Clinical Research

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https://hdl.handle.net/20.500.11888/20367

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    PROGNOSIS OF PATIENTS WITH ACUTE RESPIRATORY FAILURE AND PROLONGED INTENSIVE CARE UNIT STAY AT A TERTIARY CARE HOSPITAL: A RETROSPECTIVE STUDY
    (An-Najah National University, 2025-03-16) Mallouh, Manar
    Background: Acute respiratory failure (ARF) is one of the greatest serious clinical conditions often need ICU admission and is linked with prolonged hospital stay. The main purpose of this study was to examine outcomes in order to identify risk factors related to the length of stay (LOS) in the intensive care unit (ICU) of patients with ARF. Methods: In this retrospective cohort study, patients were admitted from 2018 to 2023 to the intensive care unit of a tertiary care hospital and were involved if they were adults diagnosed with ARF volunteer. We systematically retrieved demographic characteristics within electronic health records and documented clinical variables and interventions of every patient, including ventilation support. Logistic regression models, t-tests, and chisquare tests were completed using the Statistical Package for Social Sciences (SPSS) version 21 to govern potential predictors of mortality and LOS. Results: Out of the 460 participants, 61–52 percent were male, with an average age of 59. However, neither age nor gender was found to significantly influence mortality rates. Vital clinical signs of impending death comprise of a systolic blood pressure below 110 mmHg, a heart rate of 100 bpm or higher, a temperature under 37°C, a Glasgow coma scale score below 14, a hematocrit value of fewer than 26, a sodium concentration below 139 mEq/L, and a pH value below 7.36. There appeared to be higher survival rates between patients who had lower acute physiology and chronic health evaluation (APACHE) scores. On the other hand, shorter periods on ventilators and less invasive procedures were connected with better outcomes. Significant issues that affected mortality are such as admission for pneumonia, acute respiratory distress syndrome, and post-operative cases while complications like vasopressor use, renal disease, and hepatic injury also improved the rates of death as well as longer LOS. Conclusion: This study highlights the significance of thorough clinical assessment and modified management strategies for ICU patients with ARF who have long stays. To improve survival rates while reducing the period of hospital stays, standard risk assessment tools such as the APACHE score should be used alongside progressions in ventilation methods. Moreover, employing multidisciplinary approaches to tackle the patient's comorbidities and associated complications can improve the prognosis even more.
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    PATIENT-REPORTED OUTCOMES MEASURES OF PAIN, QUALITY OF LIFE, MENTAL STATUS AND SLEEP QUALITY AMONG SPINAL NEUROSURGERY PATIENTS IN PALESTINE: A PROSPECTIVE LONGITUDINAL QUANTITATIVE STUDY
    (An-Najah National University, 2025-01-16) Daqqa, Ahmad
    Introduction: The use of patient-reported outcomes measures (PROMs) is an application of the volume-to-value-based healthcare services, and were quantitatively used in the field of neurosurgery. Therefore, the current study aimed to investigate the preoperative and postoperative, as well as changes and factors of changes, in specific PROMs among spinal neurosurgery patients in a tertiary hospital in Palestine. Method: The study was conducted using a prospective longitudinal design on a convenience sample of 99 lumbar and 35 cervical spine neurosurgery patients, and were interviewed to fill in a preoperative and one-month postoperative questionnaire that measures pain, quality of life (QoL), sleep quality and mental health PROMs. Valid versions of Arabic translated tools were used, including Neck Disability Index (NDI), Oswestry Disability Index (ODI), EuroQoL (EQ-5D-5L), Pittsburg Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS) and Patient Health Questionnaire (PHQ-9). Data were analyzed using SPSS with full commitment of ethical considerations of anonymity and confidentiality. Results: The patients had mean age of 49.16 years old, and were 50.7% females, 74.6% married, 59.7% underwent discectomy, a mean diagnosis-to-operation period of 7.15 weeks, and used preoperative paracetamol (69.4%), cortisones (76.9%), and NSAIDs (59.7%). All Proms showed significant postoperative overall improvements (p-value < 0.001), where better NDI improvements are found among urban residents and congenital disease-related operations, better ODI improvement among tumor resection patients, without hormonal disorders or use of preoperative cortisones, while better EQ-VAS improvements found among patients who are younger, and did not use preoperative paracetamol or muscle relaxants, and better ESS improvement are shown among older patients (p-value < 0.05). Conclusion: The current study found an overall significant improvement among spinal neurosurgery patients in PROMs of pain, QoL, sleep quality and mental health. Some significant improvements were related to specific demographic and health-related factors. Several studies agree with the findings of the current study, with differences in the affecting factors related to sampling and population characteristics differences. Patient’s engagement in preoperative education, recourse allocation and conduction of RCTs are recommended.