Health Insurance Hospital Research Articles

LETROZOLE VERSUS CLOMIPHENE CITRATE FOR OVULATION INDUCTION IN WOMEN WITH POLYCYSTIC OVARY SYNDROME

Backround: Ovulation is the central event in the reproduction cycle. Anovulatory dysfunction is a common problem and is responsible for about 40% of female infertility. Polycystic ovarian syndrome (PCOS) with abnormalities in the metabolism of androgens and estrogen and in the control of androgen production remains one of its leading causes .Polycystic ovary syndrome (PCOS) is a common multisystem endocrine disorder in women, with long-term health consequences Objectives: Comparing the efficacy of Letrozole and Clomiphene citrate, as a first line treatment for induction of ovulation in cases of polycystic ovary syndrome. Patients and Methods: This study was randomized comparative study involving 100 Egyptian women having polycystic ovary syndrome attending Al-Azhar University Maternity hospital (Sayed Galal/ Infertility outpatient clinic, And 6th October Health Insurance Hospital). During the initial visit, anthropometric measurements and baseline investigations were performed. Patients were randomized to 5.0 mg Letrozole daily (50 Patients) or 100 mg Clomiphene citrate (50 Patients) from the third until the eighth day of menstruation. Serial transvaginal scans were performed to see the dominant follicles, endometrial thickness and number of follicles. Transvaginal scans were performed serially to look for evidence of ovulation. Results: The difference between Letrozole and Clomiphene citrate for ovulation rate was 44 (88%) versus 30 (60%) respectively. Patients taking Letrozole exhibited a mean endometrial thickness (ET) at mid cycle of menses (Day 11-D14) of 9.2 mm (SD 2.37) versus 8.4 mm (SD 1.61) for patients taking Clomiphene citrate, and these differences were statistically significant. In terms of pregnancy rate, Letrozole facilitated pregnancy induction in 19 patients (38%) versus 8 patients (16%) for Clomiphene citrate, which was statistically significant. More dominant follicles exhibiting a mono-follicular morphology were observed in patients treated with Letrozole compared to patients treated with Clomiphene citrate, with a mono-follicular dominant follicle observed in 23 (46%) versus 14 (28%) patients respectively. Conclusion: Letrozole provided a more efficient stimulation compared to Clomiphene citrate in terms of ovulation induction, thickening of the endometrial lining and achievement of a successful pregnancy.

LETROZOLE VERSUS CLOMIPHENE CITRATE FOR OVULATION INDUCTION IN WOMEN WITH POLYCYSTIC OVARY SYNDROME

Backround: Ovulation is the central event in the reproduction cycle. Anovulatory dysfunction is a common problem and is responsible for about 40% of female infertility. Polycystic ovarian syndrome (PCOS) with abnormalities in the metabolism of androgens and estrogen and in the control of androgen production remains one of its leading causes .Polycystic ovary syndrome (PCOS) is a common multisystem endocrine disorder in women, with long-term health consequences Objectives: Comparing the efficacy of Letrozole and Clomiphene citrate, as a first line treatment for induction of ovulation in cases of polycystic ovary syndrome. Patients and Methods: This study was randomized comparative study involving 100 Egyptian women having polycystic ovary syndrome attending Al-Azhar University Maternity hospital (Sayed Galal/ Infertility outpatient clinic, And 6th October Health Insurance Hospital). During the initial visit, anthropometric measurements and baseline investigations were performed. Patients were randomized to 5.0 mg Letrozole daily (50 Patients) or 100 mg Clomiphene citrate (50 Patients) from the third until the eighth day of menstruation. Serial transvaginal scans were performed to see the dominant follicles, endometrial thickness and number of follicles. Transvaginal scans were performed serially to look for evidence of ovulation. Results: The difference between Letrozole and Clomiphene citrate for ovulation rate was 44 (88%) versus 30 (60%) respectively. Patients taking Letrozole exhibited a mean endometrial thickness (ET) at mid cycle of menses (Day 11-D14) of 9.2 mm (SD 2.37) versus 8.4 mm (SD 1.61) for patients taking Clomiphene citrate, and these differences were statistically significant. In terms of pregnancy rate, Letrozole facilitated pregnancy induction in 19 patients (38%) versus 8 patients (16%) for Clomiphene citrate, which was statistically significant. More dominant follicles exhibiting a mono-follicular morphology were observed in patients treated with Letrozole compared to patients treated with Clomiphene citrate, with a mono-follicular dominant follicle observed in 23 (46%) versus 14 (28%) patients respectively. Conclusion: Letrozole provided a more efficient stimulation compared to Clomiphene citrate in terms of ovulation induction, thickening of the endometrial lining and achievement of a successful pregnancy.

Effect of Head Nurses Emotional Intelligence Educational Program on Nurses Motivation and Organizational Support

Head nurses' emotional intelligence is important to the quality of their job, including clinical decision-making, critical thinking, evidence, and knowledge application in practice. Therefore, the professional nurse should have the ability to understand the views and needs of a wide variety of people to be motivated, supported, and satisfied. Aim: The study aims to examine the effect of head nurse's emotional intelligence training program on staff nurses' motivation and perceived organizational support. Research design: Quasi-experimental research design was utilized in this study. Setting: The study was conducted at the health insurance Hospital – Minia governorate. Subjects: A convenience sample of head nurses and staff nurses was included in the study. Tools: four tools were used in this study; emotional intelligence knowledge questionnaire, emotional intelligence self-assessment questionnaire, motivation scale, and perceived organizational support scale. Results: The total knowledge level of emotional intelligence and its subscales among head nurses were low before the program implementation; they had high level after the program implementation with statistically significant differences; also the staff nurse motivation level and perceived organizational support level was increased after implementing emotional intelligence educational program for head nurses Conclusions: an improvement in the knowledge level has been observed after the program was implemented. Recommendations: Periodical workshops and programs for first-line managers to develop their emotional intelligence competencies to be more motivated and empowered and supported for their nurses.

Impact of an Educational Program on Pediatric Nurses Knowledge Regarding Non-Pharmacological Pain Management in Neonatal Intensive Care Units

Background: Newborns in the neonatal intensive care units (NICU) can be exposed to many painful procedures and treatments. Aim: This study was to improve nurses’ practice regarding non-pharmacological management of pain in newborns in neonatal intensive care units. Subjects and Method: A quasi-experimental research design was utilized in this study. The subjects of the study consists of all the nurses working in the NICUs in Port Said hospitals (N=40) affiliated to the Ministry of Health, including El-Nasr general hospital, Port Said general hospital, Port Fouad general hospital and El-Tadamon health insurance hospital. The data were collected using a observational checklists Conclusion: the nurses had statistically significant improvements in applying non-pharmacological pain management during painful procedures in newborns included; venous and arterial puncture, cannulation and umbilical catheter insertion. However, there were inadequate total scores regarding nurses' practice. Recommendation: continuous training courses should be provided to nurses in order to keep their practice regarding non-pharmacological pain management up to date. Also, nurses should be encouraged to attend national and international conferences and workshops about non-pharmacological management for newborns

Impact of an Educational Program on Pediatric Nurses’ Practice Regarding Non-Pharmacological Pain Management in Neonatal Intensive Care Units

Background: Newborns in the neonatal intensive care units (NICU) can be exposed to many painful procedures and treatments. Aim: This study was to improve nurses’ practice regarding non-pharmacological management of pain in newborns in neonatal intensive care units. Subjects and Method: A quasi-experimental research design was utilized in this study. The subjects of the study consists of all the nurses working in the NICUs in Port Said hospitals (N=40) affiliated to the Ministry of Health, including El-Nasr general hospital, Port Said general hospital, Port Fouad general hospital and El-Tadamon health insurance hospital. The data were collected using a observational checklists Conclusion: the nurses had statistically significant improvements in applying non-pharmacological pain management during painful procedures in newborns included; venous and arterial puncture, cannulation and umbilical catheter insertion. However, there were inadequate total scores regarding nurses' practice. Recommendation: continuous training courses should be provided to nurses in order to keep their practice regarding non-pharmacological pain management up to date. Also, nurses should be encouraged to attend national and international conferences and workshops about non-pharmacological management for newborns

Epidemiology of hidradenitis suppurativa in Germany - an observational cohort study based on a multisource approach.

Hidradenitis suppurativa (HS) is a chronic, debilitating inflammatory skin disease. In Germany, there are no population-based data on the epidemiology of HS. The objective of this study was to examine the occurrence of HS in inpatient as well as in outpatient settings. We used three data sources for analysing the prevalence, incidence and case-related occurrence of HS in different settings: data of two German statutory health insurance (SHI) companies and hospital discharge data provided by the Federal Statistical Office. The studied period was from 2010 to 2015. In a representative sample of about 2.3million insurees (out of 5.9million total persons) of the SHI DAK-Gesundheit, 791 were diagnosed with HS in 2010. This coding prevalence of 0.03% is in accordance with the data of another SHI (Barmer) on about 9million total insurees. In 2015, at least 34.7% of incident persons with HS had one potential misdiagnosis in 2014. This population-based study analyses the prevalence and incidence of HS in Germany. The coding prevalence of 0.03% observed in two independent SHI data sets is lower than expected. The findings of considerable potential misdiagnosis add to the underdiagnosis of HS in general and underline the need for future strategies to early detection and valid diagnosis of HS.

Economic burden of multiple sclerosis in France estimated from a regional medical registry and national sick fund claims

BackgroundEstimating direct healthcare costs of patients with multiple sclerosis (MS) and identifying risk factors of high costs including relapse are important drivers of public health decision making in France. MethodsThis is a longitudinal retrospective study based on patient charts (qualified registry of MS in Lorraine (ReLSEP)) and claims data (from the main compulsory health insurance and national hospital database estimated monthly. All patients with MS not deceased or lost to follow-up reported in the registry in 2013–2014 were included. Outpatient costs were those paid to the healthcare provider and inpatient costs were those related to national cost estimates. Mean total costs per patient by disease severity were estimated monthly, accounting for MS evolution over the study period. Costs of MS relapse were estimated using a general linear model. ResultsA total of 4373 patients were identified in the ReLSEP registry, and 2166 of these patients were included in the study. Among those, outpatient claims were available for 1366 and 627 were hospitalized at least once. The average annual direct costs for patients with MS were estimated to be €12,296 in 2014. Furthermore, ambulatory costs represented 87.8% out of those costs and were mainly driven by medications (60.6%) and paramedic visits (11.2%). Monthly direct costs were higher in patients with severe disease (€1249 for EDSS 7–9) compared to those with mild or moderate disease (€992 for EDSS 0–3; €953 for EDSS 4–6) (p < 0,006). Interestingly, drug costs were higher in patients with mild disease, whereas costs related to paramedical care, medical devices, and transportation were higher in those with severe MS. The unit cost of relapse was estimated between €1681 and €2193. ConclusionsCosts were mainly driven by medications and highly related to disease severity. Relapse cost was the main contributor to total cost.

Role of Multidetector Computed Tomography in Gastric Cancers

Background: Gastric cancer is the third most common cause of cancer-related death in the world. Currently, multislice computed tomography (MSCT) is a valuable tool for detection, staging, surveillance, and post-treatment evaluation of gastric neoplasm. Objective: The aim of this work is to clarify the role of multidetector CT in diagnosis and preoperative staging of gastric carcinoma. Patients and methods: The present study was conducted between October 2017 and June 2019 on 60 patients (26 males and 34 females) with age ranged from 28 to 73 years with mean age of 53 years. The patients were complaining of symptoms of gastric cancer or as a follow-up study for gastric cancer, referred to the CT Unit in Tanta University Hospital, Tanta Oncology Center and Health Insurance Hospital from the Oncology Department. Results: In our study we found that there was a significant relationship between pathological and CT staging by using MPR. CT with MPR was specific and accurate in diagnosis of all stages of gastric cancer with specificity ranged between (95-100%) and accuracy ranged between (94.5-97.5%). However, it showed lowest sensitivity in diagnosis of stage 1 of gastric cancer. On the other hand, it showed highest sensitivity (97.5%) in diagnosis of stage IV. Conclusion: MSCT is a valuable tool for detection, staging, surveillance, and post-treatment evaluation of gastric neoplasm.

Management of Lumbar Disc Prolapse Associated with Retrolisthesis

Background: retrolisthesis is the posterior displacement of one vertebral body in relation to the adjacent vertebrae to a degree less than a dislocation. However, lots of neurosurgeons consider retrolisthesis as incidental finding a rising prove that it is not a rare condition and a cause of many backaches. Aim of work: to compare between discectomy with or without fixation as regards to pain, function and rate of reoperation in patients with lumbar disc prolapse associated with retrolisthesis. Patients and Methods: This study is prospective and retrospective study in fifty cases of patients with single level of lumbar disc prolapse associated with retrolisthesis in Al-Azhar University hospitals and Health Insurance hospitals in time between 2018 and 2019. Twenty-four patients were undergone discectomy alone and 26 patients were undergone discectomy plus lumbar fusion surgery. Results: the main level of retrolisthesis is L5-S1 with higher incidence than other high levels. Sixty six percent (33 cases of 50) and conservative treatment plays an important role in initiation of treatment but surgery by discectomy and fixation according to case demand is the main convenient solution. Conclusions: In this study we showed that patients with lumbar disc prolapse with retrolisthesis should be managed by discectomy alone in cases presented with radicular pain more than low back pain with dynamic study shows no instability. And should be managed by discectomy and fixation in cases presented with low back pain more than radicular pain with dynamic study showing instability or MRI finding shows advancing facet arthritis.

EVALUATE NURSE PHYSICIAN RELATIONSHIP AND ITS IMPACT ON THEIR PERCEPTION OF NURSE ROLE

Background: Nurse–physician relationship is particularly important, given the interdependence of the two professions and the primary role they play in safe, quality patient care. The well-entrenched hierarchical authority structure and sexism complicate nurse–physician relationship . Unfortunately, disruptive communication occurs with alarming frequency in both nurses and physicians, and both sets of professionals agree that such ways of communicating decrease patient safety. Aim of the study: To evaluate nurse physician relationship and its impact on their perception of nurse`s role. Subjects and method:A descriptive design was used to carry out this study. The study was conducted at El-Mansoura Health Insurance hospital study subjects were includedall 250nurses and all 100physicians. One tool was called nurse physician relationship and its impact on their perception of nurse rolequestionnaire sheet.Resultsand Conclusion:The finding of the present study indicated that physicians scored higher mean score related to nurse physician relationship than nurses.The level of nurse physician relationship from the majority of physicians and the nurses was moderate.Recommendation: improving collaborative relationship between nurses and physiciansthrough Understand each other’s roles.

Effect of Sickle Cell Crises Prevention Guide for Children on Parents Knowledge and Reported Practices

Sickle cell anemia (SCA) is a global health concern associated with high childhood morbidity and mortality. The major associated complication is sickle cell crisis which cause frequent hospital admission. Therefore, the purpose of this study was to examine the effect of sickle cell crises prevention guide for children on parents’ knowledge and reported practices. The study was conducted at Hematology & oncology unit of Pediatric department at Menoufia University Hospital and Health insurance hospital for children. A quazi experimental design was used . A convenient sample of parents with sickle cell children in the above mentioned settings were selected (34 parents) from January to November 2018. One tool was used for data collection consists of 4-sections questionnaire to assess parents' knowledge and practice. The results of this study revealed that there were knowledge deficit between parents' about sickle cell disease, approximately two thirds of parents (64.7%) had improved on post intervention for reported practices of crisis prevention than pre intervention. Also, 79.4% of parents didn’t use social and cultural practices in prevention of sickle cell crises post intervention. Therefore, there was a highly statistical significance differences between pre and post intervention. Conclusion, implementing sickle cell prevention guide improve parents’ knowledge and reported practices for prevention of crises to promote children recovery. Recommendation , ensure that sickle cell booklets are made available to hospitals for parents in order to remind themselves on treatment and prevention of sickle cell crises. Keywords: Sickle cell crisis, knowledge, Practice DOI : 10.7176/JHMN/64-07 Publication date :July 31 st 2019

EVALUATE NURSE PHYSICIAN RELATIONSHIP AND ITS IMPACT ON THEIR PERCEPTION OF NURSE ROLE

Background: Nurse–physician relationship is particularly important, given the interdependence of the two professions and the primary role they play in safe, quality patient care. The well-entrenched hierarchical authority structure and sexism complicate nurse–physician relationship . Unfortunately, disruptive communication occurs with alarming frequency in both nurses and physicians, and both sets of professionals agree that such ways of communicating decrease patient safety. Aim of the study: To evaluate nurse physician relationship and its impact on their perception of nurse`s role. Subjects and method: A descriptive design was used to carry out this study. The study was conducted at El-Mansoura Health Insurance hospital study subjects were included all 250nurses and all 100physicians. One tool was called nurse physician relationship and its impact on their perception of nurse role questionnaire sheet. Results and Conclusion: The finding of the present study indicated that physicians scored higher mean score related to nurse physician relationship than nurses. The level of nurse physician relationship from the majority of physicians and the nurses was moderate. Recommendation: improving collaborative relationship between nurses and physicians through Understand each other’s roles.

Colorectal Cancer: Consequences of Chemotherapy Induced Nausea and Vomiting on Patients’ Functional Daily Living

The aim of this study: To assess consequences due to chemotherapy induced nausea and vomiting on patients’ functional daily living. Research design: Descriptive design was utilized to conduct this study. Setting: The study was conducted in the internal oncology department at Qena Health Insurance Hospital. Sample: Forty-eight male and female patients admitted in the internal oncology department of the above mentioned hospital. Tools: Tool (I): Patient assessment sheet. Tool (II): Functional Living Index for Emesis (FLIE) Questionnaire. Results: About one third of studied patients suffered from consequences in the form of malnutrition, electrolyte imbalance, Mallory_ Weiss Syndrome (31.3%), delayed treatment, salivation and fever, high antiemetic cost, ( 33.3%,18.8%, 20.8% respectively)which reflected on their functional daily living as 97% had worse condition before chemotherapy and all patents had worse condition of functional daily living after chemotherapy too.Conclusion: Consequences due to Chemotherapy induced nausea and vomiting had a maximum impact on nearly all patients’ functional daily living either before or after chemotherapy. Recommendation: Colorectal cancer patients who receive chemotherapy in need to intensive nursing care and appropriate strategies to manage chemotherapy side effects and consequences related to these side effects which can improve their functional daily living.

A population-level comparison of cancer-related and non-cancer-related health care costs using publicly available provincial administrative data.

Costs associated with cancer care are increasing. Cancer costs in the context of other common non-cancer diagnoses have not been extensively studied at the population level. Knowledge from such analyses can inform health care resource allocation and highlight strategies to reduce overall costs. Using cross-sectional data from publicly available population-level administrative data sources (health insurance claims, physician billing, and hospital discharge abstracts), we calculated incidence-adjusted health care costs (in 2014 Canadian dollars) for cancers and common non-cancer diagnoses in the adult population in a large Canadian province. Subgroup analyses were also performed for various provincial health administrative regions. Total costs related to cancer care amounted to $495 million for the province, of which at least $67 million (14%) was attributable to radiation and chemotherapy. Of the various cancer subtypes, hematologic malignancies were most costly at $70 million, accounting for 14% of the total cancer budget. Colon cancer followed at $51 million (10%), and lung cancer, at $44 million (9%). Cancer costs (with and without costs for radiation and chemotherapy) exceeded those for cardiovascular disease, diabetes mellitus, mental health, and trauma (p < 0.001). In addition, the costs of specific cancer subtypes varied by region, but hematologic and lung cancers were typically the most costly no matter the health region. Using provincial administrative data to establish cost trends can help to inform health care allocation and budget decisions, and can facilitate comparisons between provinces.

Assessment of Medical Records Documentation in Secondary Health Care Facilities in Kafr El-Sheikh and El-Mahalla El-Kubra Cities

AbstractBackground: Accurate, timely and accessible health care data play an important role in the planning, development and maintenance of health care services.Aim of Study: This study was undertaken to assess the quality of medical records documentation in three healthcare facilities, two of them in Kafr El-Sheikh City (Kafr El-Sheikh General Hospital and El Obor Health Insurance Hospital) and the third one in El-Mahalla El-Kubra City (El-Mahalla El-Kubra General Hospital, Gharbia Governerate).Subjects and Methods: The medical record sample calcu-lated was (200) record sample from El-Mahalla El-Kubra General Hospital, (300) record sample from Kafr El-Sheikh General Hospital and (350) record sample from El Obor Health Insurance Hospital. The calculated record sample for each hospital was selected from the discharge logs of 2017 using the systematic random sampling method.Results: General consent form and discharge summary sheet were completely absent from the medical records of El-Obor Health Insurance Hospital. Almost all documentation assessment items of patient identification part were present in more than two third of checked records in El-Obor Health Insurance Hospital. The documentation assessment items of front sheet and discharge summary sheet were not present in more than the half of reviewed records at Kafr El-Sheikh General Hospital. Recording of clinical progress notes daily was not present in more than two third of reviewed records in the three hospitals. Recording of nursing progress notes within each shift was present in the majority of reviewed records (80%) in the three studied hospitals.Conclusion: There was considerable variations between the three studied hospitals according to documentation quality.

Stress and Burnout among Preretirement Employee in Hospital at 10th of Ramadan City

&lt;em&gt;Employees are at high risk for stress and burnout. The aim of this study was to assess job stressors and burnout among employees in hospital at Tenth of Ramadan city. Design: cross-sectional descriptive design. Setting: the National Health Insurance Hospital at 10&lt;sup&gt;th&lt;/sup&gt; of Ramadan city. Samples: convenience sample consisted of 100 employees. Tools: a self-administered questionnaire including scales for job stress and strain, burnout, and coping strategies, in addition to socio-demographic data was used in data collection. Results: the majority of the nurses were younger than 30 years (78%), with diploma degree (93%), and insufficient income (69%). More nurses had high exposure to stressors (49%), than strains (19%), and 20% had high burnout. Conclusion: the coping strategy most commonly used was effective behavioral confrontation. Nurses’ stress, strain, and burnout are strongly correlated and are influenced by personal factors such as age, qualification, experience, and residence, as well as job factors such as work hours, income, and the use of ineffective coping. Recommendations: the hospital administration should deal with and periodic assess the job factors underlying nurses’ stress and burnout. Further research is proposed to investigate the effectiveness of changing work environment factors and nursing care system on nurses’ burnout.&lt;/em&gt;

Safety Training Program for Clinical Laboratory Workers Regarding Prevention of Occupational Hazards

The practices of safety measures by the clinical laboratory workers in hospitals are necessary for the prevention of occupational hazards. The aim of this study was to evaluate the effect of safety training program for laboratory workers' regarding prevention of occupational hazards. Design: A quasi-experimental design was used in carrying out this study. Setting: The study was conducted at four governmental hospitals in Benha City: - are Benha University Hospital, Benha Teaching Hospital, Health Insurance Hospital, and Fever Hospital which included clinical laboratory. The sample of this study included convenient laboratory workers (100) whom are working at four hospitals were participated in this study. Tools: 1- A structured interviewing questionnaire for the socio-demographic characteristics of the laboratory workers, and their knowledge regarding occupational hazards, 2- An observational checklist for safe laboratory environment and practices of laboratory workers regarding prevention of the occupational hazards. Results: Showed a significant positive effect of the program on knowledge and practices of the laboratory workers (P This study concluded that the program has positive effect to upgrade the laboratory workers' knowledge and improving their practices regarding prevention of occupational hazards (P The study recommended that regulatory training program should be strengthened to ensure basic lab safety practices in hospitals, and providing training courses for large number of hospitals laboratory workers about prevention of occupational hazards and safety environmental condition.

THE RELATIONSHIP BETWEEN LEADERSHIP STYLES AND NURSING STAFF LOYALTY AT MANSOURA HEALTH INSURANCE HOSPITAL

Background: Today, nursing staff's loyalty is one most difficult problems that troubles head nurses. Several ways are proposed to solve this problem, among which improving style of leadership as a key perspective, for that to, leadership style determines the relationship between head nurses and nursing staff . Aim: The study aimed to explore relationship between leadership styles and nursing staff loyalty at Mansoura Health Insurance Hospital. Methods: Descriptive Correlation design study was used and conducted on 300 of staff nurses working at Mansoura Health Insurance Hospital, using two tools: Multifactor Leadership Questionnaire (MLQ) and Loyalty to Head nurse Scale (LS). Results: revealed that there was statistically significant (P<0.05) correlation between leadership styles and loyalty. The findings of the study showed that nurses will be satisfied when head nurses using transformational leadership style followed by laissez-faire leadership style. Conclusion: the study concluded that there is statistical significant correlation between head nurses' leadership styles and nursing staff loyalty at Mansoura Health Insurance Hospital. Recommendation: The head nurse should know the necessary element for the nursing staff and the hospitals and stimulate the nursing staff to search the opportunities around them effectively. The hospital and head nurses should share the decisions and the leadership with the nursing staff. Beside, present the training and facilitation for the team. In addition, The practices and the polices should associated with the feedback system and the rewarding to satisfy the needs of the nursing staff for developing the loyalty for the nurses.

Comparison between intracervical Foley catheter plus misoprostol and misoprostol alone for labor induction

Background and objective Potential advantages of mechanical methods, compared with pharmacological methods, may include simplicity of preservation, lower cost, and reduction of the adverse effects. The objective of this study was to compare the efficacy of combined intracervical Foley catheter and vaginal misoprostol with vaginal misoprostol alone for labor induction. Participants and methods This study was a prospective randomization clinical trial carried out from July 2016 to May 2018 in Benha Health Insurance Hospital. Two hundred pregnant women underwent induction of labor with singleton pregnancies at full-term gestation with (Bishop Score ≤6) by Foley catheter plus vaginal misoprostol (group A, n = 90) or vaginal misoprostol alone (group B, n = 110). Women with fetal malpresentation, multiple pregnancies, spontaneous labor, contraindication to prostaglandins, intrauterine growth restriction, anomalous fetus, and in active phase of labor, or previous cesarean delivery were excluded. The outcome measures were induction-to-delivery time, mode of delivery, oxytocin use, tachysystole with fetal decelerations, complications, neonatal Apgar scores, and neonatal ICU admission. Data were expressed as mean ± SD. Student's t-test was used to compare the mean difference between the two groups, and P value is used to determine the significance of the result. Results The mean induction-to-delivery time was shorter in group A when compared with group B (14.5 ± 4.1 h compared with 18.9 ± 5.2 h, difference 4.4 ± 1.1 h). There were no differences in labor complications or adverse neonatal and maternal outcomes. Conclusion A combined method resulted in a shorter induction-to-delivery time without increasing labor complications.

Evaluation of the Effect of Diabetes Mellitus on Corneal Biomechanics

Background: the cornea exhibits viscoelastic properties, which give it the quality of hysteresis. Corneal hysteresis is an important indicator of the biomechanical properties of the cornea. Aim: to compare the biomechanical properties of the cornea in patients having diabetes mellitus and age matched normal individuals as regards to corneal hysteresis (CH), corneal resistance factor (CRF), Corneal compensated IOP (IOPcc) and Goldman- correlated IOP (IOPg). Patients and Methods: A total of 200 eyes of 100 patients were enrolled in our study. Patients were selected from Ophthalmology outpatient clinics in Minia Health Insurance Hospital – Ophthalmology department. The type of our study is a case-control one. Patients were divided into two equal groups: Group A: included 50 patients (100 eyes) of age matched normal individuals. Group B: included 50 patients (100 eyes) having type 2 diabetes mellitus. Results: mean CH in control group was 9.8±1.3 mm Hg in comparison to mean CH in diabetic group which was 11.9±1.4 mm Hg, which was statistically significantly higher in diabetic patients when compared to control group, (P value = 0.<001). Conclusion: the corneal biomechanics in diabetic group are significantly higher compared with those of the control group.