BACKGROUND:Some comprehensive cancer centers in industrialized countries have reported improved outcomes in their cardiopulmonary arrest (CPA) patients. Little is known about the outcomes and predictors of CPA in cancer centers in other parts of the world. The objective of this study was to examine the predictors of CPA outcome in a comprehensive cancer center closed medical-surgical intensive care unit (ICU) located in Amman, Jordan.METHODS:In this retrospective single-center cohort study, we identified 104 patients who had a CPA during their stay in the ICU between 1/1/2008 and 6/30/2009. Demographic data and CPA-related variables and outcome were extracted from medical records. Comparisons between different variables and CPA outcome were conducted using logistic regression.RESULTS:The mean age of the group was 49.7+/-15.3years. The mean APACHE II score was 23.7+/-8.0. Thirty six patients (34.6%) were resuscitated successfully but 8 of them (7.7% of the cohort) left the ICU alive and only 6 out of the 8 (5.8% of the cohort) left the hospital alive. The following variables predict resuscitation failure: acute kidney injury (OR 1.7, CI: 1.1 - 2.6), being on mechanical ventilation (OR 3.8, CI: 1.3 - 11), refractory shock (OR 4.7, CI: 1.8 - 12) and CPR duration (OR 1.1, CI: 1.1 - 1.2).CONCLUSION:Survival among cancer patients who develop CPA in the ICU continues to be poor. Once cancer patients suffered a CPA in the ICU multiple factors predicted resuscitation failure but CPR duration was the only factor that predicted resuscitation failure and ICU as well as hospital mortality.

published_or_final_version / Social Work / Master / Master of Social Work

published_or_final_version / abstract / Community Medicine / Doctoral / Doctor of Philosophy

published_or_final_version / Community Medicine / Master / Master of Philosophy

Cancer has long been a prevalent illness in Hong Kong which caused tremendous stress on patients and their families. This study examined the cognitive process and behavioral efforts which related to cancer patients’ subjective well-being. Three hypotheses were proposed. First, higher internal locus of control over the cause of illness was hypothesized to relate to poorer subjective well-being through maladaptive coping. Second, higher internal locus of control over the course of illness may result in better subjective well-being through adaptive coping. Third, higher levels of hope may relate to better subjective well-being through adaptive coping. Ninety-eight patients with different types of cancers were recruited in this study. The results showed that internal locus of control over the cause of illness was not directly related to subjective well-being. The relationship between internal locus of control over the course of illness and social/family well-being was fully mediated by adaptive cognitive-behavioral coping and social and activity-engagement coping respectively in two separate mediation analyses. The relationship between levels of hope and social/family well-being was partially mediated by social and activity-engagement coping, while levels of hope significantly associated with social/family, emotional, functional and overall well-being. The study findings enhance understanding of close relationship between cognitive process and behavioral efforts in enhancing cancer patients’ adjustment to the illness. / published_or_final_version / Clinical Psychology / Master / Master of Social Sciences

Comorbid chronic insomnia was found highly prevalent in breast cancer patients. It also persisted through survivorship. Negative emotions upon diagnosis and during the course of cancer treatment might complicate the underlying mediating factors between stress and insomnia found in non-cancer population. Cognitive Behavioural Therapy (CBT) has been evidenced in improving insomnia. With the appreciation of Mindfulness training in improving cognitive flexibility and rumination, a novel treatment approach integrating CBT and mindfulness—Mind-Body Intervention (MBI) was developed. 　　　There were three objectives in the research. Firstly, prevalence data on insomnia and clinical profile of Hong Kong Chinese breast cancer survivors were obtained. Secondly, the mediating roles of negative emotions, hyperarousal, pre-sleep arousals in the relationship between perceived stress and insomnia were examined. Thirdly, the effects of CBT and MBI for breast cancer survivors with insomnia were investigated. 　　　In the first study, 1049 women who survived from non-metastatic breast cancer were invited to complete a survey on stress, mental health, arousals and insomnia. Those who met psychophysiological insomnia were invited to participate in the second study, which was a multisite randomized controlled trial. The 73 participants were allocated to CBT (n=24), MBI (n=27) or waiting list control, WLC (n=22). Both treatments were five weekly-session group therapies. Outcomes on insomnia, mental health, arousals, dysfunctional beliefs, quality of life and mindfulness, were obtained on baseline, post-treatment, 3-month and 6-month follow-ups. 　　　Results of the first study revealed 34.6% of the participants suffered from clinical insomnia, while 15.1%, 27.4% and 12.8% endorsed moderate to extremely severe depression, anxiety and stress respectively. Duration of insomnia was correlated with insomnia severity. Hyperarousal was found moderating cognitive ore-sleep arousal and anxiety, these in turn, together with depression mediated the relationship between perceived stress and insomnia severity. Results of the second study supported the hypothesis both CBT and MBI improved insomnia and other psychological symptoms, while WLC did not. After treatment, significant decreases of 59 and 67 minutes of total wake time per night were found for CBT and MBI respectively. Sleep efficiency values significantly increased in CBT (12.2%) and MBI (12.7%). Moderate to large effect sizes and clinically significant differences were found in most sleep and psychological variables. Generally, CBT produced larger effect sizes than MBI on post-treatment. The therapeutic gains were found sustaining through 3-month to 6-month follow-ups in both treatments. However, the effect sizes of CBT were on the declining trend, while those of MBI were more stable. 　　　The results suggested that insomnia and anxiety were frequently experienced in breast cancer even after completing the medical treatments. The longer the survivors suffered from insomnia, the higher the severity was found. In additional to the cognitive pre-sleep arousal, the important mediating roles of depression and anxiety imply that insomnia treatments should incorporate strategies designed to help in decreasing rumination/worry before bedtime and improving mental health conditions. The findings also provided initial evidence for the efficacy of MBI as a viable treatment for insomnia. More vigorous randomized controlled trial and the long-term efficacy could be further studied. / published_or_final_version / Clinical Psychology / Doctoral / Doctor of Psychology

This study examined differences in psychosocial adjustment and sexual function between female survivors of Hodgkin's disease and a control group of recently diagnosed but untreated cancer patients. The Hodgkin's disease survivors were assigned to one of two groups depending on whether they had retained ovarian functioning following their cancer therapy. Differences among the three groups were examined on variables consisting of the principal components derived from scores on the: Derogatis Sexual Functioning Inventory (DSFI); Brief Symptom Inventory (BSI); and Psychosocial Adjustment to Illness Scale (PAIS). These variables included: DSFI (General background and sexual functioning, Attitudes and feelings, and Information and Drive); BSI (General distress, and Somatic anxiety); and PAIS (General social functioning, and Health care orientation). No statistically significant differences in psychosocial adjustment and sexual function were found among the three groups. Additional analyses suggested that women who required therapeutic abortions to terminate pregnancies (existing at their diagnosis or occurring while they were receiving cancer treatment) had greater problems in psychosocial adjustment and sexual function than those who did not require abortions.

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