Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines.

To provide evidence-based guidelines for early enteral nutrition (EEN) during critical illness. We aimed to compare EEN vs. early parenteral nutrition (PN) and vs. delayed EN. We defined "early" EN as EN started within 48 h independent of type or amount. We listed, a priori, conditions in which EN is often delayed, and performed systematic reviews in 24 such subtopics. If sufficient evidence was available, we performed meta-analyses; if not, we qualitatively summarized the evidence and based our recommendations on expert opinion. We used the GRADE approach for guideline development. The final recommendations were compiled via Delphi rounds. We formulated 17 recommendations favouring initiation of EEN and seven recommendations favouring delaying EN. We performed five meta-analyses: in unselected critically ill patients, and specifically in traumatic brain injury, severe acute pancreatitis, gastrointestinal (GI) surgery and abdominal trauma. EEN reduced infectious complications in unselected critically ill patients, in patients with severe acute pancreatitis, and after GI surgery. We did not detect any evidence of superiority for early PN or delayed EN over EEN. All recommendations are weak because of the low quality of evidence, with several based only on expert opinion. We suggest using EEN in the majority of critically ill under certain precautions. In the absence of evidence, we suggest delaying EN in critically ill patients with uncontrolled shock, uncontrolled hypoxaemia and acidosis, uncontrolled upper GI bleeding, gastric aspirate >500 ml/6 h, bowel ischaemia, bowel obstruction, abdominal compartment syndrome, and high-output fistula without distal feeding access

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy.

Peer reviewe

Assessing the Role and Use of Blockchain Technology in the Hospitality and Leisure Industry

Blockchain is an innovative technology, where in the hospitality and leisure industry, travelers can obtain their tourism products and services through an intermediation between travelers and service providers that causes many different problems (e.g. inefficient payment system, extra cost, etc.). The operative effect of blockchain on the hospitality and leisure industry is based on removing the intermediary from the supply chain. Blockchain capabilities are determined according to a number of massive industries, including financial sectors. Such organisations generate various methods in order to simplify trading for smaller and medium sizes of industries. The networks of the tourism value are based on power dependencies’ relationships in such a way many expert staff members have acquired additional values that are taken from their partnerships. The structure of a market can be improved based on the value, which relates to different online travel agencies via converting power from suppliers to consumers. The assessment demonstrates that the blockchain technology represents an effective technology that removes mediators, which are originally sourced from the supply chain. This technology does not allow any mediators to gain entry along towards the tourism industry, and by eliminating the market’s power.</jats:p

Saudi Higher Education Student Acceptance of Mobile Learning

This research defines the mobile learning (m-learning) acceptance and outlines the critical factors affecting m-learning adoption among higher education students in Saudi universities. This research employed qualitative and quantitative approaches with 683 randomly sampled student participants from public and private universities. This research used questionnaire for collecting data, and the research framework was based on the Unified Theory of Acceptance and Use of Technology (UTAUT) model. The model was used to outline the factors affecting student intention to use m-learning. The output of statistical analysis showed high student acceptance of m-learning.</jats:p

Dental restoration selection by students at southern Saudi Arabian universities

Dental caries is a serious oral health concern and restoration of teeth is the main solution to this issue. Various restorative materials having different properties are used for posterior restoration. The aim of this study was to find that which factors can affect the choice of selection of material for posterior restoration among dental graduate students. For this purpose, a questionnaire was shared electronically among students of three different universities (King Khalid University, Jazan University, and Najran University). After collection, data were subjected to a chi-square test to check the significance. It has been observed that almost 50% of participants choose composite resin for posterior restoration. Results showed that according to most (more than 50%) of the dental students in Southern Saudi Arabia, different patient and tooth condition related factors can affect the choice for selection of restorative material.</jats:p