Saudi Cultural Missions Theses & Dissertations
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Item Restricted EVALUATING THE EFFECT OF NURSE-PATIENT COMMUNICATION ON ANXIETY AMONG PATIENTS WITH IMPLANTABLE CARDIOVERTER DEFIBRILLATORS(UNIVERSITY OF KENTUCKY, 2024) ALTURKI, RAWAN; MOSER, DEBRA; RAYENS, MARY KAYThe implantable cardioverter defibrillator (ICD) is a battery-operated device implanted under the skin to monitor heart rate and rhythm, detecting and correcting dangerous dysrhythmias. It is the preferred choice for preventing both primary and secondary sudden cardiac death (SCD), reducing mortality by 50% compared to patients treated without an ICD. Due to the high prevalence of cardiovascular diseases and associated dysrhythmias, the demand for ICDs is growing each year. In the United States, about 75,000 adults receive an ICD annually. The presence of these devices, along with the uncertainties of living with a heart condition, can significantly affect mental health. About 20% of ICD recipients experience psychological distress and specific concerns related to their ICD. Miscommunication or misunderstandings can lead to fear, panic, and anxiety among ICD patients, with serious negative effects. Over 50% of ICD patients lack a clear understanding of their condition and often express dissatisfaction with the information provided by healthcare professionals regarding their device and treatment. Therefore, it is essential to clearly explain what patients can expect in their lives with an ICD during discussions before and after implantation, including the potential for anxiety symptoms. Effective nurse-patient communication has been shown to improve health outcomes by increasing patient satisfaction, enhancing understanding of health issues, and promoting better adherence to treatment plans through more personalized care. Evaluating nurse-patient communication among ICD recipients will provide an opportunity to identify factors that influence patients' psychological symptoms. Therefore, the purpose of this dissertation was to understand the effect of nurse-patient communication on anxiety symptoms among ICD recipients. The specific aims were: 1) test the psychometric properties of an instrument for assessing ICD device concerns among ICD recipients in the U.S.; 2) evaluate the effect of nurse and patient communication on anxiety among ICD recipients; and 3) synthesize and summarize the current literature about anxiety as a risk factor for mortality in ICD recipients. Aim 1 was achieved by conducting a psychometric analysis of the Implantable Cardioverter Defibrillators Concerns questionnaire in order to assess the extent and severity of ICD recipients’ concerns. We used data from a cross-sectional observational study conducted to test the knowledge, attitudes, and perceptions of adult ICD recipients (N= 240). The tested instrument consisted of 20 items measured on a 5-point Likert-type scale. The items are scored from 0 (I am not worried at all) to 4 (I am very much worried), and there are 20 potential concerns on the scale, corresponding to a maximum potential severity score of 80. The instrument is valid and reliable in multiple populations including, the United Kingdom and Poland, with a Cronbach’s α= 0.94. The factor analysis revealed that a one-component solution was present within the scale, explaining 48% of the variance. In addition, the hypothesis test showed a positive and statistically significant correlation between the Brief Symptoms Inventory (BSI-6) measure of anxiety and the ICDC total score (r = 0.35, p < 0.001). Aim 2 was achieved by conducting a secondary data analysis of a cross-sectional study of (N=200) patients with an ICD in order to evaluate the effect of nurse-patient communication on anxiety among ICD recipients. We have performed a simple logistic regression to distinguish whether nurse-patient communication is a predictor of anxiety among ICD recipients along with the covariates: age, gender, marital status, and health status. Simple logistic regression showed that patients aged 65 years and older are more likely to be anxious than younger patients p= .05 (OR, 2.478; CI, 0.998 – 6.15). In addition, patients who report good or very good health status are more likely to be anxious p= .008 (OR, 0.311; CI, 0.131 – 0.737). No other significant variables were shown, all relationships between discussion, gender, marital status, and anxiety remained not significant. Aim 3 was achieved by conducting a systematic literature review to identify the role of anxiety as a risk factor for mortality among patients with ICDs. Three electronic databases were searched for peer-reviewed articles: (Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, and PsycINFO). Nine studies were found and included. The Socio-Ecological Model guided this review. Studies included in this systematic review concluded that anxiety may be relevant as a risk factor for increasing mortality among patients with an ICD. In conclusion, this study has filled an important gap in the evidence of healthcare communication and psychological outcomes among ICD recipients. This comprehensive approach could lead to better support systems and communication strategies, ultimately improving both mental health and overall outcomes for ICD recipients. The findings emphasize the urgent need for routinely applied and interdisciplinary psychosocial aftercare for ICD patients. Therefore, it is necessary to ensure that ICD recipients receive the required interventions as early as possible in order to prevent any further permanent health issues associated with their devices or overall health. The next step in this area of research would be to conduct a randomized controlled trial with longitudinal follow-up to evaluate the impact of proper one-to-one communication that can help with anxiety symptoms. Additionally, to assess the feasibility of the communication strategies in decreasing anxiety among ICD patients.16 0Item Restricted Effectiveness of Adherence to Home Non-Invasive Ventilation (NIV) upon Hospitalisation Rate and Mortality of Chronic Obstructive Pulmonary Disease Patients with Chronic Hypercapnic Respiratory Failure: A Structured Literature Review.(Glasgow Caledonian University, 2024-08) Alomari, Osama; Sharp, KathrynIntroduction: Chronic Obstructive Pulmonary Disease (COPD) with Chronic Hypercapnic Respiratory Failure (CHRF) has a significant impact on hospitalisation rate and mortality. Non-invasive ventilation (NIV) is a clinically established home-based intervention; however, its impact on hospitalisation rate and mortality remains undetermined. Review Aim: This review aims to investigate existing literature to establish the impact of adherence to home NIV on reducing hospitalisation rate and mortality among patients with COPD and CHRF. Method: Between May 2024 and June 2024, this review conducted a systematic literature search of the primary medical databases (MEDLINE, Cochrane Library, CINAHL and Embase). A quality assessment was conducted using the Newcastle-Ottawa Quality Assessment tool and the National Heart, Lung, and Blood Institute (NIH) quality assessment tool. Findings: Six observational studies, involving 10,206 participants, analysed the impact of adherence to home NIV on hospitalisation rate and mortality. Five studies were considered to be high quality and one was moderate quality. Adherence to home NIV for at least four hours per day was associated with a significant reduction in hospitalisation rate and mortality. Conclusion: Adherence to home NIV significantly reduces hospitalisation rate and mortality among COPD patients with CHRF. These findings recommend the adoption of home NIV as a standard care practice for this population and emphasise the importance of patient compliance to maximise the therapeutic benefits of NIV. This review recommends that future research conducts additional randomised control trials (RCTs) to reinforce its initial findings.16 0Item Restricted Effectiveness of High Flow Nasal Oxygen in the Prevention of Intubation/Mechanical Ventilation in Adult Patients with Respiratory Failure: Using A Systematic Review and Meta-Analysis.(Queen Mary University of London, 2024-08-05) AlShammari, Mazen Khalaf; Parjam, ZolfaghariAims and Objectives: This systematic review is a study that evaluates the effectiveness of High Flow Nasal Oxygen (HFNO) in reducing the need for intubation and invasive mechanical ventilation in patients with acute respiratory failure (ARF). These findings are also compared with standardised oxygen therapy and non-invasive ventilation (NIV). The study also aims to analyse the effect of HFNO on clinical outcomes and patient mortality. Gaps in literature are also addressed and evidence-based suggestions are provided for the improvement of future research and clinical implementations. Methodology: MesH words were extracted and search strategy was formulated on the basis of these MesH words and alternative keywords on three databases: MedLine, Cochrane and Embase. A systematic review was conducted according to the PRISMA guidelines with primary and secondary screening, which revealed ten studies to be included. The Cochrane RoB tool was employed to undertake a risk of bias (RoB) analysis for randomized controlled trials (RCTs), whereas the quality of observational research was assessed using the Newcastle Ottawa Scale (NOS). Results: Ten studies were included in this systematic review, conducted in seven countries and four continents, with six of the included studies taking place in Europe. Six of the ten studies involved ARF secondary to COVID-19, while the rest included patients with heterogeneous secondary pathologies. The main intervention throughout the studies was the use of HFNO; however, the intervention structure varied. The primary outcomes included the rate of intubation and mortality rate, while secondary outcomes included the in-hospital length of stay, time to intubation, ventilator free days, and PaO2:FiO2 ratio. The adverse effects associated with HFNO use were also reported. A consistent improvement in the rates of intubation with a significant decline in comparison with standard oxygen therapy was also reported. The patient mortality showed a varying pattern, with some studies reporting a decreased mortality rate, some finding no significant difference and some with an increase in mortality. The studies also reported a reduction in the length of stay in the intensive care unit (ICU), but not in the emergency department. The number of ventilator-free days also declined with this intervention. The use of HFNO thus appears to be associated with an improvement in SaO2, PaO2:FiO2 ratio, and respiratory rate. Overall, the adverse events did not show a significant difference from standard therapy. Conclusion: HFNO has been associated with an improvement in both physiological and clinical parameters in patients with ARF, especially when considering the need for intubation. These changes reduce ventilator-associated complications. This study also addresses the gaps in literature and provides evidence-based suggestions for future research.12 0Item Restricted Body Weight and Mortality Risk in Community-Dwelling Older Adults(Monash University, 2024-02-21) Alharbi, Tagrid Abdullah; Owen, Alice; Freak Poli, Rosanne; Ryan, Joanne; Gasevic, DanijelaBackground: Overweight and obesity, generally defined by body mass index (BMI) ≥ 25 kg/m² or large waist circumference (abdominal obesity), is increasingly prevalent among older adults worldwide, however studies of excess weight and the link with mortality risk in older adults have reported mixed findings. Weight change may be a better indicator of mortality risk in older individuals, but large community-based longitudinal studies of older individuals are needed. Aims: To systematically review the association between weight change and all-cause mortality risk in adults aged ≥ 65 years, and to examine the association of weight status, abdominal obesity and weight change with the risk of mortality in community-dwelling older adults aged ≥ 65 years. Methods: A systematic review and meta-analysis conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines to examined the evidence that weight change (loss, gain and fluctuation, measured by weight or BMI) is associated with all-cause mortality. Secondary data analysis was performed using longitudinal data on community-dwelling individuals from the ESPIRIT (France, N=2,017) and ASPREE/ALSOP sub-studies (Australia, N=14,853). The association of self-reported weight loss, objectively measured weight change (loss and gain), weight status, and abdominal obesity with all-cause mortality over a 17-year follow-up period in the ESPIRIT study was explored using Cox proportional-hazard regression. To broaden understanding of the association between BMI in early (at age 18 years) and later (age ≥70 years) adulthood, and their impact on later-life mortality (over a median of 4.7 years in the ASPREE/ALSOP sub-study), Cox proportional-hazard regression was applied. Furthermore, the socio-demographic, lifestyle, and clinical characteristics associated with change in weight status between early (age 18 years) and late (age ≥ 70 years) adulthood were identified. Results: From the systematic review, weight change, particularly weight loss, was found to be associated with a 59% increased risk of mortality compared to stable weight. Longitudinal data analyses found that abdominal obesity was linked to a 49% increased mortality risk compared to non-abdominal obesity, but being overweight was associated with a 20% decreased risk compared to a normal BMI. Self-reported weight loss of >3 kg at baseline was associated with a 52% increase in mortality risk for men only; but both men and women with ≥ 5% objectively measured weight loss had a 24% increased risk of all-cause mortality. Obesity at 18 years, but not in older age, was associated with a 35% increased risk of mortality in later life. Compared to participants with a normal BMI, obesity at both early adulthood and later life was associated with 99% increase in the risk of all-cause mortality. Obesity in early and/or late adulthood was also associated with a higher risk of adverse clinical risk characteristics. Conclusion: Weight change and weight status are important predictors of mortality risk in older adults. These results highlight the importance of healthcare providers monitoring weight in older adults to detect weight loss at it is early stages, enabling more effective interventions aimed at maintaining stable weight and reducing risk of premature mortality.45 0Item Restricted Characteristics and Outcomes of Chronic Bronchitis in Alpha-1 Antitrypsin Deficiency Related Lung Disease: A Retrospective Longitudinal Analysis(Saudi Digital Library, 2023-10) Alsaab, Sulaiman; Turner, Alice; Ellis, PaulAbstract Background: Alpha-1 antitrypsin deficiency (AATD) is a genetic disorder associated with lung disease such as early-onset emphysema and chronic obstructive pulmonary disease (COPD). The presence of chronic bronchitis may accelerate disease progression in AATD patients, but few studies have specifically examined this phenotype. Objectives: To investigate the characteristics and outcomes such as FEV1 decline, DLCO decline, exacerbations frequency, and mortality of AATD patients with chronic bronchitis compared to those without chronic bronchitis. Methods: This retrospective cohort analysis utilised clinical data from the REDcap registry for 236 PiZZ and PiSZ AATD patients. Participants were categorised based on chronic bronchitis diagnosis and genotypes. Characteristics were compared between groups. Multiple linear regression analysis, logistic regression analysis, mixed linear model, and survival analysis are done to investigate outcomes including lung function decline, exacerbation frequency, and mortality among those patients. Results: Patients with chronic bronchitis (35% of the cohort) demonstrated significantly worse baseline lung function. FEV1 decline was steeper in PiZZ chronic bronchitis patients (-1.61% predicted/year, - 52 ml/year) versus PiZZ without chronic bronchitis (-1.07% predicted/year, - 31.5 ml/year). In the PiSZ genotype, the chronic bronchitis group similarly showed accelerated decline (-1.85% predicted/year, - 64 ml/year) versus the PiSZ without chronic bronchitis (-0.67% predicted/year, - 21 ml/year). Female sex was associated with higher odds of frequent exacerbations in both PiZZ and PiSZ individuals. There was no significance in terms of mortality between the groups. Conclusion: Chronic bronchitis in AATD is associated with impaired lung function and worse clinical outcomes compared to AATD alone. This high-risk phenotype warrants additional research into tailored interventions and closer monitoring. Larger longitudinal studies are needed to confirm the results and elucidate underlying mechanisms.18 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 0Item Restricted The use of balanced crystalloids versus 0.9% normal saline among critically ill patients(Saudi Digital Library, 2023-11-01) Alotaibi, Amjad; Al-Haddad, MoBackground: Intravenous (IV) fluid administration is a fundamental element of critical care management. Balanced crystalloids and 0.9% normal saline are commonly used for resuscitation and maintenance among critically ill patients. However, the impact of fluid composition on critically ill patient outcomes remains uncertain. Aim: The current systematic literature search aimed to assess, through a comparison with 0.9% normal saline, whether the use of balanced crystalloids for resuscitation and maintenance reduces the mortality rate of critically ill patients. Methods: On June 6, 2023, a comprehensive systematic literature search was carried out by using the MEDLINE (OVID), Embase (OVID), Cochrane Library, CINAHL (EBSCOhost), and Scopus databases. Predefined study selection criteria were formulated to select the relevant articles. Results: The search yielded 2,614 articles. Seven studies—three randomised controlled trials with a total of 31,891 patients and four cohort studies with a total of 7,969 patients— met the inclusion criteria. The findings of the included studies were inconsistent. Evidence from well-conducted studies showed that, compared to 0.9% normal saline, the use of balanced crystalloids did not lower the mortality rate. The other cohort studies found that the administration of balanced crystalloids reduced the mortality rate. However, the quality of the cohort studies was considered weak based on the existing evidence. Conclusion: Compared to 0.9% normal saline, the use of balanced crystalloids did not decrease the mortality rate of critically ill patients.12 0Item Restricted Determinants of In-Hospital Mortality of Patients Receiving Ward-Based Non-invasive Ventilation for Acute Hypercapnic Respiratory Failure(Saudi Digital Library, 2023-08-25) Alqahtani, Ahmed S.; Mukherjee, RahulIntroduction: Door-to-mask time is a quality metric for Non-Invasive Ventilation (NIV) treatment that is applicable across the United Kingdom. This study examined the efficacy of this metric in predicting in-hospital mortality, alongside other variables including maximum IPAP, age, and degree of acidosis after rigorous infection control measures were introduced during COVID-19 pandemic that led to substantial delays in the provision of NIV treatment. Methods: All acute NIV applications for hypercapnic respiratory failure (AHRF) pre- and post-pandemic were included in this study (April – December 2019 and April – December 2021). Mann-Whitney U test and Chi-squared test were used for continuous and categorical variables, respectively. ANOVA test was used for the analysis of variance of mean door-to-mask time and mean maximum IPAP, and logistic regression was used to predict in-hospital death adjusted odds ratios across both cohorts combined. Results: From 2019 to 2021 total patients receiving NIV decreased by 26.2% (83 vs 45). There was not a significant difference in patients age across cohorts (p=0.93). Indications for NIV treatment was not significantly different, the majority received NIV treatment for COPD 87 (66.9%) vs 63 (65.6%) in 2019 and 2021, respectively. Door-to-mask time was significantly increased, 5.45 to 10.85 hours (p<0.001). However, in-hospital deaths were not significantly different, 27 (20.8%) vs 28 (29.2%) (p=0.15). Age and degree of acidosis affected significantly in-hospital mortality, odds ratio (95% CI), 1.037 (1.01, 1.07) (p=0.02) and 0.009 (0.00, 0.70) (p=0.03), respectively. However, door to mask time did not significantly affect odds ratio of in-hospital mortality, 1.004 (1.00, 1.01), (p=0.07). Prolonged door-to-mask time and lower maximum IPAP were associated with higher in-hospital mortality, (p=0.045) and (p=0.048), respectively. Conclusion: Within this cohort, age and degree of acidosis were independent predictors of in-hospital mortality. However, door-to-mask time was not a strong predictor of in-hospital mortality, despite the association observed between prolonged door-to-mask times and higher mortality rates. Hence further research on door-to-mask time is necessary to explore its association with increased in-hospital mortality.15 0