Search

Nasser Abu-El-Noor,1,2,* Yousef Aljeesh,1,2,* Saeb Aliwaini,2,3,* Sohaib Alhamss,2,4,* Reda Darwish,2,* Mysoon Abu-El-Noor1,2,* 1Faculty of Nursing, Islamic University of Gaza, Gaza, Palestine; 2Research and Development Center at Turkish-Palestinian Friendship Hospital, Gaza, Palestine; 3Faculty of Science, Islamic University of Gaza, Gaza, Palestine; 4Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine*These authors contributed equally to this workCorrespondence: Mysoon Abu-El-Noor, Islamic University of Gaza, PO Box 108, Gaza, Palestine, Tel + 970 8 2832000, Fax + 970 8 2644800, Email maziz@iugaza.edu.psPurpose: The purpose of this study was to (1) identify the priorities of oncology research in the Gaza Strip; (2) explore the needs for improving oncology research in the Gaza Strip, Palestine.Participants and Methods: A qualitative approach for data collection was used in this study. After obtaining the ethical approvals to conduct this study, a sample of 42 health-care providers who are involved in providing oncology care and research in the Gaza Strip were included in this study. Data were collected by the researchers through seven focus groups. Thematic coding was used for data analysis. Two main themes and several sub-themes were extracted during the data analysis.Results: The two main themes extracted from data analysis were research priorities and research needs. Participants identified several priorities in relation to oncology research that are assessing for cancer awareness, cancer prevention, exploring and finding new molecular biomarkers, screening for germ-line mutations related to the most common cancers, determining genetic and environmental risk factors for developing cancer, and exploring and testing new cancer therapies. Concerning research needs, participants identified several needs to enhance oncology research, which are financial needs, need for training, availability of data, creation of interdisciplinary research teams, and transforming in vitro studies to in vivo.Conclusion: Well-designed studies will certainly help to identify the priorities and needs to improve oncology research in the Gaza Strip, which is considered one of the most important steps to help push these priorities onto the agenda of health policymakers. Therefore, they will work to set goals and design policies and programs aiming to reduce incidence and prevalence rates of cancer in the Gaza Strip, promote early detection of cancer, improve prognosis, and reduce mortality related to cancer.Keywords: research needs, research priorities, oncology care, focus group, gaza strip

Nidal A Younes,1 Raeda AbuAlRub,2 Hussam Alshraideh,3,4 Munir A Abu-Helalah,5 Sohaib Alhamss,1 Omar Qanno’1 1Department of Surgery, Faculty of Medicine, University of Jordan, Amman, Jordan; 2Department of Community and Mental Health, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan; 3Industrial Engineering Department, Faculty of Engineering, Jordan University of Science and Technology, Irbid, Jordan; 4Industrial Engineering Department, American University of Sharjah, Sharjah, UAE; 5Department of Public Health, Faculty of Medicine, Mutah University, Alkarak, JordanCorrespondence: Nidal A Younes Email younesnidal@gmail.comBackground: Mandatory relicense of all physicians in Jordan went into effect at the beginning of May 2018. The bylaw states that all physicians should engage in Continuing Professional Development (CPD) in order to upgrade their knowledge and maintain competency as a prerequisite to renew their license every 5 years. The characteristics of effective CPD are different from one country to another. Jordan has decided to link CPD to mandatory relicense; however, no research has been done to identify the factors that influence CPD offerings, needs, practices, experiences, and effectiveness in the healthcare sector in Jordan. This paper reviews the history of CPD and CME, and the different options to upgrade and improve the competence of physicians. It explores the current practices, motivation, and barriers for physicians to get engaged in CPD activities in Jordan.Purpose: The purpose of this research was to provide a better understanding of the state of CPD in the healthcare sector in Jordan with a view to informing the development of Jordan’s first CPD framework. The findings of this research will provide policymakers with baseline information concerning current CPD practices, experiences, and attitudes of physicians towards CPD, and enablers and contributors to effective CPD in Jordan.Methods: Stratified clustered self-selected participants that represented physicians working at all healthcare sectors in Jordan were used in this study. A structured pre-tested self-reported questionnaire was used to collect the data. A total of 457 physicians were included in the sample according to one-proportion sample size calculation method, and they were distributed among the healthcare sectors based on their shared proportions.Conclusion: Despite considerable evidence supporting the role of CPD in maintaining competency of physicians, participating in CPD activities in Jordan is compromised by lack of mandatory laws and barriers related to staff shortage, heavy workload, limited funds, lack of time, and cost. Personal interests and career progression are the top motivators for CPD. Most Jordanian physicians are interested in CPD activities related to health/medical informatics and enhancing their skills in evidence-informed practice. We recommend that future interventions and health policy directions should be informed by these findings in order to optimize uptake of CPD programs in Jordan.Keywords: continuing professional development, continuing medical education, CPD, CME, accreditation, re-license, Jordan

Uncertainty remains whether it is best for men to void in a sitting or standing position. The objective of this study is to evaluate the effect of standing and sitting voiding position on uroflowmetry parameters and post void residual urine (PVRU) in patients with lower urinary tract symptoms (LUTS) due to benign prostate hyperplasia (BPH) and healthy men. A total of 116 participants with BPH (Group 1) and 78 healthy men (Group 2) were enrolled in the study. The uroflowmetry parameters were measured in both positions. The PVRU volume was measured using transabdominal ultrasound after each voiding. Uroflowmetry parameters and PVRU were measured and compared between the two different voiding positions using Wilcoxon signed rank test. In Group 1, there were significant statistical differences in uroflowmetry parameters between standing and sitting voiding position. The median of maximum flow rate in Group 1 in standing and sitting position was 14.7 ml/s (IQR; 11.7-17.5) and 11 ml/s (IQR; 8.9-13.3), respectively ( p < .0001). The median voided volume at standing position was 340 ml (IQR; 276-455) while it was 267 ml (IQR; 194-390) at sitting position ( p < .0001). Median average flow rate in standing position was 5.9 ml/s (IQR; 4.5-7.5) and 5 ml (IQR; 3.2-6.4) in sitting position. There was a statistically significant difference between the median of PVRU in standing and sitting position ( p < .0001). In patients with BPH, voiding in standing position showed better uroflowmetry parameters and significant less PVRU volume.

Background: Indeterminate pulmonary nodules (IPNs) are common during initial evaluation of bladder cancer patients. Their significance is still unknown., Objective: Determine the significance of indeterminate pulmonary nodules, including their size and number, in muscle-invasive bladder cancer patients before definitive local therapy by surgery or chemo-radiotherapy., Design: Retrospective review, single-center descriptive study., Settings: A tertiary cancer center., Patients and Methods: We performed a retrospective review of patients who underwent definitive local therapy of bladder cancer by either radical cystectomy and lymph node dissection or with chemo-radiotherapy between January 1997 and December 2015. We identified patients with baseline CT scans done during staging work-up prior to definitive treatment. Patients with proven clinical metastasis at pre.sentation were excluded, while patients who had IPNs without features suggesting metastasis were included., Main Outcome Measures: Disease-free survival and overall survival., Sample Size: 168 patients., Results: The median age of patients at diagnosis was 66 years; 92% were males and 56% were smokers. IPNs (3 cm or less) were present in 74 patients (44.0%). Median follow-up was 24 months. IPNs were associated with decreased disease-free survival while IPNs did not affect the overall survival (HR=1.9; 95% CI: 1.1-3.4); P=.01 and HR=1.5; 95% CI: 1.0-2.5); P=.07, respectively. In addition, nodules greater than 1 cm had reduced disease-free survival (HR=2.5; 95% CI: 1.1-5.9); P=.04. In the surgery group (n=126), the median number of lymph nodes excised was 14, with no association between lymph nodes status and the presence of IPNs (P=.08)., Conclusion: The presence of IPNs, especially nodules greater than 1 cm had a negative effect on disease-free survival. Tailored postoperative follow-up of these patients may impact disease outcomes., Limitations: The retrospective nature, the lack of standardized preoperative imaging protocols, the lack of a central radiology review and the small number of patients., Conflict of Interest: None.

Objective: Translocation renal cell carcinoma (TRCC) represents 1% to 5% of all cases of renal cell carcinoma (RCC), with the highest frequency among children and young adults. Management of these tumors is ill defined. We sought to characterize clinicopathological features of TRCC and patterns of medical and surgical management in a middle eastern health institute., Material and Methods: Clinical and pathological data of 23 patients from a single institution diagnosed with TRCC between January 2005 and July 2017 were retrospectively reviewed. We dichotomized patients based on demographics, methods of surgical approach and pathologic tumor stage. We then evaluated the methods of medical management for metastatic disease and response to treatment based on cancer-specific survival (CSS) and progression-free survival (PFS)., Results: The median age at diagnosis was 37 years. Fifteen (65%) patients were male. Most of the patients were diagnosed incidentally (65%) during abdominal imaging for other reasons. The mean tumor size was 9 cm, 47% of the patients had pathologic ≥ T3 stage. Eleven patients had lymph node dissection for clinically enlarged lymph nodes, 7 of which (64%) had lymph node metastasis. Partial nephrectomies were performed for three tumors. Eight patients had metastasis (34.7%), and 3 of them had metastasis at the time of diagnosis. Six patients received sunitinib for the treatment of metastatic disease, one patient had complete response, 4 patients had stable disease and one had disease progression. Three patients died during follow-up period because of development of metastasis at postoperative 4 (n=1), and 21 (n=1) months, and cerebral hemorrhage (n=1). The mean follow-up period was 35 months and 3-year disease-free survival was 75%., Conclusion: TRCC is rarely seen but carries significant risk of disease progression with potential response to targeted therapy.