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Abstract Background End-stage renal disease (ESRD) is a leading cause of death and morbidity worldwide. Malnutrition is a common problem among hemodialysis (HD) patients that negatively impacts their prognosis and is linked to an increase in morbidity and mortality in these patients, as well as a decrease in their quality of life (QOL). In this study, we aimed to evaluate the QOL and to investigate factors that can influence it, including nutritional status, as well as socio-demographic factors, among Palestinian diabetic patients on HD therapy. Methods This was a cross-sectional study that occurred at a large hemodialysis center in Palestine. Malnutrition was assessed by the malnutrition-inflammation scale (MIS), and the quality of life was evaluated by using the EuroQoL five-dimensional instrument (EQ-5D). Multivariable linear regression analysis was carried out to look at the effect of multiple variables on QOL. Results A total of 118 diabetic patients on HD were included. Of these, 66.9% were male, and 60.2% were aged 60 years or higher. Having multiple comorbid diseases (p=0.004) and having been on HD for >4 years (p=0.003) were significantly associated with a higher MIS score, whereas living alone (p=0.037) and having been on HD for >4 years (p=0.002) was significantly associated with lower EQ-5D score. We also observed a significant association between the MIS score and the EQ-5D score(r=−0.616, p

Abstract Background Postoperative nausea and vomiting (PONV) and postoperative pain (POP) are most commonly experienced in the early hours after surgery. Many studies have reported high rates of PONV and POP, and have identified factors that could predict the development of these complications. This study aimed to evaluate the relationship between PONV and POP, and to identify some factors associated with these symptoms. Methods This was a prospective, multicentre, observational study performed at An-Najah National University Hospital and Rafidia Governmental Hospital, the major surgical hospitals in northern Palestine, from October 2019 to February 2020. A data collection form, adapted from multiple previous studies, was used to evaluate factors associated with PONV and POP in patients undergoing elective surgery. Patients were interviewed during the first 24 h following surgery. Multiple binary logistic regression was applied to determine factors that were significantly associated with the occurrence of PONV. Results Of the 211 patients included, nausea occurred in 43.1%, vomiting in 17.5%, and PONV in 45.5%. Multiple binary logistic regression analysis, using PONV as a dependent variable, showed that only patients with a history of PONV [odds ratio (OR) = 2.28; 95% confidence interval (CI) = 1.03–5.01; p = 0.041] and POP (OR = 2.41; 95% CI = 1.17–4.97; p = 0.018) were significantly associated with the occurrence of PONV. Most participants (74.4%) reported experiencing pain at some point during the first 24 h following surgery. Additionally, the type and duration of surgery were significantly associated with POP (p-values were 0.002 and 0.006, respectively). Conclusions PONV and POP are common complications in our surgical patients. Factors associated with PONV include a prior history of PONV and POP. Patients at risk should be identified, the proper formulation of PONV protocols should be considered, and appropriate management plans should be implemented to improve patients’ outcomes.

Abstract Background Self-efficacy is a widely applied psychosocial concept that is commonly used in association with management of chronic diseases, including hypertension. The aim of this study was to assess self-efficacy of hypertension management and patient-physician communication, as well as the factors associated with self-efficacy and patient-physician communication among patients with hypertension in Palestine. Methods We conducted face-to-face, questionnaire-based interviews using validated instruments to assess self-efficacy in managing hypertension (Self-Efficacy for Managing Chronic Disease 6-Item Scale (SES6C)) and patient-physician communication (Perceived Efficacy in Patient-Physician Interaction Questionnaire (PEPPI)) in patients with hypertension at the three main primary healthcare centers in Nablus district in northern West Bank, Palestine. We also performed a multiple linear regression analysis to determine the variables independently associated with PEPPI and SES6C scores. Results We enrolled 377 participants with hypertension in this study. The average age (measured in years) was 56.8 with a standard deviation of 11.6. The mean PEPPI and SES6C scores were 20.0 (SD 4.4) and 41.1 (SD 10.6), respectively. In a multiple linear regression model, subjects who were city dwellers (B=3.597, p=0.004), and subjects with high education levels (B=4.010, p=0.001) achieved higher PEPPI scores, whereas subjects in the normal weight category (B=5.566, p

Abstract Background Chronic kidney disease is considered as a global health problem. Hemodialysis (HD), following renal transplantation, is the most common form of renal replacement therapy. However, HD may impact the quality of life (QOL). Pain is a frequent complaint among this population that also affects their QOL. The purposes of this study were to assess pain and QOL among end-stage renal disease (ESRD) patients on HD and to examine their association. Methods This was a multicenter, cross-sectional study that occurred in Palestine between August and November 2018. Brief Pain Inventory and European Quality of Life scale 5 dimensions (EQ-5D) scale, including its European Quality of Life visual analogue scale (EQ-VAS) component, were used to assess pain and QOL, respectively. Results A total of 300 participants were included in the final study. The average age of the subjects was 54 ± 16 years. Their median EQ-5D score was 0.68 [0.54–0.88], whereas their median EQ-VAS score was 60 [40–75]. A statistically significant association of pain severity score with EQ-5D score was found (r = − 0.783, p

Abstract Background Women frequently complain of lower urinary tract symptoms (LUTS) during pregnancy due to multiple physiological and potentially pathological changes. Still, there is limited data on the characteristics of LUTS for pregnant women in Palestine. Therefore, this study was designed to assess LUTS among pregnant women in Palestine, in addition to identifying factors that exacerbate LUTS during pregnancy. Methods We devised a cross-sectional, questionnaire-based study that used the Urinary Distress Inventory (UDI) and the Incontinence Impact Questionnaire (IIQ) tools to assess LUTS during pregnancy in an antenatal care clinic setting. Multiple linear regressions were conducted to determine variables that significantly related to LUTS (UDI-6 and IIQ-7 scores as dependent variables). Results The study recruited 306 pregnant women. Regarding LUTS findings, the participants scored a mean of 31.9 ± 24.9 out of 100 points (6.7 ± 5.2 out of 21) for the IIQ-7 scale and a mean of 31.2 ± 19.2 out of 100 points (5.6 ± 3.4 out of 18) for the UDI-6 scale. Regression analysis showed that older women (p = 0.031), women with a higher body mass index (p

Abstract Background Lower urinary tract symptoms (LUTS) are prevalent among pregnant women. Several articles show the impact of LUTS on pregnant women’s quality of life (QoL). This study was designed to examine the impact of non-pathological LUTS on QoL among pregnant Palestinian women. Methods A cross-sectional, hospital-based study was conducted on women who were pregnant and receiving regular antenatal care at the obstetrics and gynecology clinic in Rafidia Hospital, Palestine. This self-administered questionnaire included the Urinary Distress Inventory – short-form (UDI-6), the Incontinence Impact Questionnaire – short-form (IIQ-7), the European Quality of Life scale – 5 dimensions (EQ-5D), and the European Quality of Life – visual analogue scale (EQ-VAS). A convenience sampling method was used. In addition to this, multiple linear regression analyses were performed aiming to identify variables that have a significant relationship with QoL (i.e. socio-demographic variables, UDI-6 score, and IIQ-7 score). Results This study included a total of 306 pregnant women. Participants had a mean age of 26.9 years (SD, 3.6). The subjects scored an average of 31.2 ± 19.2 out of 100 points for the UDI-6 scale and an average of 31.9 ± 24.9 out of 100 points for the IIQ-7 scale. On the other hand, the subjects’ average EQ-5D and EQ-VAS scores were 0.76 ± 0.17 and 67.96 ± 19.28 respectively. The subjects’ responses on UDI-6 significantly correlated with their responses on both the EQ-5D and EQ-VAS scales (r = − 0.338, p

Abstract Background The use of radiological examination is increasing worldwide. Since radiation exposure can result in many health hazards, medical professionals, as well as medical students, should possess adequate knowledge regarding radiation and its related hazards to protect themselves and the patients. Many studies have assessed medical students’ knowledge on this topic, but never in Palestine. In this study, we aimed to examine Palestinian medical students’ awareness and knowledge regarding radiological examination modalities and their risks on themselves and their patients. Methods This was an observational, cross-sectional, population-based study, conducted to assess the awareness of radiation exposure and its risks among Palestinian medical students. An online questionnaire was implemented on medical students at An-Najah National University. A total knowledge score that ranged from 0 to 22 was calculated for each participant, with higher scores indicating better knowledge regarding radiation doses and the related hazards. Results Two hundred eighty and seven students participated in our study, with a response rate of 71%. The average knowledge score of the participants was 10.97 ± 4.31 out of a maximum of 22 points. Male participants and participants in advanced study years achieved better knowledge scores (p-values were 0.034 and

Abstract Background Snakebites are emergent and life-threatening injuries that may require intensive care. Physicians face difficulties in dealing with snakebite injuries due to the knowledge gaps in the diagnosis and management of snakebites. The study aimed to assess medical students’ knowledge about the diagnosis and management of snakebite injuries, as well as their proficiency in first aid methods in case of snakebite and perception regarding snakes and snakebite injuries. Methods A cross-sectional study conducted among 200 medical students in their clinical years at An-Najah National University. A questionnaire was developed and distributed among those students. The questionnaire assessed the students’ knowledge regarding the diagnosis and management of snakebites and their attitude regarding snakes and snakebites. The total scores of knowledge were obtained and tested based on the participants’ demographic characteristics using the Kruskal-Wallis test and the Mann-Whitney U test. P-values of

Abstract Background Patients on hemodialysis (HD) commonly suffer from poor sleep quality which in turn compromises their quality of life and well as their mortality risk according to many studies. In Palestine however, no single study had emphasized the association and prevalence of sleep quality and daytime sleepiness among hemodialysis patients (HDP). Therefore, we conducted this study to determine the relationship between regular HD and the situation regarding sleep quality and daytime sleepiness in HDP. Methods In this cross-sectional survey, we targeted HDP at one HD center in An-Najah National University Hospital. Sleep problems were assessed by both the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS), which are considered as standardized tools for the assessment of sleep quality and daytime sleepiness, respectively. Results Of the 192 dialysis patients who were interviewed, 167 were included in the final analysis of this study, with a response rate of 87%. The mean age of the participants was 57.6 ± 12.9. Fifty-two percent were males, and an equal percentage of the participants were 60 years old or older. The median ESS of the participants was 7 [4–11] and 43.1% of the participants had 9 or more ESS score, indicating excessive daytime sleepiness. The median PSQI score was 8 [6–12] and 76.65% of the participants scored more than 5 points on the PSQI, indicating poor sleep quality. Neither the ESS score nor the PSQI score were significantly associated with any particular category of participants, based on their demographic or clinical characteristics. Conclusions In conclusion, we found that dialysis patients had poor sleep quality, evident by their high median PSQI score, though their excessive daytime sleepiness was less evident by their median ESS score in the high normal values. Additionally, we found a high prevalence of poor sleep quality among HDP, whereas excessive daytime sleepiness was less prevalent. Finally, no significant association was found between either of the two scores and the participants’ demographic or clinical characteristics surveyed in this study.

Abstract Background Accurate knowledge and good pain evaluation and documentation practices should be present for efficient pain management. In this study, we aimed to assess the knowledge and practices of nurses relating to the management of cancer pain in Palestine, and to determine the barriers to efficient pain control in cancer patients. Methods A cross-sectional survey took place at 8 hospitals across Northern West Bank. A convenience sample of 220 Nurses working in governmental and private hospitals in West Bank/Palestine was studied. For that purpose, a questionnaire was developed to assess knowledge, practices, perceived barriers, and delaying processes relating to cancer pain management (CPM). Results In total, 220 questionnaires were completed with a response rate of 88%. Participants’ mean age was 30.34 years. Overall, 69.5% worked in governmental hospitals, 26.8% worked in the private sector and the remainder worked in both governmental and private sectors. The correct response rate to questions that assess knowledge relating to cancer pain control was calculated and a mean knowledge score was found to be 5.1 with a standard deviation of 2.1. A relationship between the knowledge score and the sample characteristics was made and showed that males scored significantly higher (p = 0.001) than females with median scores of 6 [4–7] and 5 [3–6] for males and females, respectively. Inadequate pain assessment (76.8%), insufficient knowledge of pain control (70.5%) and strict regulation on opioid use (69.5%) were the most frequently perceived barriers. Nurses reported that they would assess pain on every round and check all items related to pain assessment. Contacting the physician for the prescription of opioids was cited as the main delaying process by 56.4% of participants. Conclusions This study allowed us to recognise the knowledge deficit and the barriers to effective management. On the other hand, the analysis has shown good pain documentation practices among nurses. Those knowledge deficits demonstrate the need for more education about CPM. The improvement of coordination and communication between physicians and nurses seems to play a crucial role in CPM, as contacting physicians was cited as the most delaying process in CPM by nurses.

Abstract Background Teaching Complementary and alternative medicine (CAM) in medical schools is becoming prevalent worldwide. Few studies have been conducted to evaluate medical students’ knowledge and attitude toward CAM. Therefore, this study was designed to assess CAM knowledge, attitudes, and beliefs among Palestinian medical students. Methods This study was developed in a cross-sectional design. It targeted medical students at An-Najah National University, between January and April of 2018. We gathered the data from students using a questionnaire printed as a hard copy. Medical students of both sexes in their 4th, 5th, or 6th year of studies were included in the survey. The questionnaire consisted of 3 sections: demographic characteristics and detailed practices of the participants, their attitude and held beliefs towards CAM, and their knowledge on CAM. Mann-Whitney U Test and Kruskal-Wallis Test were used to test if there were differences between knowledge about CAM and the characteristics of the participants. Results Of the 300 medical students who were offered the questionnaire, 251 students (43.8% male and 56.2% female) were included in the final analysis. Out of a maximum of 8 points, the mean knowledge score of the participants was 2.0 ± 1.6. The Kruskal-Wallis test showed a statistically significant difference in overall knowledge score among students of different year groups, with students at lower levels obtaining higher scores (P

Background. Snakebite is a serious and important medical emergency encountered in many parts of the world. The estimated number of victims of venomous snakebites in Palestine is about 100 to 150 annually, with death occurring in 2 to 3 of them. This study was designed to assess the level of knowledge on the diagnosis and management of snakebites among nursing students in Palestine, as well as their attitude towards snakebites. Methods. This was a cross-sectional survey that took place at An-Najah National University. Two hundred nursing students were asked to fill a questionnaire that was developed to assess the participants' knowledge and attitude regarding snakebite's diagnosis and management. Different knowledge scores were calculated, and the relationships between students' knowledge and their characteristics were calculated by implementing the Mann–Whitney U test and the Kruskal–Wallis test. The statistical significance limit of p values was set at 0.05. Results. The majority of the participants (57%) were fourth-year students with an average age of 20.7 ± 1. Areas of knowledge and the participants’ mean scores on them were as follows: Vipera palaestinae snake, 5.1/13; signs and symptoms, 9.6/16; laboratory investigations, 6.1/10; anti-venom, 4.2/11; and first aid, 6.6/15. The only statistically significant differences in knowledge were between male and female students on Vipera palaestinae (male students scored higher, p value = 0.004) and between different types of residence (village dwellers scored the highest, p value = 0.041). Conclusions. We found knowledge gaps in many aspects of snakebite’s diagnosis and management among nursing students in Palestine. Based on the results of this study, we suggest integrating more materials on this topic in the curriculum of Palestinian nursing schools, as well as more practical training, which will positively reflect on the care for snakebite victims.