Knowledge, Attitude and Training Physiotherapist Palliative Care - Gaza Strip

Background: Palliative care encompasses holistic management of patients and families facing life-threatening and life-limiting conditions. There is currently little known about Gaza strip physiotherapists’ palliative care knowledge, attitudes, beliefs, experience and training needs. Objectives: Palliative care rehabilitation has been positively associated with a high and prolonged level of independent function, which also reduces the burden on care providers(1,2). This study aimed to investigate the existing knowledge, attitudes, beliefs, training and experience of palliative care by physiotherapists working in Gaza strip. Methodology: A quantitative cross-sectional descriptive study using a face to face questionnaire included sociodemographic data, physiotherapist’s knowledge, attitude experience and training (modified PTiPC-KABE Scale)(3), the study includes eight major hospitals in the Gaza-Strip. The sample size was 120 participants, 110 were included. SPSS (version 22 for Windows) for descriptive statistics, Chi-Square, Student's t and compare mean -tests were used for the statistical analysis. Results: The total number of respondents was 110(93.3%); male 45%,and females 55%.Years of experience Palliative care intends to hasten death was significant in (p = 0.017), Palliative care does not enhance quality of life (p = 0.117), I feel a sense of personal failure when a patient dies(p=0.035), Palliative care considers dying as a complicated process (p =0.026), Caring for dying patients is traumatic for me(p = 0.004), The provision of palliative care requires emotional detachment(p = 0.009), The physical environment of my workplace is ideal for providing palliative care and rehabilitation(p = 0.026), I am often exposed to death in my workplace(p = 0.034), Conclusions: Many of Gaza's physiotherapists perform in palliative care despite inadequate training and limited knowledge in this area. Further learning and training opportunities for graduates and postgraduate students are required for physiotherapists in palliative care

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Comparative Study of Compliance Between Hospital and Primary Care Diabetic Patients

Abstract Modern day chronic diseases such as diabetes are related with the lifestyle, especially unhealthy diet and physical inactivity. This study aims to determine the level of compliance of diabetic patients with their doctors' advice about diet and physical activity, comparing ambulatory patients with those who were recently hospitalized. We developed a combined database of the two studies. Both studies were cross-sectional studies using systematic random sampling comprising patients of T2DM, and including the following variables: health facility used by the patient; age; gender; marital status; education; whether the patient received health education in the past; patient's weight and height and presence of other diseases; family history of diabetes; current smoking; dietary habits; and exercise. We used the SPSS data reduction method factor analysis to summarize the data on these two dimensions (diet and exercise) into a single summary variable each. The total number of diabetic patients included in this study was 442. Prevalence of smoking was 7.2% (6.3% among PHC patients and 9.4% among hospital patients; p=0.16). A little more than one third of the PHC patients and nearly three fourth of hospital patients had hypertension, coronary artery disease (CAD) or both (p<0.001). Similarly, a significantly greater proportion of the hospital patients had a family history of diabetes (p<0.001). Obesity was significantly higher among the PHC patients (p=0.011). The prevalence of unhealthy diet was significantly higher among hospital patients (p<0.001). Percentage of patients having unhealthy diet was significantly higher in among hospital patients in both sexes (p < 0.05), and in the 40-59 age-group; having secondary and higher level education, the prevalence of unhealthy diet was several times higher among hospital patients (p < 0.001); same was true among married patients, where the percentage of unhealthy diet was almost twice among hospital patients (p < 0.001). Finally, the prevalence of unhealthy diet was significantly higher among non-obese hospital patients than the non-obese PHC patients (p = 0.001). The prevalence of physical inactivity among male hospital patients was significantly higher than the male PHC patients (p=0.028). In the age 60 years and above, physical inactivity was significantly higher among hospital patients (p < 0.001). Similarly, among patients having less than secondary school education, physical inactivity was significantly higher among hospital patients (p = 0.002). Prevalence of unhealthy diet is significantly higher among hospital patients. We conclude that health care providers in Saudi Arabia should put greater emphasis on health education about diet and exercise. with T2DM

Breaking Bad News Issues: A Survey Among Physicians

Objective: The aim of this study was to explore the physicians' perspectives and practices in relation to breaking bad news (BBN) to patients.Methods: A quantitative survey was performed in the Qassim Region from January to July 2011. A cross-sectional study was conducted using a questionnaire administered to all practicing physicians working in both hospitals and Primary Healthcare centers in the Qassim Region. Anonymity was maintained throughout. The target groups received a self-administered questionnaire with a covering letter introducing the study and explaining their rights.Results: A total of 458 physicians participated in the study. Physicians with higher qualifications had lower total scores of the mean in BBN skills. The majority (70%) preferred to discuss information with close relatives rather than the patients. In case of serious diseases, only 32% said that they would inform the patient’s family without the patient’s consent. More than 90% of our study sample did not avoid telling their patients the bad news; however, physicians working in Primary Healthcare centers were less reserved.Conclusion: Although most of the participating physicians were keen to help their patients, they lacked the essential knowledge and skills for breaking bad news. Thus, they are in need of specific training in this regard

ADC value as a predictor for myelin loss/Preservation in MS plaques with different enhancement pattern in correlation with disease activity

Background: MS plaques display different pattern of enhancement with variable clinical course. The purpose is to assess the role of ADC value as a predictive for MS histologic changes with different enhancing pattern and its correlation with disease activity. Patients and methods: This prospective study included 28 chronic MS patients with 75 lesions, subjected for magnetic resonance imaging and ADC value measurement of the plaques and normally appearing white matter (NAWM) to be correlated with that of normal white matter (NWM) in 20 healthy controls. Results: T1-Hypointense and confluent lesions had statistical significant higher mean ADC value relative to the isointense and discrete lesions. Statistical significance difference was detected between mean ADC value of homogeneously enhancing lesions (HELs) and ring enhancing lesions (RELs) and between HELs and non-enhancing lesions (NELs), but no difference between NELs and RELs. Statistical significance difference was detected between ADC of NAWM relative to NWM of healthy controls. Conclusion: ADC value predicts histological changes in MS lesions. Pattern of enhancement doesn't correlate with neurologic deficits but ADC value is more valuable in assessing the disease activity

Anti-HIV activity of some natural phenolics

Acquired immunodeficiency syndrome (AIDS) is an immunosuppressive disease caused by human immunodeficiency virus (HIV). The urgent need for searching novel anti-HIV/AIDS medicines is a global concern. So far, a lot of medicinal and aromatic plants (MAPs) have been analyzed to select those that could assist in the prevention and/or amelioration of the disease. Among biologically active compounds present in these plants, one of the most promising group are phenolics. The purpose of this article was to report anti-HIV activity of selected phenolic compounds of plant origin

Comparative evaluation of the effects of atorvastatin and lovastatin on the pharmacokinetics of aliskiren in rats

The worldwide increase in the number patients with high blood pressure poses serious clinical challenges. Little is known regarding the interactions between the various drugs used to treat heart diseases. The present study evaluates and compares the effects of administration of multiple doses of atorvastatin or lovastatin on the pharmacokinetics of aliskiren in rats in an effort to determine their underlying mechanisms. A total of 90 healthy female albino rats were randomly divided into three groups. All groups were treated with aliskiren by oral gavage at 8.57 mg/kg daily for 14 days. In addition to aliskiren, group 2 received atorvastatin at a dose of 1.143 mg/kg for 7 days. In addition to aliskiren, group 3 received lovastatin at a dose of 1.143 mg/kg for 7 days. After blood samples were collected at specific time intervals, aliskiren concentrations were determined using liquid chromatography-tandem mass spectrometry. Relative to the control treatment, atorvastatin treatment resulted in non-significant alterations in the pharmacokinetic parameters of aliskiren. In contrast, lovastatin resulted in a significant increase in the area under the curve, peak plasma concentration, and elimination half-life by 21, 10, and 72%, respectively. Additionally, lovastatin significantly reduced oral clearance by 23%. Inhibition of aliskiren metabolism via the hepatic CYP3A subfamily and/or inhibition of intestinal P-glycoprotein and/or the CYP3A subfamily was identified as a possible mechanism. This study is the first to report that only lovastatin causes a marked increase in aliskiren bioavailability. Caution should be taken when lovastatin and aliskiren are administrated concomitantly in clinical practice

Multiple sclerosis and fecundity: a study of anti-mullerian hormone level in Egyptian patients

Abstract Background Multiple sclerosis (MS) is a neurological disease that affects people aged 20–40 years on average. It classically affects young females of reproductive age. The prevalence of MS for females to males has increased markedly in recent years (from 2.3 to 3.5:1). Females with MS seem to use infertility treatments more frequently and fecundity could be affected years before making an MS diagnosis. The anti-Müllerian hormone (AMH) level is the strongest marker of ovarian reserve. Although recent studies suggest that patients with MS have lower ovarian reserve, there is no definite data to conclude that females with MS suffer from impaired fertility. This study aimed to investigate fertility and fecundity among female patients with MS by assessing AMH level. This study included 100 patients with MS and 60 healthy controls (HC). Both groups were assessed for AMH levels, activities of daily living (ADL) were assessed using the Kurtzke Expanded Disability Status Scale (EDSS) and the reproductive history of both groups was assessed via a self-administered questionnaire. Results AMH levels among the HCs (0.34–2 ng/ml with a mean of 1.03 ± 0.41 ng/ml) were significantly higher than in patients with MS (0.15–2 ng/ml with a mean of 0.68 ± 0.31 ng/ml). The use of disease-modifying therapies (DMT) was the only predictor of below normal AMH among patients, but there was no significant correlation with age, duration of disease or type of DMT. Conclusions Levels of AMH were significantly lower in MS patients than in healthy controls