This study evaluated resilience levels and their key predictors among nurses working in hospital and primary healthcare settings in Eastern Saudi Arabia. A cross-sectional survey was conducted with 479 nurses using the validated Connor-Davidson Resilience Scale (CD-RISC-25). Multiple regression analysis was performed to identify predictors of resilience based on demographic and occupational variables, including years of experience, education, job position, and work setting. Hospital nurses demonstrated significantly higher resilience levels compared to primary care nurses. Resilience was positively associated with longer work experience and higher educational attainment. Nurses in supervisory or quality-related roles exhibited higher resilience than staff nurses. The findings underscore the importance of institutional and educational support in fostering resilience among nurses. Tailored interventions, especially within primary healthcare settings, are essential to strengthen coping capacities and promote psychological well-being in the nursing workforce. Not applicable.
Background: Palliative care in the community is increasingly recognized as essential for improving quality of life in patients with advanced illnesses. Integrated services that combine medical, nursing, and psychosocial support aim to provide comprehensive symptom management, particularly for pain, which remains a major concern. Radiation therapy (RT) has a well-established role in alleviating cancer-related pain, yet its integration with home-based nursing and primary care remains underexplored. Objective: This systematic review aimed to evaluate the effectiveness, feasibility, and outcomes of community-based palliative care models that integrate RT for pain relief, home nursing, and family physician support. Methods: A systematic search was conducted across PubMed, Scopus, Web of Science, and Cochrane Library databases for studies published up to 2025. Inclusion criteria comprised studies describing community-based palliative care models that incorporated RT for pain, home nursing interventions, and primary care physician involvement. Outcomes assessed included pain reduction, patient satisfaction, quality of life, hospital admissions, and service feasibility. Data extraction and quality appraisal were performed independently by two reviewers, with discrepancies resolved by consensus. Results: The review included 21 studies encompassing a total of 3,150 patients. Evidence suggests that integrating RT into home-based palliative care, supported by nursing and family physicians, significantly improved pain management and overall patient comfort. Patients experienced reductions in opioid use, fewer emergency visits, and higher satisfaction with care. Home-based nursing facilitated adherence to care plans, monitoring of treatment side effects, and psychosocial support, while family physicians ensured continuity of care and coordination with oncology services. Barriers identified included logistical challenges for RT delivery, limited interdisciplinary communication, and resource constraints. Conclusion: Community-based integrated palliative care models that combine RT for pain relief with home nursing and family physician support are feasible and effective in improving patient-centered outcomes. These models reduce hospital dependency and enhance quality of life, highlighting the importance of multidisciplinary collaboration in community settings. Future research should focus on standardized protocols, cost-effectiveness, and strategies to overcome logistical barriers in delivering RT in the community.
Hepatocellular carcinoma (HCC), the most prevalent liver cancer type, has a heterogeneous molecular and physiological basis with several contributing factors. Cirrhosis is the number one underlying factor for HCC, accounting for approximately 80% of cases. The recent advances in diagnostics and screening have led to a substantial increase in the number of patients diagnosed at an early stage with small HCC. The gold-standard curative treatments for early-stage HCC are thermal ablation or resection. HCC treatment is particularly challenging in cirrhotic patients due to liver dysfunction and their being prone to portal hypertension. Thus, choosing between thermal ablation and resection remains an unresolved debate that requires balancing radical removal of the tumor with preserving adequate functioning liver tissue. This review aims to explore the distinct etiology of HCC in cirrhotic patients and how it contributes to the development of malignancy. It also seeks to explore how cirrhosis affects the response to available treatment approaches by comparing the gold-standard methods used, ablation vs resection, taking into account recent evidence on liver cell preservation, portal hypertension consequences, and microvascular invasion, along with novel radiomics tools. To provide evidence-based recommendations for enhancing small HCC management in cirrhotic patients.
Directional drilling in the subject field is a challenge, especially in horizontal producer wells targeting shallow reservoirs. More than 25% of the NPT while drilling the curve section in the subject field is related to trajectory. The high DLS requirements limit the BHA design, and drilling those curved sections with a directional motor requires long sliding intervals. This reduces the overall ROP due to poor weight transfer and increases the stress on the surface equipment because of the high surface WOB required. To overcome these challenges, an advanced combo directional motor with a 1.5 adjustable-bend-housing (ABH) was paired with a short gauge 12.25-in PDC bit. This combination improved directional control and penetration rates. An Agitator Drilling System (ADS) was integrated into the bottom hole assembly (BHA), positioned 850 feet from the motor to minimize friction and boost weight transfer efficiency. The distribution and size of heavy weight drill pipes (HWDP) were optimized to enhance stability and weight transfer. A comprehensive hazard and risk matrix was developed to preemptively address potential issues, and stakeholder meetings were held to ensure alignment on objectives and strategies. Additionally, continuous follow-ups were conducted to monitor progress and implement real-time adjustments as needed. The deployment of the advanced directional motor and drilling agitator resulted in substantial improvements in drilling performance. In the initial run with the new BHA configuration, there was a remarkable 15.7% increase in the ROP in the 12.25-in section compared to previous operations. This improvement was a direct result of enhanced directional control and reduced friction, which facilitated smoother and faster drilling. Weight-on bit (WOB) transfer also saw a notable improvement. The optimization of the HWDP distribution and the integration of the agitator led to a 15% improvement in WOB transfer efficiency from depths of 3000 ft to 6200 ft. Additionally, the maximum WOB was reduced from 60 klbs to 48 klbs, which contributed to a decrease in equipment stress and increased operational safety. The strategic placement of the drilling agitator successfully minimized shock levels on measurement while drilling (MWD) equipment, reducing potential data inaccuracies and equipment failures. The combination of these factors resulted in a more efficient drilling process, with fewer interruptions and enhanced stability. The successful implementation of this innovative approach established a new benchmark for drilling performance in similar challenging conditions, demonstrating significant potential for future applications and advancements in the industry.
The objective of this paper is to highlight the approach of evaluating all pipes integrity and cement quality behind the first pipe using Multi-finger Caliper, Electromagnetic Pipe Detector and Ultrasonic-Sonic prior squeeze and restore operations to run the new completion. Different tools are used nowadays to evaluate and inspect pipe and cement conditions such as Mechanical, Electromagnetic, and Ultrasonic. However, each tool has its own advantages and limitations when it comes to challenging environments and well condition. By combining these technologies with their capabilities and correlation it will be possible to achieve our objectives and have full inspection and answers to well integrity issues. In this case, three different technologies were used (Mechanical, Electromagnetic, and Ultrasonic) to perfectly encounter the well integrity issues of this well and answer operator queries leading to successful restore and pipe recovery. Combining Multi-finger Caliper with Electromagnetic as one run in this well allowed to have high resolution inspection of first pipe from multi-finger caliper outputs and metal loss computation for all pipes from thickness measurements of electromagnetic. Using Ultrasonic with sonic cement evaluation tools, we were able to evaluate the pipe status more in addition to the cement bond quality and distribution behind casing. By combining all the results, the operator was able to determine the cut depth, the leak point and successfully managed to restore the cement and run a new completion for this well. Main challenges that pushed to use this approach were the high deviation (horizontal well), heavy mud with high solid contents (27%) and we evaluated both 7in liner and 9.625in casing with thickness of ~0.6in. There was a perfect match between the internal radius of Multi-finger Caliper and Ultrasonic and perfect evaluation of cement behind casing in terms of bond and distribution. To evaluate both corrosion and cement in such challenging conditions and environments, the approach of combining different technologies is efficient to be confident in the decision making of workover and drilling operations.
