Lina Kurdahi Badr

Predictors of neurodevelopmental outcome for preterm infants with brain injury: MRI, medical and environmental factors

This multi-center correlational prospective study examined early neonatal predictors of neurodevelopment in 59 premature infants (mean birth weight=1713.8+/-1242.5 g; mean gestational age=31.2+/-3.6 weeks) suspected to have sustained brain injury at birth. The mental and motor development of the infants selected from five university-affiliated hospitals was assessed at baseline (59 infants), 12 (55 infants), and 18 months (46 infants) using Bayley II scales. Factors correlating with Bayley II scores at 12 and 18 months included head circumference, results of neurological and magnetic resonance imaging (MRI) examination at baseline, environmental factors such as mother-infant interactions and levels of parental stress, and infant medical factors such as Apgar scores at 5 min and length of hospital stay. Multiple regression analyses distinguished the most significant predictors of mental and motor development. The best predictors of mental and motor development at 18 months were head circumference, neurological examinations, and MRI results. These findings suggest that in infants suspected of brain injury at birth, neurological assessments and head circumference measurements are just as predictive of developmental outcome at 18 months as MRI, and this is especially relevant in developing countries or other locations where MRI is not possible. The presence of this information may offer the potential of early tailored interventions to improve the mental and motor development of children in developing countries or other facilities where MRI is unavailable.

The Adaptation of Mothers of Children With Intellectual Disability in Lebanon

In many Middle Eastern countries, including Lebanon, there is a stigma attached to families who have an intellectually impaired child. These families complain of isolation and lack of community resources that could help them cope with their circumstances to optimize the child’s abilities. Health professionals and researchers should be cognizant of factors related to the process of stress adaptation to help families cope with their circumstances. The aim of this cross-sectional study was to identify factors that play a role in mothers’ adaptation to the care of their intellectually impaired children. The results, based on a sample of 127 mothers from Lebanon, reveal that a high percentage of mothers had depressive symptoms. Multiple regression analysis demonstrates that by order of importance, the factors that determine maternal depression are family strain, parental stress, and family income. The conclusions about nursing implications from a cultural perspective are discussed and recommendations proposed.

Predictors of Coping in Parents of Children With an Intellectual Disability: Comparison Between Lebanese Mothers and Fathers

This cross-sectional study was designed to assess the predictors of coping behaviors of 147 Lebanese parents (101 mothers and 46 fathers) with a child with intellectual disability. It assessed the contribution of childs and parents characteristics, informal social support, and stress on the coping behaviors of fathers and mothers. Multiple regression analysis confirmed that the fathers education, informal social support, and stress were the best predictors of coping. The childs age, severity of illness, and parental health did not significantly contribute to predicting coping behaviors. Contrary to expectations in a Middle Eastern culture, both fathers and mothers reported similar levels of stress, perceived informal social support, and coping. Although informal social support cannot be forced on parents, health professionals can mobilize resources that are culturally sensitive, such as home visitation by nurses or support from other parents. This may especially be beneficial in developing countries with limited resources.

Further Psychometric Testing and Use of the Maternal Confidence Questionnaire

Research results can be better interpreted and used when reliable and valid instruments are used to measure concepts. Researchers and clinicians, especially those from locations outside the United States, have difficulty locating existing instruments for use in their research studies. The dilemma is further exaggerated when such instruments are not published and when the author of the instrument cannot be located. This review looked at the results of 20 studies which have utilized the Maternal Confidence Questionnaire (MCQ) () with the purpose of familiarizing researchers and clinicians with its flexibility, reliability, and validity. Examples of specific published studies which have used the instrument are discussed along with unpublished studies which have used the instrument.

The effectiveness of a pressure ulcer intervention program on the prevalence of hospital acquired pressure ulcers: controlled before and after study.

BACKGROUND Pressure Ulcers (PUs) are associated with high mortality, morbidity, and health care costs. In addition to being costly, PrUs cause pain, suffering, infection, a lower quality of life, extended hospital stay and even death. Although several nursing interventions have been advocated in the literature, there is a paucity of research on what constitutes the most effective nursing intervention. OBJECTIVES To determine the efficacy of multidisciplinary intervention and to assess which component of the intervention was most predictive of decreasing the prevalence of Hospital acquired pressure ulcers (HAPU) in a tertiary setting in Lebanon. DESIGN An evaluation prospective research design was utilized with data before and after the intervention. The sample consisted of 468 patients admitted to the hospital from January 2012 to April 2013. RESULTS The prevalence of HAPU was significantly reduced from 6.63% in 2012 to 2.47. Sensitivity of the Braden scale in predicting a HAPU was 92.30% and specificity was 60.04%. A logistic multiple regression equation found that two factors significantly predicted the development of a HAPU; skin care and Braden scores. CONCLUSION The multidisciplinary approach was effective in decreasing the prevalence of HAPUs. Skin care management which was a significant predictor of PUs should alert nurses to the cost effectiveness of this intervention. Lower Braden scores also were predictive of HAPUs.

Assessing procedural pain in children with cancer in Beirut, Lebanon

This study describes the relationship between different indicators of pain, including self-reports, behavioral observations, and physiological measures, in children with cancer undergoing invasive procedures. Forty-five children between the ages of 4 and 10 years were evaluated while undergoing Port-a-Cath access. The study was conducted in the outpatient clinics of the Children’s Cancer Center in Beirut, Lebanon. Children used 2 self-report measures of pain (the Wong-Baker FACES Pain Rating Scale and an adaptation of the FACES, the DOLLS). Parents and nurses assessed the child’s pain on the FACES and the child’s distress on the Observational Scale of Behavioral Distress-Revised. Nurses recoded behavioral observations as well as physiological responses to pain. There was a high degree of consistency between the self-reports and moderate to high correlations between self-reports, behavioral parameters, and physiological parameters, suggesting that accurate pain assessments can be made by both nurses and parents. The results also demonstrate adequate validity and reliability of the DOLLS scale in a Lebanese population, in addition to being the preferred assessment tool for all the children in the study.

Effect of early nutritional support on intensive care unit length of stay and neurological status at discharge in children with severe traumatic brain injury.

ABSTRACT Pediatric severe traumatic brain injury treatment guidelines for nutrition indicate that “there are insufficient data to support a treatment guideline for this topic” (P. D. Adelson et al., 2003). Based on adult studies, the guideline provided an option for practitioners to start nutritional support within 72 hours of admission and full replacement by day 7. This retrospective, descriptive correlation study examined the timing of nutritional supplement initiation and the timing of achieving full caloric intake in relation to length of stay (LOS) in the intensive care unit (ICU) and patient disposition status at discharge from hospital in children 8–18 years old. Median time to initiation of nutrition was 1.5 days (0.02–11.9 days), and full caloric goals were achieved in 3.4 days (0.5–19.6 days). Median ICU LOS was 2.1 days (0.01–97.9 days). Overall, 48% of patients were discharged home; 28% experienced mild, moderate, or severe disability; and 24% either died or survived in a vegetative state. Early initiation and achieving full caloric intake were both positively correlated with shorter LOS in the ICU (p < .01, Spearman’s rho correlational matrix) and better disposition status at discharge from the hospital (p < .05, Kruskal–Wallis test).

The chasm in neonatal outcomes in relation to time of birth in Lebanon.

Purpose: The purpose of this study was to investigate the relationship between the time of birth and the mortality and morbidity of infants admitted to neonatal intensive care units. Design: This prospective, cohort study examined the records of women and infants admitted to the NICUs of four hospitals in Beirut, Lebanon, between July 1, 2002, and June 30, 2003. The hospitals selected were university affiliated and had a large number of deliveries (5,152 total for the year 2002–2003). Main Outcome Variables: Neonatal mortality and morbidity for infants admitted to the NICU were evaluated in relation to time of birth. Results: For the whole sample, mortality was higher for infants born during the night shift than for those born during the day shift. Mortality, morbidity, and brain asphyxia rates were also higher for infants born during the night shift and admitted to the NICU. Maternal risk factors and delivery complications were not consistently higher on the night shift.

The divergent opinions of nurses, nurse managers and nurse directors: the case in Lebanon

AIM The present study provides an overview of the status of the nursing profession in Lebanon and compares and contrasts the opinions of directors, nurse supervisors/managers and nurses regarding the nursing profession and the workplace. BACKGROUND There are limited publications concerning the working conditions of nurses in Lebanon, and no studies on the views of directors, supervisors/managers and nurses regarding the priorities of the nursing profession. Such data are necessary to build a sound theoretical basis on which recommendations for improving the nursing profession in Lebanon are made as well as to compare and contrast cross cultural findings. METHOD Data were collected from 45 hospitals using a mixed methods design. Qualitative data was obtained from 45 nursing directors whereas quantitative data were collected from 64 nursing supervisors and 624 nurses. RESULTS Similarities and differences in the opinions of nurses, nurse supervisors/managers and nurse directors regarding critical issues for the nursing profession are discussed and contrasted. CONCLUSIONS/IMPLICATIONS Nurses are more likely to be satisfied and committed to their profession when they feel that their opinions are being heard and that their work environment promotes professional advancement.

A Meta-Analysis of Preterm Infant Massage: An Ancient Practice With Contemporary Applications.

Objective:To evaluate the efficacy of massage on the short- and long-term outcomes of preterm infants. Methods:A search was conducted using the PRISMA framework. Validity of included studies was assessed using criteria defined by the Cochrane Collaboration that was carried out independently by two reviewers with a third reviewer to resolve differences. Results:Thirty-four studies met the inclusion criteria, 3 were quasi-experimental, 1 was a pilot study, and the remaining 30 were randomized controlled trials (RCTs). The outcomes that could be used in the meta-analysis and found in more than three studies noted that massage improved daily weight gain by 0.53 g (95% CI = 0.28-0.78), p < 0.0001, and resulted in a significant improvement in mental scores by 7.89 points (95% CI = 0.96-14.82), p < 0.03. There were no significant effects on length of hospital stay, caloric intake, or weight at discharge. Other outcomes were not analyzed either because the units of measurement varied or because means and standard deviations were not provided by the authors. These included vagal activity and heart rate variability (5 studies), neurobehavioral states (7 studies), pain responses (2 studies), maternal outcomes (2 studies), breastfeeding (2 studies), and physiologic parameters: bone formation (2 studies), immunologic markers (1 study), brain maturity (1 study), and temperature (1 study). The quality of the studies was variable with methods of randomization and blinding of assessment unclear in 18 of the 34 studies. Conclusions:Massage therapy could be a comforting measure for infants in the NICU to improve weight gain and enhance mental development. However, the high heterogeneity, the weak quality in some studies, and the lack of a scientific association between massage and developmental outcomes preclude making definite recommendations and highlight the need for further RCTs to contribute to the existing body of knowledge.