Factors associated with palliative care symptoms in cancer patients in Palestine

Abstract Palliative care is critical to redundancy in cancer patients seeking to improve their quality of life. Evaluation should be incorporated into clinical practice routines at all stages of cancer. The Edmonton Symptom Assessment System (ESAS) was used to rate the intensity of ten symptom evaluations designed and validated for cancer patients in various languages and cultures. Therefore, the study aims to assess the symptoms reported using ESAS scores to identify patients who would benefit from palliative care that can improve the integration of palliative care into standard cancer care at An-Najah National University Hospital (NNUH). A cross-sectional study was selected for 271 cancer patients using a convenience sampling method at NNUH. Demographic, clinical, and lifestyle characteristics are described. Furthermore, patients' moderate to severe symptoms (score > 4) were obtained using ESAS-R. The survey consisted of 271 patients, with a response rate of 95%. The average age of the patients was 47 ± 17.7 years, ranging from 18 to 84 years. The male-to-female ratio was approximately 1:1, 59.4% of the patients were outpatients, and 153 (56.5%) had hematologic malignancies. Fatigue (62.7%) and drowsiness (61.6%) were the most common moderate to severe symptoms in ESAS. Furthermore, pain (54.6%), nausea (40.2%), lack of appetite (55.0%), shortness of breath (28.5%), depression (40.6%), anxiety (47.2%) and poor well-being (56.5%) were reported. In conclusion, fatigue and drowsiness were the most reported symptoms according to the ESAS scale among cancer patients, while moderate to severe symptoms were reported in cancer patients using the ESAS. The ESAS is a functional tool for assessing cancer patients' symptoms and establishing palliative care services

Nurses’ knowledge and practice regarding mixing medications with food: a multicenter cross-sectional study from a developing country

Abstract Background Different pharmaceutical characteristics of the dosage form (DF) have a direct effect on how easily oral solid medicine is swallowed. The practice of crushing tablets or opening the capsule occurs daily in the hospital, and most nurses are unknowledgeable regarding these issues. Coadministration of medications with food can cause changes in drug absorption and lead to an alteration in gastrointestinal motility, which can cause an unexpected effect on the dissolution and absorption of the drug. Therefore, this study aimed to investigate nurses' knowledge and practices regarding the mixing of medications with food or drink in Palestine. Methods From June 2019 to April 2020, a cross-sectional study was conducted, encompassing nurses working in government hospitals across various districts of Palestine. The data were collected through face-to-face interviews, using questionnaires that assessed nurses' understanding and implementation of mixing medications with food. The sampling method employed was convenience sampling. To analyze the gathered information, the Statistical Package for the Social Sciences version 21 (IBM-SPSS) was utilized. Results A total of 200 nurses participated in the study. The data show a significant difference between the median knowledge scores according to the department of work (p < 0.001). The highest median [interquartile] knowledge score of 15 [12–15] was found for nurses working in the neonatal intensive care unit. In addition, nurses in the pediatric ward and the men’s medical ward had high scores of 13 [11.5–15] and 13 [11–14], respectively. In general, the results show that 88% of nurses modified oral DF prior to administration to patients. Regarding the type of food used, mixing medicine into juice was the most common procedure performed by nurses (approximately 84%); 35% of nurses used orange juice to mix with medicine. The most common reason for crushing was to administer medications to patients with a nasogastric tube (41.5%). In regard to medications, aspirin was the most frequently used drug that was crushed by the nurses (44%); however, 35.5% of nurses did not feel sufficiently trained to carry out this practice. Concerning the sources of information, 58% of nurses usually asked pharmacists for information about medications. Conclusions The results of this study show that crushing and mixing medications with food is common among nurses, and most nurses are unaware of the dangerous effect of this practice on patient health. Pharmacists, as medication experts, should participate in sharing knowledge about unnecessary crushing situations or when crushing should be avoided and try to find an alternative, when available, to aid administration

Prevalence of acne and its impact on quality of life and practices regarding self-treatment among medical students

Abstract Acne vulgaris is one of the most common skin diseases worldwide and causes great distress to patients. In addition, most acne patients suffer from low self-esteem and social withdrawal. This study aimed to assess the prevalence of acne and its impact on quality of life among medical students. It also evaluates the patterns of self-treatment use. The study population consisted of all medical students from An-Najah National University (ANU) and the hospital. The questionnaire consists of three parts, and the first part consists of questions regarding demographic information. The second part consisted of questions to measure the severity of acne using the acne severity scale as well as the Cardiff Disability Index, which assesses the quality of life concerning acne in medical students. Finally, the third part consisted of questions exploring and assessing acne self-treatment. The mean age of our study sample was 21.3 ± 1.9 years, with a female predominance of 72.3%. The prevalence of acne among medical students was 80.9%, and 36.6% practiced self-medication. Acne was strongly associated with female sex (p < 0.001) and skin type (p = 0.024). Regarding diet, dairy consumption (p = 0.007), sweets (p < 0.001), chocolate (p < 0.001), and oily food (p = 0.006) were all significantly associated with acne. Skin type was strongly associated with the severity of acne (p < 0.001) and the Cardiff acne disability index (p = 0.016). Gender (p = 0.039) was also associated with Cardiff acne disability. A significant correlation was found between the severity of acne and impaired quality of life. The most commonly used topical agent for self-treatment remedies was antibiotics (70.3%). The most commonly used oral agent was isotretinoin (9.4%). A total of 22.7% of the students used herbal products, while 47.7% used home remedies. Acne is prevalent among medical students, with a high percentage of students having different degrees of impairment in their daily lives. As a result, self-medication among acne sufferers is highly common. Awareness of the appropriate use of self-medication should increase among medical students

Eating habits, sleep quality, and lifestyle changes during the COVID-19 crisis: a national survey from Palestine

Abstract Background The COVID-19 pandemic and the consequences of safety measures, such as lockdowns, have impacted not only the physical health of individuals but also their lifestyle, psychosocial health, and mental health. In this analysis, we aimed to explore the effect of the COVID-19 pandemic on lifestyle, eating habits, and sleep quality in the Palestinian population. Furthermore, the current study aimed to determine the factors associated with poor sleep. Methods The study was carried out between November 2021 and February 2022 after a long lockdown. We adopted a cross-sectional design to achieve the objectives of this study. The questionnaire included information on sociodemographic characteristics and other characteristics. In addition, questions related to lifestyle changes and items related to changes in the consumption of certain types of food were included. Furthermore, in the present study, two scales were used to assess sleep quality: the Epworth Sleepiness Scale (ESS) and the Pittsburgh Sleep Quality Index (PSQI). Results A total of 978 participants were included in this study; 508 (51.9%) were women, and 465 (47.5%) were aged between 17 and 30 years. 41% of the participants added one meal or more, and almost 43% skipped one meal or more. A total of 39.2% believed that their habits worsened as a result of the COVID-19 pandemic. A significant portion of the population increased their vitamin intake by 62.5%. In general, nuts, fast food, fried food, coffee, snacks, cans, and homemade baked foods were consumed at higher rates overall. The median ESS score, which measures general levels of daytime drowsiness, was 20.00 (18.00–22.00). Residency (p = 0.008), living status (p < 0.001), salary (p < 0.001), education level (p = 0.002), job status (p = 0.015), and vitamin intake (p < 0.001) were significantly associated with the ESS score. The PSQI score, which evaluates adult sleep patterns and quality, has a median value of 5.00. (4.00–7.00). Living status (p < 0.001), salary (p = 0.006), job status (p = 0.002), smoking status (p = 0.030), chronic diseases (p = 0.002), and vitamin use (p < 0.001) were significantly associated with the PSQI score. Only taking multivitamins was a predictor of having a lower score on both the ESS (p = 0.001) and PSQI (p < 0.001). Conclusions Our findings clearly showed that the COVID-19 pandemic has substantially affected the Palestinian population in different aspects of life. We recommend that health authorities and healthcare providers continually share knowledge and awareness about good eating habits, sleep quality, and other aspects of lifestyles

Mapping the output of the global literature on the links between gut microbiota and COVID-19

Abstract Background The term “human microbiota” refers to populations of microorganisms that live harmoniously in co-existence with humans. They contribute significantly to the host's immunological response when confronted with a respiratory viral infection. However, little is known about the relationship between the human microbiome and COVID-19. Therefore, our objective is to perform a bibliometric analysis to explore the overall structure and hotspots of research activity on the links between microbiota and COVID-19 at the global level. Methods The research literature on the microbiota and COVID-19 published between 2020 and 2022 was obtained from the Scopus database. Bibliometric analysis and network visualization were performed with VOSviewer. Results Of the 701 publications selected, the USA contributed the most (n = 157, 22.40%), followed by China (n = 118, 16.83%) and Italy (n = 82, 11.70%). Hotspots in this field were “COVID-19 is associated with an altered upper respiratory tract microbiome,” “the effect of antibiotics on the gut microbiome,” as well as “patient nutrition and probiotic therapy in COVID-19.” Conclusions The links between microbiota and COVID-19 remain an urgent concern at present, and the use of probiotics or/and antibiotics during the pandemic needs to be further improved. This landscape analysis of the links between the microbiota and COVID-19 will provide a basis for future research

Comparative analysis of package inserts of local and imported antihypertensive medications in Palestine

Abstract Background Package inserts (PIs) as a reliable reference for patients and health care providers should provide accurate, complete and up-to-date information. The purpose of the current study is to assess and compare the PIs of antihypertensive agents locally produced in Palestine and their imported counterparts. Methods Thirty-five PIs were assessed for the presence of 31 information statements using a scoring method. Word counting of 20 headings and subheadings was used to evaluate and compare local and imported PIs for information quantity. Results None of the analysed PIs fulfilled the criteria. All of them included the brand name, active ingredients, indications, directions for use, adverse drug reactions, drug–drug interactions, pregnancy and lactation considerations, and storage. Whereas none of them, either local or imported PIs, included the shelf life and instructions to convert tablets or capsules into liquid forms. Additionally, only one (5%) imported and no (0%) local PIs mentioned the duration of therapy. Moreover, 93.4% of local PIs were deficient in areas regarding the inactive ingredients and date of last revision, and 86.7% did not mention the drug dose and possibility of tablet splitting. Furthermore, the maximum dose was not indicated in 90% of imported and 86.7% of local PIs. In general, imported PIs contained more detailed information than their local counterparts, where the range of differences in medians between the local and imported PIs was from 1.5-fold for pregnancy considerations to >42.00-fold for the effect on the ability to drive and use machines. Conclusions The findings of this study revealed the superiority of imported over local PIs in both quality and quantity of information provided. This emphasises the need for appropriate measures to be taken by the Ministry of Health and local manufacturers to ensure efficiency of local PIs in providing accurate, complete and up-to-date information

Prevalence of chronic pain in hemodialysis patients and its correlation with C-reactive protein: a cross-sectional study

Abstract End-stage renal disease (ESRD) is a common chronic disease worldwide that requires hemodialysis. Patients may face chronic pain and poor quality of life. Therefore, a better understanding of these variables in hemodialysis patients is essential to provide a good intervention. We aim to determine how common chronic pain is in hemodialysis patients and its correlation with sociodemographics, C-reactive protein (CRP), calcium, phosphorus, albumin, and parathyroid hormone. A cross-sectional study of hemodialysis patients was conducted in Palestine. Data collection took place between November 2020 and May 2021. We used the brief pain inventory score to assess chronic pain, and lab tests detected CRP levels. Data were collected using a convenience sampling technique. There were two hundred sixty-one patients in the present study. The mean age of the patients was 51 years, with 63.6% being men. 47.1% of them reported having chronic pain. Gender (p = 0.011), social status (p = 0.003), educational status (p = 0.010), and number of chronic diseases (p = 0.004) indicated a significant relationship with the severity score of pain. Furthermore, sex (p = 0.011), social status (p = 0.003), and number of chronic diseases (p = 0.002) were significantly associated with the pain interference score. Additionally, Person’s test indicated significant correlations between CRP and pain severity (p < 0.001) and with pain interference (p < 0.001). Albumin was significantly and negatively correlated with pain severity (p = 0.001) and pain interference (p < 0.001). Multiple linear regression analysis revealed that patients who had a higher CRP level and many chronic diseases were more likely to have a higher pain severity score. However, pain severity was the only predictor for pain interference. Our results suggest that there is a significant correlation between the existence of chronic pain in hemodialysis patients and increased CRP levels. However, further investigations are needed with a larger number of patients in more than one dialysis unit to confirm this correlation and management of chronic pain in patients with HD

Mapping the knowledge structure of research on insulin resistance and metabolic syndrome: a global perspective

Abstract Background Insulin resistance is a major pathogenic factor that plays a crucial role in the development of metabolic syndrome and has been proposed as one of its underlying causes. Most diagnostic criteria for metabolic syndrome do not directly include insulin resistance. Furthermore, research on insulin resistance continues to provide information on the development and treatment of metabolic syndromes and related health conditions. Therefore, this bibliometric analysis aimed to investigate the current research status and identify possible future research hotspots in the area of metabolic syndrome and insulin resistance by analyzing Scopus-based studies. Methods To collect published data on metabolic syndrome and insulin resistance, this study used the Scopus database as its data source without a particular starting date but including records up to December 31, 2022. The gathered documents were then exported to VOSviewer v.1.6.18 to analyze and visualize country collaborations and identify research areas of high interest. Results The study presents an overview of 1932 records between 1988 and 2022, focusing on metabolic syndrome and insulin resistance. Of these records, 77.33% were original journal articles, while 13.30% were review articles. Additionally, 9.35% of the documents fall under other types of publication, including letters, notes, and editorials. The United States came out on top with 463 items, accounting for 23.96% of the contributions in this field, followed by Japan in second place with 119 items (6.16%). China (n = 113, 5.85%) and the United Kingdom (n = 113, 5.85%) ranked third. Most publications on metabolic syndrome and insulin resistance focus on key terms related to the pathogenesis of insulin resistance syndrome, the use of waist circumference as a crucial clinical indicator to evaluate the risk of metabolic syndrome, and the association between metabolic syndrome and oxidative stress and a pro-inflammatory state. Conclusions This study presents the first bibliometric analysis of publications focusing on metabolic syndrome and insulin resistance. The findings of this study offer a comprehensive global perspective on the research carried out on metabolic syndrome and insulin resistance and can be an invaluable source for future research

Exploring the nutritional landscape and emerging trends in kidney stone research: visualization and bibliometric analysis

Abstract Background Kidney stones, or renal nephrolithiasis, are common and dangerous, increasing the risk of chronic kidney disease. Dietary manipulation is essential for the prevention and recurrence of kidney stones. Research into nutrition and kidney stones lacks library analysis, making it difficult to identify new trends. This bibliometric study was conducted to explore the current landscape of research on nutrition and kidney stones worldwide. This paper also emphasizes significant research trends in this area over the past two decades, aiming to assist researchers in understanding the current research status and identifying potential future directions. Methods The scholarly literature pertaining to diet and kidney stones was systematically explored utilizing SciVerse Scopus to identify pertinent research articles released from 2003 to 2022. The examination encompassed an assessment of publication patterns, key contributors, focal areas of research, prevalent themes, influential articles, and emerging research avenues. Following data extraction to Excel, analyses, including frequencies, percentages, and linear regression, were conducted. Visual exploration was facilitated through the use of the VOSviewer program version 1.6.19. Results Between 2003 and 2022, 697 publications on nutrition and kidney stones were identified. There were 478 original articles (68.58%), 120 reviews (17.22%) and 99 other types of publications (14.20%). The United States is the most productive country, with significant growth in research in the fields of nutrition and kidney stones. The United States has demonstrated the strongest partnerships between researchers’ networks from various countries. Cluster analysis revealed three major research themes: sex differences in kidney stone disease, the correlation between increased dietary acid consumption and calcium oxide kidney stones, and nephrolithiasis associated with a ketogenic diet. Conclusions This study offers a thorough examination of nutrition and kidney stone research, encompassing key research domains, collaborative networks, and emerging patterns. The findings can aid researchers in gaining insight into the present landscape of the discipline and determining future research directions

Assessment of practices and awareness regarding the disposal of unwanted pharmaceutical products among community pharmacies: a cross-sectional study in Palestine

Abstract Background The improper disposal of pharmaceutical preparations substantially threatens human health and environmental safety. Pharmacists are responsible for properly disposing of unwanted medications and educating patients about how to do so themselves. This study aimed to assess community pharmacists’ knowledge, determine their views on how to dispose of unwanted pharmaceuticals, and assess the extent to which they realize that it is their responsibility to guide patients toward the safe disposal of expired medications. Methods A descriptive cross-sectional study was conducted between December 2021 and April 2022 among 400 practicing pharmacists who were chosen to participate by random cluster sampling. Community pharmacists’ practices, awareness, and beliefs about disposing of unused drugs were evaluated. The Statistical Package for Social Sciences (IBM-SPSS) version 21 was used for data entry and analysis. Results Of 400 pharmacists, 348 stated that they did not participate in courses on the safe disposal of unwanted medications. Disposal of drugs in the garbage, an unsafe method, was very frequently recommended by pharmacists to patients, especially regarding inhalers, antibiotics, hormonal drugs, and solid and semisolid drugs. However, many pharmacists advised patients to return their hormonal, category B, and category C drugs to the pharmacy. A total of 61.3% of pharmacists agreed and 26% strongly agreed that unsafe disposal of drugs negatively affects the environment. A total of 54.3% of the participants agreed that improper disposal of antibiotics might be a reason for increased antimicrobial resistance, and 54.5% of them agreed that improper disposal of hormonal drugs might contribute to the development of certain cancers. A total of 80.3% of the participants perceived that most unwanted drugs in pharmacies were those returned from patients. A total of 97.3% of the participants supported establishing a drug disposal system, with 77.5% choosing to have the district health board responsible for funding this system. A total of 48.5% of the participants indicated that a lack of education and awareness on the issue of getting rid of unused drugs constitutes a challenge to the safe disposal of medicines, and 66% of them said that a lack of law enforcement constitutes another challenge. A total of 95.5% of the participants agreed or strongly agreed that good training for health sector workers and organizing workshops to develop knowledge on this subject would improve practices. A total of 93.3% supported distributing educational brochures, and 92.8% supported placing special containers in every pharmacy to collect unwanted drugs. Conclusions Most pharmacists in our study returned drugs to manufacturing companies and stores, and few followed the correct methods of incineration and return of drugs to the Ministry of Health. Current data emphasize the issue of improper disposal of medicine in Palestine and the need for improved education among healthcare workers