Aim: This study aimed to evaluate effects of patient deterioration early warning score system simulation training on nurses' performance, satisfaction and self-confidence. Methods: Convenience sample of 40 nurses working in Dawadmi general hospital and willing to participate in the study was included. A Quasi experimental research design pre/post intervention was used. Four tools were used in his study ; First tool used to assess nurses' demographic characteristics & their knowledge regarding early warning score system. Second tool used to assess nurses' practice regarding clinical deterioration to safe patients'' life. Third tool nurses' satisfaction scale this tool; used to assess nurses' satisfaction to use early warning score system simulation for deteriorated patient. Fourth tool; nurses' selfconfidence scale to assess studied nurses' self-confidence in their abilities to using early warning score system simulation for caring of deteriorated patient. Results: Studied nurses' total score of knowledge reflect highly significant differences pre and post intervention. Nurses' practice was improved significantly post the intervention; where half of them take good total score in using Early warning scoring system simulation to care for patients post intervention compared with none of them pre and their satisfaction to use early warning score system was improved significantly post intervention with statistical difference was found. There was highly statistical significant difference regarding nurses' self-confidence pre/post intervention Conclusion: nurses' practice was improved significantly post the intervention with statistical difference was found. Also nurses ' satisfaction and their self-confidence to use early warning score in caring for deteriorated patients was improved significantly post compared to pre intervention

Background: Management of diabetes requires a complex treatment plan and lifestyle changes to enhance patient adherence toward treatment. However, in patients with type-2 diabetes, living with the disease faces various obstacles. If these obstacles are not recognized, noncompliance with recommended self-care treatments and complications may occur as a result. Aim: To determine the coping obstacles among type 2 diabetic patients. Methods: A cross-sectional research design was conducted at diabetic outpatient clinics affiliated to El Mahalla El Kubra general hospital. Sample: A purposive sample of 570 patients were included and data collected by interviewing questionnaire to assess socio-demographic, clinical data and diabetes obstacles questionnaire for 5 months from beginning of October 2021 to end of February 2022. Results: The studied subjects had obstacles with medications subscales, self-monitoring, and knowledge & believe, diagnosis, life style and coping subscales with mean score 5.17± 6. 09, 3.53± 3.47, 5.03± 4.76, 4.38± 5.18, 3.44± 5.66 and 4.14± 3.69 respectively. On the other side, the studied subjects didn't experience obstacles in receiving guidance or supporting and relationship with health care sub-scales with mean scores -5.08± 7.10 and -2.73± 6.02 respectively. Conclusion: There are several obstacles faced by patients with type 2 diabetes, the total mean scores of the obstacles were influenced by educational level, occupational status, smoking habit, follow-up, practicing exercises, dietary compliance, diabetes complications, and duration of disease. Recommendation: Expanding in the application of the educational programs for diabetic patients which include health information and practical skills to cope with their disease and lifestyle changes.

Background: A robust Primary Health Care (PHC) system is critical for efficient and equitable health system. There is a paucity of research addressing the predictors of its utilization and related patient satisfaction. Aim of the study: to develop models to identify the predictors of utilization, preference, and satisfaction with the services provided in the PHC Centers in rural areas. Subjects and Methods: This analytic study with prediction modeling was carried in three PHC centers in Fayoum city on a random sample of 300 attendants. Data were collected using a selfadministered questionnaire with a scale for current visit and overall satisfaction. Results: Participants median age was 40 years, with slightly more males (56.0%); 35.7% preferred governmental health care settings, 30.0% were satisfied with the current visit, and 23.3% had an overall satisfaction with PHC services. The crowding index, being on medication, having previous hospital admission or surgery were positive predictors of PHC utilization. Having chronic disease and a private health insurance were positive predictors of PHC utilization, while being female, having sufficient income, having a crowding index 2+, and being on regular medication were negative factors. Female gender was a positive predictor of satisfaction, whereas the crowding index, having a chronic disease, and having had a previous surgery were negative predictors. Conclusion: The models indicate that despite high utilization, participants have low satisfaction and low preference for governmental settings. These are influenced by their personal characteristics and health status. Recommendations: The PHC authorities need to identify the factors underlying this low satisfaction and take proper measures for reform. Future research should explore the effects of such reforms on patients' utilization and satisfaction.