Medical and Health Sciences

Permanent URI for this collection

https://hdl.handle.net/20.500.11888/18295

Browse

Recent Submissions

Now showing 1 - 5 of 59
  • No Thumbnail Available
    Item
    ANTIMICROBIAL PROPHYLAXIS AND THE RATE OF BLOOD STREAM INFECTIONS IN ADULT STEM CELL TRANSPLANTATION: A SINGLE CENTER RETROSPECTIVE STUDY FROM PALESTINE
    (An-Najah National University, 2025-11-13) Dwikat, Mayada Fahmi
    Introduction: Hematopoietic stem cell transplantation (HSCT), particularly autologous HSCT (auto-HSCT), has the potential to cure many hematologic cancers. However, infections continue to be a serious problem in this patient population, particularly bloodstream infections (BSIs), which are the leading cause of mortality and morbidity, primarily due to prolonged immunosuppression. Although antimicrobial prophylaxis is adopted as a standard procedure to minimize the infection risk in most HSCT centers, concern regarding antibiotic resistance and Clostridium difficile infection persists. Moreover, the burden of these infections in resource-limited settings like Palestine is insufficiently studied. Therefore, this study aims to describe the antimicrobial prophylaxis and determine the incidence rate and potential risk factors of BSI in adult patients undergoing auto-HSCT at An-Najah National University Hospital (NNUH), the only auto-HSCT center in Palestine. Methods: A retrospective observational cohort study was conducted at the bone marrow transplantation (BMT) department of NNUH between January 2018 and June 2024. The study analyzed extracted medical, laboratory, and pharmacy data from patients who underwent auto- HSCT. Descriptive statistics, univariate comparisons, and multivariate logistic regression to identify independent risk factors for BSIs and CDIs were performed using Statistical Package for Social Sciences (SPSS) version 21 software. Of the 267 candidates screened, 224 adult patients (aged ≥18 years) met the inclusion criteria and were included in the final analysis. Approval from the An-Najah National University Institutional Review Board (IRB) was obtained before initiating the study. Results: Among 224 patients, Multiple myeloma (MM) was the most commonly diagnosed malignancy, followed by Hodgkin Lymphoma (HL), accounting (50.4%,38.4%) respectively. Antimicrobial prophylaxis includes fluoroquinolones, with ciprofloxacin given to 31.3% of patients and levofloxacin administered to 69.2%. In addition, antifungal prophylaxis consisted of itraconazole (50.9%), fluconazole (48.7%), while antiviral prophylaxis with acyclovir was given to all patients. The incidence rate of BSI was 17.9% with gram-negative (GNB)and gram-positive bacteria (GPB) being the predominant isolates. Among GNB isolates, Escherichia coli was the most frequently detected organism (8 cases), while Staphylococcus epidermidis was the most common GPB, also identified in 8 cases. Extended-spectrum beta-lactamase (ESBL),and Klebsiella pneumoniae showed (100%) resistance to Ciprofloxacin. Moreover, Pseudomonas aeruginosa and Acinetobacter baumannii were classified as extensively drug-resistant bacteria (XDR) GNB. Most GPB are completely resistant to levofloxacin. Clostridioides difficile infection (CDI) occurred in 15.6% of cases, with Toxin A and Toxin B positivity in 14.3% and 10.3%, respectively. Oral vancomycin was the drug of choice for all patients diagnosed with CDI. Multivariate Logistic Regression revealed that patients with multiple myeloma had 2.7 times higher odds of developing BSI compared to those without MM. Furthermore, CHD showed a possible association with CDI (adjusted OR = 2.64, 95% CI: 0.83–8.37, p = 0.099). Despite infection risks, mortality was low (1.8%), and the average hospital stay was 24.7 ± 6.5 days. Conclusion: The use of antimicrobial prophylaxis among auto-HSCT in NNUH aligns with international guidelines. The incidence rate of BSI and CDI is consistent with studies worldwide. However, quinolone Resistance remains a significant concern in both gram-positive and gram-negative bacteria. Additionally, Multiple myeloma was identified as an independent risk factor for BSI. Finally, the emergence of multidrug-resistant organisms and CDI underscores the need for risk-adapted prophylaxis and strengthened infection control measures These findings provide valuable local data to inform clinical protocols and help reduce infection-related complications in HSCT settings, particularly in resource-limited environments
  • No Thumbnail Available
    Item
    ASSESSING THE INFLUENCE OF MANAGEMENT BY OBJECTIVES (MBO) ON MOTIVATION AMONG NURSING STAFF IN A UNIVERSITY TEACHING HOSPITAL NABLUS CITY : A CROSS-SECTIONAL STUDY
    (An-Najah National University, 2025-07-31) Tammam, Nada
    Background: Performance appraisal systems are crucial in hospitals for employee development, managerial decision-making, and organizational efficiency. Nursing, the largest workforce in healthcare, is influenced by both internal and external factors. This study investigates the relationship between Management by Objectives (MBO) and the motivation of nursing staff at a university teaching hospital in Nablus. MBO, which emphasizes goal-setting, feedback, and collaboration, is hypothesized to enhance motivation and job satisfaction among nurses. The research, grounded in self-determination theory, examines how intrinsic and extrinsic motivational factors interact within the MBO framework. Aim: This research seeks to thoroughly examine the possible impact of MBO on increased motivation among nurses in the hospital environment. Method: This research will involve a cross-sectional approach examining the impact of MBO implementation on performance metrics of the MBO system and motivation levels among nursing personnel at a university teaching hospital through a self-administered questionnaire. Result: Results indicated a positive correlation between MBO execution and employee motivation, with an R² of 0.793, which explains 79.3% of the variance in motivation levels. In addition, descriptive statistics from perceptions of MBO and motivation indicated high overall means. The sample also matched on the basis of gender, age, qualifications, and experience. Results indicated that statistically significant differences did not arise based on demographic variables, therefore showing consistent effects of MBO. Conclusion: These findings point to the fact that management by objectives is able to greatly help increase motivation among nursing staff and enhance their performance. It is advised to broaden its use to other hospitals as well to enhance the quality of health care, and increased job satisfaction can be attained in exchange. Keywords: Management by Objectives; Human Resource Management; Motivation; Nursing Staff; Performance Appraisal.
  • No Thumbnail Available
    Item
    DETECTING THE CONSTRUCT VALIDATION OF SOME DEPRESSION SCALES IN THE PALESTINIAN CONTEXT
    (An-Najah National University, 2025-07-24) Massarwa, Remaa
    This study aimes to evaluate the construct validity of three globally recognized depression assessment the Beck Depression Inventory (BDI), the Hamilton Depression Rating Scale (HDRS), and the Montgomery-Asberg Depression Rating Scale (MADRS), and examine their relevance within the unique sociocultural and psychological context of Palestine, where mental health struggles are intensified by ongoing adversity and war. To achieve this, the study adopted a quantitative research approach, utilizing both descriptive statistics and factor analysis. Specifically, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were employed to thoroughly assess the structure of each instrument. The research sample included 860 participants aged 15-60, drawn from the West Bank, Jerusalem, and the 1948-occupied territories. EFA was carried out on subgroup of 280 participant, while CFA was performed on a larger group of 580 participant. Data were collected through an online questionnaire, with participants selected using a convenience sampling technique. The results revealed that the 17-item version of Beck Depression Inventory exhibited the strongest psychometric prosperities, including high validity and reliability, making it particularly effective tool for depression screening with the Palestinian context. In contrast, the 20 item Hamilton Depression Rating Scale (HDRS-20) failed to meet acceptable model fit criteria, rendering it ineffective without substantial modification. The MADRS-10 scale, after minor modifications, achieved acceptable validity and reliability, suggesting its applicability in this context. Additionally, the PDS-22 scale created in this research showed considerable validity and consistency. Considering previous results, current recommend the following: 1. Embracing the BDI-17 as the most valid measure for evaluating depression in mental health facilities within Palestine. 2. Continuing to enhance the PDS-22 should be further improved for wider use, including in clinical setting and research endeavours.
  • No Thumbnail Available
    Item
    ASSESSING THE IMPACT OF GROUP COUNSELING CBT PLAY THERAPY FOR TREATING EMOTIONAL AND BEHAVIORAL ISSUES IN ADHD CHILDREN
    (An-Najah National University, 2025-08-31) , Mai
    This thesis investigates effectiveness of Group Counseling Cognitive Behavioral Therapy (CBT) Play Therapy on addressing emotional and behavioral issues among children diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD), study employed quasi-experimental design involving 60 children, divided into an experimental group receiving CBT Play Therapy intervention and control group receiving no intervention, Data were collected using Conners 3rd Edition, validated assessment tool that measures ADHD symptoms across multiple domains, including inattention, hyperactivity/impulsivity, and oppositional behavior. Pre-test and post-test scores were analyzed to evaluate intervention's impact, with findings revealing significant reductions on ADHD symptoms among experimental group compared to control group, Specifically, results indicated substantial improvements across all measured subscales, with effect sizes demonstrating intervention's effectiveness, Demographic variables such as gender, monthly income, educational background, and parental involvement were also examined to understand their influence on treatment outcomes. The study concludes that Group Counseling CBT Play Therapy is viable and effective intervention for reducing ADHD-related behavioral and emotional issues on children, findings underscore importance of integrating therapeutic play approaches on clinical settings to support developmental needs of children with ADHD, the study recommends Implementing structured Group Counseling CBT Play Therapy in schools and clinics with trained facilitators, integrate systematic parent involvement, and conduct 3–6-month follow-ups to track maintenance of gains; future research should test optimal dosage, compare against individual CBT and behavioral parent training, and examine moderators (e.g., gender, socioeconomic status, parental involvement).
  • No Thumbnail Available
    Item
    THE IMPACT OF SYMPTOMS EXPERIENCED BY PATIENTS UNDERGOING HEMODIALYSIS TREATMENT ON THEIR QUALITY OF LIFE: A CROSS-SECTIONAL STUDY FROM PALESTINE
    (An-Najah National University, 2025-08-18) Attoun, Alaa
    Background: The present study aimed to evaluate the extent to which physical and psychological symptoms associated with hemodialysis treatment influence patients’ self-efficacy in managing their chronic illness, as well as the overall impact of these symptoms on their quality of life. Methods: A cross-sectional study design was performed to investigate the research objectives. Data were collected from hemodialysis patients at selected centers in the West Bank, Palestine, including An-Najah National University Hospital in Nablus and Al-Hussein Government Hospital in Beit Jala. The physical and psychological symptoms experienced by patients were measured using the Dialysis Symptom Index (DSI). Self-efficacy in managing chronic illness was evaluated using the Self-Efficacy for Managing Chronic Disease 6-Item Scale, while health-related quality of life was assessed through the EuroQol 5-Dimension 5-Level (EQ-5D-5L) instrument and the EQ Visual Analog Scale (EQ-VAS). Results: In this study, a total of 306 hemodialysis patients were included. The mean age of the patients was 58.1 ± 13.3 years. In multivariable models, higher self-efficacy was predicted by lower BMI, urban residence, living with family, and higher education (p < 0.001 for BMI, place of residence and education; living conditions p = 0.001). Lower self-efficacy was predicted by diabetes (p < 0.001), constipation (p < 0.001), chest pain (p < 0.001), depression (p < 0.001), difficulty with sexual arousal (p < 0.001), more hemodialysis sessions per week (p < 0.001) and longer session length (p = 0.001); marital status also showed an association (p = 0.006). Mobility, self-care problems, anxiety/depression and low health ratings were additional significant negative predictors of self-efficacy (all p < 0.001). Similarly, the mean health rating of the patients was 60.3 ± 18.3. Higher self-efficacy can be significantly predicted by having a healthy weight, living in urban areas, living with family, and having higher education (p value < 0.05). Conclusions: The results highlight the importance of addressing both the clinical and psychosocial components of patient treatment to improve both patients’ sense of self-efficacy and their physical and mental health.