A. Abyad, MD, MPH, MBA, AGSF, AFCHSE (Editor) A. Abyad, MD, MPH, MBA, AGSF, AFCHSE (Editor) Abyad Medical Center & Middle East Longevity Institute Azmi Street, Abdo Center, 2nd Floor PO BOX 618, Tripoli LEBANON Tel & Fax: 961 6 443684/5/6 Email: aabyad@cyberia.net.lb Web: www.amc-lb.com

This is the second issue this year that has a number of papers dealing with nursing issues from the region.

A paper looked at transcultural Adaptation of Best Practice Guidelines for Ostomy Care: Pointers & Pitfalls. The authors stressed that No standardized guidelines for ostomy care exist in the Middle East to support best practice. This contrasts with North America where ostomy guidelines are widely used in health service organizations. This project sought to assess the relevance of North American ostomy guidelines to a different health system and cultural context in the Middle East. The overall aim was to reach consensus to adopt, adapt or reject. A graduate student, enrolled in a Masters of Nursing (MN) program in the Gulf Cooperation Council (GCC) state of Qatar, critiqued two North American guidelines using standardized tools. The process engaged local stakeholders and opinion leaders in the colorectal cancer field, as well as international ostomy care and practice guideline experts. Appraising the quality, content and relevance of international ostomy guidelines to different jurisdictions provided opportunity for local practitioners to define and shape best practice. The adapted guideline is expected to promote consistent standards of care and optimal health outcomes for persons with ostomy in a region where cultural and religious values are intricately linked to health beliefs and practices.

A second paper looked at the effect Aerobic Exercise and Major Depressive Disorder. The author stressed that Major Depressive Disorder (MDD) is one of common health problems, and is estimated to affect 121 million adults. MDD is a recurrent illness, with high incidence of returning, and the risk of relapse that increases as the number of previous episodes increase. Hence, the choice of treatment is important to improve the quality of life and to prevent or minimize recurrent episodes. Physical exercise is an example of alternative and complementary therapy that has received considerable and significant attention in treatment of MDD. The efficacy of aerobic exercise approaches is considered and has a place in mental health practice. It is recommended that patients participating in three to five exercise sessions per week, for 30 to 45 minutes per session. Within the range of intensity for aerobic exercise, that achieves a level of heart rate of 70 to 85 % of the heart rate reserve. Furthermore, the majority of researches emphasize that the exercise regimen should be continued for at least 10 to 16 weeks to achieve the greatest antidepressant effect.

A paper from Jordan looked at the Effectiveness of Group Psychoeducation for Medications Adherence among Inpatient Adults with Schizophrenia in Psychiatric and Mental Health Settings
The authors stressed that one of the most barriers to treat clients with schizophrenia is nonadherence to medications regimen, and low levels of knowledge about their medications and side effects. Therefore, this evidence based practice paper examined the effectiveness of group psychoeducation for medications adherence among inpatient Adults with schizophrenia in psychiatric and mental health settings. studies were selected by Electronic searches of CINAHL, Pub-med, and MEDLINE, for the years between 2009 and 2013. The criteria of selection were to select all relevant systematic review and randomized controlled trials focusing on the effectiveness of group's psychoeducation for schizophrenic clients. The author concluded that group psychoeducation for medication adherences have proven to be effective in improve medication adherence among inpatient adults with schizophrenia in psychiatric and mental health settings, and positive effect on decrease relapses and rehospitalization; reduce the length of hospitalization. Furthermore, increase quality of life, self satisfaction, self-efficacy and self-esteem among these clients.

A second paper from Jordan looked at Uncontrollable Behavior and Restraints Policy Analysis. The aim is to assess and analyze the uncontrollable behavior and restraint policy for National Center of Mental Health in Jordan according to administrative ease, cost and benefits, effectiveness, equity, legality and political acceptability. The use of restraint in psychiatric settings supports putting forward a policy and program on how to deal with uncontrollable behavior as result decrease number of restraint patient. The author concluded that there are many alternatives that effective, safe to patient and staff, legally, easy to apply, and accepted politically used instead use of physical restraint.

A paper from Pakistan looks at aspects of nurse training in impoverished areas with special cultural and religious needs. The author highlights the Pakistan approach in terms of Millenium Development Goals.