Critical Care Nursing

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    COLD BLOOD CARDIOPLEGIA VERSUS COLD CRYSTALLOID CARDIOPLEGIA FOR CORONARY ARTERY BYPASS GRAFTING (CABG) IN PATIENTS WITH LOW EJECTION FRACTION -IN THREE LARGE HOSPITAL IN PALESTINE
    (2023-03-15) Hakeem Mustafa Sholi
    Myocardial protection during cardiopulmonary bypass surgery for coronary artery bypass graft surgery (OPCABG) is still a controversial topic. The primary method of protecting the myocardium during cardiac surgery is cardioplegia, which also facilitates surgery by providing a quiet, bloodless surgical field. These cardioplegia solutions include: Cold-crystalloid vs. cold-blood cardioplegia. However, there is still a debate about which solution for cardioplegia in cardiac surgery is the best solution. The Main goal of this study is to Comparing Cold-Blood Versus Cold Crystalloid Cardioplegia for Coronary Artery Bypass Grafting (CABG) Surgery in Patients with Low Ejection Fraction - To Determine Which Type is Appropriate for Surgical Myocardial Conservation in Three Major Palestinian Hospitals, after CABG surgery and reduce complications. A retrospective observational cohort design was used in this study. All patients with multi vessel coronary artery disease, who were admitted to an eligible hospital between January 1st, 2020 and December 30th 2021, aged ≥40 years and <80 years and require OPCABG surgery, were included in this study. Data were collected by reviewing patient medical records from the hospital information system. According to the findings, there is no significant difference between cold blood and cold crystalloid cardioplegia when it comes to intra-operative ejection fraction, cardioplegia volume, cardiopulmonary bypass time, blood loss between 4 and 6 hours after surgery, time spent on mechanical ventilation after surgery, time spent using pharmacological cardiac support after surgery, creatinine level after surgery, or post-operative complications. The findings demonstrate that there are considerable disparities between the Cold Blood Cardioplegia group and the Cold Crystalloid Cardioplegia group only in Ejection fraction pre operation, the mean of the Ejection fraction pre operation in the CBC group is (Mean=38%) which is considerably greater than the average in the CCC group (Mean=36%), the P-value of the test is 0.002, but this difference does not mean anything clinically because it happened before the cardioplegia was given. Significant differences exist at the 0.05 level. in the amount of Blood loss 2 hours post-operation, the mean in the CBC group is (Mean=153.8) which is considerably less than the average in the CCC group (Mean=183.8), the P-value of the test is 0.032.and there are significant differences at 0.05 level in Creatinine levels pre-operation, the mean in the CBC group is (Mean=0.78) which is significantly higher than the mean in the CCC group (Mean=0.63), the P-value of the test is 0.020. when using cold crystalloid cardioplegia as opposed to cold blood cardioplegia at a significant level of P value (0.05),and this difference does not mean anything clinically because it happened before the cardioplegia was given. This study concludes that the use of cold-blooded cardioplegia has the same myocardial preservation and complications as cold crystalloid cardioplegia. For clinical practice, it is recommended that cold crystalloid cardioplegia be used to decrease the cost of cold blood cardioplegia use when using the traditional methods and also it facilitates vision for the surgeon, and presenting the results of this study to the Palestinian Ministry of Health to make a comprehensive protocol and guidelines for all hospitals to follow cold crystalloid cardioplegia. Keywords: Cold Blood Cardioplegia, Cold Crystalloid Cardioplegia, Myocardium Protection, Ejection Fraction, Coronary Artery Bypass Graft.
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    Comparing Adaptive Support Ventilation (ASV) and Synchronized Intermittent Mode of Ventilation (SIMV) in Patients Undergoing Coronary Artery Bypass Grafting Surgery
    (جامعة النجاح الوطنية, 2021-10-06) صوالحة, نورس
    الخلفية: يستخدم جهاز التنفس الصناعي بشكل كبير ومتكرر لدعم الجهاز التنفسي لمرضى عمليه تغير الشرايين التاجية، ومن أكثر الانماط التنفسية الشائعة لدعم التنفس هي التنفس الالزامي المتزامنة المتقطعة ويمكن ايضا استخدام نمط اخر هو التهوية الداعمة التكيفية لتقليل المضاعفات الرئوية. الهدف: الهدف العام من هذا البحث هو قياس تأثيرات تهوية الدعم التكيفي على مدة التهوية التنفسية والإقامة في المستشفى في قسم القلب مقارنة مع وضع التهوية المتقطعة المتزامنة بين المرضى الذين يخضعون لعملية جراحة تطعيم مجازة الشريان التاجي. المنهجية: تم استخدام عينة عشوائية منتظمة في هذه الدراسة، حيث شملت على ١٠٠ مريض، تم تقسيمهم إلى مجموعتين، المجموعة الأولى تستخدم تهوية الدعم التكيفي، والمجموعة الثانية تستخدم التهوية المتقطعة المتزامنة. تم اجراء الدراسة في وحدة العناية القلبية في المستشفى الاستشاري العربي بفلسطين. النتائج: أظهرت النتائج عدم وجود فروق ذات دلالة إحصائية بين تهوية الدعم التكيفي والتهوية المتقطعة المتزامنة فيما يتعلق بالجنس والعمر ومؤشر كتلة الجسم (P> 0.05). كانت النسبة المئوية لمدخنين النرجيلة في المرضى الخاضعين لتهوية الدعم التكيفي ذات دلالة إحصائية مقارنة مع التهوية المتقطعة المتزامنة (18٪ مقابل 42.0٪ على التوالي، P <0.05). كان متوسط مدة التهوية الميكانيكية أقل دلالة إحصائية في المرضى الخاضعين لتهوية الدعم التكيفي مقارنة مع التهوية المتقطعة المتزامنة (4.88 ± 0.48 ساعة مقابل 5.98 ± 0.77 ساعة على التوالي وP<0.005). في نفس الوقت، كان متوسط مدة الإقامة في قسم القلب أقل أهمية من الناحية الإحصائية في مرضى تهوية الدعم التكيفي مقارنةً بـ التهوية المتقطعة المتزامنة (3.66 ± 0.56 مقابل 6.02 ± 0.84 يومًا على التوالي وP <0.005). كان متوسط عدد فحص غازات الدم أقل دلالة إحصائية في مرضى تهوية الدعم التكيفي مقارنة بـ التهوية المتقطعة المتزامنة (4.00 ± 0.64 مقابل 5.86 ± 0.64 على التوالي وP <0.005). أخيرًا، كان متوسط معدل التنفس، معدل ضغط الدم الانبساطي، معدل ضغط الدم الانقباضي، ونسبه الاكسجين، أعلى من الناحية الإحصائية في تهوية الدعم التكيفي مقارنة بـ التهوية المتقطعة المتزامنة خلال الـ 12 ساعة الأولى. الخلاصة: أظهرت النتائج أن هناك اختلافات ذات دلالة إحصائية فيما يتعلق بمدة التهوية الميكانيكية، وطول الإقامة في قسم القلب، ومتوسط عدد فحص غازات الدم، ومعدل التنفس، ومعدل ضربات القلب، ونسبة الاكسجين، ومعدل ضغط الدم الانقباضي، ومعدل ضغط الدم الانبساطي. في المقابل، لا يوجد ارتباط بين نوع التهوية والخصائص الاجتماعية والديموغرافية. الكلمات المفتاحية: تهوية الدعم التكيفي، التهوية المتقطعة المتزامنة، جراحة تغير الشرايين التاجية.
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    COMPARING THE ACCURACY OF THROMBOLYSIS IN MYOCARDIAL INFARCTION SCORE AND THE GLOBAL REGISTRY OF ACUTE CORONARY EVENTS SCORE IN PREDICTING IN-HOSPITAL, SHORT AND LONG-TERM OUTCOMES AMONG PATIENTS WITH ACUTE CORONARY SYNDROME
    (2023-09-20) Ahmed Adnan Zamel
    Background: The Thrombolysis in Myocardial Infarction (TIMI) score and the Global Registry of Acute Coronary Events (GRACE) score are frequently utilized as risk assessment instruments within the discipline of cardiology. Short-term acute coronary syndrome (ACS) outcomes are immediate treatment and survival for one months while long-term outcomes are recurrence, lifestyle-focused prevention and mortality risk for 6 months from admissions hospitals. The TIMI score is used to predict unfavorable outcomes, whilst the GRACE score to estimate death rates and significant cardiovascular events in ACS patients. Aim: This study aimed to compare the accuracy of TIMI and GRACE scoring systems in predicting in-hospital, short-term, and long-term outcomes amongst ACS patients. Method: A retrospective study was conducted from June to December 2022. The sample size was 250 people. This study focused on ACS patients who got admitted to An-Najah National University Hospital (NNUH). The response rate was 92.6%. Statistical Package for Social Science (SPSS) was used to analyze the data. Results: The findings indicated that 228 patients (91.2%) survived and 22 (8.8%) died. The GRACE score exhibited remarkable accuracy of diagnosis in prediction of survival among participants. This is supported by the observation of a specificity, sensitivity, Positive Predictive Value (PPV), negative predictive value (NPV), and total accuracy of 100%. The receiver operating characteristic (ROC) curve demonstrated exceptional differentiation between survivors and those who have died, as shown by an area under the curve (AUC) value of 1.000. In contrast, TIMI score accuracy was less robust. The study of the ROC curve yielded an AUC of 0.739 (P <0.001). The sensitivity and specificity were 68.2% and 63.6% respectively. The PPV and NPV were 15.3% and 95.4%, correspondingly. Additionally, the total accuracy for prediction and diagnosing the survival status was 64.0%. Conclusion: The GRACE score demonstrated excellent diagnostic accuracy in predicting patient survival status, with perfect sensitivity, specificity, PPV, NPV, and overall accuracy. While, the TIMI score showed comparatively weaker accuracy, with lower sensitivity, specificity, PPV, NPV, and overall accuracy. Keywords: Acute Coronary Events; Acute Coronary Events Score; An-Najah National University Hospital; Predicting in-Hospital; Thrombolysis in Myocardial Infarction.
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    COMPARING THE EFFECTS OF VOLUME-TARGETED VENTILATION MODE AND TRADITIONAL PRESSURE-LIMITED VENTILATION MODE ON THE CLINICAL OUTCOMES OF PREMATURE BABIES WITH RESPIRATORY DISTRESS SYNDROME. A CONTROLLED RANDOMIZED STUDY
    (2023-09-03) Reem Ataya
    Respiratory distress syndrome (RDS) occurs when the lungs of a premature infant are not fully developed and lack the surfactant needed to keep the air sacs open. Different modes of ventilation have evolved to decrease the lung damage of the premature infant and control the amount of air that enters the lungs with each inflation. The most commonly used modes are the traditional Pressure-Limited Ventilation (PLV) and the new Volume Targeted Pressure (VTV). The study aims to compare the effect of VTV and PLV on the clinical outcome (BP, RR, HR, SaO2, Tidal volumes and FiO2), length of intubation duration, Oxygen therapy duration and the consequent complications of the premature babies with RDS in Jenin Governmental Hospital. The study used a randomised controlled trial design. 80 premature babies made up the sample, of which 40 were randomly assigned to the experimental group (VTV) and 40 to the control group (PVL). The data was gathered using the patient data sheet. The total number of male participants was 42 (27 VTV and 15 PLV), while the total number of females was 38 (13 VTV and 25 PLV). The gestational age ranged from 29 to 36 weeks. In this study 32.5 % of all the participants were in the age group between 0-7 days, while 11.3% were in the age group from 22-24 days. The highest birth weight group was from 1.51 to 2.5 Kg (46.3%), while the lowest was more than 3.5 kg (1.3%). The weight of the largest number of the participants from the two groups ranged between 1.51 to 2.5 kg, while those weighting more than 3.5 kg were the lowest number of the participants. A total of 37.5% of participants delivered by normal vaginal delivery, while 62.5% of participants delivered by caesarean section. The mean of Spo2 in VTV (Mean=97.7) at the total 24 hours was significantly higher than the mean in PLV (Mean=95.86). There are significant differences between VTV group and PLV group in the FiO2 at the sixth, seventh and eighth 3 hours. The number of dead patients in the PLV 8(20%) was higher than in the VTV 3(7.5%), P= 0.105. However, there was no statistical significance in difference, but clinically it was relevant. The study could not identify an increase in any adverse outcomes associated with the use of VTV compared with PLV. VTV mode produced improved oxygen saturation values for SPO2, and FiO2 in comparison to PLV mode, The results showed that the number of dead patients in the PLV group was higher than in the VTV. However, there was no statistical significance in difference, but clinically it was relevant. There was no evidence of an increase in any unfavourable outcomes associated with the use of VTV in comparison to PLV. Keywords: VTV, PLV, Premature, RDS, Palestine.
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    EFFECT OF INTRAVENOUS MAGNESIUM SULFATE IN ACUTE ASTHMA
    (جامعة النجاح الوطنية, 2022-01-19) Mahameed, Abeer
    Background: Acute asthma exacerbations can lead to admission to the emergency room. When these exacerbations do not respond to standard therapy, guidelines recommend administering a single intravenous bolus dose of magnesium sulfate in addition to standard therapy for the management of patients admitted to the emergency room. Objective: This study was conducted to evaluate the effectiveness of magnesium sulfate administered intravenously in combination with standard treatment to patients with acute asthma admitted to emergency room settings in a major governmental hospital in Palestine. Methods: This study was conducted in a quasi-experimental design. Patients in both control and intervention groups were recruited from Al Watani hospital. The patients were recruited during the high season of acute asthma exacerbations. Patients in the control group received standard therapy. Patients in the intervention group received a single intravenous bolus dose of magnesium sulfate in addition to the standard therapy. Demographic and clinical variables of the patients were collected on a data collection sheet. Dyspnea was measured using a modified Borg dyspnea scale. Results: A total of 65 patients were assigned to control (n = 32) and intervention (n = 33) groups. Patients in both control and intervention groups were similar in terms of demographic and clinical variables before the intervention. There were no significant differences in dyspnea measured before the treatment. Administration of a single intravenous bolus dose of magnesium sulfate in addition to standard therapy was shown to significantly reduce signs of dyspnea as measured in the modified Borg dyspnea scale. Conclusion: Magnesium sulfate administered intravenously in combination with standard treatment to patients with acute asthma admitted to emergency room settings in Palestine might have improved signs and symptoms of dyspnea compared to standard treatment alone.
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    Effectiveness and Outcome of Implementation Therapeutic Hypothermia Asphyxiated Neonates at Governmental Hospital in West Bank
    (An-Najah National University, 2021-05-25) فياض, الهام
    Background: Birth asphyxia is the medical condition resulting from deficient supply of oxygen to the infant for extended period of time during the birth process, as a result for many etiology infant usually become cyanosis, bradycardia, Apgar score is low in the first 5 min. Extreme degrees of asphyxia are associated with high morbidity and mortality rates worldwide. There is an urgent need to improve outcomes in affected infants .Therapeutic hypothermia (TH) as whole body or selective head cooling has become a standard therapy for moderate-severe HIE in many developed countries to reduce neurological damage within the first 6 hrs of life, by systemic cooling to 34.5 ± 0.5°C for head cooling, for surface cooling (33.5 ± 0.5°C) and continuing for 72 hrs. Aims of the Study: To assess the effectiveness and outcome of implementation therapeutic hypothermia and the relationship between therapeutic hypothermia and mortality rate, seizure and to assess relationship between therapeutic hypothermia and staying day in MV & relationship between therapeutic hypothermia and neurodevelopment defect, primitive reflexes. Method: The study adopted the Quazi experimental design. The study included prospective study. Experimental group baby who received therapeutic hypothermia and historical study as control group who not received therapeutic hypothermia .Survey will be carried out at Neonatal Intensive Care Unit in Governmental Hospital in Jenin. The period is one year from February 2020 to September 2020. Results: There are no significant differences at 0.05 level between Experimental group and Control group in Age of mothers, and gestational age significant differences at 0.05 level between the Control group and the Experimental group in Continued need for PPV or Intubation at 10 mints (the P-value is less than 0.05), the percentage of infants needed PPV in the experimental group was 10(30.3%) which is significantly higher than that in the control group 0(0%), while the percentage of infants needed intubation in the experimental group was 23(69.7%) which is significantly lower than that in the control group 27(100%). First day IN control group mild HIE 2(7.4%) moderate 13(48.1%),sever 12(44.5%) , in experimental group 0(0%),30(90.9%),3(9.1%) respectively but in third day of treatment in control group mild, moderate, sever 0(0.0%),3(27.3%),24(72.7%)in experimental group 24(72.7%),9(27.3).0(0.0) respectively. The percentage of mortality for infants HIE in the control group 4(14.8%) was significantly higher than that in the experimental group 1(3%), while the percentage late neonatal death 0(0%) in the experimental group was significantly lower than that in the control group 7(25.9%) with P value 0.002.Regarding Seizures at the second and third day, the percentages of Non Seizures are 27(81.8%) and 28(84.8%) which significantly higher than that in the control group 8(29.6%) and 7(25.9%), while the percentage of Present Seizures in the experimental group are 6(18.2%) and 5(15.2%) which significantly lower than that in the control group 17(63%). Regarding MV after 6 hr from admission, the percentage in the experimental group 17 (53.1%) was significantly higher than that in the control group 7(25.9%). In the second day, the percentage in the experimental group 7(21.9%) was significantly higher than that in the control group 3(11.1%). Regarding Suck at the second day, the percentage of Weak Suck in the experimental group 25(75.8%) was significantly higher than that in the control group 7(25.9%), while the percentage of Absent Suck in the experimental group 7(21.2%) was significantly lower than that in the control group 18(66.7%) so feeding process in experimental group started feeding too early than control group who started at and above day 7 of finished cooling , but other started at day 3 of finished cooling in 9.1% , 4 day 15.2% ,5 day 45.5%, 6 day 18.2%, 7+ day 12.1%.Also the follow up assessment results showed in vision test there is no any vision loss on all babies who underwent cooling therapy compared with one vision loss on control group, the same matter in hearing test one hearing loss on control group with no losing in experimental group. Conclusions: Hypothermia is most benefit when establish in the first ≤6 hours in term infant and late prematurity GA ≥36 weeks who in HIE to limit damage in the brain. Infants offered hypothermia should meet inclusion criteria. Eligibility criteria include a pH of ≤7.0 or a base deficit of ≥16 mmol/L in a sample of umbilical cord blood or blood obtained during the first hour after birth, history of an acute perinatal event, a 10-minute Apgar score of <5, or assisted ventilation initiated at birth and continued for at least 10 minutes. In addition, a neurologic examination demonstrating moderate to severe HIE is essential. Recommendation: Excluded for the following baby in TH: Baby (<36 weeks), Baby WT <1800, HIE baby admitted after 6hr, Lethal congenital and chromosomal anomalies. The current hypothermia protocol is starting treatment within golden hours in the first 6 hrs of life, by systemic cooling to 34.5 ± 0.5°C for head cooling, for ( surface cooling ) or whole-body cooling(33.5 ± 0.5°C) and continuing for 72 hrs, also more researches needed included HIE babies who pass the first six gold hour and do TH in also first 12 hours by using wide sample size and observed the developmental defect later on like, school age.
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    Effectiveness of Early Enteral Feeding Protocol on Clinical Outcomes in Critically Ill Patients in Surgical Intensive Care Unit
    (جامعة النجاح الوطنية, 2021-04-20) شواهنه, رشا
    يعتبر الحفاظ على العلاج الغذائي الكافي عن طريق التغذية المعوية أمرًا مهمًا بشكل خاص للمرضى ذوي الحالات الحرجة الذين يحتاجون إلى التنبيب وأجهزة التنفس الصناعي. الهدف من الدراسة: لتحديد ما إذا كانت هناك علاقة بين التغذية المبكرة (في غضون 24 إلى 48 ساعة بعد قبول وحدة العناية المركزة) للمرضى المصابين بأمراض خطيرة والنتائج السريرية وتقديم إرشادات قائمة على الأدلة للتغذية المبكرة أثناء المرض الخطير. الطريقة: تم اعتماد تصميم شبه تجريبي في هذه الدراسة سيتم تسجيل جميع المرضى المقبولين في وحدة العناية المركزة الجراحية ما لم يكن هناك بطلان في التغذية المعوية، حيث تم الحصول على الدراسة في وحدة العناية المركزة في مستشفى رفيديا الجراحي، وتم جمع البيانات من خلال ملء مقياس محدد تم إعداده بمعايير محددة تتعلق بالمتغيرات من الدراسة التي قارنت بين مجموعتين من المرضى المصابين بأمراض خطيرة، بدأت واحدة في التغذية مبكرًا والمجموعة الثانية وفقًا لسياسة القسم، كان مجتمع الدراسة بالغًا أكبر من 18 عامًا. النتيجة: لا توجد فروق ذات دلالة إحصائية عند مستوى 0.05 بين المجموعة التجريبية والمجموعة الضابطة في توزيعات الجنس والعمر ومؤشر كتلة الجسم ومؤشر كتلة الجسم والحالة الاجتماعية. البقاء في وحدة العناية المركزة (اليوم) (قيمة P أقل من 0.05(. كما توجد فروق ذات دلالة إحصائية عند مستوى 0.05 بين المجموعة التاريخية ومجموعة البروتوكول في: في العلامة الحيوية (SBP ،HR ،TEMP و RR). في الاختبارات المعملية (HGB و BUNو PLATو CREAو NAو Kو ALBUMINوWBC وCa وMG). في نتيجة غازات الدم (PCO2 و PO2و HCO3). في تركيب جهاز التنفس الصناعي (TV و PEEP). فيGCS. نسبة المضاعفات ضئيلة في المجموعة الضابطة. استنتاج التغذية المبكرة (24-48 ساعة الأولى) هي الأكثر فائدة للمرضى المصابين بأمراض خطيرة. الكلمات المفتاحية: التغذية المعوية، وحدة العناية المركزة، المجموعة التاريخية.
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    Effectiveness of the Prone Position on Cardio- Respiratory Clinical Outcomes for the Neonates with Acute Respiratory Distress Syndrome
    (جامعة النجاح الوطنية, 2021-04-21) بـــدوان, أنـــس
    الخلفية: متلازمة الضائقة التنفسية الحادة هي مصدر قلق صحي شائع للمرضى في وحدات العناية المركزة، والتي تتميز بارتفاع معدل الوفيات. تم استخدام وضعية الانبطاح بشكل متزايد في علاج مرضى متلازمة الضائقة التنفسية الحادة على مدى السنوات القليلة الماضية. تهدف الدراسة إلى تقييم فعالية وضعية الانبطاح على النتائج السريرية للقلب والجهاز التنفسي للولدان الذين دخلوا وحدة العناية المكثفة للأطفال الخدج مع متلازمة الضائقة التنفسية الحادة. المنهجية: تم استخدام تصميم بحث تجريبي عشوائي محكم في هذه الدراسة. تكونت عينة الدراسة من 100 مولود (50 تداخلي و50 ضابطة). تم اختيار المشاركين بطريقة العينات العشوائية البسيطة. وتم استخدام الاستبيان لتحقيق أهداف الدراسة. حيث كان معدل الاستجابة 100٪. النتائج: أظهر نتائج الدراسة أن 50٪ (العدد = 50) من المشاركين هم من الذكور بالإضافة إلى 50٪ من الإناث. كلتا المجموعتين التداخلية والضابطة كان بأعداد متساوية من الذكور (25 (50٪) والإناث (25 (50٪)) تمت مطابقة عمر الحمل والجنس بين المجوعتين التداخلية والضابطة، وكان العمر 34.1 ± 1.4 يوم للمجموعة التداخلية بينما 34.0 ± 1.4 يوم للمجموعة الضابطة. أما بالنسبة لنوع الولادة، 79٪ من المشاركات كان لديهن ولادة مهبلية طبيعية، بينما 21٪ كان لديهن ولادة قيصرية. كما أظهرت النتائج أن نتيجة مقياس أبغار للمشاركين تراوحت بين 5-10، حيث أن 37% من المشاركين كانت لديهم نتيجة مقياس أبغار هي 9. الخلاصة: أظهرت النتائج أن متوسط معدل التنفس (نفس بالدقيقة) عند ساعتين انخفض بشكل ملحوظ في المجموعة التداخلية مقارنة بمجموعة التحكم (42.2 ± 7.0 مقابل 42.2 ± 7 نفسا في الدقيقة، (t=-3.368 & P=0.001على التوالي) في المقابل، ارتفع تشبع الأكسجين (٪100) عند ساعتين بشكل ملحوظ إحصائيًا في المجموعة التداخلية مقارنةً بمجموعة التحكم (96.9 ± 3.3 مقابل 94.3 ± 4.9٪، على التوالي). كان هذا التغيير ذا دلالة إحصائية (t=3.205, P=0.002). أيضا، هناك فروق ذات دلالة إحصائية في 0 دقيقة، 1 ساعة وساعتين بين المجموعات التداخلية مقارنة مجموعة الضوابط فيما يتعلق بمعدل التنفس، أيضًا، أظهرت اختباراتpost hoc أنه يختلف اختلافًا كبيرًا من الناحية الإحصائية في 0 دقيقة مقارنة بساعة واحدة؛ 0 دقيقة مقارنة بساعتين و1ساعة مقارنة بساعتين (P <0.05). في المقابل، أظهرت مقاييسANOVA المتكررة أنه لا يوجد فرق مع تدبه إحصائيًا بين المجموعات التداخلية مقارنة بالمجموعات الضابطة فيما يتعلق بمعدل ضربات القلب وتشبع ثاني أكسيد الكربون بالدم (P > 0.05). الكلمات المفتاحية: وضعية الانبطاح، القلب، الجهاز التنفسي، النتائج السريرية، الخُدج، وحدة العناية المركز للأطفال حديثي الولادة، متلازمة الضائقة التنفسية الحادة.
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    The Effectiveness of Tight Glycemic Control on Reducing Surgical Site Infection in Diabetic Patients Undergoing Coronary Artery Bypass Grafting
    (An-Najah National University, 2021-05-06) بلاصي, بلال
    Introduction: mellitus is associated with increased surgical morbidity and mortality. The relatively high risk may be related to the level of perioperative hyperglycemia. Glycemic control in postoperative cardiac patients is necessary to improve the outcome of wound infection and overall mortality. In recent years, clinical trials that evaluated blood glucose control in critically ill patients for intensive blood glucose management and found a significant reduction in morbidity and mortality. Some organizations have published recommendations for the management of blood glucose in critically ill patients that reflect this information. However, new clinical trials evaluating blood glucose target areas in critically ill patients have found conflicting results, leading to a reassessment of current targets and guidelines, enabling less strict blood sugar target areas. With the inconsistency in clinical trials evaluating a target blood glucose range for critically ill patients, especially postoperative cardiac surgery patients, target blood sugar is still not clearly defined. Further comparisons of specific glucose ranges would allow a clearer definition of recommended blood glucose targets for postoperative cardiac patients. Aim: The aim of this study is to evaluate the efficacy of tight glycemic control interventions intraoperative and postoperative with a continuous insulin infusion to maintain blood glucose levels of 150-180 mg/dl to reduce the complications of open heart surgery, ie. readmission, hospital mortality, length of stay, hospital stay, incidence of hypoglycemic events (blood glucose levels ≤70 mg/dl) in adult diabetic patients undergoing CABG. Material and method: A quasi-experimental study conducted among diabetic patients undergoing elective CABG. Single-center clinical trial conducted among diabetic patients, male 86 and female 14, aged 18-70 years with ASA II- III undergoing CABG from AL-Ahli Hospital, Hebron- Palestine. Patients are divided into experimental group (E group) modified tight control (Blood Sugar maintained between 150-180 mg/dl) and ahistorical Control Group (C Group) received sliding-scale insulin to maintain blood glucose). Patients were followed up to 48 hours postoperatively. Incidence of surgical site infections, readmission, in-hospital mortality, length of ICU stay, length of hospital stay, incidence of hypoglycemic events (blood sugar levels ≤70 mg/dl), and another complications in adult diabetic patients undergoing CABG were collected. Results: There are no significant differences between the historical group and the experimental group in gender, age, weight, high, and BMI (P-values>0.05). The results exhibited that there were no significant difference in the mean of preoperative blood glucose in the historical group M± SD(185.22±38.76) compared to the experimental group173.72±18.74 (p= 0.063). At the opposite of this result, the results exhibited that the mean of hemoglobin A1c in the historical group (mean=9.12) is significantly lower than that in the experimental group (mean=9.71) (p=0.003). The results exhibited that the mean of intraoperative blood glucose in the historical group M± SD (223.03±47.32) is significantly higher than that in the experimental group M± SD (170.91±2.64) (p=0.000). The results exhibited also that the mean of postoperative blood glucose in the historical group (mean=283.08) is significantly higher than that in the experimental group (mean=168.88) (p=0.000). The results exhibited that the number of patients who had deep sternal infection in the historical group (N (%) =4(8%)) is significantly higher than that in the experimental group (N(%)=0(0%)) (p= 0.041). Also the results exhibited that the number of patients who had pneumonia in the historical group (N(%)=4(8%)) is significantly higher than that in the experimental group (N (%)=0(0%)) (p= 0.041). Also the results exhibited that the number of patients who had stroke in the historical group(N(%)=4(8.2%)) is significantly higher than that in the experimental group(N(%)=0(0%)) (p=0.039) . The results exhibited that the mean of ICU-LOS (days)in the historical group (mean=4.14) is significantly higher than that in the experimental group (mean=2.18) (p=0.000). Also, the results exhibited that the mean of postoperative hospital LOS (days) in the historical group (mean=5.72) is significantly higher than that in the experimental group (mean=4.98) (p=0.000). Conclusion : Maintaining blood glucose levels (150-180) with continuous insulin infusion at all stages of the perioperative period will minimize the incidence of surgical site infection, episodes of hypoglycemia, stroke, pneumonia and length of stay in ICU and hospital in patients undergoing CABG surgery.
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    Effectiveness of Using Topical Insulin on Healing of Pressure Ulcers among Intensive Care Unit Patients, using Randomized Control Trial
    (جامعة النجاح الوطنية, 2021-12-28) قيسي, وفاء
    الخلفية والأهداف: تعد قرحة الضغط من أكبر التحديات والمشكلات التي تواجه النظام الصحي في المؤسسات، وتسبب عبئًا كبيرا على كل من المريض ونظام الرعاية الصحية، وتتمثل عملية علاج قرحة الضغط في نقاط عديدة ومتنوعة وتتضمن الكثير من الاستراتيجيات، وبالتالي فإن الهدف من هذه الدراسة هو التحقق من فاعلية تطبيق العلاج الموضعي بالأنسولين لتحسين التئام قرح الضغط في مرضى وحدة العناية المركزة في مستشفى جامعة النجاح الوطنية. الطريقة: تم إجراء تصميم بحث تجريبي حقيقي في وحدات العناية المركزة في مستشفى جامعة النجاح الوطنية. تكونت عينة هذه الدراسة من 62 مريضاً مقسمة إلى مجموعتين متساويتين. مجموعة الدراسة الذين يتلقون ضمادات الأنسولين الموضعية ومجموعة المراقبة الذين يتلقون الضمادات الروتينية في المستشفى. معايير الاشتمال للمجموعتين هي المرضى الذين تتراوح أعمارهم بين 18-70 سنة، كلا الجنسين، قرحة الضغط ذو المرحلة 2 و 3، وحجم الجرح أقل من 10 سم 2. ومعايير الاستبعاد للمجموعتين هي المرضى الذين تقل أعمارهم عن 18 عامًا وأكثر من 70 عامًا، وقرح الضغط ذات الدرجة الأولى والرابعة والغير قابلة للتحديد، والمرضى الذين يعانون من حساسية الأنسولين، وأمراض الأوعية الدموية، ونقص المناعة، والحمل، والتهاب العظم، قرح الدوالي والحروق، مرضى نقص الضغط، المرضى الذين لديهم مستويات هيموجلوبين أقل من 12.0 جم / ديسيلتر. النتائج: تحسن أكثر أهمية في التئام قرحة الضغط لمجموعة الأنسولين مقارنة بمجموعة التحكم بقيمة(p <0.05)، لا توجد ذات دلالة إحصائية في مقياس ضغط القرحة للشفاء بين مرضى السكري وغير المصابين بالسكري، لا يوجد دلالة إحصائية في النتيجة بين الذكور والإناث، لم تكن نسبة السكر في الدم العشوائية قبل وضع الأنسولين بساعتين وبعد وضع الأنسولين ذات دلالة إحصائية، والتُقطت صور قرحة الضغط للمشاركين في المجموعة التجريبية في اليوم الأول قبل واستخدام الضمادات وفي اليوم السابع بعد استخدام ضماد الأنسولين الموضعي الذي قدم الدليل لتحسين التئام قرحة الضغط. الخلاصة: استخدام الأنسولين الموضعي آمن وفعال لتسريع التئام قرحة الضغط ذات الدرجة2 و3. التوصيات: نوصي باستخدام ضمادات الأنسولين الموضعية للمرضى الذين يعانون من قرحة الضغط ذات الدرجة 2 و 3، وتقييم جلد المرضى من لحظة دخولهم المستشفى باستخدام أدوات التقييم ونماذج مراقبة المخاطر، وزيادة الوعي والمعرفة للوقاية من قرحة الضغط، إجراء مزيد من الدراسات وتطبيق ضمادات الأنسولين الموضعية للأطفال المصابين بقرحة الضغط وتطبيقها على مجتمع اوسع واكبر. الكلمات المفتاحية: الأنسولين، الأنسولين الموضعي، قرحة الضغط، قرحة الفراش، قرحة الاستلقاء، الاستلقاء والجرح المزمن.
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    HEPARINIZATION VERSUS SALINE FLUSH OF CENTRAL VENOUS CATHETER (CVC) LUMENS IN CRITICAL CARE UNIT PATIENTS IN LARGE TERTIARY HOSPITAL
    (2022-12-28) Enas Abed Al-Kareem Taleb
    Background: The central venous catheter (cvc) has a risk of complications, including catheter thrombosis. To prevent this thrombosis, flushing of CVC is needed. There are several methods for flushing (CVC): the first one is heparin with saline after each use while the second method is saline flush. Objectives: To assess the effectiveness of intermittent flushing of normal saline versus heparin to prevent occlusion in long‐term central venous catheters among adult patients in the ICU of Large Tertiary Hospital. Methodology: Randomize Control trial (RCT) design was used in this study. The sample was selected from all patients who were admitted to the ICU department of An-Najah Hospital during the period of August 2020 to October 2020 and have CVC. Patients were selected in a convenience method, and 53 patients agreed to participate in the study. These patients were distributed randomly into two groups; an experimental group (n =26 patients) and a control group (n =27 patients). The experimental group was given flush (a combination of heparin and normal saline), and the control group was given a flush with (normal saline only). To monitor the two procedures, the researcher developed a Check list that included demographic data, lab values, hemodynamic, Patency and complication of CVC. The researcher was able to fill the checklist for every patient. Results: The results showed that coagulation profile (PTT) was less than 35 seconds at admission for experimental group (76.9%) versus control group that got (48.1%) at significant level of P value; (0.031). For easy patency of CVC, the experimental group got (69.2%) which was higher than control group; (37%) while in moderate and difficult patency, the experimental group had less value than the control group (40.7% VS 26.9) and (22.2% VS 3.8%) respectively, at significant level of P value of (0.035). No differences were noticed between the experimental group and the control group in occurrence of complication such as discharge color around CVC, Swab culture result, Oozing from the CVC site. The study showed that dressing daily was for the control group (96.3%) while it was weekly for the experimental group (76.9%). Conclusion: There was a significant difference in the coagulation profile only at admission (p value is 0.031) and significant in patency (p value is 0.035). CVC of the experimental group (combination N/S with heparin group) showed easier patency than the control group (normal saline group), while there was no significant difference in the complications between the two groups. Recommendation: Nurses working at the ICU units should be oriented about the use of normal saline (0.9%) alone without heparin to flush CVC for adult patients. The benefit of this method should be emphasized as to decrease cost of heparin use, and to avoid any adverse effects with heparin use Keywords: Central Venous Catheter (CVC), Heparin, Normal Saline (NS),
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    A Hermeneutic Phenomenological Study for Patients Undergoing Kidney Transplantation
    (جامعة النجاح الوطنية, 2021-02-04) Alawneh, Ashraf
    Introduction: Kidney transplantation is considered all over the world as the best treatment for selected patients with end-stage renal disease (ESRD) as it gives a longer survival time, lower costs and better quality of life in comparison to hemodialysis. However, after the transplantation patients need to adhere to a complex medical regimen, therefore new studies are needed to investigate the unique experiences and individual differences between them. Aim: The aim of this study was to explore the lived experiences of kidney transplant recipients. Design: A qualitative phenomenological hermeneutic design was used, which focuses on subjective experiences of individuals. It is an attempt to reveal the world experienced by the subject through their life world stories. Data collection: interview guide for personal and medical information as well face-to-face open semi-structured audio recording interviews were used to collect data relevant to the study to explore the participant’s experiences. Sample: A purposive sample of 15 adult kidney recipients of both sexes were recruited. Setting: Interviews were conducted in nephrology outpatient clinic of Palestinian medical complex Ramallah . Data Analysis: The data was analyzed as a coherent text inspired by Ricoeur's thoughts on storytelling and interpretation. By analyzing the interview texts, the researcher can reveal common themes shared by participants to gain new knowledge about living through a particular phenomenon. Results: From interviews fifteen themes and related sub themes were identified as follows; encountered feelings, perceived impact on life, encountered medicalized life, prevailing fear of consequences, conflicting emotions, experiencing of altered body, acceptance of changes, understanding the necessity of self-care, enduring abiding, thanking and gratitude, appreciating of supportive encouragement, living with restrictions, long term effects after kidney transplantation, isolation, better health and more energy. Conclusion and recommendations: The participants in the current study had shown positive emotions after kidney transplants, feelings of happiness, feelings of being normal, feelings of rebirth, feelings of resuscitation and feelings of living life were among these feelings. Other feelings of anxiety and fear were also encountered against their living related donors and fear of an uncertain return to painful dialysis sessions and rejection of the new kidney. This study recommends conducting patient education programs on the issues received by the proverbs of kidney recipients in order to increase awareness of the recipients and those who are expected to undergo a kidney transplant. Also this study recommends that kidney transplant is an adaptive challenge and counselling has the potential to psychological support recipients of emotions and uncertainty which characterize the experience.
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    The Incidence and Risk Factors of Nosocomial Infections in Intensive Care Unit at Jenin Governmental Hospital
    (An-Najah National University, 2021-06-13) نزال, فيحاء
    Introduction- Infections acquired when a patient is undergoing treatment at a healthcare facility are known as nosocomial infections. It's a global health problem with rising rates of incidence and high mortality rates associated with the infection and its complications. Objectives- To determine the incidence of nosocomial infection, identify possible risk factors for these infections, clarify the distribution of the causative pathogens and to evaluate the outcome of the infected patients in terms of length of ICU stay and mortality. Methodology-Prospective, observational study conducted from Agu 2020- Dec 2020 in ICU of Jenin Governmental Hospital. 80 patients staying for more than 48 hours in the ICU were included in the study. Epidemiologic characteristics of the patients, cultures, identification of isolates and antibiotic susceptibility tests were made based on standard microbiologic methods, invasive procedures and other risk factors, and outcome of the infected patients in terms of length of ICU stay and mortality were also noted. Result- The incidence of nosocomial infection in our study was 54.7% of 44(55%) Infected Patients who have developed NIs, and 36(45%) Non-Infected Patients. Regarding Infectious disease type diagnosed in our ICU were 42.2% of patients in the sample had the type Urinary Tract Infection especially (CAUTI), 38.6% had the type Respiratory Tract Infection especially (IAP), 20.5% had the type Blood Stream Infection that was 13.6% CLBSI and 6.8% had the type (Septicemia), 15.9% had the type Surgical Site Infection (SSI) and only one patient had other infection. Gram negative bacteria were the commonest pathogens isolated, especially Klebsiella pneumonia was43.2% the highest causative agent of the diagnosed infectious disease. Diabetes mellitus, Endotracheal tube use, Nasogastric tube, and Tracheostomy, were determined as independent risk factors for developing NI. Additionally APACHE II score and length of ICU stay (were found to be high in the NI group. Mortality percentage of patients who developed NI were 50% higher than that in Non-infected group were 25%. Conclusion- Infection control steps should be considered to reduce these numbers due to the high incidence of NIs and widespread resistance among isolates species in the sample. Antibiotics must be used wisely in order to reduce antibiotic resistance in bacterial pathogens. Hospitalized patients' morbidity was increased by nosocomial infections. In our sitting , these results can be used to prepare a nosocomial infection surveillance program.
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    INCIDENCE OF POST-OPERATIVE ATRIAL FIBRILLATION IN PATIENTS UNDERGOING CORONARY ARTERY BYPASS GRAFTING SURGERY AFTER GIVING PERIOPERATIVE BETA BLOCKERS:A PROSPECTIVE OBSERVATIONAL STUDY IN A UNIVERSITY HOSPITAL IN PALESTINE
    (2022-08-24) Duha Zaki
    ABSTRACT Background: The most prevalent arrhythmia, after cardiac surgery, is postoperative atrial fibrillation (POAF).It affects 30% to 50% of patients and significantly increases morbidity and length of hospital stay. Also, it significantly increases hospital costs. A number of risk factors have been found to be associated with a higher frequency of post-coronary artery bypass grafting (CABG) AF. Beta-blockers emerge as the preventive drug, unanimously regarded as a therapy assisting in the reduction of POAF incidence. Aim: This study sought to determine the incidence of postoperative atrial fibrillation in patients undergoing on-pump CABG surgery after perioperative beta blocker (Bisoprolol) administration. Material and method: Patients were scheduled for elective CABG surgery in this prospective observational trial. Valve surgery, redo CABG surgery, and renal failure patients were excluded from the study. The (Already on Beta-Blockers) group and the (Newly Administered of Beta-blockers-Bisoprolol) group were afterwards formed from the original one group of the study sample for the purposes of analysis. Patients who were already taking beta-blockers (Already on Beta-Blockers) should continue taking them postoperatively after being extubated and awakened. They should start taking them the evening before surgery. For patients who were receiving beta blockers for the first time postoperatively( Newly Administered of Beta-blockers-Bisoprolol) and they were not on beta blocker preoperatively, the dose was adjusted according to heart rate, and blood pressure starting from 1.25mgBisoprolol (orally) and titrating according to previous parameters Results: The incidence of POAF stood at 17/150 (11.3%) post operatively in the whole group, when a subgroup analysis was done, the whole group was divided into two groups: group one Already on Beta-Blockers (n=54) and group two newly administered of Beta-blockers (n=96). The results showed that the percentages of AF cases in group one (n=2, (3.7%) were lower than group two (n=15, (15.6%).The p= 0.027, bradycardia 37/54(68.5%) in group one and 47/96(31.3%) in group two, p=0.000 was in favour of group two. Hypotension was 37/54(68.5%) in group one and 26/96(27.1%) in group two; p= 0.000 wasin favour of group two. CCU length of stay in days 4.00 ± 0.87 in group one and 3.57 ± 1.41 in group two; p= 0.046 was in favour of group two. Hospital length of stay in days was7.85 ± 2.79 in group one and 4.70 ± 2.68 in group two; p=0.000 was in favor of group two. Pain Assessment (VAS) was3.65 ± 0.84 in group one and 4.14 ± 1.16 in group two; p= 0.007 was in favour of group one, Conclusion: A perioperative beta blocker (Bisoprolol) could lower the risk of developing postoperative AF and lessen the intensity of pain following coronary bypass graft surgery. Patients on chronic beta blockers increased the likelihood of hospital and intensive care unit length of stay. Preoperative risk factors for AF include heart failure, and COPD. Keywords: Beta Blocker; Bisoprolol; Postoperative Atrial fibrillation; Coronary Artery Bypass Grafting (CABG); perioperative; length of stay.
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    Intraoperative pathophysiological changes and therapeutic interventions in patients undergoing on-pump cardiac surgery may be risk factors for the development of postoperative Delirium. Observational Study
    (An-Najah National University, 2019-11-20) Halahla, Abdallah
    Introduction: Delirium after cardiac surgery is a common complication in cardiovascular intensive care units. Estimated incidence rates are approximately 2% to 72%. Delirium is an acute organic syndrome characterized by inattention, disorientation, along with global cognitive impairment and disturbance in consciousness. Postoperative delirium is typically characterized by a varying rate and can be associated with either increased or decreased psychomotor activity. Delirium after cardiac surgery to be quite distinct from other forms of delirium for the following reasons: Different surgical Populations have different medication profiles, require different anesthesia techniques thus pharmacological triggers of delirium will vary depending on the surgery, the use of cardio-pulmonary bypass in cardiac surgeries requires special consideration since its use is associated with postoperative effects on neurotransmitter function and an increase in delirium. Research has shown that predictors of delirium appear vary depending on the surgery type and the levels of various biomarkers for delirium. Identification of risk factors of delirium is important for positive postoperative outcomes. Aim: The aims of this study are to investigate whether intra-operative events and therapeutic interventions affect the risk of postoperative delirium in patients undergoing cardiac surgery in the ICU and to determine the incidence of and risk factors for delirium in patients undergoing cardiac surgery. Material and methods: A descriptive analytical study design used; study performed at cardiac surgery units at three hospitals in Palestine. Sixty patients who underwent elective cardiac surgery are subsequently admitted to cardiac surgical ICU are enrolled into this study. A detailed clinical report form was created to collect pertinent data in order to determine the effect of pre-operative, intraoperative and postoperative variables on delirium. All subjects are screened for delirium using the RASS and CAM‑ICU test once daily, and all those who tested positive were thereafter designated as cases and the other subjects are deemed controls. Results: The percentage of patients who developed delirium right after the operation were 75.9% (41/54) of the targeted sample, the percentage continued to drop until it reached 3.7% (2 patients) in the second and third day. No relation could be detected between delirium and the demographic variables (education, smoking status, gender, marital status and age) and no relation could be detected between delirium and the pre-operative factors. Intraoperative, total amount of midazolam/mg in control group 3.31±0.398 compared to 2.41±.135 in delirium group, p= .051, (95% confidence level) and the result shows that those who did not suffer from delirium postoperative have had higher amount of midazolam. There was a significant difference at (90% confidence level) in the total amount of morphine/mg in control group (no delirium) 8.85±1.04 compared to delirium group 7.93±.45 (p= .085), those who received more morphine intra-operatively where more likely not to develop delirium after the surgery. The variable with significant relation to delirium was the use of atropine (90% confidence level) as those who seemed to use more atropine were significantly less likely to develop delirium, as in control group (not delirium) 3 (23.1%) patients received atropine compared to delirium group 1 (2.4%), p= 0.062. Regarding temperature (95% confidence level) those patients who had low grade or high temperature 19(46.3) in delirium group compared to 0(0%) in the control group (p= 0.01) were significantly more likely to develop delirium. This result indicates that low grade or high temperature postoperative is a precipitating factor for delirium. Postoperatively, bolus doses of morphine/mg (95% confidence level) as in the control (not delirium) M(SD) .00±.000 compared to 1.17±.308 in the delirium group, p= (0.001) those patients who received morphine where significantly more likely to develop delirium postoperatively. Regarding the sequential organ failure assessment score (SOFA) (90% confidence level) as those patients who scored higher SOFA in the delirium group 5.56±.191were more likely to develop delirium compared with control group (not delirium) 4.85±.390, (p= 0.083). This result indicates that higher SOFA was a precipitating factor for delirium. Hyperactive type of delirium was seen in 22/41 patients (54.7%) while 11/41 patients (25.9%) had hypoactive delirium and 6/41 (13%) patients had mixed delirium. Conclusion: A compelling percentage of cardiac surgical patients encountered delirium in ICU, broadly in its hyperactive form. Few modifiable risk factors have been determined that could lower the probability of post cardiac surgical ICU delirium. One should contemplate the use of midazolam, morphine and atropine intra-operative as protective drugs for postoperative delirium. Low and high grade fever, postoperative morphine usage and augmenting of SOFA score are precipitating factors for postoperative delirium.
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    LIVED EXPERIENCE OF PATIENTS WHO UNDERWENT CORONARY ARTERY BYPASS GRAFT SURGERY IN WEST BANK – PALESTINE: HERMENEUTIC PHENOMENOLOGY STUDY
    (جامعة النجاح الوطنية, 2022-02-19) عبادي, أيمن
    مقدمة: أصبحت عمليات ترقيع الشرايين التاجية شائعة جدًا لعلاج مرضى نقص تروية القلب. في الحقيقة، يعتبر مرض نقص تروية القلب من الامراض الشائعة والخطيرة التي تصيب الناس في جميع أنحاء العالم. فإذا لم يتم التعامل معها بشكل صحيح وسريع، سيترتب عليها عواقب وخيمة. ولذلك كان الهدف الرئيسي للدراسة استكشاف التجربة الحياتية التي عاشها مرضى نقص تروية القلب الذين خضعوا لعملية ترقيع الشرايين التاجية في فلسطين. التصميم: تم استخدام التصميم النوعي للظواهر التأويلية لإجراء هذه الدراسة، حيث أنها تصف وتفسر تجربة المشاركين بشكل عميق. تم اجراء مقابلات مع 21 مشاركًا وجرى تحليلها باستخدام نموذج ريكور للتحليل. النتائج: أظهرت النتائج أن ردود فعل المرضى تجاه الجراحة كانت متباينة. وقد عانوا من قيود عديدة على أنشطة حياتهم اليومية بعد الجراحة، وكان لفيروس كورونا تأثيرٌ على حياتهم، حيث كانوا يخافون الإصابة. وتعرّض المرضى أيضًا لتغيرات جسدية ونفسية، والعديد من المضاعفات مثل الانصباب الجنبي والسكتة القلبية. كما كان للعملية بعض الآثار المالية على حياة المرضى. وأخيرًا، سلطت الدراسة الضوء على المجموعات الداعمة لمرضى شرايين القلب وآراء المرضى بخصوص النظام الصحي الفلسطيني. الخلاصة: كشفت النتائج أن مرضى ترقيع الشرايين التاجية عانوا من تغيرات جسدية ونفسية ومالية بعد العملية. وقد واجهوا العديد من المضاعفات المتعلقة بالجراحة؛ وبالتالي، فهم بحاجة إلى دعم من الحكومة والمجتمع ومقدمي الرعاية الصحية لتلبية احتياجاتهم وتحسين نوعية حياتهم. الكلمات المفتاحية: أمراض نقص تروية القلب، الشريان التاجي، عملية ترقيع الشرايين التاجية التجربة الحياتية، التأويل.
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    MORTALITY IN HEMODIALYSIS PATIENTS AND THE LEADING CAUSE OF DEATH IN A SINGLE CENTER AT THE NORTHERN OF WEST BANK: A RETROSPECTIVE COHORT STUDY
    (2022-12-21) Malek Isam Awni Abdelghani
    Background: Currently, there were 5 to 7 million patients who have end-stage renal disease (ESRD) that need renal replacement therapy. This study was conducted to determine the mortality rates among hemodialysis patients at An-Najah National University Hospital which is one of the main referral centers in the north of the West Bank of Palestine. The study also aimed to describe the causes of death among this group of patients. Methods: This study used a quantitative correlational retrospective cohort design. The study included all adult patients with ESRD who underwent hemodialysis irrespective of their gender, and duration of dialysis. Demographic variables, etiology of the ESRD, presence of comorbidities, and laboratory findings of the patients were collected. Results: Medical records of 348 ESRD patients who were on hemodialysis between January 2017 and December 2021 were reviewed. Of the 348 ESRD patients, 95 patients died giving an overall mortality rate of 27.3%. Of the patients who died, 68.4% were male and 91.6% were dialyzed for 1-3 years. Cardiovascular disease was the leading cause of death (43.2%) among the patients in this study. Diabetic nephropathy was the leading cause of ESRD (77.9%) among the patients who died in this study. Of the patients who died in this study, 60% had diabetes mellitus and hypertension and 88% had hypoalbuminemia. Mortality was associated with older age and smoking. Conclusions: The mortality rate among patients on hemodialysis was within the range of mortality rates reported in the regional studies. Cardiovascular disease was the leading cause of death among the patients in hemodialysis. More studies are still needed to investigate the effects of manipulating some modifiable risk factors on the mortality rates among hemodialysis patients in Palestine. Keywords: Chronic kidney disease; End-stage renal disease; Hemodialysis; Mortality.
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    Nurses’ knowledge, Attitudes and Barriers to Effective Pain Management in Intensive Care Units Governmental Hospitals in West Bank, Palestine
    (جامعة النجاح الوطنية, 2021-05-19) Hariri, Bassam
    Background: Pain is a momentous affliction suffered by patients admitted to the Intensive Care Units (ICUs) that may lead to chronic pain disorders, and can negatively affect the physiological and psychological outcomes for patients and their families. Aim and objectives: This study aims at assessing nurses’ knowledge and attitudes toward pain management of ICU patients, and to identify barriers that affect the optimal pain management among ICU nurses of the Governmental hospitals in the West Bank, Palestine. Furthermore, to detect the relationship between the levels of knowledge/attitude and any other factors affecting nurses. Method: A cross-sectional survey was conducted about the ICU nurses. The study was carried out in twelve (12) governmental hospitals in Palestine, between August and November 2020. Nurses who work in the (ICUs) were invited to participate in this study. One hundred twenty-three (123) nurses who responded to participate out of (164) nurses with a (75%) response rate. Nurses who have been working in hospitals for at least six months were included in this study. The tool was a questionnaire derived from the nurses’ knowledge and attitudes survey regarding pain (NKASRP) section, and was used to gather data about pain management with a minimal test value = 0.80. Furthermore, analyses were executed employing (SPSS). Results: Despite the fact that only 37 (30.1%) of the nurses caring for ICU patients had prior education regarding pain management in the last (2) two years, more than half of nurses 71 (57.7%) testified they had an effective role in pain management. However, precise response rate of NKASRP grade was 47.8%, while the mean number of correct answers to all questions was (19.61±13.51) with a range of 24% to 80%. A statistically significant difference was found regarding years of practice in intensive care units, as well as previous pain education in the last 2 years in favor of those who had pain education (0.5048) vs. (0.4166), with the total mean scores of knowledge and attitudes (p<0.05). There was a highly associated positive correlation between knowledge and attitudes. The study revealed that the (5) least correctly answered questions were related to the case study items about the route of administration of opioid analgesics, and physical dependence. The total barrier score was 2.399 out of 3. No statistically significant differences were found between the demographic features of the nurses and the perceived barriers. However, the highest perceived nurse-related barriers to effectual pain management were insufficient staff knowledge of pain management evenly with nurses' indifference 90 (73.2%). Conclusions: Findings of this study verified that the surveyed nurses had poor knowledge of pain management and less than optimum, and was associated with poor attitudes, as well as a high barrier score signifying a gap toward effective pain management. A significant positive correlation was found between knowledge and attitudes. Recommendations: Nurses have to be well-prepared and knowledgeable on pain management modus operandi. It is recommended that ICU nurses should be provided with in-service training and ongoing pain management courses. Fitting and convenient strategies to minimize potential barriers can be renovated to better empower nurses to employ practice guidelines to yield effective pain management to ICU patients. Expectantly, this study is to be espoused and aptly integrated by MoH and vigorously to be considered legally mandatory upon all health bodies and educational organizations in Palestine.
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    Nursing Clinical Assessment to Predict Cardiac and Pulmonary Events in the End-Stage Renal Disease (ESRD)
    (جامعة النجاح الوطنية, 2021-11-16) غانم, شذى
    هدفت هده الدراسة إلى تقييم فعالية التقييم السريري التمريضي وحساب كمية السوائل المتجمعة في الجسم في التنبؤ بالأمراض القلبية والرئوية لدى المرضى الذين يعانون من الفشل الكلوي المزمن . استخدمة الباحثة تصميم الدارسة المستقبلية والذي يعني أخذ مجموعة من الموضوعات ومشاهدتها على مدى فترة طويلة. أجريت هذه الدراسة في فلسطين في مستشفى النجاح الوطني في قسم غسيل الكلى. وشملت عينة البحث (280) مريضا من قسم الكلى الصناعية بمستشفى جامعة النجاح الوطني. أظهرت نتائج الدراسة أن المرضى المتوفين لديهم معدلات أعلى من وزن الجسم والشكاوى ونوبات الاستشفاء مقارنة بنظرائهم في الوحدة خلال فترة الدراسة التي استمرت 6 أشهر ، فيما يتعلق بالمرضى الذين يخضعون لغسيل الكلى، فقد وجد أن هناك علاقة عكسية بين مؤشر كتلة الجسم وخطر الوفاة والتي أثبتتها العديد من الدراسات السابقة حيث أن مؤشر كتلة الجسم الأساسي الأعلى مرتبط بنتائج أفضل. كان التغيير في إجمالي السوائل في الجسم بين ما قبل غسيل الكلى وبعد غسيل الكلى (الذي يعكس الترشيح الفائق أو زيادة الوزن بين الكلى)، كانت الفروق والاختلافات أوسع في المرضى المتوفين مقارنة ببقية المشاركين في دراسة مرض غسيل الكلى والتي عكست نتائجها ثبات نسبي في الفروق بين النسبة المئوية لسوائل الجسم الكلية قبل وبعد غسيل الكلى، وهناك علاقة ارتباط قوية بين سرعة إزالة السوائل (أكثر من 10 مل / كجم / ساعة) أثناء غسيل الكلى ومعدلات وفيات أعلى وهذا يعزى إلى نقص التروية في نهاية العضو من عدم استقرار الدورة الدموية العلني وتحت السريري. ارتبط المرضى الأحياء بانخفاض معدلات نوبات دخول المستشفى مقارنة بالمرضى المتوفين. من المعروف أن المرضى الذين يخضعون لغسيل الكلى المزمن معرضون لخطر دخول المستشفى مقارنةً بعامة الناس. أوصى الباحث بما يلي: 1. زيادة مدة غسيل الكلى في المستشفيات إلى 4 ساعات متواصلة لسحب السوائل دون إثقال كاهل المريض. 2. العمل على مراقبة الوزن الثابت للمريض بشكل متكرر من خلال تنفيذ التقييم التمريضي والسريري ، بحيث يتم متابعة المرضى باستمرار لمعرفة أي تطور في صحة المريض. 3. يوصى بشدة بإجراء مزيد من الدراسات لتقييم فعالية التقييم الإكلينيكي التمريضي الآخر في التنبؤ بالنتائج والأمراض المصاحبة للمرضى.
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    Pre- and Post-Operative Use of 0.2% Chlorhexidine Gluconate Oral Rinse for the Prevention of Ventilator -Associated Pneumonia in Patients UndergoingCardiac Surgery
    (جامعة النجاح الوطنية, 2020-10-27) زكارنة, غسان
    الــخــلـفـيــة: تــعــتــــــــبـر عــــدم كــــفـــايــة الـــنـظـافــة الــفـمــويــة فـــــــي وحــدات الــعـنايـــة بـالــقـلــب (CCUs) مـشــــكـلـة حــرجـة وشـــائــعــة لـــدى مــرضــى الـتـهــويــة مــيــكانــيـكـيــا، حــيــث يـعــتــبــر عــامـــلاً مسببــاً للإلــتــهــاب الـــرئـــوي الـــمــصــاحــب لـلــتــهــويـــة ((VAP. ويــعـــرف الإلــتــهــاب الـــرئـــوي الــمــصـاحــب لأجـــهــــزة الـــتــنـــفــس الـصــناعــي بـأنــه الــتــهــاب الــــرئــة الــمــكــتـســـب فــــي الـمـسـتــشـــفـى الــذي يــصــيــب المرضى الــذيــن يــخــضــعــون لــلـتــهــويــة الــمــيـكـانــيــكــيــة (الــتـنـبــيــب) خلال 48 ســـاعــة أو أكــثــر، والــذيــن لـيـــس لــديــهــم عــلامــات أو أعـــراض عــدوى الــجــهـــاز الــتــنــفـسـي قـبــل الــتــنــبــيــب والــتـهــويــة الــمــيــكانــيــكــيــة. وهــي ثـانــي أكــبــر مــســـبـب لـحـالات الــعــدوى، والــســــبـب الـرئـيـســي لـلـوفـيــات. وكـعـامل مـســــاعـد عـلـى الـعــنايــة بالــصــحــة الــفــمــويــة لــدى الــمــرضـى كـإجـــراء تـحـضــيــري لـلـجــراحـــة، فـإن اســـتـخـدام الـكـلـورهـيـكـســيـديـن0.2% يـؤدي إلــى تـقـلـيــل الإلتــهــاب الــرئــوي الــمــصــاحــب للــتــهــويـــة. الأهـــداف: هـدفــت هــذه الــدراســـــــــــة إلـــــــى تقــيــيــم تــأثيــر الــحــزمــة الــوقــائـيـة الـدوائــيــة (Bundle) عـلـى انــتـشـــار الإلــتـهـاب الــرئـــوي الــمـصــاحـب لأجــهــزة الـتـنـفـــس الصــنـاعــي وتــقــلـيـلـه أو الــقــضــاء عــلـيـه، وعــلـى مــدة الـمـكــوث فــي وحــدات الــعــنـايــة بـالــقـــلب (CCUs)لــدى الـمـرضــى الــذيــن يــخـضـعــون لـلتـهــويــة الـمـيـكـانــيــكـيـة. الــمـنــهــجـيــة والإجــراءات:تــم اســتـخـدام المــنـهــج الــبـحـثــي شــــبـه التــجـريــبــي لـلـمـرضــى الـذيـــن يـخـضـعــون لــعـمـلـيـة الــقــلـب الــمـفـتــوح فـــي وحــدة الــعـنـايــة بالــقــلــب فــي مـســتـشــفـى جــامـعـة الــنــجــاح الــوطــنــيــة، فـــي الــفــتــرة الـــواقــعــة بــيــن تــشـــريــن أول 2018 وتــشـــريــن أول 2019. قـــســـمــت الــدراســـة إلــى مــجــمــوعتــيــن بــمــا مــجـمـوعــه (90 مــريــضــاً): الــمــجــمــوعــة الــتـجــريــبــيــة (45 مــريضــاً)، وهــي الــمــجــمـوعــة الــتـي تــم إعــطـاء الــمــرضــى فيـــهــا الــحـزمــة الــدوائــيـة، وكـذلـك بـإعــــطـائــهـم الــكـلـورهــيـكـســـيـديــن0.2% بـجـرعــة مـضـمـضــة تـصـل إلــى 15 mL لمــدة 30 ثانـيــة، كـــل 12 ســــاعـة، لـمـدة 3 أيـام قــبـل وبـعـد الــعـمـليـة وحــتـى خـــروج الـمـريـض مـــن الـمـســتــشــفـى. أمــا الـــمـجـمـوعـة الــثـانــيـة فـهـي الــمـجـمــوعــة الـضـابـطـة، وذلـك بــمـراجـعــة مـلـفـات الــمـرضــى (45 مــريــضـاً) الـذيــن خــضـعــوا لعـمـلـيــات الـقـلـب الــمـفـتــوح قـبــل ســــنــة مــن بـدايــة الــدراســــة فــي الــفــــتـــرة الــواقـــعـة بــيــن تـشـــريــن أول 2017 وتـشــــريـن أول 2018. شــــــمــلــت الــدراســـــة مــن كـانـــت أعـــمــارهـــم تــــزيـــد عـــن ال 18 عــامــاً، وكــذلـك مــن وقَّـــعــوا عـلـى نمـــوذج الــمــوافــقــة لـلإشــــتــــراك فـــي الــــبـــحـــث. اســتـخـدم الباحث المنهج الإســـتـرجـاعـي والتــجـريــبـي، وقــد تـمـت الــمـوافــقــة عــلــيه مـــن قــبـل” لــجـنــة أخــلاقــيـات الـبــحـث الـعـلـمـي فــي جــامــعـة الـنــجـاح الـوطــنـيــة(IRB) “. عــلاوة عــلـى ذلــك، وافــقــت لـجـنـة الأخـلاقـيـات فــي مــســتـشــفـى جـامـعـة الـنـجـاح الــوطـنـيـة –مـشــكـورة- علـى إجــراء هـــذه الـدراســـة فــي الـمـســـتـشــفـى. تــم اســـتخـدام أداة الـقـيـاس الإكـلـيـنـيـكـي لـلـعــدوى الــرئـويــة (CPIS) لــلـمـســـاعــدة فــي تــشـــخـيـص الإلــتـهـاب الــرئــوي الــمـرتــبـط بـالـتـهـويــة الــمـصــاحــب لأجـهـزة الــتـنـفــس الــصـنـاعـي (الـمـُـنـَـفِـّـســـــة). الـنـتـائــــج: أظــهــرت الـنــتــائــج تــشــابـه كــلا الــمـجـمـوعــتـيـن مــن حـيـث الــعــوامـل الديموغرافية من نـاحــيـتـي الــعـمـر والــجـنـــس تــقـريــبــاً؛ حــيـث كـان مــتــوســــط الـعـمـر والإنــحــراف الــمـعـيـاري والــمــدى لـلـمـجــمــوعــة الـتـجــريــبـيــة (58.24 ± 7.42 (26-73))، فــــــــــي حـــــيـــــن كـــان لــــلـــمـــجــــمــوعــة الــضـابـطــة (56.8±11.18 (27-77) ســــــنة، وقــد كــان مــتـوســـط الــعـمــر الــكــلـي للــمــجــمــوعــتــيــن (الإنــحــراف الــمــعــيـاري) 57.52 (9.47) مــع مـــدى (26-77) ســـــنـة. أشـــــارت الــنــتــائــج أيـــضـاً إلـــى أن 93% مـــن الـــمـشـــاركــيــن كـانــوا ضــمـن عــمــر (20>age≥70) لـكـلا الـمـجـمــوعــتـيـن تــقـريــبــاً،58.9% (n=53) كـانــوا فــي فــئــة الـذكـــور. أكــثــر الأمـــراض الــمـصاحــبـة كـان ضــغــط الــدم (HTN) حـيــث وصـلـت نـســـبـتـه (57.8%)، غــيــر أنــه كـانـــت هــنـاك حـالــة وفــاة وحــيــدة بـنـســـبـة (2.2%) فـــي الــمـجـمــوعــة الــضـابــطـة فـــقــط. أظــهــرت الــنــتــائــج انــتــشـــار 8 حــالات مــع 154 يـــوم تــهــويــة فـــي الــمـجـمـوعــة الــضــابـطــة (مــتــوســـط=3.42) مــقــارنــة مــع 2 مـــن الــحــالات مــع 132 يــوم تــهــويــة (مـتــوســـط=2.96)، وقـــد انــخــفـض مــعــدل ال (VAP) مـــن 17.8% إلـــى 4.4% لكــل1000 يـــوم تــهــويــة مــيـكــانــيــكــيــة، وقـــد كــان مــعــدل أيــام الــتــهــويــة وأيــام الــمــكــوث فـــي الــعــنـايــة فــي الــمــجــمــوعــتــيـن الــلـتـيــن تــحــتـــويــان عــلـى ال (+VAP) أكـــثــر مــنــه فــي الـــمـجــمــوعـتـــين الـلـتـيــن لا تــحــتـويـان عـلـى ال (VAP-). لــوحــظ هــنـاك انــخـفـاض كــبـيــر فــي انــتـشـــار ال (VAP) لــلـمـرضــى الـذيـن أجــروا عــمـلـيــات قـــلـب مــفــتــوح بــعــد تــطــبـيــق "الــحـزمــة الــدوائــيـة"، والـذيــن عــولــجــوا بـالـكـلــورهــيـكـســيـديــن فــي تــطــهـيـر الــبــلــعــوم، مــمـا أدى إلــى حــدوث (VAP) أقـــل، بـالإضــافـة إلــى أن "الـحــزمـة الـدوائــيــة" كـانـت فــعــالــة ومــؤثـــرة فــي تــقــلـيـل أيــام الــمــكــوث فــي وحــدة الــعـنـايــة بــالــقـلـب. وقــد بــدت مــقــايــيـــــس فــعـالــيــة الــتــداخــلات الصحــيـة مــنـاســـــبـة، حــــيـــث كـانـــت نـســـــبـة الــخـطـر (الإخــتـطـار) الـنـســــــبي وهــــو نــســــبــة حــدوث الـمـرض فــــي الــمـجـمـوعـة الـمتــعـالــجــة إلــى نــســـبـة حــدوثــه فـــــي الــمـجــــمــوعـــة غــــيــــر الــمـعـــالــجـة (%RR=32)، والــحــــد مـــــن الــمــخـاطـر الــنـســـــبــــيـــة (RRR=77%)، كـمـا أن إنـــقـــاص الـخـــطــر الــمــطـــلـــق وهــو الـفـرق بــيــن احــتـمـال حــدوث ال (VAP) مــع الــمـعــالــجــة واحــتـمـال حـــدوثـهـا بــدون الــمـعـالـجــة (ARR=13%)، عـــلاوة عــلـى ذلك، فــإن الـعــدد الــواجــب علاجــه (NNT=8)؛ أي أنــه لتــجــنــــب حــدوث (VAP) واحــــــدة، فـإنــه يــجــب مــعـــالـــجـــة 8 مــــرضــى "بــالـــحـــزمــــة الـــــدوائــــيــة". الإســـتــنـتــاجــات: خــلــصــت الــنــتــائــج إلـــــى أن الــمـعـــالـجـة الــفـمــويــة بـالـكـلـورهــيـكـســـيـديـن "والــحــزمــة الـدوائــيـة" الــخـاصــة بــهــذه الــدراســــة تــــقـــلـــل مــــن حــــدوث ال (VAP) فــي الــمـرضـى الــــذيــن يــخـضـعــون لـلـتــهـويــة الــمـيـكـانـيـكـيـة (الــــتــــنـــــبـــــيـــب)، كـمـا أنــهــــا تــقــلـل مــن فــتــرة المــكــوث فــي وحــدة الــعـنـايــة بـالــقـلــب، وقــد تــكــون مــرتـان يــومــيـاً كـافــيـة لـتـــقــلـيــل الـخـطـر بــحــوالـي الــربع تــقـريــبـاً. الـــتــوصــيــات:إلــــتــزام هـــيـئــة الــتــمـريــض "بــالــحــزمـة الــدوائــيــة" قـــد يـــؤدي إلـــى نــتــائــج جــيــدة، هــنـاك حــاجــة إلـــى إجـــراء الــمــزيــد مـــن الــدراســــــات بــعــيـنـة ومـــدة أكــبــر وفـــي أمـاكــن مــتــعــددةلـلـتـحـقــق مــن كــفـاءة الــبـروتــوكــول الــحـالــي واقــتــراح الــتــحـســيـنـات الــمـمـكـنـة، وعــلاوة عــلى ذلـك، يــــنـــبــغـــي لــمـقـــدمــي الــرعـايـة الـــطــبـيـــــة الــنـظــر فــي تــأثــيــر الــعـنــايــة بـالــفــم إلــى جـــانــب الــتــدابــيــر الــوقــائــيـة الــمــتــــنـــوعـــة لـ (VAP). وإنــه مـــن الــمـأمــول أن يــتــم دمــج هــذه الــدراســــــة حـســب الأصــول والــرجــوع إلـــيـهــا، لــتــكــون مــلــزِمــة قــانــونـًا لــجــمــيـع الــمـســـتـشـــفـيـات والــمــؤســــســـات فــي فــلـســـــطــيــن.