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

At the end of the year we would like to pass our sincere greetings to all our readers, authors editorial office and the production team. We are indebted with the success of the journal for these people.

A paper from Jordan looked at the Learned Lessons from respiratory disease outbreak in a Jordanian Hospital: for Planning Nursing School Training. The authors stressed that every real and perceived emergency such as natural disasters and pandemics requires a response. The occurrence of several pandemics in a number of Jordanian hospitals raised public and professionals' concern. This commentary highlights describes how a school of nursing dealt with the outbreak within one health care institution; gives an example of one of the applied measures; and discusses learned lessons. Policy should be available to face emergency interruptions of nursing clinical practice.

A brief review from Jordan looked at pathophysiology of Cancer Related Pain. Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Cancer related pain still Permanent, feared problematic worldwide. Cancer pain management is the most problematic that found in patients who have a malignant tumor, and represent the most feared consequences for patients and their families. Cancer related pain management remain a challenge in cancer patients, their families, and oncology nurses due to lack of knowledge and assessment of pain which causes inadequate pain management. There is agreement among experts about the classification of pain into nociceptive, neuropathic, psychogenic, mixed, or idiopathic. This classification is found useful in assessment and therapeutic decision making. The author conclude that there is a need to more studies to further understand the unique molecular mechanisms by which cancer produces sensitization and pain so that new pharmacological targets can be identified that will reduce or block tumor-evoked sensitization.

A paper explores the barriers to breast self-examination (BSE) performance, and to characterize the demographic and cognitive factors associated with their breast cancer screening behavior. The author stressed that early detection of breast cancer is of great importance to improve women's health and to decrease the cost related to cancer death. Therefore, recognition of variables related to breast cancer screening behaviors is necessary. Data were 12 article talk about the barriers to BSE, using an adapted version of Champion's revised Health Belief Model Scale. The results revealed that most women in different countries have multi factors prevent her to do breast cancer examination and other screening methods such as cultural, socio-demographic, socio-economic, behavioral and educational factors. The author concluded that eliminating barriers and increasing perceived self-efficacy with an emphasis to make the women acquainted with BSE performance; as well as increasing health motivation of women and persuading of physicians for clinical breast examination (CBE) performance with low cost, are important to promote BSE.

A paper from Saudi Arabia looks at chronic kidney disease (CKD) as a major health problem in Saudi Arabia. The author stressed that the number of people requiring kidney replacement therapy in Saudi Arabia is growing, which poses challenges for health professionals and increases the burden on the health care system. However, there is a paucity of nursing literature about CKD in the Middle Eastern region, including Saudi Arabia. The purpose of this review is to describe the epidemiology, risk factors, treatment modalities and the implications for nursing practice of CKD in Saudi Arabia. Improving nurses' knowledge and awareness about CKD and the risk factors in Saudi Arabia will help them to determine high risk groups and provide early management to delay progression of the disease.

An evidence-based review from Azzarqa looked at the effectiveness of cryotherapy in prevention of oral mucositis in adult patients who received chemotherapy. The author did a literature search using an appropriate keywords search in Cochrane, Science direct and Pubmed databases from 2009 to 2013. The inclusion criteria include: adult cancer patients who had OM, Oral mucositis induced by chemotherapy, using cryotherapy to prevent OM and articles written in English language. The findings reveal that cryotherapy has an effective method in prevention of OM with chemotherapy regimens include 5FU regimens and high dose melphalan. The author concludes that cryotherapy is effective method for prevention of oral mucositis in patients who received two specific chemotherapy regimens include 5FU regimens and high dose melphalan. In addition, the efficacy of oral cryotherapy affected by the types of chemotherapy regimens including the half life for each one and it depend on the causative mechanisms of oral mucositis including direct and indirect mucositis.