Experiences and Health Outcomes of Emerging Adults with Type 1 Diabetes: A Mixed Methods Study.

BACKGROUND: Emerging adults with type 1 diabetes are at risk of poorer diabetes-related health outcomes than other age groups. Several factors affecting the health and experiences of the emerging adults are culture and healthcare specific. OBJECTIVES: The aim of this study was to explore the experience of emerging adults living with type 1 diabetes in Lebanon, describe their diabetes self-care and diabetes-related health outcomes (HbA1c and diabetes distress), and identify the predictors of these outcomes. METHODS: A convergent mixed methods design was used with 90 participants aged 18-29 years. Sociodemographic, clinical data, and measures of diabetes distress, social support, and self-care were collected. Fifteen emerging adults participated in individual semi-structured interviews. Multiple linear regression was used to determine predictors of diabetes outcomes. Thematic analysis was used to analyze qualitative data. Data integration was used to present the mixed methods findings. RESULTS: The study sample had a mean HbA1c of 7.7% (SD = 1.36) and 81.1 % reported moderate to severe diabetes distress levels. The participants had good levels of diabetes self-care and high levels of social support. HbA1c was predicted by insulin treatment type, age at diagnosis, and diabetes self-care; while diabetes distress was predicted by diabetes knowledge, blood glucose monitoring approach, and diabetes self-care. "Living with type 1 diabetes during emerging adulthood: the complex balance of a chemical reaction" was the overarching theme of the qualitative data, with three underlying themes: "Breaking of bonds: changes and taking ownership of their diabetes", "The reactants: factors affecting the diabetes experience", and "Aiming for equilibrium". The integrated mixed methods results revealed one divergence between the qualitative and quantitative findings related to the complexity of the effect of received social support. DISCUSSION: The suboptimal health of the emerging adults despite good self-care highlights the importance of addressing cultural and healthcare specific factors such as diabetes knowledge and public awareness, social support, and availability of technology to improve diabetes health. Findings of this study can guide future research, practice, and policy development.

Pain Self-Management in Individuals With Chronic Musculoskeletal Pain During Lebanon's Overlapping Crises.

OBJECTIVES: With Lebanon facing multiple crises simultaneously, it is important to understand how Lebanese adults with chronic musculoskeletal pain (CMP) are self-managing their pain amidst challenging circumstances. This study aimed to describe the pain self-management strategies Lebanese adults with CMP are using, as measured by the Arthritis Pain Self-Management Inventory (APSI), and to determine how helpful they perceive these strategies to be for pain relief. A secondary aim was to translate, culturally adapt, and validate the APSI in Lebanese adults with CMP. METHODS: A descriptive design was used and a convenience sample of 154 Lebanese adults with CMP completed the Arabic version of the APSI and self-report measures of pain intensity and sociodemographic and clinical characteristics. RESULTS: The APSI demonstrated acceptable content and cultural validity in Lebanese adults with CMP. Self-directed arthritis education was the strategy used by the largest number of participants, although it was perceived as the second least helpful for pain relief. The second and third most common strategies used were rest/relaxation, warm baths, and maintaining a healthy weight. The most helpful strategy was maintaining a healthy weight, followed by watching religious television, music therapy, and the use of braces or splints. CONCLUSIONS: Lebanese adults with CMP should actively participate in their pain management plan and be educated on the various strategies they could use to effectively self-manage their pain.

Psychometric Evaluation of the Heart Failure Somatic Perception Scale in a Middle Eastern Heart Failure Population.

BACKGROUND: The Heart Failure Somatic Perception Scale (HFSPS) is an 18-item instrument used to assess how bothersome are common signs and symptoms of heart failure (HF). To date, the psychometric properties of the HFSPS have been tested in American, Italian, and Japanese samples. OBJECTIVE: The aim of this study was to evaluate the validity and reliability of the HFSPS in a population of Lebanese patients living with HF. METHODS: A rigorous translation and back-translation process was performed. Cultural appropriateness ratings were assessed by an expert panel. Exploratory factor analysis was conducted to confirm construct validity, whereas an independent t test using the Minnesota Living With HF Questionnaire's scores was conducted to confirm convergent validity. Pearson correlation was performed to confirm discriminant validity using the Self-Care in HF Index Management subscale, whereas predictive validity was evaluated using the Control Attitudes Scale-Revised. Internal consistency reliability was evaluated using Cronbach α. RESULTS: A total of 109 patients (mean age, 63.66 ± 10.55 years; 69.7% male) were included. A series of exploratory factor analyses was conducted and resulted in a 4-factor model. Cronbach α was 0.869. Convergent (high correlation with total Minnesota Living With HF Questionnaire; r = 0.762, P < .0001), discriminant (no correlation with self-care management; r = 0.180, P = .078), and predictive (significant correlation with the Control Attitudes Scale-Revised; r = -0.523, P < .0001) validity was supported. CONCLUSION: The reliability and validity of the HFSPS were supportive in this Middle Eastern sample. The HFSPS can be used to assess how bothersome HF symptoms are to improve their management.

Unfolding parental knowledge, attitudes, and beliefs toward palliative care for children with cancer.

BACKGROUND: Parents' views toward pediatric palliative care (PPC) remain underexplored, especially in low/middle-income countries where care relies heavily on families. A better understanding of parents' perspectives would inform strategies to support PPC integration into the care of children with cancer. This multicenter study aimed to examine knowledge, attitudes, and beliefs toward PPC among parents of children with cancer in Lebanon to uncover areas for improvement and determine associated factors. METHODS: Using a quantitative cross-sectional descriptive design, 105 primary caregivers (RR = 95.4%) were recruited during the child's visit to one of three pediatric oncology centers in Lebanon. Data were collected through structured interviews using questionnaire items newly developed or taken from validated tools. Data were analyzed using descriptive statistics, correlational analysis, and multiple linear regression. RESULTS: Only 18/105 participants (17.1%) had heard about PPC and 2% had accurate information about it. When given a brief description, more than 90% endorsed PPC and recommended its integration upon the child's diagnosis. Respectively, "Religious and spiritual engagement" and "Overwhelming negative emotions" were the most cited facilitators and barriers to integrating PPC. Knowledge, attitudes, and beliefs were significantly associated with several demographic and clinical factors such as education level, number of persons living with the child, child's symptom count, and pain score. CONCLUSION: This research is among the very first studies conducted to examine parents' perspectives toward PPC for children with cancer in Lebanon. Study findings inform future directions to promote PPC in limited-resource settings through expanded research, policy, education, and practice initiatives.

Towards better out-of-hospital cardiopulmonary resuscitation: A survey of nurses.

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.

Patients' knowledge and attitudes about myocardial infarction.

Delay in seeking emergency care contributes significantly to the mortality associated with myocardial infarction. The aims of this descriptive study were to determine Lebanese patients' knowledge, attitudes, and beliefs about heart disease following their hospitalization for acute myocardial infarction, the factors associated, and to investigate the education they receive about heart disease. The study targeted 50 participants diagnosed with myocardial infarction who were interviewed about their knowledge, attitudes, and perceived control related to heart disease in their home 1 month after being discharged from hospital using the Acute Coronary Syndrome Response Index and the Control Attitude Scale-Revised. The findings showed inadequate knowledge, with only 26% scoring over 70%. Moreover, only 16% reported having received education about heart disease. The participants reported confidence in recognizing symptoms and getting assistance during a myocardial infarction. However, their beliefs regarding the importance of prompt seeking of emergency care for myocardial infarction and control over their disease were inconsistent. Patient education and counseling about recognizing and responding adequately to symptoms of myocardial infarction must be improved in both acute and primary healthcare settings.

Factors Associated With Continued Smoking in Lebanese Patients With Acute Coronary Syndrome.

BACKGROUND: Smoking in patients with acute coronary syndrome (ACS) increases their risk for recurrent events and death. OBJECTIVES: The aim of this study was to describe the smoking trajectory among patients hospitalized with ACS and associated factors. METHODS: Forty patients with ACS who were smokers were interviewed in the hospital about smoking history, nicotine dependence, depression, self-efficacy, and social support. Phone interviews at 1, 3, 6, and 12 months after discharge assessed smoking status and related factors. RESULTS: Most patients (≥80%) were middle-aged married men, with high nicotine dependence (52.5%) and low self-efficacy for smoking cessation (mean [SD], 38.3 [27.19]) at baseline. Although 85% intended to quit after discharge, 62.5% continued smoking after 1 year. Persistent smoking was associated with lower self-efficacy (P < .01) and higher depression (P = .025). CONCLUSION: Smoking cessation intervention must start in the hospital and continue for 6 months. The program must target self-efficacy, manage depression, and involve the patient's family.

Symptom prevalence and management in older adult patients in Lebanon.

OBJECTIVE: The purpose of this study is to explore symptoms and the effectiveness of their management in older adult palliative care candidates in Lebanon. The aims of this study were to: (1) determine symptom prevalence in Lebanese older adults who qualify for palliative care; (2) identify the severity and distress of symptoms; (3) identify the prevalence of symptom management and its efficacy; and (4) explore the relationship between overall symptom burden and its correlates. METHOD: This study uses an observational cross-sectional design using convenience sampling (N = 203) to recruit older adults qualifying for palliative care from three major medical centers in Lebanon. RESULT: The mean age of the sample was 78.61 years. The most prevalent symptoms were lack of energy (93.5%), worrying (83.2%), and pain (71.4%). Psychological symptoms had the highest mean scores, preceded only by the physical symptoms and lack of energy. The most treated symptoms were physical with pain having the highest treatment prevalence (91%). Although psychological symptoms were the most burdensome, they were poorly treated. Multiple regression analysis showed that symptom scores had significant positive associations with financial status, social functioning, and comorbidities; there was a negative association with age. SIGNIFICANCE OF RESULTS: Lack of energy and psychological symptoms were the most prevalent, with the latter having the highest mean total symptom scores. Treatment was poor for psychological symptoms and effective for physical ones. Associations were found between age, comorbidity, financial problems, social functioning, and total physical and psychological mean symptom burden scores. More attention needs to be given to psychological symptoms and their management among older adults receiving palliative care.

Prevalence of depression and anxiety in end-stage renal disease: A survey of patients undergoing hemodialysis.

BACKGROUND: Dialysis is a lifelong treatment required by end stage renal disease patients who are not able to undergo renal transplantation. Dialysis impacts the patients' quality of life drastically, increasing the risk of mortality. Depression and anxiety are commonly reported among dialysis patients, but their prevalence and correlates vary by sociocultural context. OBJECTIVE: The aim of this study is to examine the prevalence of anxiety and depression and associated factors among patients receiving hemodialysis at a major tertiary referral medical center in Lebanon that receives patients from all over the country. DESIGN: A cross-sectional, descriptive design was used. METHODS: Ninety patients receiving hemodialysis were targeted using convenience sampling, with a final sample size of 83 patients. The patients were interviewed while undergoing their dialysis session using the Hospital Anxiety and Depression Scale, and asked demographic and clinical questions. RESULTS: The majority of participants were married men over 60 years of age; 48% achieved high school education. Depression was prevalent in 40.8% and anxiety in 39.6%, with 20 patients (24.1%) having both conditions. Although 24.1% self-reported anxiety symptoms, only 2.4% were taking anxiolytics. Illiterate patients had significantly higher depression scores than those with higher levels of education (p = 0.021). Patients who were living with their family had higher anxiety scores than those living alone (p = 0.014). CONCLUSION: Anxiety and depression are underdiagnosed and undertreated in Lebanese dialysis patients. Screening and appropriate referral to mental health specialists are needed.

Medical students' knowledge, attitudes and behaviours related to substance use in Lebanon: a cross-sectional survey.

The study aims were to explore the knowledge, attitudes and behaviours of Lebanese medical students related to substance use and to determine prevalence and psychosocial predictors. A cross-sectional survey of 231 medical students (48.6% male; 53.1% preclinical, 46.9% clinical) was conducted during June 2012-July 2013. The questionnaire addressed knowledge and attitudes about substance use, religiosity, depression, anxiety and demographic characteristics. The knowledge score was 52.7% (standard deviation 14.4%), and was significantly lower in 2nd year students (48.53%) than in 3rd and 4th year students (57.5% and 57.4%) (P < 0.05). Students reported more training in drug abuse than alcohol abuse (38.2% vs. 34.4%). One-fourth reported smoking, 57.7% using alcohol and 46.8% using drugs. Significant predictors of lower substance use included intrinsic religiosity and interest in working in the field. The findings reveal inadequate knowledge and considerable substance use in Lebanese medical students. Therefore, training in substance use and counseling of students are necessary.

A mapping of nursing and midwifery research in the Eastern Mediterranean Region, 2006-2016.

BACKGROUND: Nurses and midwives constitute the largest group of health care professionals globally. Challenges to these professions make it difficult to set regional priorities for policies and research development. AIMS: The purpose of this study was to map current nursing and midwifery research in the Eastern Mediterranean Region. METHODS: Nursing and midwifery schools were identified by each country's nursing and midwifery board and ministries of education/public health. Information was collected for the years 2006-2016 via surveys, websites, Google scholar and expert informants. RESULTS: A total of 299 schools were identified and 241 of these were contacted; 85 completed surveys from 15 countries were analysed. A total of 1116 research topics covered by 3287 publications were identified, many of which were clustered into the five World Health Organization priority areas. The least developed areas were disaster management and emergency preparedness. CONCLUSIONS: This study provides a database of nursing and midwifery research in the Region. Some gaps were identified based on the research priorities of the Region, but these gaps could be addressed by close collaboration among local researchers.

A family-focused intervention for heart failure self-care: conceptual underpinnings of a culturally appropriate intervention.

AIM: A discussion of the conceptual elements of an intervention tailored to the needs of Lebanese families. BACKGROUND: The role of informal caregiving is strongly recommended for individuals with chronic conditions including heart failure. Although this importance is recognized, conceptual and theoretical underpinnings are not well elucidated nor are methods of intervention implementation. DESIGN: Discussion paper on the conceptual underpinning of the FAMILY model. METHODS AND DATA SOURCES: This intervention was undertaken using linked methods: (1) Appraisal of theoretical model; (2) review of systematic reviews on educational interventions promoting self-management in chronic conditions in four databases with no year limit; (3) socio-cultural context identification from selected papers; (4) expert consultation using consensus methods; and (5) model development. RESULTS: Theories on self-care and behavioural change, eighteen systematic reviews on educational interventions and selected papers identifying sociocultural elements along with expert opinion were used to guide the development of The FAMILY Intervention Heart Failure Model. Theory and practice driven concepts identified include: behavioural change, linkage, partnership and self-regulation. IMPLICATIONS FOR NURSING: Heart failure is a common condition often requiring in-hospital and home-based care. Educational interventions targeting the socio-cultural influences of the patients and their family caregivers through a structured and well-designed program can improve outcomes. CONCLUSION: As the burden of chronic diseases increases globally, particularly in emerging economies, developing models of intervention that are appropriate to both the individual and the socio-cultural context are necessary.

Family-centred approaches to healthcare interventions in chronic diseases in adults: a quantitative systematic review.

BACKGROUND: Increasingly there is a focus on self-care strategies for both malignant and non-malignant conditions. Models of self-care interventions have focussed on the individual and less on the broader context of family and society. In many societies, decision-making and health seeking behaviours, involve family members. OBJECTIVE: To identify elements of effective family-centred self-care interventions that are likely to improve outcomes of adults living with chronic conditions. DESIGN: Review paper. DATA SOURCES: MEDLINE (Ovid), CINAHL, Academic Search Complete, PsychInfo and Scopus between 2000-2014. REVIEW METHODS: Quantitative studies targeting patient outcomes through family-centred interventions in adults were retrieved using systematic methods in January, 2015. Search terms used were: 'family', 'spouse', 'carer', 'caregiver', 'chronic', 'chronic disease', 'self-care', 'self-management' and 'self-efficacy'. Reference lists were reviewed. Risk of bias assessment was performed using the Cochrane Collaboration's tool. Data were reported using a narrative summary approach. RESULTS: Ten studies were identified. Improvements were noted in readmission rates, emergency department presentations, and anxiety levels using family-centred interventions compared with controls. Elements of effective interventions used were a family-centred approach, active learning strategy and transitional care with appropriate follow-up. CONCLUSIONS: Involving the family in self-care has shown some positive results for patients with chronic conditions. The benefits of family-centred care may be more likely in specific socio-cultural contexts. LIMITATIONS: The review has year limits and further research needs to identify support for both the patients and family caregivers.

Protocol for a block randomised controlled trial of an intervention to improve heart failure care.

AIM: To describe the design of a randomised controlled trial conducted to evaluate a culturally tailored, nurse-led educational intervention. BACKGROUND: Self-care strategies are critical to improving health outcomes in heart failure. The family unit is crucial in collectivist cultures, but little is known about involving the family in the self-care of patients with heart failure. DISCUSSION: Involving the family in the self-care of heart failure is a novel approach. To the authors' knowledge, no one has evaluated it using a randomised controlled trial. CONCLUSION: A valid comparison of outcomes between the control group and the intervention group involved in the study was provided in this trial. The chosen design, randomised controlled trial, enabled the assessment of the intervention. IMPLICATIONS FOR PRACTICE: The application of a family self-care intervention in a collectivist culture was shown to improve clinical and quality outcomes of patients with heart failure. Considering the individual and the community needs is vital in improving these outcomes.

Translation and validation of the Arabic version of the Self-care of Heart Failure Index.

Background Heart failure is a complex clinical syndrome with high demands for self-care. The Self-care of Heart Failure Index (SCHFI) was developed to measure self-care and has demonstrated robust psychometric properties across populations. Aim To assess the psychometric properties of the Arabic version of the SCHFI (A-SCHFI). Discussion The scores of the A-SCHFI administered to 223 Lebanese patients with heart failure were used to validate this instrument. Face and content validity, assessed by a panel of experts, were found sufficient. The three constructs of the A-SCHFI explained 37.5% of the variance when performing exploratory factor analysis. Adequate fit indices were achieved using the modification procedure of controlling error terms with the confirmatory factor analysis. The reliability coefficient was adequate in the maintenance, management and confidence scales. Conclusion Following adaptation, the modified A-SCHFI was shown to be a valid and reliable measure of self-care among the Lebanese population. Implications for practice Cross-cultural adaptation is a rigorous process involving complex procedures and analyses. The adaptation of the A-SCHFI should be further analysed, including sensitivity and test-retest analysis, with methods to assess the degree of agreement among the panel.

Readmission rates and related factors in heart failure patients: A study in Lebanon.

BACKGROUND: Heart failure is the leading cause of hospitalization among older adults in the United States and other developed countries. Readmission rates of heart failure patients is one of the key outcome performance measures used in evaluating the quality of care of these patients. In Lebanon, there are no published data on readmission of heart failure patients. The aim of the study was to examine the readmission rates of heart failure patients within 30, 60 and 90 days of discharge from the hospital, and factors associated with readmission. METHODS: The medical records of all 187 patients admitted with heart failure to Rafic Hariri University Hospital in Beirut between January 1, 2010 and December 31, 2010 were reviewed. Data on demographic and relevant clinical variables were retrieved. RESULTS: Readmission rates were 15%, 22.2%, and 27.8% at 30, 60 and 90 days following discharge, respectively. The majority of readmissions (73.61%) were due to heart failure exacerbations. Significant predictors of readmission were: history of diabetes mellitus, coronary artery disease, length of stay at the index admission and gamma glutamyl transpeptidase levels. Management of the patients did not always conform to the evidence based guidelines. CONCLUSION: The findings suggest the need for better adherence to clinical guidelines in caring for heart failure patients and improved documentation of discharge instructions.

Heart health in Lebanon and considerations for addressing the burden of cardiovascular disease.

INTRODUCTION: Lebanon is a small country located at the western boundary of the Middle East. Approximately 40% of health care in Lebanon is financed by the public sector. Cardiovascular diseases in Lebanon are scarcely addressed in the literature raising the need for baseline data on these health condition to be better treated. AIM: To (1) aggregate and define the burden of cardiovascular disease in Lebanon and (2) describe implications for policy, practice and research to improve health outcomes in Lebanon. METHOD: An integrative review was conducted of both peer-reviewed papers and unpublished reports. CINAHL, Medline, Google Scholar and Academic Search Complete were searched along with the websites of The World Health Organization, Ministry of Public Health Lebanon and Central Intelligence Agency of Lebanon. No year limit was applied to our search. RESULTS: The search yielded 28 peer-reviewed articles and 15 reports. Cardiovascular diseases are the leading cause of morbidity and mortality in Lebanon and is also the primary cause of hospital admission. A range of social, political, economic and cultural factors explain the burden of cardiovascular diseases, some of these risks are culture specific such as the arghile smoking and the high rates of familial hypercholesterolemia. Workforce shortage produced by high rates of migrating nurses also has an implication on the patients' outcomes. Conclusion: Much of the presented data are sourced from the gray literature; more research, using systematic and prospective data collection methods, are needed to inform health services planning, delivery and evaluation. Primary care needs to be enhanced to produce better outcomes for a population with high profile of cardiovascular risk factors.

Surviving testicular cancer: the Lebanese lived experience.

BACKGROUND: Testicular cancer is thought to have a great impact on its survivors, yet there has been limited literature on the topic globally and no literature on the topic in Lebanon and the Arab region. OBJECTIVE: The purpose of this study was to explore the lived experience of Lebanese testicular cancer survivors and gain an in-depth understanding of the psychosexual aspect of their experience. METHODS: A hermeneutic phenomenological approach with semistructured digitally recorded interviews and observational field notes was utilized. A purposive sample of Lebanese testicular cancer survivors, aged between 18 and 50 years, in remission for at least 3 years, and willing to share personal information was recruited. Interviews were transcribed verbatim in Arabic. Data saturation was achieved at the seventh interview; a total of eight informants were recruited. The opening question was, "Tell me about your life since you got treated for testicular cancer," and was followed by probing questions. Two to three weeks after the initial interview, informants were called to validate the investigators' primary analysis. RESULTS: Six core themes emerged: cancer perception in the Lebanese culture; "do not show, do not tell"; cancer experience is a turning point; fertility, manhood, and relationships; coping with cancer; and preserved aspects of life. DISCUSSION: The findings provide an in-depth understanding of the experience of Lebanese testicular cancer survivors with a focus on the psychosexual aspect of this experience. The results suggest the need to educate patients about testicular cancer and its effect on their fertility.

Contrast media induced nephropathy: a literature review of the available evidence and recommendations for practice.

BACKGROUND: Contrast media induced nephropathy (CIN) is a sudden compromise of renal function 24-48 h after administering contrast medium during a CT scan or angiography. CIN accounts for 10% of hospital acquired renal failure and is ranked the third cause of acquiring this condition. Identifying patients at risk through proper screening can reduce the occurrence of this condition. PURPOSE: This review paper aims to critique current evidence, provide a better understanding of CIN, inform nursing practice and make recommendations for bedside nurses and future research. METHOD: An integrative review of the literature was made using the key terms: "contrast media", "nephritis", "nephropathy", "contrast media induced nephropathy scores", "acute kidney failure", "acute renal failure" and "acute kidney injury". MeSH key terms used in some databases were: "prevention and control", "acute kidney failure" and "treatment". Databases searched included Medline, CINAHL and Academic Search Complete, and references of relevant articles were also assessed. The search included all articles between the years 2000 and 2013. RESULTS: Sixty-seven articles were obtained as a result of the search, including RCTs, systematic reviews, and retrospective studies. CONCLUSION: Contrast media induced nephropathy is an iatrogenic complication occurring secondary to diagnostic or therapeutic procedures. At times it is unavoidable but a systematic method of risk assessment should be adopted to identify high risk patients for tailored and targeted approaches to management interventions. CLINICAL IMPLICATIONS: As the use of contrast media is increasing for diagnostic purposes, it is important that nurses be aware of the risk factors for CIN, identify and monitor high risk patients to prevent deterioration in renal function when possible.

Comparison of quality of life in a group of Lebanese type 1 diabetics on insulin pump and those on multiple daily injections.

AIM: The aim of the study is to investigate the differences in the quality of life (QOL) in Lebanese youths with type 1 diabetes using continuous subcutaneous insulin infusion (CSII) and those using multiple daily injections (MDI) treatment modalities. METHODS: A descriptive, cross-sectional, comparative matched design was used. The sample included 36 adolescents and young adults on one of two treatment modalities (CSII or MDI) and matched for age, gender, and level of education. QOL was measured with the Indiana Diabetes Quality of Life for Youth and latest HbA1C level was recorded. RESULTS: The CSII group had significantly lower HbA1C levels (p < 0.001), and reported better health perception (p = 0.029), more satisfaction with life (p = 0.002), less impact of the disease (p = 0.002), and fewer worries about their disease (p = 0.029), compared to the MDI group. The overall quality of life score was also significantly better in the CSII group than in the MDI group (p = 0.001). CONCLUSIONS: Findings suggest that CSII is associated with better glycemic control and QOL in the Lebanese youth population with type 1 diabetes.