Key lifestyles and health outcomes across 16 prevalent chronic diseases: A network analysis of an international observational study.

Background: Central and bridge nodes can drive significant overall improvements within their respective networks. We aimed to identify them in 16 prevalent chronic diseases during the coronavirus disease 2019 (COVID-19) pandemic to guide effective intervention strategies and appropriate resource allocation for most significant holistic lifestyle and health improvements. Methods: We surveyed 16 512 adults from July 2020 to August 2021 in 30 territories. Participants self-reported their medical histories and the perceived impact of COVID-19 on 18 lifestyle factors and 13 health outcomes. For each disease subgroup, we generated lifestyle, health outcome, and bridge networks. Variables with the highest centrality indices in each were identified central or bridge. We validated these networks using nonparametric and case-dropping subset bootstrapping and confirmed central and bridge variables' significantly higher indices through a centrality difference test. Findings: Among the 48 networks, 44 were validated (all correlation-stability coefficients >0.25). Six central lifestyle factors were identified: less consumption of snacks (for the chronic disease: anxiety), less sugary drinks (cancer, gastric ulcer, hypertension, insomnia, and pre-diabetes), less smoking tobacco (chronic obstructive pulmonary disease), frequency of exercise (depression and fatty liver disease), duration of exercise (irritable bowel syndrome), and overall amount of exercise (autoimmune disease, diabetes, eczema, heart attack, and high cholesterol). Two central health outcomes emerged: less emotional distress (chronic obstructive pulmonary disease, eczema, fatty liver disease, gastric ulcer, heart attack, high cholesterol, hypertension, insomnia, and pre-diabetes) and quality of life (anxiety, autoimmune disease, cancer, depression, diabetes, and irritable bowel syndrome). Four bridge lifestyles were identified: consumption of fruits and vegetables (diabetes, high cholesterol, hypertension, and insomnia), less duration of sitting (eczema, fatty liver disease, and heart attack), frequency of exercise (autoimmune disease, depression, and heart attack), and overall amount of exercise (anxiety, gastric ulcer, and insomnia). The centrality difference test showed the central and bridge variables had significantly higher centrality indices than others in their networks (P < 0.05). Conclusion: To effectively manage chronic diseases during the COVID-19 pandemic, enhanced interventions and optimised resource allocation toward central lifestyle factors, health outcomes, and bridge lifestyles are paramount. The key variables shared across chronic diseases emphasise the importance of coordinated intervention strategies.

Effect of psychosocial aspects on medication adherence in patients with heart failure amid socioeconomic challenges.

OBJECTIVE: To evaluate stress, depression and quality of life among community-dwelling patients with heart failure (HF) and evaluate their effect on perceived medication adherence in a socioeconomically challenged setting. DESIGN: A cross-sectional design with self-administered questionnaire with data collected between October 2021 and September 2022. METHODS: Patients with confirmed diagnosis of HF were sought for data collection in the community and cardiology clinics through an electronic platform. Confirmation of cases was done through the ejection fraction, medication list and frequent symptoms of the patients. The Patient Health Questionnaire-9, the COVID-19 Stress Scale, the Minnesota Living with HF Questionnaire and the Lebanese Medication Adherence Scale were used to evaluate depression, stress, quality of life and medication adherence, respectively. Univariate analysis was done to present the descriptive statistics, whereas bivariate and multivariate analyses were done to evaluate the relationship between the variables. RESULTS: A total of 237 participants were included in the final analysis. The mean age was 61.3±17.36 years, and the majority (57.8%) were male participants. Only 44.7% were on ACE inhibitors/angiotensin receptor blockers and 54.9% on beta-blockers. The mean scores for stress, depression, quality of life and medication adherence were 75.86 (SD=24.5), 14.03 (SD=5.7), 55.73 (SD=23.05) and 6.79 (SD=6.93), respectively, indicating high stress levels, depression, poor quality of life and medication adherence. Those with a history of hypertension and depression were significantly more adherent to their medications than those who were not. Multivariate analysis showed that anxiety, medical follow-up, quality of life and functionality class were predictors of medication adherence. CONCLUSION: The study showed the population with HF in Lebanon to have psychological health problems with these variables acting as predictors for medication adherence. Sociodemographic characteristics also played a role on the outcome, which can be targeted when planning interventions to improve outcomes. Future studies should compare prescribed medication with consumed medication through longitudinal approaches and medical refilling techniques when possible.

Key lifestyles and interim health outcomes for effective interventions in general populations: A network analysis of a large international observational study.

Background: The interconnected nature of lifestyles and interim health outcomes implies the presence of the central lifestyle, central interim health outcome and bridge lifestyle, which are yet to be determined. Modifying these factors holds immense potential for substantial positive changes across all aspects of health and lifestyles. We aimed to identify these factors from a pool of 18 lifestyle factors and 13 interim health outcomes while investigating potential gender and occupation differences. Methods: An international cross-sectional study was conducted in 30 countries across six World Health Organization regions from July 2020 to August 2021, with 16 512 adults self-reporting changes in 18 lifestyle factors and 13 interim health outcomes since the pandemic. Results: Three networks were computed and tested. The central variables decided by the expected influence centrality were consumption of fruits and vegetables (centrality = 0.98) jointly with less sugary drinks (centrality = 0.93) in the lifestyles network; and quality of life (centrality = 1.00) co-dominant (centrality = 1.00) with less emotional distress in the interim health outcomes network. The overall amount of exercise had the highest bridge expected influence centrality in the bridge network (centrality = 0.51). No significant differences were found in the network global strength or the centrality of the aforementioned key variables within each network between males and females or health workers and non-health workers (all P-values >0.05 after Holm-Bonferroni correction). Conclusions: Consumption of fruits and vegetables, sugary drinks, quality of life, emotional distress, and the overall amount of exercise are key intervention components for improving overall lifestyle, overall health and overall health via lifestyle in the general population, respectively. Although modifications are needed for all aspects of lifestyle and interim health outcomes, a larger allocation of resources and more intensive interventions were recommended for these key variables to produce the most cost-effective improvements in lifestyles and health, regardless of gender or occupation.

Global impacts of COVID-19 on lifestyles and health and preparation preferences: An international survey of 30 countries.

Background: The health area being greatest impacted by coronavirus disease 2019 (COVID-19) and residents' perspective to better prepare for future pandemic remain unknown. We aimed to assess and make cross-country and cross-region comparisons of the global impacts of COVID-19 and preparation preferences of pandemic. Methods: We recruited adults in 30 countries covering all World Health Organization (WHO) regions from July 2020 to August 2021. 5 Likert-point scales were used to measure their perceived change in 32 aspects due to COVID-19 (-2 = substantially reduced to 2 = substantially increased) and perceived importance of 13 preparations (1 = not important to 5 = extremely important). Samples were stratified by age and gender in the corresponding countries. Multidimensional preference analysis displays disparities between 30 countries, WHO regions, economic development levels, and COVID-19 severity levels. Results: 16 512 adults participated, with 10 351 females. Among 32 aspects of impact, the most affected were having a meal at home (mean (m) = 0.84, standard error (SE) = 0.01), cooking at home (m = 0.78, SE = 0.01), social activities (m = -0.68, SE = 0.01), duration of screen time (m = 0.67, SE = 0.01), and duration of sitting (m = 0.59, SE = 0.01). Alcohol (m = -0.36, SE = 0.01) and tobacco (m = -0.38, SE = 0.01) consumption declined moderately. Among 13 preparations, respondents rated medicine delivery (m = 3.50, SE = 0.01), getting prescribed medicine in a hospital visit / follow-up in a community pharmacy (m = 3.37, SE = 0.01), and online shopping (m = 3.33, SE = 0.02) as the most important. The multidimensional preference analysis showed the European Region, Region of the Americas, Western Pacific Region and countries with a high-income level or medium to high COVID-19 severity were more adversely impacted on sitting and screen time duration and social activities, whereas other regions and countries experienced more cooking and eating at home. Countries with a high-income level or medium to high COVID-19 severity reported higher perceived mental burden and emotional distress. Except for low- and lower-middle-income countries, medicine delivery was always prioritised. Conclusions: Global increasing sitting and screen time and limiting social activities deserve as much attention as mental health. Besides, the pandemic has ushered in a notable enhancement in lifestyle of home cooking and eating, while simultaneously reducing the consumption of tobacco and alcohol. A health care system and technological infrastructure that facilitate medicine delivery, medicine prescription, and online shopping are priorities for coping with future pandemics.

Follow up from the Lebanese Heart Failure Snapshot: Reflection of geopolitical instability.

BACKGROUND: Heart failure has a great cost on the health care system. The readmission and mortality rates and their predictors are greatly affected by political and sociocultural unrests. AIMS: To determine the readmission and mortality rates and their predictors in heart failure population in times of political and sociocultural unrests. DESIGN: A cross-sectional follow-up with patients recruited for the Lebanese Heart Failure Snapshot was conducted over the month of June in 2019. METHODS: Phone calls were conducted at 30-90 days, 6-12 months following hospital discharge for patient previously admitted to one of the study hospitals for heart failure exacerbation. Follow-up data was conducted from July 2019 till May 2020. FINDINGS: The mean age of the 120 participants was 71 years with a mean ejection fraction of 41%. The 30-90 days, 6-12 months readmission rates were 20%, 56%, 75%, and 78%, respectively. Readmission predictors were non-sinus rhythm and low diastolic blood pressure at admission. Mortality rates at 30-90 days, 6-12 months were 7%, 11%, 17%, and 28%, respectively. Low diastolic blood pressure and longer length of hospital stay were associated with mortality. CONCLUSION: The rapid changes in the country make it difficult to formulate an intervention plan. This was seen in the increased rates of readmission and the decreased rates of mortality. Rigorous research should be conducted at every phase of the sociocultural changes in developing countries that were hit by the COVID-19 pandemic and had their economy largely affected. IMPACT: The occurrences of the countries can greatly influence the outcomes of patients with heart failure. This is true in developing countries that were affected by the COVID-19 pandemic socially, economically, and politically. Research should be done regularly to establish the effect of these changes on patients with heart failure. Nevertheless, nursing roles are the common denominator that should be adapted to all the changes and provided despite all challenges to assure improved outcomes. Such practices include discharge education tailored to the subjective needs of the patients and continuous, uninterrupted follow-up despite of all the occurrences. These practices are likely to decrease adverse outcomes in patients with heart failure.

A multi-centric study on validation of the Fear Scale for COVID-19 in five Arabic speaking countries.

BACKGROUND: The Eight-item Fear Scale is a unidimensional scale evaluating the perceived feelings of fear associated with the thought of the coronavirus. AIM: The Arabic version of this scale did not exist; hence, this study aimed to translate and evaluate the psychometric properties of the Fear Scale in participants aged 18 years and above in five Arabic countries: Egypt, Lebanon, Libya, Saudi Arabia, and Sudan by using a cross-sectional survey design. METHOD: The English version of the COVID-19 Fear Scale was translated into Arabic following the guidelines and disseminated through social media. Factorial and convergent validity and internal reliability were evaluated. RESULTS: The total number of participants was 2783; the majority was young (41.9%) and female (60.5%). Fear scores were moderate in four countries and severe in Egypt. The scale showed good structural validity, with the items explaining up to 70% of the variance. The scale items correlated significantly with the total scores, and the Cronbach alpha was above 0.9. CONCLUSION: The study concluded that the Arabic Fear Scale is a psychometrically robust scale that can be used to evaluate the perceived feelings of fear with the thought of the coronavirus or pandemic in general.

A single educational intervention on heart failure self-care: Extended follow-up from a multisite randomized controlled trial.

BACKGROUND: Heart failure outcomes remain poor, and little is known about the causes and predictors of these outcomes in Lebanon. AIM: The purpose of this article is to report the causes and predictors of the 6- and 12-month readmission and mortality of previously recruited patients to the Family focused Approach to iMprove Heart Failure care In LebanonQualitY intervention (FAMILY) study. METHODS: A multi-site block randomized controlled trial in three tertiary medical centers in Beirut. Initially, participants were randomized to either the control or the intervention group. The latter group, with their family caregivers, received heart failure self-care resources and an educational intervention on self-care and symptom management during their index admission. Participants from the FAMILY study were followed up with through phone calls for readmission and mortality at 6 and 12 months following their hospital discharge. RESULTS: A total of 218 (85%) patients were followed up with for this evaluation. There was a significant difference between the intervention group and the control group in terms of mortality at 6 months (n=18 (16%) versus n=36 (33%); p<0.05) and 12 months (n=29 (26%) versus n=45 (42%); p<0.05) post the index discharge. Mortality at 6 and 12 months was associated with aging, lower body mass index scores and readmission at 30 days post the index admission. Results of a logistic regression for mortality at 6 months showed hypertensive etiology of heart failure and 30-day readmission to be the only significant predictors. CONCLUSION: A single session intervention was associated with lower mortality, even after an extended period of time, possibly mediated by other variables. Future studies should be powered for such outcomes while also addressing the cultural needs and literacy levels of the patients using multi-session trials and more frequent follow-ups.

Literacy critical to heart failure management: a scoping review.

Heart failure is a complex clinical syndrome most commonly encountered among older adults. This complex clinical syndrome is associated with poor health outcomes such as frequent admissions and mortality. These adverse outcomes are commonly associated with poor self-care and lower health literacy. Literacy is a combination of knowledge and skills and often reflected by appropriate interaction with the community, while health literacy is the cognitive and social skills reflected by accessing and comprehending health information and making appropriate health decisions. These decisions are common and challenging to patients with heart failure. Poor outcomes are said to be reduced by adequate self-care, which is associated with health literacy among heart failure patients. Better self-care was also shown to be associated with self-efficacy and self-confidence that were in turn associated with health literacy. Hence, enhancing health literacy among patient with heart failure is critical to enable them to increase control over their disease by better understanding and participating in health care, while being empowered to take part in designing health care services and even tailoring research to serve their needs and consequently improve outcome at the individual and community level. In clinical practice, assessing health literacy, measuring health literacy, and identifying patients at risk of low nutrition literacy is important to enhance health literacy and health outcomes. Hence, developing reliable and valid methods and tools for assessment and developing tailored and targeted interventions is of critical importance.

The Lebanese Heart Failure Snapshot: A National Presentation of Acute Heart Failure Admissions.

PURPOSE: The purpose of this prospective evaluation is to document in-hospital management and discharge trends of patients presented for acute heart failure. DESIGN: A prospective evaluation of the patients presented for heart failure exacerbation at eight sites over 1 month using the method of the New South Wales Heart Failure Snapshot. METHODS: Trained personnel situated at each of the study sites recruited eligible patients to the study and collected data on their sociodemographic characteristics, clinical presentation, self-care, frailty, and depression. FINDINGS: Eight sites, out of the 27 contacted, agreed to participate in this study. A total of 137 admissions were reported in the 1-month time window. Mean age was 72 (SD = 13) years and the majority were female (52%). More than half (n = 60%) had heart failure reduced ejection fraction with a mean ejection fraction of 41%. The mean Charlson Comorbidity Index score was four with hypertension (80%) and diabetes (56%) being the most frequent. The majority were frail (86%), self-care mean scores were low; self-care maintenance (29), self-care management (48) and self-care confidence (42). The mean depression score was 14 indicating major depression. In reference to international guidelines recommendations, hospital administered medications and discharge medications were suboptimal. Some items of the discharge education recommended by the international guidelines were provided to 84% of the patients but none of the patients received the complete items of the discharge education. CONCLUSIONS: The snapshot revealed that patients admitted for acute heart failure were frail with high levels of illiteracy and low self-care scores. Despite these findings, these patients were not provided with complete discharge education in reference to the international guidelines. Additionally, when provided, discharge education was inconsistent across the study sites. This study highlights the need for enlisting complete education as part of the discharge process, in addition to abidance to the guidelines in prescribing medication. The study draws major implications for nursing practice, research and policy. CLINICAL RELEVANCE: Literacy among patients with heart failure is low and should be addressed in educational intervention to improve outcomes. Discharge education is under practiced across the country and should be implemented in accordance with the international guidelines.

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.

An evaluation of involving family caregivers in the self-care of heart failure patients on hospital readmission: Randomised controlled trial (the FAMILY study).

BACKGROUND: The prevalence of heart failure is increasing in Lebanon but to date there is no systematic evaluation of a disease management intervention. OBJECTIVE: The aim of this study was to evaluate the effect of involving family caregivers in the self-care of patients with heart failure on the risk of hospital readmission. DESIGN: A multi-site, block randomised controlled trial. SETTINGS: The study was conducted over a 13-month period in three tertiary medical centres in Beirut and Mount Lebanon, Lebanon. PARTICIPANTS: Adult patients presenting for an exacerbation of heart failure to one of the study centres were included. Patients with limited life expectancy or physical functionality, planned cardiac bypass or valve replacement surgery, living alone or in nursing homes, or aged less than 18 years were excluded. METHODS: Patients allocated to the intervention group and their family caregivers were provided with a comprehensive, culturally appropriate, educational session on self-care maintenance and symptom management along with self-care resources. The usual care group received the self-care resources only. Follow-up phone calls were conducted 30days following discharge by a research assistant blinded to treatment assignment. The primary outcome was hospital readmission and the secondary outcomes were self-care, quality of life, major vascular events and healthcare utilization. RESULTS: The final sample included 256 patients hospitalized for heart failure randomised into control (130 patients) and intervention (126 patients) groups. The mean age was 67 (SD=8)years, and the majority (55%) were male. Readmission at 30days was significantly lower in the intervention group compared to the control group (n=10, 9% vs. n=20, 19% respectively, OR=0.40, 95% CI=0.02, 0.10, p=0.02). Self-care scores improved in both groups at 30days, with a significantly larger improvement in the intervention group than the control group in the maintenance and confidence sub-scales, but not in the self-care management sub-scale. No differences were seen in quality of life scores or emergency department presentations between the groups. More patients in the control group than in the intervention group visited health care facilities (n=24, 23% vs. n=12, 11% respectively, OR=0.39, 95% CI=0.18, 0.83, p=0.01). CONCLUSION: The trial results confirmed the potential of the family-centred self-care educational intervention under evaluation to reduce the risk of readmission in Lebanese patients suffering from exacerbated heart failure. Further research is needed to validate these findings with longer periods of follow-up and to identify the intervention components and intensity required to induce sustained benefits on patients' self-care management and quality of life.

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.

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.

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.

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.

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.

Small group learning: Graduate health students' views of challenges and benefits.

UNLABELLED: Abstract Background: For health-care professionals, particularly nurses, the need to work productively and efficiently in small groups is a crucial skill required to meet the challenges of the contemporary health-care environment. Small group work is an educational technique that is used extensively in nurse education. The advantage of group work includes facilitation of deep, active and collaborative learning. However, small group work can be problematic and present challenges for students. Many of the challenges occur because group work necessitates the coming together of collections of individuals, each with their own personalities and sets of experiences. AIM: This study aimed to identify challenges and benefits associated with small group work and to explore options for retaining the positive aspects of group work while reducing or eliminating the aspects the students experienced as negative. METHOD: Online survey; thematic analysis. RESULTS: Over all, students experienced a range of challenges that necessitated the development of problem-solving strategies. However, they were able to elucidate some enjoyable and positive aspects of group work. Implications for teaching and learning are drawn from this study. CONCLUSION: The ability to work effectively in small groups and teams is essential for all health-care workers in the contemporary health environment. Findings of this study highlight the need for educators to explore novel and effective ways in which to engage nurses in group work.

Small group learning: graduate health students' views of challenges and benefits.

Abstract Background: For health care professionals, particularly nurses, the need to work productively and efficiently in small groups is a crucial skill required to meet the challenges of the contemporary health-care environment. Small group work is an educational technique that is used extensively in nurse education. The advantage of group work includes facilitation of deep, active and collaborative learning. However, small group work can be problematic and present challenges for students. Many of the challenges occur because group work necessitates the coming together of collections of individuals, each with their own personalities and sets of experiences. Aim: This study aimed to identify challenges and benefits associated with small group work and to explore options for retaining the positive aspects of group work while reducing or eliminating the aspects the students experienced as negative. Method: Online survey; thematic analysis. Results: Over all, students experienced a range of challenges that necessitated the development of problem-solving strategies. However, they were able to elucidate some enjoyable and positive aspects of group work. Implications for teaching and learning are drawn from this study. Conclusion: The ability to work effectively in small groups and teams is essential for all health care workers in the contemporary health environment. Findings of this study highlight the need for educators to explore novel and effective ways in which to engage nurses in group work.

Pneumococcus in Aboriginal and Torres Strait Islanders: the role of Aboriginal Health Workers and implications for nursing practice.

Abstract Background: Pneumonia is a common cause of hospitalization in Aboriginal and Torres Strait Islander men and women. Aim: This article seeks to describe the importance of immunizing against pneumonia in Aboriginal Australians and suggest strategies for screening and follow-up. Method: An integrative literature review, using both published and grey literature was undertaken to identify methods of screening and surveillance strategies for pneumococcus. Results: The literature was summarized under the following themes: pneumococcal disease; prevention strategies; access to care; improving access to vaccinations; culturally competent interventions and the role of Aboriginal health professionals. Conclusion: Community controlled conditions and the role of the Aboriginal Health Workers are seen as critical to reducing health disparities. Nurses can play a critical role in bridging the gap between mainstream and community controlled organizations. Working to increase the numbers of Aboriginal health professionals is a critical step in improving health outcomes for Aboriginal and Torres Strait Islander peoples.

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.