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Understanding patients’ decision-making preferences is crucial for enhancing patients’ outcomes. The current study aims to identify Jordanian advanced cancer patients’ preferred decision-making and to explore the associated variables of the passive decision-making preference. We used a cross-sectional survey design. Patients with advanced cancer referred to the palliative care clinic at a tertiary cancer center were recruited. We measured patients’ decision-making preferences using the Control Preference Scale. Patients’ satisfaction with decision-making was assessed with the Satisfaction with Decision Scale. Cohen’s kappa statistic was used to assess the agreement between decision-control preferences and actual decision-making, and the bivariate analysis with 95% CI and the univariate and multivariate logistic regression were used to examine the association and predictors of the demographical and clinical characteristics of the participants and the participants’ decision-control preferences, respectively. A total of 200 patients completed the survey. The patients’ median age was 49.8 years, and 115 (57.5%) were female. Of them, 81 (40.5%) preferred passive decision control, and 70 (35%) and 49 (24.5%) preferred shared and active decision control, respectively. Less educated participants, females, and Muslim patients were found to have a statistically significant association with passive decision-control preferences. Univariate logistic regression analysis showed that, being a male (p = 0.003), highly educated (p = 0.018), and a Christian (p = 0.006) were statistically significant correlates of active decision-control preferences. Meanwhile, the multivariate logistic regression analysis showed that being a male or a Christian were the only statistically significant predictors of active participants’ decision-control preferences. Around 168 (84%) of participants were satisfied with the way decisions were made, 164 (82%) of patients were satisfied with the actual decisions made, and 143 (71.5%) were satisfied with the shared information. The agreement level between decision-making preferences and actual decision practices was significant (ⱪ coefficient = 0.69; 95% CI = 0.59 to 0.79). The study’s results demonstrate that a passive decision-control preference was prominent among patients with advanced cancer in Jordan. Further studies are needed to evaluate decision-control preference for additional variables, such as patients’ psychosocial and spiritual factors, communication, and information sharing preferences, throughout the cancer trajectory so as to inform policies and improve practice.

Quality cancer care is a team effort. In addition, patients’ symptoms change over the course of treatment. As such, the Edmonton Symptom Assessment System (ESAS) is a simple tool designed to quickly monitor symptom change. Here, we present the results from a two-phase study aimed at validating the Arabic version of the ESAS (ESAS-A). Phase one involved the creation of two versions of the ESAS with both reverse and forward translations by bilingual, native Arabic speakers as well as evaluation by an expert panel. The reconciled version was then administered to 20 patients as a pilot from which to create the final version, which was then used with 244 patients. Phase two for the ESAS—involved an ESAS-based validation of 244 adults aged 18 years and older who were diagnosed with advanced cancer; then, further validation was completed in conjunction with two other symptom survey tools, the EORTC-Pal 15 and the HADS. The ESAS-A items possessed good internal consistency with an average Cronbach’s alpha of 0.84, ranging from 0.82 to 0.85. Moreover, the results of ESAS-A showed good agreement with those of EORTC QLQ- 15 PAL (r = 0.36 to 0.69) and HADS (r = 0.60 and 0.57) regarding anxiety and depression. We found the ESAS-A to be responsive to symptom change and a median time to completion of 3.73 min. The results of our study demonstrate that the ESAS-A is a reliable, valid, and feasible tool for the purposes of monitoring symptom change over the course of cancer treatment.

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 oc...

In January 2002, the Jordanian military field hospital was established in Mazar-e-Sharif in Afghanistan to provide medical care to many Afghanis. The Jordanian Military represented by the Royal Medical Services (RMS), a leading health authority in Jordan, was responsible for the staffing, operations, and security of the hospital, while the U.S. military offered logistical support, including the delivery of up to 7,500 different medical supplies and training of the Jordanian Special Forces team to maintain security of the field hospital.In this paper a Jordanian surgeon, who is one of the authors (A.E) shares his experience lasting for 100 days in the Jordanian military field hospital in Afghanistan in 2003 and describes the challenges and strengths/ opportunities of such experience from facilities and resources available to medical staff and surgical treatment provided. In addition, the paper outlines the faced religious, cultural and ethical issues of performing surgery at times of conflict. The 100-day mission had demonstrated the pivotal role surgeons can play in providing essential care and surgical treatment to civilians at times of conflict. A well-organized mission with the right medical expertise can make a real difference in the lives of others and can overcome many logistical, cultural and ethical barriers faced during such hard times.

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.

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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.

Validation of soil mixing for the treatment of contaminated ground is needed in a wide range of site conditions to widen the application of the technology and to understand the mechanisms involved. Since very limited work has been carried out in heterogeneous ground conditions, this paper investigates the effectiveness of soil mixing in stratified sands using laboratory-scale augers. This enabled a low cost investigation of factors such as grout type and form, auger design, installation procedure, mixing mode, curing period, thickness of soil layers and natural moisture content on the unconfined compressive strength, leachability and leachate pH of the soil-grout mixes. The results showed that the auger design plays a very important part in the mixing process in heterogeneous sands. The variability of the properties measured in the stratified soils and the measurable variations caused by the various factors considered, highlighted the importance of duplicating appropriate in situ conditions, the usefulness of laboratory-scale modelling of in situ conditions and the importance of modelling soil and contaminant heterogeneities at the treatability study stage.

The need for data sharing in stem cell research will continue to grow as the field keeps advancing. Yet, without a comprehensive and harmonized governance system to ensure ethical and responsible data and sample sharing, the field is threatened by unethical practices, compromise of participants’ privacy and loss of public trust. In 2014, the Global Alliance for Genomics and Health (GA4GH) developed a common Framework for Responsible Sharing of Genomic and Health-Related Data. At the same year, Jordan passed the first of its kind law in the region for stem cells, Statute number 10 on Stem Cells. Using specific policy principles of the GA4GH Framework and the work of the International Stem Cell Forum (ISCF) Ethics Working Party, we identified several gaps in the Jordanian Statute of Stem Cell including active participation of the public, transparency in the data sharing and access processes, ensuring the quality and safety of the data, maintaining the privacy, security & confidentiality of individuals, their samples and associated data, preforming in-depth risk-benefit analysis and maintaining sustainability of stem cell banks and registries. We recommend revisiting the current Statue in light of the GA4GH Framework, which can be integrated to foster national and international collaboration and support responsible innovation in the discovery of new therapies for cancer treatment.

Breast cancer is the most common cancer in Jordan. Mutations in BReast CAncer susceptibility gene 1 and BReast CAncer susceptibility gene 2 (BRCA1/2 genes) greatly increase the lifetime risk of developing breast and/or ovarian cancer in women. The aim of this paper is to identify functional and non-functional requirements for BRCA 1/2 testing, as a corner stone for establishing BRCA 1/2 testing services in the country and as a case example for other susceptibility genetic testing for cancer. During two sessions, the authors outlined the functional and non-functional requirements for BRCA1/2 testing, as types of categories of requirements, using the Sommerville approach. Six functional requirements were identified. Non-functional requirements were divided to: 1. Product related 2. Process related and 3. Externally related (Interoperability and Legal, Social, Ethical and Professional (LSEP) Implications). The authors will continue to build on their work in order to produce a full model for BRCA1/2 testing to provide the most comprehensive and advanced cancer care for patients and facilitate future development of innovate measures in the battle against cancer.