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Since the beginning of the Syrian conflict, the impact on the local population has rapidly increased, with severe consequent displacement to neighbouring countries (such as Turkey), material losses and psychological damage due to witnessing death, torture, physical and psychological abuse or surviving it, including high levels of gender-based violence. At the same time, available resources to aid impacted communities have not come close to matching need. To respond to this urgent need, the INSAN Psychosocial Support Centre in Istanbul, Turkey initiated the Safety Spark project as a capacity building project with 20 refugee gender-based violence survivors to be trained in Problem Management Plus. This is “a psychological intervention that aims to improve mental health, functioning and psychosocial wellbeing of adults” and thereafter to provide mental health and psychosocial support to other women survivors, thereby increasing the capacity of the community to heal itself. However, right after training, but 2 weeks before implementation sessions began, the onslaught of the coronavirus disease 2019 reached Turkey, making provision of traditional psychological support impossible. With the support of World Health Organization, an online training was added to the programme and survivors were taught to provide support remotely as well. The project is ongoing, and observed results appear to be promising. This field report provides an overview of the target population, procedures, settings and challenges faced during the training and implementation, solutions to overcome them and future recommendations.

Abstract Background Between the need for transparency in healthcare, widely promoted by patient’s safety campaigns, and the fear of negative consequences and malpractice threats, physicians face challenging decisions on whether or not disclosing medical errors to patients and families is a valid option. We aim to assess the knowledge, attitudes and practices (KAP) of physicians in our center regarding medical error disclosure. Methods This is a cross-sectional self-administered questionnaire study. The questionnaire was piloted and no major modifications were made. A day-long training workshop consisting of didactic lectures, short and long case scenarios with role playing and feedback from the instructors, were conducted. Physicians who attended these training workshops were invited to complete the questionnaire at the end of the training, and physicians who did not attend any training were sent a copy of the questionnaire to their offices to complete. To assure anonymity and transparency of responses, we did not query names or departments. Descriptive statistics were used to present demographics and KAP. The differences between response\s of physicians who received the training and those who did not were analyzed with t-test and descriptive statistics. The 0.05 level of significance was used as a cutoff measure for statistical significance. Results Eighty-eight physicians completed the questionnaire (55 attended training (62.50%), and 33 did not (37.50%)). Sixty Five percent of physicians were males and the mean number of years of experience was 16.5 years. Eighty-Seven percent (n = 73) of physicians were more likely to report major harm, compared to minor harm or no harm. Physicians who attended the workshop were more knowledgeable of articles of Jordan’s Law on Medical and Health Liability (66.7% vs 45.5%, p-value = 0.017) and the Law was more likely to affect their decision on error disclosure (61.8% vs 36.4%, p-value = 0.024). Conclusion Formal training workshops on disclosing medical errors have the power to positively influence physicians’ KAP toward disclosing medical errors to patients and possibly promoting a culture of transparency in the health care system.

Ethics are considered a basic aptitude in healthcare, and the capacity to handle ethical dilemmas in tough times calls for an adequate, responsible, and blame-free environment. While do-not-resuscitate (DNR) decisions are made in advance in certain medical situations, in particular in the setting of poor prognosis like in advanced oncology, the discussion of DNR in relation to acute medical conditions, the COVID-19 pandemic in this example, might impose ethical dilemmas to the patient and family, healthcare providers (HCPs) including physicians and nurses, and to the institution. The literature on DNR decisions in the more recent pandemics and outbreaks is scarce. DNR was only discussed amid the H1N1 influenza pandemic in 2009, with clear global recommendations. The unprecedented condition of the COVID-19 pandemic leaves healthcare systems worldwide confronting tough decisions. DNR has been implemented in some countries where the healthcare system is limited in capacity to admit, and thus intubating and resuscitating patients when needed is jeopardized. Some countries were forced to adopt a unilateral DNR policy for certain patient groups. Younger age was used as a discriminator in some, while general medical condition with anticipated good outcome was used in others. The ethical challenge of how to balance patient autonomy vs. beneficence, equality vs. equity, is a pressing concern. In the current difficult situation, when cases top 100 million globally and the death toll surges past 2.7 million, difficult decisions are to be made. Societal rather than individual benefits might prevail. Pre-hospital triaging of cases, engagement of other sectors including mental health specialists and religious scholars to support patients, families, and HCPs in the frontline might help in addressing the psychological stress these groups might encounter in addressing DNR in the current situation.

Providing routine healthcare to patients with serious health illnesses represents a challenge to healthcare providers amid the SARS-CoV-2 pandemic. Treating cancer patients during this pandemic is even more complex due to their heightened vulnerability, as both cancer and cancer treatment weaken the immune system leading to a higher risk of both infections and severe complications. In addition to the need to protect cancer patients from unnecessary exposure to SARS-CoV-2 infection during their routine care, interruption, and discontinuation of cancer treatment can result in negative consequences on patients' health, in addition to the ghost of rationing healthcare resources in high demand during a global health crisis. This article aims to explore the ethical dilemmas faced by decision-makers and healthcare providers caring for cancer patients during the SARS-CoV-2 pandemic. This includes setting triage criteria for non-infected cancer patients, fairly allocating limited healthcare resources between cancer patients and SARS-CoV-2 patients, prioritizing SARS-CoV-2 treatment or vaccine, once developed, for cancer patients and non-cancer patients, patient-physician communication on matters such as end-of-life and do-not-resuscitate (DNR), and lastly, shifting physicians' priorities from treating their own cancer patients to treating critically ill SARS-CoV-2 infected patients. Ultimately, no straightforward decision can be easily made at such exceptionally difficult times. Applying different ethical principles can result in very different scenarios and consequences. In the end, we will briefly share the experience of the King Hussein Cancer Center (KHCC), the only standalone comprehensive cancer center in the region.

The use of stem cells in research has caused much controversy and ethical dilemma. The primary source of stem cells is human embryos, a source which has been confronted with objections based on ethical, moral, and religious positions. Jordan has passed the first of its-kind Statute in the region, aiming at regulating the use of stem cells both for therapeutic and research purposes. The Statute adopted a regulatory approach between the restrictive and intermediate. The Statute, however, pays more attention to stem cell banking in many of its articles. Many critical aspects in regulating stem cell research activities are overlooked. This is including but not limited to the process of informed consent, protecting privacy, maintaining confidentiality, the need for a national entity responsible for regulating embryonic stem cell (ESC) research, and requirements of monitoring activity. The authors recommend further review of the current Statute in light of the deficiencies discussed so as to develop a more comprehensive and coherent Statute.

Objectives: Community-acquired pneumonia (CAP) is linked with high morbidity and mortality, particularly among the elderly. Because of the high incidence and accompanying financial expenses, accurate diagnosis and adequate care of this group hospitalized with CAP are required. The purpose of the study was to assess the level of adherence to CAP national guidelines at a private hospital, as well as the impact of adherence to these national recommendations on clinical outcomes. Methods: Data from electronic medical records of adult patients hospitalized with CAP between 2018 and 2019 were retrieved for a quantitative observational retrospective cohort research. Results: This study comprised 159 patients, with 76 patients (47.8%) receiving therapy according to the recommendations of the guidelines. A total of 75 (98.7%) of those patients were hospitalized across the ICU wards. In contrast, 98.4% (64/65) of patients who had received empiric antibiotic treatment within isolation floors were non-compliant. There was a statistically significant relationship between the level of adherence to CAP clinical guidelines and the following variables: The 72-hour reassessment (P = 0.01), medications altered OR retained when culture findings were revealed (P = 0.01), primary diagnosis (P = 0.028), and total intended period of antibiotic therapy (P = 0.007). Conclusions: According to the findings of this study, higher adherence to the guidelines amongst ICU patients was linked to better outcomes, such as a significant reduction in the overall planned period of antibiotic therapy. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to describe antimicrobial prescribing patterns in hospitalized adult patients with confirmed diagnosis of COVID-19 infection, and to determine the relationship between antimicrobial agent used and non-survival amongst the studied COVID-19 patients. Methods: This is an observational, retrospective study. Specialty Clinic Hospital in Jordan is selected as the study setting for this conducted study. The study comprised of all hospitalized adult patients with confirmed diagnosis of COVID-19 infection who were admitted to the hospital between October 2020 and December 2020. Findings: A total of 216 hospitalized patients with confirmed COVID-19 were included in the analysis. The majority of patients were prescribed antibiotic agents (n=149, 69.0%). Almost half of the patients have been prescribed antivirals agent (n=111, 51.4%). Survivals were significantly more likely to have been prescribed third generation cephalosporin (19.8% vs 3.4%, p=0.02). Non-survivals were significantly more likely to be older in age (mean age: 70.5 vs 62.7 years, p=0.009), have higher mean Charleston Comorbidity Index Score (3.7 vs 2.7, p=0.01), have at least one comorbidity (93.1% vs 71.1%, p=0.008), had shortness of breath at admission (72.4% vs 50.8%, p=0.023) and were admitted to the ICU during current admission (96.6% vs 18.7%, p<0.001) compared to survivors. Non-survivals were significantly more likely to had increased levels of WBC count (41.4% vs 19.7%; p=0.034), increased neutrophiles count (72.4% vs 39.4%; p=0.004) and higher mean C-reactive protein (167.2 vs 103.6; p=0.001) at admission. Conclusions: The results of this study demonstrated factors are associated with the non-survival, and additionally benchmarked the mortality rate, amongst the studied COVID 19 patients. [ABSTRACT FROM AUTHOR]

Opioid availability and accessibility represent major challenges to cancer patients, particularly in low- and middle-income countries. When palliative care service is available, referrals mostly occur late during the course of disease. In this retrospective study, we examined the pattern and predictors of opioids utilization during the final hospitalization for patients admitted to a tertiary cancer center in Jordan, we assessed factors contributing to opioid use among patients with cancer during the final hospitalization and estimated opioid use in oral morphine equivalents (OME). A total of 297 patient files were reviewed. Patients received the highest doses of opioids at 48 and 24 h prior to death (median dose 34.8 mg OME and 34.5 mg OME, respectively). The palliative care service prescribed higher OME doses than other services (OR 3.54; P < 0.001). The median OME dose used by patients above 65 years was lower than the dose used by the younger group (OR 1.04/years of age; P < 0.001). Spine and bone metastasis were associated with increased opioid consumption (OR 2.45; P < 0.002). We concluded that palliative care patients received higher doses of opioids in the final hospitalization compared to patients in other services. A palliative care referral may be helpful for patients with pain requiring opioids. [ABSTRACT FROM AUTHOR]

The use of stem cells in research has caused much controversy and ethical dilemma. The primary source of stem cells is human embryos, a source which has been confronted with objections based on ethical, moral, and religious positions. Jordan has passed the first of its-kind Statute in the region, aiming at regulating the use of stem cells both for therapeutic and research purposes. The Statute adopted a regulatory approach between the restrictive and intermediate. The Statute, however, pays more attention to stem cell banking in many of its articles. Many critical aspects in regulating stem cell research activities are overlooked. This is including but not limited to the process of informed consent, protecting privacy, maintaining confidentiality, the need for a national entity responsible for regulating embryonic stem cell (ESC) research, and requirements of monitoring activity. The authors recommend further review of the current Statute in light of the deficiencies discussed so as to develop a more comprehensive and coherent Statute. [ABSTRACT FROM AUTHOR]

The article offers various country reports including Brazil, Canada, China for medicare industry. It mentions that researchers in genomics are exploring novel ways to interact directly with prospective participants without utilizing physicians, hospitals, or biobanks as intermediaries. It also reportsb that the researchers are interested in using the internet to directly recruit and enroll research participants in genomic studies by posting information online about active or proposed studies.

Asthma is a chronic inflammatory disease, and its prevalence is relatively high among children. Optimal management of asthma often requires long-term pharmacotherapy; however, the effects of these medications on orthodontic treatment is uncertain. We evaluated the effects of the leukotriene LTD4 receptor antagonist montelukast on orthodontic tooth movement in an animal model. Eight mongrel dogs were given montelukast for periods up to 4 weeks. An orthodontic force of 150-200 g was applied to move the second and fourth premolars toward the site of the extracted third premolar. The distance between premolars was measured at baseline and at weeks 1, 2, and 4. Histological examination with hematoxylin-eosin staining was used to evaluate osteoclast activity. A slight delay in orthodontic movement and decreased osteoclast activity were observed in the montelukast-treated group, as compared with untreated controls. However, the differences were not statistically significant (P > 0.05). Our findings suggest that montelukast use will not interfere with orthodontic treatment of asthma patients. However, these findings require confirmation in clinical studies. [ABSTRACT FROM AUTHOR]

Background: Between the need for transparency in healthcare, widely promoted by patient's safety campaigns, and the fear of negative consequences and malpractice threats, physicians face challenging decisions on whether or not disclosing medical errors to patients and families is a valid option. We aim to assess the knowledge, attitudes and practices (KAP) of physicians in our center regarding medical error disclosure.Methods: This is a cross-sectional self-administered questionnaire study. The questionnaire was piloted and no major modifications were made. A day-long training workshop consisting of didactic lectures, short and long case scenarios with role playing and feedback from the instructors, were conducted. Physicians who attended these training workshops were invited to complete the questionnaire at the end of the training, and physicians who did not attend any training were sent a copy of the questionnaire to their offices to complete. To assure anonymity and transparency of responses, we did not query names or departments. Descriptive statistics were used to present demographics and KAP. The differences between response\s of physicians who received the training and those who did not were analyzed with t-test and descriptive statistics. The 0.05 level of significance was used as a cutoff measure for statistical significance.Results: Eighty-eight physicians completed the questionnaire (55 attended training (62.50%), and 33 did not (37.50%)). Sixty Five percent of physicians were males and the mean number of years of experience was 16.5 years. Eighty-Seven percent (n = 73) of physicians were more likely to report major harm, compared to minor harm or no harm. Physicians who attended the workshop were more knowledgeable of articles of Jordan's Law on Medical and Health Liability (66.7% vs 45.5%, p-value = 0.017) and the Law was more likely to affect their decision on error disclosure (61.8% vs 36.4%, p-value = 0.024).Conclusion: Formal training workshops on disclosing medical errors have the power to positively influence physicians' KAP toward disclosing medical errors to patients and possibly promoting a culture of transparency in the health care system. [ABSTRACT FROM AUTHOR]