Saudi Cultural Missions Theses & Dissertations
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Item Restricted Time-to-Death Analysis and Prolonged ICU Stay Prediction Using MIMIC-III Data(Saudi Digital Library, 2025) Alanazi, Abdullah; Welberry, HeidiThis study investigated two critical questions in intensive care using the MIMIC-III database. First, we examined whether time-to-death differs across ICU types using survival analysis methods. Second, we developed a machine learning model to predict prolonged ICU stays (≥7 days) from early clinical features, addressing the class imbalance inherent in this outcome. Our survival analysis of 24,754 adult ICU admissions revealed significant mortality differences between ICU types, with SICU and TSICU patients showing approximately 50% lower hazard of death compared to MICU patients (adjusted HR 0.51, 95% CI: 0.44-0.60 and 0.51, 95% CI: 0.42-0.62, respectively). For prolonged stay prediction, our Random Forest model with balanced training achieved strong discrimination (AUC-ROC 0.84) and balanced accuracy (76.6%), outperforming traditional logistic regression. The most important predictive features were Glasgow Coma Scale measures, mechanical ventilation, and vasopressor use—all indicators of illness severity. These findings suggest that ICU type substantially influences mortality risk and that early prediction of prolonged stays is feasible using routinely collected clinical data.22 0Item Restricted Procalcitonin-Guided Antibiotic Discontinuation in ICU Sepsis: Effects on Duration and Mortality – A Systematic Review(Saudi Digital Library, 2025) Albalawi, Faisal Mohammed; Denney-Wilsson, ElizabethBackground: Sepsis remains a leading cause of morbidity and mortality in intensive care units (ICUs), where early empirical antibiotic therapy is essential for survival. However, prolonged antibiotic exposure contributes to antimicrobial resistance and high mortality. Procalcitonin (PCT) has emerged as a promising biomarker to guide antibiotic discontinuation and optimise antimicrobial stewardship in ICU patients with sepsis. This systematic review evaluates the effectiveness of PCT-guided antibiotic discontinuation in reducing antibiotic duration and its impact on mortality outcomes among adult ICU patients with sepsis. Methods: A systematic search was conducted on three databases: PubMed, Medline via Ovid, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) between March and April 2025. Randomised controlled trials (RCTs) published in English within the past 10 years were included if they evaluated PCT-guided antibiotic discontinuation in adult ICU patients with sepsis and reported outcomes on antibiotic duration and mortality. The methodological quality of the included studies was appraised using the Mixed Methods Appraisal Tool (2018). Results: Eight RCTs comprising 6,043 adult ICU patients met the inclusion criteria. Six studies demonstrated statistically significant reductions in antibiotic duration in the PCT-guided groups, particularly those incorporating daily PCT testing and clear discontinuation thresholds. Two large multicentre RCTs reported significant reductions in short-term mortality, while others found non-inferior outcomes. One study focusing on cancer ICU patients reported increased mortality, highlighting the need for caution in immunocompromised populations. Conclusion: PCT-guided antibiotic discontinuation appears to be an effective and generally safe strategy for reducing antibiotic exposure in ICU sepsis patients. However, mortality benefits remain inconsistent may be influenced by patient risk profiles and adherence to PCT protocols. Further large-scale .trials with standardised PCT algorithms are warranted9 0Item Restricted Exploring Factors Influencing Nurse Attrition in Intensive Care Unit in Critical Care in Saudi Arabia: A Systematic Review(Queens University Belfast, 2025-02-10) McKenna, Niall; Brown, MichaelBackground Methodology & search strategy Result Discussion conclusion26 0Item Restricted Perceived Barriers and Facilitators by Critical Care Nurses and The Impact of Cultural Variations Between Nurses and Patients on End-Of-Life Care at Intensive Care Units(University of Cincinnati, 2024-10-18) Alali, Khairayah; Smith, Carolyn R.Background: Due to the complexity of medical conditions in the intensive care unit (ICU), mortality rates are typically high in most hospitals. End-of-life care (EOLC) begins when curative treatments are no longer beneficial, shifting the focus to comfort and quality of life for patients and families. Despite EOLC being a standard part of ICU management, healthcare professionals encounter complexities and uncertainties when transitioning from life-saving treatments to comfort-focused care. Additionally, EOLC in the ICU is influenced by the cultural backgrounds of both nurses and patients. The nursing culture in Saudi Arabia reflects a diverse workforce, with a significant reliance on expatriate nurses from various countries, leading to cultural and language differences that can influence EOLC. Objectives: To explore the perceived barriers and facilitators of critical care nurses in providing EOLC in intensive care units, how cultural variations between nurses and patients impact care, and how nurses address and meet the cultural needs of dying patients. Method: The study employed a qualitative descriptive method, utilizing semi-structured interviews that were conducted virtually through Zoom. Purposeful sampling techniques and a homogeneous sampling approach were used to recruit participants. Open-ended questions were used from an interview guide to prompt the critical care nurses to share their viewpoints and experiences. Results: The exploration of the perceived barriers and facilitators of critical care nurses during EOLC for terminally ill patients in the ICU revealed three main themes: (a) EOLC barriers, (b) EOLC facilitators, and (c) suggestions to improve the EOLC and overcome barriers. The exploration of how cultural variations between nurses and patients impact care, and how nurses address and meet the cultural needs of dying patients revealed five main themes: (a) cultural practices and traditions of patients & families, (b) cultural competence during EOLC, (c) culturally competent nursing care decisions and actions (d) challenges in providing culturally competent nursing care, and (e) suggestions to improve cultural competence. Conclusion: This study identified barriers to EOLC, including family acceptance, understanding of EOLC, unrealistic expectations, over-involvement, poor policy awareness, staffing shortages, high workloads, care continuity, and insufficient training. Nurses showed a strong commitment to respecting patients' cultural and religious practices but faced challenges in delivering culturally competent care. Recommendations include better family education, clear communication, integrating EOLC training into nursing education, addressing language barriers, implementing advance directives, and fostering a collaborative team environment with adequate resources and flexible visiting hours. These steps can enhance the quality and compassion of EOLC.58 0Item Restricted The Impact of Positive End-Expiratory Pressure on Mortality Rate among Patients with Acute Respiratory Distress Syndrome(Saudi Digital Library, 2023-08-23) Alrayes, Mashael; Hunter, JoannaBackground: High levels of Positive End-Expiratory Pressure (PEEP) have been found to potentially increase lung volume and improve oxygenation in patients with Acute Respiratory Distress Syndrome (ARDS). They also increase the risk of lung injury caused by overdistention. ARDS has a high mortality rate; however, the impact of increased PEEP on clinical outcomes in patients with ARDS is variable. Aim: The aim of this dissertation is to examine the available studies that compared the impact of high PEEP levels with that of low PEEP levels on the reduction of ARDS mortality rates. Methods: A comprehensive search of literature on Randomised Controlled Trials (RCTs) and cohort studies was conducted using four databases—MEDLINE, Embase, Cochrane Library and CINAHL (EBSCOhost) from the last 15 years to June 2023. The inclusion criteria were studies that examined the ARDS mortality rate in patients subjected to high PEEP levels (as the intervention group) and to low PEEP levels (as the control group). An automation tool was utilised, along with duplicates removal options through Endnote and Rayyan reference management tools. Results: A total of 1637 studies were identified. They were screened through the evaluation of their titles and abstracts and then, of their full text, in accordance with predetermined inclusion and exclusion criteria. Finally, seven studies were selected and included in this dissertation. Conclusion: The mortality reduction in patients with ARDS who received higher levels of PEEP did not differ significantly from that in patients with ARDS who received lower levels of PEEP.33 0