Ostomy-related problems and their impact on quality of life of Saudi ostomate patients: A mixed-methods study.

AIM AND OBJECTIVE: The aim of this study is to explore the health-related quality of life outcomes and ostomy-related obstacles among patients with ostomy in Saudi Arabia. BACKGROUND: Negative effects on quality of life for patients following ostomy creation are a globally important health concern. Paucity of understanding factors that influenced quality of care after ostomy surgery hinders the ability of healthcare providers to offer appropriate care to improve patient's quality of care. METHODS: This mixed-methods study was undertaken through survey (COHQOL-Q Arabic version) for collecting the quantitative data (n = 421) and semi-structured interview for collecting qualitative data (n = 12). This study employed STROBE and GRAMMS checklists. RESULTS: Multiple health-related quality of life challenges was indicated by Saudi patients with intestinal stomas. Ostomy surgery interferes with religious practice in Muslim people, particularly obtaining Hajj worship and fasting for Ramadan. The overall QOL mean score was moderate level (M = 7.57) for ostomy patients in Saudi Arabia. The highest domain mean score was the social well-being (M = 7.84) and the lowest in the physical well-being (M = 7.18). Reshaping of religious practices, apprehension and adaptation to living with a stoma were the most common themes that participants discussed related to ostomy issues they experienced following ostomy surgery. CONCLUSION: The study findings reported a greater understanding of challenges that patients with stoma experience in Saudi Arabia. The process of the adaptation and the change of their lifestyle also affects patient's quality of life. The healthcare providers can use the study results to create a supportive intervention strategy that needed for maximise QOL for people with stoma. RELEVANCE TO CLINICAL PRACTICE: This study identifies issues associated with stoma creation among Saudi people and can help in planning and providing the required nursing care which may support in the reduction of predictable problems. Recommendations for future studies related to nursing professional practice are indicated.

Health-related quality of life among patients with an ostomy regarding sex, disease diagnosis, health care provider, and ostomy type: a descriptive cross-sectional study.

BACKGROUND: Ostomy surgery can negatively affect quality of life; however, the lived experiences of individuals with ostomies in Saudi Arabia are not well understood. PURPOSE: To examine how sex, ostomy type, disease diagnosis, and health care provider shape health-related quality of life (HRQOL) in individuals with ostomies in Saudi Arabia. METHODS: A descriptive cross-sectional study was conducted based on self-reported data of a convenience sample of 421 patients (239 male, 182 female) with ostomies (206 temporary, 211 permanent, 4 unknown) from 5 hospitals in Riyadh, Saudi Arabia. Data were collected using the City of Hope-Quality of Life-Ostomy Questionnaire (Arabic version) and analyzed by univariate and multiple regression analyses to identify predictors of physical, psychological, social, spiritual, and overall HRQOL. RESULTS: HRQOL scores correlated significantly with ostomy type (temporary vs permanent), sex, and health care provider. There were no significant differences in HRQOL scores by disease diagnosis (cancer vs non-cancer). CONCLUSION: Several potential predictors of HRQOL among patients with ostomies in Saudi Arabia were identified, which may assist in developing intervention strategies to improve patients' HRQOL. Additional studies are needed to understand the specific barriers in each group.

City of Hope-Quality of Life Questionnaire-Arabic Version: assessment of reliability and validity.

BACKGROUND: Arabic is spoken as a native language by more than 400 million people worldwide. However, there is no specific Arabic language instrument to measure stoma-related quality of life. PURPOSE: This study was designed to assess the validity and reliability of the City of Hope-quality of life-Ostomy Questionnaire (COH-QOL-OQ) Arabic version. METHODS: A cross­sectional design was used. Intra-class correlation coefficients were calculated to measure reliability, and Pearson's correlations of an item with its own scale and other scales were scored to evaluate convergent and discriminant validity. Content validity was reviewed by a panel of 5 experts. RESULTS: There were 421 participants with colostomy, ileostomy, or urostomy (239 [56.8%] male and 182 [43.2%] female). All COH-QOL-OQ subscales for the Arabic version demonstrated a high level of internal consistency (Cronbach's α = 0.71-0.87). The initial administration of the confirmatory factor analysis model showed inadequate goodness-of-fit indices (χ² /df = 3.902, NFI = .845, CFI = .880, RMSEA = 0.083). However, after removing item 2 in the social dimension, the final administration of the confirmatory factor analysis model showed significant goodness-of-fit indices (χ² /df = 2.663, NFI = .900, CFI = .935, RMSEA = 0.063). CONCLUSION: The findings suggest that the COH-QOL-OQ Arabic version is a valid and reliable tool to measure quality of life among patients with an ostomy in Saudi Arabia.

Confidence, skills and barriers to ostomy patient care by nursing staff in Saudi Arabia.

AIM: This study examined the confidence level and perceived barriers to providing ostomy care among staff nurses in Saudi Arabia. BACKGROUND: Patients with ostomies experience increased comfort and satisfaction when nurses are confident in their knowledge and skills. DESIGN: A descriptive, cross-sectional design was used to conduct the research. The study included a convenience sample of 214 staff nurses from five hospitals in Riyadh, Saudi Arabia. The researchers used a survey questionnaire to gauge participants' confidence in their knowledge and skills, as well as identify any perceived barriers to ostomy care. RESULT: Overall, 95.1% of participants worked in adult care and 82.2% worked in surgical areas. There were significant relationships between the nurses' confidence in their ostomy care knowledge and skills and their years of nursing experience and having received ostomy care training in nursing school (p < .05); however, the nurses' level of education had no correlation (p > .05). CONCLUSION: While the majority of nurses were confident in their ability to care for patients with ostomies, they were concerned about causing stoma problems. This suggests that improving the quality of ostomy care provided by nurses may result in fewer negative outcomes for patients with ostomies.

Quality of life among ostomy patients: A narrative literature review.

AIM AND OBJECTIVE: This study aims to identify and summarise factors related to ostomy patients' experiences and how these impact the perceived quality of life for those patients. BACKGROUND: Ostomy formation is a common therapeutic technique used to treat different colorectal diseases such as colorectal cancer. Although surgical intervention and ostomy formation may prolong a patient's life, it may cause many problems in their daily lifestyle and affect their quality of life. The surgical creation of an ostomy has a significant impacts on a patient's quality of life from multiple perspectives, including physical, psychological, social and spiritual aspects. DESIGN: A narrative literature review, using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline). METHODS: This review analysis of search filters was conducted in the following databases: PubMed (MEDLINE), CINAHL, Embase, ProQuest, Science Direct, Scopus, and PsycINFO. A validation data set of 283 research articles between January 2000 and December 2019 were used to identify the impact of stoma surgery on patients' quality of life. RESULT: Thirty-seven studies were identified as suitable for inclusion in this literature review. The results of the review indicate that quality of life (QoL) in patients who have an ostomy is influenced by many modifiable factors. Exercise, preoperative stoma site identification, family support, maintenance of social networks, education, spirituality and financial stability are all potentially modifiable factors that can improve the QOL for ostomy patients. CONCLUSION: This review has identified multiple challenges that ostomy patients experience, which were clustered according to physical, psychological, social and spiritual challenges. RELEVANCE TO CLINICAL PRACTICE: This study identifies issues associated with stoma creation and can help in planning and providing the required nursing care which may assist in the reduction of predictable challenges. Recommendations for future research related to nursing practice are stated.

Identification of protein quality control regulators using a Drosophila model of TPI deficiency.

Triosephosphate isomerase (TPI) deficiency (Df) is a rare recessive metabolic disorder that manifests as hemolytic anemia, locomotor impairment, and progressive neurodegeneration. Research suggests that TPI Df mutations, including the "common" TPIE105Dmutation, result in reduced TPI protein stability that appears to underlie disease pathogenesis. Drosophila with the recessive TPIsugarkill allele (a.k.a. sgk or M81T) exhibit progressive locomotor impairment, neuromuscular impairment and reduced longevity, modeling the human disorder. TPIsugarkill produces a functional protein that is degraded by the proteasome. Molecular chaperones, such as Hsp70 and Hsp90, have been shown to contribute to the regulation of TPIsugarkill degradation. In addition, stabilizing the mutant protein through chaperone modulation results in improved TPI deficiency phenotypes. To identify additional regulators of TPIsugarkill degradation, we performed a genome-wide RNAi screen that targeted known and predicted quality control proteins in the cell to identify novel factors that modulate TPIsugarkill turnover. Of the 430 proteins screened, 25 regulators of TPIsugarkill were identified. Interestingly, 10 proteins identified were novel, previously undescribed Drosophila proteins. Proteins involved in co-translational protein quality control and ribosome function were also isolated in the screen, suggesting that TPIsugarkill may undergo co-translational selection for polyubiquitination and proteasomal degradation as a nascent polypeptide. The proteins identified in this study may reveal novel pathways for the degradation of a functional, cytosolic protein by the ubiquitin proteasome system and define therapeutic pathways for TPI Df and other biomedically important diseases.

Improving Care Provision to Older Adults with Dual Diagnosis: Recommendations from a Mixed-Methods Study.

Older adults with dual diagnosis remain an under-diagnosed population in mental health services, with complex needs and high rates of medical comorbidity. Dual diagnosis is a significant challenge to contemporary mental health services, with recognition of the increased rate of relapse and costs of care of poorly managed dual diagnosis identified through comprehensive research. Unfortunately, the research attention paid to those with dual diagnosis in younger age groups has not been replicated in the older adult cohort, with few studies specifically exploring the treatment needs of these individuals. Of the studies that do exist, many identify poor screening and assessment, clinician frustration and a lack of cohesive treatment for co-occurring alcohol and other drug use disorders for older adults. We draw from a mixed methods exploratory study conducted in an inner Melbourne community older adult mental health service providing care to consumers with dual diagnosis to formulate recommendations to improve the care provision to this cohort. We discuss changes to the way older adult mental health services operate that are essential to improve the care and response to consumers presenting with dual diagnosis. Ultimately, we aim to discuss how older adult mental health services can improve to provide timely, responsive care to those with dual diagnosis.

Advance Statements within the Victorian Mental Health Setting: A Contextual and Legislative Global Comparison.

This article provides context to the establishment of advance statements within the Australian mental health setting, in the state of Victoria. A movement to legislate for a more humane and liberal approach to mental health consumer care resulted in changes to the Victorian Mental Health Act (2014a). This Act mirrored legislative changes across the western world and resulted in a socially progressive movement embracing recovery focussed care and consumer clinician partnerships. Thus, we purport that an identified need for a more liberal way to work with individuals who have a diagnosis of mental ill health was a major aim of this law reform. The advance statement model is seen as a tool in addressing a growing recognition of how mental health providers engage consumers of mental health services, and value their preferences to care received. This article arises from a larger study which has aimed to explore the role and scope of advance statements. This research has sought to demonstrate how advanced statements can be used within mental health services by providing recommendations for the mental health nursing workforce in relation to the implementation and deliverables for training.

A study of tuberculosis in road traffic-killed badgers on the edge of the British bovine TB epidemic area.

The role of badgers in the geographic expansion of the bovine tuberculosis (bTB) epidemic in England is unknown: indeed there have been few published studies of bTB in badgers outside of the Southwest of England where the infection is now endemic in cattle. Cheshire is now on the edge of the expanding area of England in which bTB is considered endemic in cattle. Previous studies, over a decade ago when bovine infection was rare in Cheshire, found no or only few infected badgers in the south eastern area of the county. In this study, carried out in 2014, road-killed badgers were collected through a network of local stakeholders (farmers, veterinarians, wildlife groups, government agencies), and Mycobacterium bovis was isolated from 21% (20/94) badger carcasses. Furthermore, there was strong evidence for co-localisation of M. bovis SB0129 (genotype 25) infection in both badgers and cattle herds at a county scale. While these findings suggest that both badgers and cattle are part of the same geographically expanding epidemic, the direction of any cross-species transmission and the drivers of this expansion cannot be determined. The study also demonstrated the utility of using road-killed badgers collected by stakeholders as a means of wildlife TB surveillance.

Perioperative antiemetic efficacy of dexamethasone versus 5-HT3 receptor antagonists: a meta-analysis and trial sequential analysis of randomized controlled trials.

BACKGROUND: Dexamethasone has many desirable pharmacologic properties for perioperative use. Its antiemetic potential has been a focus of many recent trials. METHODS: Trials comparing dexamethasone to 5-HT3-receptor antagonists (5HT3-RA) for 24 h postoperative vomiting incidences published till August 2017 were searched in the medical database. Comparisons for antiemetic efficiency variables (vomiting incidence, nausea incidence, rescue antiemetic need, and patients with complete response) during early (until 6 h) and late postoperative phase were made. Comparative analgesic requirements were also evaluated. RESULTS: Twenty randomized controlled double-blinded trials were included in the final analysis. Twenty-four-hour vomiting incidence was similar (Fixed-effects, P = 0.86, I2 = 2.94%). Trial sequential analysis (TSA) confirmed non-inferiority of dexamethasone for 24-h vomiting incidence. (α = 5%, ß = 20%, δ = 10%) with "information size" being 1619 (required > 573). Equivalence was also verified from early and delayed nausea rate as well using TSA. Pooled results did not demonstrate superiority/inferiority of 5-HT3-RAs over dexamethasone in all other antiemetic efficacy variables (early and delayed). Heterogeneity was found to be low in all of the comparisons. Linear-positive dose-response curve for dexamethasone 24-h vomiting and nausea incidence was seen (correlation coefficient being 0.21 and 0.28, respectively). Dexamethasone reduced the analgesic need (MH-odds of 0.64 (95% CI being 0.44 to 0.93) P = 0.02, I2 = 0)). Possibility of publication bias could not be ruled out (Egger's test, X-intercept = 1.41, P = 0.04). CONCLUSIONS: Dexamethasone demonstrates equal antiemetic efficacy compared to 5-HT3 receptor antagonists. The agents perform equally well both in early postoperative phase and up to 24 h after surgery. Use of dexamethasone replacing 5-HT3 RAs offers an additional advantage of lowering the opioid requirements during the perioperative period.

The Experiences of Older Adults with Dual Diagnosis in an Inner Melbourne Community Mental Health Service.

Less is known about the experiences of older adults (65+ years of age) with co-occurring mental health and alcohol and other drug use disorders (dual diagnosis) than is known about the experiences of their younger counterparts. This exploratory qualitative study sought to interview individuals receiving case management from an inner Melbourne community mental health service to determine their experiences of living with dual diagnosis and explore their interactions with mental health and addiction treatment, and general medical services alike. Six older adults with a dual mental health and substance disorder agreed to participate in a semi-structured interview process and provided their perspectives about living with complex mental illness and alcohol and other drug use. Several key themes emerged throughout the interview process, mirroring the notion of dual diagnosis being a complex phenomenon involving a number of interrelated factors: these include medical complexity, poor service engagement and long-term use of alcohol and other drugs. Interviews also demonstrate the challenges inherent in providing care to this cohort, with the participants frequently describing their experiences with services as being fraught with difficulty. The increased understanding of the perspectives of older adults with dual diagnosis provides the foundation for further research into this population in addition to influencing future nursing care provided to this cohort.

The Experiences of Clinicians Caring for Older Adults with Dual Diagnosis: An Exploratory Study.

Dual diagnosis has been identified as a significant challenge to mental health services, resulting in higher rates of psychiatric relapse and greater illness severity. Much research explores dual diagnosis in the adult mental health cohort, however little research attention has been paid to older adults with dual diagnosis. Far from being a trivial issue, preliminary studies have shown that dual diagnosis in older adults is under diagnosed and poorly identified by clinicians with few specific treatment options available. In addition, studies of the ageing baby boomer cohort demonstrate a potential for dual diagnosis presentations to increase in the coming years. This article explores the experiences of a clinical team providing care to older adults with dual diagnosis in Melbourne, Australia, through a semi-structured interview process. The participants described a number of systemic barriers to providing care to the older adults with dual diagnosis presenting to the mental health service, in addition to feeling poorly prepared and expressing a degree of clinical helplessness. Additionally, the participants described service improvement, which included a strong dual diagnosis culture in the leadership team of the mental health service and role modelling dual diagnosis competent practice among clinicians.

Alcohol Use in an Older Adult Referred to a Consultation-Liaison Psychiatry Service: A Case Report.

Alcohol use disorder in older adults is associated with a number of substantial medical complications, including cognitive decline. Due to limited success and application of screening approaches in this cohort, older adults are more likely to present to general hospital settings with undiagnosed problematic alcohol use. Consultation-liaison psychiatry services operating in general hospital settings are likely to be referred older adults with alcohol use disorders for assessment and management. A 77-year-old female presented to a metropolitan hospital with symptoms including frequent falls, slurred speech, difficulty judging distance, hypersomnia, poor reasoning, and odd behaviours. She also presented with severe anxiety and bruxism. Several diagnostic tests were inconclusive, and a consultation-liaison psychiatry assessment revealed a prominent heavy drinking pattern and concurrent abuse of oxycodone and benzodiazepines. This report adds further support to the case for uniform screening of all older adults for alcohol and other drug (AOD) use. A number of weeks had passed before the patient's drinking pattern was established, with no withdrawal management in place. A multifaceted treatment approach, including antidepressant therapy, anticraving medication, benzodiazepine as well as opiate rationalisation, and AOD counselling support was commenced prior to discharge from the general hospital.

Happy to help/happy to be here: Identifying components of successful clinical placements for undergraduate nursing students.

INTRODUCTION: The clinical placement learning environment is a critical component of nursing education where Australian nursing students spend a minimum of 800h. Identifying components of successful clinical placements for undergraduate nursing students is therefore paramount. PURPOSE: To assess nursing students' views of the learning environment during clinical placement with an emphasis on the pedagogical atmosphere, leadership style of the ward manager, and premises of nursing on the unit or ward. MATERIAL AND METHODS: The study used Clinical Learning Environment, Supervision and nurse teacher (CLES+T) questionnaire to examine 150 final year undergraduate students' perceptions of the clinical placement learning environment. The questionnaire was anonymous and completed by the students at the end of their clinical placement. The statistical program SPSS v22 was used. Principal components analysis (PCA) for data reduction was run on the 42-question section of the first dimension ('pedagogical atmosphere on the ward') of the questionnaire that measured the perceptions of the learning environment of the clinical placement of the 150 final-year undergraduate nursing students. The comments sections of the factors were subjected to interpretive content analysis to create the themes for the two components. RESULTS: Principle Component Analysis revealed two components that had eigenvalues greater than one: 'Happy to Help' Component 1 and 'Happy to be Here' Component 2. These components were statistically significant (p<0.0005), using Bartlett's Test of Sphericity indicating that the data was likely factorizable. These components scored higher than any other related factors. CONCLUSIONS: Student nurses value a welcoming workplace where staff and educators are happy to help and have a positive attitude to student presence on the wards. More than any other factors these ward-based factors appear to have the strongest influence on student satisfaction.

Prevalence of co-occurring alcohol and other drug use in an Australian older adult mental health service.

Co-occurring mental illness and substance use disorder, known as dual diagnosis, is a significant challenge to mental health services. Few older adult specific alcohol and other drug treatment services exist, meaning older adult mental health services may become the default treatment option for many. Evidence suggests that dual diagnosis leads to substandard treatment outcomes, including higher rates of psychiatric relapse, higher costs of care and poorer treatment engagement. This paper explores the prevalence of co-occurring alcohol and other drug (AOD) use in an older adult community mental health service in inner Melbourne, Australia. This aim was accomplished by using a retrospective file audit of clinical intake assessments (n = 593) performed on consumers presenting to the service over a two-year period, June 2012-2014. Of consumers presenting to the service, 15.5% (n = 92) were assessed by clinicians as having co-occurring AOD use. Depression predominated in the dual diagnosis group as the primary mental health disorder. Dual diagnosis consumers in this sample were statistically more likely to be male and younger than their non-dual diagnosis counterparts. A limitation of this audit was the lack of implementation of screening tools, leaving assessment to clinical judgement or the interest of the clinician. This may also explain the discrepancy between the results of this study and previous work. Although appearing to be a relatively small percentage of assessments, the results accounted for 92 individuals with complex mental health, AOD and medical issues. Poor screening procedures in a population that is traditionally difficult to assess need to be rectified to meet the future challenges inherent in the ageing baby boomer generation, changing drug use trends and extended lifespans through harm reduction initiatives and medical advancements.

An Ageing Methadone Population: A Challenge to Aged Persons' Mental Health Services?

Oral administration of methadone has been used as a treatment strategy for opiate addiction for many years. The state of Victoria, Australia, has a long-running methadone program with a large number of participants. Accordingly, a growing number of adults have utilised methadone maintenance treatment for a number of years and are now moving into older age due to advances in medical treatment and harm reduction initiatives. The objective of this review is to examine the literature pertaining to co-occurring mental illness in older methadone treatment participants and to explore the future challenges this growing cohort of ageing adults pose to aged persons' psychiatry services. As part of a broader study into dual diagnosis in older adults, a search of the Scopus, ProQuest, and CINAHL journal databases was performed. Twenty abstracts from literature published within the previous 15 years (1999­2014) were identified that explored methadone maintenance programs and the older adults maintained on them. A number of researchers have identified the ageing methadone population to have a high degree of comorbid mental illness and psychological distress. Studies also indicate that individuals enrolled in methadone maintenance programs may engage in a degree of continual substance use, potentially leading to deleterious effects on their psychosocial function. An ageing methadone population experiencing a high degree of comorbid mental illness is likely to challenge aged persons' psychiatry services. These services are likely to be increasingly called on to manage these individuals, particularly within Victoria where few substance use services exist for those over the age of 65. It is essential that aged persons' psychiatry services prepare to provide care for these individuals in a responsive manner that is inclusive of both their mental health and substitution pharmacotherapy.

Maturing out, natural recovery, and dual diagnosis: What are the implications for older adult mental health services?

In 1962, Charles Winick proposed that addiction was a self-limiting process, whereby individuals stopped using substances once the stresses of life transitions ceased. The notion of maturing out, as labelled by Winick, often forms the basis of the natural recovery movement in alcohol and other drug (AOD) research, aiding the notion that older individuals either cease their substance use or fall victim to the higher mortality rates prevalent in substance-using populations. As more consumers present to adult mental health treatment settings with co-occurring substance use disorders, the idea that individuals will simply cease using AOD is outdated. Given the future challenges of an ageing population, it is prudent to explore those who fail to mature out of substance use, as well as challenge the notion that older adult mental health services rarely encounter substance-using individuals. The present study explores Winick's research in the context of an ageing population and older adult mental health services. It also ponders the proposition put forth in subsequent research that older individuals with lifelong substance use switch to substances that are easier to obtain and better tolerated by their ageing bodies.

Growing Old With Ice: A Review of the Potential Consequences of Methamphetamine Abuse in Australian Older Adults.

This review analyzes contemporary literature in the context of Australian aging methamphetamine users, service response, and challenges to provision of care to this population. The article focuses on Australian literature with comparisons made with trends arising from international scholarship. Searches of the CINAHL, ProQuest, and Scopus electronic journal databases were performed in early 2014 as part of a wider study investigating dual diagnosis in older adults. Methamphetamine abuse is common in individuals with comorbid mental illness. The literature presented in this review outlines potential neuropsychological and persistent psychiatric sequelae associated with the use of methamphetamine, along with a number of concerning behaviors prevalent in individuals with comorbid human immunodeficiency virus-positive status. Despite an abundance of literature discussing methamphetamine use in adult populations, this is the first review exploring methamphetamine use in the context of aging and older adult mental health. Contemporary literature suggests that methamphetamine dependence will be a significant challenge for services that cater to older adults, requiring further research to fully assess the impact this cohort will have on the healthcare system.

Dual diagnosis in older adults: a review.

Dual diagnosis is associated with frequent relapse, poor treatment engagement and overall unsatisfactory treatment outcomes. A comprehensive review of the contemporary literature examining this issue was conducted, finding a paucity of literature concerning dual diagnosis in older adults. Of the literature appraised for this review, a number of studies examined US Veteran's Affairs populations, which were largely male. Studies concerning older mental health populations were scarce. During the literature search, a number of background studies that influenced contemporary research regarding dual diagnosis in older adults were found; these studies were examined regarding their contribution to contemporary paradigms concerning older adults with co-occurring mental illness and substance use disorders. This review presents the results of the contemporary literature concerning dual diagnosis in older adults. Several recurring themes emerge from the literature, including the notion of a statistically small population that, in absolute terms, represents a sizeable number of individuals coming to the attention of aged mental health services in the future. Additionally, the potential for under-diagnosis in this cohort is highlighted, potentially creating a hidden population of older adults with dual diagnosis.