Search

Aim: To identify the learning barriers, nursing students encounter throughout distinct stages of simulation‐based education. Design: Qualitative study exploring learning barriers in simulation training. Methods: Data were collected through interviews with 13 fourth‐year nursing students at Dongnam Health University, divided into four groups. These students had prior simulation experience with a variety of medical scenarios, including shortness of breath, chest pain, preterm labor, postoperative pain management, and neonatal care. Interviews were conducted using a semistructured format and lasted approximately one hour per group. We then used content analysis to identify primary and secondary themes. Results: Three main themes and 13 subthemes were identified, highlighting learning challenges across different stages of simulation training: limitations in integrating theoretical foundations during the prebriefing phase, the impact of psychological stress on clinical reasoning abilities during the scenario phase, and constraints in reflective thinking during the debriefing phase. Conclusion: This paper highlights significant learning obstacles across the simulation training process and advocates for targeted educational strategies to overcome these barriers. Specific recommendations include implementing additional measures to enhance student immersion, ensuring psychological safety, and enhancing debriefing sessions to encourage reflective thinking. Implications: This paper emphasizes the need for immersive and realistic training in nursing education. It suggests enhancements in applying theoretical knowledge, managing stress‐induced clinical reasoning, and fostering reflective thinking to better prepare students for clinical realities. It also acknowledges that the sample size may limit generalizability and recommends further studies with larger cohorts. Impact: This study aims to better prepare nursing students for the complexities of clinical practice by emphasizing the development of holistic patient care and adaptive problem‐solving skills. The research implications suggest a potential transformation in nursing education and practice, aiming to improve healthcare outcomes. [ABSTRACT FROM AUTHOR]

Background: A humble leadership style promotes human relationships above transactional relationships. Purpose: This study aimed to evaluate predictors and differences in humble nursing leadership and team performance based on sample characteristics and the total scores of the concepts. Methods: Using a quantitative cross‐sectional design, convenience snowball samples of 260 participants distributed as nursing academics (66), senior nurses (94), and novice nurses (100) were recruited. An online poll was distributed in March 2022 in selected Jordanian public and private universities and hospitals. Using the Statistical Package for the Social Sciences (SPSS), the general linear model (GLM) was used to determine predictors of humble leadership style and team performance. T‐tests or one‐way analyses of variance (ANOVAs) were employed to detect the differences in the total scores of the studied concepts. Results: Academics, nurses, and teams were generally humble. The team functioned relatively well and effectively. Humble leadership scores correlated moderately with team performance. The ANOVA showed some significant differences between the two studied variables. Conclusions. A humble leadership style improves employees' and the team's performance. This study illuminates how a humble leadership style affects team performance. [ABSTRACT FROM AUTHOR]

Purpose: To find whether the CHA2DS2‐VASc score, a system for stratifying stroke risk among patients with atrial fibrillation, correlates with visual acuity prognosis following retinal vein occlusion (RVO). Participants and Methods: This retrospective study included 83 eyes of 83 patients with a diagnosis of branch or central RVO between June 2017 and August 2022 with at least 12 months of follow‐up in Assuta Ashdod Medical Center, Ashdod, Israel. The patients were divided into three groups, with CHA2DS2‐VASc scores of 0–2 (N = 31), 3–5 (N = 45), or 6–9 (N = 7). The change in best‐corrected visual acuity (BCVA) between the groups was examined about 1 year after the presentation of RVO. Results: The patient mean age was 67.9 ± 13.8 years; 38.6% were women. The mean visual acuity was 0.83 ± 0.67 LogMAR units at the first admission and 0.78 ± 0.80 LogMAR units at the last visit. Patients with a CHA2DS2‐VASc score from 6 to 9 had a significantly poorer BCVA prognosis at 1‐year (+0.60 ± 0.94 [−0.27, 1.47] LogMAR units) compared to groups with a CHA2DS2‐VASc score from 3 to 5 (−0.01 ± 0.65 [−0.20, 0.19] LogMAR units) and a CHA2DS2‐VASc score from 0 to 2 (−0.12 ± 0.59 [−0.33, 0.10] LogMAR units) (p = 0.038). Conclusions: Following RVO, patients with a CHA2DS2‐VASc score of 6 or higher had a worse prognosis in their visual acuity than patients with a lower score. [ABSTRACT FROM AUTHOR]

Purpose: To compare the standard outcomes between the PanOptix and Symfony multifocal intraocular lenses (MIOLs) in Chinese patients. Methods: This prospective observational cohort study enrolled patients with cataracts between April 2021 and December 2021 at Xiamen Eye Center Affiliated to Xiamen University. The patients were grouped in the PanOptix (TIOL group) and Symfony (EDF group) according to the IOLs implanted. Uncorrected distant, corrected distance, binocular uncorrected intermediate, and near visual acuity (UNVA), distance‐corrected intermediate and near VA (DCNVA) , defocus curve, spectacle independence, contrast sensitivity (CS), and visual disturbances were evaluated after 3 months. Results: Forty patients (80 eyes) were enrolled in the study (20/group). Three months after the operation, UNVA (0.13 ± 0.16) and DCNVA (0.08 ± 0.08) were better in the TIOL group than in the EDF group (0.22 ± 0.08 and 0.22 ± 0.08, respectively, p = 0.003 and p < 0.001, respectively). The TIOL group achieved a better‐than‐0.15‐logMAR VA from +0.5 D to −2.5 D (40 cm). VAs of the TIOL group from −1 D (100 cm) to −4 D (25 cm) were better than in the EDF group (p < 0.05). There were no significant differences in the intermediate and far vision outcomes (p > 0.05). Total near‐vision spectacle independence was higher in the TIOL group (80%) than in the EDF group (50%) (p = 0.039). Conclusion: Compared with EDF, TIOL leads to better near‐vision outcomes without significant differences for intermediate and distant vision outcomes. Trial Registration: ClinicalTrials.gov identifier: ChiCTR2100044558. [ABSTRACT FROM AUTHOR]

Background. Breast cancer is an important cause of cancer‐related death in women worldwide and represents the second most frequent cause of brain metastases after lung cancer. The aim of this study was to determine the characteristics and outcomes of triple‐negative breast cancer (TNBC) patients with brain metastasis (BM). Methods. We retrospectively reviewed a cohort of patients diagnosed with TNBC at the "Instituto Nacional de Enfermedades Neoplasicas" (period 2000–2014) to evaluate patients who developed BM. Survival rates were assessed by the Kaplan–Meier method, and prognostic factors were identified with the Cox regression analysis. Results. Of a total of 2007 TNBC patients, 193 (9.62%) developed BM. Of these, 169 stages I–III patients with a median age of 45 years (range:21–78) were included. The stage in this cohort was 4 (2.4%) clinical stage (CS) I, 23 (13.6%) with CS II and 142 (84.0%) with CS III. Most of these patients presented ECOG ≥2 (68.6%). The most common symptom was headache (74.0%), followed by nausea‐vomiting (46.7%). Imaging showed that 80 patients (53.0%) had ≥1 metastatic brain lesion. Regarding the treatment of BM in this cohort, 132 patients (84.6%) received radiotherapy (RT), 2 (1.5%) surgery, and 6 (4.5%) surgery plus RT. The overall survival (OS) rate of BM was 59.8%, 37.3%, and 15.0% at 3, 6, and 12 months, respectively. A multivariate analysis showed RT to be the only factor with a positive impact on the OS of BM (hazard ratio (HR) = 0.48, 95% confidence interval (CI):0.30‐0.77, and p = 0.002), while ECOG ≥2 was associated with a worse OS (HR = 1.69, 95%CI:1.15–2.48, and p = 0.007). Conclusion. Despite the poor prognosis of TNBC patients who develop BM, RT showed a benefit in OS rates, while ECOG ≥2 was the only prognostic factor associated with a worse OS. These results may be useful for multidisciplinary teams for treatment planning in patients with TNBC and BM. [ABSTRACT FROM AUTHOR]

Background. Systemic sclerosis (SSc) is an autoimmune disease characterized by inflammation, progressive vasculopathy, and fibrosis of skin and internal organs. The aim of the study was to evaluate extended inflammatory parameters (EIP) in patients with SSc in comparison to the control group of healthy subjects. Methods. A total of 28 patients with SSc and 29 healthy controls (HCs) were included in the study. The following EIP parameters were analyzed: neutrophil reactive intensity (NEUT‐RI), neutrophil granularity intensity (NEUT‐GI), antibody‐synthesizing lymphocytes (AS‐LYMP), and reactive lymphocytes (RE‐LYMP). Results. Patients with SSc showed significantly higher values of parameters determining neutrophil reactivity and neutrophil granularity when compared to HCs (respectively, 49.16 FI vs. 44.33 FI, p < 0.001, and 152.01 SI vs. 147.51 SI, p < 0.001). Moreover, patients with SSc had higher absolute numbers of RE‐LYMP than HCs (0.69 × 103/µl vs. 0.04 × 103/µl, p < 0.001). Importantly, significant correlations between the RE‐LYMP and either IL‐6 (R = 0.447, p < 0.001) or ESR (R = 0.532, p < 0.001) were found among patients with SSc. Conclusions. Changes in NEUT‐RI, NEUT‐GI, and RE‐LYMP levels positively correlate with inflammation in SSc and, thus, could potentially be used as an additional reliable inflammatory biomarker to assess inflammation in this disease. [ABSTRACT FROM AUTHOR]

Background. Novel educational strategies are essential to cultivate a cadre of nurses with the requisite skills, critical thinking abilities, and adaptability demanded by contemporary healthcare contexts. The shift towards various learning modalities in nursing education, including online, hybrid, and in‐person formats, raises questions about their impact on student engagement and academic self‐concept. Objectives. This study aimed to assess and compare the levels of student engagement and academic self‐concept among nursing students engaged in different study modalities (online, hybrid, and in‐person). Methods. In this descriptive comparative study, 203 nursing students were evaluated using the university student engagement inventory (USEI) and academic self‐concept questionnaire (ASCQ). Participants were divided into groups based on their involvement in online, hybrid, or in‐person study modes. Differences and correlational analysis within variables were performed to evaluate the comparison between groups. Results. Significant differences were observed in the USEI scores among the study modalities: online (mean = 45.7, SD = 5.6), hybrid (mean = 48.8, SD = 6.1), and in‐person (mean = 50.4, SD = 6.2), with in‐person students displaying the highest levels of engagement (F = 10.663, P < 0.001). Academic self‐concept scores also varied notably (F = 9.422, P < 0.001) between modalities, particularly between online (mean = 54.8, SD = 5.3) and in‐person students (mean = 58.8, SD = 7.7). Correlational analysis within each modality revealed significant relationships among the subdomains of USEI and ASCQ. Conclusion. The study demonstrates that the mode of study substantially influences nursing students' engagement and academic self‐concept, with in‐person learners showing higher scores in both domains. These results are vital for educators and policymakers in nursing education to optimize learning experiences across different modalities. [ABSTRACT FROM AUTHOR]

The increased funding provided for Community Health Worker (CHW) hiring and training as part of the COVID‐19 pandemic response was to increase their impact in alleviating the effects of negative social determinants of health in the lives of the most vulnerable individuals and communities. This enhanced use of CHW in vulnerable populations can also be used to improve access to such populations for applied research to study ways to improve health outcomes for low‐income minority populations. We carried out a feasibility study using the State CHW association as partners to reach CHWs working with low‐income minority population. Three hundred and three (303) clients of CHWs were interviewed on various demographic, health access, and employment information and both univariate and multivariate analyses was used to determine factors associated with being unvaccinated against COVID‐19 and chi‐squared used to determine if employment was associated with having health insurance. About half of the clients self‐identified as Black/African American and half as Hispanic. Two‐thirds were women and 52.1% were unemployed and 55.1% had no health insurance. There was no association between employment status and having health insurance. Majority (71.6%) had received one dose of a type of COVID‐19 vaccine and being younger and being African American were associated with not getting a dose of COVID‐19 vaccine, as well as being unemployed and not having health insurance. Most of the clients came to see the CHW about a Health/Healthcare issue of the five social determinants of health (SDOH). There were 38 different job titles provided by the clients and the job titles were mainly blue collar jobs and jobs in health and personal care. Our results indicate that CHWs reach the most vulnerable population who have limited health access and high unemployment and that CHWs can effectively be used for linkage to low‐income minority population for applied research. Our analyses found that in this low‐income population, being younger, being African American, being unemployed, and not having health insurance are each associated with not getting vaccinated against COVID‐19, and employment is not associated with having health insurance. We have shown that partnership with CHWs to access their clients as research subjects leads to elucidating new information on the population that can be used in addressing public health programming. [ABSTRACT FROM AUTHOR]

Aim: To determine the frequency and possible associated dietary and environmental factors of functional constipation (FC) among children in Lebanon followed at a single pediatric health system. Method: A prospective cross‐sectional study was conducted in all pediatrics clinics at the American University of Beirut Medical Center (AUBMC). Children aged 2–7 years presenting for a well‐child visit were recruited. Data relating to the child's bowel habits and other history items were obtained from parental questionnaires. Results: The mean age of the 172 recruited participants was 4.94 years with 56.4% being males. FC was present in 32.6% of the participants. Although there was no difference in the frequency of FC based on age and gender, the peak frequency of FC was at 5 years. The daily frequency of withholding stools was 64.3%, and 46.6% of the children with FC always experienced straining while stooling for the past 2 months. Decreased physical activity and diet were not significantly associated with FC. Conclusion: The present study shows that 32.6% of children aged 2–7 years in Lebanon suffer from constipation while only 51.7% of the recruited children's physicians inquire about the child's bowel movement during the well check visit. These numbers highlight the need to raise more awareness among pediatricians on the need to screen for constipation during clinic visits as a standard of care practice. [ABSTRACT FROM AUTHOR]

Background. We evaluated the prognosis of traumatic out‐of‐hospital cardiac arrest (OHCA) by assessing the presence of hepatic portal vein gas (HPVG) observed in ultrasound (US) or point‐of‐care ultrasonography (POCUS) performed during CPR. Furthermore, we aimed to understand the role of HPVG in decision‐making regarding CPR discontinuation or withholding in traumatic OHCA. Methods. The retrospective study was conducted at the level 1 trauma center of urban academic medical centers in South Korea. We included adult trauma OHCA patients who underwent CPR between January 1, 2020, and June 30, 2022. Data on traumatic OHCA patients who presented to the level I trauma center during this period were extracted from the hospital's electronic medical record system. The arrest data were separately managed through the hospital's electronic medical record system for quality control, specifically the arrest registry. US images or clips of the hepatic portal vasculature (HPV) during CPR were used to assess the presence of HPVG. These images were independently reviewed by two emergency medicine physicians with several years of US examination experience who were blinded to all clinical details and outcomes. We evaluated the prognosis of traumatic OHCA by assessing the presence of HPVG using the US. In addition, we analyzed the general characteristics and assessed the impact on the ROSC in traumatic OHCA. Results. Among the 383 cardiac arrest patients, 318 traumatic OHCA patients were included. The mean age was 54.9 ± 19.4 years, and most patients were male. The initial rhythm was mainly asystole, and falls were the most frequent cause of injury. The overall ROSC rate was 18.8%, with a survival rate of 7.2% at hospital discharge. Among the 50 patients who underwent a US examination of HPV, 40 showed HPVG. The HPVG group had a significantly lower ROSC rate and survival rate at ED discharge and hospital discharge compared to the group without HPVG. Conclusion. Traumatic OHCA with HPVG presents a significantly worse prognosis. This suggests that early consideration of termination or withholding of CPR may be appropriate in such cases. [ABSTRACT FROM AUTHOR]

Objectives. This study aimed to report clinical outcomes of patients with vaginal melanoma (VaM) or vulvar melanoma (VuM) who were treated with immune checkpoint inhibitors (ICI) and discuss the development of immune‐related adverse events (irAE). Materials and Methods. This is a retrospective case series of patients diagnosed with VaM or VuM between July 2011 and September 2022 at the University of Virginia, Emily Couric Clinical Cancer Center. Patient demographics, disease characteristics, treatment outcomes, and adverse events were abstracted. The primary outcome was incidence of irAE. Results. Eight patients were included in this study, four with VaM and four with VuM. Most (n = 6) had local or regional disease at first presentation, and 25% (n = 2) presented with distant metastasis. All patients received a CTLA‐4 inhibitor and 75% (n = 6) received PD‐1 inhibitor alone or in combination with a CTLA‐4 inhibitor. Most (75%, n = 6) patients experienced irAE. Of those who had irAE, 83% (n = 5) required therapy interruption or discontinuation. Most (66%, n = 4) underwent ICI rechallenge of which 75% (n = 3) experienced subsequent irAE. Of all patients in the series, 75% of patients (n = 6) had partial or complete response to ICI. Conclusion. This series is the first to detail incidence of irAEs and ICI rechallenges in vulvovaginal melanoma. Our findings indicate that while ICIs are effective, their use is associated with significant irAE development. Rechallenge of ICI after irAE is feasible but associated with risk of recurrent/new irAE. Further studies are needed to better quantify this risk. [ABSTRACT FROM AUTHOR]

Objective. Oncology and palliative care guidelines for patients with incurable cancer recommend supporting patients at the end of life (EOL) by considering their personal values, wishes, and goals to facilitate decision making in advance care planning and patient‐centered care. It is unclear, though, how to successfully address and integrate personal values in clinical practice. The aim of this study was to explore values, wishes, and goals from the perspective of patients with advanced lung cancer. Methods. Semistructured interviews were conducted with patients with advanced lung cancer and transcribed verbatim. The data were analysed using a structured content analysis. After identification of main categories, values were identified using Schwartz's Theory of Basic Human Values as a theoretical framework. Results. Identified main categories were "the individual in medical care," "living now," and "coming to terms." Values in the dimensions "conservation" and "openness to change" were described concerning patient‐physician interaction, therapy goals, preparedness for EOL, and life goals. "Self‐transcendence" values mainly related to caring for the burden on relatives. In general, patients showed reluctance in expressing information about personal values when communicating with physicians. Conclusion. Patients with advanced lung cancer engage in various ways to determine how they want and can influence their life and medical care. Different values and the associated wishes and goals play a crucial role in this context and should be taken into account by healthcare providers. The reluctance to express personal information in medical encounters underscores the need for a proactive attitude in physicians and improved interprofessional collaboration. The study was registered in the German register for clinical trials (DRKS00026993). [ABSTRACT FROM AUTHOR]

Aim. To investigate the effect of the triggering method on the results of fresh embryo transfer in patients who underwent gonadotropin‐releasing hormone antagonist cycles. Methods. The study was conducted retrospectively at a university‐based tertiary reproductive center. The sample consisted of a total of 295 patients, of whom 111 were in the human chorionic gonadotropin (hCG) trigger group and 184 were in the dual trigger group. The main outcome measure of this study was the live birth rate, and secondary outcomes were the implantation rate, clinical pregnancy rate, miscarriage rate, and good‐quality embryo rate. Results. Patient demographics and baseline characteristics did not significantly differ between the dual and hCG trigger groups. The results also indicated statistically nonsignificant differences between the two groups in terms of the number of oocytes retrieved (p > 0.05), the number of mature oocytes (p > 0.05), and the fertilization rate (p > 0.05). The number of good‐quality embryos (p = 0.002) was higher in the dual trigger group compared with the hCG trigger group. However, the rates of clinical pregnancy and live births did not significantly differ between the groups (p > 0.05). Conclusions. Although the number of total and high‐quality embryos obtained was higher in the dual trigger group, there were no significant differences between the two groups in terms of pregnancy outcomes. The fresh embryo transfer yielded similar rates of implantation and live births in both trigger groups. [ABSTRACT FROM AUTHOR]

As global populations age, a looming nursing shortage is anticipated to become a critical issue. Charge nurses have the responsibility of optimally allocating nursing resources to ensure the quality of patient care during a shift. Therefore, an accurate estimate of nursing demand is crucial. However, the ability to forecast future nursing demand remains underdeveloped, mainly because the nature of nursing demand is highly individualized and does not follow a definitive pattern. In practice, the nursing demand is often perceived as unpredictable, leading to an ad hoc approach to staffing. The primary objective of our study is to demonstrate that longitudinal data analysis can reveal strong statistical regularities in the temporal dynamics of nursing demand. This approach not only provides new possibilities for efficient resource allocation but also paves the way for data‐driven prediction of nursing demand. Our study uses Sankey diagrams to visualize the temporal dynamics of nursing demand within each ward for each fiscal year, representing these dynamics as an overlay of trajectories from multiple individual patients. Consequently, our study reveals ward‐specific statistical regularities in the temporal dynamics of nursing demand. In one ward, approximately 25% of patients experienced an increase in nursing demand from 1 to between 6 and 9 points from the second to the third day of hospitalization, while in another, only 0.1% showed such an increase. These findings suggest that patients admitted to the wards tend to exhibit a certain probabilistic change in nursing demand. This study can predict probabilistically the temporal variation of nursing demand among patients in the coming years by analyzing data on the temporal changes in nursing demand over the past years. Our findings are expected to significantly influence the forecasting of nursing demand and the estimation of nursing resources, leading to data‐driven and more efficient nursing management. [ABSTRACT FROM AUTHOR]

Background: Patients with inflammatory bowel disease (IBD) often experience worries related to travel due to frequent bowel movements. However, there is currently limited research focusing on the travel worries of patients with IBD. The aim of this study was to assess the level of worry regarding out‐of‐home activities in patients with IBD and identify factors associated with worry. Methods: This study included patients with IBD who visited the outpatient clinics between September 2020 and March 2022, during the COVID‐19 pandemic. Participants completed a self‐designed questionnaire, providing general clinical data and indicating their level of worry for out‐of‐home activities. Results: A total of 529 patients with IBD completed the questionnaire. Patients with Crohn's disease (CD) had a higher proportion of individuals under 40 years old and males compared to patients with ulcerative colitis (UC). Regarding out‐of‐home activities, patients with UC expressed greater worry about going out and taking buses than patients with CD. However, there were no significant differences observed between the two groups in terms of travel worries and worries about finding public washrooms. A significant majority (85.4%) of patients with clinically active IBD expressed worries about not finding public washrooms when going out, while 46.7% of patients in clinical remission had similar worries. Moreover, the worry about finding public washrooms was higher in patients with UC compared to those with CD, both during the clinical activity and remission. Conclusion: This survey conducted during the COVID‐19 pandemic reported worries among patients with IBD about out‐of‐home activities. The patients with clinically active IBD, especially UC, expressed worries about not finding public washrooms when going out. We highlight the actual psychological and quality of life challenges faced by patients with IBD. [ABSTRACT FROM AUTHOR]

Aim. The current study investigated the levels and predictors of leaders' humble leadership, participants' psychological safety, knowledge sharing in the team, and followers' creativity in nursing. Background. Humble leadership, psychological safety, knowledge sharing, and followers' creativity are non‐nursing research fields, and humble leadership has recently been examined in nursing. Methods. A cross‐sectional research design was employed via an online survey. A nonprobability convenience snowball sample of 245 nursing academics (n = 85, 34.70%), nurses (n = 140, 57.10%), and nursing leaders (n = 20, 8.20%) was recruited from three universities and three hospitals. Results. The participants rated "high" the leaders' humble leadership, knowledge sharing in the team, and followers' creativity in nursing. However, participants' psychological safety was precarious. The four variables' predictors were assessed based on the sample's characteristics. Leaders' humble leadership did not predict participants' psychological safety; the sole predictor of the variable was the organization's quality initiatives. The predictors of knowledge sharing in the team were leaders' humble leadership, age, level of education, and accreditation initiatives in the organizations. The predictors of followers' creativity were leaders' humble leadership, level of education, and quality initiatives in the organizations. The lowest means of the four variables should be immediately managed. Conclusion. Quality initiatives in organizations and the number of tenures were the most influential predictors of the four variables evaluated. Leaders' humble leadership predicted knowledge sharing in the team and followers' creativity, but not participants' psychological safety. As followers' psychological safety contributes to trustful relationships within the team, workplace boundaries and conducive work environments should be promoted. Training programs are required to develop humble nurses and leaders' leadership. [ABSTRACT FROM AUTHOR]

Introduction. There is still minimal scientific understanding of effects of fulvic acid (FA) on breast cancer. We investigated the prophylactic, therapeutic, and combined effects of FA in a breast cancer model created using MCF‐7 cell line in severe combined immunodeficiency disease (SCID) mice. Results. Four experimental groups were established as the control group (Group C), prophylaxis group (Group P), therapeutic group (Group T), and prophylaxis + therapeutic group (Group P + T). Tumor growth was observed by the in vivo imaging system and macroscopically in mammary glands of all mice (100%) of Group C, microscopically in only one mouse of Group P (12.5%), in four mice in Group T (50%), but only one animal (12.5%) in Group P + T. Immunohistochemistry (IHC) showed that p53 staining was significantly higher in tissues of Group C compared to other groups (P < 0.05). No difference was found in IHC scores for p53 between Group P and P + T (P > 0.05). Bcl‐2 staining was significantly higher in Group C compared to Group P + T (P = 0.015) and higher in Group P + T compared to Group T (P = 0.021) but no significant difference was found between Group P and others (P > 0.05). Bax staining was significantly higher in Group C compared to others (P < 0.05) but no significant difference was found between FA groups (P > 0.05). Conclusion. Prophylactic FA treatment can prevent tumor formation by inducing variations in the expression of p53, BcL‐2, and Bax proteins in mammary glands of SCID mice before tumor formation. This suggests that FA may be a powerful inhibitory candidate for the prevention of tumorigenesis in breast cancer. [ABSTRACT FROM AUTHOR]

Background. Granulomatous dermatoses, particularly on facial skin, pose a diagnostic challenge, as similar histologic patterns can be produced by different causes. Aim. To evaluate the correlation between clinical suspicion and histopathological findings in various facial granulomatous dermatoses. Materials and Methods. This retrospective, cross-sectional study included all patients with the histopathological diagnosis of facial granulomatous dermatoses from the years 2016 to 2021 in an academic hospital. Demographic, clinical, and histopathologic features were reviewed and analyzed. Results. In this study, 150 histopathological records with the diagnosis of facial granulomatous dermatoses from the years 2016 to 2021 were reviewed. The most common clinical diagnosis was rosacea 34 (23.6%), followed by sarcoidosis 27 (18.8%), leishmaniasis 15 (10.4%), and granulomatous rosacea 10 (6.9%). The frequency of clinical diagnosis of rosacea (70.6), sarcoidosis (66.7), foreign body G (62.5), TB (75), pseudolymphoma (75), acne agminata (66.7), and granulomatous rosacea (70) in female patients was higher than that in males (P value = 0.03). The effect of age on the type of both clinical and histopathological diagnosis was statistically significant (P value = 0.0001 and 0.004, respectively). Conclusion. Our study contributed significantly to the understanding of the clinicopathological aspects of facial granulomatous dermatoses and advocated for a multidisciplinary approach to the diagnosis and management of these complex skin conditions. [ABSTRACT FROM AUTHOR]

Background. Atrial fibrillation (AF) is associated with significant mortality and morbidity from stroke and thromboembolism. Despite the availability of effective oral anticoagulation medication, AF patients remain at a high risk of stroke if not treated properly. The purpose of this study was to evaluate antithrombotic therapy practices in patients with AF in the adult cardiac clinic at Hawassa University Comprehensive Specialized Hospital (HUCSH). Methods. It was a retrospective document review study. Total charts of 119 patients who had follow‐up at the adult cardiac clinic with a history of documented AF from January 1 to December 30, 2018, were included. Indicators for antithrombotic therapy based on the congestive heart failure, hypertension, age ≥75 (doubled), diabetes, stroke (doubled), vascular disease, age 65 to 74, and sex category (female) (CHA2DS2‐VASc) score were recorded. A p value of 0.05 was considered statistically significant. Data analysis was done using SPSS 23 software. Results. In this study, about 55% of patients with AF were receiving the appropriate antithrombotic treatment. The patients were 48 ± 18.2 years old. Of these, 70% were women. The most frequent underlying cardiac etiology was chronic rheumatic valvular heart disease (50%), followed by cardiomyopathy (14%). In nonvalvular AF, the mean CHA2DS2VASc score was 4.0 ± 1.07. In valvular AF compared to nonvalvular AF, the need for appropriate antithrombotic therapy was substantially greater (p 0.0001). Only 8 (13.6%) of the warfarin‐using patients had adequate anticoagulation. Conclusion. The study's findings in regard to antithrombotic usage and maintenance of appropriate antithrombotics for stroke prevention in our patients revealed a discrepancy between recommendations and practice. Therefore, we demand that patients with AF who meet the criteria utilize antithrombotics properly to prevent stroke. Warfarin‐taking patients' subpar optimum anticoagulation has to be addressed. Lastly, we advocate proper CHA2DS2‐VASc score utilization for nonvalvular heart disease. A regular INR follow‐up is also advised for patients who have started taking warfarin. [ABSTRACT FROM AUTHOR]

Purpose. Breast cancer is considered a huge health problem among women all over the world due to its increased mortality rate. Breast cancer deaths are decreased by 28–34% due to improvement in treatment and early detection. In order to detect breast cancer early and provide the best possible therapy, knowledge and awareness are essential. So, this study aimed to assess risk of breast cancer among nurses, the knowledge and practices of breast self-examination (BSE) and determine its barriers, and implement an educational program for them. Design. A quasiexperimental research design was used. Methods. This study was conducted at two university hospitals (main university hospital and woman's health hospital). A purposive sample of 280 nurses with age more than thirty-five years were included in the study using three tools, namely, structure interview questionnaire, breast cancer risk assessment tool, and a structured breast cancer knowledge and practice questionnaire. Nurses' knowledge and practices regarding breast cancer and BSE were first assessed and then they were provided with two educational courses covering theoretical and practical information. One month after the program ended, the nurses' knowledge and practices were assessed again. Results. About 3.2% of the participants have five years high risk of developing breast cancer according the risk assessment tool, the main barriers of do not do BSE did not find any symptoms and scared from finding any abnormality. There was a significant increase in knowledge and practice of breast self-examination posteducation compared to pre-education (73.2 and 98.2%, respectively). Also, there was a statistically significant difference between pre- and postprogram with a p value of 0.0001. Conclusion. This study concluded that 3.2% of the nurses with high risk of developing breast cancer needed a follow-up; more than half of them do not perform breast self-examination because they think that do not have any symptoms in the breast and the educational program with a significant effect on knowledge and practices of nurses. So, the researchers recommend the nurses need for an empowerment program and support by providing assistance in places of work as done free clinical examination and mammography by female specialist for privacy. [ABSTRACT FROM AUTHOR]

Cervical cancer has a significant impact on the lives of caregivers of cervical cancer patients, including male partners. Disturbances in physical, psychological, sexual, spiritual, and socioeconomical aspects of life are reported by male partners of cervical cancer patients. To reduce the impact associated with cervical cancer, adaptive coping mechanisms are needed. In this regard, little is known about the coping mechanisms used by male partners of women diagnosed with cervical cancer in sub-Saharan African countries. Therefore, this study aimed to explore the coping mechanisms used by male partners of women diagnosed with cervical cancer at the Ocean Road Cancer Institute in Dar es Salaam, Tanzania. A descriptive cross-sectional study design with a qualitative approach was employed to explore coping strategies used by male partners of cervical cancer patients between December 2022 and March 2023. Participants were selected using a purposeful sampling technique guided by the principles of saturation. In-depth interviews with thirteen male partners of cervical cancer patients were carried out, and the interviews were audio-recorded and transcribed verbatim. The data were then analyzed using a thematic analysis approach. Four themes highlighting coping mechanisms used by male partners of cervical patients were identified after data analysis. They include religious coping, emotional expression and regulation strategies, support-seeking strategies, and problem-solving strategies. Male partners of cervical cancer patients used various mechanisms to cope with the stressful situations they encountered. While most of the coping mechanisms used by male partners of cervical cancer patients were adaptive, some were maladaptive. Therefore, regular assessment among this population needs to be done to identify maladaptive coping and provide relevant support. [ABSTRACT FROM AUTHOR]

Background. Over 1 billion people worldwide suffer from the common chronic medical condition of hypertension. A hypertensive crisis occurs when blood pressure exceeds 180/110 mmHg. Depending on whether the target organ is harmed, the situation may be presented as a hypertensive emergency or urgency. Objective. To assess the prevalence and risk factors of patients with hypertensive crises who visited the Emergency Outpatient Department (EOPD) at Adama Hospital Medical College in Adama, Oromia, Ethiopia, between January 01 and August 31, 2021, G.C. Methodology. A cross-sectional, prospective study on the hypertensive crisis was conducted at Adama Hospital Medical College from January 01 to August 31, 2021, G.C. The data were collected using a standardized questionnaire, validated for completeness, and analyzed using SPSS. The findings were tabulated, and conclusions and recommendations were conveyed. Result. Out of 9,082 patients who visited the EOPD during the six-month period, 444 individuals with hypertensive crises were identified, representing a prevalence of 4.9%. Of these, 56.8% were men, resulting in a M : F ratio of 1.31 : 1. Those between the ages of 66 and 75 were the most affected. At presentation, 91.0% of the study participants were known hypertensive patients. Among the known hypertensive patients, the majority (34.9%) were known to have been hypertensive for 5–10 years. Of the known hypertensive patients, 48.6% were found to be adherent. Hypertensive urgency was discovered to be far more common than hypertensive emergencies (63.5% vs. 36.5%). Headache was the most common presenting symptom, and most patients (36.5%) presented to the health setup in less than 24 hours. The main risk variables identified were drug discontinuation, family history of hypertension, salt consumption, and alcohol usage. The main excuse for the lack of adherence was the cost of the medications. More than half of the patients do not have any additional comorbidities, and of those who do, diabetes mellitus is the most prevalent. A stroke was identified as a major complication. Conclusions and Recommendations. Hypertensive crises are one of the most prevalent reasons for EOPD admission and are linked to significant consequences. At presentation, most of the study subjects were known hypertension patients. Diabetes mellitus was discovered to be a comorbid condition in one-quarter of them. Although more than half of the patients had improved, the death rate still remained high. Infrastructure and capacity building to provide hospitals with the requisite baseline investigations are among the government's recommendations. Health practitioners are expected to make improvements, such as by educating the public about the need for lifestyle changes and evaluating and managing any hypertension problems. [ABSTRACT FROM AUTHOR]

Introduction. Little is known about how shifting hospital visitor restrictions issued by national health authorities were communicated, managed, and adapted by hospital charge nurses during the COVID-19 pandemic. Aims. To describe the shifting visitor restrictions and the passing on of restrictions from the national authority level to charge nurses and secondly describe charge nurses' management of the restrictions and their challenges when enforcing them. Methods. The study consisted of a document analysis and a cross-sectional survey including open-ended questions. Descriptive statistics and qualitative content analysis were used. The survey was distributed online to 88 charge nurses in somatic units in a Danish university hospital from March 2020 to April 2021. Results. Restrictions were communicated from national authority level in an effective administrative cascade. The charge nurses led their enforcement in each unit. In total, 71 charge nurses (81%) responded to the survey. For 70%, the wording of the restrictions was clear, while 31% found them challenging to handle. On a weekly or daily basis, 68% of the charge nurses deviated from the restrictions. They identified both upsides and downsides to the absence of relatives. Communication, collaboration, and leadership were experienced as key tools in the ongoing processes of adapting to shifting restrictions. Conclusion. During this severe health crisis, essential information was passed on through well-defined management levels in an effective communication pathway. Charge nurses and their professional values were challenged when balancing shifting national restrictions against individual needs of patients and relatives. Implications for Nursing Management. Charge nurses serve as vital intermediaries between national authorities and frontline nursing practice in managing shifting visitor restrictions during a pandemic. Their experiences can contribute to further qualifying nurse managers' considerations when designing family-centred hospital visitor policies for the future. Also, they may strengthen the handling of future sudden major organizational changes. [ABSTRACT FROM AUTHOR]

Introduction. An accurate urine analysis is a good indicator of the status of the renal and genitourinary system. However, limited studies have been done on comparing the diagnostic performance of the fully automated analyser and manual urinalysis especially in Ghana. This study evaluated the concordance of results of the fully automated urine analyser (Sysmex UN series) and the manual method urinalysis at the Komfo Anokye Teaching Hospital in Kumasi, Ghana. Methodology. Sixty-seven (67) freshly voided urine samples were analysed by the automated urine analyser Sysmex UN series and by manual examination at Komfo Anokye Teaching Hospital, Ghana. Kappa and Bland-Altman plot analyses were used to evaluate the degree of concordance and correlation of both methods, respectively. Results. Substantial (κ = 0.711 , p < 0.01), slight (κ = 0.193 , p = 0.004), and slight (κ = 0.109 , p < 0.001) agreements were found for urine colour, appearance, and pH, respectively, between the manual and automated methods. A strong and significant correlation (r = 0.593 , p < 0.001) was found between both methods for specific gravity with a strong positive linear correlation observed for red blood cell count (r = 0.951 , R 2 = 0.904 , p < 0.001), white blood cell count (r = 0.907 , R 2 = 0.822 , p < 0.001), and epithelial cell count (r = 0.729 , R 2 = 0.532 , p < 0.001). A perfect agreement of urine chemistry results in both methods was observed for nitrite 67 (100%) (κ = 1.000 , p < 0.001) with a fair agreement for protein 46 (68.7%) (κ = 0.395 , p < 0.001). A strong agreement was found in both methods for the presence of cast 65 (97.0%) (κ = 0.734 , p < 0.001) with no concordance observed for the presence of crystals (κ = 0.115 , p = 0.326) and yeast-like cells (YLC) (κ = 0.171 , p = 0.116). Conclusion. The automated and manual methods showed similar performances and good correlation, especially for physical and chemical examination. However, manual microscopy remains necessary to classify urine sediments, particularly for bacteria and yeast-like cells. Future research with larger samples could help validate automated urinalysis for wider clinical use and identify areas requiring improved automated detection capabilities. [ABSTRACT FROM AUTHOR]

Background. The mnemonic learning method is a systematic approach that helps nursing students memorize new information more effectively, productively, and easily by connecting new information with existing information and exploring unfamiliar information through visual images or combinations of letters and words. While mnemonics can help students remember specific information, it is essential to examine how well they facilitate the transfer of learning to real-world nursing practice. Aim. To investigate the effect of the mnemonic learning strategy on critical care nursing students' tracheal suction skill acquisition and learning satisfaction. Methods. A quasi-experimental research design was used. A total of 280 second-year nursing students enrolled in critical care and emergency nursing courses were recruited. These students were assigned to study and control groups. The study group used a mnemonic learning strategy to recall the steps involved in the tracheal suction procedure, while the control group used the traditional learning strategy. Two tools were used for data collection: the tracheal suction procedure checklist and learning satisfaction scale. Comparisons between both groups regarding their performance and satisfaction scores were done. Results. Performance scores regarding the tracheal suction procedure were significantly higher in the study group than in the control group in the 5th, 6th, and 10th weeks (P < 0.001 , <0.001, and <0.001). A total of 70.6% of the participants in the study group reported high satisfaction using the mnemonic learning experience. Conclusion. Using a mnemonic learning strategy with critical care nursing students was effective. Participants in the study group exhibited improvement in their tracheal suction procedure scores over time. Critical care nursing students reported higher levels of learning satisfaction with the mnemonic learning method than with the traditional method. [ABSTRACT FROM AUTHOR]

Background. The pandemic situation of the novel coronavirus (severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)) and its associated disease (coronavirus disease 2019 (COVID-19)) represents a challenging condition with a plethora of aspects. The course of COVID-19 in patients with immune-mediated inflammatory diseases (IMID) such as inflammatory bowel disease (IBD) and rheumatic diseases (RD) is not well known. Our study is one step toward closing this gap by collecting data on vaccination rates, infection-free survival, and individual symptom severity. Methods. We conducted a prospective questionnaire-based study between April 2022 and October 2022 at our university hospital. Outward patients over the age of 18 years were screened for participation and reported about their infection/infection-free survival since the start of the pandemic. Results. Finally, 156 patients were included in the study, 117 (75.0%) of which had inflammatory bowel disease and 39 (25.0%) patients with rheumatic disease. Altogether, 143 (91.7%) persons had received at least one vaccination against SARS-CoV-2. A total of 153 patients provided information regarding their COVID-19 history: 81 patients (52.0%) self-reported about their SARS-CoV-2 infection. In general, courses of infection were mild: only two patients (2.5% of patients with reported COVID-19) were hospitalized due to COVID-19 with one (1.2%) of the two needing intensive care. Asymptomatic COVID-19 had been described by 7 persons (8.6% of patients with reported COVID-19). Acute COVID-19 was accompanied by fatigue/tiredness in 58 persons (71.6% of patients with history of COVID-19) as the most frequent symptom. Other complaints were common cold (55 patients = 67.9%), cough (51 patients = 63.0%), headache (44 patients = 54.3%), and fever (35 patients = 43.2%). Stratified by vaccination status (unvaccinated vs. at least once vaccinated), the time to infection differed significantly (logrank test: p = 0.04 , Chi2 4.1). At least once vaccinated people had a median COVID-19-free survival of 28.5 months (confidence interval (CI): 23.6 months-not reached). Without any vaccination, the estimated time to infection was 25.1 months (CI: 23.6 months-not reached). Conclusion. Our IMID patients have a high rate of vaccination against SARS-CoV-2. Data show a significantly longer infection-free survival in vaccinated IMID patients as compared to unvaccinated patients. Discrimination between symptoms of COVID-19 and a concomitant inflammatory disease is difficult as complaints might be overlapping. This trial is registered with DRKS00028880. [ABSTRACT FROM AUTHOR]

Introduction. Oncologic mastectomy in the setting of obesity poses challenges in achieving a flat closure that includes the lateral adiposity. The angel wing (AW) technique was developed to address this issue. We aim to demonstrate the safety of AW by evaluating incidence of arm lymphedema (AL) and decreased range of motion (dROM) in patients postmastectomy with and without the AW closure. Methods. We performed a single-center retrospective cohort study at an academic referral center of patients who underwent mastectomy with and without the AW technique from May 2014 to October 2022. Those who received breast reconstruction (immediate or delayed), partial mastectomy, and male patients were excluded. The presence of postoperative AL and dROM was evaluated. Subgroup analysis was performed for patient factors including BMI, extent of axillary surgery, PMRT, and pathologic stage. Results. A total of 390 patients met inclusion criteria. Of those, 173 (44.4%) underwent AW and 217 (55.6%) had non-AW mastectomy. Expectedly, the average BMI was significantly higher in the AW cohort (p < 0.0001). The overall rate of AL was 51/390 (13.1%), seen in 27 (15.6%) undergoing AW and 24 (11.1%) non-AW (p value = 0.18). While the rate of dROM within the cohort was 52/390 (13.1%), 27 (15.6%) underwent AW vs. 24 (11.1%) non-AW (p value = 0.22), resulting in no statistical significance between AW and non-AW mastectomy upon subsequent development of AL or dROM. Conclusion. Our study demonstrates the AW technique does not convey an increased risk of overall AL or dROM, even when considering known risk factors such as obesity, PMRT, and extent of axillary surgery. As we strive to provide our patients with improved surgical techniques for oncologic resection, we submit that this technique is a viable and safe option for achieving the goals of cosmesis with oncologic safety. [ABSTRACT FROM AUTHOR]

Background. As nursing interns enter challenging clinical settings, evaluating their preparation and readiness is vital for adaptation success. Sufficient real-world experience and patient care are crucial preparation components that enable effective practice and higher competencies. Aim. This study aimed to assess nurse interns' perception of clinical preparation and readiness for clinical internship experiences. Methods. A self-administered questionnaire was distributed, comprising three sections on demographics, clinical preparation requirements, and the Casey–Fink Readiness for Practice Survey. Descriptive statistics as the mean and standard deviation, numbers and percentages, linear regression model, and Pearson correlation coefficient were used for reporting normal distribution, categorical variables, and relationship between a scalar response and one or more explanatory variables and to calculate statistics between two continuous variables. Results. The participants were 130 nurse interns who were involved in an internship between 2016 and 2020, 50% of the nurse interns. They had a moderate level of clinical preparation, and 28.5% of them exhibited a low level. In addition, 53.8% were found to be moderately ready for practice, while 22.3% had a low level of readiness Conclusion. The observed significant positive correlation between perceived preparation and readiness underscores the pivotal role of clinical preparation in influencing practice readiness. Implications. These findings emphasize the importance of targeted interventions aimed at enhancing clinical preparation to directly bolster overall readiness for professional practice among nurse interns. [ABSTRACT FROM AUTHOR]

The aim was to explore why registered nurses (RNs) in Sweden choose to quit their jobs in hospitals, also in relation to experienced patient safety. Previous research has shown that nurse turnover, especially in hospital settings, is a serious challenge for society and health care globally. Insufficient staffing of RNs is linked to poorer patient outcomes and a general patient safety at risk. It is, therefore, important to continually explore how nurses describe their reasons for quitting their jobs. The study was conducted using a qualitative descriptive design, based on 11 semistructured interviews with RNs. The analysis generated four categories describing the results: Feeling that the profession is not valued; Psychological and physical symptoms related to work; An insufficient and unsupportive organization; and Unsatisfying leadership and teamwork. Specifically, the RNs participating in this study described a range of reasons for quitting, where the feeling of not being valued and treated as a respected and autonomous profession was a common thread throughout the results. RNs experienced that, overall, the insufficient work conditions, also resulting in lower patient safety, ultimately led to their decision to quit. The findings highlight the crucial need for employers to develop working conditions for RNs, to make sure that the profession is valued according to professional standards and provide the potential for autonomous nursing practice. To reduce nurse turnover, and instead attract and retain nurses, leadership and management in nursing need to be adjusted to meet the demands of a modern academic profession. [ABSTRACT FROM AUTHOR]

Background. A−β+ ketosis-prone diabetes (KPD) in adults is characterized by presentation with diabetic ketoacidosis (DKA), negative islet autoantibodies, and preserved β-cell function in persons with a phenotype of obesity-associated type 2 diabetes (T2D). The prevalence of KPD has not been evaluated in children. We investigated children with DKA at "T2D" onset and determined the prevalence and characteristics of pediatric A−β+ KPD within this cohort. Methods. We reviewed the records of 716 children with T2D at a large academic hospital and compared clinical characteristics of those with and without DKA at onset. In the latter group, we identified patients with A−β+ KPD using criteria of the Rare and Atypical Diabetes Network (RADIANT) and defined its prevalence and characteristics. Results. Mean age at diagnosis was 13.7 ± 2.4 years: 63% female; 59% Hispanic, 29% African American, 9% non-Hispanic White, and 3% other. Fifty-six (7.8%) presented with DKA at diagnosis and lacked islet autoantibodies. Children presenting with DKA were older and had lower C-peptide and higher glucose concentrations than those without DKA. Twenty-five children with DKA (45%) met RADIANT A−β+ KPD criteria. They were predominantly male (64%), African American or Hispanic (96%), with substantial C-peptide (1.3 ± 0.7 ng/mL) at presentation with DKA and excellent long-term glycemic control (HbA1c 6.6% ± 1.9% at follow-up (median 1.3 years postdiagnosis)). Conclusions. In children with a clinical phenotype of T2D and DKA at diagnosis, approximately half meet criteria for A−β+ KPD. They manifest the key characteristics of obesity, preserved β-cell function, male predominance, and potential to discontinue insulin therapy, similar to adults with A−β+ KPD. [ABSTRACT FROM AUTHOR]

Background. COVID-19 has reduced the capacity for delivering essential health services due to lockdown restrictions. Telehealth is an effective alternative option to improve healthcare access. However, there remain implementation challenges to patient adoption in resource-limited settings such as Ethiopia. Therefore, the purpose of this study was to assess patient satisfaction following the implementation of telehealth in ambulatory settings during the COVID-19 pandemic. Methods. A cross-sectional study was conducted at Ayder Comprehensive Specialized Hospital in the Tigray region of Northern Ethiopia. Patients who used the telehealth service were invited to participate in a patient satisfaction survey. All statistical analyses were performed using STATA Version 14.1. Result. A total of 149 patients have participated in the survey. Out of the total participants, 129 (86.6%) found that telehealth is easy to understand and overall satisfaction for telehealth was 87.9%. About two-thirds of the patients (97, 65.1%) reported that the telehealth visit is just as good as a traditional visit. The vast majority of participants (148, 98.6%) stated that they would definitely or probably use telehealth again and would recommend it to others. The majority of respondents (137, 91.9%) followed the recommendations provided. Conclusion. Patients have a high level of satisfaction with the use of telehealth during the COVID-19 pandemic. About two-thirds of patients said the telehealth visit was just as good as a traditional visit. The majority of patients followed the recommendations given to them by the healthcare providers and stated that they would definitely or probably use telehealth in the future and would recommend it to others. This high level of patient satisfaction with telehealth implementation suggests that the service could be considered in low-income countries as well. [ABSTRACT FROM AUTHOR]

Aim. We investigated the impact of empowering leadership on both perceived stress and salivary cortisol, a commonly utilized biological indicator for stress assessment. Background. Empowering leadership is gaining increasing interest in companies. However, the impact of empowering leadership on stress is still insufficiently explored, with conflicting findings within the literature on this topic. While certain studies indicate that empowering leadership reduces perceived stress, other studies have suggested that empowering leadership could be stressful. Methods. We conducted a cross-sectional study using a questionnaire among a sample of 397 participants working in a French hospital. Participants' salivary cortisol was assessed. All analyses exploring the relationships between empowering leadership, perceived stress, and salivary cortisol were performed using multiple imputation methods. Results. Empowering leadership could simultaneously increase and decrease perceived stress. Specifically, although the empowering leadership global factor showed a negative correlation with perceived stress, some specific empowering leadership behaviors were positively associated with perceived stress. However, salivary cortisol was positively related to perceived stress and strictly negatively related to empowering leadership. Furthermore, salivary cortisol could be explained by a significant interaction effect between perceived stress and empowering leadership, indicating that empowering leadership enables employees to cope with perceived stress. Conclusions. Although empowering leadership was an ambiguous antecedent of perceived stress, our findings suggested that empowering leadership was a protective factor against increased salivary cortisol. These results suggest that empowering leadership behaviors could prevent biological stress. Implications for Nursing Management. While empowering leadership showed a protective effect on salivary cortisol, it is essential for managers to adopt the full set of empowering leadership practices to guarantee protective effects on perceived stress. This trial is registered with NCT04010773. [ABSTRACT FROM AUTHOR]

Purpose. Hypertension (HTN) is one of the most common adverse drug reactions to tyrosine kinase inhibitors (TKIs) targeting vascular endothelial growth factor (VEGF), but little is known about its clinical risk factors. The aim of this study was to elucidate the association between baseline clinical characteristics and the occurrence of HTN in advanced gastric cancer (GC) patients prescribed apatinib, a commonly used VEGF-TKI in China, in a real-world setting. Patients and Methods. Fifty-five GC patients treated with apatinib from December 1st, 2016, to December 1st, 2020, were retrospectively included in electronic medical records. Adverse drug reactions were defined according to the National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE) v5.0. Univariate and multivariable logistic regression analyses were used to investigate potential clinical risk factors for apatinib-related HTN. Results. The incidence of apatinib-related HTN of all grades was 45.45%, and grade 3 HTN occurred in 16.36% of patients. The median maximal systolic blood pressure (SBP) during apatinib treatment was 153 mm·Hg, and the median time to event was 25 days. New-onset HTN occurred in 10/33 (30.30%) patients. Preexisting HTN (odds ratio [OR]: 4.155; 95% confidence interval [CI]: 1.252, 13.787; p = 0.020) was the key independent risk factor associated with apatinib-related HTN. Conclusion. The incidence of HTN was high in patients treated with apatinib, and preexisting HTN was an independent risk factor. It is important to provide thorough and close monitoring of patients during treatment with apatinib, especially for those with preexisting HTN. This trial is registered with ChiCTR1900024531. [ABSTRACT FROM AUTHOR]

Background. Using a fluid-filled wire with a pressure sensor outside the patient compared to a conventional pressure wire may avoid the systematic error introduced by the hydrostatic pressure within the coronary circulation. Aims. To assess the safety and effectiveness of the novel fluid-filled wire, Wirecath (Cavis Technologies, Uppsala, Sweden), as well as its ability to avoid the hydrostatic pressure error. Methods and Results. The Wirecath pressure wire was used in 45 eligible patients who underwent invasive coronary angiography and had a clinical indication for invasive coronary pressure measurement at Sahlgrenska University Hospital, Gothenburg, Sweden. In 29 patients, a simultaneous measurement was performed with a conventional coronary pressure wire (PressureWire X, Abbott Medical, Plymouth, MN, USA), and in 19 patients, the vertical height difference between the tip of the guide catheter and the wire measure point was measured in a 90-degree lateral angiographic projection. No adverse events caused by the pressure wires were reported. The mean Pd/Pa and mean FFR using the fluid-filled wire and the sensor-tipped wire differed significantly; however, after correcting for the hydrostatic effect, the sensor-tipped wire pressure correlated well with the fluid-filled wire pressure (R = 0.74 vs. R = 0.89 at rest and R = 0.89 vs. R = 0.98 at hyperemia). Conclusion. Hydrostatic errors in physiologic measurements can be avoided by using the fluid-filled Wirecath wire, which was safe to use in the present study. This trial is registered with NCT04776577 and NCT04802681. [ABSTRACT FROM AUTHOR]

The aim of this study was to identify factors affecting the noise management performance of adult intensive care unit (ICU) nurses in Korea. The ICU environment is exposed to various types of noises due to the use of medical devices for the treatment of critically ill patients. The noise has an adverse effect on nurses' health and their nursing performance, which might potentially threaten patient safety. A cross-sectional study was conducted with a total of 148 nurses working in adult ICUs from two university hospitals in Korea. Data were collected using self-administered questionnaires, which included various aspects such as noise knowledge, response to noise, patient safety culture, and noise management performance. Multiple regression analysis revealed that teamwork (β = 0.33, p = 0.004), patient safety policy, and procedure (β = 0.25, p = 0.037), which were subscales of patient safety culture, as well as frequency of noise experience (β = 0.16, p = 0.030) were significant factors affecting adult ICU nurses' performance of noise management. This study provides a significant basis for promoting adult ICU nurses' performance in noise management. A structured policy and procedure for noise management should be established for reducing noise in adult ICUs. In terms of nursing education, it is necessary to consider and develop team-based training programs to promote noise management performance in the ICU. Nurse managers and nursing organizations should consider how to create conditions in which nurses can recognize the importance of noise reduction and perform well in noise management. [ABSTRACT FROM AUTHOR]

Aims. Baccalaureate nursing students often enter nursing programs with varying degrees of writing skills. The use of formative assessment can provide students and faculty with information to act upon during a course and improve learning. This study aimed to test the use of a program-level written communication rubric as a formative assessment to be able to provide targeted interventions for improvement as part of curricular evaluation. Methods. A written communication rubric (14 criteria with scores ranging from 1–4) was applied twice during the semester to assess the writing assignments of 33 undergraduate nursing students enrolled in a nursing research course. A targeted intervention was designed and implemented based on deficient aggregate assessment results from the first student assignment. Results. Paired t-test analysis demonstrated a significant upward change in student performance in the second student assignment for all seven of the targeted competency scores (all p < 0.05). Conclusions. The use of a program-level rubric as a formative assessment paired with a targeted intervention improved the writing skills of nursing students during a single semester. By harnessing the tools of online learning management systems, faculty can quickly identify specific challenges for students in academic writing. There is potential for formative assessment to be used by faculty and students to direct the ongoing development of writing skills both during a course and throughout the program of study. [ABSTRACT FROM AUTHOR]

Rationale. Contribute to the understanding of DNR decision-making and conducting end-of-life conversations, about which there is a paucity of data available in the current literature. Aims and Objectives. Assess how the decision-making process to determine a DNR code is implemented in the day-to-day clinical practice in a tertiary teaching hospital. Familiarity with the use of different scores as a possible objective support for DNR decisions and the influence of various elements on a DNR decision was explored. Method. A cross-sectional survey study was conducted between February 2021 and April 2021 for all doctors and doctors in training, working in the Antwerp University Hospital during the COVID-19 pandemic. Results. 127 doctors participated in this study. The familiarity with the different scores used in the triage during the COVID-10 pandemic was 51% for the Clinical Frailty Scale (CFS) and 20% for the Charlson Comorbidity Index (CCI). Participants indicated that their DNR decision is based on various aspects such as clinical assessment, comorbidities, patient's wishes, age, prognosis, and functional state. Conclusion. The familiarity with the different scores used during triage assessments is low. The total clinical picture of the patient is needed to make a considered decision, and this total picture of the patient seems to be well encompassed by frailty measurement (CFS). Although many participants indicated that the different scores do not offer much added value compared to their clinical assessment, it can help guide DNR decisions, especially for doctors in training. [ABSTRACT FROM AUTHOR]

Aim. To explore and describe nurse managers' experiences of how the COVID-19 pandemic affected their leadership work. Background. As frontline leaders in healthcare, the work of nurse managers was dominated by the global COVID-19 pandemic in recent years. Method. Semistructured interviews were carried out during autumn 2021 at a Finnish university hospital. Twelve nurse managers participated in video call interviews, and the data were analysed by inductive content analysis. Results. Four main categories of COVID-19 effect on the nurse managers' leadership work were identified: increased work requirements; changes in work content; crisis communication; and human resources. The main categories included a total of 14 subcategories. Conclusion. The complexity and range of nurse managers' leadership work during the pandemic were emphasized. Nurse managers performed several important tasks that ensured ongoing delivery of healthcare services. Flexibility, ability to solve problems, capacity to tolerate uncertainty, pressure and rapidly evolving situations, excellent crisis communicational skills, and an ability to address the diverse needs of their staff were key competencies that nurse managers relied on during this period. Implications for Nursing Management. Nurse managers' experiences of COVID-19 can inform practice, policies, nursing, and nursing leadership education in relation to future crises. [ABSTRACT FROM AUTHOR]

The purpose of this study was to explore nurses' experiences of conflict management at a central hospital in Namibia. Conflict in nursing practice is inevitable and experienced regularly. Understanding how nurses experience conflict is at the centre of the successful handling of conflict, which may enhance teamwork and quality of patient care. A phenomenological transcendental (descriptive) phenomenology design was used in this study. Fifteen nurses were purposively selected at the teaching hospital and interviewed to generate data, which were analysed thematically between June and November 2021. Five themes were generated from a rigorous analysis process: understanding of conflict and conflict management; development of conflict; conflict management approaches; consequences of conflict; and in-service training. Conflict situations that nurses face during their practice may remain unresolved or inappropriately resolved if they lack the necessary education and skills in conflict management. Nursing education and continuous education on conflict management should thus be provided to all nurses to empower them to manage conflict situations, which could improve their nursing practice and quality of patient care. There is a need to strengthen conflict management education in both undergraduate and continuous education programmes for nurses. [ABSTRACT FROM AUTHOR]

Background. Granuloma annulare (GA) is a common, benign, idiopathic inflammatory dermatosis. Aside from case reports and small studies, there are limited data about the characteristics of GA in children. Objective. This study aimed to better characterize the epidemiologic and clinical features, triggering factors, disease associations, and outcomes of GA in the pediatric population. Methods. We conducted a retrospective study of 73 pediatric patients diagnosed with GA at the University of Rochester Medical Center over a 7-year period. Results. The most common subtype was localized GA (71.2%, n = 52), followed by subcutaneous (also known as "deep GA"; 16.4%, n = 12) and generalized (12.3%, n = 9) subtypes. Over 90% of patients had idiopathic GA, with the remaining patients reporting viral infection or trauma as triggers. Half of the patients studied had comorbid conditions, most frequently atopic dermatitis (17.8%, n = 13), obesity (9.59%, n = 7), asthma (6.85%, n = 5), and allergic rhinitis (6.85%, n = 5). The median duration of the disease was 11.00 months (interquartile range (IQR) 15.75 months); generalized GA had the shortest duration (median 10.00 months, IQR 15.50 months), while subcutaneous GA had the longest duration (median 12.00 months and IQR 29.00 months). Although recurrence rates for subcutaneous and generalized GA were high at 45.5% and 33.3%, respectively, most patients achieved clearance or improvement with treatment. Conclusion. Most cases of GA in our study were idiopathic, with no clear differences between GA subtypes and associated comorbidities. Topical steroids were the most prescribed treatment with mixed efficacy. [ABSTRACT FROM AUTHOR]

Introduction. Anticoagulation treatment is routinely underused in patients with atrial fibrillation (AF), particularly in settings with limited resources. The current study is aimed at evaluating the appropriateness of oral anticoagulation treatment among AF patients at the Yekatit 12 Hospital Medical College (Y12HMC), Addis Ababa, Ethiopia. Methods. Institutional-based retrospective cross-sectional study conducted in Y12HMC from November 2019 to March 2020. During the study period, 256 patients' medical records were found; 231 of them met the eligibility criteria and were included in the study. The data were analyzed using SPSS version 25, descriptive statistics were used to summarize the data, and binary logistic regression was performed to identify predictors of inappropriate anticoagulation management. Results. The majority of study participants were males (55.8%), and over half of them (57.6%) had a nonvalvular type of AF. The majority of patients (61.9%) were receiving anticoagulant treatment, and of them, warfarin was prescribed to most of the study subjects (71.3%). Nearly half (47.6%) of the study participants had inappropriate anticoagulation treatment; among these, the majority of them (69.1%) were from a valvular type of AF. Patients with a valvular type of AF and having the diagnosis of congestive heart disease as comorbidity showed a statistically significant association towards inappropriate anticoagulation management. Conclusion. According to the study, a significant portion of AF patients received inappropriate anticoagulant treatment, which may play a significant role for the increased risk of stroke in these groups of patients. All of the inappropriate cases were due to failure to start anticoagulant treatment. [ABSTRACT FROM AUTHOR]

Background. Stroke is a life-threatening condition that occurs due to impaired blood flow to brain tissues. Every year, about 15 million people worldwide suffer from a stroke, with five million of them suffering from some form of permanent physical disability. Globally, stroke is the second-leading cause of death following ischemic heart disease. It is a public health burden for both developed and developing nations, including Ethiopia. Objectives. This study is aimed at estimating the time to death among stroke patients at Jimma University Medical Center, Southwest Ethiopia. Methods. A facility-based retrospective cohort study was conducted among 432 patients. The data were collected from stroke patients under follow-up at Jimma University Medical Center from January 1, 2016, to January 30, 2019. A log-rank test was used to compare the survival experiences of different categories of patients. The Cox proportional hazard model and the accelerated failure time model were used to analyze the survival analysis of stroke patients using R software. An Akaike's information criterion was used to compare the fitted models. Results. Of the 432 stroke patients followed, 223 (51.6%) experienced the event of death. The median time to death among the patients was 15 days. According to the results of the Weibull accelerated failure time model, the age of patients, atrial fibrillation, alcohol consumption, types of stroke diagnosed, hypertension, and diabetes mellitus were found to be the significant prognostic factors that contribute to shorter survival times among stroke patients. Conclusion. The Weibull accelerated failure time model better described the time to death of the stroke patients' data set than other distributions used in this study. Patients' age, atrial fibrillation, alcohol consumption, being diagnosed with hemorrhagic types of stroke, having hypertension, and having diabetes mellitus were found to be factors shortening survival time to death for stroke patients. Hence, healthcare professionals need to thoroughly follow the patients who pass risk factors. Moreover, patients need to be educated about lifestyle modifications. [ABSTRACT FROM AUTHOR]

Background. Sinonasal teratocarcinosarcoma is a rare, aggressive malignancy located almost exclusively in the nasal cavity, paranasal sinuses, or anterior skull base. Histopathological diagnosis can be challenging due to the heterogeneous composition. Methods. Retrospective analysis of 3 patients with sinonasal teratocarcinosarcoma diagnosed and treated at the University Medical Center Utrecht was conducted. Results. Patients presented with nasal obstruction, epistaxis, headaches, or behavioral changes. All three patients had locally advanced disease, and one had lymph node metastases. Two patients underwent surgery followed by radiotherapy, and one underwent neoadjuvant chemotherapy followed by surgery. The follow-up duration ranged from 3 to 32 months. All three patients died due to progression of their disease. Conclusion. Sinonasal teratocarcinosarcoma is characterized by rapid, aggressive local expansion. The prognosis is poor due to a high risk of metastases and locally recurrent disease. Multimodality treatment consisting of surgery, followed by (chemo)‐radiotherapy, is essential for optimizing outcomes. Neoadjuvant therapy offers a promising treatment option. [ABSTRACT FROM AUTHOR]

Background. Blood component therapy helps in managing patients with reduced hematopoiesis, elevated peripheral destruction of cells, and generalized blood loss (bleeding). Increased prevalence of arterial and venous thrombotic disease linked to the impact of ABO blood group on plasma levels of coagulation glycoprotein is demonstrated by blood group non-O persons. Objective. This study had a main objective of determining the association between blood group and change in coagulation factors in plasma preparation for transfusion purpose. Methods. The study employed a longitudinal study design. Factor assay evaluation was done by the use of Erba Mannheim ECL 105 semiautomated coagulation analyzer from India. Thawing meant for consequent coagulation factor analysis and sequential testing of stored cryoprecipitate and fresh frozen plasma was performed by the use of Stericox plasma thawing bath before being analyzed by the coagulation analyzer. Blood group of the collected blood sample in purple EDTA vacutainer was analyzed using blood antisera and a clean white tile, and results were recorded which helped in establishing the association existing between plasma and blood group. The data were fed into Excel and were evaluated by the use of SPSS version 25. Results. There was no significant association between coagulation factors in fresh frozen plasma and blood group, coagulation factors in cryoprecipitate plasma and blood group of the donors showed that the relationship was not significant with, (r = −0.116, −0.097, 0.007 and 0.047 with p value (0.900, 0.087, 0.096 and 0.096), respectively, which are greater than 0.005 standard alpha value. Conclusion. This study has shown no significant association existing between blood group and change in coagulation factors in plasma preparations at Kisii Teaching and Referral Hospital. [ABSTRACT FROM AUTHOR]

Background. Oral mucosa is encountered by various lesions and normal variants. Some are not to be worried about, whereas others may be of significance. Knowing the prevalence of oral mucosal lesions in a particular region helps better evaluate, diagnose, and, thus, manage these lesions. Objectives. To assess the prevalence and distribution of oral mucosal lesions and normal variants among various age groups, genders, and sites of the orofacial region. Methods. This cross-sectional study was conducted in the Department of Oral Medicine and Radiology, KIST Medical College and Teaching Hospital from January 2021 to March 2021. Three different proformas were designed according to age, gender, and location of lesions for entry as per the WHO's guide. The obtained data were entered into a Microsoft Excel sheet for frequency analysis by SPSS, and the results were tabulated. Results. Among the records of 16572 (9703 (58.55%) males and 6869 (41.44%) females) OPD patients, 3495 (21.08%) (1934 (55.33%) males and 1561 (44.66%) females) had OMLs and 2314 (13.96%) (1626 (70.26%) males and 688 (29.73%) females) had normal mucosal variants. The most commonly seen OML categories were tobacco-associated lesions, i.e., 2056 (34.07%), tongue lesions, i.e., 1598 (26.48%), oral potentially malignant disorders, i.e., 815 (13.50%), ulcers i.e., 728 (12.06%), and infectious lesions, i.e., 256 (4.24%). Conclusion. The Nepalese population has a wide range of oral mucosal lesions and normal variants, and this study has attempted to have baseline data for the same. The most common OML was smoker's melanosis. [ABSTRACT FROM AUTHOR]

Although individual factors play a vital role in determining professional autonomy, their specific impact during the coronavirus disease 2019 (COVID-19) pandemic has not been studied. This study aimed to compare nurses' professional autonomy when caring for patients with COVID-19 and for other patients and explore factors related to autonomy when caring for these patients. A paper-based questionnaire survey was conducted from June to August 2022 among nurses working at a university hospital in Japan. The survey included demographic factors (10 items, including, age, section, years of nursing experience, position, educational background, ladder level, and having certified nurse specialists or certified nurse qualifications) and individual experience factors (4 items: number of COVID-19 patients experienced, frequency and contents of searching for the latest information about COVID-19, frequency of using scientific sources, and frequency of training/study sessions on COVID-19 attended at the hospital). Additionally, basic knowledge of COVID-19 was evaluated. The scale for nurses' professional autonomy was developed based on a previous study. A paired t-test and stepwise multiple linear regression were used for the analyses. Overall, 241 nurses participated in the survey. The average length of nursing experience was 10.3 ± 9.2 years. The total scores for nurses' professional autonomy in all 5 factors 27 items were significantly lower (t = −12.1, p < 0.001) when caring for COVID-19 patients than when caring for other patients. Specifically, Factor 1 (Cognition) exhibited the most decreased scores when caring for COVID-19 patients than when caring for other patients. Factor 4 (Abstract judgment) differed the least between caring for COVID-19 and for other patients, but the average score was the lowest. More years of nursing experience (β = 0.208, p = 0.001) and a higher number of patients with COVID-19 cared for (β = 0.140, p = 0.026) were associated with higher autonomy scores. In conclusion, to enhance professional autonomy during an unprecedented pandemic, nurses must enhance cognition and abstract judgment. In the event of a future pandemic, nurses need to create an environment in which they routinely access and utilize the latest information and scientific evidence to provide high-quality nursing care based on their professional judgment and competence. [ABSTRACT FROM AUTHOR]

Background. Magnesium (Mg) disorders are common among hospitalized patients and are linked to poor health outcomes. We aimed to determine the incidence of dysmagnesemia among medically hospitalized patients and to identify factors that are associated with dysmagnesemia. Methods. A prospective cohort study was conducted at Sultan Qaboos University Hospital (SQUH) from April 1st, 2022, to October 31st, 2022, and involved hospitalized adult patients (≥18 years) under the care of the general internal medicine unit. The patients' serum total magnesium (Mg) concentrations were categorized as hypomagnesemia (≤0.69 mmol/L), hypermagnesemia (≥1.01 mmol/L), or dysmagnesemia, which encompassed either hypomagnesemia or hypermagnesemia. Results. Of the 304 patients evaluated, dysmagnesemia was observed in 22.0%, which comprised of 17.4% with hypomagnesemia and 4.6% with hypermagnesemia. Statistically significant associations were identified between hypermagnesemia and chronic kidney disease (CKD) (p = 0.05) and elevated creatinine levels (p < 0.01) and lower estimated glomerular filtration rate (eGFR) (p < 0.01). Hypomagnesemia was linked to lower ionized calcium (p = 0.03) and admission due to infectious diseases (p = 0.02). However, ordered regression analysis did not find any significant associations with the different magnesium groups. Conclusion. Dysmagnesemia was prevalent among hospitalized patients and was associated with different factors; however, ordered regression analysis did not find any association with the different magnesium group, probably due to the limited number of included individuals. [ABSTRACT FROM AUTHOR]

Objective. In Ethiopia, there is no national-level cancer registry except capital Addis Ababa, and little research was performed on ovarian tumors. This study is aimed at assessing different histopathologic patterns of ovarian tumors and their distribution based on age, biological behavior, and gross findings at a tertiary-level hospital in Ethiopia. Methods. In this study, 187 biopsy-confirmed ovarian tumors from September 2017 to August 2021 were included. All data were collected from the pathology department report format, classified according to the latest World Health Organization (WHO) classification system, and analyzed using SPSS 20.0 and Microsoft Excel 2010 at Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia. Results. A total of 187 women with ovarian tumors were included in this study. Of these, 143 (76.5%) were benign, 35 (18.7%) were malignant, and 9 (4.8%) were borderline tumors. Both benign and borderline tumors mostly occur at the age of 20–39 years. Surface epithelial tumors were the most common histopathologic pattern at 57.8% followed by germ cell tumors at 29.4% and sex cord-stromal tumors at 11.7%. Mature cystic teratomas were the most common benign ovarian tumors accounting for 37.8% of them, while serous cystadenocarcinomas were the most common malignant ovarian tumors accounting for 31.4% of malignant neoplasms. Conclusion. In the current study, surface epithelial tumors were the most common ovarian tumors followed by germ cell tumors. Younger age at presentation was observed for malignant ovarian tumors. [ABSTRACT FROM AUTHOR]

Background. After-hours triage of pediatric patients by trained nurses improves consistency of triage decisions, access, and quality of care, and decreases burden on physicians on-call. There is a lack of published experience with this approach in the pediatric diabetes population. Methods. An after-hours call service was established in September 2019 in our large urban pediatric teaching hospital. Barton Schmitt guidelines, which are widely accepted as the standard for telephone triage care, were modified to include institution specific diabetes management protocols. We analyzed demographics, reasons for call, clinical presentation to the emergency room, and clinical disposition of the callers. Results. The after-hours call service handled 70% of calls without physician involvement. There were no patients triaged to home care who subsequently required an emergency room visit or hospitalization. Patients who called the after-hours nurse line prior to coming to the emergency room were less sick and were discharged more often from the emergency room. Spanish-speaking parents utilized the service less than English speakers. There were no disparities in utilization based on the insurance status or race. Conclusions. The after-hours service accurately triaged calls and reduced physician burden. Patients of all races and insurance statuses utilized the after-hours service equally well. Language was a barrier in the utilization. [ABSTRACT FROM AUTHOR]

Introduction. Despite heightened risk of cardiovascular disease (CVD) among individuals with type 1 diabetes, few studies in this population have investigated the development of CVD using early markers in adolescence. We compared risk factors (blood pressure (BP) and dyslipidemia) and early markers of CVD between adolescents with and without type 1 diabetes and explored effect modification by sex. Methods. Cross-sectional study using data from the CARdiovascular Disease risk in pEdiatric type 1 diAbetes (CARDEA) study. We recruited 100 adolescents with type 1 diabetes at the Sainte-Justine University Hospital Center and 97 adolescents without diabetes (14–18 years). We measured arterial stiffness by carotid-femoral pulse wave velocity, endothelial function by brachial artery flow-mediated dilation test, as well as left ventricular (LV) mass, papillary mass, and wall thickness by cardiac MRI. We used multivariable linear regression models to assess the impact of type 1 diabetes on each outcome adjusting for age, sex, ethnicity, adiposity, and familial income. Results. Adolescents with type 1 diabetes had 0.21 standard deviations (SD) (95% CI: 0.04; 0.38) higher diastolic blood pressure z-score (zDBP), 0.21 mmol/L (95% CI: 0.02; 0.40) higher low-density lipoprotein cholesterol (LDL-c) levels, and 17% (95% CI: 4; 29) higher triglyceride levels and lower endothelial function based on acceleration (−77.4 cm/s2, 95% CI: −133.1; −21.6) compared with adolescents without diabetes. Girls with type 1 diabetes had higher systolic blood pressure z-score (zSBP), and boys with type 1 diabetes had lower LV mass and wall thickness compared to healthy peers. Conclusions. In addition to higher BP and abnormal lipid profiles, adolescents with type 1 diabetes present endothelial dysfunction and alterations in cardiac structure (in boys) compared to adolescents without diabetes, suggesting that CVD prevention should be incorporated into type 1 diabetes management early in the disease. [ABSTRACT FROM AUTHOR]