Sustained ambulatory hypertension, anticoagulant therapy and posterior bleeding may be associated with recurrent epistaxis, and should be recorded. Oral ice pack use may decrease severity and can be considered as first aid. Coagulation studies are appropriate for patients with a history of anticoagulant use or bleeding diatheses.

Purpose Endovascular stenting has been used to manage superior vena cava syndrome for several decades and has become standard firstline practice. This study aims to investigate the outcomes of endovascular stenting in the management of superior vena cava syndrome (SVCS). Methods MEDLINE, EMBASE and PUBMED online databases were searched, with studies involving more than ten adult patients included. Studies identified spanned 27 years, from 1993 to 2020. Meta-analyses were performed based on Clopper–Pearson estimation. Results Fifty-four studies were identified, for a total of 2249 patients, of which 2015 had malignant SVCS and 222 benign SVCS. Pooled technical success and clinical success rates were 96.8% (95% CI 96.0–97.5%) and 92.8% (95% CI 91.7–93.8%). Technical success and clinical success rates for studies investigating benign SVCS alone were identical at 88.8% (95% CI 83.0–93.1%). Pooled patency remained above 90% for the first year. Average complication and re-intervention rates were 5.78% (SD = 9.3182) and 9.11% (SD = 11.190). Conclusions This review confirms the effectiveness of endovascular stenting in managing SVCS. Further directions of research may include specific outcomes of endovascular stenting in benign SVCS, and the impact of procedural characteristics, such as the use of anticoagulation and type of stent used, on outcomes. Level of Evidence Level III, systematic review of retrospective cohort studies.

Objectives: We aimed to audit current United Kingdom (UK) practice of Head and Neck Cancer (HNC) post-treatment surveillance against national guidelines and determine the outcomes of these practices in detecting recurrence. Design: National cross-sectional study of current HNC surveillance practice. Setting: UK HNC outpatient departments. Participants: HNC patients reviewed for post-treatment surveillance. Main outcome measures: Compliance with UK multidisciplinary guidelines and rates of cancer recurrence detection by time, clinic type and symptoms. Results: Data were analysed from 5,123 consultations across 89 UK centres. 30% of consultations were in dedicated multidisciplinary clinics, with input from allied health professionals (AHPs) available on the day in 23% of all consultations. Recurrence was suspected in 344 consultations and investigated with MRI in 29.6% (n = 102) and PET-CT in 14.2% (n = 49). Patient education regarding recurrence symptoms, and smoking and alcohol advice, was provided in 20.4%, 6.2% and 5.3% of cases, respectively. Rates of recurrence detected were 35% in expedited appointments and 5.2% in planned follow-ups (P = .0001). Of the expedited appointments, 63% were initiated by patients and 37% by clinicians. Recurrence was higher in those with new symptoms (7.1% versus 2.2%). The strongest predictors of recurrence were dyspnoea (positive predictive value (PPV)=16.2%), neck pain (PPV = 10.4%) and mouth/throat pain (PPV = 9.2%). Conclusions: Dedicated multidisciplinary clinics comprise a minority of consultations for HNC surveillance in the UK, with low availability of AHPs. PET-CT and MRI were underutilised for the investigation of suspected recurrence. There may be scope for greater emphasis on patient education and consequent patient-initiated symptomdriven follow-up.

Objective Evidence for the management of acute otitis externa (AOE) is limited, with unclear diagnostic criteria and variably reported outcome measures that may not reflect key stakeholder priorities. We aimed to develop 1) a definition, 2) diagnostic criteria and 3) a core outcome set (COS) for AOE. Study design COS development according to Core Outcome Measures in Effectiveness Trials (COMET) methodology and parallel consensus selection of diagnostic criteria/definition. Setting Stakeholders from the United Kingdom. Subjects and methods Comprehensive literature review identified candidate items for the COS, definition and diagnostic criteria. Nine individuals with past AOE generated further patient-centred candidate items. Candidate items were rated for importance by patient and professional (ENT doctors, general practitioners, microbiologists, nurses, audiologists) stakeholders in a three-round online Delphi exercise. Consensus items were grouped to form the COS, diagnostic criteria, and definition. Results Candidate COS items from patients (n = 28) and literature (n = 25) were deduplicated and amalgamated to a final candidate list (n = 46). Patients emphasised quality-of-life and the impact on daily activities/work. Via the Delphi process, stakeholders agreed on 31 candidate items. The final COS covered six outcomes: pain; disease severity; impact on quality-of-life and daily activities; patient satisfaction; treatment-related outcome; and microbiology. 14 candidate diagnostic criteria were identified, 8 reaching inclusion consensus. The final definition for AOE was ‘diffuse inflammation of the ear canal skin of less than 6 weeks duration’. Conclusion The development and adoption of a consensus definition, diagnostic criteria and a COS will help to standardise future research in AOE, facilitating meta-analysis. Consulting former patients throughout development highlighted deficiencies in the outcomes adopted previously, in particular concerning the impact of AOE on daily life.

No abstract

Purpose: This research attempts to investigate the functionality of each of the five Internal control components, effectiveness of the control system and its relationship with financial performance. Methodology: Sample size for this research is 210 respondents comprising of employees from 6 Banks in Hyderabad: NBP and Sindh bank from the public sector, MCB and HBL from the private sector, Meezan bank and Bank Alfalah as Islamic banks. In this study, internal control is measured by the five components whereas financial performance is measured through three profitability ratios. Data is collected through primary as well as secondary sources. The primary source used is questionnaire taken from a combination of instruments developed by Baker, Castro, Labrena & Meyer (2005). Secondary source used are the financial statements of the sample banks for a period of four years. Return on Asset (ROA), Return on Equity (ROE), Profit expense ratio (PER) are the profitability ratios used to measure the financial performance. Data was analyzed using the Statistical Package for Social Scientists (SPSS). The statistical methods of correlation and one-way ANOVA were used for the testing of the research hypotheses. Findings: Results showed that Internal control effectiveness is strongest in private banks, followed by public banks and weakest in islamic banks, although the difference is not statistically large, but slight variation exists. Moreover, private banks had a high level of financial performance, public banks had moderate level of financial performance whereas islamic banks were found to have low financial performance. Hence it was concluded that Internal control effectiveness has a positive relationship with the Financial performance of the banks. Practical Implications: The detailed evaluation and understanding of the Internal control system effectiveness and its components provides valuable insights to managers and employees of how they can manage or improve their control systems in order to achieve greater operational as well as financial performance.

IntroductionMask ventilation is one of the key components in the management of airway during general anaesthesia, particularly when laryngoscopy is challenging. Adequate mask ventilation provides anaesthesiologists a safe time in case of unanticipated or anticipated difficult airway situations. The aim of this study was to determine the incidence of difficult bag-mask ventilation and intubation in patients having three or more predictors for difficult mask ventilation (DMV) in adult patients scheduled for elective surgery under anaesthesia. MethodsA total of 294 patients requiring endotracheal intubation for elective surgical procedure having three or more risk factors were evaluated for the presence of difficulty in bag-mask ventilation and intubation by the anaesthesiologist. Chi-square test or Fisher's exact test and a multivariable stepwise logistic regression model were performed to identify predictors of DMV. Crude and adjusted odds ratio with 95% confidence interval were reported. ResultsIn this study, the average age of the patients was 53.59±13.32 years with a 2:1 male-to-female ratio. DMV and difficult intubation (DI) were observed in 31.6% and 3% of patients, respectively. Multivariate analysis identified history of snoring, BMI (>35 kg/m 2 ), presence of beard and Mallampati III or IV as independent predictors for DMV. Patients with multiple factors (≥3 factors) had a threefold (OR=2.57) increased risk of difficulty in mask ventilation and a nearly fivefold (OR=4.63) increased risk of difficulty with intubation. ConclusionIn our study, the incidence of DMV was observed in 93 (31.6%) patients and DI was found in 9 (3%) patients. A simple DMV risk score may help to predict DMV better, potentially improving safety during difficult airway management, decreasing morbidity and mortality associated with it.

In today's continuous volatile dynamic environment, this study has examined empirically how environmental awareness and green marketing have an important role in forming the consumers' conscious and green attitude towards buying behavior of green products. A cross[1]sectional survey was designed, and convenience sampling was used. The relation between environmental awareness and green marketing has been tested for causality using statistical interference. The model is tested based on the online survey results of 26 individual customers from Lahore Pakistan by using SPSS. Five-point Likert scale was used to measure the constructs of environmental awareness, green marketing, and conscious-green consumers buying intention of green products. The findings of the research illustrate that environmental awareness and green marketing both influences customers buying behavior towards conscious and purchasing green products. The key findings of this research show a positive relationship between environmental awareness and green marketing. This study conveys important implications for organizations. Companies that influence their consumers to buy their products must market themselves as green. Green marketing campaigns by the companies can inspire millions of people, especially those living in developing countries like Pakistan to be environmentally conscious and vice versa. Environmentally conscious people can be triggered by green marketing communications to have purchase intention of green products. The shift of consumers being conscious and having an intention towards Purchasing Green products, especially after Covid 19 in developing countries makes this study an important one.