RESUMO
Aim of the study: Hepatocellular carcinoma (HCC) is a leading cause of mortality among patients with liver cirrhosis. According to the current practice guidelines, different ablations are used either as curative or palliative therapies. The current study aimed at determining bacterial infections as causes of fever and the predictive role of procalcitonin (PCT) among patients with HCC who had ablation therapy. Material and methods: This cross sectional study was carried out on 100 patients with HCC during the period from November 2019 to December 2021. All patients were evaluated by full history taking, clinical examination, complete blood picture (CBC), liver biochemistry, coagulation profile, kidney function, C-reactive protein (CRP), serum PCT and blood cultures. All were done for all participants at the 4th day follow-up after the procedures of ablation. HCC was treated according to the guidelines. Results: The frequency of fever after HCC ablation was 64% with variable intensities. Bacterial cultures were positive in 20 patients (20%). Twenty-four out of 100 patients had abnormally high PCT level. There was a highly statistically significant increase of PCT level in patients with a high CRP count and positive blood culture, p < 0.05. There was a statistically significant correlation between increased levels of PCT and levels of CRP, WBCs, albumin, AST, ALT, degree of fever, creatinine and BUN. Conclusions: Bacterial infection accounts for 20% of fever among HCC patients after ablation therapy. PCT is 100% sensitive and specific for detection of the bacterial causes of fever among those patients.
RESUMO
Background: Nursing managers and leaders must fight to retain nurses in hospitals by constructing an inviting organizational climate that is attractive to work in, not toxic. The organizational climate is primarily affected by employees' internal work environment and behavior. Hence, nursing managers and leaders must implement effective strategies to increase nurses intention to stay by address the organizational climate. Aim: This study was designed to assess nurses' perception of the effects of organizational climate and toxic leadership behaviors on their intention to stay and the differences in these domains between the two hospitals studied. Methods: A descriptive comparative design was used. Data were collected in 2022 from 250 nurses working in the two largest hospitals in Assiut, an Egyptian city south of Cairo, using three self-administered questionnaires: the organizational climate questionnaire (42 items categorized into nine domains), the toxic leadership scale (30 items categorized into five domains), and the Chinese version of the intent-to-stay scale. Results: Most nurses reported their intention to stay as "normal." The nurse participants perceived that a positive organizational climate was not present, but toxic leadership was at a low level (13.6% and 25.6%, respectively). The model of regression analysis was significant, showing that the organizational climate represented by supportive systems impacted nurses' intention to stay in the hospitals under study. Meanwhile, toxic leadership behaviors, represented by authoritarian leadership, unpredictability in the university hospital, and self-promotion in the insurance hospital, affected nurses' intention to stay. Conclusion: Positive organizational climate played a significant role in retaining nurses through investing in incentives and providing supportive systems. Authoritarian leadership, unpredictability, and the self-promotion of leaders' behaviors impacted the nurses and the climate negatively. Hence, we recommend investing in potential strategies to improve the nurses' intention to stay through performance standards, increased pay and benefits, clear reward mechanisms, participation in decision making, and assessments of leaders' behaviors. Furthermore, decision and policy makers need to establish effective, supportive systems in hospitals to retain nurses. Hence, nursing managers and leaders must rethink how they can use their leadership skills and behavior in a positive manner to promote nurse retention. Study registration: Not registered.