The Effects of Zinc and Selenium Co-Supplementation on Resting Metabolic Rate, Thyroid Function, Physical Fitness, and Functional Capacity in Overweight and Obese People under a Hypocaloric Diet: A Randomized, Double-Blind, and Placebo-Controlled Trial.

Evidence of the effectiveness of zinc (Zn) and selenium (Se) on resting metabolic rate (RMR) and physical function parameters in people with overweight and obesity is scarce, while the effects of zinc and selenium on thyroid function and body composition are still a topic of debate and controversy. The aim of this randomized, double-blind, and placebo-controlled trial was to examine the effects of a hypocaloric diet and Se-Zn co-supplementation on RMR, thyroid function, body composition, physical fitness, and functional capacity in overweight or obese individuals. Twenty-eight overweight-obese participants (mean BMI: 29.4 ± 4.7) were randomly allocated (1:1) to the supplementation group (n = 14, 31.1 ± 5.5 yrs, 9 females) and the placebo group (n = 14, 32.1 ± 4.8 yrs, 6 females). The participants received Zn (25 mg of zinc gluconate/day) and Se (200 mcg of L-selenomethionine/day) or placebo tablets containing starch for eight weeks. The participants of both groups followed a hypocaloric diet during the intervention. RMR, thyroid function, body composition, cardiorespiratory fitness (VO2max), and functional capacity (sit-to-stand tests, timed up-and-go test, and handgrip strength) were assessed before and after the intervention. A significant interaction was found between supplementation and time on RMR (p = 0.045), with the intervention group's RMR increasing from 1923 ± 440 to 2364 ± 410 kcal/day. On the other hand, no interaction between supplementation and time on the thyroid function was found (p > 0.05). Regarding the effects of Zn/Se co-administration on Se levels, a significant interaction between supplementation and time on Se levels was detected (p = 0.004). Specifically, the intervention group's Se serum levels were increased from 83.04 ± 13.59 to 119.40 ± 23.93 µg/L. However, Zn serum levels did not change over time (90.61 ± 23.23 to 89.58 ± 10.61 umol/L). Even though all body composition outcomes improved in the intervention group more than placebo at the second measurement, no supplement × time interaction was detected on body composition (p > 0.05). Cardiorespiratory fitness did not change over the intervention. Yet, a main effect of time was found for some functional capacity tests, with both groups improving similarly over the eight-week intervention period (p < 0.05). In contrast, a supplement x group interaction was found in the performance of the timed up-and-go test (TUG) (p = 0.010), with the supplementation group improving more. In conclusion, an eight-week intervention with Zn/Se co-supplementation combined with a hypocaloric diet increased the RMR, TUG performance, and Se levels in overweight and obese people. However, thyroid function, Zn levels, body composition, and the remaining outcomes of exercise performance remained unchanged.

The Effects of Zinc and Selenium Supplementation on Body Composition and Thyroid Function in Individuals with Overweight or Obesity: A Systematic Review.

People with obesity have been found to have lower zinc (Zn) and selenium (Se) circulatory levels and abnormal thyroid function than people with normal weight. Studies about the effects of Zn and Se supplementation on body composition and thyroid function of overweight-obese people showed inconsistent results. A systematic review of randomized controlled trials was conducted to determine the effects of Ζn supplementation, Se supplementation, and their combination on body composition and thyroid function of individuals with overweight or obesity. Databases of PubMed, ScienceDirect, and Cochrane, were searched from inception to February 27, 2022, to identify relevant articles. For the assessment of the methodological quality of the studies, the Jadad scale was used. After screening the articles, thirteen studies were finally included and were analyzed using the strength of the evidence approach. Regarding the effectiveness of Zn supplementation on body composition, moderate evidence was found, while the effects of Se were found to be mixed. Zn supplementation was found to affect the thyroid function of people with overweight or obesity by increasing their free triiodothyronine (FT3) levels. However, this result is based only on one study among hypothyroid patients. At this point, the effectiveness of Zn, Se, and their combination, on the body composition and the thyroid function of people with overweight or obesity cannot safely be determined because of the controversial results, small number, and the limitations of the identified studies. The results of this systematic review must be interpreted with caution due to the limitations detected.

Postoperative Analgesia Management Evaluation in the Postanesthesia Unit: An Exploratory Analysis Based on Patient and Surgery Characteristics.

PURPOSE: Several methods have been proposed for postoperative pain management, including administration of opioid analgesics, epidural analgesia, and perineural and infiltrative techniques; however, data are lacking on the relationship between pain intensity, patients' age and gender, and surgery duration. DESIGN: Prospective, observational, single-center study. METHODS: The study included patients greater than or equal to 18 years old who underwent surgery with different anesthesia types, grouped according to the American Society of Anesthesiologists' physical status classification score. The McGill Pain Questionnaire was used to assess postoperative pain intensity. The postoperative pain evaluation was performed in the first 5 minutes on entering the postanesthesia care unit (PACU), and at 30 minutes and 24 hours after the operation. RESULTS: Our results showed a significant negative relationship between pain intensity as assessed at 5 and 30 minutes postoperatively and age. Postoperative pain intensity at 24 hours was significantly lower after low-risk surgeries lasting up to 1 hour; pain intensity was also significantly lower at 30 minutes following epidural anesthesia. When nonsteroidal anti-inflammatory drugs were not administered in the PACU, pain intensity was significantly lower at 5 minutes, 30 minutes, and 3 hours. CONCLUSIONS: Postoperative analgesic administration should be conducted in accordance with age and surgery type. Additionally, epidural anesthesia can reduce the immediate postoperative pain intensity.

Barriers to the Adoption of Evidence Based Practice in Nursing: a Focus Group Study.

Background: Evidence Based Practice is considered a complex process with many factors hindering its implementation. The use of focus groups to detect barriers to its application can provide an in-depth investigation of the phenomenon. Objective: The investigation of nurses' views regarding the obstacles connected to the implementation of Evidence Based Practice. Methods: This is a qualitative study carried out using focus groups and constitutes the continuation of a quantitative study. Deliberate sampling was used to recruit a total of 31 nurses. Results: The main categories that emerged regarding the obstacles in the implementation of Evidence Based Practice in nursing, concerned the lack of logistical support, the difficulty of accessing data, the insufficient knowledge of nurses as well as their attitude, the nature of the work, the decision-making process and the impossibility of safeguarding decisions made. Conclusion: In this study, various factors were identified that affect the application of Evidence Based Practice, in the nursing environment of Cyprus. Identifying these factors can be the basis for discussions and finding ways to resolve the problems that exist by health care managers.

A Scoping Review on the Status of Female Breast Cancer in Asia with a Special Focus on Nepal.

This study aimed to provide updated evidence on the status of female breast cancer and cancer treatment facilities in Asia, with a special focus on Nepal. This review used search phrases that included, breast neoplasm or cancer, health status, epidemiology, breast cancer survivors, cancer care facilities, Asia, Nepal. Researchers examined databases from January 2011 to December 2020 (PubMed, PMC, Google Scholar, and the reference lists of included papers). Studies of any design and reviews, were included in the study, except for qualitative studies. The study findings are presented in a narrative synthesis format using Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews. An initial search resulted in 974 papers, and 896 were reviewed after being checked for duplication using the Zotero software. Accordingly, utilizing the inclusion and exclusion criteria, 188 publications were selected, and after review of titles and abstracts, an additional 98 papers were removed for different reasons. Finally, the study looked at 90 female breast cancer papers. Results showed that the number of cases of breast cancer is growing all around the world, including in Asia and Nepal. Age, early menarche, late menopause, nulliparity, positive family history, excessive fat consumption, alcohol, and smoking are all frequent risk factors for breast cancer found in Asian women. Breast self-examination, clinical breast examination, and mammography screening are common methods for detecting breast carcinoma. Chemotherapy, radiation, and modified mastectomy are commonly used options for treatment. The number of breast cancer survivors is growing throughout the world, indicating better clinical care. There is a paucity of survival data in many Asian countries, including Nepal. There is also a scarcity of health workforce specialized in cancer care and treatment, as well as a few health facilities that are available to treat cancer cases in many Asian countries, including Nepal.

Evidence of distorted proprioception and postural control in studies of experimentally induced pain: a critical review of the literature.

OBJECTIVES: Deficits in proprioception and postural control are common in patients with different musculoskeletal pain syndromes. It has been proposed that pain can negatively affect proprioception and postural control at a peripheral level, however research is limited to animal studies. Human studies have shown that it is more likely, that the link between pain and proprioceptive deficits, lies within changes in the central nervous system where noxious and non-noxious stimuli may overlap. In clinical studies, causality cannot be determined due to other factors which could confound the assessment such as pathophysiological features of the underlying musculoskeletal disorder and different psycho-social influences especially in patients with chronic pain. On the other hand, experimentally induced pain in healthy participants is able to control most of these confounding factors and perhaps offers an assessment of the effects of pain on proprioception and postural control. The aim of this paper is to critically appraise the literature related to the effect of experimentally induced pain on proprioception and postural control. Results from these studies are discussed and limitations are highlighted for future research. METHODS: A search of databases (Medline, Scopus, PubMed) was conducted as well as reference check from relevant articles published since 2000. Fifteen studies which explored the effect of experimentally induced pain on postural control and ten studies which explored the effect of experimentally induced pain on proprioception were included. RESULTS: We found that in the majority of the studies, postural control was negatively affected by experimentally induced pain. Results for proprioception were mixed depending on the body region and the way the painful stimuli were delivered. Kinesthesia was negatively affected in two studies, while in one study kinesthesia was enhanced. Joint position sense was not affected in four out of five studies. Finally, force sense was affected in three out of four studies. CONCLUSIONS: From a clinical point of view, findings from the available literature suggest that experimentally induced pain impairs postural control and could potentially increases the risk for falls in patients. Interventions aiming to reduce pain in these patients could lead to preservation or improvement of their balance. On the other hand, the same conclusion cannot be drawn for the effect of experimentally induced pain on kinesthesia and joint position sense due to the limited number of studies showing such an effect.

Acceptance of coronavirus disease 2019 vaccination by cancer patients in Cyprus: A cross-sectional study.

INTRODUCTION: The acceptance of an individual to be vaccinated following the introduction of a new vaccine is dependent on multiple factors. Governing factors directing one's decision to be vaccinated against severe acute respiratory syndrome coronavirus 2, however, are currently unknown and the present study aims at researching these factors within the population of cancer patients. METHODS: A cross-sectional self-administered survey was conducted anonymously between 22 January and 12 February 2021, during the second vaccination phase against severe acute respiratory syndrome coronavirus 2 in Cyprus. The data were collected via an online questionnaire which was formerly used by previously conducted studies. The Mann-Whitney U test was applied for the comparison of means between bivariate variables, while the Kruskal-Wallis test was used for the comparison of means in variables with more than two groups. In addition, Spearman correlation coefficients were applied to explore the correlation of continuous variables. RESULTS: The sample size consisted of a total of 211 cancer patients, 64.9% of which were women with a mean age of 52.6 ± 12.4 years. The findings of the current research indicate a moderate vaccination acceptance among cancer patients (Μ = 3.3 ± 0.7, R = 1-5). CONCLUSION: During the promotion of a vaccine against severe acute respiratory syndrome coronavirus 2 to cancer patients, particular emphasis on specific demographic characteristics, vaccination history and preferred sources of informing the individual are required. In addition, through reviewing the prospective effectiveness and possible outcomes of the specific vaccine according to cancer type and anti-cancer therapy, many of the existing concerns and reservations from cancer patients are expected to be diminished.

Health Workers' knowledge and perception regarding the risk of spread of COVID-19 during the pandemic: A systematic review.

Certain Health Workers (HWs) may have inadequate knowledge and perceptions regarding COVID-19. As a result, they may not be completely aware of the danger/risk involved, which could impact their ability to control the spread of the virus. This systematic review aims to enhance HWs' knowledge and their perception of the spread risk of COVID-19 during the pandemic. A search was conducted in four databases (Medline, CINAHL, Scopus, and ScienceDirect) to locate peer-reviewed studies published in English between January 2020 and April 2020. Eventually, nine articles satisfied the inclusion criteria and were, therefore, included in the present study. Six of the aforementioned studies specifically investigated HWs' perception of risk. Apart from a study that indicated medium perception (min = 56.5%), all other studies found high levels of risk perception (n = 5, max 92.1%). As for HWs' knowledge, apart from two studies that indicated medium percentage levels (min = 56.5%), the rest of the studies report high percentages (n = 7, max = 93.2%). Two of the studies, which assessed the sources of information that HWs use, agree that social media is the most widely used source of information. The findings of this study suggest that HWs had a satisfactory perception of risk during the spread of COVID-19. Although fields with medium knowledge levels were identified, HWs' overall knowledge may also be described as satisfactory. It is also noted that certain demographic characteristics (occupation, age, and years of experience) appear to affect HWs' knowledge and perceptions. The application of educational strategies aiming to provide continuous support to HWs is unanimously recommended by all studies.

Factors Affecting the Application and Implementation of Evidence-based Practice in Nursing.

BACKGROUND: Even though Evidence-Based Practice is a complex process, it's application has been recognized worldwide as a lever of improvement of the provided health services. OBJECTIVE: This study investigates the factors which influence the implementation of Evidence-Based Practice and their correlation with nurses' socio-demographic characteristics. METHODS: This is a cross-sectional study for which data were collected through an anonymous questionnaire. The study sample included 302 nurses from six public hospitals in Cyprus. Data collection was conducted from April 2018 to July 2018. RESULTS: According to the nurses, the biggest obstacle for the application of Evidence-Based Practice is the lack of authority/power to change care procedures (83.8%), followed by the view that the results were not applicable in the nurses' environment (81.5%). CONCLUSION: The identification of factors affecting the implementation of Evidence-Based Practice can serve as a basis for improving the quality of healthcare, as well as for developing strategies for resolving existing problems. This study showed that there is a need to create opportunities for the use of Evidence-Based Practice by nurses.

Assessment of Knowledge and Perceptions of Health Workers Regarding COVID-19: A Cross-Sectional Study from Cyprus.

The COVID-19 disease is presently a matter of global public health concern as it could be potentially fatal. Health workers have at the moment, inadequate knowledge of prevention measures, and their erroneous practices may directly increase the risk of spread. As a result, matters are complicated further as far as the chain of infection is concerned. The present cross-sectional study was conducted with 494 Health Worker participants in Cyprus between the 1st and 20th of May and the data were collected via an online questionnaire. The survey was created using information from a previous study as well as current directives published on the WHO website. The statistical software SPSS 22.0 was used for data analysis. The ANOVA test was used for the comparison of quantitative variables, while the Kruskal-Wallis test was used in cases of non-parametric distribution. The Pearson or Spearman coefficients were used to test correlation and the levels of materiality were set to 0,05. Women constituted 66,7% of the participants and 44,8% of all participants were between the age of 30-39 years old. The majority (75,4%) of the participants were Nursing Officers and 44,5% held postgraduate qualifications. HWs appeared to have a positive perception (x̅ = 3.58, SD = 0.53, MR = 1-5) regarding the course of the pandemic and their knowledge of the virus was found to be generally satisfactory. The findings of the current study indicate that in case of a similar global public health crisis, certain educational interventions should be implemented. This could be achieved with the use of an appropriate strategy. As a result, all demographic-working strata of health professionals would be well-educated and informed.

Exploration of empathy in Cyprus nursing and health care students: A mixed method study.

Developing professionals who are perceptive to the needs of patients and can respond by expressing empathetic behavior is one of the aims of health care education. The aim of this study was to explore the level of empathy in health care students through a mixed method. The quantitative approach included the use of the Jefferson Scale of Empathy and the qualitative a focus group approach to further deepen into the descriptive results. 869 health care students (RR=81%) participated in the study and the level of empathy ranged from 42 to 139 with a mean score of 100.6 (20-140 scale). Significant statistical differences were found between the disciplines (F=8.6, p-value<0.001) and gender (p-value<0.001) with nursing students and women scoring the higher levels. Two focus groups of ten participants each were conducted with 3rd and 4th year nursing students. Four themes were derived from the analysis of these data a) empathy as an imperative component of care b) contact with the clinical reality c) the influence of family and choice of studies d) gender stereotypes. There is a lack of mixed methodologies in the empathy research and this study provided the opportunity of a better understanding of the health care students' views.

Vaccination Coverage and Awareness of Hepatitis B Virus Among Healthcare Students at a University in Cyprus.

INTRODUCTION: The risk for healthcare students to get infected by transmitting infectious viruses, including hepatitis B virus (HBV), in a hospital setting is extremely high through exposure to blood and/or body secretions. AIM: The aim of this work was to evaluate both the vaccination history of healthcare students at a University in Cyprus and their serologic immunity against HBV. In addition, we assessed their knowledge and behaviors towards the transmission and prevention of hepatitis B (HB). RESULTS: Total amount of 168 students participated in this study and more than 50% of them provided complete documentation of vaccination history against HBV. Antibodies levels ×10 mIU/mL to HB surface antigen (HBsAg) were detected for the 98.8% of healthcare students while 1.2% of the participants tested positive for HBsAg and antibodies to HB core antigen indicating chronic infection. Our study also revealed significant gaps in the knowledge of healthcare students on the efficiency of the vaccine against HBV and in terms of the HBV transmission. CONCLUSIONS: More information needs to be provided to healthcare students in Cyprus regarding HBV transmission and vaccination. In addition, there is a need for intervention to provide a safer workplace environment.

Evaluation of the Integrated Health Information System (IHIS) in Public Hospitals in Cyprus Utilizing the DIPSA Framework.

INTRODUCTION: The Ministry of Health of the Republic of Cyprus has implemented an Integrated Health Information System (IHIS) in two hospitals. However, no evaluation of IHIS has been conducted to assess its safety, efficiency and effectiveness. The proper utilization of IHIS is essential for the provision of quality healthcare services. AIM: The purpose of this study was to evaluate the current IHIS in public hospitals in Cyprus utilizing the DIPSA evaluation framework. METHODS: A total of 309 subjects, including doctors, nurses and other healthcare professionals, participated in the study. The DIPSA evaluation framework assessed the users' perception in five categories namely, satisfaction, collaboration, system quality, safety and procedures, using Likert scale and 3 open questions. Correlation between the categories was assessed using the Pearson correlation coefficient, and multiple regression analysis was used to examine the relationship between the demographic characteristics and categories. Data analysis was done using SPSS v24. RESULTS: All five categories were rated moderately, between 2.5 and 3, by the participants. All categories were correlated (P < 0.01). Multiple regression analysis indicated the need for improvement between the professionals (mainly doctors and nurses) and the categories. The open questions pointed out the need for improvement in all 3 factors examined (Technology, Human Factor, Organization). DISCUSSION: The moderately rated categories, in the Cyprus IHIS, suggest that there is a lot of room for improvement. Some interventions are suggested that could positively and simultaneously affect one or more categories.

Assessment of Nurse's Safe Behavior Towards Chemotherapy Management.

INTRODUCTION: The management of chemotherapy in the hospital environment has been associated with increased risk of exposure to harmful factors. The use of the designated protective area and equipment during the preparation and the administration of chemotherapy is considered the gold standard of prevention. AIM: The aim of the study was to assess nurse's behavior in one public and one private hospital during the management of chemotherapy. METHODS: A cross sectional study design, using a self-completing questionnaire was used to collect the data, the final sample consisted of n=82 nurses, employed in the oncology and haematology department of Limassol general hospital and the bank of Cyprus oncology center. RESULTS: Most of the sample had a positive attitude towards the management and preparation of chemotherapy and kept the personal protection measures 52,4%. Inadequate aeration system was found to exist in both the health care centers 17,1%. The knowledge levels of the nurses employed in the bank of Cyprus oncology center was found to be statistically higher than the nurses employed in Limassol general hospital (84,4% Vs 23,4%, p<0,001). CONCLUSION: Educational programs need to be designed and implement to update nurses with the latest safety techniques and procedures, aiming at the protection of the employees from side effects as a result from the exposure to chemotherapy. The management of the healthcare institution need to ensure that the workplace environment fulfils all the safety standards and health regulations regarding the preparation of chemotherapy. Lastly more studies need to be conducted to monitor the knowledge and attitudes levels, and the implementation of safety and health regulation from the health care organizations regarding the safe management and preparation of chemotherapy.

Awareness of human papilloma virus and cervical cancer prevention among Cypriot female healthcare workers.

BACKGROUND: Cervical cancer incidence varies around the world with the highest rates in Eastern Africa and the lowest rates in Western Asia. In Cyprus, a small Mediterranean island, cervical cancer incidence was 6.4 per 100,000 in 2013. HPV is an established risk factor for cervical cancer with HPV-16 and HPV-18 being the most common carcinogenic strains. Cervical cancer is preventable through primary (HPV vaccination) and secondary (Pap and HPV tests) prevention. These prevention methods should be promoted, however, in order to design a cancer prevention programme and the awareness and characteristics of populations should be investigated so that prevention programmes can be targeted specifically to them. METHODS: In this work, we sought to investigate awareness of HPV and cervical cancer prevention among female healthcare workers in Cyprus. To achieve this, we conducted a 60-item survey among 200 healthcare professionals in randomly selected hospitals in two different cities within Cyprus. RESULTS: Our results revealed that nearly 10% of our participants reported not ever having had a Pap test. 88.5% of the healthcare workers knew about HPV and 86.5% reported that HPV is transmitted through sexual intercourse. 83.5% of the participants were willing to vaccinate themselves for cervical cancer prevention. CONCLUSION: Even though awareness and vaccination acceptance were relatively high, they are still not optimal for healthcare professionals who play an essential role in health promotion. We suggest the design of educational programmes to target this population and improve their knowledge so that they can promote cervical cancer prevention in their health practice.

Knowledge and attitudes of nurses in a major public hospital in Cyprus towards pressure ulcer prevention.

STUDY AIM: The main aim of the study was to identify the knowledge and attitudes of nurses towards pressure ulcer prevention in a major public hospital in Cyprus. MATERIAL AND METHODS: A descriptive and cross-sectional study design was used to collect the data between December 2014 and February 2015, the sample consisted of n = 102 nurses employed in a major public hospital in Cyprus. Customised and standardised Pressure Ulcer Knowledge Test and an attitudes Likert questionnaire was used to investigate both parameters. Descriptive and inferential statistics, parametric (t-test), non-parametric tests (Mann-Whitney U) and Pearson test was applied. Statistical significance was set at p = 0.05. RESULTS: The majority of the participants (44.1%) n = 45 were employed in the intensive care unit, were female (61.8%) n = 63, registered nurses (93.1%) n = 95, had more than 5 years of experience (59.4%) n = 32 and 10.8% (n = 11) had a postgraduate title. The mean value regarding the knowledge questionnaire was 16.16, IQR: 17(15-18) correct answers 77%. In the attitudes questionnaire the median value was 41.82, IQR: 43 (40-46). Knowledge and attitudes correlated positively and statistically significantly (Pearson's R = 0,223, p = 0,019). CONCLUSION: The result suggests that nurses had relatively inadequate knowledge levels and positive attitudes, attitudes and knowledges correlated statistically significantly and positively. It is proposed that through the development of educational programs and the frequent measurement of the two parameters further improvement can be achieved.

The Impact of Stress on Pressure Ulcer Wound Healing Process and on the Psychophysiological Environment of the Individual Suffering from them.

INTRODUCTION: The occurrence of a pressure ulcer constitutes a major psychological and physiological burden and it has been linked with a reduced quality of life and increased stress of the individual. OBJECTIVE: The main objective was to investigate the impact that stress has on pressure ulcer healing process and on the psychophysiological environment of the individual suffering from them. METHOD: The scientific literature was reviewed through Cinahl, Pub-med, EBSCO, Medline and Google scholar. The articles were chosen due to their direct correlation with the objective under study and their scientific relevance. RESULTS: Increased stress has been demonstrated to increase the glucocorticoids levels affecting negatively the production of wound healing cytokines (IL1α, IL1ß and TNFα). Matrix metalloproteases has been identified to be unregulated in occasions of increased stress in acute wounds. Stress has also been correlated with poor health behaviors that may not have a direct link on the wound healing process, although they can in part explain or enhance some of the effects of stress on wound healing. CONCLUSION: The correlation between stress and wound healing in acute wounds has been thoroughly investigated and its negative effects have been established. The presence of a pressure ulcer can have a detrimental impact on the stress level of an individual although further investigation is needed to establish the role of stress in chronic wounds such as pressure ulcers.

Conflict management among health professionals in hospitals of Cyprus.

AIM: To record the types of conflict management that health professionals in Cyprus hospitals encounter in their daily work and to explore the conflicts, their parameters and causes, and the role ambiguity faced by the hospital employees. MATERIAL AND METHODS: This is a descriptive study in which data were collected with an anonymous self-referral questionnaire. The study population consisted of 300 health professionals from six different hospitals in Cyprus. Data are presented with averages and standard deviations. RESULTS: The health professionals identified the following causes of conflicts in the workplace in descending order: heavy workload, low pay, and varying instructions from different leaders. To deal with the conflict, 73.2% of the participants reported using avoidance, 54.2% engaged in negotiation for mutual benefit, and 40.5% cited compromise as a method. CONCLUSIONS: Identifying the way in which conflicts are managed contributes to the smooth functioning of organisations, and it improves the effectiveness of the services provided. IMPLICATIONS FOR NURSING MANAGEMENT: It is generally known that the high levels of conflict in hospitals are associated with increased mistakes and low employee satisfaction and performance levels. Managers deal with conflict-management issues within organisations on a daily basis. It is therefore essential to comprehend the reasons behind conflicts and provide suitable training for the development of communication skills and conflict-management strategies.

Evaluation of the Validity and Reliability of the Waterlow Pressure Ulcer Risk Assessment Scale.

INTRODUCTION: Prevention is the ideal strategy to tackle the problem of pressure ulcers. Pressure ulcer risk assessment scales are one of the most pivotal measures applied to tackle the problem, much criticisms has been developed regarding the validity and reliability of these scales. OBJECTIVE: To investigate the validity and reliability of the Waterlow pressure ulcer risk assessment scale. METHOD: The methodology used is a narrative literature review, the bibliography was reviewed through Cinahl, Pubmed, EBSCO, Medline and Google scholar, 26 scientific articles where identified. The articles where chosen due to their direct correlation with the objective under study and their scientific relevance. RESULTS: The construct and face validity of the Waterlow appears adequate, but with regards to content validity changes in the category age and gender can be beneficial. The concurrent validity cannot be assessed. The predictive validity of the Waterlow is characterized by high specificity and low sensitivity. The inter-rater reliability has been demonstrated to be inadequate, this may be due to lack of clear definitions within the categories and differentiating level of knowledge between the users. CONCLUSION: Due to the limitations presented regarding the validity and reliability of the Waterlow pressure ulcer risk assessment scale, the scale should be used in conjunction with clinical assessment to provide optimum results.

Development of an Evaluation Framework for Health Information Systems (DIPSA).

INTRODUCTION: Use of Integrated Health Information Systems (IHIS) for the provision of healthcare services benefits both healthcare professionals and patients, while requiring continuous evaluation and upgrading to fully support its role. AIM: The main purpose of the study was to develop an evaluation framework for hospitals utilizing IHIS, within the three main areas identified as Human factor, Technology and Organization. MATERIAL AND METHODS: The questionnaire consisted of 43 questions, with 17 questions (related to categories procedures, system quality and satisfaction), 25 questions (related to categories, safety and collaboration) and 1 question related to accessibility to the system (within the category system quality). Three open questions were added to evaluate users' perception on what was needed for the improvement of health services in their respective hospitals for all 3 variables being evaluated. The open questions were included to allow participants to express their opinion in a more detailed setting. A database was developed, and the data were processed and analyzed. RESULTS: Factor analysis formed 5 categories for the evaluation framework. Cronbach's alpha coefficient was found in all categories to be above > 0.85. CONCLUSION: Evaluation frameworks can be designed, developed and implemented by using different methodologies. For an evaluation framework to be effective it should be designed and implemented based on the aims and purpose of the research and the specific needs of the particular healthcare setting or hospital. Considering the categories satisfaction, collaboration, safety, system quality, procedures, and by using Likert scale and open questions in the current study, DIPSA can provide a holistic image of IHIS by evaluating any hospital system.