Effect of Time Management Program on Job Satisfaction for Head Nurses

Background:- Time management and job satisfaction all related to each other and greatly affect success of organization.Subjects and Methods:-The study aimed to  evaluate the efficacy of a designed program of time management on job satisfaction for head nurses. A Quasi-experimental design was used for a total number of head nurses participated. Two tools of data collection used, namely, time management knowledge Questionnaire and job satisfaction Questionnaire.Results: There was a significant   response related to head nurse's time waster post program implemented and three quarter of head nurses reported that job satisfaction was moderate levels post  program.  There is highly statistically significant relationship between time management   and job satisfaction.Recommendation: the study recommended that time management training should be held for all hospitals and hospital personnel, especially nurses who tolerate more problems. Keywords: Head nurses, Time management, Job satisfaction, Training program

Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Risk factors for sexual dysfunction in Egyptian patients with rheumatoid arthritis and its relation to disease activity

Aim of the work: To assess risk factors for sexual dysfunction in married rheumatoid arthritis (RA) patients. Patients and methods: 216 RA (187 females and 29 males) and 187 matched healthy controls were included. Sexual function in male was assessed by modified International Index of Erectile Function Questionnaire (IIEF questionnaire) including: erectile function, sexual desire (libido), orgasmic and ejaculatory problems. For females, in addition to questions about libido, orgasmic problems, frequency of sexual intercourse and dyspareunia were considered. Disease activity scores (DAS-28) and modified health assessment questionnaire (mHAQ) were calculated. Results: The mean age of the patients was 45.2 ± 12.1 years and disease duration was 8.2 ± 7.6 years. All sexual dysfunction parameters were significantly higher in RA than in the controls. Patients with sexual dysfunction were older (p = 0.008), illiterate (p = 0.04), diabetics (p = 0.004), hypercholesterolemics (p = 0.002), had high ESR (45.1 ± 21.6 mm/1st h) (p < 0.001), longer MS duration (39.3 ± 40.9 minutes) (p = 0.01), had high DAS28 (p < 0.001) and mHAQ (p = 0.004) and used higher doses of leflunomide (p = 0.01). Multivariate regression analysis revealed that the presence of DM (OR 5.1; 95%CI 1.3–19.4), hypertension (OR 3.5; 95%CI 1.9–6.1), hypercholesterolemia (OR 3.6; 95%CI 1.5–8.2), older age (⩾45 years) (OR 2.4; 95%CI 1.3–4.5) (p = 0.003), active RA patients were associated with a higher risk of sexual dysfunction (OR 2.7; 95%CI 1.09–6.5) (p = 0.03); OR increased to 5.6 (95%CI 2.7–11.8) in patients with severe disease activity. Conclusion: DM, hypertension, hypercholesterolemia, older age and high disease activity in RA increase the risk of sexual dysfunction

Clinical significance of Galectin-1 and Galectin-4 in rheumatoid arthritis patients and their potential role as diagnostic markers

Aim of the work: To investigate the utility of serum Galectin-1 (Gal-1) and Galectin-4 (Gal-4) as potential markers for diagnosis of rheumatoid arthritis (RA) and to explore their relationship with disease activity. Patients and methods: Serum Gal-1 and Gal-4 of 60 RA patients were compared to 30 age and sex-matched controls. Potential relationship of both markers with disease activity assessed using Disease activity score-28 joints (DAS-28), seropositivity (Rheumatoid factor (RF) and anti-citrullinated protein antibody (ACPA)), functional classification assessed using modified health assessment questionnaire (MHAQ), radiographic progression assessed using Larsen score and treatment was investigated. Results: The study included 60 patients; 54 (90 %) females and 6 (10 %) males with a mean age of 42.6 ± 10.1 years and disease duration of 7.5 ± 6.4 years. Their mean DAS-28 was 4.6 ± 1.0, their MHAQ was 1 ± 0.5 and their Larsen score was 41.3 ± 9.9. The mean of Gal-1 and Gal-4 were both significantly lower in RA patients in comparison to control group (4.4 ± 1.5 ng/ml vs 38.1 ± 25.5 ng/ml and 1.2 ± 0.7 ng/ml; p < 0.001vs 8.1 ± 7.0 ng/ml; p < 0.001 respectively. At a cut off value ≤7.7 for Gal-1 and ≤2.3 for Gal-4 was successfully able to differentiate between RA patients and control group. There was no correlation between both Gal-1 &amp; Gal-4 and DAS-28, MHAQ, Larsen score, RF or ACPA titres. Conclusion: Gal-1 &amp; 4 serum levels have a potential role as diagnostic markers in patients with RA. Both markers however cannot be regarded as disease activity or severity markers

Urological comorbidities in Egyptian rheumatoid arthritis patients: Risk factors and relation to disease activity and functional status

Aim of the work: To assess the urological disorders in rheumatoid arthritis (RA) patients, analyse the risk factors and to find their relation to disease activity and functional status. Patients and methods: 291 RA patients (253 females and 38 males; F:M 6.7:1) and 242 matched controls were included. Urological disorders in the form of urinary tract infections (UTI), urolithiasis and acute urine retention (AUR) were assessed, risk factors were analysed. Disease activity score (DAS-28) and modified health assessment questionnaire (mHAQ) were calculated. Results: RA patients had more frequent urological disorders (38.14%) than controls (20.66%), more UTI (p < 0.001) and this difference persisted in females (p < 0.001). Urolithiasis tended to be more frequent in RA patients (p = 0.3); the difference was significant between the female patients and controls (p = 0.04). Urinary stones were comparable between the male patients and controls (p = 0.2). RA patients had more AUR (4.8%) than the controls (2.1%) (p = 0.07). Asthmatic patients particularly the females had more UTI (p = 0.001 and p < 0.001 respectively). UTIs were observed with higher steroid doses (p = 0.04) and urolithiasis were noticed more in hypertensive female patients (p = 0.03). Patients with higher DAS-28 and mHAQ developed more urological comorbidities (p0.49 and p = 0.82 respectively). UTI and urolithiasis were detected in patients with higher DAS 28 (p = 0.1 and p = 0.4 respectively). Conclusion: RA patients were found to have more urological disorders. Bronchial asthma, hypertension and higher steroid doses may increase risk for urinary comorbidities in RA. Patients with higher DAS28 and mHAQ had more urological comorbidities, however without statistically significant difference

Role of diagnostic ultrasonography in detecting gouty arthritis

AbstractIntroductionGout is a form of inflammatory arthritis that is characterized by attacks of active synovitis related to the presence of monosodium urate (MSU) crystals in the joints and periarticular soft tissues.Aim of the workTo establish the usefulness of ultrasonography (US) in diagnosing subclinical gouty arthritis and to determine whether there are sonographic features that are characteristic of gout.Patients and methodsWe studied 20 patients known to be gouty (group 1), 20 patients with asymptomatic hyperuricemia (AH) (group 2) and 20 controls (group 3) in a cross sectional study. Demographic, clinical and serological data were evaluated. Knee and 1st MTP joints were assessed by musculoskeletal (US) to detect subclinical gouty arthritis.ResultsClinical gouty arthritis was found in only (20%) in (group 1), but subclinical gouty arthritis had been found in (75%) in (group1) and (25%) in (group 2). There were statistically significant differences between the examined groups regarding the presence of double contour (DC) sign (p<0.001), joint effusion (p=0.04), serum uric acid (SUA) level (p<0.001), diuretics use (p<0.001), allopurinol use (p<0.001), also it was found that only SUA was the risk factor for the occurrence of the double contour (DC) sign (p=0.03) and cut-off value of SUA was 9.1mg/dl above which DC sign was detected.ConclusionUltrasonography (US) is a useful tool to detect subclinical gouty arthritis; also serves as a non-invasive, bedside and non-ionizing tool

Increased arterial stiffness in rheumatoid arthritis and Its relation to disease activity: A cross sectional study

Background: Rheumatoid arthritis (RA) is associated with elevated plasma level of inflammatory markers. Chronic inflammation is known to predispose to endothelial dysfunction and increased arterial stiffness, which is an important marker of subclinical atherosclerosis and increased cardiovascular risk. Objective: The aim is to test for the relationship between disease activity and arterial stiffness in RA patients. Methods: The study included 90 RA patients, at different grades of disease activity and 45 healthy subjects, as a control group. Patients were subjected to full history taking and clinical examination, laboratory investigations including serum lipid profile and high sensitivity CRP (hs-CRP) measurements and plain x-rays of hands and feet. Modified Larsen method was used as radiographic scoring method. Disease activity score (DAS 28) was used for assessment of disease activity. Transthoracic echocardiography was performed to detect aortic stiffness parameters. Duplex ultrasound imaging of both common carotid arteries was performed to measure carotid stiffness parameters. Results: The mean age of RA patients was 39.86 ± 9.39 years and most of them (83.3%) were females. RA patients had higher carotid stiffness index compared to control group patients (8.57 ± 4.83 vs 4.08 ± 1.13, p < .001). Very poor correlation was found between DAS-28 and aortic (r = 0.1, p = .28) as well as carotid (r = 0.05, p = .7) stiffness indices. No statistically significant correlation was found between hs-CRP and aortic stiffness index (r = 0.64, p = .55). Disease duration was significantly correlated to intima-media thickness (p < .01) as well as with other carotid stiffness parameters. Age also show a statistically significant positive correlation with carotid stiffness parameters. Conclusion: RA is associated with increased arterial stiffness, a well-recognized marker of cardiovascular risk. This is attributed to the inflammatory nature of the disease. It seems that the most important factors determining stiffness are patients' age and duration of illness. Keywords: RA, hs-CRP, Arterial stiffnes