Assessment of adherence to guidelines for testing and treatment of pharyngitis among children in Palestine: A retrospective review study.

Introduction: One of the most common reasons for pediatric outpatient visits is acute pharyngitis, an upper respiratory tract infection. Bacterial pharyngitis is caused by Group A beta-hemolytic Streptococcus (GABHS), also known as Streptococcus pyogenes. This research aimed to assess physicians' adherence to clinical guidelines for diagnosis, management, and selecting appropriate treatment for children suspected of bacterial pharyngitis. Methods: A retrospective, observational study was conducted by reviewing patient charts for childred aged 3 to 13 years old diagnosed with pharyngitis from June 2019 until December 2019 at the Emergency Department of Palestine Medical Complex (PMC). The Modified Centor score, throat swab collections, and assessment of antimicrobial selection were used to assess the extent of physicians' adherence to clinical guidelines for appropriate diagnosis and management of pharyngitis. SPSS was used for data analysis. Results: Out of 290 cases diagnosed with acute pharyngitis, 217 patients (74.8%) had a Modified Centor score of ≥2; 126 received antibiotics, and eight had their throat swabbed to confirm the diagnosis; furthermore, 73 patients (25.2%) had a Modified Centor score of <2; 34 of them received antibiotics. Azithromycin was the most commonly prescribed antibiotic (41.3%), followed by amoxicillin-clavulanic acid (38.1%). The frequency of empirical antibiotics prescribing was significantly higher among children with a Centor score >2, older children, and those presenting with fever. Conclusions: Most cases were not appropriately tested to confirm the diagnosis of bacterial pharyngitis and were mostly treated with inappropriate antimicrobial agents such as azithromycin. Nonadherence to clinical guidelines is very evident in this study.

Electrolyte Imbalance Among Patients With and With No ST-Elevation Myocardial Infarction: A Cohort Study.

Electrolytes imbalances are highly prevalent and have shown a high impact on mortality in patients with acute myocardial infarction. These electrolytes imbalance have prognostic value in predicting mortality in patients with acute myocardial infarction. The purpose of this study was to assess the prognostic value of electrolyte imbalances in predicting 1-month mortality among patients with myocardial infarction with and with no ST-elevation. This cohort study was conducted in a referral hospital in the West Bank, Palestine. All patients with confirmed medical diagnosis of acute myocardial infarction and admitted to the medical coronary care unit in the hospital were eligible participants. A convenience sample of 186 participants was obtained. These participants were followed up for 1 month to assess their survival (alive or dead). Demographic and clinical data were recorded by reviewing their health records. The derived data were analyzed using SPSS version 19. About 36% of all patients were found to be hyponatremic, 15% of them have hypokalemia, and 9% of patients had hypocalcemia. There was a significant difference between STEMI and non-STEMI in sodium (t = 4.7, P < .001). A multivariate logistic regression analysis was performed to predict 1-month mortality for patients with myocardial infarction with and with no ST-elevation. The predictors that were found to be significant are sodium (odds ratio [OR] = 0.789, P = .010), calcium (OR = 0.221, P = .014), diastolic blood pressure (OR = 0.933, P = .047), and blood urea nitrogen (OR = 0.821, P = .005). Electrolyte imbalance was highly prevalent among patients with acute myocardial infarction. Hyponatremia and hypocalcemia were present and associated significantly with predicting 1-month mortality. Health care providers should take into consideration the electrolytes of patients with acute myocardial infarction from the first moment of admission and correct them early to maximize the clinical outcomes and survival for patients.

Challenges to online education during the time of COVID-19: A focus group study.

AIM: To explore the experience of online education during coronavirus disease 2019 (COVID-19) from the perspectives of nurse educators, postgraduate students, and undergraduate students in two universities in the Occupied Palestinian Territory (OPT). This article only highlights the challenges faced by nurse educators and students. METHOD: A qualitative design using a focus group strategy was employed. The data were collected from two universities in the OPT from September 2020 to October 2020. The maximum variation sampling strategy was used. FINDINGS: Seven focus groups were conducted with nurse educators (n = 2), postgraduate students (n = 1), and undergraduate students (n = 4). The findings revealed that nurse educators and students faced several challenges when they were abruptly turned to online learning. These challenges included challenges concerning clinical courses, lack of resources, lack of interaction, evaluation, and their home environment. CONCLUSIONS: This study is the first to demonstrate the challenges involved in nursing education in OPT during the COVID-19 pandemic. IMPACT: The findings of this study can be used to improve the online learning experience during COVID-19. As a recent change to nursing education, it is vital to understand the nature of the problems related to this sudden change.

Bacterial and fungal co-infections among ICU COVID-19 hospitalized patients in a Palestinian hospital: a retrospective cross-sectional study.

Background: Diagnosis of co-infections with multiple pathogens among hospitalized coronavirus disease 2019 (COVID-19) patients can be jointly challenging and essential for appropriate treatment, shortening hospital stays and preventing antimicrobial resistance. This study proposes to investigate the burden of bacterial and fungal co-infections outcomes on COVID-19 patients. It is a single center cross-sectional study of hospitalized COVID-19 patients at Beit-Jala hospital in Palestine. Methods: The study included 321 hospitalized patients admitted to the ICU between June 2020 and March 2021 aged ≥20 years, with a confirmed diagnosis of COVID-19 via reverse transcriptase-polymerase chain reaction assay conducted on a nasopharyngeal swab. The patient's information was gathered using graded data forms from electronic medical reports. Results: The diagnosis of bacterial and fungal infection was proved through the patient's clinical presentation and positive blood or sputum culture results. All cases had received empirical antimicrobial therapy before the intensive care unit (ICU) admission, and different regimens during the ICU stay. The rate of bacterial co-infection was 51.1%, mainly from gram-negative isolates ( Enterobacter species and K.pneumoniae). The rate of fungal co-infection caused by A.fumigatus was 48.9%, and the mortality rate was 8.1%. However, it is unclear if it had been attributed to SARS-CoV-2 or coincidental. Conclusions: Bacterial and fungal co-infection is common among COVID-19 patients at the ICU in Palestine, but it is not obvious if these cases are attributed to SARS-CoV-2 or coincidental, because little data is available to compare it with the rates of secondary infection in local ICU departments before the pandemic. Comprehensively, those conclusions present data supporting a conservative antibiotic administration for severely unwell COVID-19 infected patients. Our examination regarding the impacts of employing antifungals to manage COVID-19 patients can work as a successful reference for future COVID-19 therapy.

Parental Child Rearing Practices in Palestine: A Cross-Sectional Study.

The objectives of this study were to explore parenting practices from the perspectives of Palestinian parents and their children, and concordance between parents and children in their reports of parenting practices, in a culture that is underrepresented in the literature. A descriptive cross-sectional design was used. The Alabama Parenting Questionnaire (APQ) was administered to 120 parents and 120 children drawn from 4 districts in Palestine. Children had higher scores on parental involvement, positive parenting, poor monitoring, inconsistent discipline, and corporal punishment. Three significant parent-child relationships were obtained1: parental involvement (r = .276, P = .003), positive parenting (r = .0301, P = .001), and poor parental monitoring (r = -.241, P = .008). The findings of this study might be used by Palestinian authorities and policy-makers to formulate guidelines and training to aid parental decision-making about child rearing.

The acceptance and awareness of healthcare providers towards doctor of pharmacy (Phram D) in the Palestinian health care system.

Clinical pharmacy (Pharm.D or MSc Clinical Pharmacy graduates) is a patient care oriented specialty. It aims to improve patient therapeutic outcomes and minimize medication errors. In Palestine, it is a new specialty taught at two universities. In order to implement this new specialty in healthcare settings, healthcare providers should have a high awareness about it, its role and importance in clinical settings. This study aimed to evaluate the awareness and acceptance levels among healthcare providers' about clinical pharmacy specialty. A cross sectional study carried out using a self-administered questionnaire that was developed and tested by a panel of experts for validity and reliability, then it was distributed and filled by the convenient sample of health care providers in the northern and middle of Palestine between January and March 2019. An awareness scale and acceptance scale were developed from the questions used to identify the healthcare providers' awareness and acceptance. Chi-square (X2) -testing was performed to check for the significant association. Data were analyzed using SPSS (version22). Among 309 respondents, 203(65.7%) were male, 67(21.7%) were working at Jerusalem, 229(74.1%) of them completed their first degree at Arab countries and 69(54.7%) completed higher education. Regarding their work, 169(54.7%) were physicians, followed by 85(27.5%) nurses and 55(17.8%) pharmacists. Results revealed that the majority of healthcare providers had a moderate 182(58.9%) and good 81(26.2%) awareness level toward the Clinical pharmacy specialty roles and 217 (70.2%) had a good acceptance level toward their implementation among the health worker team. Significant differences were found between healthcare providers' awareness level and their sex (P = 0.001), professions (P = 0.006) and job descriptions (P = 0.013). There were no significant differences between the health care providers' acceptance level and their age, sex, qualification, profession and job descriptions. Our results revealed the ability to collaborate in the integration of such specialty within the Palestinian healthcare system. Additional interest from the Ministry of Health is recommended to integrate clinical pharmacy workers among the health system and promote their relations with other disciplines.

Pain, Sleep Disturbance, and Quality of Life Among Palestinian Patients Diagnosed with Cancer.

The objective of this descriptive study is to explore the relationships between pain, sleep disturbance, and quality of life among Palestinian patients diagnosed with cancer in the West Bank. A cross-sectional, descriptive-correlational design was used to collect data from 184 patients with cancer. The quality of life questionnaire, visual analogue pain scale, and physical health status were used in data collection. The results showed that the mean score for pain was 5, the best functioning was for cognitive scale (M = 75, SD = 29), the worst symptoms experienced by patients was appetite loss (M = 47, SD = 35), a moderate global health status (M = 53, SD = 27), and the mean for sleep disturbance was 43 (SD = 35). Pain and sleep disturbance showed high negative correlations with functional scales of quality of life and positive with symptom scales. The findings showed that the co-occurrence of pain and sleep disturbance was negatively correlated with quality of life (QoL) and positively with symptom scales. The regression analysis revealed that pain and sleep disturbance accounted for a significant proportion of variance in the QoL (p < 0.001), and the highest proportion was in predicting global health status (41.9 %). The findings of this study give evidence about the importance of assessing pain and sleep quality among Palestinian patients with cancer.