maha arnaout - Academia.edu (original) (raw)
Papers by maha arnaout
Cancer Care in Countries and Societies in Transition, 2016
During times of forced migration, the focus in children is on infectious diseases, which are mana... more During times of forced migration, the focus in children is on infectious diseases, which are managed by vaccinations and antibiotics; and malnutrition that is managed by nutritional support. Cancer treatment is costly and not a priority during these times.
Pediatric Palliative Care: Global Perspectives, 2011
In most Middle Eastern countries pediatric palliative care as a special medical discipline is not... more In most Middle Eastern countries pediatric palliative care as a special medical discipline is not as yet in existence. In some countries this specialty is in its infancy, and only in a few countries has it become a recognized specialty and is practiced in the major medical ...
Leukemia, 2000
The purpose of this study was to assess the feasibility and efficacy of a treatment regimen for p... more The purpose of this study was to assess the feasibility and efficacy of a treatment regimen for pediatric acute myelogenous leukemia (AML) that uses four rotating drug pairs and adjusts dosages of etoposide and cytarabine to target specific plasma concentrations. Thirty-one girls and 27 boys (median age, 9.7 years) with de novo AML were treated on the protocol. Six cycles of chemotherapy were planned. Cycles 1 to 4 comprised the drug combinations cytarabine plus etoposide, cytarabine plus daunomycin, etoposide plus amsacrine, and etoposide plus azacitidine, respectively. For cycles 5 and 6, the first two combinations were repeated. Dosages were adjusted to achieve plasma concentrations of 1.0 µM ± 0.1 µM cytarabine and 30 µM ± 0.3 µM etoposide. Forty-four patients (76%) entered complete remission. Of those, 24 have had relapses; 23 remain alive in first or subsequent remission. The 5-year event-free survival (EFS) estimate was 31.0% ± 5.9%; the 5-year survival estimate was 41.4% ± 6.3%. Six patients (10%) died of the toxic effects of therapy. Severe neutropenia occurred in all cycles. Long-term complications of therapy included hepatitis C, cardiac insufficiency, and hearing loss. Adjustment of cytarabine and etoposide dosage was feasible for achieving targeted plasma drug concentrations; however, the potential clinical efficacy of this approach was offset by substantial acute and long-term toxicity.
The Journal of Pediatrics, 1998
A 24-day-old boy presented with a 2-hour history of swelling and bluish discoloration of the left... more A 24-day-old boy presented with a 2-hour history of swelling and bluish discoloration of the left lower limb, genitalia, and buttocks. Physical examination revealed swelling of the left lower limb, extending from the inguinal area to the ankle. The mass was indurated, irregular, covered with ecchymosis, and spared the foot (Fig 1). A complete blood count revealed hemoglobin of 10.5 g/dL and platelet count of 10 × 10 9 /L. There was evidence of a micro-angiopathic process on the blood smear. Coagulation studies revealed a low fibrinogen level (93 mg/dL) and a positive D-dimer test result. The coronal magnetic resonance imaging sequence (T1 inversion recovery [short tau inversion recovery]) (Fig 2) showed abnormal bright material infiltrating the muscle and subcutaneous fat in the pelvis and the left leg. The patient was treated with high doses of intravenous steroids (methylprednisolone, 6 mg/kg per day) for 4 to 6 weeks with marked diminution in the size of the mass and normalization of his platelet, hemoglobin, and fibrinogen values.
Journal of Pediatric Hematology/Oncology, 1999
Journal of Pain and Symptom Management, 2010
Journal of Pain and Symptom Management, 2010
Journal of Pain and Symptom Management, 2008
Children's pain is undertreated worldwide. Using a model of pediatric cancer pain management in A... more Children's pain is undertreated worldwide. Using a model of pediatric cancer pain management in Amman, Jordan, the authors demonstrated that an action research approach to pain service development resulted in a sustainable program of pain control. Barriers to care were due more often to health professionals' misconceptions concerning pain and opioid use than to concerns related to cultural, religious, or societal beliefs. Successful implementation of a pain management program requires education, policy development, and support from several levels of hospital administration. Role-modeling and mentorship are important factors. Established knowledge translation theories explained some but not all of the findings. Outcomes included consistent pain assessment and documentation by nursing staff, increased consultation for pain management, and increased use of intravenous opioids.
The Journal of Pain, 2004
Annals of Oncology, 2012
Background: In larger parts of the Middle East palliative care is still misunderstood among healt... more Background: In larger parts of the Middle East palliative care is still misunderstood among health professionals, cancer patients and the public at large. One reason to that is because the term does not obviously communicate the intent of this clinical discipline, which is lending better quality of life while combating cancer. Further, culture, tradition and religion have contributed to this misgiving and confusion especially at the terminal stage of the disease.
Journal of Pain and Symptom Management, 2006
There has been little research on implementation of pediatric pain programs. These studies are pa... more There has been little research on implementation of pediatric pain programs. These studies are part of a project to develop such a program for the King Hussein Cancer Centre in Jordan. Study 1 captured information on pain prevalence in 35 children using chart reviews and parent/child interviews to establish baseline pain burden. Forty-seven percent of children had pain at the time of interview; 11% had ''a lot'' of pain and only 22% received analgesics. Twenty-two parents were interviewed in Study 2 to identify attitudes toward pain management. Thematic analysis revealed six themes: 1) pain can and should be managed; 2) God's will; 3) parent's worst pain was emotional pain due to child's diagnosis; 4) belief that their presence could ameliorate their child's pain; 5) desire for shared decision making; and 6) the child's responsibility to express pain. These study results were used to inform the action research approach in the overall project.
Cancer Care in Countries and Societies in Transition, 2016
During times of forced migration, the focus in children is on infectious diseases, which are mana... more During times of forced migration, the focus in children is on infectious diseases, which are managed by vaccinations and antibiotics; and malnutrition that is managed by nutritional support. Cancer treatment is costly and not a priority during these times.
Pediatric Palliative Care: Global Perspectives, 2011
In most Middle Eastern countries pediatric palliative care as a special medical discipline is not... more In most Middle Eastern countries pediatric palliative care as a special medical discipline is not as yet in existence. In some countries this specialty is in its infancy, and only in a few countries has it become a recognized specialty and is practiced in the major medical ...
Leukemia, 2000
The purpose of this study was to assess the feasibility and efficacy of a treatment regimen for p... more The purpose of this study was to assess the feasibility and efficacy of a treatment regimen for pediatric acute myelogenous leukemia (AML) that uses four rotating drug pairs and adjusts dosages of etoposide and cytarabine to target specific plasma concentrations. Thirty-one girls and 27 boys (median age, 9.7 years) with de novo AML were treated on the protocol. Six cycles of chemotherapy were planned. Cycles 1 to 4 comprised the drug combinations cytarabine plus etoposide, cytarabine plus daunomycin, etoposide plus amsacrine, and etoposide plus azacitidine, respectively. For cycles 5 and 6, the first two combinations were repeated. Dosages were adjusted to achieve plasma concentrations of 1.0 µM ± 0.1 µM cytarabine and 30 µM ± 0.3 µM etoposide. Forty-four patients (76%) entered complete remission. Of those, 24 have had relapses; 23 remain alive in first or subsequent remission. The 5-year event-free survival (EFS) estimate was 31.0% ± 5.9%; the 5-year survival estimate was 41.4% ± 6.3%. Six patients (10%) died of the toxic effects of therapy. Severe neutropenia occurred in all cycles. Long-term complications of therapy included hepatitis C, cardiac insufficiency, and hearing loss. Adjustment of cytarabine and etoposide dosage was feasible for achieving targeted plasma drug concentrations; however, the potential clinical efficacy of this approach was offset by substantial acute and long-term toxicity.
The Journal of Pediatrics, 1998
A 24-day-old boy presented with a 2-hour history of swelling and bluish discoloration of the left... more A 24-day-old boy presented with a 2-hour history of swelling and bluish discoloration of the left lower limb, genitalia, and buttocks. Physical examination revealed swelling of the left lower limb, extending from the inguinal area to the ankle. The mass was indurated, irregular, covered with ecchymosis, and spared the foot (Fig 1). A complete blood count revealed hemoglobin of 10.5 g/dL and platelet count of 10 × 10 9 /L. There was evidence of a micro-angiopathic process on the blood smear. Coagulation studies revealed a low fibrinogen level (93 mg/dL) and a positive D-dimer test result. The coronal magnetic resonance imaging sequence (T1 inversion recovery [short tau inversion recovery]) (Fig 2) showed abnormal bright material infiltrating the muscle and subcutaneous fat in the pelvis and the left leg. The patient was treated with high doses of intravenous steroids (methylprednisolone, 6 mg/kg per day) for 4 to 6 weeks with marked diminution in the size of the mass and normalization of his platelet, hemoglobin, and fibrinogen values.
Journal of Pediatric Hematology/Oncology, 1999
Journal of Pain and Symptom Management, 2010
Journal of Pain and Symptom Management, 2010
Journal of Pain and Symptom Management, 2008
Children's pain is undertreated worldwide. Using a model of pediatric cancer pain management in A... more Children's pain is undertreated worldwide. Using a model of pediatric cancer pain management in Amman, Jordan, the authors demonstrated that an action research approach to pain service development resulted in a sustainable program of pain control. Barriers to care were due more often to health professionals' misconceptions concerning pain and opioid use than to concerns related to cultural, religious, or societal beliefs. Successful implementation of a pain management program requires education, policy development, and support from several levels of hospital administration. Role-modeling and mentorship are important factors. Established knowledge translation theories explained some but not all of the findings. Outcomes included consistent pain assessment and documentation by nursing staff, increased consultation for pain management, and increased use of intravenous opioids.
The Journal of Pain, 2004
Annals of Oncology, 2012
Background: In larger parts of the Middle East palliative care is still misunderstood among healt... more Background: In larger parts of the Middle East palliative care is still misunderstood among health professionals, cancer patients and the public at large. One reason to that is because the term does not obviously communicate the intent of this clinical discipline, which is lending better quality of life while combating cancer. Further, culture, tradition and religion have contributed to this misgiving and confusion especially at the terminal stage of the disease.
Journal of Pain and Symptom Management, 2006
There has been little research on implementation of pediatric pain programs. These studies are pa... more There has been little research on implementation of pediatric pain programs. These studies are part of a project to develop such a program for the King Hussein Cancer Centre in Jordan. Study 1 captured information on pain prevalence in 35 children using chart reviews and parent/child interviews to establish baseline pain burden. Forty-seven percent of children had pain at the time of interview; 11% had ''a lot'' of pain and only 22% received analgesics. Twenty-two parents were interviewed in Study 2 to identify attitudes toward pain management. Thematic analysis revealed six themes: 1) pain can and should be managed; 2) God's will; 3) parent's worst pain was emotional pain due to child's diagnosis; 4) belief that their presence could ameliorate their child's pain; 5) desire for shared decision making; and 6) the child's responsibility to express pain. These study results were used to inform the action research approach in the overall project.