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Coronavirus disease 2019 (COVID-19) caused a global public emergency between 2020 and 2022 with various morbidity and mortality across the regions. While the impact in sub-Saharan Africa appeared relatively limited, data from regional referral hospitals remain scarce.
To determine the in-hospital mortality rate, risk factors and clinical characteristics of COVID-19 patients admitted to the COVID-19 treatment unit (CTU) at Lira Regional Referral Hospital (LRRH) in northern Uganda
Cross-sectional study with the use of secondary data
This study was conducted at LRRH between January 2023 and December 2023. The data used were for patients admitted from May 2020 to March 2022.
Records of 490 patients admitted with laboratory confirmed COVID-19 were collected and analysed. Selection was by simple census sampling technique. Inclusion criteria were moderately to critically ill patients and those with mild/asymptomatic infection but with comorbidities.
Of the 490 participants, 52% were females and 41% were aged ≥60 years. The most common symptoms were cough (89.6%), difficulty in breathing (78.8%) and chest pain (69.3%). Hypertension (30%), diabetes mellitus (19.5%) and human immunodeficiency virus (10%) were the leading comorbidities. Severe and critical illness was observed in 40% and 7% of cases, respectively. The overall in-hospital mortality rate was 29%. Factors significantly associated with reduced mortality included normal oxygen saturation (SPO2) (adjusted odds ratios (aOR) 0.11, 95% CI 0.03 to 0.44), normal body temperature (aOR 0.22, 95% CI 0.05 to 0.99), absence of chronic liver disease (aOR 0.01, 95% CI 0.001 to 0.46) and younger age (31–45 years; aOR 0.14, 95% CI 0.03 to 0.74).
The study revealed a high in-hospital mortality rate of 29% among COVID-19 patients admitted to the CTU at LRRH, primarily driven by severe disease presentation and limited access to critical interventions such as oxygen therapy. Independent predictors of survival included younger age, normal oxygen saturation, absence of chronic liver disease and normal body temperature at admission. These findings underscore the urgent need for early identification of high-risk patients and improved access to supportive care, particularly oxygen delivery systems, to reduce mortality in future outbreaks. Strengthening diagnostic capacity, clinical monitoring and preparedness for respiratory pandemics—alongside prospective studies capturing broader patient data—will be essential to refine response strategies and improve outcomes.
Inhaled anaesthetics can be used in mechanically ventilated critically ill patients to provide sedation. This approach to sedation potentially improves patient and health system outcomes, but further supportive evidence is needed. The objective of the SAVE-ICU clinical trial is to compare the effectiveness of inhaled versus intravenous sedation in ventilated adults with acute hypoxaemic respiratory failure.
SAVE-ICU is a multicentre, open-label, pragmatic, randomised controlled trial conducted in 15 intensive care units (ICUs) in Canada and the USA. Eligible patients include mechanically ventilated and sedated adults with acute hypoxemic respiratory failure from COVID-19 or non-COVID causes with PaO2/FIO2 ratio 12 hour). A hierarchy of outcomes was identified at the time of trial design, as the trial was launched during the COVID-19 pandemic when study drug shortages, staffing challenges and healthcare system pressures were prevalent and there was a requirement for rapid evidence generation and implementation on this topic. The primary outcome and highest in the hierarchy is hospital mortality (requiring 758 participants). Secondary and lower hierarchical outcomes are ventilator-free days at day 30 (200 patients), quality of life at 3 months (144 participants) and ICU-free days at day 30 (128 participants). Additional secondary outcomes include median daily oxygenation at day 3 (PaO2/FIO2 ratio), need for adjunctive acute respiratory distress syndrome therapies (prone positioning, inhaled nitric oxide, paralysis with a neuromuscular blocking agent and extracorporeal membrane oxygenation) during ICU stay, days alive and free from delirium and coma at day 14, hospital-free days at day 60 and disability score at 3 months and 12 months after enrolment.
The protocol was approved by all hospital ethics committees and by Health Canada. Informed consent will be obtained from substitute decision makers or deferred consent (as permitted by site ethics board). Trial findings will be shared at the end of the study using peer-review publications, conference presentations and social media as part of the trial knowledge translation plan.
Effective young adults’ sexual health education is crucial for promoting informed decision-making and healthy behaviours. National and international guidelines provide a framework for developing and implementing effective programmes. However, these guidelines may vary in their content, focus and recommendations. This scoping review protocol details a plan to map the literature on national and international young adults’ sexual health education guidelines. The review will focus on identifying key dimensions and characteristics of these interventions.
Guideline selection will be conducted using the Population, Intervention, Professionals, Outcomes and Healthcare setting/context framework. A comprehensive three-stage search of academic databases, grey literature and citation tracking will be conducted to identify all relevant literature. Data extraction will be performed by two independent researchers using a standardised, piloted data charting form to ensure accuracy and minimise bias. The form will capture key guideline characteristics. The process will be iterative, allowing refinement of variables for comprehensive data capture. Findings will be synthesised and presented using diagrams, tables and a narrative summary to provide a clear overview of the existing literature.
Adhering to all relevant guidelines and regulations, this study will proceed under the approval of the Ethics Committee of Shahroud University of Medical Sciences, Semnan, Iran. This scoping review will identify and examine the dimensions and characteristics of national and international guidelines for young adults’ sexual health education. By analysing the dimensions and characteristics of these guidelines, this review will identify commonalities, differences and gaps in the current landscape. The findings will have significant implications for policymakers, educators and researchers engaged in the development and implementation of young adults’ sexual health programmes. The results will be disseminated through publication in a relevant peer-reviewed journal to inform future research and practice in this field.
Ethical code: IR.SHMU.REC.1403.085. URL: https://ethics.research.ac.ir/EthicsProposalView.php?id=494573.
Amid a global nurse staffing crisis, in 2019 Scotland legislated the Health and Care (Staffing) (Scotland) Act to address health care workforce challenges. Instead of requiring patient-to-nurse ratios as legislated elsewhere, this act requires staffing decisions according to guiding principles, duties, and a common staffing method. Measuring variation in hospitals' adherence to the act's provisions at baseline is important for policymakers to evaluate fulfillment of the act's requirements and goals. Results will inform policymakers about which provisions are achieved at baseline and which require support for employers to achieve. The purpose of the study was to establish the baseline of nurse staffing standards in Scotland at April 2024 implementation of the Act. Nurse reports of quality, safety, and their intent to leave were measured to complement assessment of the implementation status.
A cross-sectional study design was used. A convenience sample of registered nurses and nursing support workers was recruited through professional organizations and trade unions. Nurses were invited to complete an online survey between May 1 and July 31, 2024. The survey content included demographic and professional characteristics, international nursing metrics, the Act's provisions, and job intentions. Descriptive statistics were calculated to describe the sample, act's provisions, and nurses' job intentions.
The sample comprised 1870 nurses, of whom 93% were registered nurses, from all regions with characteristics reflecting the Scottish nursing workforce. Regarding the act's provisions, 9% reported that nursing staffing is appropriate to provide safe, high-quality care every shift. Similarly, few nurses reported that the quality of care was excellent (17%) or graded safety an A (10%). Most nurses disagreed that current staffing levels met the eight guiding principles. Most nurses reported that the common staffing method and duties regarding real-time staffing decisions were followed at best occasionally. Nearly half of nurses (45%) intend to stay in their current job over the next year. Among those intending to leave their current job, about half plan to leave the profession through retirement or another unspecified job change. The other half plan to seek another similar nursing job or promotion.
Few nurses report that the act's overarching goal is being met at the point of implementation. Although most nurses see nursing as a long-term career, workforce disruption is anticipated through routine turnover, promotion, or retirement, requiring workforce retention policies. Whether the act's complex provisions can be achieved and its goals fulfilled may not reverse the trend of exiting nurses. The complexity of the approach will be a challenge to achieving the objective of safe staffing. Therefore, this approach to achieving safe staffing may be too complex to be recommended widely. These remain urgent questions for Scottish policymakers, nurse leaders, and researchers.
FreshRSS 