Impact of Nurses’ Work Patterns on Nurses and Patients in Critical Care and Toxicology Care Units of Alexandria University Hospitals

Background: Nowadays, there are difficulties in recruiting and retaining nursing staff with increasing pressures and demands on nurses working in critical care areas. The role of nursing care in patients' safety and healthcare outcomes has led to increased interest in measuring and reporting nurses’ work patterns and their consequences on nurses and patients. Objectives:  Describe nurses’ work patterns and their impacts on nurses and patient outcomes. Methods: Self-report forms were used to collect data regarding nurses’ time spent on direct and indirect nursing activities, non- nursing care and personal activities as well as care left undone. Questionnaires were used to measure stress, tension, conflict, nurses’ intent to leave, nurses' satisfaction and  patient satisfaction  Results: nurses spent their working time on direct nursing care (36.64 %); indirect nursing care (28.18 %), non-nursing care (30.64 %) and personal activities ( 4.7%). Profile of direct and indirect patient care and personal activities increased in night shifts, while the profile of non-nursing tasks increased in morning shifts.  There was a positive correlation between care left undone and three non-nursing tasks. Besides, there was a positive correlation between left care undone, non-nursing duties and four nursing job outcomes. There also was a negative correlation between care left undone, non-nursing tasks and nurses' and patients' satisfaction.  Conclusion:  the study focused on the importance of direct patient care on improving quality of care and patient safety. Reducing the performance of non-nursing duties by nurses and decreasing care left undone will most likely result in greater nurses’ and patients’  satisfaction, reduced stress, tension, and conflict and decreased numbers of  nurses’ leaving their jobs. Keywords: work, patterns, nurses, patients, outcome

Young-IFSO Bariatric/Metabolic Surgery Training and Education Survey

Background This international Young-IFSO survey aims to address variations, trends, and obstacles in bariatric/metabolic surgery (BMS) training globally, since expectations and resources differ among young surgeons.Methods The Young-IFSO scientific team designed an online confidential questionnaire with 50 questions analyzing the individual BMS training. The survey link was sent to all IFSO/ASMBS members and was shared in social media. All Young-IFSO members (age up to 45 years) were invited to participate between 16 December 2022 and 4 February 2023.Results A total of 240 respondents from 61 countries took the survey. Most respondents (70.24%) described their current position as a consultant surgeon with an average of 5.43 years' experience working in BMS, and 55% are working in a bariatric center of excellence. More than 50% of the respondents performed none or less than 10 BMS during residency. Preparation of the stomach and stapling during sleeve gastrectomy (SG) were the first steps performed, and SG was the first BMS completed as a first operating surgeon by most of the respondents (74%). In total, 201 (84.45%) surgeons reported to perform scientific work. Most respondents (90.13%) reported that surgical mentorship had improved their surgical skills.Conclusion This international experts' survey underlines the lack of a standardized global surgical curriculum of BMS during residency. It shows that SG is the single most performed procedure by young surgeons. These data might underline the importance of advancing surgical education in BMS, and accredited fellowship programs should be offered globally to maintain and raise quality of BMS

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)