Prevalence of Depression and Its Associated Factors Among Hemodialysis Patients in Hodeida City, Yemen.

Background: Depression has a negative impact on the health outcomes of hemodialysis (HD) patients, including decreased quality of life and increased morbidity and mortality rates. Therefore, this study aimed to determine the prevalence of depression and its associated factors among HD patients in Hodeida city, Yemen. Methods: A cross-sectional study involving 200 HD patients at the Dialysis Center in Hodeida was conducted from February to May 2022. Data on depression were collected using the 9-item Patient Health Questionnaire (PHQ-9). Association of sociodemographic characteristics of patients with depression were assessed using chi-square, subsequently by multivariable logistic regression. Statistical significance was set at P-values <0.05. Results: The response rate was 98% (200/204). Depression was prevalent among 63% of HD patients at the Dialysis Center in Hodeida city. Sex was significantly associated with depression, where female patients were more frequently depressed than males (82.4% vs 56.4%, P < 0.001). In addition, employment status and medical insurance were significantly associated with depression, where unemployed patients were more frequently depressed than employed patients (67.6% vs 52.5%, P = 0.041) and patients with medical insurance were less frequently depressed than their counterparts (47.1% vs 66.3%, P = 0.035). Conclusion: Depression is highly prevalent among HD patients in Hodeida city. Female sex, unemployment and lack of medical insurance are predictors of depression among HD patients. These findings emphasize the urgent need for targeted interventions. Implications for practice: Depression is common among HD patients, so that, psychiatric physicians and nurses are increasingly needed in HD centers to implement mental health assessment of patients for depression signs and symptoms to help in early diagnosis and management of depression in order to improve patients' quality of life and preventing negative outcomes.

Medication Errors in Pediatric Emergency Departments: A Systematic Review and Recommendations for Enhancing Medication Safety.

OBJECTIVE: This systematic review aims to investigate the prevalence, preventability, and severity of medication errors in pediatric emergency departments (P-EDs). It also aims to identify common types of medication errors, implicated medications, risk factors, and evaluate the effectiveness of interventions in preventing these errors. METHODS: A systematic review analyzed 6 primary studies with sample sizes ranging from 96 to 5000 pediatric patients in P-EDs. The review followed Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines and included observational studies and randomized controlled trials involving patients aged 18 years and younger. Comprehensive searches in biomedical databases were conducted, and conflicts in record screening were resolved by a third reviewer using systematic review software. RESULTS: Medication errors in P-EDs are prevalent, ranging from 10% to 15%, with dosing errors being the most common, accounting for 39% to 49% of reported errors. These errors primarily stem from inaccurate weight estimations or dosage miscalculations. Inadequate dosing frequency and documentation also contribute significantly to medication errors. Commonly implicated medications include acetaminophen, analgesics, corticosteroids, antibiotics, bronchodilators, and intravenous fluids. Most errors are categorized as insignificant/mild (51.7% to 94.5%) or moderate (47.5%). Risk factors associated with medication errors in P-EDs include less experienced physicians, severely ill patients, and weekend/specific-hour ordering. Human factors such as noncompliance with procedures and communication failures further contribute to medication errors. Interventions such as health information technology solutions like ParentLink and electronic medical alert systems, as well as structured ordering systems, have shown promise in reducing these errors, although their effectiveness varies. CONCLUSIONS: Overall, this systematic review provides valuable insights into the complexity of medication errors in the P-ED, emphasizes the need for targeted interventions, and offers recommendations to enhance medication safety and reduce preventable errors in this critical health care setting.

Violence against healthcare workers in the emergency departments of Al-Madinah hospitals, Saudi Arabia.

BACKGROUND: Workplace violence (WPV) directed against healthcare workers (HCWs) in healthcare facilities has always been neglected. These occupational hazards have been investigated in recent times and received greater attention from decision-makers. This study aimed to assess the WPV committed against HCWs in the emergency departments (EDs). MATERIALS AND METHODS: All the emergency department (ED) healthcare workers (HCW) in the hospitals of Al-Madinah Province, Saudi Arabia, were invited to participate in this cross-sectional study by completing an online questionnaire during May 15 to August 15, 2020. Information sought included characteristics of the participant and workplace, violence, the participants' responses and emotions, the consequences of the WPV incident, and the level of satisfaction with the management of the WPV incident. Data was analyzed using SPSS; Chi-square test was used to assess the association between WPV and various participant and workplace characteristics. Binary logistic regression analysis performed to identify independent predictors of work place violence. RESULTS: A total of 250 HCW filled the questionnaire. One-third of the participants were victims of at least one violent event, mostly nonphysical. The perpetrators were primarily the patient's companions, and a heavy workload/understaffing or an overcrowded environment was the main cause of the violence. The most frequent reaction was to call the hospital security. The emotions the participants experienced were disappointment, low self-esteem, and sadness. Most victims did not report the WPV incident because they believed that reporting was useless, insignificant, or they were fearful of adverse consequences. CONCLUSION: The rate of violence in EDs in Al-Madinah hospitals was lower than expected, and only 33.3% of HCWs had experienced a violent incident in the last year. However, there is a substantial margin for interventions to improve the situation and protect the HCWs in the EDs.

Investigating Saudi Nursing Students' Health Beliefs about Testicular Cancer and Testicular Self-Examination: A Cross-Sectional Study Using the Health Belief Model.

INTRODUCTION: Testicular cancer (TC) is a serious health issue, which requires early detection through testicular self-examination (TSE). OBJECTIVES: To investigate Saudi nursing students' health beliefs about TC and TSE using the Health Belief Model (HBM) scale and assess the validity and reliability of the HBM scale. METHODS: This cross-sectional study recruited a convenience sample of 374 nursing students from six nursing colleges in different cities in Saudi Arabia. Data were collected through self-report questionnaires that included demographic and academic information, as well as a valid and reliable HBM scale for TC and TSE. RESULTS: Most participants were single (88.8 %), in their third year of nursing education (43.9 %), had excellent or very good health (83.2%), had no family history of TC (88.9%), and had no medical problems with their testicles (92.8%). The participants had low susceptibility to TC and moderate beliefs about the seriousness of TC. Furthermore, participants reported moderate levels of perceived benefits and health motivation for preventing TC and practicing TSE, but high levels of perceived barriers and low levels of self-efficacy for practicing TSE. The internal reliability (Cronbach's alpha) of susceptibility, benefits and health motivation, seriousness, barriers, self-efficacy, and health motivation and promotion sub-scales was 0.91, 0.89, 0.88, 0.84, 0.67, and 0.65, respectively. Significant relationship between students' performing TSE and their health beliefs about Susceptibility (t=1.93, p=0.04) and Seriousness of having TC (t=2.88, p=0.03), and self-efficacy (t=3.91, p<0.001) and barriers (t=-2.51, p=0.04) to practice TSE. CONCLUSION: The study concluded that Saudi nursing students had moderate levels of health beliefs about TC and TSE, with high perceived barriers and low levels of self-efficacy for practicing TSE.

Health professionals and family members during cardiopulmonary resuscitation: A qualitative study on the experience of witnessing resuscitation in Jordanian critical care units.

BACKGROUND: The interaction between healthcare professionals (HCPs) and family members during cardiopulmonary resuscitation (CPR) in critical care units (CCUs) has received significant attention. In the Arabic region, family members are typically excluded from participating in critical care treatments, despite the cultural and religious significance of their presence. This highlights a lack of policies and research addressing the cultural factors related to family involvement in CPR within this context. OBJECTIVES: The purpose of this study was to explore the nature of the relationship between HCPs and family member relations during CPR in Jordanian CCUs. METHODS: This study employed a qualitative research design. Data were collected through semi-structured interviews with 45 participants, including 31 HCPs and 14 family members of patients who had undergone CPR in Jordan. Data was managed, organized, and thematically analyzed using NVivo. RESULTS: The study revealed three main themes: Family-Witnessed Resuscitation (FWR) through the eyes of HCPs, FWR through the eyes of family members, and the relationship between HCPs and family members during CPR. The last theme has three subthemes: "Looking out for the Patient," "Looking out for Ourselves," and "Looking out for Each Other." These themes highlighted the complex and dynamic relationships between HCPs and family members during CPR in Jordan. Participants emphasized the importance of clear communication, mutual respect, and a collaborative approach to decision-making during CPR. CONCLUSION: The resultant study model uniquely explains the relationship between Jordanian health professionals and family members during CPR, with important implications for clinical practice and healthcare policies regarding family involvement during resuscitation in Jordan. Further research is needed to explore the cultural and societal factors influencing family involvement in resuscitation in Jordan and other Arab countries.

Saudi Nursing Students' Knowledge and Perception of Testicular Cancer Assessment and Management: A Cross-Sectional Study.

INTRODUCTION: Testicular cancer (TC) incidence is increasing worldwide. This study aimed to investigate Saudi nursing students' knowledge and perception about TC. METHOD: This cross-sectional study was done using convenience sampling method. In this study, 280 nursing students from different nursing schools in six cities of Saudi Arabia were recruited. A structured self-report questionnaire was used to collect data. RESULT: About 49.2% of the participants received education about TC in their nursing schools. The findings showed lack of enough knowledge about TC among Saudi nursing students. Mostly, the participants reported that heredity factor and having family history of TC (48.9%) and age between 56 and 70 years (41.8%) were the most common risk factors of TC. According to the participants, physical examination was the most common diagnostic test usually used for early detection of TC (40.4%) and biopsy test was the most accurate test to confirm TC diagnosis (45.4%). Only one third of the participants (34.6%) knew that between 75% and 100% of TC cases can be cured in case of early detection. About half of the participants (51.8%) reported that surgical procedure was the most common treatment for TC. The nursing students who had high GPA (r=0.86, p<0.001), were unwilling to get more information on TC (r=0.24, p=0.04), had family history of TC (r= 0.53, p=0.02), medical problems with testicles (r= 0.69, p=0.01), received education about TC in their school of nursing (r=0.65, p=0.02), and were more self-confident in assessing and managing TC (r=0.38, p=0.03) had higher level knowledge about TC.  Conclusion: Despite the importance of nurses' roles in assessing and managing TC, nursing students in Saudi Arabia still did not have enough knowledge about TC. Improving nursing programs' curricula and conducting health education programs are recommended.

Healthcare workers' knowledge of evidence-based guidelines for prevention of ventilator-associated pneumonia in Hodeida, Yemen.

OBJECTIVES: Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in patients requiring mechanical ventilation in intensive care units (ICUs). VAP is associated with delayed extubation, prolonged hospital stays, increased healthcare costs and mortality rates. The aims of this study to evaluate the level of knowledge for the prevention of VAP among healthcare workers (HCWs) in ICUs and to assess their knowledge in relation to their socio-demographic characteristics. METHODS: A descriptive, cross-sectional design was conducted to assess HCWs' knowledge of the guidelines for prevention of VAP in the ICUs of public and private hospitals in Hodeida city, Yemen. Around 140 self-administered multiple-choice questionnaires were distributed between April and July 2017. RESULTS: A total of 120 (85.6%) HCWs completed questionnaire were obtained (20 physicians, 20 anesthesia technicians and 80 nurses) in this study. The total mean score of the HCWs' knowledge was low (41 ± 18). A statistically significant difference was found in the HCWs' knowledge scores according to their specialties and gender. Anesthesia technicians had the highest knowledge score followed by physicians and nurses (52.2 ± 16.2, 45.6 ± 21.2 and 37.1 ± 16.9, respectively, p=0.002). Males had higher scores than females (Median [IQR] 4 [3-5] vs. 3 [2-4], p<0.001). Participants who received information about the prevention of VAP had better knowledge than those who did not (46.2 ± 17.7 vs. 36.8 ± 17.3, p=0.006). CONCLUSIONS: HCWs had a low knowledge level of the guidelines for the prevention of VAP, which may affect their practice. HCWs' knowledge was affected by their previous received information that increases the necessity to provide them with regular in-service education and training programs.

Safety and efficacy of daridorexant in the treatment of insomnia: a systematic review and meta-analysis of randomized controlled trials.

Daridorexant is a novel dual orexin receptor antagonist used in treating insomnia disorder. Daridorexant improves sleep quality without impairing daytime functioning. We assess the safety and efficacy of this novel drug in the treatment of insomnia. We performed a systematic search for electronic databases in SCOPUS, PubMed, Web of Science and the Cochrane library. Seven randomized controlled trials were included in this review, with 2425 participants enrolled. Daridorexant was superior to placebo in reducing wake time after sleep onset (MD = -13.26; 95% CI, -15.48 to -11.03; P < 0.00001), latency to persistent sleep (MD = -7.23; 95% CI, -9.60 to -4.85; P < 0.00001), with increasing the total sleep time (MD = 14.80; 95% CI, 11.18-18.42; P < 0.00001) and subjective total sleep time (MD = 14.80; 95% CI, 11.18-18.42], P < 0.00001). The 25 mg and 50 mg were the most officious doses. Treatment with daridorexant has resulted in a slightly higher incidence of adverse events [risk ratio (RR) = 1.19; 95% CI, 1.05-1.35;, P = 0.005], specifically somnolence (RR = 1.19; 95% CI, 1.13-3.23; P = 0.005) and fatigue (RR = 2.01; 95% CI, 1.21-3.36; P = 0.007). Daridorexant is superior to placebo in improving sleep quality. However, the drug resulted in a slightly higher incidence of adverse events, including somnolence and fatigue.

Adherence of critical care nurses to endotracheal suctioning guidelines: a cross-sectional study.

BACKGROUND: Endotracheal suctioning (ETS) is one of the most common invasive procedures performed by critical care nurses (CCNs) to remove accumulated pulmonary secretions, ensure airway patency for adequate ventilation and oxygenation as well as prevent atelectasis in intubated patients. OBJECTIVES: To assess the practice of CCNs in intensive care units (ICUs) before, during, and after performing the ETS procedure and identify factors affecting their practice. METHODS: A cross-sectional and non-participant observational design was conducted in the ICUs of four hospitals in Hodeida city, Yemen. The data were collected using a 25-item observational checklist in the period from May to August 2019. RESULTS: More than half (55%) of CCNs scored undesirable (< 50%) regarding their adherence to ETS practice guidelines while the rest scored moderate (50-75%), with none of showing desirable adherence (> 70%) to the guidelines. There was no significant association between gender, age, education level, or length of experience of CCNs in the ICUs and their practice during performance ETS procedures. However, training (p = 0.010) and receiving information about ETS (p = 0.028) significantly improved the CCNs' practice. CONCLUSION: Most CCNs at the ICUs of Hodeida hospitals do not adhere to evidence-based practice guidelines when performing ETS procedures, possibly resulting in numerous adverse effects and complications for patients. CCNs receiving information and training show better ETS practice than do their counterparts. Therefore, it is necessary to provide the nursing staff with clear guidelines, continuous education and monitoring to improve their practices.

Nurses' Knowledge and Attitudes Regarding Pain Assessment and Management in Saudi Arabia.

Inadequate pain management affects the patient outcome. Pain assessment and management are fundamental in nursing care, and nurses must be equipped with adequate knowledge and a positive attitude toward pain assessment and management. This study aims to evaluate nurses' knowledge and attitudes regarding pain assessment and management at King Fahad Hospital, Al-Madinah, Kingdom of Saudi Arabia. A quantitative, cross-sectional survey, using a self-administered questionnaire, was conducted from January to February 2020 with 660 registered nurses working in the Emergency Department, critical care units, inpatient and outpatient departments at King Fahad Hospital in Al-Medinah, Kingdom of Saudi Arabia. The data were analyzed with descriptive and inferential statistics. Of the 660 nurses, 291 responded, resulting in a response rate of 44.09%. The participants' scores ranged from 17.7% to 100%, with a mean score 45.29%. The majority of the participants (70.1%) had a poor level of knowledge and attitudes (score < 50%). Nurses working in the outpatient department scored significantly higher than the group working in the Emergency Department and inpatient wards. Deficient knowledge and negative attitudes were found and nurses continue to underassess and undertreat pain. Nursing school curricula and in-service continuous education must equip nurses with the required knowledge and attitudes to enable them to manage pain effectively.

Critical care nurses' compliance and barriers toward ventilator-associated pneumonia prevention guidelines: cross-sectional survey.

OBJECTIVES: This study aims to determine the compliance of critical care nurses with the ventilator-associated pneumonia prevention guidelines and the factors that affect their compliance. We also explored the barriers faced by the nurses in the implementation of these guidelines. METHODS: A cross-sectional descriptive survey was conducted using a self-administered questionnaire containing 17 recommended strategies to prevent ventilator-associated pneumonia and 15 possible barriers. All critical care nurses of varying qualifications, levels of experience, and nationalities working in adult ICUs were invited. Between January and March 2018, the questionnaire was distributed to 283 nurses at eight ICUs in five public hospitals in Almadinah Almunawwarah, KSA. RESULTS: A total of 229 invitees responded to the questionnaire. The mean compliance score was 85.9%. More than half (54%) of the sample had a high or acceptable compliance level. The lowest compliance rate was reported for the suctioning of subglottic secretions. The main reported barriers were the shortage of nursing staff, forgetfulness, and hospital cost control policies. Working in general ICUs with the capacity of 10-15 beds or prior education related to ventilator-associated pneumonia prevention influenced the nurses' compliance. CONCLUSION: In our study, the overall compliance of the critical care nurses with the ventilator-associated pneumonia prevention guidelines is acceptable. Shortage of nursing staff, forgetfulness, and cost control policies were the main reported barriers to compliance.

Diagnosis and risk stratification of coronary artery disease in Yemeni patients using treadmill test.

BACKGROUND: Coronary artery disease (CAD) is a common medical problem that remains a great cause of morbidity and mortality. Based on clinical manifestation, CAD span from chronic stable angina to acute coronary syndrome (ACS), which encompasses (1) unstable angina (UA), (2) non-ST-elevation myocardial infarction (NSTEMI), and (3) ST-elevation myocardial infarction (STEMI). OBJECTIVE: This study was conducted to describe the risk stratification and prognosis of CAD in Yemeni patients undergoing an exercise stress test. METHOD: A retrospective descriptive study involved the records of 302 patients who undergoing exercise stress testing by the Bruce protocol of Treadmill (TMT). RESULTS: Out of 302 patients, the mean age was 43.29 years, (range, 22-70 years), and 79.80% were males. The majority of patients (86.75%) were normal. Most of the affected patients (82.50%) were males. All of the affected peoples were more than 30 years old with predominance in more than 50 years old. Results showed that 45% of the positive (+ve) patients were in high-risk group, and 55% were in intermediate and low-risk groups. CONCLUSIONS: CAD affects males more than females. It affects patients older than 30 years and predominates in elderly patients. Most of the affected patients were in the high, intermediate, and low-risk groups and rarely were in the very high-risk group.

Prevention of ventilator-associated pneumonia. A knowledge survey among intensive care nurses in Yemen.

OBJECTIVE: To evaluate knowledge of nurses working in Yemen intensive care units (ICUs) on evidence-based strategies for preventing ventilator-associated pneumonia (VAP), and to determine if there is any association between certain nurses` as well as workplaces` characteristics and the knowledge scores of nurses. METHODS: A descriptive cross-sectional survey was carried out in 37 ICUs of 23 hospitals in Sana`a city, Yemen. A self-administered multiple-choice questionnaire listing 15 evidence-based preventive strategies was distributed to all nurses and collected between December 2012 and February 2013. The results were analyzed and tabulated using the Statistical Package for Social Sciences Version 17. RESULTS: Three hundred and eighty-seven questionnaires were collected (response rate 75.4%). The nurses were most frequently correct (>60%) regarding regular oral care, semi-recumbent position, preventing unplanned extubation, emptying of condensate from ventilator tubing, daily sedation interruption and assessment of readiness for weaning, and endotracheal tubes with extra lumen for subglottic secretions drainage. Nurses had the least knowledge (<24%) regarding frequency of humidifier and suction systems changes, use of kinetic beds, and oral route for tracheal intubation. The nurses' knowledge mean total score was 47.3% (7.1 on 15 items). Holding a bachelor degree in nursing and acquisition of short course in respiratory therapy were shown to be associated with better knowledge scores. CONCLUSION: Knowledge of evidence-based strategies for preventing VAP is low among most nurses working in Yemen ICUs.

Management of central venous catheters at the intensive care units in Yemen. Survey of practices.

OBJECTIVE: To describe the intensive care units (ICU) current infection control practices regarding the management of central venous catheters (CVCs) in Yemeni hospitals and compare the current practices with the evidence-based guidelines. METHODS: This study was carried out in ICUs of Sana'a hospitals, Republic of Yemen, in July 2010. We gathered the data regarding the infection control practices associated with CVC management in 25 ICUs of 14 hospitals. A self-administered questionnaire was distributed to ICUs' nurse managers in Sana'a city. The results were analyzed and tabulated using the Statistical Package for Social Sciences software version 11, and compared with the evidence-based guidelines. RESULTS: Only 44% of units had written policies for CVC management. The 2 most commonly used practices that comply with the guidelines were: wearing of gloves and dressing material. None of the units used 2% chlorhexidine solutions. More than half of the units were adherent to the recommended practice for hand hygiene (before and after insertion, accessing, dressing or replacing/repairing of CVC), preferred insertion site, antimicrobial-coated catheters, aseptic technique during catheter insertion and site care, disinfection of intravenous access ports, capping stopcocks and infusion set tips while they are not in use, and CVC replacement/removal. In all other sections, only the minority were adherent to the recommended practices. CONCLUSION: There is a diversity of current practices and lack of consistent adherence to the evidence-based guidelines for the prevention of intravascular catheter-related infections.