Introductionintensive care unit (ICU) beds are a scarce resource, and admissions may require prioritization when demand exceeds supply. However, there are few data regarding both outcomes of admitted patients to intensive care unit (ICU) in comparison with outcomes of not admitted patients. The aim of this study was to assess reasons and factors associated to refusal of admission to ICU as well as the impact on mortality at 28 days and patients' outcomes.MethodsSingle-center, cross-sectional descriptive study conducted in 8-bed Medical ICU at a Tunisian University hospital. All consecutive adult patients referred for admission to ICU during 6 months were included. We collected demographic data, ICU admission/refusal reasons, co-morbidity and diagnosis at time of admission, mortality probability model (MPMII0) score, day and time of admission, request for admission and mortality at 28 days.Results327 patients were evaluated for ICU admission and 260 were refused to ICU (79.5%). Patients refused because of unavailability of beds represented 50% and patients considered “too sick to benefit” represented 22%. Multivariate analysis showed that the presence of acute respiratory failure and request by direct contact in the unit were independently associated to admission to ICU (OR: 0.15; 95% CI: 0.07-0.31 and OR: 0.16; 95% CI: 0.08-0.31, respectively). Higher mortality rates were shown in patients “too sick to benefit” (80.7%) and unavailable beds (26.56%).ConclusionRefusal of ICU admission was correlated with the severity of acute illness, lack of ICU beds and reasons for admission request. ICU clinicians should evaluate their triage decisions and, if possible, routinely solicit patient preferences during medical emergencies, taking steps to ensure that ICU admission decisions are in line with the goals of the patient. Ultimately, these efforts will help ensure that scarce ICU resources are used most effectively and efficiently.
Purpose In pediatric asthma, family empowerment education has been beneficial for the quality of life, pulmonary function, and family functioning. Few studies addressed the impact of a family empowerment program on asthma symptom control, acute healthcare use (AHCU), and medication use in children with asthma. This study aimed to assess the effect of a family empowerment intervention on asthma symptom control, AHCU, inhaler technique, and controller adherence in children with asthma. Design and Methods A single‐center study using a randomized controlled design was conducted in a university hospital in the center of Tunisia from May 2018 to September 2019. Eighty‐two families were randomly assigned to the intervention group (n = 41) of 8 weeks of group training sessions, or to the control group (n = 41) of usual care education. Thirty‐seven families in the intervention group and 39 families in the control group received allocated intervention at baseline. Thirty‐four families in each group completed the study at the 12‐month follow‐up. Results At baseline, the intervention and control groups were statistically comparable (p > .05). At follow‐up, there were significant differences between the intervention and the control group in asthma symptom control, χ2 (1, N = 34) = 9.950, p = .002, and inhalation technique, χ2 (1, N = 34) = 5.916, p = .01. For AHCU and adherence to asthma controller, there was no significant difference between groups, χ2 (1, N = 34) = 3.219, p = .07, χ2 (1, N = 34) = 0.541, p = .46, respectively. The difference within time in asthma symptom control and inhalation technique was significant (p = 10−3, p = .001; respectively). Practice Implications This study demonstrated that a family empowerment program significantly improved asthma symptom control and inhaler technique in children with asthma aged 7–17 years. This intervention could be clinically useful and time‐saving for pediatric nurses.
Introduction Smoking cessation is the most important step to limit the complications of chronic obstructive pulmonary disease (COPD). Outcomes from studies that assessed the association between health-related quality of life (HRQL) and smoking cessation have been controversial. This study aimed to assess the relationship between HRQL and smoking cessation in patients with COPD in Tunisia. Methods A cross-sectional study was carried out in the two main primary care centers in the center of Tunisia over a period of three months (April-June 2016). Clinic and socio-demographic data were collected from patients' records. HRQL was assessed by the Medical Outcomes Study Short-form 36 (SF-36). This instrument is composed of two dimensions: physical and mental components. The questionnaire outcomes were described as means and standard deviation. T-test was performed to assess the statistical difference between the dependent and categorical variables. Results A total of 249 COPD patients participated in the study with a mean age of 67.77±11.13. Of this sample, 169 (67.9%) ceased smoking. The average period of smoking cessation was 10 years. The mean of total HRQL score in patients who ceased smoking was lower in comparison to patients who did not quit smoking (40.65±24.49, 43.37±24.49; respectively). The T-test reported a significant difference between the physical component of HRQL and smoking status. Patients with current smoking status had a better physical component score in comparison with patients who quit smoking (43.76±22.62, 37,86±18.21, p = 0.04, respectively). No significant differences were found between smoking cessation, mental component, and HRQL total score (p = 0.89, p = 0.39; respectively). Conclusions This study revealed that smoking cessation was associated with the physical component of HRQL. The smoking dependence in patients with COPD could explain this finding. Health care professionals should work harder on effective smoking cessation strategies. Key messages These findings suggested that HRQL was better among patients who did not quit smoking. Patients who did not cease smoking reported better physical status and poorer mental status in comparison with patients who quit smoking.
Introduction Stress and its deleterious effects are currently a major topic in public health. Health care studies can be very stressful as they pose a challenge for students around the world. The aim of this study was to assess stress perception among healthcare students and to identify its associated factors. Methods A descriptive cross-sectional study was carried out over a five-month period (January-May 2017) among healthcare students at the Higher School of Health Sciences, University of Sousse (Tunisia), during the 2016/2017 academic year. The socio-demographic and health status data have been collected using a pre-established data collection sheet. Stress perception was assessed by the French version of the Perceived Stress Scale with 10 items (PSS-10). Factors associated with stress were examined using ANOVA and T-student tests. Results A total of 237 students participated in the study with a response rate of 64.40%. The average age was 20.57±1.05 with a female predominance of 90.7%. The mean of the PSS-10 total score was 31.37±4.406. A rate of 89% of cases had a perceived high-stress score. Factors associated with stress were social status (p = 0.005), housing (p = 0.01), hometown (p = 0.03), presence of a diagnosed health condition (p = 0.02), presence of eating disorder (p = 0.04), presence of sleeping disorder (p = 0.004). Conclusions This study reported that healthcare students had a high level of stress associated with endogenous and exogenous factors. Stress management strategies must be included in the educational curriculum in healthcare schools. Key messages Health care studies pose a challenge for students around the world. Healthcare students had a high level of stress associated with endogenous and exogenous factors.
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