Entrepreneurial leadership, nurses' proactive work behavior, and career adaptability: a structural equation model.

BACKGROUND: Healthcare organizations with practitioners who exhibit proactive work behavior and career adaptability acquire a competitive advantage in the face of many adversities. Entrepreneurial leadership (EL) is a new leadership approach that has a huge impact on followers' behavior, although research into its theory and empirical evidence is still in its infancy. METHODS: A non-probability convenience sample methodology (n = 450) was utilized to choose study participants, who were equally dispersed among the two private hospitals in Alexandria. A cross-sectional study was carried out in all departments of the hospitals, which were chosen at random using a simple random procedure. Three validated scales were used in this study to measure the study variables and establish a structural equation model. RESULTS: The result of this study revealed that nurses perceived moderate mean scores of all variables; entrepreneurial leadership (140.84 ± 11.94), proactive work behavior (46.02 ± 5.85), and career adaptability (85.55 ± 10.35). In addition, the structured equation model revealed a goodness fit index and presents that entrepreneurial leadership significantly affects nurses' proactive work behavior with an estimated ß of 0.555, coefficient of regression C.R. of 4.006, at P value < 0.001. Also, it significantly affects career adaptability with an estimated ß of .834, a coefficient of regression C.R. of 3.491 at P value < 0.001. CONCLUSIONS: The developed structural equation model confirmed the significant impact of entrepreneurial leadership (EL) on nurses' proactive work behavior (PWB) and career adaptability (CA)". Therefore, this study offers important implications for nurse managers, staff nurses, hospital human resources management practice, and academics.

Maxillary sinus volume in patients with canted occlusal plane: A cone-beam computed tomography study.

OBJECTIVES: To compare the maxillary sinus volume between both sides in adult patients with upper occlusal canting (>2 mm cant) and a control group (≤2 mm cant) using cone-beam computed tomography scans. MATERIALS AND METHODS: This retrospective study included a total of 84 scans (42 scans per group) according to predetermined selection criteria. OnDemand 3-D™ software was used for volumetric and linear measurements of the maxillary sinus. Maxillary occlusal canting was determined at the level of the maxillary first molars. It was defined as the vertical difference between right and left sides relative to the Frankfort horizontal plane. Non-parametric tests were applied. RESULTS: The median difference in the maxillary sinus volume between the sides was statistically significant between the control and cant groups (P < 0.001). Also, the median difference in the maxillary sinus craniocaudal height and apex sinus distance between the sides was statistically significant between the control and cant groups (P < 0.05 and P < 0.001, respectively). CONCLUSION: In adult patients, maxillary occlusal canting of more than 2 mm was associated with asymmetric maxillary sinus volumes. In the cant group, maxillary first molars on the canted-down side were in close proximity to the sinus floor, which suggests a limited leeway for molar intrusion.

Post COVID-19 workplace ostracism and counterproductive behaviors: Moral leadership.

BACKGROUND: The wide proliferation of Covid-19 has impacted billions of people all over the world. This catastrophic pandemic outbreak and ostracism at work have posed challenges for all healthcare professionals, especially for nurses, and have led to a significant increase in the workload, several physical and mental problems, and a change in behavior that is more negative and counterproductive. Therefore, leadership behaviors that are moral in nature serve as a trigger and lessen the adverse workplace effects on nurses' conduct. AIM: this research is directed to explore the impact of post-COVID-19 workplace ostracism on nurses' counterproductive behavior and examine the role of moral leadership as a mediating factor in post-COVID-19 workplace ostracism and nurses' counterproductive behavior. ETHICAL CONSIDERATION: Ethical review and approval Was received from Ethical Committee at the Faculty of Nursing, Alexandria University, Egypt. METHODS: A cross-sectional and correlation study was implemented in all units of medical, surgical, critical and intensive care units by using three tools; moral leadership questionnaire, Workplace Ostracism Instrument (WOS), and Counterproductive Work Behaviors Questionnaire (CWBs). A convenient sample of 340 from 699 bedside nurses was granted. RESULTS: This study revealed that nurses' perceived moderate mean percent (55.49 ± 3.46) of overall workplace ostracism and counterproductive behavior (74.69 ± 6.15). However, they perceived a low mean percentage of moral leadership. There was a significant positive correlation between workplace ostracism and counterproductive behavior. Otherwise, a significant negative correlation was found between moral leadership, workplace ostracism and counterproductive behavior. Also, this study proved the mediating effect of moral leadership in decreasing workplace ostracism by 79.3% and counterproductive behavior by 36.7%. CONCLUSION: Hospital administrators need to be aware of the significance of moral leadership and apply integrity in the clinical setting to reduce the drawback of isolation on nurses' conduct and increase value for the organization as a whole and nurses in particular.

Crisis, ethical leadership and moral courage: Ethical climate during COVID-19.

BACKGROUND: The global COVID-19 pandemic has challenged nurse leaders in ways that one could not imagine. Along with ongoing priorities of providing high quality, cost-effective and safe care, nurse leaders are also committed to promote an ethical climate that support nurses' moral courage for sustaining excellence in patient and family care. AIM: This study is directed to develop a structure equation model of crisis, ethical leadership and nurses' moral courage: mediating effect of ethical climate during COVID-19. ETHICAL CONSIDERATION: Approval was obtained from Ethics Committee at Faculty of Nursing, Alexandria University, Egypt. METHODS: A cross-sectional design was used to conduct this study using validated scales to measure the study variables. It was conducted in all units of two isolated hospitals in Damanhur, Egypt. A convenient sample of 235 nurses was recruited to be involved in this study. RESULTS: This study revealed that nurses perceived a moderate mean percent (55.49 ± 3.46) of overall crisis leadership, high mean percent (74.69 ± 6.15) of overall ethical leadership, high mean percent (72.09 ± 7.73) of their moral courage, and moderate mean percent of overall ethical climate (65.67 ± 12.04). Additionally, this study declared a strong positive statistical significant correlation between all study variables and indicated that the independent variable (crisis and ethical leadership) can predict a 0.96, 0.6, respectively, increasing in the dependent variable (nurses' moral courage) through the mediating impact of ethical climate. CONCLUSION: Nursing administrators should be conscious of the importance of crisis, ethical leadership competencies and the role of ethical climate to enhance nurses' moral courage especially during pandemic. Therefore, these findings have significant contributions that support healthcare organizations to develop strategies that provide a supportive ethical climate. Develop ethical and crisis leadership competencies in order to improve nurses' moral courage by holding meetings, workshops, and allowing open dialogue with nurses to assess their moral courage.

Can ethanol intoxication secondary to docetaxel be predicted based on dose administered using a point-of-care saliva ethanol test?

BACKGROUND: The Food and Drug Administration issued a drug safety alert highlighting the potential association of docetaxel infusion with signs and symptoms of alcohol intoxication. This concern is significant because patients treated with docetaxel often have comorbidities and are prescribed concomitant centrally active medications. As a result, these patients may be at risk for iatrogenic events. OBJECTIVE: The objective of this study was to identify a correlation with docetaxel infusion and saliva ethanol concentration using a point-of-care ethanol test. METHODS: In this pilot study, ethanol concentrations were measured using a validated saliva ethanol test in patients receiving intravenous docetaxel as part of their chemotherapy regimen. Both ethanol dose and infusion rate were calculated based on the amount of the specific docetaxel product administered. Saliva ethanol concentrations were measured at baseline, immediately after infusion completion, and at 30 and 60 min postinfusion. RESULTS: A total of 17 patients were included in the analysis. The mean ethanol dose administered was 2.6 ± 0.5 g of ethanol per infusion of docetaxel with a mean infusion rate of 3.2 ± 0.7 ml of ethanol per hour. At baseline, immediately after infusion, and 30 and 60 min postinfusion, all patients had a saliva ethanol test result of 0 mg/dl. CONCLUSION: Based on this small pilot study, the prediction of patients who will experience ethanol intoxication using a point-of-care saliva ethanol test based on the docetaxel dose administered is challenging. This observation requires confirmation in larger and more heterogeneous populations.

Relationship between ethical ideology and moral judgment: Academic nurse educators' perception.

BACKGROUND: Ascertaining the relationship between ethical ideology, moral judgment, and ethical decision among academic nurse educators at work appears to be a challenge particularly in situations when they are faced with a need to solve an ethical problem and make a moral decision. PURPOSE: This study aims to investigate the relationship between ethical ideology, moral judgment, and ethical decision as perceived by academic nurse educators. METHODS: A descriptive correlational research design was conducted at Faculty of Nursing, Alexandria University. All academic nurse educators were included in the study (N = 220). Ethical Position Questionnaire and Questionnaire of Moral Judgment and Ethical Decisions were proved reliable to measure study variables. ETHICAL CONSIDERATIONS: Approval was obtained from Ethics Committee at Faculty of Nursing, Alexandria University. Privacy and confidentiality of data were maintained and assured by obtaining subjects' informed consent. FINDINGS: This study reveals a significant positive moderate correlation between idealism construct of ethical ideology and moral judgment in terms of recognition of the behavior as an ethical issue and the magnitude of emotional consequences of the ethical situation (p < 0.001; p = 0.031) respectively. Also, there is a positive significant moderate correlation between relativism construct of ethical ideology and overall moral judgment (p = 0.010). Approximately 3.5% of the explained variance of overall moral judgment is predicted by idealism together with relativism. DISCUSSION: The findings suggest that variations in ethical position and ideology are associated with moral judgment and ethical decision. CONCLUSION: Organizations of academic nursing education should provide a supportive work environment to help their academic staff to develop their self-awareness and knowledge of their ethical position and promoting their ethical ideologies and, in turn, enhance their moral judgment as well as develop ethical reasoning and decision-making capability of nursing students. More emphasis in nursing curricula is needed on ethical concepts for developing nursing competencies.

Multidisciplinary Approach to Treatment of Soft Tissue Sarcomas Requiring Complex Oncologic Resections.

BACKGROUND: To review the experience and outcome of utilizing a multidisciplinary team, including vascular surgery and orthopedic surgery, in the operative treatment of soft tissue sarcomas (STSs) at an academic, tertiary care hospital. METHODS: A retrospective review was performed of all patients who underwent elective STS resection between July 1, 2012 and January 31, 2015, since the addition of a specialized cancer treatment center and a dedicated oncologic division of orthopedic surgery. Surgical cases performed in conjunction with both orthopedic and vascular surgery were reviewed. RESULTS: Sixty-three patients underwent 66 surgical resections for STS during the study period. There were no perioperative deaths. Fifty-two lower-extremity resections (78.8%), 6 upper-extremity resections (9.1%), and 8 pelvic resections (12.1%) were performed. Sixteen cases required a vascular intervention (24.2%). These interventions included bypass in 2 patients (12.5%), primary repair of a named vessel in 4 patients (25%), and ligation of a named vessel in 10 patients (62.5%). Three patients had local recurrence of their tumor (4.5%), requiring further resection during the follow-up period. Seven patients required a primary amputation (10.6%). The average size of the tumor removed was 1,776 mL, ranging from 5 mL to 36,300 mL. CONCLUSIONS: The quality of surgical resection is paramount in optimal treatment of STS; however, wide resection of STS can result in prolonged operative times, significant blood loss, vascular complications, and functional deficits. A multidisciplinary surgical team including orthopedic and vascular teams may improve the treatment by optimizing complex resections that may require involved vascular control or reconstruction.

Relative value unit-based compensation incentivization in an academic vascular practice improves productivity with no early adverse impact on quality.

OBJECTIVE: Given the increased pressure from governmental programs to restructure reimbursements to reflect quality metrics achieved by physicians, review of current reimbursement schemes is necessary to ensure sustainability of the physician's performance while maintaining and ultimately improving patient outcomes. This study reviewed the impact of reimbursement incentives on evidence-based care outcomes within a vascular surgical program at an academic tertiary care center. METHODS: Data for patients with a confirmed 30-day follow-up for the vascular surgery subset of our institution's National Surgical Quality Improvement Program submission for the years 2013 and 2014 were reviewed. The outcomes reviewed included 30-day mortality, readmission, unplanned returns to the operating room, and all major morbidities. A comparison of both total charges and work relative value units (RVUs) generated was performed before and after changes were made from a salary-based to a productivity-based compensation model. P value analysis was used to determine if there were any statistically significant differences in patient outcomes between the two study years. RESULTS: No statistically significant difference in outcomes of the core measures studied was identified between the two periods. There was a trend toward a lower incidence of respiratory complications, largely driven by a lower incidence in pneumonia between 2013 and 2014. The vascular division had a net increase of 8.2% in total charges and 5.7% in work RVUs after the RVU-based incentivization program was instituted. CONCLUSIONS: Revenue-improving measures can improve sustainability of a vascular program without negatively affecting patient care as evidenced by the lack of difference in evidence-based core outcome measures in our study period. Further studies are needed to elucidate the long-term effects of incentivization programs on both patient care and program viability.

Glucagon for refractory asthma exacerbation.

Glucagon, a hormone secreted by pancreatic alpha cells, causes bronchial smooth muscle relaxation by activating the synthesis of cyclic adenosine monophosphate. It was studied in the 1980s and 1990s as a treatment option for the management of asthma but has since not been evaluated. Data to support its use are limited, but it may serve as a last-line agent for refractory asthma exacerbation. Here we describe 4 cases in which intravenous glucagon was used to manage severe, refractory asthma exacerbation in the emergency department.

Assessment of hospital pharmacy preparedness for mass casualty events.

OBJECTIVES: To assess the preparedness of hospital pharmacies in New Jersey to provide pharmaceutical services in mass casualty scenarios. METHODS: An electronic cross-sectional survey was developed to assess the general knowledge of available resources and attitudes toward the preparedness of the pharmacy department. RESULTS: Out of 60 invitations to participate, 18 surveys (30%) were completed. Respondents practiced at community hospitals (12, 66.6%) with no trauma center designation (11, 67.4%) that served more than 500 licensed beds (five, 29.4%). Six respondents (35.3%) indicated that 75,000 to 100,000 patients visited their emergency departments annually. Seventeen sites (94.4%) reported the existence of an institutional disaster preparedness protocol; 10 (55.5%) indicated that there is a specific plan for the pharmacy department. Most respondents (10, 55.5%) were unsure whether their hospitals had an adequate supply of analgesics, rapid sequence intubation agents, vasopressors, antiemetics, respiratory medications, ophthalmics, oral antimicrobials, and chemical-weapon-specific antidotes. Five (27.7%) agreed that the pharmacy disaster plan included processes to ensure care for patients already hospitalized, and four (22.2%) agreed that the quantity of medication was adequate to treat patients and hospital employees if necessary. Medication stock and quantities were determined based on national or international guidelines at three (16.6%) institutions surveyed. CONCLUSION: This survey demonstrates a lack of general consensus regarding hospital pharmacy preparedness for mass casualty scenarios despite individualized institutional protocols for disaster preparedness. Standardized recommendations from government and/or professional pharmacy organizations should be developed to guide the preparation of hospital pharmacy departments for mass casualty scenarios.

Analysis of Pharmacy Student Perceptions and Attitudes Toward Web 2.0 Tools for Educational Purposes.

Background: The use of Wikis, blogs, and podcasts can engage students in collaborative learning, allow peer feedback, and enhance reflective learning. However, no survey to date has been performed across all professional years of pharmacy students in order to obtain a comprehensive overview of student perceptions. Objectives: To identify the familiarity of pharmacy students with Web 2.0 resources available for medical education, and what barriers exist. Methods: This study surveyed students enrolled in the professional program of a US-accredited pharmacy school to assess their knowledge and current use of available online resources and attitudes toward the use of Web 2.0 technologies for educational purposes. Results: Of the 836 surveys distributed, 293 were collected and analyzed (35.0% response rate). Students reported using the following Web 2.0 technologies in the didactic and experiential settings, respectively: Wikipedia (88%, 70%), YouTube (87%, 41%), Khan Academy (40%, 5%), and medical or scientific blogs (25%, 38%). Although these technologies were more commonly used in the classroom, students agreed or strongly agreed such resources should be used more often in both the didactic (n = 187, 64%) and experiential settings (n = 172, 59%). The barriers associated with the use of Web 2.0 in both the didactic and experiential settings that were ranked highest among students included accuracy and quality of information and lack of familiarity among faculty members and preceptors. Conclusion: Pharmacy students across all professional years actively use Web 2.0 tools for educational purposes and believe that opportunities exist to expand use of such technologies within the didactic and experiential settings.

Peripheral occlusive disease may provide the highest hospital margins despite rising costs.

OBJECTIVE: The objective of this study was to review vascular surgical financial trends in a tertiary care setting and to evaluate the impact of a vascular program within a health care system in the face of lower reimbursements and rising costs. METHODS: With use of Current Procedural Terminology codes and diagnosis-related groups, vascular categories of aortic disease, cerebrovascular disease, and peripheral occlusive disease (POCD) were identified at an academic tertiary health care center. Hospital margins were calculated for each of the defined categories by Health Quest cost accounting data cross-walked with Current Procedural Terminology codes, date of service, and admitting physician for each year from 2010 to 2012. RESULTS: All categories realized volume growth and a positive margin for the hospital. In comparison of 2010 and 2012, aortic cases showed an overall volume growth of 19%, revenue increase of 31%, and cost increase of 54%, resulting in an overall margin decrease of 7%. Cerebrovascular cases showed a 30% increase in volume growth, revenue increase of 13%, and cost increase of 5%, resulting in a margin increase of 18%. POCD cases showed overall volume growth of 35%, revenue increase of 37%, cost increase of 54%, and a margin increase of 15%. The margin for POCD exceeded the margin for aortic and cerebrovascular cases combined by 77%. CONCLUSIONS: In evaluating a vascular program's fiscal viability, volume-driven POCD was the only category producing growing hospital margins in the face of significant cost increases.

The Scholarly Merit of Social Media Use Among Clinical Faculty.

Background: Social media (SoMe) platforms such as blogs, Twitter, and Facebook are increasingly becoming incorporated into education and scientific communities. In fields such as emergency medicine, clinicians have established communication channels through SoMe to engage in academic and clinical discussions for the purposes of professional growth. While the use of SoMe as an educational tool within the classroom has been previously described, its use as a professional tool has not been adequately investigated. Objective: To assess the perception of SoMe as an academic tool among deans of accredited health care professional schools in the United States. Methods: An electronic cross-sectional survey was distributed to deans of accredited medical, nursing, and pharmacy schools across the United States to assess the knowledge of SoMe, attitudes toward academic merit, and challenges to incorporating SoMe into scholarly activity. Responses were analyzed using descriptive statistics. Results: Of 188 responses (response rate = 22%), 162 (86%) agreed publication in a peer-reviewed journal ranked highest in academic merit, followed by publishing in medical Web sites (157, 84%), publication in a university-based newsletter (147, 78%), and personal medical education blog (150, 80%). Fifty-one (31%) of respondents stated that volume of viewership would improve academic merit, while 85 (52%) believed a peer-review process would improve academic merit. Conclusion: Although professional SoMe activities should not replace traditional publications, the result of this study suggest establishing a peer-review process to improve validity of such activities.

Lateral geniculate artery pseudoaneurysm after arthroscopic medial meniscectomy.

Vascular complications after arthroscopy are rare and generally present as transient paresthesia most likely due to nervous injury or vasospasm. Rare cases of genicular artery injuries can occur and generally involve the medial genicular artery due to proximity to the right arthroscopic knee hook. This case, however, represents a rare lateral inferior genicular artery injury resulting in a symptomatic pseudoaneurysm. In addition, during the workup, the best visualization of the pseudoaneurysm was possible using duplex ultrasound. The diagnostic information seen on ultrasound was paramount and superseded the findings from conventional angiography and computed tomography angiography, both of which were nonspecific. In brief, this case not only highlights a rare surgical complication but also emphasizes the importance of duplex ultrasound compared with angiography and computed tomography in the workup of pseudoaneurysms.

Activated prothrombin complex concentrates for the reversal of anticoagulant-associated coagulopathy.

OBJECTIVE: Prothrombin complex concentrate (PCC) products are emerging as alternative strategies for reversing anticoagulant pharmacotherapy. Factor eight inhibitor bypassing activity (FEIBA, or anti-inhibitor coagulant complex) is an activated PCC (aPCC). Although FEIBA is approved by the FDA to control spontaneous bleeding episodes and to prevent bleeding with surgical interventions in hemophilia A and hemophilia B patients with inhibitors to factor VIII, recent data have suggested that the product may be used off-label as an anticoagulant-reversal agent. To evaluate the safety and efficacy of aPCC products in reversing anticoagulant pharmacotherapy, we searched online databases for English-language publications that discussed this topic. DATA SOURCES: The EMBASE, MEDLINE, and International Pharmaceutical Abstracts databases were used. We evaluated all articles published in the English language identified from the data sources. We included studies conducted in human subjects and in in vitro and in vivo models in our review. RESULTS: Current published evidence suggests that the use of an aPCC, compared with fresh-frozen plasma, is associated with a significantly faster correction of supratherapeutic International Normalized Ratios (INRs) secondary to warfarin therapy. Conflicting evidence exists regarding the ability of aPCCs to reverse the prolonged bleeding times caused by the anticoagulant agents dabigatran etexilate (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis), and fondaparinux (Arixtra). CONCLUSION: The theoretical risks of thrombosis associated with PCC products must be carefully considered before they are administered to patients who require coagulation therapy. The use of aPCCs to reverse the anticoagulant effects of warfarin, dabigatran, or rivaroxaban should be limited because of the lack of efficacy and safety data in humans. Moreover, the safety of aPCCs in off-label indications has not been adequately assessed.

Optimization of antidote stocking, availability, and administration practices for a large multihospital organization.

PURPOSE: Inadequate hospital antidote inventory is a widely documented international issue due to high medication costs, lack of emphasis on antidote importance, variable international standards, hospital size, and drug availability. A large health system underwent process and policy implementation for antidote stocking, availability tracking, and administration strategies to ensure appropriate inventory and improve patient safety. SUMMARY: Process and policy implementation occurred over a 12-month period across the health system's 11 acute care hospitals with emergency department services. Opportunities for optimization were identified following data capture surrounding institution-specific antidote inventory and usage across the health system. Specifically, minimum par levels at each institution were determined from 2018 expert recommendations for both the central pharmacy and automated dispensing machines within the emergency department. These quantities ensured the availability of an antidote within a specific timeframe contingent on the acquisition acuity for at least one 100-kg patient. Entries for order sets, order statements, and smart pump drug libraries were modified or formulated to facilitate standardized practices and minimize safety errors before a system-wide electronic health record transition. CONCLUSION: It is prudent for all institutions, independent or within a health system, to identify areas of improvement for antidote inventory and management. Implementation of a similar process for antidote stocking, sharing, and delivery at other institutions is feasible and necessary to mitigate issues with drug acquisition and timely administration.