Impact of a comprehensive rehabilitation palliative care program on the quality of life of patients with terminal cancer and their informal caregivers: a quasi-experimental study.

BACKGROUND: Palliative care schemes, which include pain management, symptom control, psychosocial support and rehabilitation, aim to boost patients' quality of life, ease the burden and anxiety of informal caregivers, and ultimately provide a comprehensive approach to enhance well-being during this challenging and sensitive period. This study aims to evaluate the impact of a comprehensive rehabilitation palliative care program on the quality of life of patients with terminal cancer and their informal caregivers. METHODS: This quasi-experimental study, conducted from August 2023 to January 2024 at outpatient clinics affiliated with the Oncology Center at Mansoura University, Egypt, focused on cancer patients and their caregivers in the palliative care department. Employing pre- and post-test phases, data were gathered using a questionnaire, EORTC QLQ C30, Hospital Anxiety and Depression Scale, Short Form Health Survey, Caregiver Burden Inventory, and Beck Anxiety Inventory. The investigation evaluated a 16-week rehabilitation program comprising exercise, psychoeducation, individual counselling, and spiritual support. Exercises, led by a physiotherapist, targeted fatigue and stress through tailored aerobic and resistance training. Psychoeducation sessions aimed to bolster coping abilities, covering fatigue management and nutrition. Trained counsellors addressed spiritual and existential concerns. Personal advisory sessions were available for individual support. Caregivers received education on rehabilitation and palliative care protocols, ensuring comprehensive patient care. RESULTS: The mean age for cancer patients was 65.79 ± 13.85. In contrast, the mean age for primary carers was 42.05 ± 11.15. The QOL for cancer patients during the pre-test phase was 77.8 ± 7.16 and rose to 87.34 ± 14.56 during the post-test phase. Additionally, the total anxiety level of patients before the rehabilitation palliative care program was conducted was 15.45 ± 3.05 compared to 6.12 ± 3.21 after the post test phase. Furthermore, the total depression levels of the patients during the pre-test phase were 20.89 ± 9.21. However, after implementing the rehabilitation palliative care program, it decreased to 15.5 ± 6.86. In regards to the total quality of life of informal caregivers, it was measured at 67.28 ± 32.09 before conducting the program. Nevertheless, it increased to 25.95 ± 40.29 after conducting it. Additionally, the total Caregiver Burden Inventory before implementing the program was 37.45 ± 25.7, and it decreased to 29.36 ± 16.4 after conducting it. Additionally, the total score on the Beck Anxiety Inventory decreased from 45.7 ± 4.3 during the initial testing phase to 17.35 ± 23.67. CONCLUSION: The program for rehabilitation palliative care successfully achieved its goals by enhancing the overall quality of life for cancer patients and their caregivers. Additionally, it reduced the anxiety and depression levels among the patients, as well as the anxiety and caregiver burden among the caregivers. Continue research into the effectiveness of rehabilitation palliative care programs to identify best practices, improve existing programs, and expand access to these services.

Exploring the relationship between nursing students' knowledge and attitudes towards climate change and their psychological distress: a cross-national investigation.

BACKGROUND: Climate change poses a worldwide challenge with anticipated exacerbation in the future, resulting in irreversible consequences. Nursing students may be vulnerable to experiencing psychological effects associated with climate change. AIM: The current study aimed to investigate the relationship between nursing students' knowledge and attitudes toward climate change and their psychological distress. METHOD: This descriptive cross-sectional study recruited 377 nursing students from three universities located in Saudi Arabia, Jordan, and Egypt in the Middle East. Data collection was conducted using scales for assessing nursing students' knowledge and attitudes towards climate change and their psychological distress. Correlations were assessed and multiple regression analysis was conducted to explore the predictors of students' psychological distress. RESULTS: The current study showed that knowledge regarding climate change significantly and positively correlated to the attitude toward climate change (r = 0.213), then again, the score of psychological distress significantly and negatively correlated to the score of students' knowledge and attitude regarding climate change (r = - 0.182 and - 0.110 respectively). Regression analyses showed that academic achievement had the strongest positive impact on students' psychological distress, while knowledge regarding climate change and attitude toward climate change had negative impacts (ß = 0.381, ß=-0.205, and ß=-0.045 respectively). Moreover, knowledge and attitude regarding climate change were found to be significant predictors of students' psychological distress, collectively accounting for 18.2% of the observed variance. CONCLUSIONS/IMPLICATION FOR FUTURE PRACTICE: The findings highlight the importance of incorporating climate change into nursing education programs. By enhancing nursing students' knowledge and attitudes towards climate change, there is potential to reduce their psychological distress. This study underscores the need for curriculum reforms that integrate climate change topics, aiming to foster a well-informed and resilient future nursing workforce.

Optimizing geriatric palliative care in Egypt: Comprehensive patient and family perspectives.

OBJECTIVES: In Egypt, palliative care for geriatric patients is understudied, necessitating exploration for service optimization. Amidst rising chronic illnesses and aging, understanding perspectives of geriatric patients and families is crucial for targeted improvements. This study aims to explore geriatric patients' and their families' perspectives on palliative care in Egypt, seeking opportunities to optimize service delivery for the elderly. METHODS: Employing a cross-sectional design with 110 geriatric patients and an equal number of family caregivers from the Damietta Oncology Institute and the pain treatment clinics for cancer patients at Zagazig University Hospital, the study focuses on a specialized pain clinic. Validated tools (Palliative Care Outcome Scale, Family Satisfaction with End-of-Life Care [FAMCARE] Scale, Edmonton Symptom Assessment System [ESAS], Caregiver Strain Index [CSI]) assess quality of life, family satisfaction, symptom severity, and caregiver strain. RESULTS: Geriatric patients (mean age: 65.0 ± 8.1 years; 45.5% male, 55.5% female) have diverse diagnoses (e.g., breast cancer 22%). Palliative care outcomes reveal challenges: low emotional well-being (2.6 ± 0.0) and alarming overall quality of life (1.8 ± 0.0). Family dissatisfaction (FAMCARE) is pervasive (total mean score 2.6 ± 0.5). Symptom severity (ESAS) is high, and caregiver strain (CSI) is notable (8.5 ± 2.2). SIGNIFICANCE OF THE RESULTS: The findings underscore the significance of the challenges faced by geriatric patients and caregivers in palliative care. Patients confront considerable symptom burdens and emotional distress, while caregivers experience notable strain. Urgently needed are targeted interventions designed to enhance patient well-being, alleviate caregiver burden, and elevate satisfaction. The critical importance of implementing these interventions promptly is highlighted, as they are instrumental in improving the overall care experience for geriatric patients and their caregivers. Moreover, the results underscore the imperative of developing comprehensive support mechanisms to address the intricate dimensions of palliative care, ultimately contributing to a more compassionate and effective care continuum.

Burden of care and quality of life among informal caregivers to Alzheimer patients in Egypt.

BACKGROUND: Alzheimer's disease is a chronic neurodegenerative disorder that results in total cognitive impairment and functional decline. Family members are the most usual caregivers worldwide, resulting in an increasing total burden and a subsequent degradation of their quality of life. OBJECTIVES: To evaluate the burden of care and quality of life among informal caregivers to Alzheimer patients in Egypt. METHODS: A descriptive research design was used. The study was conducted at outpatient clinics of El-Abbasya Mental Hospital in Cairo, Egypt. This study included 550 informal caregivers of Alzheimer patients. Data were gathered through questionnaires using the Sociodemographic Profile of Family Caregivers, an adopted version of the Montgomery Borgatta Caregiver Burden scale, and Health-Related Quality of Life Scale. RESULTS: Nearly three quarters (73.5%) of the informal caregivers were female. Additionally, the physical burden among the informal caregivers was the highest (21.58 ± 8.13), while the psychological burden was the lowest (7.48 ± 25.35). Besides, around one-third (30%) of the informal caregivers had a total poor quality of life. SIGNIFICANCE OF RESULTS: Total burden among informal caregivers of Alzheimer patients was relatively high (64.71 ± 26.86). Moreover, less than one-tenth (8%) of the informal caregivers for Alzheimer's patients had a good quality of life, whereas more than half (62%) of them had an average quality of life. In the Egyptian context, ongoing health education initiatives for those who care for Alzheimer patients are essential, and additional research employing large study sample sizes in varied contexts is strongly advised.

Palliative and Supportive Care for Patients with End-Stage Hepatocellular Carcinoma: Perspectives of Egyptian Domestic Caregivers.

OBJECTIVES: Palliative care is a holistic, patient-centered approach to improving the quality of life for those with terminal diseases and their families. The main objective of the current study was to evaluate the Egyptian domestic caregivers' knowledge, attitudes, and competencies related to palliative and supportive care. METHODS: Three hundred and thirty-five family caregivers in total were recruited. A descriptive research design was used. Four tools were used to collect data; structured interview questionnaire to collect demographic questions, palliative care knowledge questionnaire, Palliative Attitude Scale, and Competence Scale. The study was conducted in oncology outpatient and pain clinics located at the Damietta Cancer Institute in Damietta Governorate, Egypt. RESULTS: Nearly two-thirds of the informal family caregivers are aged between 30-40 years old; 54% are female, and 83% are married. Also, sixty-seven point eight of the informal family caregivers were working (part-time). Furthermore, 65 % of them had insufficient knowledge, 68 % had a positive attitude, and 58% of the informal family caregivers had non-competency skills regarding palliative and supportive care. CONCLUSION: Approximately two-thirds of informal care providers had insufficient total knowledge scores, more than half possessed a positive attitude, and more than half reported non-competency skills regarding palliative care of hepatocellular patients. RECOMMENDATION: It is highly advisable to launch extensive health education programs and campaigns aimed at all of the unpaid informal family careers of patients with serious terminal illnesses, including hepatocellular carcinoma, at various governments with greater sample sizes.

Vagal Stimulation Ameliorates Non-Alcoholic Fatty Liver Disease in Rats.

BACKGROUND: The harmful consequences of non-alcoholic fatty liver disease (NAFLD) are posing an increasing threat to public health as the incidence of diabetes and obesity increases globally. A non-invasive treatment with a range of autonomic and metabolic benefits is transcutaneous vagus nerve stimulation (tVNS). AIM OF THE STUDY: To investigate the possible preventive impacts of VNS against adult rats' NAFLD caused by a high-fat diet (HFD) and to clarify the underlying mechanisms. METHODS: A total of thirty-two adult male rats were split into two groups: the HFD-induced NAFLD group (n = 24) and the control normal group (n = 8). The obesogenic diet was maintained for 12 weeks to induce hepatic steatosis. The HFD-induced NAFLD group (n = 24) was separated into three groups: the group without treatment (n = 8), the group with sham stimulation (n = 8), and the group with VNS treatment (n = 8). VNS was delivered for 30 min per day for 6 weeks after the establishment of NAFLD using a digital TENS device. The subsequent assessments included hepatic triglyceride, cholesterol content, serum lipid profile, and liver function testing. In this context, inflammatory biomarkers (TNF-α, IL-6) and hepatic oxidative stress (MDA, SOD, and GPx) were also assessed. To clarify the possible mechanisms behind the protective benefits of VNS, additional histological inspection and immunohistochemistry analysis of TNF-α and Caspase-3 were performed. RESULTS: In the NAFLD-affected obese rats, VNS markedly decreased the rats' body mass index (BMI) and abdominal circumference (AC). Liver function markers (albumin, ALT, and AST) and the serum lipid profile-which included a notable decrease in the amounts of hepatic triglycerides and cholesterol-were both markedly improved. Additionally, oxidative stress and inflammatory indicators showed a considerable decline with VNS. Notably, the liver tissues examined by histopathologists revealed that there is evidence of the protective impact of VNS on the oxidative and inflammatory states linked to HFD-induced NAFLD while maintaining the architectural and functional condition of the liver. CONCLUSIONS: Our findings suggest that VNS may represent a promising therapeutic candidate for managing NAFLD induced by obesity. It can be considered to be an effective adjuvant physiological intervention for the obese population with NAFLD to spare the liver against obesity-induced deleterious injury.

Efficiency of an intervention study on nursing students' knowledge and practices regarding nutrition and dietary habits.

Poor eating habits and hazardous weight-control measures are prevalent among university students. Hence, practical and efficient intervention programs are necessary to enhance nutritional awareness and promote healthy dietary practices encompassing food choices and diet quality. This study aims to evaluate the efficiency of an intervention study on nursing students' knowledge and practices regarding nutrition and dietary habits. A quasi-experimental research design with pre-post phases was used to study 250 nursing students at the College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, in the Kingdom of Saudi Arabia. The sample was non-randomized and taken from March 2023 until the end of May of the same year. The closed-ended questionnaire focused on participant demographics, knowledge, and practices relating to nutrition and eating habits. The survey was divided into three main sections. Technical terms were consistently defined throughout the questionnaire, and the language used was clear and objective. The research adhered to conventional academic structure and formatting, following the guidelines of the relevant style manual. Grammatical correctness and precise word choice were ensured, and filler words were avoided. The participants in the study displayed an increase in knowledge scores from 33.7 ± 4.6 in the pre-test to 52.6 ± 7.2 in the post-test. Moreover, prior to program implementation, their overall nutrition practice scores stood at 64 ± 9.5, but after the program, the score had risen to 107.7 ± 4.22. A significant difference in the total knowledge and practice scores was identified between the pre- and post-test phases, with an a p-value of 0.001. The nursing students' scores for both knowledge and practical application of nutrition and eating habits showed a significant increase following the implementation of the program. Therefore, it is imperative to introduce well-structured training programs on nutrition and promote healthy diet habits for all medical faculties, paramedics, and applied health institutions across Saudi Arabia.

Knowledge and attitudes towards mpox and effect of intervention among College of Applied Medical Sciences students.

Objectives: This research aims to assess the base level of knowledge and attitude of Applied Medical Sciences Students regarding mpox and whether an educational intervention could improve their knowledge and attitude. Methods: A quasi-experimental research was used, involving 960 medical students from Applied Medical Sciences College at Prince Sattam Bin Abdulaziz University, KSA. They were recruited from the beginning of November 2022 till the mid of January 2023 based on the non-randomized sampling method. A standardized, anonymous, and closed-ended questionnaire was used, compromising three main sections: participants' demographics, knowledge, and attitudes toward the mpox epidemic. Results: Total knowledge scores of the studied sample in the pretest phase were 45.43 ± 6.29 compared to 65.03 ± 2.93 in the post-test phase. Besides, total attitude scores were 48.62 ± 4.78 before program implementation, while after conducting the program reached 70.65 ± 5.13. There was a notable improvement in the total knowledge score of the sample studied after the intervention was implemented, particularly for neurological manifestations. Conclusion: After the program's implementation, there was an obvious improvement in the medical students' total knowledge and attitude scores concerning the mpox epidemic. It is necessary to initiate well-organized training initiatives for all other medical faculties, paramedics, and applied health institutions in Saudi Arabia.