High-risk subtypes of chronic lymphocytic leukemia are detectable as early as 16 years prior to diagnosis.

Chronic lymphocytic leukemia (CLL) is preceded by monoclonal B-cell lymphocytosis (MBL), a CLL precursor state with a prevalence of up to 12% in aged individuals; however, the duration of MBL and the mechanisms of its evolution to CLL remain largely unknown. In this study, we sequenced the B-cell receptor (BcR) immunoglobulin heavy chain (IGH) gene repertoire of 124 patients with CLL and 118 matched controls in blood samples taken up to 22 years prior to diagnosis. Significant skewing in the BcR IGH gene repertoire was detected in the majority of patients, even before the occurrence of lymphocytosis and irrespective of the clonotypic IGH variable gene somatic hypermutation status. Furthermore, we identified dominant clonotypes belonging to major stereotyped subsets associated with poor prognosis up to 16 years before diagnosis in 14 patients with CLL. In 22 patients with longitudinal samples, the skewing of the BcR IGH gene repertoire increased significantly over time to diagnosis or remained stable at high levels. For 14 of 16 patients with available samples at diagnosis, the CLL clonotype was already present in the prediagnostic samples. Overall, our data indicate that the preclinical phase of CLL could be longer than previously thought, even in adverse-prognostic cases.

Identifying the obstacles facing emergency nurses regarding treating CTAS1 and CTAS2 in Saudi Arabia.

BACKGROUND: Emergency nurses play a pivotal role in delivering efficient emergency healthcare, yet they often encounter numerous challenges, especially while managing life-threatening cases, impacting both their well-being and patient satisfaction. This study seeks to identify the prevalent challenges faced by these nurses in Saudi hospitals when handling Canadian Triage and Acuity Scale (CTAS1 and CTAS2) cases, with the aim of mitigating or managing these issues in the future. METHODS: This study incorporated a mixed-method approach to identify obstacles in Emergency Department (ED) nursing treatment of CTAS1 and CTAS2 cases in two major Saudi Arabian hospitals. The research began with qualitative focus group interviews with expert ED nurses, followed by a quantitative survey to measure and explore relationships among the qualitative findings. Data analysis leveraged qualitative thematic analysis and principal component analysis, ensuring rigorous examination and validation of data to drive meaningful conclusions. FINDINGS: From expert interviews, key challenges for emergency nurses were identified, including resource management, communication, training compliance, and psychological factors. A survey of 172 nurses further distilled these into five major issues: patient care management, handling critical cases, administration support, patient care delay, and stress from patients' families. CONCLUSION: Through a mixed-method approach, this study pinpoints five pivotal challenges confronting emergency nurses in Saudi hospitals. These encompass difficulties in patient care management, the psychological toll of handling critical cases, inadequate administrative support, delays due to extended patient stays, and the stress induced by the presence of patients' families, all of which significantly impede emergency department efficiency and compromise nurse well-being.

Fostering green transformational leadership: the influence of green educational intervention on nurse managers' green behavior and creativity.

AIM: This study aimed to investigate the influence of green transformational leadership educational intervention on nurse managers' green behavior and creativity. BACKGROUND: Organizational creativity is greatly influenced by leaders and their personality attributes. Additionally, innovative employee behavior is crucial for organizational performance and survival, which in turn promotes long-term organizational growth. METHOD: A quasi-experimental design was conducted by using pre-test, post-test, and follow-up for a group that included 116 nurse managers who completed the intervention. Data were collected through the green transformational leadership knowledge questionnaire, green transformational leadership scale, green behavior questionnaire, and green creativity scale. RESULTS: Following the implementation of the Green Transformational Leadership educational intervention, there was an improvement in responses connected to the nurse manager's use of green behavior and creativity. Three months after the intervention ended, the improvement was still present. CONCLUSION: Nurse managers who had good knowledge about green transformational leadership showed increased green behavior and green creativity, which enhanced the organization's success. This study showed the significance of developing and improving the skills of managerial creativity for the nurse supervisor of a hospital through training in transformational leadership. IMPLICATIONS FOR NURSING MANAGEMENT: The concept of "green transformational leadership" refers to leadership behaviors and strategies aimed at promoting environmental sustainability and responsibility within an organization or a specific context. In the case we mentioned, it involves implementing educational interventions targeted at nurse managers to enhance their understanding and adoption of green practices, as well as fostering green behavior and creativity among them.

Management of the COVID-19 pandemic: challenges, practices, and organizational support.

BACKGROUND: Health organizations currently face tremendous challenges in the management of the COVID-19 pandemic. To do this, successful and proven scientific practices and support are needed. AIM: This study aimed to explore the challenges, practices, and organizational support dealt with by nursing managers in the management of the COVID-19 pandemic. METHOD: A qualitative content analysis study evaluated 35 nursing managers in five university hospitals through a semi-structured interview. The Consolidated Criteria for Reporting Qualitative Research were used for this qualitative study. RESULTS: Three main themes emerged: Challenges include the development of a COVID-19 crisis management plan, a shortage in nursing staff, and psychological problems. Practices include; changes in work schedules for nursing staff, the exchange process, hospital preparation, and training and education. And organizational support includes both support at an organizational level and support at an individual level. CONCLUSION: This study revealed that nursing managers are faced with many challenges in the management of COVID-19, requiring good practices and organizational support. This study offers evidence for nursing managers to expect problems that may arise during the pandemic. RECOMMENDATIONS: The COVID-19 pandemic requires the development of an integrated plan, and this plan must be disseminated to the hospital's nursing and medical teams to better equip them for the current and future crises.

Integrating sustainability development education program in nursing to challenge practice among nursing interns in health care.

AIM: This study aimed to investigate the Integrating Sustainability Development Education Program in Nursing to Challenge Practice Among Nursing Interns in Health Care. BACKGROUND: The combination of sustainable development and climate change in health care delivery benefits from the apparent environmental changes. SUBJECTS AND METHODS: The quasi-experimental, cross-sectional, comparative study included 160 nursing interns who completed the intervention. Both genders were assigned to Saudi (N = 80) and Egyptian nursing interns (N = 80). Data was collected using a self-administered questionnaire, which included the Sustainability Consciousness Questionnaire and the Sustainability Attitudes in Nursing Survey. RESULTS: A statistically significant difference was found between student nurses' knowledge, attitude and behaviour during pre-intervention and post-intervention, as well as in student nurses' sustainability development dimension effectiveness after than before program implementation. CONCLUSION: The program had a significant effect on all sustainability development domains and a large effect on total sustainability development during post-intervention. This study recommended that educational programs can upgrade sustainability development and challenge practice levels. IMPLICATIONS FOR NURSING MANAGEMENT: Sustainable development is the future of management and is the next phase of management innovation. Sustainability, in the context of health care, is about progress in high-quality patient care delivery for all by promoting the three elements of sustainable development: environmental, social and financial. Nurses play a significant leadership role in addressing environmental sustainability and climate change.