Comprehending the disruptive influence of workplace gaslighting behaviours and mobbing on nurses' career entrenchment: A multi-centre inquiry.

AIM: To explore the disruptive influence of workplace gaslighting behaviours and mobbing on nurses' career entrenchment across multiple healthcare centres. DESIGN: A multi-centre cross-sectional. METHODS: Data were collected from 483 nurses from various healthcare settings in Egypt, spanning from January 2024 to February 2024. The Gaslighting at Work Questionnaire, Luxembourg Workplace Mobbing Scale and Career Entrenchment Scale were employed for data collection. RESULTS: The study revealed moderate levels of gaslighting, mobbing and nurses' career entrenchment. Also, there is a negative correlation between nurses' career entrenchment and both gaslighting and mobbing, while gaslighting and mobbing exhibit a positive correlation. The study also highlighted regional disparities in the prevalence of these phenomena, with the highest incidences noted in urban healthcare settings. CONCLUSION: The findings underscore the critical impact of workplace gaslighting and mobbing on nurses' career entrenchment. REPORTING METHOD: The relevant reporting method has been adhered to, that is, STROBE. IMPLICATION FOR THE PROFESSION: The future of the nursing profession requires building productive nurses who can cope with negative workplace experiences. This could be achieved by cultivating a workplace culture that has zero tolerance for these experiences. Offering counselling services or employee assistance programmes to help nurses cope with the emotional toll of these negative experiences is a promising strategy. IMPACT: This study is the first to examine serious workplace practices like gaslighting and mobbing in a nursing context, emphasizing their effect on nursing-sensitive indicators like career entrenchment. It is one of the important initiatives geared towards upgrading the competitiveness and magnetism of healthcare organizations in the era of green human resources management. Results provide valuable insights for nurse leaders to control nursing turnover and shortage crises in different endeavours. PATIENT OR PUBLIC CONTRIBUTION: In our study, nurses from diverse geographical regions and varied specialties actively participate, offering a rich tapestry of experiences and perspectives.

Threats of nursing productivity in the digital era: investigating the interplay between smartphones addiction and procrastination behavior among nurses.

BACKGROUND: Controlling smartphone addiction and procrastination among nurses is crucial for enhancing the productivity of both nursing and the healthcare system. Critical care nurses are highly vulnerable to smartphone addiction and procrastination behaviors than other groups. They may purposefully delay their tasks, a practice known as active procrastination, or inadvertently delay them, a practice known as passive procrastination. AIM: This study was designed to assess the prevalence of smartphone addiction and procrastination behavior among nurses, examine the effect of smartphone addiction on the active and passive procrastination behaviors, and explore the correlation between active and passive procrastination behaviors among nurses. METHOD: This is a descriptive correlational exploratory study that was conducted at 23 critical care units of one large educational hospital in Egypt. Data were collected from 360 nurses who were conveniently selected using three tools: the Smartphone Addiction Inventory, the New Active Procrastination Scale, and the Unintentional Procrastination Scale. Correlation and regression analyses were conducted to test the hypothetical relationship among the study variables. RESULTS: This study revealed that 55.0%, 80.0%, and 45.3% of nurses had a moderate perceived level of smartphone addiction, active procrastination behavior, and passive procrastination behavior, respectively. There is a significant positive correlation between smartphone addiction and both nurses' active and passive procrastination behaviors. Smartphone addiction accounts for 25% of the variance in nurses' active procrastination behavior and 18% of the variance in their passive procrastination. Furthermore, there is a moderately significant negative correlation between nurses' active procrastination behavior and their passive procrastination behavior. CONCLUSION: Nurses are exhibiting moderate levels of smartphone addiction and procrastination, which is a significant threat to the healthcare industry and nursing productivity. This requires technological, educational, and organizational interventions that foster active procrastination and combat passive procrastination behaviors among nurses. IMPLICATIONS: Continuous training programs are required to enhance time management skills among nurses and increase the awareness of nurse managers with the symptoms of smartphone addiction among nurses. Nurse leaders should early detect and address the addictive use of smartphones among nurses, identify potential procrastinators, and provide counseling to eradicate these behaviors in the workplace.

Perceived stress, coping strategies, symptoms severity and function status among carpal tunnel syndrome patients: a nurse-led correlational Study.

BACKGROUND: Carpal tunnel syndrome (CTS) is a prevalent condition characterized by hand pain, tingling, and numbness. The severity of symptoms and functional status in CTS patients may be influenced by perceived stress and how individuals cope with it. However, scarce knowledge exists about the role of coping strategies as moderators in this relationship. Unfolding the role of perceived stress and coping strategies for CTS management will help the nurse to provide comprehensive and tailored nursing care. This will ultimately improve patient comfort, functionality, and quality of life. PURPOSES: This study aimed to examine the role of coping strategies (adaptive and maladaptive) in the relationship between perceived stress and both symptoms severity and function status among those patients. METHOD: We employed a multisite, correlational study design with moderation analysis. The study included 215 patients with CTS from neurosurgery outpatient clinics at three hospitals in Egypt. After obtaining their consent to participate, eligible participants completed anonymous, self-reported measures of perceived stress, the brief COPE inventory, and the Boston Carpal Tunnel Questionnaire. Demographic and biomedical data were also collected. The questionnaire took about 20 min to be completed. The data was collected over six months, starting in February 2023. RESULTS: The results showed that perceived stress, adaptive coping, and maladaptive coping were significant predictors of symptoms severity and functional status. Adaptive coping moderated the relationships between perceived stress and both symptoms severity and function status, while maladaptive coping did not. The interaction between perceived stress and adaptive coping explained a moderate effect on symptoms severity and function status after controlling for the main effects and the covariates. CONCLUSION: This study explored the relationship between perceived stress, coping strategies, and outcomes in patients with CTS. The results indicate that nurses play a vital role in assessing and assisting patients to adopt effective coping strategies to manage perceived stress and alleviate symptoms and functional impairment. Moreover, the findings support the need for psychological interventions that address both perceived stress and coping strategies as a way to enhance the functioning status and quality of life of patients with CTS.

Humble leadership and nurses' turnover intention: The moderating effect of leader expertise.

AIM: This study was designed to examine the relationship between humble leadership and nurses' turnover intention and investigate the moderating role of leader expertise in this relationship. BACKGROUND: Leader humility and expertise are two key dimensions of professional spirit in competitive magnet organizations. Many organizational factors could make nurses take a decision to leave their organization; however, leader humility and expertise could help nurses retract from this decision. METHOD: This is a multisite cross-sectional study that was conducted at all medical-surgical units of four university hospitals. Using scales for assessing leader humility, nurses' turnover intention, and leader expertise, 385 nurses were surveyed. Data were investigated via descriptive and inferential statistics, where correlation, path analysis, and structured equation modeling were used to test the hypothetical relationship among study variables. RESULTS: There is a statistically significant negative relationship between humble leadership and nurses' turnover intention. Humble leadership and leader expertise were significant predictors of nurses' turnover intention. The moderating effect of leader expertise on the relationship between humble leadership and nurses' turnover intention was statistically significant, making it more negative, implying that leader expertise amplifies the effect of leader humility on reducing nurses' turnover. CONCLUSION: Incorporating leader expertise with humility could provide an efficient panacea for reducing turnover intentions among nurses in different healthcare organizations. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Healthcare organizations could develop an efficient retention plan for nurses by cultivating humility among both leaders and nurses. In addition, building nurse leaders' expertise through opening avenues for professional development is a good strategy in the face of nurses' shortage and high turnover. Furthermore, succession planning in healthcare organizations must consider humility as a vital skill among anticipated leaders.

The influence of supportive work environment on work-related stress and conflict management style among emergency care nurses: A descriptive correlational study.

BACKGROUND: Stress and conflict in emergency departments are inevitable but can be managed. A supportive work environment is key to helping emergency care providers, especially nurses, constructively manage work-related stress and conflict. AIM: The aim of this study was to assess the influence of supportive work environments on work-related stress and conflict management style among emergency care nurses. METHODS: A descriptive correlational research design was utilized. Data were collected from 221 staff nurses recruited from two university hospital emergency departments in Alexandria, Egypt. Three instruments were used: (1) perceived organizational support scale, (2) nurses' occupational stressors scale, and (3) conflict management style inventory. RESULTS: There was a highly significant correlation between supportive work environments and work-related stress (p = .000) and a significant correlation between supportive work environments and conflict management style (p = .026). Supportive work environments had a significant inverse negative relationship with work-related stress experienced by nurses (p = .001) and accounted for 51% of variance in work-related stress. Meanwhile, supportive work environments had a significant positive relationship with conflict management styles of nurses (p = .026). Work-related stress had a significant relationship with nurses' conflict management style (p = .000) and accounted for 45% of the variance in conflict management style. LINKING EVIDENCE TO ACTION: The style of conflict management modeled by staff within emergency departments can positively or negatively influence the work environment and level of work-related stress. There is a necessity to cultivate a supportive culture for nurses in emergency departments to develop skills for constructive conflict management styles to reduce work-related stress.

Application of Kano model for optimizing the training system among nursing internship students: a mixed-method Egyptian study.

BACKGROUND: Clinical experience is an important component of nursing education because it translates students' knowledge into practice, which serves as the cornerstone of nursing practice in health care delivery. PURPOSE: The study aims to explore the quality attributes required for optimizing the training system of nursing internship students using Kano model. METHODS: A concurrent exploratory sequential triangulation design was used for mixed-methods research. A total of 295 nursing internship students (Target Population) were recruited (whole-population sampling) from the study settings in Egypt. Of them, 280 (97.2%) agreed to participate in the study and completed the interview and the self-administered questionnaire. Data collection was done over 6 months from February to August, 2022. Inferential statistics and thematic data analysis were used to analyze the results. RESULTS: Findings revealed that there were 35 fundamental attributes required for high-quality nursing students' internship training. Kano model was used to categorize and prioritize the 35 quality attributes. Kano analysis revealed that 22 attributes were categorized as "attractive" and 11 attributes were as categorized as "must be" and two were indifferent attributes. CONCLUSION: Incorporating the voice of nurse interns during their training is the key to providing efficient and high-quality internship training experience. It could give realistic impressions about the drawbacks of training and proposed solutions. IMPLICATIONS OF THE STUDY: Nurse managers and educators in clinical settings and educational institutions should put much emphasis on the training attributes and pillars to ensure that nursing internship students are mastering the skills of competent alumni. Provision of conducive training environment that fulfill the basic needs of internship students to maintain passion for learning as well as commitment of internship students to nursing profession will improve the satisfaction level and quality of education, training, and practice. Also, incorporating internship students support system with motivation strategies are helpful tools to maintain exemplary performance of internship students during the training period.

Job embeddedness and missed nursing care at the operating theatres: the mediating role of polychronicity.

BACKGROUND: Perioperative missed nursing care is a serious issue that can compromise patient safety and quality of care. However, little is known about the factors that influence perioperative missed nursing care. AIM: This study aimed to examine the effects of job embeddedness and polychronicity on perioperative missed nursing care as well as to test the mediating role of polychronicity on the relationship between job embeddeness and perioperative missed nursing care. METHOD: This was a cross-sectional correlational study that used a convenience sample of 210 operating room nurses from nine hospitals in Egypt. Data were collected using self-administered questionnaires that measured job embeddedness, polychronicity, and perioperative missed nursing care. Structural equation modeling was used to test the hypothesized relationships among the variables. RESULTS: The findings demonstrated a significant negative and moderate association between missed perioperative care and both nurses' job embeddedness and polychronicity. Moreover, there was a moderately positive and significant correlation between polychronicity and job embeddedness. Path analysis revealed a significant positive causal effect between job embeddedness and polychronicity. The results of mediation revealed that the indirect effect of job embeddedness on missed care through polychronicity was statistically significant; suggesting that polychronicity partially mediated this relationship. CONCLUSION: This study sheds light on the intricate relationship between nurses' job embeddedness, missed care, and polychronicity in the operating theater context. By enhancing job embeddedness and fostering polychronicity among nurses, healthcare organizations can reduce perioperative missed care and ultimately improve patient care outcomes in this critical healthcare setting.

Availability of PEth testing is associated with reduced eligibility for liver transplant among patients with alcohol-related liver disease.

BACKGROUND: Serum phosphatidylethanol (PEth) is a highly sensitive test to detect alcohol use. We evaluated whether the availability of PEth testing impacted rates of liver transplant evaluation terminations and delistings. METHODS: Medical record data were collected for patients who initiated transplant evaluation due to alcohol-related liver disease in the pre-PEth (2017) or PEth (2019) eras. Inverse probability weighting (IPW) was used to balance baseline patient characteristics. Outcomes included termination of evaluation or delisting due to alcohol use; patients were censored at receipt of transplant; death was considered a competing risk. The Fine-Gray method was performed to determine whether PEth testing affected risk of evaluation termination/ delisting due to alcohol use. RESULTS: Three hundred and seventy-five patients with alcohol-related indications for transplant (157 in 2017; 210 in 2019) were included. The final IPW-adjusted model for the composite outcome of terminations/delisting due to alcohol use retained two significant variables (P < .05): PEth era and BMI category. Patients evaluated during the PEth era were almost three times more likely to experience an alcohol-related termination/delisting than those in the pre-PEth era (sHR = 2.86; 95%CI 1.67-4.97) CONCLUSION: We found that availability of PEth testing at our institution was associated with a higher rate of exclusion of patients from eligibility for liver transplant. Use of PEth testing has significant potential to inform decisions regarding transplant candidacy for patients with alcohol-related liver disease.

The Effect of Career Plateauing as a Mediating Factor on Nurses' Job Satisfaction and Promotability.

AIM: The aim of this study was to investigate the effect of career plateau as a mediating factor on nurses' job satisfaction and promotability. BACKGROUND: A nurse's career, as well as other professionals, may arrive at a point where further hierarchical development is limited. Nurses may remain longer than expected in the same position within an organization and may be plateaued, resulting in career dissatisfaction, job dissatisfaction, and turnover. METHODS: This is a descriptive correlational study. Two hundred twenty-one nurses were recruited from 1 university hospital in Egypt. Respondents completed the self-administered, printed questionnaires. Measures included career plateau, job satisfaction, and promotability questionnaires. Findings were investigated via descriptive and inferential statistics as well as structured equation modeling to examine the mediating effect of career plateauing on job satisfaction and promotability. RESULTS: The mean scores of job satisfaction, career plateauing, and promotability were 3.09 ± 0.71, 3.75 ± 0.43, and 3.70 ± 0.53, respectively. Data revealed that nurses' career plateauing accounted for 34% and 18% of the variance of their job satisfaction and promotability, respectively. CONCLUSION: Career plateauing is a significant determinant of nurses' job satisfaction and promotability.

Middle turbinate resection is unlikely to cause empty nose syndrome in first year postoperatively.

PURPOSE: Empty nose syndrome (ENS) is characterized by nasal dryness, crusting, and paradoxical nasal obstruction most commonly after inferior turbinate resection. ENS has also been reported to occur after middle turbinate resection (MTR), and concern for causing ENS is a possible reason surgeons preserve the MT during endoscopic sinus surgery (ESS). The objective was to determine whether MTR during ESS led to ENS. MATERIALS AND METHODS: This was a prospective case series of 95 consecutive patients that underwent bilateral subtotal MTR during ESS with either Draf IIB or Draf III frontal sinusotomies, for chronic rhinosinusitis with or without nasal polyps, and frontal sinus inverted papillomas. Demographic data and postoperative Empty Nose Syndrome 6-item Questionnaire (ENS6Q) scores were obtained. Nasal crusting was also documented on last postoperative nasal endoscopy. RESULTS: Pathologies included chronic rhinosinusitis with nasal polyps (69), without nasal polyps (12), and inverted papillomas (14). Fifty-six patients underwent subtotal MTRs during ESS with Draf IIB, and 39 with Draf III. Mean follow-up was 19.4 months (range 12-49). Mean postoperative ENS6Q score was 2.1. Only 2.1% had ENS6Q scores ≥ 11, and 6.3% had nasal crusting at last follow-up. None of the patients with ENS6Q scores ≥ 11 had nasal crusting at last follow-up. There were no significant differences in outcomes between ages, genders, surgery types, or pathologies. CONCLUSIONS: Patients who underwent bilateral subtotal MTR during ESS were unlikely to develop ENS by at least 1 year postoperatively, based on patients rarely experiencing ENS6Q scores ≥ 11 or persistent nasal crusting.

New insight into HCV E1/E2 region of genotype 4a.

INTRODUCTION: Hepatitis C virus (HCV) genome contains two envelope proteins (E1 and E2) responsible for the virus entry into the cell. There is a substantial lack of sequences covering the full length of E1/E2 region for genotype 4. Our study aims at providing new sequences as well as characterizing the genetic divergence of the E1/E2 region of HCV 4a using our new sequences along with all publicly available datasets. METHODS: The genomic segments covering the whole E1/E2 region were isolated from Egyptian HCV patients and sequenced. The resulting 36 sequences 36 were analyzed using sequence analysis techniques to study variability within and among hosts in the same time point. Furthermore, previously published HCV E1/E2 sequence datasets for genotype 4a were retrieved and categorized according to the geographical location and date of isolation and were used for further analysis of variability among Egyptian over a period of 15 years, also compared with non-Egyptian sequences to figure out region-specific variability. RESULTS: Phylogenetic analysis of the new sequences has shown variability within the host and among different individuals in the same time point. Analysis of the 36 sequences along with the Egyptian sequences (254 sequences in E1 in the period from 1997 to 2010 and 8 E2 sequences in the period from 2006 to 2010) has shown temporal change over time. Analysis of the new HCV sequences with the non-Egyptian sequences (182 sequences in E1 and 155 sequences in the E2) has shown region specific variability. The molecular clock rate of E1 was estimated to be 5E-3 per site per year for Egyptian and 5.38E-3 for non-Egyptian. The clock rate of E2 was estimated to be 8.48E per site per year for Egyptian and 6.3E-3 for non-Egyptian. CONCLUSION: The results of this study support the high rate of evolution of the Egyptian HCV genotype 4a. It has also revealed significant level of genetic variability among sequences from different regions in the world.

The moderating role of just culture between nursing practice environment and oncology nurses' silent behaviors toward patient safety: A multicentered study.

BACKGROUND: Patient safety is a critical part of healthcare delivery that must be prioritized to guarantee optimal patient outcomes. Oncology nursing is a specialized area of nursing that demands great focus on patient safety because of the high-risk nature of this patient group. Nurses play an important role in ensuring that patients receive safe and effective care. However, the nursing practice environment can have a substantial impact on how nurses respond to patient safety problems. A just culture can promote open communication and identify potential safety issues, whereas a culture of silence can have a negative impact on patient outcomes. OBJECTIVE: Firstly, assess the relationship between the nursing practice environment and oncology nurses' silent behavior towards patient safety. Secondly, the interaction effect of just culture as a moderator in this relationship. METHOD: A cross-sectional, correctional research design was employed. Data was collected from 303 nurses working at the oncology departments of five hospitals in Egypt using three questionnaires. Data was analyzed using SPSS-PROCESS Macro (v4.2). RESULTS: There was a moderate, negative, and significant correlation between the nurse practice environment and silent behavior of nurses towards patient safety. The interaction effect of just culture with nurse practice environment strengthens this relationship, thus enhancing errors reporting. CONCLUSIONS: This study emphasized on the importance of creating a just culture that facilitates open communication and eliminating the potential hazards result from nurses' silence. Thus, oncology nurses must be encouraged to report issues related to patient safety.

Attitudes of Gastroenterologists Regarding Delivery of Cancer Diagnoses: a Cross-Sectional Study.

GOALS: To determine the attitudes and practices of gastroenterologists regarding the delivery of cancer diagnoses. BACKGROUND: Gastroenterologists frequently diagnose colorectal cancer. Receiving the news of a cancer diagnosis is difficult, and the delivery of the diagnosis can influence a patient's understanding of their disease. No study to date has reported how gastroenterologists deliver cancer diagnoses to their patients. STUDY: An anonymous questionnaire was sent online to gastroenterologists of the American College of Gastroenterology to assess views regarding the delivery of cancer diagnoses. RESULTS: Of the 280 complete responses (response rate = 1.64%), most respondents were male (n = 205, 73.21%), in practice between 0 and 9 years (n = 133, 47.50%), and at the attending/faculty level (n = 69.53%, 194). Most responded that they would disclose a cancer diagnosis to the patient themselves if they had made the discovery on endoscopy/colonoscopy (n = 255, 94.80%), with the preferred methods being an in person discussion (n = 187, 71.65%). Most respondents were not familiar with any guidelines for delivering cancer diagnoses (n = 202, 75.94%) and would be open to receiving training on cancer diagnosis delivery (n = 207, 78.11%). CONCLUSIONS: Most gastroenterologists take personal responsibility in the delivery of cancer diagnoses. Many gastroenterologists receive no specific training on how to deliver this news and are unaware of any guidelines to follow that may be helpful in their practice. However, most displayed a willingness to learn these guidelines through some form of formal education. Future directions should consider the incorporation of education in cancer diagnosis delivery for gastroenterologists and gastroenterology fellows.

Age-Related Macular Degeneration in Patients with Androgenetic Alopecia: Could the Monocyte/HDL Ratio Be the Link?

INTRODUCTION: Both Androgenetic alopecia (AGA) and age-related macular degeneration (AMD) shared the microinflammatory milieu and increased oxidative stress as important criteria in their pathogenesis. The monocyte/high density lipoprotein (HDL) ratio (MHR) seems to be an easy-to-calculate prognostic marker of microinflammation. OBJECTIVES: To assess MHR in patients with AGA and its correlation to AMD in these patients, if any. METHODS: Forty patients with AGA aged 40 years or more of both sexes and 40 control subjects participated in this case-control study. General, dermatological, and ophthalmologic examination, MHR evaluation and optical coherence tomography (OCT) were performed. RESULTS: The mean MHR was significantly higher in AGA patients (6.98 ± 2.21) than in controls (3.82 ± 0.68) (P < 0.001). AMD was significantly higher in patients than controls (P < 0.001). Eighty percent of AGA patients were diagnosed with AMD versus 20% of control subjects. The presence of AMD in AGA was significantly related to the degree of severity of AGA in male patients (P = 0.02). The MHR was significantly higher in AGA patients found to have AMD (9.37 ± 1.1 and 7.01 ± 1.42 in the wet and dry type respectively) than those without AMD (P < 0.001). CONCLUSIONS: AMD may develop more frequently in those with AGA. The MHR seems to be a missing link between both conditions, and could be utilized as a potential biomarker for predicting AMD in AGA patients.

Autoimmune Autonomic Ganglionopathy Presenting as Constipation.

Autoimmune autonomic ganglionopathy (AAG) is a rare post-ganglionic disorder that causes a range of symptoms, often including gastrointestinal disorders. Patients may be seropositive or seronegative for antibodies against the nicotinic acetylcholine receptor. Here, we describe the case of a 56-year-old woman with a previous diagnosis of sensorimotor peripheral neuropathy who presented with severe constipation that was not responsive to laxative therapy. The evaluation showed diffuse colonic hypomotility, rectal hypersensitivity, and type IV pelvic floor dysfunction. The patient was diagnosed 10 months after the presentation as having seronegative AAG, and she responded well to treatment with intravenous methylprednisolone and apheresis.

Evidence-based clinical practice guidelines for the management of psoriasis: systematic review, critical appraisal, and quality assessment with the AGREE II instrument.

BACKGROUND: Psoriasis is considered one of the stubborn lifelong dermatologic diseases, making the patients seized in their social cage. Evidence-based clinical practice guidelines (CPGs) and expert opinions ensure that patients with psoriasis render the most recent and developed care. This systematic review assessed and compared the most recently approved international CPGs with the AGREE II instrument. METHODS: After we identified our research question, we searched the bibliographic international databases to identify and screen for relevant and eligible guidelines that address the topic of interest. Four independent reviewers (Senior Expert Dermatologist in Psoriasis) have critically appraised the selected guidelines via the AGREE II instrument. We conducted inter-rater analysis and percent agreement among raters and calculation of intra-class correlation coefficient (ICC) 'Kappa'. RESULTS: Out of 33 articles for CPGs, only Four eligible CPGs fulfill the inclusion criteria. Selected CPGs were critically appraised; first from the American College of Rheumatology that is also National Psoriasis Foundation (ACR/NPF-2018), second from the UK's National Institute for Health and Care Excellence (NICE-2017) for Psoriasis: Assessment and Management, third from the Saudi practical guidelines on the biologic treatment for Psoriasis (Saudi CPGs, 2015), and lastly from the American Academy of Dermatology (AAD/NPF-2019) Management and Treatment of Psoriasis with Awareness and Attention to Comorbidities. The complete assessments (OA) of two CPGs (AAD/NPF and NICE) scored greater than 80%; 'six domains' of AGREE II had greater score that is congruent with results; (1) scope and motive, (2) shareholder involvement, (3) rigor of growth, (4) clarity of speech, (5) validity, and (6) journalistic independence domains. Domain (3) scored (84, 71, and 90%), domain (5) (51%, 47, and 90%), domain (6) (70, 52, and 90%) for (Saudi CPGs, AAD/NPF, and NICE), respectively. Generally, the clinical recommendations were significantly better for NICE CPGs. CONCLUSIONS: Four evidence-based 'CPGs' introduced a high-quality methodological analysis. NICE indicated the greatest quality followed by Saudi CPGs and AAD/NPF and all four CPGs were suggested for practice.

Perioperative Point-of-Care Ultrasound Use by Anesthesiologists.

Point-of-Care ultrasound (POCUS) is the bedside utilization of ultrasound, in real-time, to aid in the diagnosis and treatment of patients. Image acquisition from POCUS utilization by anesthesiologists involves the assessment of multiple organs in different perioperative situations. POCUS can be utilized to enhance clinical decision-making in a variety of perioperative situations due to its ability to assess endotracheal tube placement, cardiac function, pulmonary function, aspiration risk, hemodynamics, vascular access, and nerve visualization for regional procedures. The mounting clinical evidence for the value of POCUS in perioperative settings, its growing affordability, and its low associated risks are responsible for the nationwide movement across many anesthesiology residency programs to increase the focus on perioperative ultrasound training. The purpose of this review is to present to current anesthesiologists and anesthesiology trainees, a broad discussion regarding the diverse utility and importance of POCUS in perioperative settings.

Mantle Cell Lymphoma Presenting as Diarrhea in a Liver Transplant Recipient.

We present a 63-year-old man with a medical history of hepatocellular carcinoma who underwent orthotopic liver transplant 10 years prior on long-term immunosuppressive therapy. The patient presented to the clinic with diarrhea, and the workup revealed mantle cell lymphoma. Mantle cell lymphoma is an extremely rare finding in transplanted livers. It is essential to include mantle cell lymphoma, along with a broad differential, during the workup of diarrhea in post-transplant patients.

Risk factors associated with adenoma recurrence following cold snare endoscopic mucosal resection of polyps ≥ 20 mm: a retrospective chart review.

Background and study aims Cold snare endoscopic mucosal resection (EMR) is being increasingly utilized for non-pedunculated polyps ≥ 20 mm due to adverse events associated with use of cautery. Larger studies evaluating adenoma recurrence rate (ARR) and risk factors for recurrence following cold snare EMR of large polyps are lacking. The aim of this study was to define ARR for polyps ≥ 20 mm removed by cold snare EMR and to identify risk factors for recurrence. Patients and methods A retrospective chart review of colon cold snare EMR procedures performed between January 2015 and July 2019 at a tertiary care medical center was performed. During this period, 310 non-pedunculated polyps ≥ 20 mm were excised using cold snare EMR with follow-up surveillance colonoscopy. Patient demographic data as well as polyp characteristics at the time of index and surveillance colonoscopy were collected and analyzed. Results A total of 108 of 310 polyps (34.8 %) demonstrated adenoma recurrence at follow-up colonoscopy. Patients with a higher ARR were older ( P  = 0.008), had endoscopic clips placed at index procedure ( P  = 0.017), and were more likely to be Asian and African American ( P  = 0.02). ARR was higher in larger polyps ( P  < 0.001), tubulovillous adenomas ( P  < 0.001), and polyps with high-grade dysplasia ( P  = 0.003). Conclusions Although cold snare EMR remains a feasible alternative to hot snare polypectomy for resection of non-pedunculated polyps ≥ 20 mm, endoscopists must also carefully consider factors associated with increased ARR when utilizing this technique.

Comparison between different techniques for treatment of submacular haemorrhage due to Age-Related Macular Degeneration.

PURPOSE: To compare the outcome of vitrectomy, subretinal tissue plasminogen activator (TPA), and gas with and without subretinal air versus Intravitreal TPA and gas in the treatment of submacular haemorrhage (SMH) due to Neovascular age related macular degeneration. METHODS: We analysed the notes of 29 cases presented with SMH in the period between 01/2016 and 09/2018 at James Cook University Hospital. Presenting visual acuity (BCVA), size and location of SMH, Procedure done, final BCVA at 6 months and any surgical complications were recorded. 11 Cases (Group 1) received intravitreal TPA (50 µg in 0.1 ML), 0.3 ml of pure sulfur hexafluoride (SF6). 18 cases (Group 2) received 23 G Pars Plana vitrectomy, Subretinal TPA injection (25 µg in 0.1 ml), and 20% SF6 gas filling. Group 2 was further divided into 2A (10 patients) who received only subretinal TPA and group 2B (8 patients) who received additional 0.1 ml subretinal air. RESULTS: The mean BCVA at presentation was 0.0068 in group 1 and 0.0067 in group 2 (p = 0.8734). The mean postoperative BCVA at 6 months was 0.31 in group 1 and 0.58 in group 2 (p = 0.0015). Subgroup analysis of group 2 didn't show statistically significant difference in outcome when adding subretinal air to the vitrectomy procedure (p = 0.7009). CONCLUSION: Vitrectomy, gas and subretinal TPA has more successful displacement rate and better visual outcome than Intravitreal TPA & Gas alone in treating SMH involving the fovea in age-related macular degeneration. Additional subretinal air doesn't seem to improve the outcome in cases having vitrectomy.