this study, 160 swab samples were collected from the radiology department at a tertiary care hospital in Palestine during May and June 2022. Samples were obtained from 80 predefined surfaces twice within and outside of CT and MRI examination rooms, as well as from US and Plain X-ray machines and portable X-ray machines. Samples were taken at 7:00 a.m. using cotton swabs following the regular cleaning procedure. Bacterial colony-forming units (CFUs) per square centimeter (cm2) were calculated after swabbing a 100 cm2 surface. Nearly all of the surfaces tested had bacterial CFUs. The highest contamination rate was found on keyboards ranging from (1.2-8) CFU/cm2, the sides of patient tables (1.2-20) CFU/cm2, knee coil (2.4-3) CFU/cm2, and patient leg supports (1.2-8) CFU/cm2. Noticeable increase in the contamination was noticed in June comparing to May and this was consistent with the increase in: number of isolated patients in the hospital, the workload in the radiology department and number of patients referred to the hospital. In our study, none of the examined sites showed contamination with MDR gram negative bacteria like Extended-Spectrum Beta-lactamases producing Enterobacterales (ESPL) or Carbapenemase-Producing Enterobacterales (CPE). On the other hand, methicillin resistant Staphylococcus aureus (MRSA), vancomycin resistant Staphylococcus aureus (VRSA) and vancomycin resistant Enterococcus (VRE) were detected. All of the radiology department equipment and sites could be a source of bacterial infection including MDR; so, obligatory and committed disinfection protocol must be revised and implemented in the morning and between patients. Keywords: Radiology Department, MDR, Hospital-acquired infection, Bacterial nosocomial infection, Contamination.
ASSESSING THE PREVALENCE OF PHARMACEUTICAL RESIDUES IN WADI ZOMAR CATCHMENT AREA IN PALESTINE: RISK ASSESSMENT FOR REUSE AND IMPACT ON HUMAN HEALTH
(2023-06-08) Ala'a Monther Hassan Jaddou
Abstract The occurrence of various classes of antibiotics and pharmaceuticals (PhCs) in the environment and their contribution to Antimicrobial resistance (AMR) development is questionable. AMR is recognized as a major health threat. Discharges from wastewater treatment plant (WWTP) is considered to be the major source contributing to the vast bulk of different pharmaceuticals in the environment. The researcher intends to investigate the prevalence of pharmaceutical residues in diverse aquatic matrices with more attention to the removal capacity of West Nablus WWTP with respect to the detected pharmaceuticals. Method: 2 raw wastewater, 2 treated wastewater, and 2 surface wastewater run-offs were collected in two grab sampling campaigns. An additional ground water sample was collected using a Passive Organic Chemical Integrative Sampler (POCIS). All samples were analyzed using LC-MS/MS. The Risk Quotient (RQ) was used for Measured Environmental Concentration (MEC) of detected antibiotics against Predicted No-Effect Concentration ((PNEC) to evaluate the risk for antibiotic resistance development according to the detected antibiotics residues. Sulfamethoxazole, Trimethoprim, Diclofenac, and Carbamazepine were the most frequently detected in all water samples. West Nablus WWTP delivered a significant removal efficiency in both campaigns. However, it was noticed that there was a significant spatial difference between the WWTP effluent discharge point and the Anabta-Zomar point of sampling directly after the rainy season. Ofloxacin residual concentration in immediate WWTP effluent discharges and surface run-offs along the sampling point is found to pose risk for AMR development in the environment. Groundwater is found to be polluted with Carbamazepine, Diclofenac, Ciprofloxacin, and Sulfamethoxazole. The local status indicates the need for further in-depth investigation regarding the risk of antibiotics to the environment and its role in the emergence of AMR concerning the detected antibiotics. Additional wastewater treatment methodologies are needed for better removal yield. Groundwater pollution requires urgent ecotoxicological studies for both human and animal health and environmental life forms. Keywords: Antibiotics; Antimicrobial resistance; Bacteria; Environment; Health; Pharmaceuticals; Wastewater; WWTP.
ASSOCIATION BETWEEN NURSES’ QUALITY OF WORK LIFE AND COMPLIANCE WITH STANDARD PRECAUTIONS: A CROSS-SECTIONAL STUDY FROM PALESTINE
(2023-06-11) Salwa Mohammad Asaad
In nearly all healthcare facilities globally, nurses constitute the most populous cadre of healthcare practitioners. The quality of nursing work life and adherence to the standard precautions were less than optimal. The objective of this investigation was to evaluate the degree to which nurses in governmental healthcare institutions in Palestine adhere to established guidelines for universal precautions and to assess the quality of their professional livelihood. This study was carried out in a descriptive cross-sectional design in six government hospitals in the West Bank. The questionnaire contained compliance with the standard precautions scale (CSPS) and the Brooks Quality of nursing work life (BQNWL) survey. A total of 257 nurses participated in this study and returned completed questionnaires. The mean percentage of ideal compliance was 77.1% ± 9.8% and 10 (3.9%) nurses had a CSPS % of ideal compliance of < 60%. Nurses in obstetrics, operations room, incubator unit, internal medicine, surgery, and renal unit were more likely to score ≥ 60% of ideal compliance. The BQNWL total score mean was found to be 177.0 ± 30.2. In detail, the mean scores were 28.5 ± 6.5, 43.2 ± 7.8, 88.5 ± 17.3, and 16.8 ± 5.5 in the work life-home life, work design, work context, and work world domains, correspondingly. Moreover, a statistically significant weak positive association was observed between CSPS scores and BQNWL scores, with a Pearson’s r of 0.16 and p-value of 0.011. Furthermore, a significantly low positive correlation was identified between CSPS scores and work context scores, with a Pearson’s r of 0.19 and p-value of 0.003. Nurses working in different hospitals in Palestine reported moderate adherence to standard precautions. Conversely, the nurses who participated in the study reported a moderately elevated quality of professional nursing livelihood. Specifically, female nurses reported a greater degree of compliance with universal precautions and a higher caliber of nursing work in comparison to their male counterparts. Additionally, a statistically significant weak positive correlation was detected between CSPS and BQNWL scores. In light of these results, healthcare policymakers and administrators may benefit from taking these findings into account to enhance nurses' adherence to established protocols and to improve the quality of their professional work life. Keywords: Infection control; Nursing; Quality of nursing work; Standard precautions.
EPIDEMIOLOGY AND ANTIMICROBIAL SUSCEPTIBILITY OF METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS ISOLATES: A RETROSPECTIVE STUDY AT A TERTIARY CARE HOSPITAL IN PALESTINE BETWEEN 2020-2021
(2023-06-14) Hala Zidan Masri
Increased rates of resistance of Staphylococcus aureus (S. aureus) to different classes of antibiotics, makes the researchers think about studying the antimicrobial profile of it, and other risk factors that may be associated with infection. The goals of our study are to determine the prevalence of methicillin-resistant S. aureus (MRSA) among Palestinian patients, and to identify risk factors, susceptibility patterns, and to determine the most suitable antibiotics to be used empirically. Data of positive S. aureus cultures from patients’ specimens during the time period between January 2020 and December 2021 was collected from An-Najah National University Hospital, Nablus-Palestine, classified to methicillin-sensitive S. aureus (MSSA) or MRSA by using Vitek 2 system which is available in the hospital. Each isolate was tested for susceptibility to each oxacillin, cefuroxime, amoxicillin, piperacillin-tazobactam clindamycin, erythromycin, gentamycin, levofloxacin, linezolid, moxifloxacin, ciprofloxacin, quinopristin/dalfopristin, rifampicin, tetracycline, tigecycline, trimethoprim-sulfamethoxazole (TMP-SMX), and vancomycin by Vitek2 system. Other information related to patients and other comorbidities were collected from the hospital information system. 126 (49.6%) of 254 patients with S. aureus were infected with MRSA, with no significant association with various age groups and gender. Prevalence of MRSA was highest in pediatric unit followed by emergency room, 61.1% and 59.6% respectively, followed by surgical unit with MRSA prevalence of 52.7%. There is a significant difference in MRSA and MSSA distribution in the kidney unit (p-value = 0.009). Lung diseases are the co-morbidities which are associated with MRSA. Skin and soft tissues, and pus/wound specimen are associated with MRSA infection. All isolated were still susceptible to vancomycin. The prevalence of MRSA seemed to be similar to other Asian countries. Vancomycin is the most suitable option to be used empirically for serious MRSA infections. Keywords: Methicillin-resistant Staphylococcus aureus, resistance, risk factors, susceptibility pattern.
TRENDS IN ANTIBIOTICS RESISTANCE OF BACTERIAL PATHOGENS IN A TERTIARY CARE HOSPITAL: A RETROSPECTIVE STUDY FROM PALESTINE
(2023-06-22) Ayman Dawoud
Antibiotic resistance has become a major public health problem worldwide, resulting in more severe infections and longer hospital stays. The goal of this study is to detect changes in resistance rates to first-line and last-resort antibiotics in Nablus, Palestine. A retrospective assessment of data gathered from a tertiary care hospital's microbiology department between January 2018 and December 2021. The resistance rate of the bacterial isolates was the outcome of interest. Microsoft Excel 2019 was used to depict trends from 2018 to 2021, and statistical analysis was performed using the Statistical Package for Social Science (SPSS) version 26. A total of 4659 isolates, of six highly virulent and antibiotic resistant bacterial pathogens were included in our study. The most common source for these organisms was urine (34.6%) followed by swabs from different parts of the body (30.7%), (13%) from respiratory samples, (10.1%) from blood culture samples, (7.6%) from body fluid samples, and (4%) from tissue samples. The most commonly isolated organism of the ESKAPE family was Escherichia coli (27%), followed by Klebsiella pneumoniae (15.5%), Enterococcus faecalis (14.6%), P. aeruginosa (13.0%), S. aureus (10.6%), Enterococcus faecium (10.2%), and Acinetobacter baumannii (9.0%) Over the four years period of study, ampicillin and penicillin showed the highest rates of resistance ranging from 55-75. Resistance of E. coli to amoxicillin/clavulanic acid decreased significantly while carbapenem-resistant E. coli and K. pneumoniae increased. For K. pneumoniae there is a significant increase in resistance to trimethoprim-sulfamethoxazole and a significant decrease in resistance to norfloxacin. Enterococcus Spp. showed an increase to last-resort antibiotics i.e., linezolid and vancomycin. P. aeruginosa demonstrated a significant decrease in resistance. Our study showed that antibiotic resistance is a major concern in Palestine because our country has limited resources. Policy-makers in the country should take the proper measures to slow down the development of resistance. Among the steps that should be taken into consideration is instituting antibiotic stewardships in all hospitals, putting forward legislation to stop dispensing antibiotics without prescriptions and increasing the public awareness of antibiotic resistance. Keywords: Antimicrobial Resistance; First-Line; Last-Resort Antibiotics; Nablus; Palestine; Stewardship Programs; Surveillance.
NURSES’ PERCEPTION OF THE DISCHARGE PLANNING PROCESS FOR ADULT PATIENTS IN AN ACUTE MEDICAL CARE DEPARTMENTS IN RAMALLAH HOSPITALS
(2023-10-18) Ali Thaher Mohamed Gawabreh
Introduction: Discharge planning is an integral part of patient care in hospital departments because the goal for all patients is that they will leave this setting once acute healthcare needs have been managed or it is clear what the next phase of care will be. All patients who leave hospitals require discharge planning. The discharge planning is different for each patient as a result of the different needs after discharge, from simple and straightforward needs to more complex requirements . Aim: To investigate the nurses’ perception of the discharge planning process for adult patients in acute medical care departments in Ramallah hospitals. Method: 400 modified questionnaires were distributed to fit this study to 400 nurses working in acute departments in several hospitals in Ramallah. Results: The survey consisted of 300 nurses, with a response rate of 75%. 50.7% of the nurses participating in the study were male; 53.3% of them work in government hospitals. Also, most study participants are registered nurses (61.7%), as well as full-time employees (83.3%) and (54.3%) with experience of 5 years or less. 63.8% of nurses have perceptions about discharge planning, and 74.2% are familiar with the coordination of discharge planning and the timing of discharge. In the multivariate analysis models, perception was a strong predictor for discharge planning, skills, and barriers. Conclusion: The results showed a Preparing or implementing discharge planning is one of the tasks of the nurse following up on the patient. and implementing a discharge plan effectively requires nurses' administrative or interpersonal skills. In addition, future research should be directed toward discovering factors that improve the discharge process, and it is recommended that frequent nursing development courses be established in the communication process, especially in cases of developing discharge planning for patients. Keywords: Discharge Planning, Adult Patients, Acute Medical Care.
FACTORS INFLUENCING ACCEPTANCE OF HEALTH INFORMATION SYSTEM AMONG HEALTH CARE PROVIDERS IN PALESTINE MEDICAL COMPLEX –RAMALLAH-PALESTINE
(An-Najah National University, 2024-02-07) Abu Sofyan, Fayez
Most of the Palestinian government hospitals have a unified health information system to deal with health care recipients, which is positively reflected on the quality of medical services. To ensure the continuity of providing the best possible care, the factors affecting acceptance to the health information system among health care providers must be studied, as they are the main user of the system, and they have a direct impact on the success of this system and ensure its development. The purpose of the study is to investigate the factors that affecting acceptance to the health information system among health care providers. A quantitative-based cross- sectional study was conducted among health care providers, attending in Palestine medical complex in Ramallah city between September and October of 2022. A structured Self administred questionnaire was administered on participants who were recruited using the systemic random sampling technique. Linear and Binary logistic regression analysis were conducted using statistical package for the social science version 25. Technological factors which included into the system quality, in which (62.3%) of the participants found HIS to provide all the functions included in completing the job to be very high, while (49%) found its ability to integrate with other systems’ information to be low, as well as its fast response time to be low (31.3%) or medium (54.7%), compared to (74.3%) who found its 24/7 support services to be very high as major factors that influenced them acceptance of health information system. In addition, (37%) of the study participants noticed a low level of HIS features that prevent unauthorized persons from accessing data. Technological and human factors are the main factors that influence acceptance of health information system among health care providers in Palestine.
ASSESSMENT OF CURRENT PRE-DISCHARGE NEONATAL JAUNDICE SCREENING PRACTICES IN GOVERNMENTAL HOSPITALS OF WEST BANK
(An-Najah National University, 2024-02-07) Barhoush, Abeer
About (60%) of mature and (80%) of premature newborns experience jaundice in the first 7 days of life, and about (10%) of themstay jaundiced till one month. Pre-Hospital discharge jaundice screening for early detection of newborns who are at risk is essential. This is the first study to assess the current practice of pre-discharge neonatal jaundice screening in governmental hospitals inthe West Bank. A questionnaire-based quantitative study was conducted among all pediatrician doctors who work at 8 West bank governmental hospitals, between September 2022 and May 2023. A structured Self-administered questionnaire was administered to participants who obtained from Personnel Affairs in selected Palestinian governmental hospitals a month before the data acquisition. A full of 138 pediatrician doctors participated in this study, which showed a relative weakness in adherence to jaundice screening guidelinesand the results of pediatricians' practices regarding the screening of neonatal jaundice were relatively low. pediatricians doctors shows low adherence levels and inadequate practices regarding screening of neonatal jaundice pre-hospital discharge. Studies are needed in our country to evaluate the impact of this practice on infants with jaundice.
THE MEDICAL REFERRALS IN THE PALESTINIAN MINISTRY OF HEALTH 2022: A DESCRIPTIVE STUDY
(An-Najah National University, 2024-03-16) Turkman, Mohammed
The percentage of purchasing service from outside the Palestinian Ministry of Health during 2022 reached about 37.5% of the total health spending in the Ministry of Health, at a total cost of 974,782,080 NIS. This study aimed to identify and find out the reality and truth of medical referrals in the Palestinian Ministry of Health. Methodology: A descriptive study was conducted that included all the medical referrals carried out, conducted, and made by the Palestinian Ministry of Health during the year 2021 was conducted utilizing simple random technique to recruit 554 referrals from 99,064 referrals. Results: Oncology management ranked the first with the highest number of referrals, (27.6%) of all referrals in 2021. The age group 50 years and older constituted the most medical referrals, with a rate of 48.9%. The unavailability of treatment or the lack of it in the hospitals was the biggest reason for medical referrals, with a rate of 94.9% of the total referrals. 46.2% of the total medical referrals were covered by the Palestinian Ministry of Health within rates ranging from 91-100%. The governorates of the northern West Bank accounted for 28.5% of the total referrals, followed directly by the southern governorates with a percentage of 27.8%. According to the patient’s residency, the Hebron governorate had the highest referral rate with 21.3%, followed by the Jerusalem governorate with 17.7%. 54.7% of the medical referrals were directed and sent to hospitals and health facilities located in Jerusalem Governorate. Based on the findings it has become imperative to work to reduce the costs and burden resulting from medical referrals outside the Palestinian Ministry of Health facilities, by working to localize the medical services in the related hospitals.
IMPACT OF ELECTRONIC MANAGEMENT SYSTEM ON THE EMPLOYEE'S PERFORMANCE OF PRIMARY HEALTH CARE, A CROSS-SECTIONAL STUDY, IN NORTHERN WEST BANK, PALESTINE.
(An-Najah National University, 2024-06-23) Hammad, Nawal
Background: This study deals with electronic management systems and their Internet components (Hardware, software, networks, and electronic training) and their impact on job performance from the point of view of primary healthcare workers in the northern West Bank. The Palestinian Ministry of Health seeks to transfer administrative functions from their traditional form to the computerized form, as the electronic form is considered a public benefit and a basic and competitive advantage for health institutions. Aims: This study aims to identify the impact of the electronic management system on job performance from the point of view of employees in primary healthcare in the northern West Bank. Methods: A convenient sample technique, a cross-sectional study, by distributing questionnaires to 228 employees out of a total of 1,201 employees during the study period in primary healthcare centers in the northern West Bank (Nablus, Jenin, Tubas, Tulkarm, and Qalqilya), including all levels of health workers (doctors, nurses, pharmacists, laboratories, radiologists, and administrators). A descriptive analytical approach was used to select all employees eligible to participate in the study. Results: The study found that primary healthcare (PHC) employees viewed the level of use of the electronic management system (EMS) as average, with a total score of 2.89. The highest score was in the hardware field (2.93), and the lowest was in electronic training (2.79). Job performance was rated as high (3.52), indicating a positive relationship with electronic management (r = 0.59, p≤ 0.01). Networking and software were the main factors that contributed to functionality (28.30% and 35.10%, respectively). Gender did not significantly affect electronic management scores. However, the variables of (age, educational level, workplace, work seniority, and job title) influenced perceptions of specific system components. There were no statistically significant differences in job performance according to (gender, age, workplace, and job title). while, the level of education in favor of (Manager), work seniority from (1-5) years, and nature of the current job in favor of (director) showed statistically significant differences and effects. Conclusions: This study provided useful insights into the positive relationship between staff performance in primary health care and electronic management systems (EMS). It highlighted several main topics, the most important of which is improving performance resulting from using the electronic management system in primary health care centers. Together, healthcare organizations and policymakers must overcome implementation obstacles, make ongoing training investments, continue to pay attention to the infrastructure for implementing the electronic management system, and foster a climate that allows the management system to operate to its full potential. By applying these technologies, the primary healthcare sector can improve employee productivity and performance, and create a more beneficial and effective healthcare system. Keywords: electronic management systems, employee performance, Job performance, primary healthcare.
THE PERCEPTION OF RADIOGRAPHERS IN RADIOLOGY DEPARTMENT TOWARDS THE IMPLEMENTATION OF PICTURE ARCHIVING AND COMMUNICATION SYSTEM (PACS) SYSTEM IN PALESTINIAN PUBLIC HOSPITALS
(An-Najah National University, 2024-08-07) Shalabi, Nada
Introduction: Picture Archiving and Communication System (PACS), is one of the most necessary systems recured in radiology department for archiving and retrieving medical imaging. The perception of its users considered as one of the important impacts on its adaptation. The aim of this study is to measure the acceptance of PACS in Palestinian public hospitals. Method: in 2023 a cross-sectional study was conducted at Palestinian general hospitals. The targeted population was all radiographers working in radiology department at general hospitals. Out of (170) participant only (151) answered the distributed questionnaire. The questionnaire consisted of five inter- related variables i.e., socio-demographics factor, external environment, expected outcome, expected challenges and satisfaction. These factors were designed to measure the acceptance of PACS in radiology department. Results: this study showed a significant relationship between the acceptance of PACS and the related variables i.e., socio-demographics factor, external environment, expected outcome, expected challenges and satisfaction. It also explained the positive impact of PACS. Conclusion: this study showed the positive perception of users toward PACS in Radiology department. Also, the effect of PACS on users’ productivity and the ability to adopt the system in radiology department. The result of this study aims to provide health care worker a better understanding to increase the adaptation of PACS from radiographers in radiology department.
ASSESSMENT OF ADHERENCE TO IRON CHELATION THERAPY AMONG PALESTINIANS WITH THALASSEMIA AT AL-WATANI GOVERNMENTAL HOSPITAL, NABLUS, PALESTINE
(An-Najah National University, 2024-09-19) Ieran, Zein
Introduction: Adherence to iron chelation therapy is a crucial step in reducing excess iron levels in the body, as all patients aim to decrease iron levels beyond the normal range. Factors such as age, having a sibling with thalassemia, lack of parental supervision, lower family income, infrequent blood transfusions, and psychological issues are likely to be investigated as significant predictors of nonadherence. Additionally, the relationship between disease knowledge and adherence status will be examined. It is important for healthcare providers to be aware of the high prevalence of poor adherence to iron chelation therapy among patients. Therefore, nurses should regularly assess, monitor, and encourage adherence behaviors that could impact patient outcomes. Aim: To assess different barriers to adherence patients with Beta thalassemia included patient-related factors, medications-related factors, sociocultural-related factors, environmental context and resources, and patient–health care provider relationship factors Method: A descriptive cross-sectional design is adopted to assess the adherence for thalassemia patients of the National Thalassemia Center at the National Hospital, Nablus. The sample size of 120 thalasemia patients. Data was collected using an direct interview or by phone that composed questionnaire of three parts. The first part of the questionnaire Sociodemographic and clinical characteristics of the samples in Thalassemia center the second part of the questionnaire included Assessment of disease knowledge gaps among thalassemia patients. And the third part of the questionnaire on adherence patient to iron chelation therapy.Collected data was entered and analyzed in SPSS version 21. P value of <0.05 was taken as significant. Results: Nearly equal gender distribution (63% males, 57% females) and a predominant age range of 18 to 26 years were studied. Adherence to iron c helation therapy correlated with lower ferritin levels, indicating treatment efficacy. Notably, both adherent and non-adherent patients demonstrated a good understanding of thalassemia, suggesting sufficient disease knowledge among the participants. However, adherence positively influenced patient satisfaction with hospital treatment and medical services, highlighting the importance of patient education and support systems in enhancing treatment adherence and overall healthcare experience. Conclusion: The study concluded that many patients at the National Governmental Hospital in Nablus show adherence to iron chelation therapy. However, challenges remain, including difficulties in obtaining medication and external influences that affect adherence despite adequate knowledge. The role of health care providers is important in strengthening relationships between the patient and the service provider, providing multidisciplinary care, highlighting the importance of education and continuous support for patients, in addition to addressing the obstacles that lead to patients’ non-compliance with treatment.
NURSES’ PERCEPTIONS OF AND BARRIERS TO EVIDENCE BASED PRACTICE UTILIZATION IN WEST BANK HOSPITALS: A CROSS-SECTIONAL STUDY IN PALESTINE
(An-Najah National University, 2024-10-09) Tamara, Yassin
Introduction: The importance of evidence-based practice in nursing is a genuine consideration in the provision of quality nursing care. This research study was assess the level of knowledge, attitude toward, and practice of EBP among nurses and the challenges experienced in implementing this level of practice in selected hospitals in Nablus City, Palestine. Methods: A total of 275 nurses completed the structured interview with questionnaires designed to obtain demographic information, attitude toward EBP, knowledge level and barriers to research use in nursing practice. Results: The results showed that most of the participants (82.2%) possessed a level of knowledge on EBP which was rated as high with a median score of knowledge being 76.00. In spite of this encouraging level of knowledge, however, challenges in the effective use of EBP was noted where 41.1% of respondents indicated moderate challenges while 33.5% indicated high challenges. In statistical terms, positive EBP attitudes were significantly related to knowledge levels (r = .451, p < .001) while negative EBP attitudes correlates to research usage barriers (r = -.486, p < .001). Conclusion: The study presents knowledge as an essential facilitator for the promotion of EBP participation, emphasizing the need for appropriate educational measures to be put in place to overcome the challenges which have been identified already. In addition, the study shows that understanding the attitude of nurses towards scientific research helps to understand the problems they encounter. This is important for health care institutions that seek to improve the quality of patient care through the use of evidence-based practices. Nevertheless, in the subsequent studies, emphasis should be given to longitudinal studies which evaluate the effect of the implementation of educational programs on EBP and the results of patients over time.
FACTORS ASSOCIATED WITH INPATIENTS' DISCHARGE TIME: PRIVATE HOSPITALS BASED-STUDY AT NABLUS GOVERNORATE
(An-Najah National University, 2024-10-13) Saify, Ahmed
This work explores factors that affect the discharge time of patients from a private Nablus hospital, West Bank, State of Palestine. This study adopts a retrospective observational design with regression analysis and identifies age, patient condition, occurrence of complications, and type of care as key determinants for discharge times. Introduction and Background: The present research is undertaken to get an overview of the various factors that go with the discharge time of patients from a private hospital setup and contribute toward the better understanding of the process, ultimately leading to improved outcomes and enhanced patient satisfaction. Methodology: This was an observational retrospective study with existing quantitative data culled from the electronic health records, management, and financial databases of the hospital. Regression analysis was used to predict the relationships between patient characteristics and times of discharge. Results: There were significant factors that influenced the time for discharge of patients as obtained by regression analysis. Major findings are: age, B = 0.077, p<0.001; patient's condition, B = 2.417, p = 0.016; occurrence of complications, B = 11.649, p<0.001; and type of care, p<0.001, all having a significant effect on the length of stay in the hospital. Conclusion: Timing of discharge remains one of the most critical areas for discharge process optimization and enhancing patient satisfaction. In this regard, the improvement of communication, streamlining the trajectories of care, and rendering priority to patient-centered care are recommended towards the attainment of these objectives.
OPERATING ROOM PROFESSIONALS’ ATTITUDES TOWARDS PATIENT SAFETY AND THE INFLUENCING FACTORS IN GOVERNMENTAL HOSPITALS IN NORTH OF THE WEST BANK, PALESTINE
(An-Najah National University, 2024-10-14) Alhashash, Raed
Background: Patient safety has evolved to be the overriding focus in health care systems, prodded by milestone reports and frameworks calling for safety actions across the whole system. This study will investigate attitudes towards, and factors that influence attitudes to, patient safety among operating room professionals working in governmental hospitals in northern West Bank, Palestine. Methodology: The study design was cross-sectional and involved targeting 150 operating room practitioners, both physicians and nurses, in six hospitals belonging to the northern West Bank governments. In the current study, attitude of participants was measured by using a Patient Safety Attitude Questionnaire referred to as PSAQ, based on attitude dimensions targeting team-work climate, safety climate, management perception, among others. Descriptive statistics using Cronbach's Alpha SPSS software was used for data analysis and reliability testing. Results: A total of 117 questionnaires was successfully administered, bringing the response rate to 82%. Most of them were between 31 and 40 years of age, male, married, and bachelor's degree holders. The total mean attitude score was 114.26 out of 180. The highest positive response obtained in the subscale of "teamwork climate" was 54.4%. The other subscale scores showed that the subjects had intermediate levels of job satisfaction, safety climate perception, and management perception. Conclusions: The results were revealing in a positive attitude toward the teamwork climate and at the same time identifying the weaknesses in the safety climate and management perception from the professionals working in the operating room. These findings must be useful to design focus intervention with the aim of instilling a safety culture among these hospitals, which shall benefit the patients in the region. More research is needed to establish the root causes behind such an attitude and probable impacts of professional development activities. Keywords: Operation Room, Attitude, Patient, Safety, Hospitals, Palestine.
KNOWLEDGE AND ATTITUDES OF PHYSICIANS AND NURSES TOWARDS MENTAL DISORDERS AND RELATED HEALTH SERVICES: A CROSS-SECTIONAL STUDY IN PALESTINE
(An-Najah National University, 2024-10-23) Qattawi, Ayat
Background: The provision of mental health services faces several financial and health challenges, while the healthcare professionals (HCPs) should acquire the appropriate levels of knowledge and attitude towards mental disorders and mentally ill patients, which the current study aimed to identify, as well as the most common demographic and professional factors that related to them. Method: The study utilized a cross-sectional, quantitative design, in which the researcher recruited a convenient sample of 89 doctors and 232 nurses from private and governmental hospitals and primary health clinics (PHC) in Nablus – Palestine. The study questionnaire consisted of demographic data, Mental Health Knowledge Schedule (MAKS) and Attitude to Mental Disorders (AMI) tools, which were analyzed using SPSS. Results: The median age of recruited HCPs was 31 years old (IQR = 8), 46.4% males, 60.4% married, 58.3% of more than 5 years of experience, and 60.1% not received a course on mental disorders. The median knowledge score was 68.42% (IQR = 12.63), with 69.5% having a moderate knowledge level, which was not significantly related to any factor (p-value > 0.05). The median attitude level was 63.70% (IQR = 11.85), with 62.0% having moderate attitude level, and was significantly higher in females (p-value < 0.001), lower income (p-value = 0.002), other social status (p-value = 0.016) and non-hospital workplace type (p-value < 0.001). A significant, moderate, positive correlation between knowledge and attitude was found (r = 0.252, p-value < 0.001). Conclusion: The Palestinian nurses and doctors in Nablus city have moderate knowledge and attitude levels towards mental disorders. More focus on mental disorders is needed and recommended by the policymakers, health sector, universities and HCPs themselves. Further research is needed in the Palestinian context, including longitudinal and qualitative approaches. Keywords: mental health, mental disorders, psychiatric disease, knowledge, awareness, perception, attitude, doctors, physicians, nurses.
QUINOLONE RESISTANCE AMONG ESCHERICHIA COLI AND KLEBSIELLA PNEUMONIAE BACTERIA ISOLATED AT RAFIDIA AND AN-NAJAH NATIONAL UNIVERSITY HOSPITALS IN NABLUS DISTRICT: PROSPECTIVE CROSS-SECTIONAL STUDY
(An-Najah National University, 2024-10-24) Khatatbeh, Marah
Background: Among several bacterial genera, quinolone resistance has become more prevalent in recent years. This was clear among common nosocomial pathogens such as Escherichia coli and Klebsiella pneumoniae. While quinolones are a valuable part of the current antimicrobial treatment options, growing quinolone resistance poses a threat to their continued efficacy. Objectives: First, this study aimed to determine the prevalence of resistance of E. coli and K. pneumoniae to quinolone antibiotics (ciprofloxacin and levofloxacin) at two major hospitals in Nablus District, Rafidia and An-Najah National University Hospital. Second, the association of resistance to these antibiotics with various demographic and clinical findings was examined. Third, mechanisms of quinolone resistance among E. coli and K. pneumoniae were determined through resistance gene detection by PCR. Methodology: A cross-sectional study design was selected. A total of 219 bacterial isolates (169 isolates of E. coli and 50 isolates of K. pneumoniae) were collected from the first of June 2023 to the last day of September 2023, from all patients infected with those bacterial species. The included bacteria in this study were isolated from patients admitted to the two mentioned Hospitals during the study period. Types of bacteria were already identified by the VITEK 2 system (BioMérieux) in the two mentioned hospitals. Resistance of the included bacteria to ciprofloxacin and levofloxacin was determined by the disk diffusion method. In addition, multiplex PCR was used for detection of resistant genes in order to determine quinolone resistance mechanisms among 118 resistant strains. The detected mechanisms and genes were target modification (qnrA, qnrB, and qnrS genes), enzymatic modification (aac(6’)-Ib-cr gene), and efflux pump mechanism (QepA, OqxA, and OqxB genes). Association of quinolone resistance with clinical symptoms, demographic information, and other risk factors were evaluated. Results: Relatively high frequencies of ciprofloxacin resistance (46.1%) and levofloxacin resistance (47.9%) were found among E. coli isolates. Higher resistance frequency of ciprofloxacin (70%) and levofloxacin (68%) among K. pneumoniae isolates were detected. Escherichia coli and K. pneumoniae ciprofloxacin resistant bacteria isolated at An-Najah National University Hospital (60% and 92.9%, respectively) were significantly higher (P= 0.000 and P= 0.001, respectively) than that of the isolates obtained from Rafidia Hospital (37.3% and 40.9%, respectively). Ciprofloxacin resistance among E. coli isolated from the general surgery unit was significantly higher than that of the emergency ward (54.5%; P=0.002) and the outpatients (36.9%; P= 0.016). However, E. coli levofloxacin resistance frequency in the intensive care unit was significantly higher than that of the outpatients (49.2%; P=0.018), emergency (45.5%; P=0.022), and general surgery (42.9%; P=0.037). Escherichia coli isolation rate from urine (80%) was significantly higher than that of wound swabs (76.3%; P=0.013). Furthermore, K. pneumoniae isolation rate from urine (20%) was significantly higher than that of wound swabs (23.7%; P=0.036). Escherichia coli ciprofloxacin resistance was significantly higher (P=0.008) in male isolates (53.6%) than in female isolates (36.3%). Escherichia coli isolated from patients over 65 years of age had the highest levofloxacin resistance frequency (62.5%), which was also significantly (P= 0.007) higher than that of the 40–65-year age group. Escherichia coli ciprofloxacin resistant bacterium isolated from patients with urinary catheters (91.7%) had a significantly higher frequency than that of hypertension patients (85.5%; P=0.013), diabetes mellitus patients (84.8%; P=0.017), cancer patients (81.9%; P=0.022), and hepatic cirrhosis patients (64.1%; P=0.028). However, K. pneumoniae ciprofloxacin resistant bacterium isolated from hepatic cirrhosis patients (77.8%) had a significantly higher frequency than that of hypertension patients (65.2%; P=0.003), cancer patients (61.9%; P=0.019), and diabetes mellitus patients (58.9%; P=0.032). Frequency of levofloxacin resistant E. coli isolated from diabetes mellitus patients (89.1%) was significantly higher than that of hypertension patients (76.3%; P=0.013), cancer patients (73.6%; P=0.016), patient with the urinary catheter (77.8%; P=0.021), and hepatic cirrhosis patients (51.3%; P=0.028). On the other hand, levofloxacin resistant K. pneumoniae isolated from diabetes mellitus patients (71.8%) had a significantly higher frequency than that of hypertension patients (56.5%; P=0.009), cancer patients (52.4%; P=0.016), hepatic cirrhosis patients (59.3%; P=0.023), and patient with the urinary catheter (48%; P=0.031). With respect to the quinolone resistance mechanisms, the efflux pump among E. coli isolates was the most predominant (43.3%) with OqxA (23.5%) being the most common gene, followed by enzymatic modification by Aac(6’)-Ib-cr enzyme (29.6%) and target modification mechanism (26%) in which the QnrS gene was the most common (13.6%). Similarly, the efflux pump mechanism of quinolones resistance among K. pneumoniae isolates was also the most common (37.8%) with the OqxA gene exhibiting the highest frequency (27%), followed by enzymatic modification by Aac(6’)-Ib-cr enzyme (32.4%) and target modification mechanism (29.7%) with QnrS and QnrB being the most commonly detected genes (10.8%). Conclusion: Our findings showed high rates of ciprofloxacin and levofloxacin resistance among E. coli and K. pneumoniae isolates, also a high percentage of the efflux pump mechanism with OqxA being the most common gene, followed by enzymatic modification by Aac(6’)-Ib-cr enzyme and target modification mechanism in which the QnrS gene was the most common. We emphasize that it is necessary to perform an antibiotic susceptibility test before choosing a prescription. Monitoring the rates of resistance in the nations clinical facilities should be a greater priority for the relevant government health departments.
EPIDEMIOLOGY OF ACINETOBACTER BAUMANNII INFECTIONS AMONG PATIENTS ADMITTED TO THREE INTENSIVE CARE UNITS IN PALESTINE: A RETROSPECTIVE CHART REVIEW STUDY
(An-Najah National University, 2024-10-30) Arjan, Shaden
Background: Multidrug-resistant (MDR) strains of Acinetobacter baumannii pose significant treatment challenges. This study aimed to evaluate the sociodemographic and clinical characteristics of patients with A. baumannii infections in medical intensive care units (ICUs) across three hospitals in the West Bank, Palestine. It also sought to determine the prevalence of multidrug-resistant and extensively drug-resistant strains and assess patient survival and mortality rates. Methods: A retrospective cohort design was conducted from 2019 to 2020, spanning a period of two years, and including patients from adult medical ICUs from three hospitals of the north (NICU), the center (CICU), and the south (SICU) of in the West Bank, Palestine. Data on infections acquired during ICU stays or present at admission were analyzed using patient medical records, where sociodemographic, clinical, and treatment-related information, including comorbidities, infection history, diagnostic results, therapies, device usage, and outcomes such as ICU length of stay and mortality, were collected, and prevalence was calculated. Results: The study encompassed 231 patients, with 136 (58.9%) from CICU Hospital, 56 (24.2%) from SICU Hospital, and 36 (16.9%) from NICU Hospital. The median patient age was 63 years. Prevalence rates of A. baumannii infections were 11.5% at CICU Hospital, 6.5% at NICU Hospital, and 5.3% at SICU Hospital, with an overall rate of 8.2%. Of the patients, 46 (19.9%) had infections upon admission, while 185 (80.1%) developed infections during their ICU stay. The isolates included 154 (66.7%) extensively drug-resistant (XDR), 61 (26.4%) multidrug-resistant (MDR), and 16 (6.9%) non-resistant strains. Factors associated with increased mortality included recent ICU admission (2.65 times more likely), heart failure (4.95 times more likely), and central line catheter use (3.46 times more likely). Higher white blood cell counts, lower platelet counts, longer ICU and mechanical ventilation durations, and shorter hospital stays, shorter therapy were linked to survival. Conclusions: This study provides a comprehensive understanding of A. baumannii infections in the medical ICUs, highlighting the critical need for multidisciplinary infection control, especially for critically ill patients with comorbidities. The rise of drug-resistant bacteria underscores the importance of antimicrobial stewardship and infection control. Findings suggest a need for ongoing research and collaboration to address this growing hospital-acquired issue effectively.

Browse

Browsing Health Sciences by Issue Date

Results Per Page

Sort Options