Foreign body removal assisted by an intraoral ultrasound probe

Abstract

Ultrasonography has recently been applied to the field of oral and maxillofacial surgery because of its noninvasiveness and ease of use. However, traditional transducers are not used in the intraoral area because of their large size. A novel intraoral transducer was introduced with size, volume, and axis modifications. This new transducer allows the surgeon to approach the intraoral region during dental procedures. This report describes a case of successful removal of a foreign body using the newly developed intraoral ultrasound probe. Precise localization and minimally invasive removal of the foreign body using the intraoral transducer were simultaneously conducted. Because of its many advantages, this intraoral ultrasound transducer has the potential to be applied in oral and maxillofacial surgery.

http://ift.tt/2r6vP11

Agricultural non-point source pollution management in a reservoir watershed based on ecological network analysis of soil nitrogen cycling

Abstract

The Miyun Reservoir plays a pivotal role in providing drinking water for the city of Beijing. In this research, ecological network analysis and scenario analysis were integrated to explore soil nitrogen cycling of chestnut and Chinese pine forests in the upper basin of the Miyun Reservoir, as well as to seek favorable fertilization modes to reduce agricultural non-point source pollution. Ecological network analysis results showed that (1) the turnover time was 0.04 to 0.37 year in the NH₄⁺ compartment and were 15.78 to 138.36 years in the organic N compartment; (2) the Finn cycling index and the ratio of indirect to direct flow were 0.73 and 11.92 for the chestnut forest model, respectively. Those of the Chinese pine forest model were 0.88 and 29.23, respectively; and (3) in the chestnut forest model, NO₃⁻ accounted for 96% of the total soil nitrogen loss, followed by plant N (2%), NH₄⁺ (1%), and organic N (1%). In the Chinese pine forest, NH₄⁺ accounted for 56% of the total soil nitrogen loss, followed by organic N (34%) and NO₃⁻ (10%). Fertilization mode was identified as the main factor affecting soil N export. To minimize NH₄⁺ and NO₃⁻ outputs while maintaining the current plant yield (i.e., 7.85e0 kg N/year), a fertilization mode of 162.50 kg N/year offered by manure should be adopted. Whereas, to achieve a maximum plant yield (i.e., 3.35e1 kg N/year) while reducing NH₄⁺ and NO₃⁻ outputs, a fertilization mode of 325.00 kg N/year offered by manure should be utilized. This research is of wide suitability to support agricultural non-point source pollution management at the watershed scale.

http://ift.tt/2DdtDuj

Pustular psoriasis and related pustular skin diseases

Summary

Patients with pustular psoriasis or related pustular diseases may have genetic abnormalities impairing the function of key players of the innate skin immune system. Recently, identification of these abnormalities has changed the paradigm of several of these diseases. These include generalized pustular psoriasis, palmoplantar pustular psoriasis and acrodermatitis continua of Hallopeau, and also drug-induced acute exanthematous generalized pustular eruption. Identified mutations in IL36RN, CARD14 and AP1S3 in different groups of patients lead to enhanced inflammatory cascade in several cellular subtypes including keratinocytes, and to the recruitment and activation of neutrophils and macrophages. These insights have unveiled pathophysiological features that shift the existing paradigms and emphasize the autoinflammatory nature of skin pustular disorders. They also highlight the crucial role of the innate immune system across entities belonging to the psoriasis disease spectrum, allowing identification of new appealing therapeutic targets.

http://ift.tt/2FE0fLe

Vitiligo-like lesions and immune checkpoint inhibition therapy: is it truly an adverse event exclusive to patients with melanoma?

http://ift.tt/2mE166J

Increased sensitivity and high specificity of indirect immunofluorescence in detecting IgG subclasses for diagnosis of bullous pemphigoid

Summary

Background

Indirect immunofluorescence (IIF) microscopy on monkey oesophagus is an important assay for the diagnosis of bullous pemphigoid (BP). Its relatively low sensitivity (60–80%) may be partly due to insufficient detection of minor IgG subclasses.

Aim

To determine the operating characteristics of an IgG subclass in IIF.

Methods

We designed a retrospective, dual-centre, controlled cohort study on sera from 64 BP sera that had been rated as false negatives by traditional IIF microscopy, and assessed circulating IgG₁, IgG₃ and IgG₄ autoantibodies.

Results

The sensitivities of IIF in detecting IgG₁, IgG₃, IgG₄ and all three in combination were 45.3%, 18.8%, 32.8% and 48.4%, respectively. Specificities were > 97%.

Conclusion

Detection of IgG subclass (especially IgG₁ and IgG₄) autoantibodies by IIF on monkey oesophagus can significantly improve diagnostic performance of IIF microscopy for diagnosis of BP.

http://ift.tt/2r9dIY8

Evaluation of universal immunohistochemical screening of sebaceous neoplasms in a service setting

Summary

Background

Muir–Torre syndrome (MTS) is a subtype of Lynch syndrome, which encompasses the combination of sebaceous skin tumours or keratoacanthomas and internal malignancy, due to mutations in DNA mismatch repair genes. Sebaceous neoplasms (SNs) may occur before other malignancies, and may lead to the diagnosis, which allows testing of other family members, cancer surveillance, risk-reducing surgery or prevention therapies.

Aim

To evaluate the efficacy of universal immunohistochemistry (IHC) screening of SNs in a service setting.

Methods

Patients with SNs were ascertained by a regional clinical pathology service over a 3-year period. Results of tumour IHC, clinical genetics notes and germline genetic testing were retrospectively reviewed.

Results

In total, 62 patients presented with 71 SNs; 9 (15%) of these patients had previously diagnosed MTS. Tumour IHC was performed for 50 of the 53 remaining patients (94%); 26 (52%) had loss of staining of one or more mismatch repair proteins. Fifteen patients were referred to the Clinical Genetics department, and 10 patients underwent germline genetic testing. Two had a new diagnosis of MTS confirmed, with heterozygous pathogenic mutations detected in the MSH2 and PMS2 genes (diagnostic yield 20%). The PMS2 mutation was identified in a 57-year-old woman with a sebaceous adenoma and history of endometrial cancer; to our knowledge, this is the first time a PMS2 mutation has been reported in MTS.

Conclusions

Universal IHC screening of SNs is an effective method to identify cases for further genetic evaluation. Rates of referral to clinical genetics were only moderate (58%). Increased awareness of MTS could help improve the rate of onward referral.

http://ift.tt/2mEp95I

Serum levels of psoriasin (S100A7) and koebnerisin (S100A15) as potential markers of atherosclerosis in patients with psoriasis

Summary

Background

Psoriasin (S100A7) and koebnerisin (S100A15) are proinflammatory proteins upregulated in psoriasis, but their relation to atherosclerosis remains unclear.

Aim

To evaluate the role of serum psoriasin and koebnerisin as possible markers for subclinical atherosclerosis in patients with psoriasis.

Methods

Serum levels of psoriasin and koebnerisin were measured by ELISA in 45 patients with psoriasis and in 45 healthy controls (HCs). Intima–media thickness (IMT) of the right and left common carotid arteries was measured to detect the presence of subclinical atherosclerosis. Clinical severity of psoriasis was estimated using the Psoriasis Area and Severity Index (PASI).

Results

Compared with HCs, patients with psoriasis had significantly higher levels of psoriasin (26.61 ± 22.45 ng/mL vs. 6.31 ± 1.68 ng/mL, P < 0.001) and koebnerisin (21.2 ± 13.12 ng/mL vs. 12.2 ± 4.67 ng/mL, P = 0.001), and significantly higher IMT values (1.07 ± 0.4 mm vs. 0.61 ± 0.1 mm, P < 0.001). A positive correlation was observed between IMT and PASI (r = 0.78, P < 0.001), serum psoriasin (r = 0.48, P > 0.01) and serum koebnerisin (r = 0.48, P < 0.01). Patients with psoriasis with subclinical atherosclerosis had higher serum levels of koebnerisin compared with patients without subclinical atherosclerosis (P = 0.04), which was not observed for psoriasin (P = 0.94).

Conclusion

Serum psoriasin and koebnerisin correlate with IMT, underlining their value as a potential link between psoriasis and atherosclerosis. In particular, koebnerisin seems to be a useful marker of subclinical atherosclerosis in patients with psoriasis.

http://ift.tt/2r8osGi

Pemphigus herpetiformis with autoantibodies to desmocollins 1, 2 and 3

http://ift.tt/2mE1far

Outpatient erbium:YAG (2940 nm) laser treatment for snoring: a prospective study on 40 patients

Abstract

Snoring is a sleep phenomenon due to the partial upper airway obstruction during sleep which causes vibration of the tissues of the rhino-oro-hypopharynx and less frequently the larynx. This study evaluated the use and effectiveness of the erbium:YAG 2940-nm laser as an adjunctive in providing treatment for patients suffering from chronic snoring-related sleep disorders. A prospective study of 40 consecutive patients with snoring and sleep disorders was performed, assessing data before and after three Er:YAG laser treatment sessions. During laser treatment, the pain was almost absent. There were no side effects, except a very mild sore throat in 1 out of 40 patients. The patient's evaluation of satisfaction of the results obtained after the treatments showed that 85% of cases were very satisfied, 5 patients (12.5%) reported being fairly satisfied with the treatment and only 1 subject (2.5%) was not satisfied. Mallampati, Friedman Tongue Position, and degree of O (oropharynx) at nose oropharynx hypopharynx and larynx classification were significantly decreased after the laser sessions. The decrease of Epworth Sleepiness Scale and Visual Analogue Scale for loudness of snoring, waking up during sleep because of snoring, dry mouth on waking, and choking was all statistically significant. The incidence of dreaming during the night also raised significantly; 30/40 (75%) of cases perceived less tightness in their throat and better breathing after treatment. These results were stable at 20 months follow-up (14–24 q) in 72% of cases. Nonsurgical and non-invasive Er:YAG laser treatment demonstrated to be a valid procedure in reducing the loudness of snoring.

http://ift.tt/2B3nJpK

High final energy of gallium arsenide laser increases MyoD gene expression during the intermediate phase of muscle regeneration after cryoinjury in rats

Abstract

The aim of this study was to determine the effects of gallium arsenide (GaAs) laser on IGF-I, MyoD, MAFbx, and TNF-α gene expression during the intermediate phase of muscle regeneration after cryoinjury 21 Wistar rats were divided into three groups (n = 7 per group): untreated with no injury (control group), cryoinjury without GaAs (injured group), and cryoinjury with GaAs (GaAs-injured group). The cryoinjury was induced in the central region of the tibialis anterior muscle (TA). The region injured was irradiated once a day during 14 days using GaAs laser (904 nm; spot size 0.035 cm², output power 50 mW; energy density 69 J cm⁻²; exposure time 4 s per point; final energy 4.8 J). Twenty-four hours after the last application, the right and left TA muscles were collected for histological (collagen content) and molecular (gene expression of IGF-I, MyoD, MAFbx, and TNF-α) analyses, respectively. Data were analyzed using one-way ANOVA at P < 0.05. There were no significant (P > 0.05) differences in collagen density and IGF-I gene expression in all experimental groups. There were similar (P < 0.05) decreases in MAFbx and TNF-α gene expression in the injured and GaAs-injured groups, compared to control group. The MyoD gene expression increased (P = 0.008) in the GaAs-injured group, but not in the injured group (P = 0.338), compared to control group. GaAs laser therapy had a positive effect on MyoD gene expression, but not IGF-I, MAFbx, and TNF-α, during intermediary phases (14 days post-injury) of muscle repair.

http://ift.tt/2Dd8fp2

Possible protective effect of the algae spirulina against nephrotoxicity induced by cyclosporine A and/or gamma radiation in rats

Abstract

The present study was conducted to evaluate the possible protective role of the algae spirulina (Sp) against nephrotoxicity and oxidative stress which are the main secondary effects induced by the immunosuppressant drug CSA and/or ionizing radiation. In this study, male rats were given Sp (1 g/kg) either for 15 days before irradiation (6.5 Gy) or 5 days before and 10 days concomitant with CSA (25 mg/kg). Markers used to assess renal injury included serum creatinine, urea, glucose, albumin, protein, and lipid profile as well as kidney content of reduced glutathione (GSH); lipid peroxidation (thiobarbituric acid reactive substances (TBARS)); nitrite and superoxide dismutase (SOD) activity. In addition, some trace elements (Zn and Mg) were estimated in kidney. Apoptosis was assessed by immunohistochemical estimation of caspase-3 expression in addition to histopathological examination. Results revealed that gamma radiation and/or CSA induced elevation in urea, creatinine, lipids, and glucose while decreasing albumin and protein levels. There was a noticeable increase in kidney content of GSH, TBARS, and nitrite. Meanwhile, profound decrease in kidney SOD activity was observed. Treatment with Sp significantly reversed the changes induced by CSA and/or gamma radiation in renal function tests. Spirulina also ameliorated kidney oxidative stress through decreasing GSH, TBARS, and nitrite kidney content while increasing SOD activity. Histopathological examination further confirmed Sp protective efficacy. Moreover, kidney caspase-3 expression that was triggered by CSA and/or gamma radiation was decreased. In conclusion, spirulina can be regarded as a promising renoprotective natural agent against renal injury induced by CSA and/or gamma radiation.

http://ift.tt/2FFcffp

Diurnal variations in personal care products in seawater and mussels at three Mediterranean coastal sites

Abstract

The presence of personal care products (PCPs) in the marine environment is of major concern. PCPs, UV filters, and musks can enter the marine environment indirectly through wastewater or directly via recreational activities. We conducted this study to document patterns in the occurrence of seven PCPs at three coastal sites impacted by recreational activities during 1 day. The study focused on diurnal variations in these seven PCPs in seawater and indigenous mussels. In seawater, UV filters showed diurnal variations that mirrored variations in recreational activities at the sites. Ethylhexyl methoxycinnamate (EHMC) and octocrylene (OC) water concentrations increased from under the limit of quantification in the morning to 106 and 369 ng/L, respectively, when recreational activities were the highest. In mussels, diurnal variations in OC were observed, with the lowest concentrations recorded in the morning and then increasing throughout the day. As Mytilus spp. are widely used as sentinels in coastal pollution monitoring programs (mussel watch), our findings on diurnal variations could enhance sampling recommendations for recreational sites impacted by PCPs.

http://ift.tt/2EJ8Haz

Frontmatter

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Volume: 31
Issue: 1
Pages: i-iv

http://ift.tt/2EHKa63

Growth and growth hormone: recent papers on efficacy and adverse effects of growth hormone and World Health Organisation growth standards

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Volume: 31
Issue: 1
Pages: 1-3

http://ift.tt/2FBzsiI

Allergic and non-allergic skin reactions associated with growth hormone therapy: elucidation of causative agents

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Volume: 31
Issue: 1
Pages: 5-11

http://ift.tt/2EHK9z1

Adherence to growth hormone therapy in children and its potential barriers

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Volume: 31
Issue: 1
Pages: 13-20

http://ift.tt/2FCNdxm

Short-term adverse effects of testosterone used for priming in prepubertal boys before growth hormone stimulation test

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Volume: 31
Issue: 1
Pages: 21-24

http://ift.tt/2EEQdbp

Growth response to growth hormone treatment in patients with SHOX deficiency can be predicted by the Cologne prediction model

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Volume: 31
Issue: 1
Pages: 25-31

http://ift.tt/2FCNaSc

WHO 2006 Child Growth Standards overestimate short stature and underestimate overweight in Japanese children

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Volume: 31
Issue: 1
Pages: 33-38

http://ift.tt/2EGhOci

Identifying depressive symptoms among diabetes type and the impact on hemoglobin A1c

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Volume: 31
Issue: 1
Pages: 39-44

http://ift.tt/2FAzTK3

Insulin resistance and lung function in obese asthmatic pre-pubertal children

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Volume: 31
Issue: 1
Pages: 45-51

http://ift.tt/2EGUFq8

Obesity is associated with vitamin D deficiency in Danish children and adolescents

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Volume: 31
Issue: 1
Pages: 53-61

http://ift.tt/2FCN8K4

Daily sitting time associated with the risk of metabolic syndrome in Korean adolescents

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Volume: 31
Issue: 1
Pages: 63-69

http://ift.tt/2EH0Vhu

Molecular basis and clinical presentation of classic galactosemia in a Croatian population

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Volume: 31
Issue: 1
Pages: 71-75

http://ift.tt/2FCN64U

Clinical outcome in a series of pediatric patients with congenital generalized lipodystrophies treated with dietary therapy

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Volume: 31
Issue: 1
Pages: 77-83

http://ift.tt/2EEQcUT

Spondyloepiphyseal or spondylometaphyseal dysplasia in ancient Greek art

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Volume: 31
Issue: 1
Pages: 85-86

http://ift.tt/2FDyeDk

Sirolimus therapy for congenital hyperinsulinism in an infant with a novel homozygous KCNJ11 mutation

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Volume: 31
Issue: 1
Pages: 87-89

http://ift.tt/2EEQf31

Veganism as a cause of iodine deficient hypothyroidism

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Volume: 31
Issue: 1
Pages: 91-94

http://ift.tt/2FCMX1m

A case of Riley Ruvalcaba syndrome with a novel PTEN mutation accompanied by diffuse testicular microlithiasis and precocious puberty

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Volume: 31
Issue: 1
Pages: 95-99

http://ift.tt/2EIJ1uG

Addison’s disease presenting with perimyocarditis

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Volume: 31
Issue: 1
Pages: 101-105

http://ift.tt/2FCMT1C

Superior Mesenteric Artery Syndrome: An Uncommon Cause of Abdominal Pain

Publication date: Available online 11 January 2018
Source:The Journal of Emergency Medicine
Author(s): Anita Lui, Marion-Vincent Mempin




http://ift.tt/2D8Wvnd

Are Geriatric Patients Placed in an Emergency Department Observation Unit on a Chest Pain Pathway More Likely Than Non-Geriatric Patients to Re-Present to the Hospital within 30 Days?

Publication date: Available online 11 January 2018
Source:The Journal of Emergency Medicine
Author(s): Christopher C. Gruenberg, Alan H. Breaud, James H. Liu, Patricia M. Mitchell, James A. Feldman, Kerrie P. Nelson, Joseph H. Kahn
BackgroundEmergency department observation units (EDOUs) are used frequently for low-risk chest pain evaluations.ObjectiveThe purpose of this study was to determine whether geriatric compared to non-geriatric patients evaluated in an EDOU for chest pain have differences in unscheduled 30-day re-presentation, length of stay (LOS), and use of stress testing.MethodsWe conducted an exploratory, retrospective, cohort study at a single academic, urban ED of all adult patients placed in an EDOU chest pain protocol from June 1, 2014 to May 31, 2015. Our primary outcome was any unscheduled return visits within 30 days of discharge from the EDOU. Secondary outcomes included EDOU LOS and stress testing. We used Wilcoxon non-parametric and χ² tests to compare geriatric to non-geriatric patients.ResultsThere were 959 unique EDOU placements of geriatric (n = 219) and non-geriatric (n = 740) patients. Geriatric compared to non-geriatric patients had: no significant difference in unscheduled 30-day return visits after discharge from the EDOU (15.5% vs. 18.5%; p = 0.31); significantly longer median EDOU LOS (22.1 vs. 20.6 h; p < 0.01) with a greater percentage staying longer than 24 h (42% vs. 29.1%; p < 0.01). Geriatric patients had significantly fewer stress tests (39.7% vs. 51.4%; p < 0.01), more of which were nuclear stress tests (78.2% vs. 39.5%; p < 0.01).ConclusionsIn this exploratory retrospective study, geriatric EDOU chest pain patients did not have an increased rate of re-presentation to the hospital within 30 days compared to non-geriatric patients. Geriatric patients had a longer EDOU LOS than non-geriatric patients. Geriatric patients in the EDOU had fewer stress tests, but more of those were nuclear stress tests.



http://ift.tt/2AYItil

Failure of Intracardiac Pacing After Fatal Propafenone Overdose: A Case Report

Publication date: Available online 11 January 2018
Source:The Journal of Emergency Medicine
Author(s): Ivan Zeljković, Nikola Bulj, Matea Kolačević, Vedran Čabrilo, Diana Delić Brkljačić, Šime Manola
BackgroundPropafenone is a sodium-channel blocker, class IC antiarrhythmic drug, frequently used to manage supraventricular dysrhythmias, especially atrial fibrillation. We report a self mono-intoxication with propafenone.Case ReportA 68-year-old woman presented with a decreased level of consciousness, hypotension, and electrocardiogram showing QRS widening with atrial asystole and extreme bradycardia < 20 beats/min. After initial stabilization with transcutaneous pacing, laboratory findings detected normal electrolyte ranges and metabolic acidosis, and her medical history revealed availability of propafenone due to paroxysmal atrial fibrillation and depressive syndrome, which led to the suspicion of intoxication. Despite intravenous sodium bicarbonate, calcium, norepinephrine, and aggressive fluid replacement (10% glucose with insulin), hemodynamic stability was not achieved. Temporary intracardiac pacing was implanted. However, even with multiple electrode positions, effective capture could not be achieved. At that time, transcutaneous pacing was also ineffective. Consequently, the patient died in refractory asystole due to complete myocardial nonexcitability. The concentration of 5270 ng/mL of propafenone was found in the blood at autopsy, using gas spectrometry–mass chromatography. It is the third highest reported propafenone lethal concentration and the first case in which the myocardial nonexcitability refractory to intracardiac pacing was seen despite normal electrode position in the right ventricle, with failure to achieve the patient's hemodynamic stability.Why Should an Emergency Physician Be Aware of This?Emergency physicians should be aware of possible propafenone ingestion causing toxicity, which is probably more frequent than previously described, especially because propafenone is widely available due to its use in managing atrial fibrillation, the most common arrhythmia nowadays.



http://ift.tt/2DboeE4

Posterior Reversible Encephalopathy Syndrome: A Rare Childhood Case with Unconsciousness

Publication date: Available online 12 January 2018
Source:The Journal of Emergency Medicine
Author(s): Akira Komori, Daisuke Mizu, Koichi Ariyoshi
BackgroundPosterior reversible encephalopathy syndrome (PRES) is a condition characterized by seizures, altered consciousness, visual disturbances, and headache. Characteristic findings on neuroimaging include cerebral edema, typically involving the parieto-occipital white matter. PRES has been associated with hypertension, autoimmune disease, and Henoch-Schölein purpura (HSP), but few cases have been reported, and fewer cases of PRES have been reported in children.Case ReportWe report the case of a 4-year-old girl who presented with blindness and semi-consciousness. The patient had no significant medical history and no abnormalities on physical examination or laboratory testing, although she had slightly elevated blood pressure. After hospitalization, the patient showed some characteristic signs of HSP and cranial magnetic resonance imaging revealed PRES as the cause of semi-consciousness. In our discussion, we examine the clinical features of PRES and remarkable points for the clinical diagnosis and management of this rare but important disease.Why Should an Emergency Physician Be Aware of This?Although reports of PRES in children are rare, PRES should be considered in the differential diagnosis of children presenting with disturbance of consciousness. Emergency physicians should consult with pediatric physicians to confirm diagnoses of PRES and determine an appropriate treatment plan, given its variable etiology. Measurements of blood pressure, which are often missing in pediatric cases, can help physicians to arrive at a correct diagnosis.



http://ift.tt/2AZeeHO

Professional quality of life, wellness education, and coping strategies among emergency physicians

Abstract

Professional quality of life (ProQOL) is affected by and affects professional well-being and performance. The objectives of this study are to identify risk factors of ProQOL among EM physicians in Zagazig University hospitals (ZUHs), to detect the relationship between ProQOL and coping strategies, and to measure the implication of the Worksite Wellness Education (WWE) program on improving knowledge skills, ProQOL, and coping. An intervention study was conducted among 108 EM physicians at ZUHs through two stages: assessing ProQOL subscales (CS, BO, and STS) and coping strategies and conducting the WWE program. A pre–post-test design was used in the evaluation. CS was higher among the older age group, smokers, nighttime sleepers, and hobbies' practitioners. Coping strategies carried out by EM physicians to overcome stress and their ProQOL scores were improved significantly post program. ProQOL has multiple factors that affect it. Applying the WWE program will address this concept and may raise awareness about how to cope with work stressors.

http://ift.tt/2Dfhnss