Knowledge of blood transfusion practices among medical students and residents.

A study was conducted to assess and compare the knowledge of blood transfusion practices among medical students and residents in Lebanese and Saudi medical institutions. The online survey consisted of 26 questions: 4 about personal data and experience with transfusion and 22 about knowledge on transfusion practices in the areas of blood donation and donor selection, production and storage of blood components, selection of appropriate blood components, administration of blood components, transfusion reactions, and complications. One hundred and twenty-six students from Saudi Arabia, 84 students from Lebanon, 31 residents from Saudi Arabia, and 23 residents from Lebanon participated in the survey. There were no significant differences between students' and residents' levels of knowledge. Similarly, there was no difference between the students' level of knowledge in the two countries. The correct responses (48% and 46%, for students and residents, respectively) were below the acceptable limit of 60% for both groups. This reflects the need for more vigorous and well-structured education and training for both students and residents.

Healthcare Workers' Assessment of a Visual Triage System (VTS).

Overcrowding and extended waiting times in the emergency department (ED) can pose a significant risk of COVID-19 transmission from patients to healthy individuals. In 2017, the Saudi Ministry of Health (MOH) introduced a visual triage system (VTS) with scoring to notify healthcare workers (HCWs) in EDs about the Middle East respiratory syndrome coronavirus (MERS-CoV) infection risk. During the COVID-19 pandemic, the MOH employed a VTS to classify patients according to their potential risk of COVID-19 infection upon their admission to the ED. Suspected patients were then directed along specific pathways to reduce their contact with healthy individuals. This study assessed HCWs' satisfaction with the VTS in the ED of two major government hospitals within the Riyadh region. Additionally, it assessed HCWs' perceptions of VTS effectiveness. This study used a cross-sectional, observational design and relied on surveys for data collection. A total of 127 participants completed the survey, of which 87 (68.5%) were based in the EDs of the two hospitals. Among the ED participants, 18.1% expressed satisfaction with the VTS, 46.4% were neutral, and 33.1% reported dissatisfaction. ED participants provided feedback on the system's effectiveness, with 24.1% finding it effective, 66.7% considering it somewhat effective, and 9.2% deeming it ineffective. Of the total (127) study participants (70.1%) reported that the HCWs required better training to effectively implement the VTS infection control plans for suspected cases. Fewer than half of the participants (35.4%) deemed the time spent by VTS personnel to identify COVID-19 cases to be reasonable, whereas 22% found it too short and 27.6% considered it too long. Of the total 127 participants, 63% reported that language differences between patients and HCWs constituted barriers to the effective application of the VTS. Our study findings indicated that most ED participants had a neutral outlook on their satisfaction with the VTS and a neutral perspective on the effectiveness of VTS, viewing it as only somewhat effective. Reported weaknesses and key obstacles to the successful implementation of the VTS included language barriers. and insufficient training for HCWs, and unclear VTS pathways. The reported strengths of the VTS included its effectiveness in reducing crowds and identification of COVID-19 patients.

Helicobacter pylori Infection: Clinical, Endoscopic, and Histological Findings in Lebanese Pediatric Patients.

BACKGROUND: Helicobacter pylori (H. pylori) is a common and universally distributed bacterial infection. However, in children, active gastritis and ulcer are rarely seen. OBJECTIVES: The aims of this study were to establish the prevalence of H. pylori infection and to compare the clinical, endoscopic, and histopathological findings between infected and noninfected pediatric patients at Makassed General Hospital. METHODS: Patients aged between 1 month and 17 years who underwent upper gastrointestinal endoscopy from January 2011 to January 2017 were included. The diagnosis of H. pylori was confirmed by a CLO test and/or its presence on biopsy specimens. Demographic data, clinical characteristics, endoscopic and histopathological findings, and gastritis score were recorded retrospectively. RESULTS: During the study period, 651 children underwent upper gastrointestinal endoscopy. The main indication was abdominal pain (61%). The prevalence of H. pylori infection was 16.5%. The infection was most commonly seen among children aged between 6 and 10 years (43%). A large number of family members were associated with increased risk of infection (4.8 ± 1.5 versus 5.2 ± 1.8; p < 0.05). Epigastric pain was more associated with H. pylori (61.3% versus 14.6% in noninfected patients; p < 0.05). Nodular gastritis was commonly seen in infected patients (41.5% vs. 7.9%; p < 0.05). Mild and moderate gastritis was seen more in infected versus noninfected patients (mild: 53.8% vs. 14%; moderate: 27.4% vs. 2.4%, respectively). CONCLUSION: Although epigastric pain was associated with H. pylori, other diagnoses should be considered since the infection are rarely symptomatic in children. Antral nodularity was associated with H. pylori infection; however, its absence does not preclude the diagnosis.

African Head and Neck Society Clinical Practice guidelines for thyroid nodules and cancer in developing countries and limited resource settings.

BACKGROUND: International thyroid nodule and cancer management guidelines generally fail to take into account potential limitations in diagnostic and treatment resources. METHODS: Thyroid cancer specialists from the African Head and Neck Society and American Head & Neck Society Endocrine Section developed guidelines for diagnosis and management of thyroid nodules and cancer in low resource settings. Recommendations were based on literature review and expert opinion, with level of evidence defined. RESULTS: Using the ADAPTE process, diagnostic and treatment algorithms were adapted from the National Comprehensive Cancer Network (NCCN). Low resource settings were simulated by systematically removing elements such as availability of laboratory testing, hormone replacement, imaging, and cytopathology from NCCN guidelines. CONCLUSIONS: Successful management of thyroid nodules and cancer in low resource settings requires adaptation of treatment methodologies. These guidelines define specific scenarios where either more or less aggressive intervention for thyroid pathology may be advisable based on limited available resources.

Anthropometrics Analysis of Mental Foramen and Accessory Mental Foramen in Zambian Adult Human Mandibles.

The mental foramen (MF) and accessory mental foramen (AMF) are the strategically important landmarks during surgical interventions and anaesthetic nerve blocks procedures involving the mental nerve. The study aimed at evaluating anthropometrics of MF and AMF in Zambian adult human mandibles and it was cleared for ethics from TDRC Ethics Review Committee (Reg. No.: 00002911; FWA: 00003729). A total of 33 Zambian adult human mandibles were evaluated for shape, position, and direction of opening of foramen. All measurements were performed using a Digital Vernier Calliper and statistically analysed for per cent frequency and mean and standard deviations, and we performed the one sample t-test for comparative analysis. Data were considered significant at p<0.05. All mandibles that were examined had bilateral MF while unilateral AMF was found in two mandibles (6%). The foramens were mostly oval in shape and their most common position was between the second premolar and first molar and the most common orientation was posterior-superior. The comparative analysis of mandibular anthropometrics showed significant variations (p<0.05) with different ethnic groups. The findings emphasize the ethnic variations and edify that the foramen position is not always as stated in reference textbooks. The clinical creditability of the study is cautioning the surgeons on possible variations of the MF and AMF anthropometrics compared to existing literature in order to avoid any unforeseen injury related to anaesthesia or dental surgeries. Further studies with large sample sizes representing whole country are recommended to establish the standard MF and AMF anthropometrics of Zambian population.

African head and neck fellowships: A model for a sustainable impact on head and neck cancer care in developing countries.

BACKGROUND: There is an extreme shortage of head and neck surgeons in Africa. Fourteen head and neck surgeons have completed fellowships in Cape Town and Cameroon. This study determines whether such Africa-based fellowships are a good model for developing countries by making a sustainable impact on head and neck cancer care. METHODS: An observational study was conducted by emailing questionnaires to past fellows. RESULTS: All fellows had returned to teaching hospitals in their counties. Seven established new multidisciplinary cancer teams. Head and neck operations had increased by >335%, as had complexity of the surgery. There was effective transfer of surgical skills to trainees. All considered head and neck fellowships to be the best model to grow head and neck care. CONCLUSION: Head and neck fellowships in developing countries are effective models for establishing training programs and for increasing provision of specialized surgical services in a sustainable fashion.

Phosphodiesterase type 5 inhibitors usage and prostate cancer: a match-paired analysis.

BACKGROUND: To treat erectile dysfunction (ED), phosphodiesterase type 5 inhibitors (PDE5i) are commonly used. However, to date, only a few studies exist evaluate a possible effect on the incidence of prostate cancer. One such study completed by the authors' institution suggested men who use PDE5i for ED may have a lower incidence of prostate cancer. This study was meant to address some of the shortcomings of the former study and further characterize the link between prostate cancer and PDE5i use. METHODS: A retrospective, match-paired analysis was undertaken: 5,717 patients were identified between 2000 and 2011; a 1:2 match pair analysis ultimately identified 394 cases with cancer and 788 controls without cancer. Pairs were matched based on age, ethnicity, and PSA value. RESULTS: No correlation existed between PDE5i use and prostate cancer [OR 1.02, 95% confidence interval (CI): 0.78-1.35, P=0.8842] or diabetes mellitus and prostate cancer (OR 1.12, 95% CI: 0.84-1.48, P=0.4499). A statistically significant correlation was demonstrated with PSA and prostate cancer (OR 1.48, 95% CI: 1.38-1.58, P<0.0001). CONCLUSIONS: The data suggest that there is essentially no association with PDE5i use and prostate cancer.

Characterization of influenza outbreaks in Lebanon during the 2013/14 and 2014/15 seasons.

Despite the significant burden of influenza outbreaks, active disease monitoring has been largely absent in the Middle East, including Lebanon. In this study we characterized influenza virus in 440 nasopharyngeal swabs collected from patients with acute respiratory infections during two influenza seasons in Lebanon. Influenza A(H3N2) was dominant in the 2013/14 season while the A(H1N1)pdm09 and B/Yamagata strains were most prevalent in the 2014/15 season. All tested isolates were susceptible to 4 neuraminidase inhibitors (oseltamivir, zanamivir, peramivir and laninamivir). Genetic analysis of the haemagglutinin gene revealed multiple introductions of influenza viruses into Lebanon from different geographic sources during each season. Additionally, large data gaps were identified in the Middle East region, as indicated by the lack of current influenza sequences in the database from many countries in the region.

Antenatal corticosteroids in the late preterm period: A prospective cohort study.

OBJECTIVE: The study objective was to examine the effect of antenatal corticosteroids on the incidence of short-term neonatal morbidities in singletons born during the late preterm period. STUDY DESIGN: This was a prospective cohort study of singleton gestations at risk of imminent delivery between 34 0/7 and 36 6/7 weeks. Short-term neonatal morbidities were compared between the corticosteroid exposed and non-exposed groups. The rates of Neonatal Morbidity Composite and Any Adverse Neonatal Morbidity were then compared between the two groups. RESULTS: During the two-year study period, a total of 295 subjects were included. Of those, 74 were exposed to antenatal corticosteroids, while 221 cases constituted the non-exposed group. There was no statistically significant difference in the rate of Any Adverse Neonatal Morbidity (47.3% vs. 40.7% , p = 0.32) or the rate of Neonatal Morbidity Composite (34.4% vs. 37.8% , p = 0.59) between the two groups. Additionally, there was no statistically significant difference in the rates of neonatal intensive care unit admission, respiratory distress syndrome, transient tachypnea of the newborn, hypothermia, and need for phototherapy. CONCLUSION: Administration of antenatal corticosteroids to parturients at risk of imminent delivery during the late preterm period does not appear to reduce short-term neonatal morbidities.

Dyslipidemia and reduced total antioxidant status in young adult Saudis with prediabetes.

AIMS: Lifestyle related noncommunicable health conditions are having an increasingly negative impact on the health. This study aimed to assess the lipid profile, total antioxidant capacity, and the lifestyle predictors of conversion to prediabetes in young Saudis with prediabetes. MATERIALS AND METHODS: One hundred and twenty-one young Saudis with fasting plasma glucose (<125 mg/dl) enrolled in this study who further categorized into normal glucose tolerance "NGT" group (n=86) and prediabetes group (IFG; n=08/IGT; n=27) based on American Association criteria. Venous blood samples were collected at fasting and 2h postprandial from participants. Chemistry parameters and total antioxidant status (TAS) were assayed by standard procedures. Questionnaires were applied to collect information including demographic characteristics, physical activity, and family history to diabetes. Statistical analysis was performed using SPSS version 17. RESULTS: Compared to NGT subjects, the prediabetics characterized by marked obesity (p=.027), visceral obesity (p=.002), dyslipidemia, significantly increased HbA1c (p=.003), reduced TAS (p<.001), more sedentary lifestyle (p=.010). Positive correlations were documented between FPG, 2-h plasma glucose and HbA1c, BMI, WC, TC, LDL cholesterol, TG while negative correlations with HDL cholesterol, TAS. CONCLUSION: The current study reported that prediabetes condition (in young adult Saudis) was associated with dyslipidemia, reduced total antioxidant status, obesity, central obesity, and physical inactivity compared to those with normoglycemia. Lifestyle modifications (through weight loss, regular physical activity, and healthy diet) should be encouraged especially among young Saudis to prevent the progression to type 2 diabetes and its complications from prediabetes state.

Consultation on the Libyan health systems: towards patient-centred services.

The extra demand imposed upon the Libyan health services during and after the Libyan revolution in 2011 led the ailing health systems to collapse. To start the planning process to re-engineer the health sector, the Libyan Ministry of Health in collaboration with the World Health Organisation (WHO) and other international experts in the field sponsored the National Health Systems Conference in Tripoli, Libya, between the 26th and the 30th of August 2012. The aim of this conference was to study how health systems function at the international arena and to facilitate a consultative process between 500 Libyan health experts in order to identify the problems within the Libyan health system and propose potential solutions. The scientific programme adopted the WHO health care system framework and used its six system building blocks: i) Health Governance; ii) Health Care Finance; iii) Health Service Delivery; iv) Human Resources for Health; v) Pharmaceuticals and Health Technology; and vi) Health Information System. The experts used a structured approach starting with clarifying the concepts, evaluating the current status of that health system block in Libya, thereby identifying the strengths, weaknesses, and major deficiencies. This article summarises the 500 health expert recommendations that seized the opportunity to map a modern health systems to take the Libyan health sector into the 21st century.

Incidence rate of prostate cancer in men treated for erectile dysfunction with phosphodiesterase type 5 inhibitors: retrospective analysis.

The purpose of this study was to determine the incidence rate of prostate cancer among men with erectile dysfunction (ED) treated with phosphodiesterase type 5 inhibitors (PDE-5i) over a 7-year period vs. men with ED of the same age and with similar risk factors who were not treated with PDE-5i. In a retrospective review of electronic medical records and billing databases between the years 2000 and 2006, men with ED between the ages of 50 and 69 years and no history of prostate cancer prior to 2000 were identified. These individuals were divided into two groups: 2362 men who had treatment with PDE-5i, and 2612 men who did not have treatment. Demographic data in each group were compared. During the study period, 97 (4.1%) men with ED treated with PDE-5i were diagnosed with prostate cancer compared with 258 (9.9%) men with ED in the non-treated group (P<00001). A higher percentage of African Americans were treated with PDE-5i vs. those who were not (10.5% vs. 7.1%; P<0.0001). The PDE-5i group had lower documented diagnosis of elevated prostate-specific antigen (10.0% vs. 13.1%; P=0.0008) and higher percentage of benign prostatic hyperplasia (38.4% vs. 35.1%; P=0.0149). Men with ED treated with PDE-5i tended to have less chance (adjusted odds ratio: 0.4; 95% confidence intervals: 0.3-0.5; P<0.0001) of having prostate cancer. Our data suggest that men with ED treated with PDE-5i tended to have less of a chance of being diagnosed with prostate cancer. Further research is warranted.

Purification, structural elucidation and antitumor activity of a novel mannogalactoglucan from the fruiting bodies of Lentinus edodes.

A mannogalactoglucan, named LE-MGG, was isolated from the basidiocarps of Lentinus edodes by hot water-extraction, ethanol precipitation anion exchange chromatography, and further purified by gel-permeation chromatography (GPC). Its structural features were investigated by high performance liquid chromatography (HPLC), high performance gel-permeation chromatography (HPGPC), methylation analysis, periodate oxidation-Smith degradation, and by IR and NMR spectroscopy, including two-dimensional (2D) NMR. HPLC analysis revealed that LE-MGG contained mannose-galactose-glucose in the molar ratio of 10:18:72. GPC and HPGPC showed that LE-MGG was a homogeneous fraction (d=1.34) and its molecular weight was estimated to be 18kDa. Chemical and spectroscopic studies indicated that LE-MGG consists of (1→6)-, (1→4)- and (1→3)-linked ß-d-glucopyranosyl residues, (1→6)-linked α-d-galactopyranosyl residues, (1→3,6)- and (1→2,4)-linked α-d-mannopyranosyl residues and terminal residues of ß-d-glucopyranosyl. Cytotoxicity assay showed that LE-MGG presented higher antitumor activities against S-180 cell with a dose-dependent manner, and exhibited lower cytotoxicity to carcinoma HCT-116 and HT-29 cells. Our studies showed also that LE-MGG presented antitumor bioactivities on Sarcoma 180 solid tumor cell implanted in Kunming mice. This finding suggests that mannogalactoglucan should be explored as potential antitumor agents and could be potentially applied as a natural antitumor drug.

Purification and in vitro anti-proliferative effect of novel neutral polysaccharides from Lentinus edodes.

A (1→6)-ß-D-glucan (WPLE-N-1) and two mannogalactoglucans (WPLE-N-2 and WPLE-N-3) were isolated from the basidiocarps of Lentinus edodes by hot water extraction, ethanol precipitation, anion exchange chromatography, and further purified by gel-permeation chromatography (GPC). Their structural features were investigated by high performance liquid chromatography (HPLC), high performance gel-permeation chromatography (HPGPC), methylation analysis, periodate oxidation-Smith degradation, Fourier transform-infrared (FT-IR) and NMR spectroscopy, including two-dimensional (2D) NMR. HPLC analysis revealed that WPLE-N-1 was mainly composed of glucose (92%) with small amount of galactose (3.9%) and mannose (4.1%), WPLE-N-2 and WPLE-N-3 contained mannose-galactose-glucose in the molar ratio of 10:27:63 and 5:12:83, respectively. GPC and HPGPC showed that WPLE-N-1, WPLE-N-2 and WPLE-N-3 are homogeneous fractions and their molecular weights were estimated to be 757.5 kDa, 20.9 kDa and 4.7 kDa, respectively. Chemical and spectroscopic studies indicated that WPLE-N-1 consisted of (1→6)-ß-D-glucopyranosyl residues; while WPLE-N-2 and WPLE-N-3 were found to contain (1→6)-, (1→4)- and (1→3)-α-D-glucopyranosyl residues, (1→6)-α-D-galactopyranosyl residues, (1→3,6)- and (1→2,4)-α-D-mannopyranosyl residues and terminal residues of D-glucopyranosyl residues. On a preliminary bioactivity test, these three polysaccharides exhibited antitumor activity against Sarcoma S-180, Carcinoma HCT-116 and HT-29 in vitro. This finding suggests that mannogalactoglucan should be explored as potential antitumor agents and utilized as tumor cell growth inhibitors for food and pharmaceutical industries.

Neuroprotective effects of ginseng pectin through the activation of ERK/MAPK and Akt survival signaling pathways.

In this study, we investigated the neuroprotective activities of ginseng pectin (GP) against hydrogen peroxide (H2O2)-induced neuronal toxicity in different neuronal cells. GP selectively attenuated H2O2-induced damage up to 26% in primary cortical neuron cells and human glioblastoma U87 cells. Following H2O2 exposure, DAPI staining and neuron-specific ß-tubulin antibody probing indicated that GP maintained cell integrity and decreased nuclei condensation. Data from western blot analysis revealed that pre-treatment with GP increased the phosphorylation of both the extracellular signal-regulated kinases 1 and 2 (ERK1/2) and Akt in cortical neuron cells. However, the phosphorylation of ERK1/2 was increased, but that of Akt was decreased in U87 cells. These results suggest that the protective effects of GP against H2O2-induced apoptosis may be due to the activation of the phosphorylation of ERK1/2 and Akt; however, the mechanisms involved differ depending on the cell line. This neuroprotective property indicates that GP could serve as a potential therapeutic agent for neurodegenerative diseases.

A comparison of pudendal block vs dorsal penile nerve block for circumcision in children: a randomised controlled trial.

We compared the analgesic and anaesthetic efficacy of pudendal nerve block with that of dorsal penile nerve block in male patients aged 3-5 years of age, undergoing elective circumcision. Thirty patients had a nerve stimulator-guided pudendal nerve block with two separate injection points 1.5-2 cm from the centre of the anus, and thirty patients received a dorsal penile nerve block. The same total anaesthetic volume of 0.3 ml.kg(-1) was used in both groups. The pudendal nerve group showed significantly lower postoperative pain scores than the dorsal group (SD) (p < 0.05), and significantly fewer patients consumed analgesics in the pudendal group than the dorsal group: 0 vs 5 (17%) at 0 and 6 h, respectively. This study demonstrates the effectiveness of pudendal nerve block in comparison to the dorsal nerve block, with improved postoperative outcomes in children undergoing circumcision.

Comparison of polypropylene versus polyester mesh in the Lichtenstein hernia repair with respect to chronic pain and discomfort.

BACKGROUND: Inguinal hernias are the most common operative procedure performed by general surgeons, and tension-free mesh techniques have revolutionized the procedure. While hernia recurrence rates have decreased, chronic postoperative pain has become recognized more widely. New mesh products offer the potential to decrease pain without compromising recurrence rates. Polyester mesh is a softer material than traditional polypropylene and may offer the benefit of causing less postoperative pain and improved quality of life. METHODS: Prospective, single-blind, randomized controlled trial involving 78 patients assigned to receive Lichtenstein type repair with either polyester (n = 39) or polypropylene (n = 39) mesh. Attempt was made to identify ilioinguinal, iliohypogastric, and genitofemoral nerves intraoperatively and document their handling. Patients were interviewed and examined preoperatively and postoperatively at 2 weeks and 3 months. Inguinal Pain Questionnaire (IPQ) and VAS scores were obtained and analyzed using two sample t test for continuous variables and Chi-square test for categorical variables. RESULTS: VAS scores at 3 months were 0.46 for the polyester group versus 0.56 for the polypropylene group (P = 0.6727). At 3 months, 82.3% of the polyester and 76.4% of the polypropylene group had VAS = 0 (P = 0.5486). There was no significant difference between the two groups' VAS scores at 3 months. IPQ did not show any difference between the two groups with the exception of "catching or pulling" being reported in 34.3% of polyester and 5.7% of polypropylene groups (P = 0.0028). CONCLUSIONS: Polyester mesh does not decrease the amount of chronic pain at 3 months. Outcomes with polyester mesh are comparable to polypropylene mesh for Lichtenstein inguinal hernia repair with regards to postoperative pain and quality of life. The sample size in this study was small and limits the significance of the results. Further studies are needed to find the optimal mesh for inguinal hernia repair.

Elevated body mass index in Texas Head Start children: a result of heredity and economics.

OBJECTIVE: The problem of high body mass index (BMI) for age in the Head Start population in Texas is of great concern. The primarily Mexican American population is at high risk for diabetes and cardiovascular disease. This study examines the prevalence of elevated BMI for age in the Head Start population in a sampling of South Texas border counties and a Central Texas county from 2003-2008, and compares it to the Centers for Disease Control and Prevention (CDC) and National Health and Nutrition Examination Survey (NHANES) data for Hispanic preschool children. METHODS: 18,462 age/gender-adjusted BMI measurements obtained by Texas Head Start centers for 2-5 year old children were analyzed to determine the prevalence of BMI for age at the 97th, 95th, and 85th percentiles. RESULTS: In the overall Texas population, 40.79% of males and 36.73% of females were overweight (85th percentile and above) and 20.01% of the males and 19.04% of the females were obese (95th percentile and above). The prevalence of high BMI for age was stable between 2003-2008; however, the overweight cohort increased with the age of the children over that period of time. CONCLUSION: The observed prevalence of elevated BMI in the Texas population is significantly higher than the results for the 2000 age-adjusted gender specific CDC growth charts for Mexican-American children ages 2-5 years old in the NHANES data for 2003-2006. The Texas-Mexico border counties had the highest prevalence of elevated BMI, demonstrating a critical need for dietary and exercise interventions in this medically underserved area.

Perceived stress among nursing and administration staff related to accreditation.

BACKGROUND: Nurses in hospital administration and management positions may experience workplace stress, which can have important consequences on the health and well-being. PURPOSE: The aim of this study was to examine the effects of perceived stress on nursing hospital management and administrative employees of a large health care organization before and after a review by The Joint Commission on the Accreditation of Healthcare Organizations. METHODS: A total of 100 hospital employees were randomly selected to complete questionnaires assessing their perception of stress and its effect on their well-being before and after the site review. They were also asked to rate their subjective experience of sleep, anxiety, depression, and job satisfaction. RESULTS: Perceived stress was significantly related to employees' increased health concerns, symptoms of depression and anxiety, interpersonal relationships, and job satisfaction (p = .003). CONCLUSIONS: Hospital accreditation reviews may increase perceived stress and appears to be related to emotional and physical well-being. APPLICATION: The implications include evidence there is a need for organizations to initiate corrective action to help nurses in administrative roles to cope with increased levels of job strain, minimize potential psychological and physiological consequences, and preserve job satisfaction.