Hepatitis B virus-related mortality in rheumatoid arthritis patients undergoing long-term low-dose glucocorticoid treatment: A population-based study.

BACKGROUND/PURPOSE: Glucocorticoids (GC) are commonly used in rheumatoid arthritis (RA) patients which bears a risk of hepatitis B virus (HBV) reactivation. The purpose of this study was to investigate the risk of HBV-related mortality under long-term low-dose GCs in Taiwanese RA patients. METHODS: We retrospectively analyzed 45,423 RA patients using National Health Insurance Research Database from January 1999 to December 2011. Of them, 2204 patients had the diagnosis of HBV and were classified into four groups according to GCs regimens. Outcome comparison by Cox model analysis for liver-related mortality was performed. RESULTS: In this cohort, 90.5% were older than 40. One hundred and five patients had been treated with short-term large-dose GCs (Group A); 862 patients received GCs ≥20 mg/day for ≥3 days or a variable dose but did not meet Group C criteria (Group B); 689 patients were continuously treated with low-dose (<20 mg/day) GCs for ≥3 months for at least one session (Group C); and 548 patients had never been exposed to GCs (Group D). Two hundred and sixty-one patients had been exposed to antiviral agents, which was significantly higher in Group C. Fifty-eight patients (2.63%) died of acute hepatic failure, while no statistically significant difference between each groups (p = 0.074). Groups C and D comparison by two-sample test showed that long-term low-dose GC treatment was not associated with liver-related death after adjusting for malignancy. CONCLUSION: Long-term low-dose GC treatment was not associated with liver-related mortality in RA with concomitant HBV patients probably due to commonly applied antiviral therapy by rheumatologists.

Cross-cultural adaptation and validation of the Chinese Comfort, Afford, Respect, and Expect scale of caring nurse-patient interaction competence.

AIMS AND OBJECTIVES: To investigate the construct validity and reliability of the Chinese Comfort, Afford, Respect, and Expect scale, which can be used to determine clinical nurses' competence. The results can also serve to promote nursing competence and improve patient satisfaction. BACKGROUND: Nurse-patient interaction is critical for improving nursing care quality. However, to date, no relevant validated instrument has been proposed for assessing caring nurse-patient interaction competence in clinical practice. This study adapted and validated the Chinese version of the caring nurse-patient interaction scale. DESIGN: A cross-cultural adaptation and validation study. METHODS: A psychometric analysis of the four major constructs of the Chinese Comfort, Afford, Respect, and Expect scale was conducted on a sample of 356 nurses from a medical centre in China. Item analysis and exploratory factor analysis were adopted to extract the main components, both the internal consistency and correlation coefficients were used to examine reliability and a confirmatory factor analysis was adopted to verify the construct validity. RESULTS: The goodness-of-fit results of the model were strong. The standardised factor loadings of the Chinese Comfort, Afford, Respect, and Expect scale ranged from 0.73-0.95, indicating that the validity and reliability of this instrument were favourable. Moreover, the 12 extracted items explained 95.9% of the measured content of the Chinese Comfort, Afford, Respect, and Expect scale. CONCLUSIONS: The results serve as empirical evidence regarding the validity and reliability of the Chinese Comfort, Afford, Respect, and Expect scale. RELEVANCE TO CLINICAL PRACTICE: Hospital nurses increasingly demand help from patients and their family members in identifying health problems and assisting with medical decision-making. Therefore, enhancing nurses' competence in nurse-patient interactions is crucial for nursing and hospital managers to improve nursing care quality. The Chinese caring nurse-patient interaction scale can serve as an effective tool for nursing and hospital managers to evaluate the caring nurse-patient interaction confidence of nurses and improve inpatient satisfaction and quality of care.

Assessment of Educational Needs and Quality of Life of Chronic Hepatitis Patients.

BACKGROUND: Patient education is crucial in improving the health-related quality of life (HRQOL) of patients. At the same, understanding the concerns and needs of patients is essential in providing appropriate education. This study assessed the educational needs and HRQOL experienced by chronic hepatitis patients. METHODS: We developed structured questionnaires with satisfactory validity and reliability to assess the educational needs of patients. HROQL was measured using a generic Short Form 36 (SF-36) and a liver disease-specific Chronic Liver Disease Questionnaire (CLDQ). Descriptive statistic measures and Pearson's correlation analysis were applied for data analysis. RESULTS: A total of 135 subjects were recruited from two regional teaching hospitals in Taiwan. "Disease characteristics and management" exhibited the highest mean score (3.17) among all the subscales of educational needs. In comparison with those without antiviral therapy, chronic hepatitis patients undergoing antiviral treatment scored significantly higher on all subscales of educational needs, especially on "side effects of antiviral treatment" (p < 0.010). The median range of the physical component summary score was 45.94, the mental component summary score was 49.37, and the mean CLDQ was 5.70. Several domains of educational needs were significantly inversely correlated with the CLDQ and SF-36 subscales. CONCLUSIONS: Education is highly required by chronic hepatitis patients, especially those receiving antiviral therapy and patients with poor HRQOL. These findings can serve as a useful reference for nursing personnel who perform needs assessment to develop individual nursing instruction and thereby improve the quality of care for chronic hepatitis patients.

The Drosophila GOLPH3 homolog regulates the biosynthesis of heparan sulfate proteoglycans by modulating the retrograde trafficking of exostosins.

The exostosin (EXT) genes encode glycosyltransferases required for glycosaminoglycan chain polymerization in the biosynthesis of heparan sulfate proteoglycans (HSPGs). Mutations in the tumor suppressor genes EXT1 and EXT2 disturb HSPG biosynthesis and cause multiple osteochondroma (MO). How EXT1 and EXT2 traffic within the Golgi complex is not clear. Here, we show that Rotini (Rti), the Drosophila GOLPH3, regulates the retrograde trafficking of EXTs. A reduction in Rti shifts the steady-state distribution of EXTs to the trans-Golgi. These accumulated EXTs tend to be degraded and their re-entrance towards the route for polymerizing GAG chains is disengaged. Conversely, EXTs are mislocalized towards the transitional endoplasmic reticulum/cis-Golgi when Rti is overexpressed. Both loss of function and overexpression of rti result in incomplete HSPGs and perturb Hedgehog signaling. Consistent with Drosophila, GOLPH3 modulates the dynamic retention and protein stability of EXT1/2 in mammalian species. Our data demonstrate that GOLPH3 modulates the activities of EXTs, thus implicating a putative role for GOLPH3 in the formation of MO.

Risk of nonpsychotic mental disorders development in antiviral-treated mentally healthy chronic hepatitis C patients: A population-based study.

BACKGROUND/PURPOSE: Interferon (IFN) is able to induce significant psychiatric side effects in chronic hepatitis C (CHC) patients, whereas the risk of nonpsychotic mental disorder (NPMD) development in antiviral-treated mentally healthy CHC patients remains obscure. We used a population-based study to assess the risk of NPMD development in patients who had undergone antiviral treatment compared with untreated chronic hepatitis C virus (HCV)-infected and nonalcoholic fatty liver disease (NAFLD) patients. METHODS: Data were retrieved from Taiwan's National Health Insurance Research Database cohort consisting of 1 million individuals for a longitudinal analysis. A total of 313 mentally healthy CHC patients who received IFN-based antiviral therapy were recruited and compared with those without antiviral therapy and NAFLD patients. The Chi-square test was used to obtain the hazard ratio and 95% confidence interval. RESULTS: Among the 313 CHC patients receiving pegylated interferon/ribavirin therapy, 62 patients (19.8%) were associated with NPMD. In the comparison cohort, composed of 313 age- and sex-matched CHC patients not receiving antiviral therapy, 70 patients (22.4%) were associated with NPMD. The Chi-square analysis revealed that antiviral therapy was not significantly associated with NPMD. The diagnosis of HCV-infected hepatitis was independently associated with NPMD when compared with NAFLD. The hazard ratio was 1.67 (95% confidence interval, 1.11-2.52; p = 0.018). Furthermore, generalized anxiety disorder was specifically higher in HCV-infected patients than those with NAFLD. CONCLUSION: Patients with HCV infection are at high risk of developing NPMD with or without IFN-based therapy.

Assessment of health-related quality of life in antiviral-treated Taiwanese chronic hepatitis C patients using SF-36 and CLDQ.

BACKGROUND: Interferon (IFN) therapy can cause significant side effects in chronic hepatitis C (CHC) patients; however, the health-related quality of life (HRQOL) of antiviral-treated CHC patients has not been established in Taiwan. This study evaluated domains and the degree to which antiviral treatment affects the HRQOL in CHC patients and identifies factors associated with variations between patients. METHODS: Health-related quality of life (HRQOL) was assessed using the Short Form-36 (SF-36) and the Chronic Liver Disease Questionnaire (CLDQ) in 108 antiviral-treated CHC patients. Eight scales and two summary scales of the SF-36 were compared with 256 age- and gender-matched population norms and 64 age- and gender-matched CHC patients without antiviral therapy. Descriptive statistic measures, one-way ANOVA, and regression analysis were used for data analysis. RESULTS: (1) CHC patients receiving antiviral treatment displayed significantly lower scores in six scales, the Physical Component Summary (PCS), and the Mental Component Summary (MCS) of the SF-36, when compared to the population norms and patients without antiviral therapy (p < 0.05). (2) The mean CLDQ score of antiviral-treated patients was lower than that of patients without antiviral therapy, including subscales of 'fatigue', 'systemic symptoms', and 'role emotion'. (3) All SF-36 subscales significantly correlated with all CLDQ subscales, with the greatest correlation coefficients shown between fatigue and vitality and mental health of SF-36. (4) Antiviral therapy had a greater negative impact on females in the CLDQ, on all patients during treatment weeks 9-16 in the PCS and on patients with a monthly income of less than NT$10,000 in the CLDQ, PCS, and MCS. CONCLUSIONS: This study highlighted impairments in the quality of life of chronic hepatitis C patients treated with IFN-based therapy. The significant factors associated with HRQOL include gender, income, and treatment duration. The results of this study might provide nurses with a comprehensive understanding of HRQOL and its determining factors in antiviral-treated CHC patients. The findings can serve as a useful reference for nursing personnel in developing instructions for upgrading the care of CHC patients.

Exercise engagement in people with prediabetes--a qualitative study.

AIMS AND OBJECTIVES: To explore the experiences of people with prediabetes who engage in exercise, from the initiation of exercise to the discontinuation or continuation of exercise. BACKGROUND: People with prediabetes are the high-risk group for developing type 2 diabetes. Engaging in exercise is an important health behaviour to prevent or delay this. However, many people with prediabetes fail to develop and maintain a regular exercise regime. DESIGN: A grounded theory study. METHODS: Data were collected from August 2011-November 2012. Twenty participants with impaired fasting glucose from a medical centre in Taiwan were enrolled in this study for in-depth interview. The data were entered into NVivo 8·0 qualitative data management software after transcription and were analysed by constant comparative method. RESULTS: A theory of the process by which people with prediabetes approach the development of exercise behaviour was developed, comprising four stages: developing awareness, creating the health blueprint, action cycle of internal struggle and developing spontaneous regular exercise. Developing awareness was the starting point for the process of implementing exercise. The core category was action cycle of struggle that all participants experienced this stage, and the spontaneous regular exercise was the highest level of exercise process. CONCLUSION: It is not easy for people with prediabetes to develop a regular exercise regime. Exercise behaviour will be either continued or discontinued secondary to driving and resistive forces. RELEVANCE TO CLINICAL PRACTICE: This study provides useful information to help practitioners design exercise intervention strategies and provide psychological support to people with prediabetes.

Risk of musculoskeletal disorder among Taiwanese nurses cohort: a nationwide population-based study.

BACKGROUND: Musculoskeletal disorders (MSDs) represent the leading causes of occupational injuries among nursing staff. This population-based study was designed to assess the incidence and age-specific incidence of MSDs among a Taiwanese nurse cohort compared with non-nurses. DESCRIPTION: Data from the Taiwan National Health Insurance Research Database were used to identify MSDs in the study population. A total of 3914 nurses with a diagnosis of MSD were included, together with 11,744 non-nurses as a comparison group. The comparison subjects were randomly selected at a ratio of 3:1 relative to the nurse population and were matched by gender and age. The incidence of MSDs was calculated for the study group, with nurse-to-reference risk ratios presented as odds ratios with 95% confidence intervals (CIs). During the period 2004-2010, 3004 MSDs occurred among the nurses (76.24%) and 7779 (65.79%) in the non-nurses. The annual incidence of MSDs for the nurses increased from 28.35% in 2006 to 33.65% in 2010. The nurse-to-reference risk ratio was 1.27 (95% CI 1.19-1.35) in 2004 and 1.46 (1.37-1.55) in 2010. Herniation of intervertebral disc, lumbago, rotator cuff syndrome, medial epicondylitis, trigger finger and carpal tunnel syndrome were the most common problems. CONCLUSIONS: Nurses are at higher risk of MSDs and the trend is increasing. Incorrect work-related posture/movement, psychological issues and the rolling shift system may be the major causes of MSDs among nurses in Taiwan.

Evaluation of Guided Respiration Mindfulness Therapy (GRMT) for Reducing Stress in Nurses.

Guided respiration mindfulness therapy (GRMT) is a clinical model of breathwork that has shown promise as a treatment for depression, anxiety, and stress. This study examined the effectiveness of GRMT as a holistically oriented intervention for reducing psychological distress in nurses. Sixty-two nurses were assigned to either five sessions of GRMT or 5 sessions of a mindfulness-based intervention (MBI) comparison condition which were conducted over 5 weeks. A no-treatment control was also included. Session-by-session change in depression, anxiety, and stress, along with change in mindfulness and self-compassion were assessed. Multilevel analysis showed GRMT resulted in statistically significant reductions in overall psychological distress, anxiety, and stress levels, as well as significant increases in mindfulness and self-compassion with large to very large effect sizes. On all measures, GRMT performed better than the comparison MBI intervention which showed no significant effect on stress levels. Results suggest that GRMT can provide nurses with an effective group intervention for reducing stress, and increasing mindfulness and self-compassion which are foundational elements of self-care for the holistic nurse.

Psychometric testing of the Chinese evidence-based practice scales.

AIM: This article is a report of the psychometric testing of the Chinese version of Evidence-Based Practice Implementation and Beliefs, and Barriers to, and Facilitators of Research Utilization scales. BACKGROUND: Investigations into the effect of evidence-based practice on clinical care could be facilitated by instruments for measuring the levels of evidence-based practice implementation; the strength of beliefs in evidence-based practice; the barriers to, and the facilitators of research utilization. An English version of the scales measuring the above constructs has been tested whereas the Chinese one has not. DESIGN: Instrument development. METHODS: Psychometric analyses of the four evidence-based scales were conducted on a sample of 361 nurses from a medical centre in Taiwan. Both the internal consistency and squared multiple correlation coefficients were used to examine reliability. The validity testing for the four scales was estimated by examining their construct and concurrent validity. Data were collected between December 2008-January 2009. FINDINGS: Internal consistencies exist for the Chinese Evidence-Based Practice Implementation, Beliefs, and Barriers to, and Facilitator of Research Utilization scales (≥0·85); some were greater than 0·9, which may indicate redundancy in items. Construct validity of the four scales was supported by hypotheses testing. Concurrent validity of the four scales was supported by known-group analysis, in which experienced nursing researchers had higher scores compared with clinical nurses. CONCLUSION: These scales may have value in discrimination between implementation of EBP and perception of barriers to, and facilitators of research utilization among nurses with different education levels, research experiences or working years in clinical setting.

Knowledge of using acetaminophen syrup and comprehension of written medication instruction among caregivers with febrile children.

AIM: This article aims to explore caregivers' knowledge of acetaminophen and comprehension of written medication instructions about acetaminophen syrup when administered to febrile children. BACKGROUND: Fever is one of the most common problems about which primary caregivers seek medical advice for their children. Administration of acetaminophen is the most common form of treatment for febrile children. Medication safety is of the upmost importance for medication administration in this patient group. DESIGN: A cross-sectional study design was used. METHODS: The study included 102 caregivers with febrile children under six years old. A self-designed questionnaire was used to solicit participants' responses concerning: (1) approaches to fever management prior to hospital admission; and (2) knowledge and comprehension of antipyretic medication administration. Caregivers were asked to answer specific questions about the instructions provided with the medication. Results. Antipyretic by oral (66%) and antipyretic suppository (60%) were the most commonly used forms of fever management in febrile children. After reading the written medication instructions, one-third of the participants had more than one misunderstanding of the instructions for medication with timing, time interval of administration and/or medication dosage. Almost two-thirds of the participants misunderstood the side effects of acetaminophen. Participants with a poorer academic background were associated with poorer comprehension of the provided instructions. CONCLUSION: Administration of antipyretic medication is the most common approach taken to reduce children's temperature. A significant percentage of primary caregivers appear to lack a thorough understanding of the instructions provided with antipyrexial medication. RELEVANCE TO CLINICAL PRACTICE: Written medication instruction is a major source of information for primary caregivers. Clinical nurses have a potentially important role to play to provide caregivers with legible and understandable medication instructions and to ensure that caregivers fully comprehend this information.

A Tai Chi exercise programme improved exercise behaviour and reduced blood pressure in outpatients with hypertension.

This two-group pretest and posttest quasi-experimental study aimed to evaluate the effects of a Tai Chi exercise programme on exercise behaviour and blood pressure (BP) in outpatients with hypertension. The experimental group (n = 27) received the Yang-style Tai Chi exercise programme three times a week for 8 weeks. The control group (n = 31) received routine care with no Tai Chi exercise. Exercise behaviour and exercise time using Routine Health Care Behaviour scale and BP were assessed at baseline and 8 weeks. The experimental group had a significant improvement on exercise behaviour (t = 2.11, P < 0.001) and exercise time (t = 1.44, P = 0.003), and a significant reduction in systolic BP (t = 2.57, P < 0.001) and diastolic BPs (t = 2.86, P < 0.001) compared with those of the control group. Tai Chi is an inexpensive and viable exercise and can improve exercise behaviour and BP control in outpatients with hypertension. Tai Chi exercise might offer outpatients with hypertension additional options, such as an adjunct to formal cardiac rehabilitation or as an exercise alternative in their management of hypertension. Nursing staff can easily learn and incorporate this exercise in patient education or care planning in the care of patients with hypertension in outpatient settings.

Nurse-Led Counseling Intervention of Postoperative Home-Based Exercise Training Improves Shoulder Pain, Shoulder Disability, and Quality of Life in Newly Diagnosed Head and Neck Cancer Patients.

This randomized controlled trial investigated the effectiveness of the nurse-led counseling intervention (NLCI) of postoperative home-based exercise training (HBET) on functional outcomes in patients with newly diagnosed head and neck cancer (NDHNC). Forty NDHNC patients were randomly and equally divided into the control and intervention groups. Both groups received routine care, and were instructed to undergo a HBET program with 40 min moderate-intensity exercise 3-4 times per day for 12 weeks after their surgery. Only the intervention group received the NLCI with a bedside demonstration, coaching, consultation, and a weekly telephone follow-up. Shoulder pain (SP), shoulder disability (SD), and quality of life (QOL) scores were assessed using questionnaires at 2 weeks presurgery and at several timepoints postsurgery. Over the 12-week study period, all three scores remained relatively stable in the control group. By contrast, the SP, SD, and QOL scores significantly improved in the intervention group. The generalized estimating equation analysis revealed a significant time effect, group effect, and group-time interaction. The analysis of covariance revealed that all three scores significantly improved in the intervention group compared with those in the control group at 12 weeks postsurgery. We concluded that the NLCI of postoperative HBET improved the SP, SD, and QOL of NDHNC patients.

Multimedia education programme for patients with a stoma: effectiveness evaluation.

AIM: This paper is a report of an evaluation of the effectiveness of a multimedia education program in relation to stoma knowledge, self-care attitudes and behaviour with patients with a stoma in the postoperative period. BACKGROUND: Multimedia education programmes not only give patients with useful information in the absence of health professionals, but can also augment information given in traditional clinical practice. However, the literature on the effectiveness of different approaches to stoma education is limited. METHOD: A randomized experimental study design was used. Participants were recruited from a surgical unit in a large hospital in Taiwan. A total of 102 patients with a stoma were randomly assigned to either the multimedia education programme (n=46) or a conventional stoma education programme (n=56) with a follow-up of 1 week. Outcome variables measured were levels of self-care knowledge, attitudes towards self-care and self-care behaviour. FINDINGS: Patients who received the multimedia education programme improved their overall self-care knowledge, attitudes and behaviour statistically significantly when compared with those who received the conventional stoma education programme. CONCLUSION: Although further, longer-term follow-up will be useful, this study demonstrates that multimedia packages can enhance patient involvement in their stoma care and can augment stoma education - particularly in resource challenged healthcare environments.

The Concerns and Experience of Decision-Making Regarding Do-Not-Resuscitate Orders Among Caregivers in Hospice Palliative Care.

A do-not-resuscitate (DNR) order is an important end-of-life decision. In Taiwan, family caregivers are also involved in this decision-making process. This study aimed to explore the concerns and experiences regarding DNR decisions among caregivers in Taiwan. Qualitative study was conducted. Convenience sampling was used, and 26 caregivers were recruited whose patients had a DNR order and had received hospice care or hospice home care. Semi-structured interviews were used for data collection, including the previous experiences of DNR discussions with the patients and medical staff and their concerns and difficulties in decision-making. The data analysis was based on the principle of thematic analysis. Four themes were identified: (1) Patients: The caregivers respected the patients' willingness and did not want to make them feel like "giving up." (2) Caregivers' self: They did not want to intensify the patients' suffering but sometimes found it emotionally difficult to accept death. (3) Other family members: They were concerned about the other family members' opinions on DNR orders, their blame, and their views on filial impiety. (4) Medical staff: The information and suggestions from the medical staff were foundational to their decision-making. The caregivers needed the health care professionals' supports to deal with the concerns from patients and other family members as well as their emotional reactions.

Development and Validation of Nurses' Well-Being and Caring Nurse-Patient Interaction Model: A Psychometric Study.

Nurses' care nurse-patient interaction (CNPI) competence is critical for improving nursing care quality. The focus is the psychological quality of nurses, which may be derived from their sense of well-being. The purpose of this study was to develop a conceptual model of nurses' well-being and their CNPI competence. A cross-sectional survey was conducted with a total of 212 valid questionnaires obtained from a medical center. Structural equation modeling analysis was performed to validate the conceptual model. The results demonstrated the positive correlation between two constructs of nurses' well-being ("contentment" and "joyfulness") and CNPI competence. A positive correlation between nurses' CNPI competence and their health-promoting lifestyle and work environment satisfaction was supported. Among the constructs of CNPI competence, "respect patients' life experience" was the most correlated with their well-being, health-promoting lifestyle, and work environment satisfaction. The constructs of these three scales, which showed a middle correlation with CNPI competence, are psychological constructs rather than material constructs. When nurses have a greater sense of well-being, a positive attitude towards life, and feel supported and respected in their work environment, their CNPI competence increases. The findings of this study provide important insights and can serve as empirical evidence for nursing managers to enhance nurses' CNPI competence.

GenoWatch: a disease gene mining browser for association study.

A human gene association study often involves several genomic markers such as single nucleotide polymorphisms (SNPs) or short tandem repeat polymorphisms, and many statistically significant markers may be identified during the study. GenoWatch can efficiently extract up-to-date information about multiple markers and their associated genes in batch mode from many relevant biological databases in real-time. The comprehensive gene information retrieved includes gene ontology, function, pathway, disease, related articles in PubMed and so on. Subsequent SNP functional impact analysis and primer design of a target gene for re-sequencing can also be done in a few clicks. The presentation of results has been carefully designed to be as intuitive as possible to all users. The GenoWatch is available at the website http://genepipe.ngc.sinica.edu.tw/genowatch.

A cost-effectiveness analysis of a multimedia learning education program for stoma patients.

STUDY AIMS: The purpose of this study was to compare the costs and effectiveness of enterostomal education using a multimedia learning education program (MLEP) and a conventional education service program (CESP). BACKGROUND: Multimedia health education programs not only provide patients with useful information in the absence of health professionals, but can also augment information provided in traditional clinical practice. However, the literature on the cost-effectiveness of different approaches to stoma education is limited. DESIGN: This study used a randomised experimental design. METHODS: A total of 54 stoma patients were randomly assigned to MLEP or CESP nursing care with a follow-up of one week. Effectiveness measures were knowledge of self-care (KSC), attitude of self-care (ASC) and behavior of self-care (BSC). The costs measures for each patient were: health care costs, MLEP cost and family costs. RESULTS: Subjects in the MLEP group demonstrated significantly better outcomes in the effectiveness measures of KSC, ASC and BSC. Additionally, the total social costs for each MLEP patient and CESP patient were US$7396·90 and US$8570·54, respectively. The cost-effectiveness ratios in these two groups showed that the MLEP model was better than the CESP model after one intervention cycle. In addition, the Incremental Cost Effectiveness Ratio was -20·99. CONCLUSION: This research provides useful information for those who would like to improve the self-care capacity of stoma patients. Due to the better cost-effectiveness ratio of MLEP, hospital policy-makers may consider these results when choosing to allocate resources and develop care and educational interventions. RELEVANCE TO CLINICAL PRACTICE: This study provides a cost effective way of addressing stoma care in the post-operative period that could be usefully transferred to stoma care settings internationally.