Preoperative anxiety, postoperative pain tolerance and analgesia consumption: A prospective cohort study.

BACKGROUND: Anxiety affects the patient's perception of postoperative pain and causes a significant increase in the consumption of analgesia postoperatively. OBJECTIVE: This study assesses the relationship between preoperative anxiety, postoperative pain and postoperative pethidine consumption. METHODS: A prospective cohort design was used. Data were collected from 100 patients who were undergoing a laparoscopic cholecystectomy at St Joseph Hospital, Jerusalem. Pain-controlled analgesia with pethidine was utilised to manage pain throughout the postoperative period. The visual analogue scale scores and pethidine consumption of all patients were recorded. FINDINGS: Participants' mean level of pain was higher in the preoperative period (mean visual analogue scale = 1.3) compared with their mean level of pain in the postoperative period (mean visual analogue scale = 0.5). There is a statistically significant difference between the participants' level of anxiety and postoperative pain level (p < 0.001). Gender, weight, level of education and smoking were predictors of developing preoperative anxiety. Also, gender, smoking and medication were statistically significant predictors of developing postoperative pain. Furthermore, gender, medical history and medication were statistically significant predictors of pethidine consumption postoperatively. CONCLUSIONS: The preoperative anxiety reduction intervention should be promoted and implemented as routine care for all surgical patients.

Challenges of distance learning encountering nursing students after the COVID-19 pandemic: a study from the Middle East.

BACKGROUND: The COVID-19 pandemic necessitated an abrupt transition to online learning in nursing education, presenting unprecedented challenges. This research aims to comprehensively assess the challenges faced by nursing students during this transition, exploring key issues, recommending strategies, and analyzing their impact on student perceptions. METHODS: Using a cross-sectional design, the study surveyed 941 nursing students across eight Arab countries-Jordan, Iraq, Lebanon, Palestine, Oman, KSA, UAE, and Egypt-to ensure a representative sample and enhance external validity. Data collection involved a thorough survey covering academic, technological, and administrative challenges. Reliability analysis, descriptive statistics, and variance analysis using Kruskal -Wallis and Mann-Whitney tests were conducted to examine differences between countries and sociodemographic variables. RESULTS: Descriptive statistics revealed significant demographic disparities. Single individuals in Jordan and those with lower family income in Palestine and Lebanon reported notably higher challenges. Female students in Iraq and Lebanon perceived greater challenges compared to males. Students pursuing diplomas in Jordan and bridging programs in Lebanon faced elevated difficulties. Governmental university students in Lebanon and private university students in Jordan encountered distinct challenges. Lack of available internet was particularly challenging in Jordan and Lebanon, whereas students using tablets in Lebanon and laptops in Palestine reported heightened challenges. Economic disparities, notably in family income, further hindered engagement with online learning materials. Across countries, academic challenges included managing coursework and accessing resources, exacerbated by administrative inefficiencies, especially in Palestine and Lebanon. Students in the UAE reported fewer challenges, facilitated by robust internet infrastructure and comprehensive institutional support. CONCLUSION: This study provides critical insights into the challenges faced by nursing students during the Middle East's online learning transition. Key challenges encompass technological issues, academic workload, and administrative inefficiencies, with significant disparities across countries. The findings underscore the urgent need for targeted interventions, particularly in Palestine, to enhance online learning experiences. Policymakers and educational institutions can leverage these insights to advocate for student-centric approaches and policy development aimed at improving online learning across the region.

Jordanian nursing students' knowledge and attitudes of corneal donation.

A high success rate of corneal transplants is evident. However, there is still a lack of corneal grafts available to meet demand, largely because donors are reluctant to donate. Given their critical role in future healthcare teaching and advocacy. There has not been much research on Jordanian nursing students' perspectives on corneal donation, so it's critical to identify and eliminate any obstacles. This study aims to evaluate the knowledge and attitudes of Jordanian nursing students concerning corneal donation. A cross-sectional, descriptive design was used to recruit (n = 440) nursing students from four Jordanian universities. A self-reported questionnaire was used to obtain data on knowledge and attitudes regarding corneal donation. The average age of senior nursing students was (M = 23.07, SD = 3.63) years. Varying levels of understanding were revealed amongst university students toward corneal donation items. Generally, good attitude of nursing students toward corneal donation (M = 34.1, SD = 8.1). Weak positive relationship was found between total knowledge scores and age (r = 0.141, p = 0.003) while there is no significant relationship between age and total attitude score (r = 0.031, p = 0.552). Age was found to be a significant predictor (B = 0.01, Beta = 0.12, t = 2.07, p = 0.04). Also, the educational level of fathers is a significant positive predictor (Beta = 0.128, p = 0.008) for the total attitude scores among nursing students. Limited awareness of corneal donation, highlighting the need for focused educational interventions to improve their comprehension.

The Depression Anxiety Stress Scale 8: investigating its cutoff scores in relevance to loneliness and burnout among dementia family caregivers.

The global trend of advanced aging comes at the cost of amplified onset of age-related diseases. Dementia is a common multifactorial age-related neurodegenerative disorder, which manifests with progressive declines in cognitive functioning and ability to perform activities of daily living. As polices discourage institutionalized care, family members act as primary caregivers and endure increased vulnerability to physical and mental health problems secondary to care-related changes in life routine and relationships. Targeting clinically significant distress at earlier stages through valid brief measures may promote caregivers' wellbeing and dementia care continuity/quality. This study aimed to determine the optimal cutoff score of the Depression Anxiety Stress Scale 8-items (DASS-8) in a convenience sample of 571 European caregivers (Mean age = 53 ± 12 years, Italian = 74.4%, Swiss = 25.6%) through three methods. K-means clustering classified the sample into high- and low-distress clusters based on DASS-8 score of 19. Receiver operator curve (ROC) analysis using 48 and 7 cutoffs of the Zarit Burden Interview (ZBI) and the Three-Item University of California, Los Angeles, Loneliness Scale-version 3 (UCLALS3), revealed two DASS-8 cutoffs (12.5 and 14.5, area under the curve (AUC) = 0.85 and 0.92, p values < .001, 95% CI 0.82-0.88 and 0.89 to 0.94, sensitivity = 0.81 and 0.78, specificity = 0.76 and 0.89, Youden index = 0.57 and 0.67, respectively). Decision modeling produced two DASS-8 cutoffs (9.5 and 14.5) for predicting low and high caregiving burden and loneliness, respectively. According to the median of all DASS-8 cutoffs (14.5) the prevalence of mental distress was 50.8%. Distress correlated with key mental problems such as burnout and loneliness-in path analysis, DASS-8 scores were predicted by the ZBI, UCLALS3, care dependency, and receiving help with care, especially among older, female, and spouse caregivers. Further diagnostic workup should follow to confirm psycho-pathogenicity among caregivers with DASS-8 scores above 14.5. Investigations of the DASS-8 in other countries/populations may confirm the validity of this cutoff score.

Obstacles of Online Learning Facing Nursing Students after the COVID-19 Pandemic.

Background: After the COVID-19 pandemic, the online style of instruction started to replace the traditional style in Jordan. Aims: This study aims to (1) assess the nursing students' perceived obstacles to online learning in Jordan; (2) explore significant relationships between participants' characteristics and their perceived obstacles; and (3) assess for significant differences in the perceived obstacles based on participants' characteristics. Methods: A cross-sectional, descriptive design was utilized in this study. A convenient sample of 325 nursing students responded to a self-reported questionnaire utilizing Google Forms. Both descriptive and inferential statistics were used to analyze the dataset using the SPSS software. Results: The mean scores of the obstacles to online learning were 2.94 (SD = 0.95) for the academic obstacles subscale, 2.90 (SD = 0.83) for the technological obstacles subscale, and 3.25 (SD = 1.00) for the administrative obstacles subscale. Significant associations were found between participants' characteristics and perceived obstacles to online learning. For instance, the type of university was significantly associated with academic (r = -0.32, p < 0.01), technological (r = -0.21, p < 0.01), and administrative obstacles (r = -0.32, p < 0.01). Furthermore, significant differences were found in the perceived obstacles based on the participants' demographic and studentship-related characteristics. Conclusions: According to their perceptions of online learning, nursing students in Jordan face three types of obstacles: academic, technical, and administrative. Decision-makers should intervene to enhance the online learning experience by overcoming the reported obstacles.

University Students' Physical Activity: Perceived Barriers and Benefits to Physical Activity and Its Contributing Factors.

Introduction: In general, undergraduate university students in the north of Jordan have a low level of physical activity. Objectives: To examine the physical activity level, perceived barriers and benefits to physical activity, and the contributing factors among university students in north of Jordan. Methods: A cross-sectional study design was used, and data was collected from 235 university students through a self-reported questionnaire. The International Physical Activity Questionnaire (IPAQ) was utilized to calculate the amount of physical activity, while the exercise benefits and barriers scale (EBBS) was used to measure the perceived benefits and barriers of physical activity. Results: According to the findings, less than half of the students (48.1%) reported engaging in physical activity. Several factors were found to be significantly related to higher levels of physical activity, including being younger, single, having a normal body weight, and reporting excellent health status. Logistic regression analysis revealed that overweight (OR = -0.068, 95% CI 0.025-0.183) and obese (OR = -0.250, 95% CI 0.068-0.924) were less likely to be physically active, while those who rated their health as excellent had higher rates of physical activity (OR = 3.590, 95% CI 1.263-10.201). The students agreed most strongly with the perceived benefit item "Exercise improves the way my body looks," while the perceived barrier item they identified most strongly with was "There are too few places for me to exercise." Conclusion: This study provides important data for health promotion programs aimed at supporting physical activity among university students.

Cut-off scores of the Depression Anxiety Stress Scale-8: Implications for improving the management of chronic pain.

AIM: Mental distress, non-specific symptoms of depression and anxiety, is common in chronic pelvic pain (CPP). It contributes to poor recovery. Women's health nurses operate in multidisciplinary teams to facilitate the assessment and treatment of CPP. However, valid cut-off points for identifying highly distressed patients are lacking, entailing a gap in CPP management. DESIGN: This instrumental cross-sectional study identified a statistically derived cut-off score for the Depression Anxiety Stress Scale-8 (DASS-8) among 214 Australian women with CPP (mean age = 33.3, SD = 12.4, range = 13-71 years). METHODS: Receiver operator characteristic curve, decision trees and K-means clustering techniques were used to examine the predictive capacity of the DASS-8 for psychiatric comorbidity, pain severity, any medication intake, analgesic intake and sexual abuse. The study is prepared according to the STROBE checklist. RESULTS: Cut-off points resulting from the analysis were ordered ascendingly. The median (13.0) was chosen as an optimal cut-off score for predicting key outcomes. Women with DASS-8 scores below 15.5 had higher analgesic intake. CONCLUSION: CPP women with a DASS-8 score above 13.0 express greater pain severity, psychiatric comorbidity and polypharmacy. Thus, they may be a specific target for nursing interventions dedicated to alleviating pain through the management of associated co-morbidities. IMPLICATIONS FOR PATIENT CARE: At a cut-off point of 13.0, the DASS-8 may be a practical instrument for recommending a thorough clinician-based examination for psychiatric comorbidity to facilitate adequate CPP management. It may be useful for evaluating patients' response to nursing pain management efforts. Replications of the study in different populations/countries are warranted.

Managing disabled workers due to occupational accidents in Indonesia: a case study on return to work program.

BACKGROUND: Limited research and studies prove the usefulness of case management for persons with disabilities, which helps disabled employees recover their dignity through medical vocational, and psychological rehabilitation in underdeveloped countries' Return To Work (RTW) programs. METHODS: This qualitative case study design involved semi structured interviews with case managers as the primary data source, supplemented by secondary data from BPJS Ketenagakerjaan. Data analysis utilized QDA Miner Lite and Python with ArcGIS integration for descriptive visualization. RESULTS: The RTW program of BPJS Ketenagakerjaan has already adopted ILO's fundamental suggestion, which creates two central themes: internal aspects that are essential to the RTW framework and external variables that impact RTW practice. The key themes produce six main pieces to discuss further: personal skill, personal literacy, providers, guidelines, authorities, and stakeholder support. CONCLUSION: Return to Work Program benefits companies, and the implementation of a career development service or a partnership with non-governmental organizations guarantees that disabled employees who cannot return to work with their former employers are still in the global economy.

Burnout, quality of life and perceived patient adverse events among paediatric nurses during the COVID-19 pandemic.

PURPOSE: This cross-sectional, descriptive, correlational study aimed to measure burnout, quality of life (QOL) and perceptions of patient-related adverse events among paediatric nurses amid the COVID-19 pandemic and assess the relationships between these scores and participants' demographic and work-related characteristics. BACKGROUND: The mental health of most nurses may severely suffer due to the significant adversities that they struggle with while they care for their patients amid the COVID-19 pandemic. Mental distress negatively affects nurses' relationships and work performance, which may adversely influence the quality of care and patient safety. METHODS: A convenient sample of 225 Jordanian paediatric nurses completed a test batter comprising the Copenhagen Burnout Inventory, the Brief Version of the World Health Organisation's Quality of Life questionnaire and the nurse-perceived patient adverse events' questionnaire. This study was prepared and is reported according to the STROBE checklist. RESULTS: Paediatric nurses reported high levels of burnout, low QOL and high occurrence of hospital-acquired infections. Participants' age and hospital/unit capacity were significantly associated with burnout and QOL. CONCLUSION: Personal traits, perceived salary insufficiency and hospital/unit capacity represent factors that aggravate burnout, lower quality of life and worsen perceived patient safety among paediatric nurses. RELEVANCE TO CLINICAL PRACTICE: Policymakers should promote nurses' mental integrity and patient safety by addressing issues of workload and financial sufficiency and by provide interventions aimed to increase nurses' resilience. PATIENT OR PUBLIC CONTRIBUTION: Patients or public were not involved in setting the research question, the outcome measures, the design or implementation of the study. However, paediatric nurses responded to the research questionnaires.

Extracorporeal Membrane Oxygenation and Lebanese Critical Care Nurses' Perceptions: A Qualitative Phenomenological Study.

Introduction: The training of nursing staff to deliver extracorporeal membrane oxygenation in Lebanon has recently attracted attention. It is important to comprehend the background of nurses who take on this new duty. Objectives: The main objectives of this study were to (1) explore the experiences of intensive care unit nursing staff who work with extracorporeal membrane oxygenation, (2) identify the psychological and physiological challenges experienced by intensive care unit nurses while managing patients with extracorporeal membrane oxygenation, and (3) determine the roles assumed by intensive care unit nurses while managing patients utilizing extracorporeal membrane oxygenation. Methods: A qualitative phenomenological design utilizing semistructured interviews utilizing a purposive sampling of 15 intensive care unit nurses using extracorporeal membrane oxygenation devices. Interviews were audio recorded, verbatim transcribed, and thematically analyzed. Results: Three themes emerged, namely (1) nurses' role in extracorporeal membrane oxygenation, (2) skills and training, and (3) challenges faced by extracorporeal membrane oxygenation nurses. Conclusion: This study demonstrates that nurses play a crucial role in providing extracorporeal membrane oxygenation patient care, placing them under significant occupational stress due to the intensive care unit's routine workload and the demands of extracorporeal membrane oxygenation. Additionally, role confusion brought on by a lack of professional practice norms and emotional exhaustion made occupational pressure worse.

Translation and validation of the Hungarian Version of the infection control standardized questionnaire: a cross-sectional study.

BACKGROUND: To our knowledge, there is currently no psychometrically validated Hungarian scale to evaluate nurses' knowledge about infection prevention and control (IPC) practices. Thus, we aim in this study to assess the validity and reliability of the infection control standardized questionnaire Hungarian version (ICSQ-H). METHODS: A cross-sectional, multisite study was conducted among 591 nurses in Hungary. The original ICSQ included 25 questions. First, the questionnaire was translated into Hungarian. Then, content validity was assessed by a committee of four specialists. This was done by calculating the item content validity index and scale content validity index. Afterward, structural validity was evaluated in a two-step process using principal component analysis and confirmatory factor analysis. The goodness of fit for the model was measured through fit indices. Convergent validity was assessed by calculating the average variance extracted. Additionally, discriminant validity was evaluated by computing the Spearman correlation coefficient between the factors. Finally, the interitem correlations, the corrected item-total correlations, and the internal consistency were calculated. RESULTS: The content validity of the questionnaire was established with 23 items. The final four-factor ICSQ-H including 10 items showed a good fit model. Convergent validity was met except for the alcohol-based hand rub (ABHR) factor, while discriminant validity was met for all factors. The interitem correlations and the corrected item-total correlations were met for all factors, but the internal consistency of ABHR was unsatisfactory due to the low number of items. CONCLUSIONS: The results did not support the original three-factor structure of the ICSQ. However, the four-factor ICSQ-H demonstrated an adequate degree of good fit and was found to be reliable. Based on our findings, we believe that the ICSQ-H could pave the way for more research regarding nurses' IPC knowledge to be conducted in Hungary. Nevertheless, its validation among other healthcare workers is important to tailor effective interventions to enhance knowledge and awareness.

How to Engage Health Care Workers in the Evaluation of Hospitals: Development and Validation of BSC-HCW1-A Cross-Sectional Study.

Organizations worldwide utilize the balanced scorecard (BSC) for their performance evaluation (PE). This research aims to provide a tool that engages health care workers (HCWs) in BSC implementation (BSC-HCW1). Additionally, it seeks to translate and validate it at Palestinian hospitals. In a cross-sectional study, 454 questionnaires were retrieved from 14 hospitals. The composite reliability (CR), interitem correlation (IIC), and corrected item total correlation (CITC) were evaluated. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used. In both EFA and CFA, the scale demonstrated a good level of model fit. All the items had loadings greater than 0.50. All factors passed the discriminant validity. Although certain factors' convergent validity was less than 0.50, their CR, IIC, and CITC were adequate. The final best fit model had nine factors and 28 items in CFA. The BSC-HCW1 is the first self-administered questionnaire to engage HCWs in assessing the BSC dimensions following all applicable rules and regulations. The findings revealed that this instrument's psychometric characteristics were adequate. Therefore, the BSC-HCW1 can be utilized to evaluate BSC perspectives and dimensions. It will help managers highlight which BSC dimension predicts HCW satisfaction and loyalty and examine differences depending on HCWs' and hospital characteristics.

Children's rates of COVID-19 vaccination as reported by parents, vaccine hesitancy, and determinants of COVID-19 vaccine uptake among children: a multi-country study from the Eastern Mediterranean Region.

BACKGROUND: Huge efforts are being made to control the spread and impacts of the coronavirus pandemic using vaccines. However, willingness to be vaccinated depends on factors beyond the availability of vaccines. The aim of this study was three-folded: to assess children's rates of COVID-19 Vaccination as reported by parents, to explore parents' attitudes towards children's COVID-19 vaccination, and to examine the factors associated with parents' hesitancy towards children's vaccination in several countries in the Eastern Mediterranean Region (EMR). METHODS: This study utilized a cross-sectional descriptive design. A sample of 3744 parents from eight countries, namely, Iraq, Jordan, Kuwait, Lebanon, Palestine, Qatar, Saudi Arabia (KSA), and the United Arab Emirates (UAE), was conveniently approached and surveyed using Google forms from November to December 2021. The participants have responded to a 42-item questionnaire pertaining to socio-demographics, children vaccination status, knowledge about COVID-19 vaccines, and attitudes towards vaccinating children and the vaccine itself. The Statistical Package for Social Sciences (SPSS- IBM, Chicago, IL, USA) was used to analyze the data. A cross-tabulation analysis using the chi-square test was employed to assess significant differences between categorical variables and a backward Wald stepwise binary logistic regression analysis was performed to assess the independent effect of each factor after controlling for potential confounders. RESULTS: The prevalence of vaccinated children against COVID-19 was 32% as reported by the parents. Concerning parents' attitudes towards vaccines safety, about one third of participants (32.5%) believe that all vaccines are not safe. In the regression analysis, children's vaccination was significantly correlated with parents' age, education, occupation, parents' previous COVID-19 infection, and their vaccination status. Participants aged ≥50 years and those aged 40-50 years had an odds ratio of 17.9 (OR = 17.9, CI: 11.16-28.97) and 13.2 (OR = 13.2, CI: 8.42-20.88); respectively, for vaccinating their children compared to those aged 18-29 years. Parents who had COVID-19 vaccine were about five folds more likely to vaccinate their children compared with parents who did not receive the vaccine (OR = 4.9, CI: 3.12-7.70). The prevalence of children's vaccination in the participating Arab countries is still not promising. CONCLUSION: To encourage parents, vaccinate their children against COVID-19, Arab governments should strategize accordingly. Reassurance of the efficacy and effectiveness of the vaccine should target the general population using educational campaigns, social media, and official TV and radio channels.

Effect of the knee replacement surgery on activity level based on ActivPAL: a systematic review and meta-analysis study.

BACKGROUND: The knee replacement (KR) surgery aims to restore the activity level and reduce the risk of experiencing disabilities. The outcomes of this surgery are evaluated mainly with subjective tools or low validity objective tools. However, the effect of the surgery on activity level using high validity objective accelerometer is still in question. METHODS: A systematic review and meta-analysis were conducted to evaluate the benefit of KR surgery alone to enhance physical activity recommendations based on high validity accelerometer. Two independent reviewers evaluated five electronic databases (Cochrane-Central-Register-of-Controlled Trials, EMBASE, PubMed, Web of Science, and Scopus) to find relative studies between January 2000 and October 2021. The quality assessments and risk of bias assessments were examined. RESULTS: Three articles were included with 202 participants (86 males, 116 females), with an average age of 64 years and an average 32 kg/m2 body mass index. The results found that the number of steps was significantly improved up to 36.35 and 45.5% after 6-months and 1-year of the surgery, respectively. However, these changes did not meet the recommended activity level guideline and could be related to the patients' health status and their activity level before the surgery. No significant changes were seen in sedentary time, standing time, and upright time after 6-months and 1-year follow-ups. Heterogeneity among studies was low to moderate (0-63%). CONCLUSION: Knee replacement surgery is an effective treatment for improving patients' quality of life with severe knee injuries. However, various factors impact the success of surgical and achieving maximum benefit of the surgery. One factor, sedentary time, can be reduced by implementing pre-and post-surgery exercise or physical activity recommendations. Further studies are needed to understand the benefit of surgery with or without rehabilitation assessed using high validity monitors.

A systematic review: the dimensions to evaluate health care performance and an implication during the pandemic.

BACKGROUND: The balanced scorecard (BSC) has been implemented to evaluate the performance of health care organizations (HCOs). BSC proved to be effective in improving financial performance and patient satisfaction. AIM: This systematic review aims to identify all the perspectives, dimensions, and KPIs that are vital and most frequently used by health care managers in BSC implementations. METHODS: This systematic review adheres to PRISMA guidelines. The PubMed, Embase, Cochrane, and Google Scholar databases and Google search engine were inspected to find all implementations of BSC at HCO. The risk of bias was assessed using the nonrandomized intervention studies (ROBINS-I) tool to evaluate the quality of observational and quasi-experimental studies and the Cochrane (RoB 2) tool for randomized controlled trials (RCTs). RESULTS: There were 33 eligible studies, of which we identified 36 BSC implementations. The categorization and regrouping of the 797 KPIs resulted in 45 subdimensions. The reassembly of these subdimensions resulted in 13 major dimensions: financial, efficiency and effectiveness, availability and quality of supplies and services, managerial tasks, health care workers' (HCWs) scientific development error-free and safety, time, HCW-centeredness, patient-centeredness, technology, and information systems, community care and reputation, HCO building, and communication. On the other hand, this review detected that BSC design modification to include external and managerial perspectives was necessary for many BSC implementations. CONCLUSION: This review solves the KPI categorization dilemma. It also guides researchers and health care managers in choosing dimensions for future BSC implementations and performance evaluations in general. Consequently, dimension uniformity will improve the data sharing and comparability among studies. Additionally, despite the pandemic negatively influencing many dimensions, the researchers observed a lack of comprehensive HCO performance evaluations. In the same vein, although some resulting dimensions were assessed separately during the pandemic, other dimensions still lack investigation. Last, BSC dimensions may play an essential role in tackling the COVID-19 pandemic. However, further research is required to investigate the BSC implementation effect in mitigating the pandemic consequences on HCO.

The Nine-Item Internet Gaming Disorder Scale (IGDS9-SF): Its Psychometric Properties among Sri Lankan Students and Measurement Invariance across Sri Lanka, Turkey, Australia, and the USA.

The prevalence of internet gaming disorders (IGD) is considerably high among youth, especially with the social isolation imposed by the ongoing COVID-19 pandemic. IGD adversely affects mental health, quality of life, and academic performance. The Internet Gaming Disorder Scale (IGDS9-SF) is designed to detect IGD according to DSM-IV diagnostic criteria. However, inconsistent results are reported on its capacity to diagnose IGD evenly across different cultures. To ensure the suitability of the IGDS9-SF as a global measure of IGD, this study examined the psychometric properties of the IGDS9-SF in a sample of Sri Lankan university students (N = 322, mean age = 17.2 ± 0.6, range = 16-18 years, 56.5% males) and evaluated its measurement invariance across samples from Sri Lanka, Turkey, Australia, and the USA. Among Sri Lankan students, a unidimensional structure expressed good fit, invariance across different groups (e.g., gender, ethnicity, and income), adequate criterion validity (strong correlation with motives of internet gaming, daily gaming duration, and sleep quality), and good reliability (alpha = 0.81). Males and online multiplayers expressed higher IGD levels, greater time spent gaming, and more endorsement of gaming motives (e.g., Social and Coping) than females and offline players. Across countries, the IGDS9-SF was invariant at the configural, metric, and scalar levels, although strict invariance was not maintained. The lowest and highest IGD levels were reported among Turkish and American respondents, respectively. In conclusion, the IGDS9-SF can be reliably used to measure IGD among Sri Lankan youth. Because the scale holds scalar invariance across countries, its scores can be used to compare IGD levels in the studied countries.

Paediatric nurses' burnout and perceived health: The moderating effect of the common work-shift.

AIMS: This study aimed to: (1) explore the relationship between paediatric nurses' burnout, perceived health and common work-shift, (2) examine the moderating effect of the common work-shift on the relationship between paediatric nurses' burnout and perceived health, (3) compare burnout and perceived health between paediatric nurses working on day shifts and night/alternate shifts. DESIGN: A cross-sectional, correlational design was used in this study. METHODS: A convenient sample of 225 paediatric nurses was selected from nine hospitals in Jordan. Participants were surveyed using a self-administered questionnaire. RESULTS: The perceived health correlated negatively with paediatric nurses' burnout and their common work-shift. Also, nurses' burnout and common work-shift were significantly correlated. The common work-shift moderated the relationship between paediatric nurses' burnout and their health. To control the impact of paediatric nurses' burnout on their health, the ratio of the night-to-day shifts should be observed and balanced.

The deployment of balanced scorecard in health care organizations: is it beneficial? A systematic review.

BACKGROUND: Balanced Scorecard (BSC) has been implemented for three decades to evaluate and improve the performance of organizations. To the best of the researchers' knowledge, no previous systematic review has performed a comprehensive and rigorous methodological approach to figure out the impact of BSC implementation in Health Care Organizations (HCO). AIMS: The current work was intended to assess the impact of implementing the BSC on Health Care Workers' (HCW) satisfaction, patient satisfaction, and financial performance. METHODS: The authors prepared the present systematic review according to PRISMA guidelines. Further, the authors customized the search strategy for PubMed, Embase, Cochrane, Google Scholar databases, and Google's search engine. The obtained studies were screened to isolate those measuring scores related to HCW satisfaction, patient satisfaction, and financial performance. The Risk of Bias (RoB) in the non-Randomized Intervention Studies (ROBINS-I) tool was used to assess the quality of observational and quasi-experimental studies. On the other hand, for the Randomized Controlled Trials (RCTs), the Cochrane (RoB 2) tool was used. RESULTS: Out of 4031 studies, the researchers included 20 studies that measured the impact of BSC on one or more of the three entities (HCW satisfaction, patient satisfaction, and financial performance). Throughout these 20 studies, it was found that 17 studies measured the impact of the BSC on patient satisfaction, seven studies measured the impact on HCW satisfaction, and 12 studies measured the impact on financial performance. CONCLUSION: This systematic review provides managers and policymakers with evidence to support utilizing BSC in the health care sector. BSC implementation demonstrated positive outcomes for patient satisfaction and the financial performance of HCOs. However, only a mild impact was demonstrated for effects related to HCW satisfaction. However, it is worth noting that many of the studies reflected a high RoB, which may have affected the impacts on the three primary outcomes measured. As such, this systematic review reflects the necessity for further focus on this area in the future. Moreover, future research is encouraged to measure the real and current impact of implementing BSC in HCO during the pandemic since we did not find any.

The relationship between paediatric nurses' quality of life and intent to leave: The moderating role of hospital type.

BACKGROUND: Different types of hospitals exist in Jordan, and each type has its own leadership style. This might affect the nursing workforce in terms of quality of life and intent to leave. AIM: This study aimed at (1) assessing the relationship between paediatric nurses' quality of life and intent to leave, (2) examining the moderating effect of the hospital type on this relationship, (3) comparing the quality of life of paediatric nurses working at ministry of health and the University-Affiliated hospitals and (4) exploring the determinants of nurses' intent to leave. DESIGN: A cross-sectional, comparative and correlational design was used in this study. METHODS: A multi-site sample was selected from two types of hospitals in Jordan; the ministry of health and the University-Affiliated hospitals. A sample of 225 paediatric nurses responded to the brief quality of life questionnaire by the World Health Organization in addition to a group of sociodemographic and work-related questions. RESULTS AND CONCLUSION: Nurses' quality of life and intent to leave were negatively correlated. This correlation was moderated by the type of hospital. Nurses' quality of life was significantly different in the two types of hospitals. Both salary and nursing care model predicted paediatric nurses' intent to leave. The managerial style and work environment of the ministry of health hospitals should be benchmarked against the University-Affiliated hospitals.