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Background: Low pre-albumin, body mass index, and thiamine levels have been associated with poor nutritional status and cognitive/memory deficits in adult heart failure patients. However, the relationship of these nutritional/dietary intake biomarkers to cognition has not been assessed in adolescents post-Fontan procedure and healthy controls., Methods: This is a cross-sectional study. Adolescents (14-21 years of age) post-Fontan completion were recruited from paediatric cardiology clinics and controls from the community. The Montreal Cognitive Assessment was administered (normal ≥ 26), and blood draw (thiamine [normal 70-110 nmol/L] and pre-albumin levels [adolescent normal 23-45 mg/dL]) and the Thiamine Food Frequency Questionnaire were completed by all participants., Results: Seventy subjects, 40 post-Fontan (mean age 16 ± 1.6, female 51%, Hispanic 44%, hypoplastic left heart syndrome 26%) and 30 controls (mean age 16.8 ± 1.9, female 52%, Hispanic 66%), were participated. Post-Fontan group had lower median total cognitive scores (23 versus 29, p < 0.001), pre-albumin levels (23 versus 27, p = 0.013), and body mass index (20 versus 24, p = 0.027) than controls. Post-Fontan group had higher thiamine levels than controls (127 versus 103, p = 0.033). Lower pre-albumin levels (< 23) and underweight body mass index were associated with abnormal total cognitive scores (p = 0.030). Low pre-albumin level (p = .038) was an independent predictor of worse cognition., Conclusion: Lower pre-albumin was an independent predictor for worse cognition in adolescents post-Fontan. Lower pre-albumin levels may reflect chronic liver changes or protein-losing enteropathy seen in Fontan physiology. These findings highlight the possibility for nutrition-induced cognitive changes.

Objectives: To examine the knowledge, attitude and practice of nurses in Lebanon regarding out-of-hospital resuscitation, compare hospital nurses to those who work in community settings on the variables of interest, determine the nurses' willingness to attempt resuscitation in the community and identify predictors of their willingness., Background: Only 5.5% of victims survive out-of-hospital cardiac arrest in Lebanon. There is no national guideline for cardiopulmonary resuscitation nor a policy for nurses' training in resuscitation in Lebanon for neither in-hospital nor out-of-hospital settings. However, some hospitals have their own policies., Methods: A cross-sectional descriptive design was used with a cluster sample of 692 working nurses. A 28-item questionnaire developed for this study was mailed to the nurses. Data were analysed with correlational and multivariable regression analyses. The STROBE checklist for observational studies was used in reporting this study., Results: Most nurses received cardiopulmonary resuscitation training, but 19.8% did not renew their certification in the past two years, because of limited training centres and lack of time. Only one third of the sample knew the first step to be taken in an arrest, yet 61% knew the compression-to-breath ratio. Nurses who work in community settings had significantly less frequent training in resuscitation than hospital nurses. Most nurses were willing to resuscitate in the community. In deciding to perform out-of-hospital cardiopulmonary resuscitation, the nurses were mostly influenced by their training, courage, recent practice, policy, fear of infection and hesitation to do mouth-to-mouth breathing. Receiving training, fear of being sued, religious beliefs, geographic location and believing in the importance of training laypeople in resuscitation predicted the nurses' willingness to perform resuscitation in the community., Conclusion: Lebanon needs a national policy on cardiopulmonary resuscitation, regular training of all nurses and a Good Samaritan law., Relevance to Clinical Practice: This study informs policy related to nurses' training in out-of-hospital resuscitation., (© 2021 John Wiley & Sons Ltd.)

Although there is a vast literature on the concept of well-being, there appears to be no consensus regarding its meaning. A clear conceptualization of adolescent well-being is necessary as the foundation for interventions and research addressing this phenomenon. Adolescence is a transitional period characterized by rapid growth, gaining independence, and learning social skills as well as behaviours that lay the foundations for future well-being. Therefore, the purpose of this paper was to analyse the concept of adolescent well-being and identify its attributes, antecedents, and empirical referents based on the literature. The Walker and Avant (2019) method was used. Ninety-four articles were included in the final review. The defining attributes of adolescent well-being were identified as autonomy, connectedness, optimism and competency. The antecedents were grouped under internal and external factors. Internal factors included the behavioural, physical, psychological, and spiritual domains. External factors included the environmental, economic, education, leisure, social, and safety as well as security domains. For the adolescent to reach well-being, all these domains must be present, albeit, the social domain was highly stressed. The consequences of adolescent well-being included eudaimonia, having high resilience as well as low risk-taking behaviours and delinquency. Empirical referents were discussed in terms of ways of measuring the defining attributes. Stemming from the eudaimonic perspective, to promote adolescent well-being, care providers need to integrate in education, practice, and research the importance of establishing positive relations and connectedness, to enhance adolescent autonomy and optimism and assist them to grow into competent and self-fulfilled beings., (© 2021 John Wiley & Sons Australia, Ltd.)

Introduction: Substance use among adolescents is on the rise globally. Adolescents rarely seek help for problematic substance use and healthcare professionals can easily fail to identify adolescents with risky substance use. There is therefore a significant global need for substance use screening by healthcare professionals followed by appropriate intervention. Screening, brief intervention, and referral to treatment (SBIRT) is an evidence-based practice that enables clinicians to determine adolescents' risk for substance use and intervene accordingly. However, little effort has been placed on empowering primary care clinicians to use it in Lebanon. We explored the attitudes, perceptions, and practices of primary care nurses and physicians regarding adolescent SBIRT use., Methods: The study used a cross-sectional multisite survey design targeting urban and rural areas in Lebanon. A national sample of 140 physicians and nurses was recruited using random sampling stratified by governorate. Participants completed mailed or online surveys addressing their practices, attitudes, role perceptions, and self-efficacy regarding SBIRT use., Results: This study revealed that 57.8% of healthcare professionals were not familiar with the SBIRT model and that 76.2% did not practice SBIRT in their setting. The majority addressed the problem of substance use through educating and counseling adolescents about the dangers of substance use (84.2%) and encouraged them to stop (82%) but only 2% reported using standardized instruments for substance use screening. Most participants (88.1%) reported their willingness to use SBIRT in their clinical practice and 92.4% expressed an interest in receiving SBIRT training. Overall, the results showed positive attitudes ( M  = 4.38, SD = 0.89) and role responsibility ( M  = 4.47, SD = 1.62) toward addressing substance use in adolescents, in addition to a high level of perceived self-efficacy in addressing substance use ( M  = 4.04, SD = 0.92). Our results showed minimal differences between nurses' and physicians' perceptions and self-efficacy regarding SBIRT use., Conclusions: Our study confirms the lack of a standardized approach toward adolescent substance use screening and intervention by primary healthcare providers in Lebanon but revealed the readiness and willingness to receive training and proper support to adopt an evidence-based approach such as SBIRT., Competing Interests: Declaration of conflicting interests:The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2021.)

Objective: Children are at a high risk of developing allergic reactions. Since they spend lots of time at the school or day care, the odds of having an allergic event in this setting is high, hence placing the onus of properly managing their event on nurses. In Lebanon, little is known whether a standardised policy for managing allergic and anaphylactic reaction exists, leaving children unsafe and the school personnel liable. Thus, the aim of this study is to describe the current practices in the management of severe allergies and anaphylaxis by Lebanese nurses working in schools and day cares and to explore the perceived need for a protocol to manage anaphylaxis reaction., Methods: A cross-sectional survey with nurses working at schools and day cares in Lebanon was conducted., Results: A total of 59 school and day care nurses participated. Eighteen of the school and day care nurses reported having a written policy describing the management steps. Only 12 had witnessed an anaphylactic event. Of those, 10 reported administering an antihistamine medication orally instead of epinephrine intramuscular. Most respondents (56) believed that a standardised guideline for the management of anaphylaxis was essential, and 9 indicated being hesitant to give the epinephrine intramuscular even in the presence of a policy. Finally, 55 stated the need for training nurses in identifying and managing anaphylaxis as a must., Conclusion: Currently, the management of anaphylaxis reaction in schools and day cares is suboptimal. Hence, there is a need for a standardised nursing guideline and training for nurses in these settings., Competing Interests: Competing interests: None declared.

Background: The survival rate of out-of-hospital cardiac arrest (OHCA) victims in Lebanon is low. A national policy on resuscitation practice is lacking. This survey explored the practices of emergency physicians related to the resuscitation of OHCA victims in Lebanon., Methods: A sample of 705 physicians working in emergency departments (EDs) was recruited and surveyed using the LimeSurvey software (Carsten Schmitz, Germany). Seventy-five participants responded, yielding 10.64% response rate., Results: The most important factors in the participants' decision to initiate or continue resuscitation were presence of pulse on arrival (93.2%), underlying cardiac rhythm (93.1%), the physician's ethical duty to resuscitate (93.2%), transport time to the ED (89%), and down time (84.9%). The participants were optimistic regarding the survival of OHCA victims (58.1% reporting > 10% survival) and reported frequent resuscitation attempts in medically futile situations. The most frequently reported challenges during resuscitation decisions were related to pressure or presence of victim's family (38.8%) and lack of policy (30%)., Conclusion: In our setting, physicians often rely on well-established criteria for initiating/continuing resuscitation; however, their decisions are also influenced by cultural factors such as victim's family wishes. The findings support the need for a national policy on resuscitation of OHCA victims.