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Alshehri SS, Minhaji BI, Pasha MR, Fouda D, Joseph J, Ahmed N. Characteristics and Outcomes of Children With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection Admitted to a Quaternary Hospital: A Single-Center Experience. Cureus 2024; 16:e52532. [PMID: 38371066 PMCID: PMC10870100 DOI: 10.7759/cureus.52532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 02/20/2024] Open
Abstract
Objectives In the setting of the recent global pandemic, children infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus causing the coronavirus disease 2019 (COVID-19) presented to our hospital with a variety of symptoms ranging from mild to severe disease including multiorgan dysfunction. Our objective was to study the clinical profile, risk factors, complications, and outcomes in pediatric patients admitted to our center with SARS-CoV-2 infection. Methods This retrospective observational study was conducted at a large quaternary center in Riyadh between May 2020 and September 2021. The study population was comprised of children between 0 and ≤14 years with SARS-CoV-2 suspicion or positivity. Results One hundred and fifty-six children were included in the study, the majority of whom were 1-10 years old. One hundred and twenty of them (76.93%) were SARS-CoV-2 positive. Fifty-nine patients (37.18%) were labelled as multisystem inflammatory syndrome in children (MIS-C) based on clinical and lab criteria, of whom 35 (22.44%) tested SARS-CoV-2 positive. Hematological disease was found to be the most common comorbidity, followed by neurological and chronic lung diseases. The most common symptoms encountered were fever, cough, vomiting, fatigue, and diarrhea. Eighty patients (51%) required pediatric intensive care unit (PICU) admission (length of stay: 5-12 days), among whom 32 (40%) required ventilation, 26 (32.5%) needed hemodynamic support, and three patients (3.75%) underwent continuous renal replacement therapy (CRRT). The overall mortality rate was 4.5% (seven patients) among the studied population. The most frequent lab abnormalities were found to be elevated serum ferritin, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and lactate dehydrogenase (LDH) levels. Ninety-one percent received antibiotics, and prophylactic anticoagulant was used in 32%. In the MIS-C subset, 80.5% received steroids, 71.43% intravenous immunoglobulin (IVIG), and 5.17% (three patients) tocilizumab. Conclusion The SARS-CoV-2 infection presented with a range of severity among our cohort of children; however, most of the patients responded well to appropriate supportive treatment. A slight male preponderance was noted. The most common symptoms encountered were fever, cough, vomiting, fatigue, and diarrhea. Inflammatory markers such as ESR, CRP, serum ferritin, and LDH levels were found to be elevated in nearly all patients. Raised serum lactate and serum creatinine and lymphopenia were of significant note in patients with MIS-C. Higher mortality rates were observed in patients with MIS-C and those requiring respiratory support. In addition to these two factors, the presence of comorbidities and the need for CRRT were associated with prolonged PICU length of stay.
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Affiliation(s)
- Saleh S Alshehri
- Pediatric Intensive Care Unit, King Saud Medical City, Riyadh, SAU
| | - Bushra I Minhaji
- Pediatric Intensive Care Unit, King Saud Medical City, Riyadh, SAU
| | - Mohsina R Pasha
- Pediatric Intensive Care Unit, King Saud Medical City, Riyadh, SAU
| | - Dina Fouda
- Pharmaceutical Care Services, King Saud Medical City, Riyadh, SAU
| | - Jency Joseph
- Nursing Administration, King Saud Medical City, Riyadh, SAU
| | - Nehad Ahmed
- Clinical Pharmacy, Prince Sattam bin Abdulaziz University, Alkharj, SAU
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Pasi R, Babu TA, Kalidoss VK. Development and validation of structured training module for healthcare workers involved in managing pediatric patients during COVID-19 pandemic using "Objective Structured Clinical Examination" (OSCE). JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:15. [PMID: 37034853 PMCID: PMC10079168 DOI: 10.4103/jehp.jehp_578_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/05/2022] [Indexed: 06/19/2023]
Abstract
BACKGROUND COVID-19 (Coronavirus disease-19) is an ongoing pandemic. COVID vaccine administration in adults has provided some degree of protection from infection but children are still susceptible So, we have to be prepared to handle COVID-19 infection in children by training our healthcare workers by updating both their knowledge and skills. We developed a training module to train our healthcare workers in all domains of learning and also planned related assessment methods to know the effectiveness of the module. MATERIALS AND METHODS This was a quasi-experimental study with pre- and post-intervention conducted at a tertiary-level teaching medical college in southern India from July to September 2021. The training module was developed as per the "ADDIE" model of the development process module. It was further validated by five experts before implementation. In addition to the quasi-experimental method of evaluation like pre- and post-test, Observed Skill clinical examination (OSCE) had been also used as an assessment tool at the completion of training. A total of 92 participants have been trained as per this module in our tertiary-level care hospital. The association between continuous and categorical variables was assessed using an independent t-test and ANOVA, and paired t-test was used for comparing the difference between pre- and post-test scores. RESULTS Pre-test scores had no association with years of experience (P = 0.803) and previous training status of participants (P = 0.350). The mean difference of pre- and post-test scores was 3.8 and it was statistically significant (P value < 0.001) A weak positive correlation between pre- and post-test was present by the Spearmen correlation test (r = 0.337). The correlation between post-test score and OSCE score does not have a significant correlation. CONCLUSION Structured training module was effective in training the participants. Multimode assessment method (Pre-test, Post-test, and OSCE) is an important step to evaluate any training program as compared to only the pre- and post-test methods of evaluation.
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Affiliation(s)
- Rachna Pasi
- Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi, India & Former Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Mangalagiri, India
| | - Thirunavukkarasu Arun Babu
- Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi, India & Former Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Mangalagiri, India
| | - Vinoth Kumar Kalidoss
- Department of Community and Family Medicine, All India Institute of Medical Sciences (AIIMS), Mangalagiri, Andhra Pradesh, India
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Ravaghi H, Naidoo V, Mataria A, Khalil M. Hospitals early challenges and interventions combatting COVID-19 in the Eastern Mediterranean Region. PLoS One 2022; 17:e0268386. [PMID: 35657795 PMCID: PMC9165776 DOI: 10.1371/journal.pone.0268386] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 04/28/2022] [Indexed: 01/10/2023] Open
Abstract
Background During rapidly evolving outbreaks, health services and essential medical care are interrupted as facilities have become overwhelmed responding to COVID-19. In the Eastern Mediterranean Region (EMR), more than half of countries are affected by emergencies, hospitals face complex challenges as they respond to humanitarian crises, maintain essential services, and fight the pandemic. While hospitals in the EMR have adapted to combat COVID-19, evidence-based and context-specific recommendations are needed to guide policymakers and hospital managers on best practices to strengthen hospitals’ readiness, limit the impact of the pandemic, and create lasting hospital sector improvements towards recovery and resilience. Aim Guided by the WHO/EMR’s “Hospital readiness checklist for COVID-19”, this study presents the experiences of EMR hospitals in combatting COVID-19 across the 22 EMR countries, including their challenges and interventions across the checklist domains, to inform improvements to pandemic preparedness, response, policy, and practice. Methods To collect in-depth and comprehensive information on hospital experiences, qualitative and descriptive quantitative data was collected between May-October 2020. To increase breadth of responses, this comprehensive qualitative study triangulated findings from a regional literature review with the findings of an open-ended online survey (n = 139), and virtual in-depth key informant interviews with 46 policymakers and hospital managers from 18 out of 22 EMR countries. Purposeful sampling supported by snowballing was used and continued until reaching data saturation, measures were taken to increase the trustworthiness of the results. Led by the checklist domains, qualitative data was thematically analyzed using MAXQDA. Findings Hospitals faced continuously changing challenges and needed to adapt to maintain operations and provide essential services. This thematic analysis revealed major themes for the challenges and interventions utilized by hospitals for each of hospital readiness domains: Preparedness, Leadership, Operational support, logistics, supply management, Communications and Information, Human Resources, Continuity of Essential Services and Surge Capacity, Rapid Identification and Diagnosis, Isolation and Case Management, and Infection, Prevention and Control. Conclusion Hospitals are the backbone of COVID-19 response, and their resilience is essential for achieving universal health coverage. Multi-pronged (across each of the hospitals readiness domains) and multi-level policies are required to strengthen hospitals resilience and prepare health systems for future outbreaks and shocks.
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Affiliation(s)
- Hamid Ravaghi
- Universal Health Coverage and Health Systems Department, World Health Organization, Eastern Mediterranean Regional Office, Cairo, Egypt
| | - Vanessa Naidoo
- Division of Emergency Medicine at the University of Cape Town, Cape Town, South Africa
| | - Awad Mataria
- Universal Health Coverage and Health Systems Department, World Health Organization, Eastern Mediterranean Regional Office, Cairo, Egypt
| | - Merette Khalil
- Universal Health Coverage and Health Systems Department, World Health Organization, Eastern Mediterranean Regional Office, Cairo, Egypt
- * E-mail:
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Arabi YM, Al Ghamdi AA, Al-Moamary M, Al Mutrafy A, AlHazme RH, Al Knawy BA. Electronic medical record implementation in a large healthcare system from a leadership perspective. BMC Med Inform Decis Mak 2022; 22:66. [PMID: 35292008 PMCID: PMC8922058 DOI: 10.1186/s12911-022-01801-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 03/03/2022] [Indexed: 11/17/2022] Open
Abstract
Background Information on the use of change management models to guide electronic medical records (EMR) implementation is limited. This case study describes the leadership aspects of a large-scale EMR implementation using Kotter’s change management model.
Methods This case study presents the experience in implementing a new EMR system from the leadership perspective at King Abdulaziz Medical City, a large tertiary care hospital in Riyadh, Kingdom of Saudi Arabia. We described the process of implementation and outlined the challenges and opportunities, throughout the journey from the pre-implementation to the post-implementation phases.
Results We described the corresponding actions to the eight domains of Kotter’s change management model: creating a sense of urgency, building the guiding team, developing a change vision and strategy, understanding and buy-in, removing obstacles, creating short-term wins, building on the change and anchoring the changes in corporate culture. Conclusions The case study highlights that EMR implementation is not a pure information technology project but rather is a technical-based complex social adaptive project that requires a specific set of leadership competencies that are central to its success. It demonstrates that change management models might be useful for large-scale EMR implementation.
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Affiliation(s)
- Yaseen M Arabi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. .,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. .,Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
| | - Abdullah Ali Al Ghamdi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Clinical Affairs, Family Medicine and Primary Healthcare, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Mohamed Al-Moamary
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Development and Quality Management, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abdullah Al Mutrafy
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,King Abdullah Specialized Children's Hospital, Riyadh, Saudi Arabia.,Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Raed H AlHazme
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.,College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Information Technology Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia.,College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Bandar Abdulmohsen Al Knawy
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.,King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Efendi D, Hasan F, Natalia R, Utami AR, Sonko I, Asmarini TA, Yuningsih R, Wanda D, Sari D. Nursing care recommendation for pediatric COVID-19 patients in the hospital setting: A brief scoping review. PLoS One 2022; 17:e0263267. [PMID: 35113925 PMCID: PMC8812980 DOI: 10.1371/journal.pone.0263267] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/14/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The hospitalization of children during the COVID-19 pandemic has affected their physical and mental health. Pediatric nurses have faced challenges in providing high-quality nursing care for children and their families. However, the pediatric nursing care recommendations for COVID-19 patients in the hospital setting remain unclear. The current scoping review provides recommendations for nursing interventions for pediatric COVID-19 patients in the hospital setting. METHODS AND FINDINGS The selected articles containing management and nursing recommendations for COVID-19 that have occurred in pediatric patients ages 0-19 years old. A search strategy was developed and implemented in seven databases. We included peer-reviewed articles that reported observational or interventional studies, as well as policy papers, guides or guidelines, letters and editorials, and web articles. A total of 134 articles and other documents relevant to this review were included. We categorized the results based on The Nursing Intervention Classification (NIC) taxonomy which consists of six domains (e.g., Physiological: Basic); eleven classes (e.g., Nutrition Support); and eighteen intervention themes (e.g., Positioning, Family Presence Facilitation, Family Support, and Discharge Planning). CONCLUSION Apart from the intervention of physical problems, there is a need to promote patient- and family-centered care, play therapy, and discharge planning to help children and families cope with their new situation.
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Affiliation(s)
- Defi Efendi
- Department of Pediatric Nursing, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
- Neonatal Intensive Care Unit, Universitas Indonesia Hospital, Depok, Indonesia
| | - Faizul Hasan
- School of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Regina Natalia
- School of Nursing, Mitra Bunda Health Institute, Batam, Indonesia
| | - Ayuni Rizka Utami
- Department of Pediatric Nursing, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
| | - Ismaila Sonko
- School of Nursing, Taipei Medical University, Taipei, Taiwan
- Ministry of Health and Social Welfare, The Quadrangle, Banjul, The Gambia, West Africa
| | - Titik Ambar Asmarini
- Department of Pediatric Nursing, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
- Neonatal and Pediatric Intensive Care Unit, Gatot Soebroto Indonesian Central of Army Hospital, Jakarta, Indonesia
| | - Risna Yuningsih
- Neonatal Intensive Care Unit, Dr. Dradjat Prawiranegara General Hospital, Banten, Indonesia
| | - Dessie Wanda
- Department of Pediatric Nursing, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
| | - Dian Sari
- School of Nursing, Prima Nusantara Health Institute, Bukittinggi, Indonesia
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Abstract
Objectives: To examine the demographics and common presentations of pediatric coronavirus disease 2019 patients in the emergency department (ED), as well as their contact with positive COVID-19 cases, return visits, and patients’ disposition from the ED. Methods: A retrospective chart review of confirmed cases of COVID-19 presenting to the Pediatric ED from March 2020 until June 2020 was conducted. Results: Fifty-two patients were identified, with a higher frequency of male patients. Forty-four (85%) patients were discharged from the ED, and 8 (15%) required admission. Three patients were admitted to the pediatric intensive care unit and 2 died, resulting in a mortality rate of 3.8%. The most frequent presentations were fever (85%), cough (48%), and diarrhea (23%). Conclusion: In our study, the second most affected system after the respiratory tract was the gastrointestinal tract, which was also the system responsible for the most return visits due to diarrhea. Coronavirus disease 2019 poses clinical and operational challenges given its variable clinical presentations.
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Affiliation(s)
- Roaa S Jamjoom
- Department of Emergency Medicine, Faculty of Medicine King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. E-mail.
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Kari JA, Shalaby MA, Albanna AS, Alahmadi TS, Sukkar SA, MohamedNur HAH, AlGhamdi MS, Basri AH, Shagal RA, Alnajar A, Badawi M, Safdar OY, Zaher ZF, Temsah MH, Alhasan KA. Coronavirus disease in children: A multicentre study from the Kingdom of Saudi Arabia. J Infect Public Health 2021; 14:543-549. [PMID: 33756192 PMCID: PMC7981189 DOI: 10.1016/j.jiph.2021.01.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 01/07/2021] [Accepted: 01/11/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The COVID-19 global pandemic caused by severe acute respiratory syndrome coronavirus 2 infection, warranted attention for whether it has unique manifestations in children. Children tend to develop less severe disease with a small percentage present with clinical manifestations of paediatric multisystem inflammatory syndrome and have poor prognosis. We studied the characteristics of COVID-19 in children requiring hospitalisation in the Kingdom of Saudi Arabia and assessed the clinical presentation and the risk factors for mortality, morbidity, and paediatric intensive care (PICU) admission. METHODS We conducted a retrospective analysis of COVID-19 patients under 15 years hospitalised at three tertiary academic hospitals between 1 March and 30 June 2020. RESULTS Eighty-eight children were enrolled (>20% were infants). Seven (8%) were in critical condition and required PICU admission, and 4 (4.5%) died of which 3 met the full diagnostic criteria of multi-system inflammatory syndrome and had a high Paediatric Risk of Mortality (PRISM) score at the time of admission. The initial polymerase chain reaction (PCR) test result was positive for COVID-19 in most patients (97.7%), and the remaining two patients had positive result in the repeated confirmatory test. In a subset of patients (20 subjects), repeated PCR testing was performed until conversion to negative result, and the average duration for conversion was 8 (95% CI: 5.2-10.5) days Children requiring PICU admission presented with signs of respiratory distress, dehydration, and heart failure. Most had fever (71.4%) and tonsillitis; 61.4% were discharged within 7 days of hospitalisation. Risk factors for mortality included skin rash, hypotension, hypoxia, signs of heart failure, chest radiograph suggestive of acute respiratory distress syndrome, anaemia, leucocytosis, hypernatraemia, abnormal liver enzymes, and high troponin I, and risk factors for prolonged hospitalisation (>7 days) included the presence of comorbidities, leucopaenia, hyponatraemia, and elevated C-reactive protein. CONCLUSIONS The majority of hospitalised children had a brief febrile illness and made a full recovery, but a minority had severe disease.
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Affiliation(s)
- Jameela A Kari
- Paediatric Nephrology Centre of Excellence, Department of Paediatrics, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Mohamed A Shalaby
- Paediatric Nephrology Centre of Excellence, Department of Paediatrics, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Amr S Albanna
- King Abdullah International Medical Research Centre, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Turki S Alahmadi
- Department of Paediatrics, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Samaher A Sukkar
- Department of Paediatrics, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Manar S AlGhamdi
- Department of Paediatrics, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Afnan H Basri
- Department of Paediatrics, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Reem A Shagal
- Paediatrics Department, King Saud University, Riyadh, Saudi Arabia
| | - Abeer Alnajar
- Department of Paediatrics, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mazen Badawi
- Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Osama Y Safdar
- Paediatric Nephrology Centre of Excellence, Department of Paediatrics, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Zaher F Zaher
- Department of Paediatrics, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Khalid A Alhasan
- Paediatrics Department, King Saud University, Riyadh, Saudi Arabia
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