Background An increasing number of studies have investigated the clinical epidemiology and outcomes of ventilator-associated pneumonia (VAP) in intensive care units. However, these findings have not been clearly defined in broad subgroups of mechanically ventilated adults. Hence, this protocol for a systematic review and meta-analysis is designed to better understand the clinical and epidemiological features of VAP in these patient populations by establishing its overall prognosis of and risk factors for morbidity and mortality and to determine the differences in clinical and economic outcomes between VAP and non-VAP patients. Methods This present review will systematically search available full-text articles without date and language restrictions and indexed in PubMed, CENTRAL, CINAHL, Web of Science, and EMBASE databases. In addition, reference lists and citations of retrieved articles and relevant medical and nursing journals will be manually reviewed. Supplementary search in other databases involving trials, reviews, and grey literatures, including conference proceedings, theses, and dissertations, will be performed. Study investigators will be contacted to clarify missing or unpublished data. All prognostic studies meeting the pre-defined eligibility criteria will be included. The study selection, risk of bias assessment, data extraction, and grading of the quality of evidence will be carried out in duplicate, involving independent evaluation by two investigators with consensus or a third-party adjudication. The degree of inter-rater agreement will be calculated using the kappa statistic. For meta-analysis, dichotomous and continuous outcome measures will be pooled using odds ratios and standardized mean differences with 95% confidence intervals, respectively. The Mantel-Haenszel or inverse variance methods with random effects model will be used as a guide for analysis. The heterogeneity of each outcome measure will be assessed using both X 2 and I 2 statistics. In addition, sensitivity and subgroup analyses will be performed to ensure consistency of pooled results. The review protocol described herein is in accordance with the PRISMA-P standards. Discussion The investigation of the epidemiological profiles, prognostic factors, and outcomes associated with VAP is critical for the identification of high-risk groups of mechanically ventilated patients and evaluation of possible clinical endpoints. This may provide substantial links for improved VAP prevention practices targeting modifiable risk factors. Implications for future research directions are discussed. Systematic review registration PROSPERO CRD42017048158 Electronic supplementary material The online version of this article (10.1186/s13643-019-1080-y) contains supplementary material, which is available to authorized users.

Background: Elevation of blood pressure during pregnancy can adversely affect both fetal and maternal outcomes. Other maternal and fetal complications may also arise which may result to maternal and fetal mortality. Objective: This study aimed to determine the fetal and maternal outcomes of hospitalized pregnant clients with hypertension. Methods: This 6-year retrospective research design was carried out in Shaqra General Hospital between January 2008 and November 2013. Following approval by the hospital research ethics committee and hospital administrators, hospital records were reviewed and examined using guide checklist. Universal sampling was applied totaling to 56 evaluable cases of pregnant women with hypertension. Results: Of 56 cases studied, year 2008 to 2013 had the most frequency of hypertensive mothers. Most women are in middle adulthood stage with age 25 years old and above, had more than one pregnancy (multigravida) and more than one viable pregnancy (multipara). Fetal outcome resulted to high number of babies who were term, appropriate for gestational age, with good Apgar score, no birth defect but high frequency of neonatal intensive care unit (NICU) admissions. Maternal outcome recorded no maternal deaths; however, 4% maternal complications (i.e., post-partum hemorrhage and HELLP syndrome) and more caesarean section deliveries were observed. Conclusion: Good Apgar score and absence of birth defects is associated with higher frequency of roomed-in babies and less NICU admissions. There were lesser complications to mothers who had more than one pregnancy. There were more NICU admissions from caesarean section deliveries.

Background:  The healthcare workforce of Saudi Arabia is characterized by diverse cultural backgrounds as a consequence of employment of expatriate workers from various countries. The heterogeneity of both providers of health services and clients resulted to cultural barriers that affected the delivery care.  It is paramount to evaluate the cultural competence of the healthcare providers (HCPs) to maintain quality holistic care. Objective: The primary objective of this study was to assess the cultural diversity experience, cultural competence behavior (CCB) and cultural awareness and sensitivity (CAS) of HCPs in a hospital setting of Saudi Arabia. Methods: This was a cross-sectional study involving survey of HCPs from medical, nursing and laboratory technology disciplines using the Cultural Competence Assessment (CCA) tool.  Results: There were a total of 104 HCPs who completed the survey. The characteristics of the respondents resulted to a mean age of 38.7 ±10.4 who were predominantly Asians and nurses. The majority had working experience of 10 years and below, with more than half who had prior diversity trainings. Reported cultural diversity experience included all HCPs caring for Arab Middle Easterners and Asians and encountering at least one or more special population groups. There was an overall high cultural competence (5.28 ±0.46), high CCB (5.84 ±0.56) but only moderately high CAS (4.72 ±0.35). Significant differences were only identified between CCB scores and three demographic variables (racial/ethnic identification, area of discipline and years of experience). No significant result was found between CAS scores and demographic variables as well as between CCB and CAS scores.     Conclusions: In spite of high CCB, the HCPs responded with lower CAS scores. Interventions should be initiated to increase CAS such as cultural diversity training and availability of cultural care resources.