American University of Beirut

 Clinical and Translational Research

  • ​​​​​​​​​​​​​​​​​​Beat-to-beat blood pressure variability-Souha Fares, PhD

Blood pressure (BP) varies on the long-, short-, and very short-term. Particularly, changes in BP can be observed from week-to-week, day-to-day, and more importantly from beat-to-beat. Characterizing beat-to-beat blood pressure dynamics and understanding the role of beat-to-beat blood pressure variability as potential markers for early diagnosis of cardiovascular deteriorations is the main focus of my research program. Beat-to-beat blood pressure variability (BPV) is the oscillation of BP values measured continuously over a defined time interval, or the variability of the BP time series; it has been recently identified as a measure of early subtle changes in BP dynamics, independently of average BP levels. I study the variability of continuous beat-to-beat blood pressure time series data measured non-invasively using the FinaPres NOVA device, that we purchased specifically for our studies on beat-to-beat BPV, in diverse disease populations. I assess beat-to-beat BPV using conventional linear measures such as the standard deviation and coefficient of variation and non-linear advanced theoretical measures that quantify the degree of complexity/irregularity and correlation of BP time-series (entropy and detrended fluctuation analysis).

  • ​​​Abnormal Blood Pressure Complexity and Fluctuation: An Indicator of Vascular Disease Independent of Mean Blood Pressure (Interdisciplinary​) - Souha Fares, PhD

Our research project is focused on the use of non-conventional blood pressure variability (BPV) metrics, specifically complexity analysis and deternded fluctuation analysis, to examine the potential role of this novel cardiovascular risk factor in the adult Lebanese population. Time series data of blood pressure and heart rate will be collected continuously over a 30-60minute period. We aim to assess whether the reduction in BP which follows bariatric surgery is in fact associated with normalization of abnormal blood pressure variability and complexity in these populations. In addition, the study will examine the effect of demographic factors (age, gender, family history) on blood pressure complexity and fluctuation among obese normotensive, pre-hypertensive, and hypertensive patients. Impact: Clinical monitoring of BPV by nontraditional indices such as those described here may provide earlier indication of subtle changes in intravascular filling and pressure many years before the onset of hypertension and its resultant vascular injury and end-organ damage. Our study will be the first study looking at fairly novel measures of BPV among obese and morbidly obese subjects, specifically complexity measures and DFA. If our hypotheses are proven to be correct, our research will help in identifying new ways to discriminate between No-HTN and HTN patients through novel analyses of physiological measurements. If the new BP variability measures prove useful in determining the influence of demographic factors in discriminating between those two groups, they may prove to be useful metrics in measurement of the efficacy of drugs under development or other treatment protocols.

Research Team: Co-I: Drs. Kamal Badr, Issam Lakkis, Ramzi Alami

  • Patient and Caregiver Dyad Engagement in Heart Failure Self-Care- Angela Massouh, PhD, MScN, CNS
This project investigates patient and dyadic determinants of self-care in Heart Failure care dyads while controlling for dyadic interdependence. Secondary aims of this study are to: 
  1. Describe the relationships among dyad determinants and self-care in a sample of HF patient-caregiver dyads.
  2. Typify distinct patterns of HF patient-caregiver dyads in terms of degree of engagement in self-care. 
  3. Compare outcomes (30-day hospital readmissions, functional status, QOL, adherence to low salt diet, perceived control, and perceived caregiver strain) of HF patients in the different dyadic types.​
  4. Establish a neurocognitive profile of the HF patient.
  5. Establish whether an association exists between the severity of HF and cognitive abilities as well as cognitive abilities and self-care.
  6. Validate the Arabic Salt Knowledge, Attitudes, and Behavioral Assessment Questionnaire.
​Research Team: Dr. Hala Darwish (HSON), Dr. Souha Fares (HSON), Dr. Huda Abu Saad Huijer (HSON), Dr. Hadi Skouri (FM), Dr. Lara Nasreddine (FAFS), and Dr. Paula Meek (university of Colorado, Denver). 

  • ​Smartphone-Assisted Heart Rate Variability Biofeedback for Smoking Cessation-Nour Alayan, PhD, RN

Individuals attempting to quit smoking face numerous challenges to maintaining long-term abstinence. Current smoking cessation interventions focus on the pharmacological and behavioral components of addiction and the low success rates suggest the need for more holistic interventions. Studies have shown that those who fail to quit smoking often have low heart rate variability (HRV) demonstrating detriments in their capacity to regulate affective states, such as stress and craving, through heart-brain pathways. HRV Biofeedback (HRV-BFB) is a type of slow paced breathing that increases HRV and exercises heart-brain pathways, which in turn enhances affective and behavioral self-regulation. HRV-BFB could help individuals attempting smoking cessation to better manage stress and craving, and thus support long-term abstinence.

This study investigates the use of a smartphone-assisted HRV-BFB in maintaining abstinence in individuals enrolled in AUB's smoking cessation program. Participants will be randomly assigned to receive the HRV-BFB intervention. They will be trained to breathe at their resonance frequency (i.e. the breathing rate that helps optimal heart-brain connection) through a smartphone application. Participants will then practice resonance breathing on daily basis and monitor their HRV changes over 8 weeks. The primary outcome will be abstinence from smoking. We will also assess psychosocial factors at baseline, 1-month, 2-months, 3-months, 6-months, and 9-months after enrollment.​

Research Team: Co-PI: Dr.  Maya Romani, Dr. Martine El-Bejjani, Dr. David Eddie, Dr. Angela Massouh, and Dr. Samar Noureddine

  • Arterial Stiffne​ss as a Marker of Cardiovascular Disease - Houry Puzantian, PhD, FAHA

​​Cardiovascular diseases are the leading cause of death, worldwide. Various metabolic and inflammatory derangements contribute to cardiovascular disease development. Our biobehavioral nurse researchers at the HSON collaborate with investigators from various disciplines including the Faculty of Medicine (Divisions of Endocrinology and Metabolism, Nephrology and Hypertension, Infectious Diseases), the Faculty of Agricultural and Food Science (Department of Nutrition and Food Sciences) and others in investigating and addressing cardiovascular risk factors like obesity, hyperglycemia, kidney disease, HIV.

Herein, we highlight our ongoing projects addressing arterial stiffness in the context of various metabolic states. In striving to identify biomarkers associated with disease, and investigating the effects of dietary and pharmacologic interventions on the vasculature, our work may reveal therapeutic targets for the prevention and treatment of cardiovascular disease.

  • The influence of overprotective parenting on growth and development of children with congenital heart defects: a systematic review - Tamar Avedissian, RN, MSN, Ph.D. Student

Congenital Heart Defects (CHDs) are the most common anomalies of childhood affecting 8-12 out of 1,000 live births worldwide. Fortunately, with the advanced medical treatment options available, the survival rate of these children have markedly improved. On the other hand, the growth and development of these children remains poor, which is attributed to the consequences of the treatments as well as the disease itself.

About 20-30% of people with a CHD have some kind of a physical or neurodevelopmental delay. It has been also reported that parenting has a significant impact on child growth and development. The way parents behave and react with their child can either promote or hinder development. However, there is little information regarding the impact of parenting on delay and growth among children with CHDs. Therefore, a group of researchers from RHSON aim to conduct a systematic review to explore particularly the influence of overprotective parenting on growth and development of toddlers and preschoolers with CHDs.

The findings of this review may support the presence of delay in growth and development of children with CHDs having overprotective parents. Hence, suggest the need to assess parenting behaviors and develop parenting interventions that promote growth and development among children with CHDs. ​

Research Team: Dr. Samar Noureddine, Ms. Layal Hneiny, and Ms. Sally Atwi.

  • Exploring Dignity in Advanced Chronic and Terminal Illnesses in Lebanon: Patients and Caregivers Perspective​ - Silv​aDakessian Sallian, RN, MPH, PhD Candidate 

Palliative care aims at delivering comprehensive, compassionate care to patients facing life threatening conditions to uphold their dignity towards the end of life. Lebanon is a middle eastern country with beginning palliative care services. During advanced and terminal illness, communication with health care providers as well as plan of care is affected by the close family members' input and the religious faith of the patient. This unique interplay of family presence and cultural values may shape patient dignity by enhancing or diminishing it.

The purpose of this study is to explore the interpretation and conceptual qualities of personal dignity in adult patients facing advanced chronic or terminal illnesses and their family caregivers. It seeks to understand how personal dignity is interpreted in the illness experience and how it is influenced during interactions with health care providers and consuming health services in a middle eastern environment.

Understanding how personal dignity is perceived and experienced from the patient and family caregiver perspective in Lebanon will bring new insight to the patient-family-health care provider dynamics guiding clinical practice, health education as well as national policy in delivering dignity conserving care to patients with palliative care needs.

Research Team: Dr. Yakubu Salifu , Dr. Nancy Preston

  • ​Acceptability of Mobile Health Intervention for Supportive Pain Management for Adolescents with Cancer: A Qualitative Study​ - Dina M. Madi RN, PhD

The use of mobile application for pain management is a new avenue which is gaining support of clinician and experts in pain management. Utilizing cancer-focused applications in general is increasing and has gained considerable interest over the past years. This is particularly relevant to adolescents who rely on mobile technology for several major functions including support and information. In this study, acceptability of a mobile health intervention for supportive pain management in adolescents with cancer will be explored. We hypothesize that digital solutions are needed and are of paramount importance from an accessibility and usability point of view in this digital age, especially for young adolescents whose primary contact with their environment is increasingly dependent on technology. This project attempts to validate this hypothesis through a qualitative approach inspired by an established and recent theoretical framework of acceptability. Based on the outcome of this research, the ultimate goal of this study (to be addressed in future research) is to create a pain logging and management tool by developing a treatment center-based social network accessible through a smartphone app, complemented by team activities and group therapy sessions. The app will provide a parallel complementary pain management tool over existing pain treatments. ​

Research Team: Co-PI: Dr. Myrna A.A. Doumit​

  • Impact of person-centered care on dementia-related aggressive behaviors and quality of life on people with dementia living in nursing homes in Lebanon: a feasibility study - Marina Gharibian Adra, PhD

The symptoms of dementia such as aggression and agitation, that are thought to be related to unmet needs, have traditionally been treated with pharmacological agents, but many medications are as likely to harm older people with dementia as to help them. In residential care, neglect of needs can exacerbate need-driven dementia-compromised behaviors, leading to loss of self-care, decision making, social engagement and increased social alienation that can be deeply damaging to people's sense of personhood and might even undermine physical wellbeing.

In Western countries, non-pharmacologic interventions are increasingly being investigated as ways to reduce these symptoms as they are recommended as the initial treatment approach. However, no such studies have been undertaken yet in nursing homes in Lebanon.

Two faculty members at HSON opted to evaluate the impact of person-centered care (PCC) on aggressive symptoms of dementia and quality of life of older nursing home residents living with dementia. The psychological needs of people with dementia are the backbone of PCC. It views the world from patients' perspectives and facilitates positive relationships and communications to meet individualized needs beyond just the physical needs. The focus in PCC is the need to preserve the patient's personhood through the course of the disease.

Implications: The lessons learned from this study will provide the evidence base for better practice in caring for patients with dementia in nursing homes leading to a better quality of life. Shifting the current focal point of healthcare for aggressive dementia patients towards a more person-centered approach will have a positive impact on patient care; it may have benefits in reducing the severity of agitation and aggression, likely prolonging or negating the use of pharmacological alternatives.

Research Team: Co-I: Dr. Hala Darwish, Dr. Souha Fares

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