To explore how nurses in interprofessional hospital teams experience and negotiate professional autonomy within hierarchical decision-making environments. Nurse autonomy is essential for safe, patient-centred care, yet it is often constrained by institutional protocols, electronic order-entry systems, and interprofessional hierarchies. While international literature highlights systemic barriers, little is known about the subtle strategies nurses use to reclaim influence within team-based hospital contexts, particularly in Middle Eastern healthcare settings. A qualitative hermeneutic phenomenological design was employed, following COREQ guidelines. Seventeen registered nurses working in polyclinics affiliated with King Faisal University, Al-Ahsa, Saudi Arabia, participated in semi-structured interviews conducted. Data were analysed using reflexive thematic analysis, supported by NVivo 14. Ethical approval was obtained from the King Faisal University Institutional Review Board. Four interrelated themes emerged: (1) The invisible architecture of (de)autonomy, (2) Teamroom hierarchies and the choreography of voice, (3) Quiet resistance and boundary work, and (4) Conditions that enable nurse autonomy. Nurses described struggling with structural and cultural barriers but also revealed micro-autonomies, alliances, and advocacy practices that protected both patient safety and professional identity. Autonomy is not merely an individual trait but an organisational property shaped by policies, governance, and team dynamics. Leadership strategies that embed nurses’ voices into decision-making structures are critical for improving patient outcomes and professional well-being. Not applicable (qualitative study).

Background and Aims: Antibiotic resistance in Saudi Arabia has led to decreased efficacy of conventional triple therapy for Helicobacter pylori (H. pylori) eradication, prompting the development of alternative treatments like levofloxacin‐based triple and bismuth‐based quadruple therapies. However, comparative data regarding its efficacy are lacking. Therefore, this study's goal was to compare the efficacy of levofloxacin‐based triple therapy with that of standard bismuth‐based quadruple therapy as first‐line regimens.Methods: This retrospective analysis included 197 treatment‐naïve adults with H. pylori infection who received levofloxacin‐based triple (levofloxacin + amoxicillin + PPI) therapy (n = 81) or standard bismuth‐based quadruple (bismuth + tetracycline + metronidazole + PPI) therapy (n = 116). H. pylori eradication was evaluated 4–8 weeks after medication administration using the ¹³C‐urea breath test, and variables that could affect the rate of success were examined.Results: There were no differences between groups in terms of age, sex, nationality, or type of proton pump inhibitor (PPI) used. The bismuth‐based quadruple therapy group exhibited a markedly superior success rate compared to the levofloxacin‐based triple therapy group when the latter was administered for 7 or 10 days (81.03% vs. 6.66%, p < 0.001, and 81.03% vs. 36.1%, p < 0.001, respectively). However, when the levofloxacin‐based triple therapy was extended to 14 days, its H. pylori eradication rate became comparable to that of the 10‐day bismuth‐based quadruple therapy (81.03% vs. 80%, p = 0.898). Eradication rates for both regimens were similar for patients aged ≥ 60, non‐Saudi, when using omeprazole and those treated with levofloxacin‐based triple therapy for 14 days.Conclusion: Quadruple treatment based on bismuth is superior to triple therapy based on levofloxacin for eradicating H. pylori in Saudi Arabia and should be used as a first‐line treatment. However, the 14‐day levofloxacin‐based triple treatment had an H. pylori eradication rate comparable to that of the 10‐day bismuth‐based quadruple therapy.

Background: Inflammatory bowel disease (IBD) represents a growing health challenge in regions undergoing socioeconomic transition. This study characterized IBD epidemiology across Gulf Cooperation Council (GCC) countries, forecasted future burden, and identified country-specific determinants to inform targeted health policy interventions. Methods: IBD data from the Global Burden of Disease study (1990–2021) were analyzed for all six GCC countries using descriptive epidemiology, temporal trend analysis, three forecasting models (Age-Period-Cohort, Joinpoint regression, Bayesian age-standardized rate modeling), and regression analyses to identify socioeconomic, environmental, gender-specific, and healthcare system factors associated with IBD burden variation. Results: Age-standardized IBD prevalence rates varied across GCC countries (28.92–42.93 per 100,000), with Qatar and the United Arab Emirates (UAE) showing the highest rates and fastest increases (967% and 898% since 1990). Kuwait uniquely demonstrated stable or slightly declining trends. Significant female predominance emerged in most countries (male ratio 0.70–0.91) with strong birth cohort effects (1970s cohorts showing 18–48% higher risk than 1950s cohorts). IBD manifested primarily as disability rather than a mortality burden. Projections indicate continued increases through 2030, potentially reaching 55–59 per 100,000 in Qatar and the UAE. Fast food outlet density, processed food imports, antibiotic consumption, and female vitamin D deficiency were the most significant modifiable risk factors. Conclusions: The GCC region faces a growing IBD epidemiological profile characterized by rising burden, female predominance, and generational differences in risk observations. Identification of modifiable determinants provides actionable targets for intervention, while country-specific projections offer a foundation for healthcare planning to address this challenge.

Eosinophilic esophagitis (EoE) is a chronic immune-mediated disease characterized by esophageal dysfunction and eosinophilic inflammation. Traditional diagnostic methods rely on endoscopy with biopsy, which is invasive and resource-intensive. The recent advancements have focused on developing noninvasive and minimally invasive diagnostic tools to improve patient experience and facilitate disease monitoring. This systematic review aims to evaluate emerging noninvasive diagnostic techniques for EoE, including biomarkers, esophageal string tests (EST), and advanced imaging modalities, and their potential to complement or replace conventional diagnostic methods. A systematic search was conducted in major databases, including PubMed, Embase, and Cochrane Library, to identify studies investigating noninvasive diagnostic approaches for EoE. Inclusion criteria focused on original research and clinical trials evaluating diagnostic accuracy, patient acceptability, and clinical utility. Data on diagnostic methods, outcomes, and limitations were extracted and analyzed. Emerging diagnostic methods, such as blood and urine biomarkers (e.g., EDN, ECP, eotaxin-3), EST, and advanced imaging (e.g., optical coherence tomography, EndoFLIP), demonstrated comparable sensitivity and specificity to endoscopic biopsy in detecting EoE. These tools offer advantages in reducing procedural burden, enabling dynamic disease monitoring, and enhancing patient adherence. However, challenges include variability in diagnostic thresholds and limited large-scale validation. Noninvasive diagnostic tools for EoE hold promise in transforming clinical practice by reducing reliance on invasive endoscopy. Further research is needed to standardize protocols and validate these methods for routine use.

Background/Objectives: Azathioprine (AZA) is widely used for maintaining remission in inflammatory bowel disease (IBD), but the implications of its withdrawal remain unclear. This study evaluates relapse rates after AZA discontinuation in adult IBD patients in remission and identifies predictors of relapse. Methods: A systematic review and meta-analysis were conducted according to PRISMA 2020 guidelines and registered in PROSPERO (CRD420251016594). Databases were searched from inception to 4 January 2025, including RCTs and cohort studies involving adult IBD patients who discontinued AZA in clinical remission. The main outcome assessed was relapse incidence, with additional outcomes covering time until relapse, predictors of relapse, and management following relapse. Random-effects meta-analysis, subgroup analyses, and meta-regression were performed. Results: Twenty-two studies comprising 3057 patients were included. The pooled relapse rate after AZA withdrawal was 32.5% (95% CI: 28.2–37.2%; I² = 94.2%). UC patients exhibited higher relapse rates (41.3%) than CD patients (24.7%, p = 0.003). Shorter AZA duration, elevated CRP, and absence of mucosal healing were associated with increased relapse risk. Meta-regression identified AZA duration as a significant predictor (β = −0.18, p = 0.009). Post-relapse management often involved AZA reintroduction or escalation to biologics, with low surgery rates. The GRADE assessment revealed that the certainty of evidence for the majority of primary outcomes was classified as low to very low. Conclusions: While this meta-analysis suggests that relapse after AZA withdrawal occurs frequently in IBD patients, the low to very low certainty of evidence limits definitive recommendations. The significant heterogeneity indicates that relapse risk varies across different patient populations and different settings.

Nursing workforces worldwide are ageing, yet little is known about how senior nurses experience ageing at work and adapt their professional roles within ra