Mohannad Eid AbuRuz

Patient- and Family Caregiver-Related Barriers to Effective Cancer Pain Control

Cancer is a worldwide health problem. In Jordan, cancer is the second leading cause of death. Approximately 2,000 people die from cancer every year, 70% of them experiencing varying high levels of pain as a result of ineffective pain relief. The purpose of this study was to identify the attitudinal barriers to effective cancer pain relief in patients and their family caregivers in Jordan. A cross-sectional questionnaire survey was used. A convenience sample of 300 cancer patients and 246 family caregivers were recruited from four different Jordanian hospitals between August 2009 and May 2010. Patients completed the Arabic version of the Barriers Questionnaire II (ABQ-II), the Arabic Brief Pain Inventory (A-BPI), and a demographic questionnaire. Family caregivers completed the ABQ-II and a demographic questionnaire. The A-BPI results identified that more than 70% of cancer patients in localized stage and more than 90% of patients with advanced cancer experienced substantial pain. Four major barriers to pain control were highlighted: fears related to addiction, side effects, communication concerns, and fatalistic beliefs. This study provides baseline information about the barriers to effective cancer pain control in Jordan.

Quality of Life for Saudi Patients With Heart Failure: A Cross-Sectional Correlational Study

Introduction: Heart failure is a major public health issue and a growing concern in developing countries, including Saudi Arabia. Most related research was conducted in Western cultures and may have limited applicability for individuals in Saudi Arabia. Thus, this study assesses the quality of life of Saudi patients with heart failure. Materials and Methods: A cross-sectional correlational design was used on a convenient sample of 103 patients with heart failure. Data were collected using the Short Form-36 and the Medical Outcomes Study-Social Support Survey. Results: Overall, the patients’ scores were low for all domains of Quality of Life. The Physical Component Summary and Mental Component Summary mean scores and SDs were (36.7±12.4, 48.8±6.5) respectively, indicating poor Quality of Life. Left ventricular ejection fraction was the strongest predictor of both physical and mental summaries. Conclusion: Identifying factors that impact quality of life for Saudi heart failure patients is important in identifying and meeting their physical and psychosocial needs.

Factors associated with quality of life in Arab patients with heart failure.

The aim of this study was to examine the relationships of demographic characteristics, medical variables and perceived social support with quality of life (QOL) in Arab patients with heart failure. A cross-sectional study was conducted to identify factors associated with QOL in Arab patients with heart failure. Participants with heart failure (N = 99) were enrolled from a nonprofit hospital and an educational hospital. Data were collected on QOL using the Short Form-36 survey. Perceived social support was measured with the Medical Outcomes Study Social Support Survey. The majority of the patients reported significant impairment in QOL as evidenced by subscale scored. Left ventricular ejection fraction was the strongest correlate of most QOL domains. Tangible support was significantly associated with most QOL domains. Other social support dimensions were not significantly related to QOL domains. Most patients with heart failure had significant disrupting pain and limitations in performing activities which interfered with their usual role. Due to the importance of understanding QOL and its determinants within the context of culture, the outcomes of this study may provide valuable guidance to healthcare providers in Arabic countries as well as Western society in caring for these patients. Further studies are needed to explore the relationship between social support and QOL among patients with heart failure in the Arabic culture.

Health-Related Quality of Life in Heart Failure in Jordan from Patients perspectives

Background: Heart failure is a global burden and a major public health issue, especially in developing countries, including Jordan. Most related research was conducted in Western cultures and may have limited applicability for individuals in Jordan. Aim: To explore the quality of life of patients with heart failure in Jordan from their perspectives. Methods: A qualitative descriptive design was adopted. Semi-structured interviews with 25 heart failure patients were undertaken. Results: Analysis of transcripts identified three major themes. The first theme described the awareness of health related quality of life (HRQoL) concept and perceptions of patients about heart failure (HF). The second theme described the influence of HF on patients in terms of physical ability, psychosocial life, spirituality, economic status and cognitive aspects. The third theme showed different steps to improve HRQoL from patients’ perspectives. Conclusion: HRQoL is a multidimensional, subjective concept that is affected by a variety of factors. Heart failure had negative impacts on the patients’ HRQoL, especially in the physical domain.

DOES EXCESSIVE ABSENCE FROM CLASS LEAD TO LOWER LEVELS OF ACADEMIC ACHIEVEMENT

Electronic arbitration (E-arbitration) is usually defined as a method to settle disputes through online platforms providing arbitration services. It constitutes a recent process dispute resolution mechanism between economic agents through the use of information and communication technology. Earbitration is inseparable from the growth of e-commerce and cross-border trade transactions. Contracting parties in such transactions expect a swift, cost-effective and efficient dispute resolution mechanism. It is no coincidence therefore that an increasing number of domestic legislations and international regulations adhere to the rules governing E-arbitration. The fact remains that, surprisingly, the Lebanese regulatory framework puts several obstacles to the successful implementation of E-arbitration in Lebanon. In this respect, this contribution endeavors to identify the scope of such obstacles, and discusses the solutions adopted in other legal frameworks.

Depressive Symptoms and Complications Early after Acute Myocardial Infarction: Gender Differences

Background: Cardiovascular disease is the first leading cause of death worldwide. Coronary heart disease is the most common manifestation of cardiovascular disease. Acute myocardial infarction is the primary manifestation of coronary heart disease. Depression is a common and predicted complication after acute myocardial infarction. Limited studies evaluated gender differences in depressive symptoms after acute myocardial infarction especially in developing countries. Objective: The study aimed to determine whether there was a difference in depression levels and rate of complications based on gender early after acute myocardial infarction. Method: This was a prospective comparative study on 230 patients (150 men and 80 women) with a confirmed diagnosis of acute myocardial infarction. All participants signed an informed consent, filled sociodemographic and clinical questionnaire and the Depression Subscale of the Hospital Anxiety and Depression Scale. Clinical data were abstracted from the participants’ medical record after discharge. Results: Eighty-six participants (37.4%), 54 men and 32 women, developed 1 or more complications during hospitalization. Female patients were more depressed (14.4±3.5 vs. 8.3 ± 2.6) and developed more complications (1.9 ± 0.9 vs. 0.8 ± 0.5) than male patients did. Depressive symptoms increased the occurrence of complication by 40% and 33% for female and male patients respectively after controlling for sociodemographic and clinical variables. Conclusion: Depressive symptoms independently predicted complications after acute myocardial infarction in both men and women. The inclusion of depression assessment tools in acute myocardial infarction treatment protocols is highly recommended.

Depressive symptoms are associated with in-hospital complications following acute myocardial infarction

AIM To examine the effect of depressive symptoms on in-hospital complication rates after Acute Myocardial Infarction (AMI). BACKGROUND Coronary Heart Disease (CHD) is the primary cause of death worldwide. AMI is the most common consequence of CHD. Depressive symptoms are an important risk factor for CHD and increased risk of AMI. Understanding the relationship between depressive symptoms and short term complications for patients with AMI is important for determining their needs, developing interventions, and evaluating the outcomes of interventions. METHODS A prospective observational study was conducted with 175 patients who were admitted to the Intensive Care Units (ICUs) of four large hospitals in Jordan. During the interview, within 72h (mean, 38±16h) of admission to the hospital, participants completed the sociodemographic and clinical questionnaire and the Beck Depression Inventory Scale. RESULTS The mean age was 66.9±11.0years. The number of patients with mild, moderate, and severe depressive symptoms who developed complications was significantly higher than those with minimal depressive symptoms, p˂0.001. Patients with mild, moderate, and severe depressive symptoms had longer lengths of stay in the ICU and in hospital than patients with minimal depressive symptoms. Patients with mild, moderate and severe depressive symptoms were at 1.22 times higher risk for developing complications than patients with minimal depressive symptoms. Moreover, previous AMI history increased the risk for developing complication by 150%. CONCLUSIONS Depressive symptoms were an independent predictor of complications and increased length of stay after AMI. Interventions to control depressive symptoms early after AMI are necessary.

Gender Differences in Anxiety and Complications Early After Acute Myocardial Infarction

Background: Anxiety is the earliest psychological response to acute myocardial infarction. When anxiety persists or becomes severe, it has negative consequences including increased risk for in-hospital complications. Therefore, it is necessary to determine which groups of people are at risk for high anxiety after acute myocardial infarction. Objective: The aim of this study was to determine whether there is a difference in anxiety levels and rate of complications based on gender early after acute myocardial infarction. Methods: A comparative design was used. Patients with acute myocardial infarction were interviewed within 72 hours (mean [SD], 40 [18] hours) of admission to the hospital and completed a sociodemographic and clinical questionnaire and the Anxiety Subscale of Hospital Anxiety and Depression Scale. In addition, clinical data were abstracted from the participants’ medical record after discharge. Results: A total of 250 patients, with a confirmed diagnosis of acute myocardial infarction, participated in this study: 163 men and 87 women. Female patients were more anxious (15.5 [3.6] vs 8.1 [2.9], P < .01) and had more complications (1.1 [1.9] vs 0.6 [0.08], P < .05) than male patients did. Conclusions: Anxiety is a global problem after acute myocardial infarction. Exploration of reasons why women of different cultures are at a higher risk for anxiety after acute myocardial infarction is necessary. It is of high clinical importance to determine strategies for managing anxiety in patients with or suspected to have acute myocardial infarction, especially women.

Quality of Life among Patients with Acute Coronary Syndrome

Objectives: The purposes of this study were to describe the quality of life for patients with acute coronary syndrome in Jordan, identify the mostly affected quality of life domains and if there was an association between quality of life socio-demographic and clinical characteristics. Methods: A non-experimental descriptive cross-sectional correlational design was used with a convenience sample of 372 patients with acute coronary syndrome. Data were collected from six different hospitals in Amman city by a self-reported questionnaire. Results: Overall, the patients’ quality of life mean score for all domains was low (4.06 ± 1.16). The physical domain was the most affected (3.87 ± 1.28), followed by the emotional (4.21 ± 1.18) and lastly is the social domain (4.26 ± 1.25). There were statistically significant differences in quality of life scores according to gender, level of education, employment status, physically activity, history of dyslipidemia and medical diagnosis. Conclusion: The results of this study indicated that Jordanian patients with acute coronary syndrome have poor quality of life especially in the physical domain. Social domain of their quality of life was the least affected indicating that there is a strong family support and relation. Different treatments to improve quality of life for those patients are warranted.