Incidence of intraoperative hypotension and its factors among adult traumatic head injury patients in comprehensive specialized hospitals, Northwest Ethiopia: a multicenter observational study.

INTRODUCTION: Traumatic head injury (THI) poses a significant global public health burden, often contributing to mortality and disability. Intraoperative hypotension (IH) during emergency neurosurgery for THI can adversely affect perioperative outcomes, and understanding associated risk factors is essential for prevention. METHOD: A multi-center observational study was conducted from February 10 to June 30, 2022. A simple random sampling technique was used to select the study participants. Patient data were analyzed using bivariate and multivariate logistic regression to identify significant factors associated with intraoperative hypotension (IH). Odds ratios with 95% confidence intervals were used to show the strength of association, and P value < 0.05 was considered as statistically significant. RESULT: The incidence of intra-operative hypotension was 46.41% with 95%CI (39.2,53.6). The factors were duration of anesthesia ≥ 135 min with AOR: 4.25, 95% CI (1.004,17.98), severe GCS score with AOR: 7.23, 95% CI (1.098,47.67), intracranial hematoma size ≥ 15 mm with AOR: 7.69, 95% CI (1.18,50.05), and no pupillary abnormality with AOR: 0.061, 95% CI (0.005,0.732). CONCLUSION AND RECOMMENDATION: The incidence of intraoperative hypotension was considerably high. The duration of anesthesia, GCS score, hematoma size, and pupillary abnormalities were associated. The high incidence of IH underscores the need for careful preoperative neurological assessment, utilizing CT findings, vigilance for IH in patients at risk, and proactive management of IH during surgery. Further research should investigate specific mitigation strategies.

Family Satisfaction with Care Provided in Intensive Care Unit; a Multi-Center, Cross-Sectional Study.

Background: Healthcare provided in medical facilities should prioritize the needs of families, as it enhances the quality of care for the patients. Family satisfaction gauges how effectively healthcare professionals address the perceived needs and expectations of family members. Numerous factors, including information dissemination, communication, family dynamics, patient characteristics, hospital facilities, and the caregiving process, serve as predictors of family satisfaction. Thus, this study seeks to evaluate the satisfaction of families with the care received by patients admitted to the intensive care unit. Methods: A hospital-based cross-sectional study involving 400 participants was conducted across multiple centers from March to June 2023. Multicollinearity was assessed by examining variance inflation factors (VIF), while the goodness-of-fit was evaluated using the Hosmer and Lemeshow test. Both bivariable and multivariable logistic regression analyses were utilized to identify factors correlated with family satisfaction. Variables with a p-value below 0.2 in the bivariable logistic regression were included in the multivariable logistic regression analysis. Adjusted Odds Ratios (AORs) with 95% Confidence Intervals were computed to indicate the strength of association. In the multivariable analysis, variables with a p-value less than 0.05 were deemed statistically significant. Results: The overall family satisfaction with the care provided in the intensive care unit was 58.6%, with a 95% confidence interval ranging from 55.882% to 61.241%. Families expressed higher satisfaction levels with patient care (64.8%) and professional care (67.4%). However, they reported lower satisfaction levels regarding care provided for families (52.2%), the ICU environment (56.8%), and involvement of families in decision-making (55.8%). Lack of formal education (AOR: 1.949, 95% CI: 1.005, 4.169), completion of primary education (AOR: 2.581, 95% CI: 1.327, 5.021), and completion of grades 9-12 (AOR: 2.644, 95% CI: 1.411, 4.952) were found to be significantly associated with overall family satisfaction. Conclusion and recommendation: The overall level of satisfaction is satisfactory. To enhance service quality and family satisfaction, healthcare providers should prioritize effective and regular communication with family members. Keeping them well informed about the patient's condition and treatment plan is essential.

Risk stratification, prevention and management of perioperative corneal abrasion for non-ocular surgery: Systematic Review.

Background: A corneal abrasion is a flaw in the cornea's epithelial surface, which is located in the front of the eye. It causes recurrent erosions, corneal inflammation, and chronic corneal defects. In a context with limited resources, the goal of this review was to provide an evidence-based procedure for perioperative risk stratification, prevention, and management of corneal abrasion during non-ocular surgery. Methods: A medical search engines of PUBMED, GOOGLE SCHOLAR, COCHRANE REVIEW, and PUBMED CENTERAL to get access for current and updated evidence on procedures on risk stratification, prevention and management of corneal abrasion for non-ocular surgery. The authors formulate the key questions, scope, and articles written in English language, human study focuses on corneal abrasion, articles in the last 20 year was implemented to identify or filter high-level evidences were included. Reports contain corneal abrasion due to ocular surgery were excluded. All the research articles, which were identified from searches of electronic databases, were imported into Endnote software, duplicate were removed advanced search strategy of electronic sources from databases and websites was conducted using Boolean operators (cornea AND (abrasion OR injury OR laceration)) AND ("Perioperative Period" OR "general anesthesia"). Screening of literatures was conducted with proper appraisal checklist. This review was reported in accordance with preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 statement. Results: From 8767 identified articles, two hundred articles were removed for duplication and 7720 studies were excluded, 1205 articles were retrieved and evaluated for eligibility. Finally, 24 were included in this systematic review. Advanced age, Prominent eyes, exophthalmus, ocular surface abnormalities (dry eye), expected duration of surgery (>1 h), the favourable position of the surgery, prone,Trendelenburg and lateral, risk of bleeding, surgical site of the surgery(head /neck) and diabetes mellitus were risk for corneal abrasion. The use of appropriate intervention with pharmacological and Non-pharmacological strategies minimizes the occurrence of perioperative corneal abrasion was crucial for the quality of care. Conclusion: Preventing and managing corneal abrasion improves patients' quality of life. However, there was insufficient evidence to draw conclusions, and high-quality trials of multimodal interventions matched to risk stratification and prevention of corneal abrasion needed to provide robust evidence to guide prevention and management of perioperative corneal abrasion.

Assessment of post-operative nausea and vomiting prophylaxis usage for cesarean section, 2021: A cross sectional study.

Background: Post-operative nausea and vomiting (PONV) are common and distressing to patients. This common anesthetic and surgical side effect has been reported to increase patient dissatisfaction and can be more distressing to patients than post-operative pain. It has multi-factorial causes: patient, anesthesia and surgery related risk factors have been identified. Prevention of PONV is important since it has psychological and physical effects, and it can also cause severe complications. Objective: To determine the level of practice of PONV prophylaxis usage for caesarean section. Methods: This clinical perspective study was conducted at all pregnant mothers scheduled for caesarean section under anesthesia from March 1 to March 30, 2021 consecutively. The standards were directly changed into question forms with two integral checking components, "Yes", and "No". Data were entered and analyzed by statistical package of social sciences (SPSS) version 20. Results: A total of 100 parturients scheduled for caesarean section were included with a response rate of 100%. Based on the standards, Anti-emetic treatment to patients with post-operative nausea and vomiting (PONV), adherence of anesthetists to local evidence based guideline for PONV prevention and more importantly no prophylactic administration to patients at low risk for PONV were implemented with a percentage of 17%,47%, and 14% respectively. Conclusions: and recommendations: There was a significant performance gap in the clinical practice of prevention of post-operative nausea and vomiting. We strongly suggest that adherence to a Protocol to reduce baseline risk and the adoption of a multimodal approach will highly likely ensure success in the management of PONV. The usage of appropriate anti-emetic prophylaxis to the right patient is necessary to have a good outcome after surgery and anesthesia.

Burden and Associated Factors of Virological Failure Among People Living with HIV in Sub-Saharan Africa: A Systematic Review and Meta-Analysis.

United Nations program on HIV/AIDS 90-90-90 ambitious goal recommends 90% of people living with HIV and taking antiretroviral therapy should achieve viral suppression by 2020. However, virological failure is still a global public health problem, especially in sub-Saharan African countries. Thus, this systematic review and meta-analysis aimed at estimating the burden of virological failure and its associated factors among peoples living with HIV in sub-Saharan Africa. We searched Google Scholar, PubMed, Cochrane Library, and Scopus for studies that reported virologic failure and its associated factors. I-squared statistics and Egger's statistical test were used to detect heterogeneity and publication bias respectively. The pooled prevalence of virological failure was estimated using the DerSimonian-Laird random-effects model. Sensitivity analysis was done to check the presence of outlier results included in the studies. The estimated pooled prevalence of virological failure was 1.7.25%. Lower Adherence to ART drugs,longer ART duration, lower CD4 count,and being co-infected with TB were significantly associated with the pooled estimate of virological failure.Virological failure was found to be high in sub-Saharan Africa. Adherence, duration of ART, CD4 + count, and TB co-infection were the significant factors associated with the pooled estimate of virological failure. Therefore, to achieve the 90-90-90 target and sustainable development goal 3 policymakers should design mechanisms to improve ART adherence, and early detecting and prevent opportunistic infections such as TB.

Magnitude and factors associated with preoperative depression among elective surgical patients at University of Gondar comprehensive specialized hospital, North West Ethiopia: A cross-sectional study.

BACKGROUND: Depression one of the world's prevalent mental illnesses is a leading cause of major public health problems globally and its frequency has been increasing, particularly in low and middle-income countries. Little is known about the magnitude and contributing factors of preoperative depression among elective surgical inpatients in the country and in the study area as well. The aim of the current study was to assess the magnitude and factors associated with preoperative depression among elective surgical inpatients. METHOD: A cross-sectional study was conducted from May 01, 2021 to June 30, 2021 among preoperative surgical inpatients at University of Gondar comprehensive specialized hospital. Non probability sampling was used. A nine-item questionnaire screening tool was used to assess depression. We computed the bi-variable and multivariable binary logistic regression analyses. Crude and adjusted odds ratio with 95% confidence interval were used. RESULT: The magnitude of depression was 28.3%. In the multivariable logistic regression analysis female (AOR = 2.27, 95% CI: 1.15, 4.5), being widowed (AOR = 3.271, 95% CI: 1.25, 8.56), divorced (AOR = 3.41, 95% CI: 1.13, 10.26), length of hospital stay of 7-14 days (AOR = 2.7, 95%CI: 1, 7.2) and more than 14 days (AOR = 3.19, 95% CI: 1.3, 7.8), having co-existing diseases (AOR = 2.78, 95%CI: 1.28, 6.02), current history of pain (AOR = 3.12, 95%CI: 1.6, 5.7), admission to orthopedics (AOR = 3.28, 95%CI: 1.55, 6.95) and gynecology ward (AOR = 2.43, 95% CI: 1.03, 5.7) and poor social support AOR = 2.24, 95% CI: 1.1, 4.6) were significantly associated with depression. CONCLUSION: The magnitude of pre-operation depression was 28.3%. Female, Widowed, being divorced, length of hospital stays, coexisting chronic illness, current history of pain, admission at orthopedic and gynecology wards and poor social support were factors significantly associated with depression. We recommend strengthening the linkage of the psychiatric department with preoperative patients to provide psychotherapy behavioral modification.

Analgesic efficacy of posterior and anterior psoas compartment block: Lumbar plexus versus three -in-one nerve block after lower limb orthopedic surgery under spinal anesthesia: A prospective cohort study.

INTRODUCTION: Postoperative pain is the most common complaint in patients who underwent orthopedic surgery. Regarding with the severity of pain, orthopedic patients suffered more than non-orthopedic patients in the immediate post-operative period. Therefore, pain management is crucial for better patient outcome. Lumbar plexus (LB) and three -in-one (3IN1) nerve blocks have been routinely practiced as pain management techniques in the study area but the analgesic efficacy was not studied yet. Thus, this study was aimed to compare the analgesic efficacy of the LBP versus 3IN1B as postoperative pain management after thigh orthopedic surgery under spinal anesthesia. METHOD: An institutional-based prospective cohort study was conducted from October 10, 2020 to March 30, 2021 at the University comprehensive specialized hospital. Non-probability convenient sampling was used to select participants in both groups. The time to first analgesic request, severity of pain and total analgesia consumption within the first postoperative 24 h were measured. RESULT: The mean and standard deviation to seek the first analgesia request time was 11. 55 ± 2. 82hr and 13. 35 ± 2. 58hr (p- 0.07) in patients who received LPB and 3IN1B respectively. Pain severity at rest and on movement was also comparable. The total tramadol consumption was 67. 65 ± 27. 20 mg and 70. 59 ± 37. 19 mg (p- 0.71), while total Diclofenac consumption was 63. 23 ± 45. 74 mg and 44. 88 ± 34. 72 mg (p-0.07) in LPB and 3IN1B groups respectively. CONCLUSION: The study showed that there was no significant difference in the time to first analgesia request, postoperative pain, both at rest and movement and total analgesic consumption, between the LPB and 3IN1B.

"The magnitude and associated factors of intraoperative shivering after cesarean section delivery under Spinal anesthesia'': A cross sectional study.

BACKGROUND: Shivering is an involuntary, spontaneous, and repetitive contraction of the skeletal muscle and increases patients' discomfort, oxygen-consuming, wound infection; increased surgical bleeding, and morbid cardiac events. The aim of this study was to determine the magnitude and associated factors of intraoperative shivering after cesarean section delivery. METHODOLOGY: An institution-based cross-sectional study was conducted. A total of 326 willing patients were included in the study after obtaining ethical consent and we have used consecutive sampling techniques. Axillary temperature was recorded preoperatively and in the intra-operative period every 5 min. Descriptive statistics, cross-tabs, and binary logistic regression analysis were performed to identify the association shivering and independent variables. The strength of the association was presented using an adjusted odds ratio with a 95% confidence interval and a p-value<0.05 was considered as statistically significant. RESULTS: The overall incidence of intraoperative shivering after cesarean section delivery under spinal anesthesia was 51.8% (95% CI: 46.3, 57.1). The majority of the patients who developed shivering were after 20 min of spinal anesthesia. In this study body temperature, mean arterial pressure of the patient, and duration of surgery were significantly associated with shivering. CONCLUSION: In this study duration of surgery, hypothermia and hypotension were the independent associated risk factors for intraoperative shivering.

Factors associated with knowledge towards postoperative nausea and vomiting management among health professionals in referral Hospitals of Northwest Ethiopia. A multi-center cross-sectional study.

BACKGROUND: Knowledge of health care professionals on postoperative nausea and vomiting (PONV) and antiemetic prescription trends affects patient's outcome after surgery and anesthesia and also patient and family satisfaction. Hence, knowing the knowledge status of health professionals towards PONV management is vital for the optimal care of surgical patients. Therefore, the study aimed to assess the knowledge and factors associated with PONV management among health professionals in referral hospitals of Northwest Ethiopia. METHODS: An institutional based cross-sectional study was conducted on 407 health care professionals from March 1 to 30, 2019. A Simple random sampling technique was used to select the study participants. Both bivariable and multivariable logistic regression analysis were used to identify factors associated with the knowledge level of health professionals on PONV management. In the multivariable analysis, variables with a p-value <0.05 were considered statistically significant. RESULTS: In this study, about 52.8% (95% CI: 47.9, 57.2) of the participants had good knowledge of PONV management. Being male (AOR = 1.95; 95% CI: 1.20, 3.17), Physician (AOR = 5.36; 95% CI: 2.20, 13.5), Anesthetist (AOR = 3.88; 95% CI: 1.66, 9.08), and taking training on PONV management (AOR = 5.32; 95%CI: 1.58, 17.89) were positively associated with good knowledgeable of health professionals about PONV management. CONCLUSION: and recommendation: More than half of health care professionals who are working in the perioperative sites of the referral hospitals had good knowledge about the PONV management. Being male, Physician, Anesthetist and taking in-service training on PONV management were significantly affecting the knowledge level of health professionals on PONV management. Thus, providing regular in-service training on PONV management, especially for physician and anesthetist is highly recommended.

Prevalence and Factors Associated with Back Pain among Patients Undergoing Spinal Anesthesia at the University of Gondar Comprehensive and Specialized Hospital, North West Ethiopia: An Institutional Based Cross-Sectional Study.

BACKGROUND: Back pain is often reported as a common complaint after surgery. Many studies showed that the prevalence of back pain after spinal anesthesia is high and its magnitude is considerable in developing countries. It is highly related to reduced quality of life, loss of work productivity, burden of health care costs, and satisfaction regarding health care service; therefore, measures should be taken to reduce or prevented postspinal back. The aim of this cross-sectional study was to assess the prevalence and factors associated with back pain among patients undergoing spinal anesthesia at the University of Gondar Comprehensive and Specialized Hospital, Northwest Ethiopia. Methodology. An institutional based cross-sectional study was conducted from March to May 2020. A total of 215 participants were enrolled in this study. A convenience sampling technique was used to get the study participants. Both univariable and multivariable logistic regression were used to identify factors associated with postspinal back pain. Variables with a p value less than <0.2 in the bivariable analysis were fitted into the multivariable analysis. In the multivariable analysis, a variable with a p value of <0.05 was considered statistically significant. RESULTS: The overall prevalence of postspinal back pain was 40.5% (95% CI: 34.0, 47.4). Being overweight (AOR = 3.8; 95% CI: 1.47, 9.96) and obese (AOR = 4.9; 95% CI: 1.19, 20.4), using big spinal needles (AOR = 5.9; 95% CI: 1.04, 33.4), two attempts of lumbar puncture (AOR = 5.5; 95% CI: 1.74, 17.59), more than three attempts of lumbar puncture (AOR = 4.9; 95% CI: 1.63, 15.2), and the number of bone contacts during spinal anesthesia procedure (AOR = 3.1; 95% CI: 1.14, 8.45) were positively associated with postspinal back pain. Conclusion and Recommendation. The overall incidence of back pain is high. Body mass index, size of spinal needle, number of attempts, and number of bone contacts are significantly associated with the incidence of back pain following spinal anesthesia. Thus, it is better to minimize the number of lumbar puncture attempts and bone contacts during spinal anesthesia to reduce postspinal back pain. In addition, using smaller size spinal needle is a good choice.

Magnitude and Factors Associated with Preoperative Anxiety Among Pediatric Patients: Cross-Sectional Study.

BACKGROUND: Anesthesia and surgery are common sources of anxiety and stressful experiences in children. This unpleasant sensation depends on several factors. This study aimed to determine the magnitude of preoperative anxiety and associated factors in pediatrics patients at the University of Gondar Comprehensive Specialized Hospital North West Ethiopia 2020. METHODS: An institutional-based cross-sectional observational study was conducted from March to September 2020 at the University of Gondar Comprehensive Specialized Hospital. After obtaining ethical approval from the institutional review board. All consecutive ASA physical status I & II boys and girls with the age of 2-12 years scheduled for a variety of elective (general, urologic, ENT, ophthalmic and other surgical) operations were included. The level of anxiety was measured using the Modified Yale Preoperative Anxiety Scale short form (m-YPAS-SF) observational tool. Parental anxiety was assessed using Spielberger's short version of state-trait anxiety. Binary logistic regression analysis was performed to identify the association between preoperative children's anxiety and independent variables. The strength of the association was present by adjusted odds ratios. RESULTS: The magnitude of preoperative anxiety in children in the operation room was 75.44% (95% confidence interval (CI): 68.36, 81.34). Age (AOR: 3.83; 95% CI: 1.58, 9.30), previous surgery and anesthesia (AOR: 6.73, 95% CI: 1.25, 36.19), outpatient surgery (AOR: 5.16, 95% CI: 1.32, 20.23) and parental anxiety (AOR: 3.26, 95% CI: 1.30, 20.23) were significantly associated with preoperative children anxiety. CONCLUSION: The magnitude of preoperative anxiety in pediatric patients was considerably high in our setup. Younger age, previous surgery and anesthesia, outpatient surgical setting, and parental anxiety were the independent risk factors for preoperative anxiety. Therefore, the operating staff should assess the child's anxiety and should consider appropriate anxiety reduction methods during the preoperative visit of pediatric patients and their families.

Knowledge and Attitude of Ethiopian Oncology Nurses About Cancer Pain Management: National Survey.

BACKGROUND: Cancer is becoming a leading cause of death worldwide. Pain is a common and devastating symptom of cancer patients that can significantly affect the patient's quality of life. Optimal cancer pain control requires adequate knowledge and positive attitudes of nurses. Little is known about the knowledge and attitudes of oncology nurses towards cancer pain management in Ethiopia. The current study aimed to assess the knowledge and attitude of nurses and determinants of cancer pain management in all oncology centers in Ethiopia. METHODS: A nationwide cross-sectional survey was conducted on 138 nurses in all oncology centers in Ethiopia. Self-completed survey questionnaires were distributed using the 'Knowledge and Attitudes Survey Regarding Pain (KASRP)' tool. Both bivariable and multivariable logistic regression analyses were used. Both crude odds ratio and adjusted odds ratio with the corresponding 95% CI were calculated to show the strength of association. Variables with a p-value of <0.05 were considered as statistically significant. RESULTS: Only 7.2% (95% CI: 2.9, 11.6) of oncology nurses had good knowledge and attitude about cancer pain management. Among 41 items, the mean number of correctly answered questions was 20.4 (SD = 5.13). Nurses who had a master's degree in nursing were positively associated with good knowledge and attitude about cancer pain management. CONCLUSION: In this nationwide study, the overall knowledge and attitude level of oncology nurses towards cancer pain management were poor. Nurses who had a master's degree in nursing were significantly associated with good knowledge and attitude towards cancer pain management. Regular training and revision of the contents of pain management education in the academic curriculum of nursing education are recommended.

Factors associated with knowledge and attitude towards adult cardiopulmonary resuscitation among healthcare professionals at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia: an institutional-based cross-sectional study.

OBJECTIVE: This study was conducted to assess the factors associated with knowledge and attitude towards adult cardiopulmonary resuscitation (CPR) among health professionals at the University of Gondar Hospital, Northwest Ethiopia. STUDY DESIGN: An institutional-based cross-sectional study was conducted from 15 February to 15 March 2018. Both bivariable and multivariable logistic regression analyses were used to identify factors associated with knowledge and attitude level of health professionals towards CPR. Variables with a p value less than <0.2 in the bivariable analysis were fitted into the multivariable analysis. In the multivariable analysis, variables with a p value <0.05 were considered statistically significant. SETTING: University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. PARTICIPANTS: A total of 406 health professionals (physicians, nurses, anaesthetists, health officers and midwives) were included. RESULTS: Among the study participants, 25.1% (95% CI 21.2 to 29.3) had good knowledge and 60.8% (95% CI 55.9 to 65.5) had good attitude towards adult CPR. Work experience (adjusted OR (AOR): 5.02, 95% CI 1.25 to 20.20), number of work settings (AOR: 6.52, 95% CI 2.76 to 15.41), taking CPR training (AOR: 2.76, 95% CI 1.40 to 5.42), exposure to cardiac arrest case (AOR: 2.16, 95% CI 1.14 to 4.07) and reading CPR guidelines (AOR: 5.57, 95% CI 2.76 to 11.20) were positively associated with good knowledge. Similarly, taking CPR training (AOR: 1.74, 95% CI 1.42 to 1.53) and reading CPR guidelines (AOR: 2.74, 95% CI 1.55 to 4.85) were positively associated with good attitude. CONCLUSIONS: The level of knowledge and attitude of health professionals towards adult CPR was suboptimal. Health professionals who were taking CPR training and reading CPR guidelines had good knowledge and attitude towards CPR. In addition, work experience, number of work settings and exposure to cardiac arrest case had a positive association with CPR knowledge. Thus, providing regular CPR training and work setting rotations is highly crucial.