Background: Cesarean sections (CS), although commonly performed and generally considered safe, may be associated with prolonged hospitalization, increased postoperative pain, and a higher risk of complications. Accordingly, this study aimed to evaluate the effectiveness of a nurse-led Enhanced Recovery Program (ERP) on selected outcomes among women undergoing elective CS. Methods: A quasi-experimental study was conducted across inpatient and outpatient settings at Cairo University Obstetrics and Gynecology Hospital, including 90 women allocated into a study group ( n = 45) and a control group ( n = 45). Data was collected using structured interviews, numerical pain rating scale, postoperative recovery criteria, functional outcome assessment, and satisfaction questionnaire. Results: Both groups had comparable demographic characteristics. The ERP group demonstrated significantly better outcomes including reduced pain scores (2.71 vs. 4.26 at discharge, p < 0.001), faster ambulation (4.37 vs. 8.11 h), shorter hospital stays (9.22 vs. 11.88 h), and zero wound infections compared to 13.3% in controls. The intervention group showed higher satisfaction rates (33.3% vs. 8.9% completely satisfied) and greater functional outcomes in physical activities, self-care, and baby care 48 h post-discharge ( p < 0.0001). Conclusion: The nurse-led ERP effectively improved post-cesarean outcomes, including pain control, recovery time, functional independence, and maternal satisfaction with self and infant care. The findings support integrating nurse-led ERP into cesarean section protocols across maternity hospitals to enhance maternal and neonatal outcomes. Clinical trial number: Not applicable.

Background: Mental health nurses work in high-pressure environments where leadership styles strongly influence well-being and job performance. Toxic leadership, including abusive and authoritarian behaviors, can contribute to psychological distress, somatic symptoms, reduced job satisfaction, and lower organizational effectiveness. It may also decrease Organizational Citizenship Behavior (OCB), which reflects voluntary positive workplace behaviors. Intrinsic motivation may help buffer these negative effects by enhancing employees’ internal drive and resilience. Therefore, this study examines the associations between toxic leadership, psychological distress, somatic symptoms, and organizational citizenship behavior among mental health nurses while exploring the potential role of intrinsic motivation. Methods: This descriptive-correlational study, based on Structural Equation Modeling (SEM), was conducted at the Psychiatric Inpatient Department of Mansoura University Hospital. A total of 117 mental health nurses were recruited through simple random samplings. Data were collected using four standardized tools: the Toxic Leadership Scale, the Brief Symptom Inventory (BSI), the Intrinsic Motivation Inventory (IMI), and the Organizational Citizenship Behavior (OCB) Scale, starting from the end of May and completed by the end of June 2024. Data analysis was conducted using IBM SPSS 22 and AMOS 22, employing descriptive statistics, Pearson’s correlations, independent t-tests, and Structural Equation Modeling (SEM). Results: Toxic leadership was positively associated with psychological distress (β = 0.46, p < 0.001). Psychological distress was strongly associated with somatic symptoms (β = 0.99, p < 0.001). Intrinsic motivation was positively associated with organizational citizenship behavior (β = 0.31, p < 0.001). However, intrinsic motivation was not significantly associated with psychological distress or somatic symptoms, and no significant direct association was observed between toxic leadership and organizational citizenship behavior. Conclusions: Toxic leadership was significantly associated with higher levels of psychological distress among mental health nurses, while psychological distress was strongly associated with somatic symptoms. Intrinsic motivation was positively associated with organizational citizenship behavior. However, the hypothesized mediating role of intrinsic motivation was not supported by the structural model. These findings highlight the importance of addressing toxic leadership and promoting supportive workplace environments to enhance nurses’ well-being and organizational outcomes. Relevance for Clinical Practice: Addressing toxic leadership is essential for enhancing nurses’ well-being and organizational outcomes. Interventions targeting leadership behaviors and promoting supportive workplace environments may help reduce psychological distress and its associated somatic symptoms among mental health nurses. In addition, creating workplace conditions that support intrinsic motivation may encourage organizational citizenship behavior and professional engagement, ultimately benefiting clinical practice and patient care quality.

Background: Sublingual immunotherapy (SLIT) is an effective treatment for house dust mite (HDM)-induced allergic rhinitis (AR); however, the significance of qualitative changes in specific IgE (sIgE) remains unclear. This study evaluated post-treatment changes in sIgE reactivity and compared the performance of three immunoassays. Methods: In this prospective study, monosensitized patients with HDM-induced AR were identified using skin prick testing and followed for 12 months after SLIT. Serum sIgE levels were assessed at baseline and after treatment using immunoblot, chemiluminescent immunoassay (CLIA), and ImmunoCAP as the reference method. Qualitative changes in sIgE reactivity were analyzed. Clinical response was assessed using the total nasal symptom score (TNSS), and total IgE (tIgE) levels were measured. Results: At baseline, HDM-sIgE reactivity was detected in 85.7%, 82.1%, and 92.9% of patients by immunoblot, CLIA, and ImmunoCAP, respectively. Following SLIT, a significant qualitative conversion to non-reactive status was observed across all assays (p < 0.001). Conversion rates were 94.0% for immunoblot, 83.3% for CLIA, and 100.0% for ImmunoCAP. Significant improvements in TNSS and reductions in tIgE were also observed. Conclusions: SLIT induces a marked qualitative reduction in HDM-sIgE reactivity, with complete serological conversion detected by ImmunoCAP. Although the immunoassays showed comparable rates of HDM-sIgE detection, their agreement in classifying individual patients differed, indicating variability in assay performance. Qualitative assessment of sIgE may provide a clinically meaningful approach for monitoring immunotherapy response.

Background: Asthma during pregnancy is associated with adverse maternal and neonatal outcomes. Nursing education, self-management support, and mobile health (mHealth) technologies may support asthma management during pregnancy. Aim: This study evaluated the effect of a structured nursing intervention supported by an mHealth application on asthma control, treatment adherence, and self-monitoring, and maternal and neonatal outcomes among pregnant women with asthma. Design and Setting: A quasi-experimental pretest–posttest design with a control group was conducted at two Maternal and Child Health Centers in Shebin El-Kom, Menoufia Governorate, Egypt. Participants: A convenience sample of 140 pregnant women with physician-diagnosed asthma was recruited and allocated non-randomly according to the center attended to a study group (n = 70) and a control group (n = 70). The sample size was calculated a priori based on a previous study using a 5% significance level and 80% statistical power, with a 1:1 allocation ratio, resulting in a required sample of 70 participants per group. All recruited participants completed the study, with no withdrawals or loss to follow-up. Intervention: The study group received routine antenatal care plus an eight-week structured nursing intervention consisting of four individualized weekly educational sessions (60–90 min each) addressing asthma management, medication adherence, self-monitoring, trigger avoidance, warning signs, inhaler technique, lifestyle modification, and rhythmic breathing exercises. Participants were trained to use the Airlyn mHealth application for guided breathing exercises, practiced 2–3 times daily, and received telephone/WhatsApp follow-up during weeks 6–8. The control group received routine antenatal care according to usual MCH center procedures. Measures: Asthma control was assessed using the Asthma Control Test (ACT). Treatment adherence and self-monitoring were assessed using the Asthma Adherence and Self-Monitoring Questionnaire. Maternal outcomes included hypertensive disorders, gestational diabetes, infections, preterm labor/PPROM, hemorrhage, and mode of delivery. Neonatal outcomes included birth weight, Apgar scores, respiratory distress and respiratory support, NICU admission and length of stay, and condition at discharge. The researcher-developed instruments underwent expert assessment of content validity and assessment of internal consistency before use. Results: Baseline ACT scores were comparable between the study and control groups (14.5 ± 4.2 vs. 14.1 ± 4.3; mean difference = 0.4; p = 0.580). Following the intervention, ACT scores were higher in the study group than in the control group (19.7 ± 3.6 vs. 15.2 ± 4.2; mean difference = 4.5; 95% CI: 3.189–5.811; p < 0.001; Cohen’s d = 1.147). Well-controlled asthma was observed in 75.7% of the study group compared with 17.1% of the control group (p < 0.001). Treatment adherence and self-monitoring scores were also better in the study group (5.6 ± 2.7 vs. 9.1 ± 3.1; mean difference = −3.5; 95% CI: −4.476 to −2.524; p < 0.001; Cohen’s d = 1.199). The overall maternal outcome score was more favorable in the study group (3.5 ± 1.7 vs. 6.1 ± 2.6; mean difference = −2.6; 95% CI: −3.340 to −1.860; p < 0.001; Cohen’s d = 1.174), as was the overall neonatal outcome score (7.7 ± 2.2 vs. 5.5 ± 2.1; mean difference = 2.2; 95% CI: 1.480–2.920; p < 0.001; Cohen’s d = 1.022). Significant between-group differences were also observed in birth weight, Apgar scores, respiratory distress, and NICU admission. Conclusions: Participants who received the structured nursing intervention supported by the Airlyn mHealth application were associated with improved asthma control, treatment adherence, and self-monitoring, as well as more favorable maternal and neonatal outcomes, compared with those receiving routine antenatal care. However, the quasi-experimental design, convenience sampling, and non-randomized allocation limit causal interpretation and the generalizability of the findings. Therefore, the findings should be interpreted cautiously. Recommendations: Larger randomized controlled trials with standardized protocols, adequate sample sizes to evaluate maternal and neonatal outcomes, and longer follow-up periods are recommended to confirm these findings and further assess their clinical relevance.

Background: Burnout is a major challenge to the ongoing viability of the nursing workforce. However, only a limited number of studies have integrated work shift characteristics, satisfaction with work–life balance, and chronic illness into the same model. Aim: To examine whether shift work patterns, satisfaction with work–life balance, and chronic illness are independently associated with burnout among nurses. Methods: Between March and May of 2025, an analytical cross-sectional study was conducted on 100 nurses in two Egyptian military hospitals. Burnout was measured with the 20-item Burnout Syndrome Assessment Scale (BOSAS; Cronbach’s α = 0.832 in the present sample). Unadjusted associations were examined using univariable linear regression with HC3 robust standard errors, and hierarchical multiple linear regression was used to identify factors independently associated with the total burnout score. Results: The reported prevalence of burnout was 30.0% mild, 57.0% moderate, and 13.0% severe. The mean total burnout score was 46.72 ± 11.55. The final model of the regression explained 43.9% of the variance in burnout. Work–life balance satisfaction showed the strongest association with burnout among the variables in the model (standardized β = −0.479, p < 0.001), with each one-category increase in satisfaction corresponding, on average, to a 4.49-point lower burnout score. Chronic illness showed a borderline association with higher burnout (B = 4.40, p = 0.0499). In addition, nurses aged 36–45 years had lower scores than those aged 18–25 years. Shift duration, gender, and physical activity were not independently associated with burnout, although the near-uniform shift patterns in this sample limited the ability to detect an effect of shift length. Conclusions: In this sample, greater work–life balance satisfaction was associated with lower burnout, while the near-uniformity of shift exposure limited what could be concluded about shift duration. The cross-sectional design precludes causal inference and the direction of these relationships cannot be established. Preventive measures that protect work–life balance, such as predictable rosters, sufficient recovery time, and staffing that eases competing work and family demands, warrant evaluation, as does early support for nurses living with chronic disease.

Background: Pushing technique may influence maternal effort, labor progression, and birth outcomes, yet evidence comparing physiological and directed pushing remains inconsistent, particularly for early maternal recovery. This study compared the two approaches in relation to postpartum fatigue and perceived energy, second-stage duration, and selected maternal and neonatal outcomes. Methods: This non-randomized quasi-experimental comparative study included 120 women assigned during two sequential labor-unit implementation periods to physiological pushing (n = 60) or directed pushing (n = 60). No individual random allocation sequence was used. The physiological-pushing intervention was provider-guided open-glottis, short-duration pushing with urge-led initiation, whereas directed pushing used coached closed-glottis Valsalva efforts. The primary outcome was fatigue at 24 h postpartum. Covariate-adjusted regression was used for 24 h fatigue and perceived energy, mixed-effects models for repeated scores, proportional-odds regression for categorized second-stage duration, and exact methods for binary outcomes. Propensity-score overlap weighting evaluated the robustness of the primary result. Results: At 24 h postpartum, no between-group difference in fatigue was detected after adjustment for baseline fatigue, age, body mass index, education, gravidity, gestational age, first-stage duration, and oxytocin use (physiological-minus-directed difference, 0.20 points; 95% CI, −2.05 to 2.45; p = 0.860). Adjusted perceived energy was also similar (difference, −0.79 points; 95% CI, −2.18 to 0.59; p = 0.260). Across both groups, fatigue decreased and perceived energy increased over time (both time effects p < 0.001), with no group × time interaction. The overlap-weighted analysis supported the primary finding (difference, 0.25 points; 95% CI, −1.79 to 2.29; p = 0.809). Physiological pushing was associated with lower odds of occupying a longer second-stage-duration category in the adjusted proportional-odds model (adjusted OR, 0.20; 95% CI, 0.09 to 0.45; p < 0.001; Holm-adjusted p = 0.0007). None of the six binary maternal or neonatal outcomes differed after Holm correction. Conclusions: Compared with directed pushing, physiological pushing was not associated with lower fatigue or higher perceived energy at 24 h postpartum. Directed pushing likewise showed no consistent advantage over physiological pushing across the evaluated maternal and neonatal outcomes. The observed association between physiological pushing and lower odds of a longer second-stage duration represents an exploratory secondary finding and should be interpreted cautiously in view of the non-randomized design and the possibility of residual confounding.