Physicians’ approach to end of life care: comparison of two tertiary care university hospitals in Lebanon

Abstract Background The care of terminally ill patients is fraught with ethical and medical dilemmas carried by healthcare professionals. The present study aims to explore the approaches of Lebanese attending physicians towards palliative care, end of life (EOL) care, and patient management in two tertiary care university hospitals with distinct medical culture. Methods Four hundred attending physicians from the American University of Beirut Medical Center (AUBMC) and Hotel Dieu de France (HDF) were recruited. Participants were Medical Doctors in direct contact with adult patients that could be subject to EOL situations providing relevant demographic, educational, religious as well as personal, medical or patient-centric data. Results The majority of physicians in both establishments were previously exposed to life-limiting decisions but remains uncomfortable with the decision to stop or limit resuscitation. However, physicians with an American training (AUBMC) were significantly more likely to exhibit readiness to initiate and discuss DNR with patients (p<0.0001). While the paternalistic medicinal approach was prevalent in both groups, physicians with a European training (HDF) more often excluded patient involvement based on family preference (p<0.0001) or to spare them from a traumatic situation (p=0.003). The majority of respondents reported that previous directives from the patient were fundamental to life-limiting decisions. However, the influence of patient and medical factors (e.g. culture, religion, life expectancy, age, socioeconomic status) was evidenced in the HDF group. Conclusion Early physician-initiated EOL discussions remain challenged in Lebanon. Paternalistic attitudes limit shared decision making and are most evident in European-trained physicians. Establishing a sound and effective framework providing legal, ethical and religious guidance is thus needed in Lebanon.

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First Candida auris Outbreak during a COVID-19 Pandemic in a Tertiary-Care Center in Lebanon

Pathogens ◽

10.3390/pathogens10020157 ◽

2021 ◽

Vol 10 (2) ◽

pp. 157

Author(s):

Fatima Allaw ◽

Nada Kara Zahreddine ◽

Ahmad Ibrahim ◽

Joseph Tannous ◽

Hussein Taleb ◽

...

Keyword(s):

Infection Control ◽

Medical Center ◽

Care Center ◽

Tertiary Care ◽

Arab Countries ◽

Infection Prevention And Control ◽

Tertiary Care Center ◽

Candida Auris ◽

American University ◽

American University Of Beirut

Candida auris is an emerging fungal pathogen considered as a global health threat. Recently there has been growing concern regarding drug resistance, difficulty in identification, as well as problems with eradication. Although outbreaks have been reported throughout the globe including from several Arab countries, there were no previous reports from Lebanon. We herein report the first cases of C. auris infection from the American University of Beirut Medical Center, a tertiary care center in Lebanon describing the clinical features of the affected patients in addition to the infection control investigation and applied interventions to control the outbreak. Fourteen patients with C. auris infection/colonization identified using MALDI-TOF and VITEK 2- Compact system were reported over a period of 13 weeks. Patients were admitted to four separate critical care units. All of them came through the emergency room and had comorbid conditions. Half of the patients were infected with COVID-19 prior to isolation of the C. auris. C. auris was isolated from blood (two isolates), urine (three isolates), respiratory tract (10 isolates) and skin (one isolate). All the patients had received broad spectrum antibiotics prior to isolation of C. auris. Six patients received antifungal treatment, while the remaining eight patients were considered colonized. Environmental cultures were taken from all four units and failed to isolate the organism from any cultured surfaces. A series of interventions were initiated by the Infection Prevention and Control team to contain the outbreak. Rapid detection and reporting of cases are essential to prevent further hospital transmission. A national standardized infection control registry needs to be established to identify widespread colonization.

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Five-Year Incidence and Progression of Diabetic Retinopathy in Patients with Type II Diabetes in a Tertiary Care Center in Lebanon

Journal of Ophthalmology ◽

10.1155/2017/9805145 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Carl-Joe Mehanna ◽

Maamoun Abdul Fattah ◽

Hani Tamim ◽

Mona P. Nasrallah ◽

Raya Zreik ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Type Ii Diabetes ◽

Medical Center ◽

Statistical Significance ◽

Care Center ◽

Tertiary Care ◽

Progression Rate ◽

Type Ii ◽

American University ◽

American University Of Beirut

Objective. To estimate the 5-year incidence of progression rate and regression rate and risk factors for diabetic retinopathy (DR) in a cohort of Lebanese patients with type II diabetes. Methods. We followed a cohort of 462 Lebanese patients with type II diabetes for over 5 years at the American University of Beirut Medical Center. Patients underwent yearly complete ophthalmic evaluation and fundus photographs and were assessed for the incidence, stage, and evolution of DR using modified Airlie House classification. Results. Among the 462 patients, 281 had no DR at baseline. The 5-year cumulative incidence of any DR was 10% (95% CI: 6–13), and only baseline microalbuminuria correlated with the development of DR (OR=10.53, 95% CI: 4.39–25.23, p<0.0001). Among the 181 patients with baseline DR, the worsening and regression rates of DR were 31.5% (95% CI: 25–38) and 9% (95% CI: 5–13), respectively. Microalbuminuria also approached statistical significance as a risk factor for DR worsening (OR=1.89, 95% CI: 0.97–3.70, p=0.06). Conclusion. The 5-year incidence of DR in this hospital-based cohort is relatively low. Microalbuminuria was independently associated with the incidence and progression of the disease. We recommend to screen patients with type II diabetes for microalbuminuria as prognostic for the development and worsening of DR.

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Clinical and Microbiological Profile of Urinary Tract Infection at a Tertiary-Care Center in Lebanon

Infection Control and Hospital Epidemiology ◽

10.1086/502298 ◽

2004 ◽

Vol 25 (1) ◽

pp. 82-85 ◽

Cited By ~ 8

Author(s):

Roula Fadel ◽

Ghenwa K. Dakdouki ◽

Zeina A. Kanafani ◽

George F. Araj ◽

Souha S. Kanj

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Medical Center ◽

Care Center ◽

Tertiary Care ◽

American University ◽

E Coli ◽

American University Of Beirut ◽

Hospital Acquired

AbstractWe compared community-acquired urinary tract infection (UTI) with hospital-acquired UTI at the American University of Beirut Medical Center. Escherichia coli was the most frequently isolated organism. Hospital-acquired E. coli isolates were often rnultidrug resistant. These results can be used to improve empiric treatment of UTI.

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The effectiveness of the DIBH technique in protecting the heart of radiotherapy breast cancer patients treated at the American University of Beirut Medical Center in Lebanon

Health and Technology ◽

10.1007/s12553-021-00569-z ◽

2021 ◽

Author(s):

Ibrahim Duhaini ◽

Bilal Shahine ◽

Youssef Zeidan ◽

Abbas Mkanna ◽

Ahmad Maarouf ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Medical Center ◽

Breast Cancer Patients ◽

American University ◽

American University Of Beirut

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Radiology of terror injuries: the American University of Beirut Medical Center experience

Clinical Imaging ◽

10.1016/j.clinimag.2007.09.007 ◽

2008 ◽

Vol 32 (2) ◽

pp. 83-87 ◽

Cited By ~ 9

Author(s):

Maurice C. Haddad ◽

Nabil J. Khoury ◽

Mukbil H. Hourani

Keyword(s):

Medical Center ◽

American University ◽

American University Of Beirut

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SUMMIT (Serially Unified Multicenter Multiple Sclerosis Investigation): creating a repository of deeply phenotyped contemporary multiple sclerosis cohorts

Multiple Sclerosis Journal ◽

10.1177/1352458517726657 ◽

2017 ◽

Vol 24 (11) ◽

pp. 1485-1498 ◽

Cited By ~ 10

Author(s):

Riley Bove ◽

Tanuja Chitnis ◽

Bruce AC Cree ◽

Mar Tintoré ◽

Yvonne Naegelin ◽

...

Keyword(s):

Multiple Sclerosis ◽

San Francisco ◽

Medical Center ◽

Clinically Isolated Syndrome ◽

American University ◽

American University Of Beirut ◽

Longitudinal Investigation ◽

American Academic

Background: There is a pressing need for robust longitudinal cohort studies in the modern treatment era of multiple sclerosis. Objective: Build a multiple sclerosis (MS) cohort repository to capture the variability of disability accumulation, as well as provide the depth of characterization (clinical, radiologic, genetic, biospecimens) required to adequately model and ultimately predict a patient’s course. Methods: Serially Unified Multicenter Multiple Sclerosis Investigation (SUMMIT) is an international multi-center, prospectively enrolled cohort with over a decade of comprehensive follow-up on more than 1000 patients from two large North American academic MS Centers (Brigham and Women’s Hospital (Comprehensive Longitudinal Investigation of Multiple Sclerosis at the Brigham and Women’s Hospital (CLIMB; BWH)) and University of California, San Francisco (Expression/genomics, Proteomics, Imaging, and Clinical (EPIC))). It is bringing online more than 2500 patients from additional international MS Centers (Basel (Universitätsspital Basel (UHB)), VU University Medical Center MS Center Amsterdam (MSCA), Multiple Sclerosis Center of Catalonia-Vall d’Hebron Hospital (Barcelona clinically isolated syndrome (CIS) cohort), and American University of Beirut Medical Center (AUBMC-Multiple Sclerosis Interdisciplinary Research (AMIR)). Results and conclusion: We provide evidence for harmonization of two of the initial cohorts in terms of the characterization of demographics, disease, and treatment-related variables; demonstrate several proof-of-principle analyses examining genetic and radiologic predictors of disease progression; and discuss the steps involved in expanding SUMMIT into a repository accessible to the broader scientific community.

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Brief Report Susceptibility of Filipino Nurses to the Varicella-Zoster Virus

Infection Control ◽

10.1017/s019594170006392x ◽

1986 ◽

Vol 7 (2) ◽

pp. 71-72 ◽

Cited By ~ 18

Author(s):

Nabil T. Nassar ◽

Helen C. Tourna

Keyword(s):

Varicella Zoster Virus ◽

Immunosorbent Assay ◽

Medical Center ◽

Young Female ◽

Enzyme Linked Immunosorbent Assay ◽

American University ◽

Varicella Zoster ◽

American University Of Beirut ◽

Filipino Nurses ◽

Risk Areas

AbstractFollowing an outbreak of varicella, 18% of a group of 174 young female Filipino nurses ranging in age from 20 to 25 years and working at the American University of Beirut Medical Center (AUMC) were found susceptible to the varicella-zoster virus; as compared to 3% of a matched group of 133 of their Lebanese colleagues. The level of antibody was determined by the Enzyme Linked Immunosorbent Assay (ELISA). Those susceptible were assigned duties in low-risk areas to varicella-zoster in the hospital.

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