Bariatric surgeons' views on pre-operative factors associated with improved health-related quality of life following surgery.

Bariatric surgery is an effective treatment for severe obesity, affording significant improvements in weight loss and health-related quality of life. However, bariatric surgeons' views on whether certain pre-operative factors predict improvements in post-operative health-related quality of life, and if so, which ones, are largely unknown. This cross-sectional survey study examined the views of 58 bariatric surgeons from Australia and New Zealand. A total of 18 factors were selected for exploration based on their mention in the literature. Participants rated the extent to which they thought these pre-operative factors would improve post-operative health-related quality of life. Responses showed that bariatric surgeons held diverse perspectives and revealed a lack of consensus regarding "predictive" factors. Generally, respondents agreed that better than average health literacy, higher socioeconomic status, good physical and psychological health, and positive social support were predictors of improved health-related quality of life following surgery. However, poor eating behaviours, smoking, and the use of alcohol or other substances were deemed negative predictors. Interestingly, aside from higher socioeconomic status, good psychological health, and positive social support, none of the aforementioned views aligned with existing literature. This study offers an initial insight into bariatric surgeons' views on the influence of different pre-operative factors on post-operative health-related quality of life. The array of views identified suggests that there may be an opportunity for medical education, but the findings warrant caution due to the sample size. Replication with a larger survey may be useful, especially as predicted health-related quality of life outcomes could guide decisions regarding surgical (non)progression.

Systematic review with meta-analysis: Current and emerging models of preoperative psychological preparation for individuals undergoing stoma surgery.

OBJECTIVE: Stoma surgery is a profoundly life changing event that can result in a range of negative psychological and mental health outcomes, often requiring significant postoperative adaption. While postoperative avenues of support to address these outcomes exist, there remains a lack of preoperative psychological preparation for surgical candidates in standard models of care. The present systematic review and meta-analysis aims to examine the current and emerging models of psychological preparation available to stoma surgery candidates during the preoperative period. METHODS: A systematic search of PubMed, Embase, Emcare, PsycINFO, CINAHL, and SCOPUS was conducted. All studies examining the effects of preoperative psychological interventions targeting postoperative psychological adjustment and/or mental health outcomes for individuals planning to undergo or who had undergone stoma surgery were included. RESULTS: Overall, 15 publications meeting inclusion criteria were identified, encompassing 1565 total participants. Intervention types ranged from psychoeducational, counselling, and practical based skills, examining the postoperative outcomes of anxiety, depression, quality of life, adjustment, self-efficacy, and systematic improvements to standard models of care. Five studies examining postoperative anxiety were included for meta-analysis, demonstrating an overall significant effect (SMD = -1.13, 95% CI -1.96 to -0.30, p = .008). Due to the high level of heterogeneity between remaining studies, articles examining postoperative outcomes other than anxiety were synthesised in narrative form. CONCLUSION: Despite some promising advancements in the field, there remains insufficient evidence to judge the overall effectiveness of current and emerging models of preoperative psychological preparation on postoperative psychological outcomes for individuals facing stoma surgery.

Improving management of needle distress during the journey to dialysis through psychological education and training-the INJECT study feasibility pilot protocol.

BACKGROUND: Needle-related distress is a common yet poorly recognised and managed problem among haemodialysis (HD) patients. The aim of this pilot study is to test the feasibility and acceptability of the INJECT Intervention-an innovative psychology-based intervention to empower patients to self-manage needle distress with the support of dialysis nurses. METHODS: This investigator-initiated, single-arm, non-randomised feasibility study will take place in a large dialysis service in Adelaide, Australia. Participants will include patients aged ≥ 18 years, commencing or already receiving maintenance HD, recruited through dialysis physicians and nursing staff as individuals believed to be at risk of needle distress. They will be screened for inclusion using the Dialysis Fear of Injection Questionnaire (DFIQ) and enrolled into the study if the score is ≥ 2. The multi-pronged intervention encompasses (i) psychologist review, (ii) patient self-management program and (iii) nursing education program. The primary aim is to evaluate feasibility and acceptability of the intervention from patient and dialysis nurse perspectives, including recruitment, retention, engagement with the intervention and completion. Secondary exploratory outcomes will assess suitability of various tools for measuring needle distress, evaluate acceptability of the nursing education program and measure cannulation-related trauma and vascular access outcomes. CONCLUSION: The results will inform the protocol for larger trials addressing needle distress in HD patients. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621000229875, approved 4 April 2021, https://www.anzctr.org.au/ .

Impact of dealing with bereaved clients on the psychological wellbeing of veterinarians.

BACKGROUND: Research has identified that members of the veterinary profession are at high risk of occupational stress, burnout, poor psychological wellbeing and an elevated rate of suicide. Although scholarly interest in veterinarians has increased in recent years, relatively few studies have specifically examined the emotional work in veterinary interactions and what effect dealing with companion animal owners' grief has on the wellbeing of veterinarians. The purpose of this study was to determine if dealing with bereaved clients affected the psychological wellbeing of veterinarians. The concept of compassion fatigue was explored, including whether veterinarians believed that their training had equipped them for communicating with grieving clients. METHODS: Veterinary surgeons registered in South Australia in 2015 were invited to complete an online survey, with 105 participants responding. RESULTS: Many participants, particularly female and younger veterinarians, were experiencing mild to severe psychological distress and nearly half of the sample was experiencing high to very high levels of compassion fatigue. No participants reported seeking psychological or other professional mental health support and the majority had not referred a grieving client to a psychologist or other mental health professional. A significant proportion of veterinarians felt their own mental health was affected by dealing with clients grieving the loss of a companion animal. DISCUSSION: The findings are discussed in terms of increasing the wellbeing of veterinarians through improved curriculum training and workplace health promotion, particularly considering the high suicide rate reported for the profession.

Patients' expectations and experiences of eating behaviour change after bariatric procedures.

Patients' pre-surgical expectations and post-surgical experiences of eating-related behaviour change after bariatric surgery may vary by procedure and time since surgery. To investigate this, data were coded from 206 Australian adults ≥2 months post-Roux-en-Y gastric bypass (RYGB; 17%), adjustable gastric band (AGB; 23%) or vertical sleeve gastrectomy (VSG; 60%) who completed an online questionnaire including open-ended questions about pre-surgical eating-related expectations and post-surgical experiences. Participants were 94% female, and mean age was 45.9 (SD = 10.0). Average time since surgery varied (AGB: 69.6 months; RYGB: 22.8; and VSG: 17.8). The proportions reporting any one or more 'positive' (healthy, helpful or desired; RYGB 82%; AGB 76%; and VSG 84%) or any one or more 'negative' (unhealthy, unhelpful or unwanted; RYGB 46%; AGB 46%; and VSG 42%) post-surgical eating-related experience did not differ by procedure. Negative experiences were more often reported at ≥18 months than 2 to <18 months (P = 0.035). After both VSG and AGB, but not RYGB, reporting any one or more positive eating-related experience was related to better outcomes (VSG: in mental health; AGB: in weight loss, physical health, satisfaction) and negative experiences were linked to poorer outcomes (VSG: in mental health, satisfaction; AGB: in mental and physical health, satisfaction). Reporting any one or more positive experience was related to better mental health improvement at 2 to <18 months and greater satisfaction at 18+ months post-surgery. The findings highlight the necessity of long-term, multidisciplinary patient care and further investigation into impacts of eating-related experiences on outcomes, with attention to procedure-based and temporal effects.

Changes in problematic and disordered eating after gastric bypass, adjustable gastric banding and vertical sleeve gastrectomy: a systematic review of pre-post studies.

Despite differences in their mechanisms and outcomes, little is known about whether postsurgical changes in eating behaviours also differ by bariatric procedure. Following a systematic search, 23 studies on changes in binge eating disorder (BED) and related behaviours, bulimia nervosa and related behaviours, night eating syndrome, grazing and emotional eating after Roux-en-Y gastric bypass (RYGB), adjustable gastric banding (AGB) and vertical sleeve gastrectomy (VSG) were reviewed. Significant methodological problems and a dearth of literature regarding many behaviours and VSG were seen. Regarding BED and related behaviours, although later re-increases were noted, short to medium-term reductions after RYGB were common, and reported changes after AGB were inconsistent. Short to medium-term reductions in emotional eating, and from a few studies, short to long-term reductions in bulimic symptoms, were reported after RYGB. Reoccurrences and new occurrences of problem and disordered eating, especially BED and binge episodes, were apparent after RYGB and AGB. Further conclusions and comparisons could not be made because of limited or low-quality evidence. Long-term comparison studies of changes to problematic and disordered eating in RYGB, AGB and VSG patients are needed. It is currently unclear whether any bariatric procedure leads to long-term improvement of any problematic or disordered eating behaviours.

Mental health nurses' and psychiatrists' views on the prognosis of schizophrenia and depression: an exploratory, qualitative investigation.

This study uses a qualitative methodology to explore mental health literacy, specifically perceptions of prognosis, which is typically investigated with a quantitative, questionnaire-based approach. Two vignettes--one of a person with schizophrenia and one with depression--were shown to three mental health nurses and three psychiatrists. During semi-structured, open-ended interviews, they were asked to discuss their thoughts about the prognosis for the patient presented in each vignette. Participants tended to use the terms 'prognosis' and 'outcome' interchangeably. Psychiatrists tended to be more guarded in determining a prognosis than nurses. Both groups emphasized the importance of clinical experience in formulating views. However, nurses also discussed the role of the multidisciplinary team, whilst psychiatrists emphasized their reliance upon the scientific literature in shaping opinions. Participants identified information relevant for incorporating into future vignettes, to allow more informed research into literacy. The results of quantitative mental health literacy research should be interpreted with caution. Simplifying responses to allow comparative analysis is necessary, but masks more complex and important interpretations. Further qualitative research is recommended, the results of which can inform more comprehensive quantitative studies in the area.

The eating-related behaviours, disorders and expectations of candidates for bariatric surgery.

It is important that clinicians and researchers understand the possible eating-related difficulties experienced by pre-bariatric surgery candidates, as well as their expectations of how their eating and hunger will change after surgery. This review examines English-language publications related to the eating-related behaviours, disorders and expectations of bariatric candidates. Seventy-five articles related to binge eating disorder, grazing, night eating syndrome, emotional eating, food cravings and addiction, and pre-surgical expectations of post-surgical eating in this population were critically reviewed. A variety of often problematic eating behaviours appear more common in bariatric candidates than in non-obese populations. The literature suggests that 4-45% of candidates may have binge eating disorder, 20-60% may graze, 2-42% may have night eating syndrome, 38-59% may engage in emotional eating and 17-54% may fit criteria for food addiction. Binge eating may also be more prevalent in bariatric candidates than in similarly obese non-surgical individuals. Expectations of surgery are high, with pre-surgical candidates believing their bariatric procedure will virtually guarantee significantly improved eating behaviours. Study replications are needed, and further investigation into prevalence, impacts and candidate characteristics related to disordered eating behaviours, as well as candidates' expectations of eating after surgery, will be important. Further comparisons of bariatric candidates to similarly obese non-bariatric populations will be important to understand eating-related characteristics of candidates beyond those related to their weight. Future research may be improved by the use of validated measures, replicable methodologies, minimization of data collected in circumstances where respondents may been motivated to 'fake good', use of prospective data and consistent definitions of key terminology.

Using standardized patients to evaluate undergraduate medical students' proficiency in speaking English.

PURPOSE: To explore the use of standardized patients for evaluating medical student's proficiency in speaking English. METHOD: In 1995, using a language rating scale constructed by the authors, six standardized patients evaluated the English-language proficiencies of 127 second-year medical student undergraduates enrolled at the University of Adelaide, Australia, many of whom were from a non-English speaking background. RESULTS: An earlier standardized test (Screening Test for Adolescent Language) had identified approximately one third of the students as potentially experiencing difficulties in using English in their training. Students so identified were rated lower than were their peers by the standardized patients. CONCLUSION: The study proved useful both in identifying aspects of speech that can be reasonably rated by standardized patients and also in identifying students who might benefit from language interventions. Replication studies with the new instrument are required to further establish its reliability, validity, and generalizability across different student cohorts.

Interrater reliability of the scoring of the screening test of adolescent language.

Group administrations of the Screening Test of Adolescent Language have been successful in identifying students with English-language problems among groups of university students who include many recent immigrants from southeastern Asia. However, scoring several items requires subjective judgement. Accordingly, interrater reliability was investigated by having two independent examiners score the written responses of 299 first-year medical students at two Australian universities. The examiners produced very similar distributions of total scores with means of 20.36 and 19.36 and achieved a high agreement in the categorisation of students with English problems. The Spearman rank-order correlation of 0.83 was high and statistically significant from zero.

Language background, proficiency in English, and selection for language development.

With a diverse language background profile in an Australian medical student population, teaching interventions are necessary for students whose English language proficiency is not adequate for the study of medicine. This paper describes the screening of written and aural English language proficiency in 143 first year undergraduate students using a standardized instrument. Students identified as experiencing language difficulties were subsequently assessed by interview and allocated to faculty-based Language Development Programme. Students with the greatest need for language support participated in a full 2 year programme. Those requiring less assistance were offered more limited support in the form of specific modules within the programme. Students allocated to the full programme were significantly weaker in language proficiency compared to those offered specific modules and those not offered a placement. The information gathered during the structured interview is valuable in establishing for medical educators specific areas in which language-related teaching for students who require it can be directed. Future research is required to evaluate the effectiveness of faculty-based language interventions in terms of improvement in language proficiency over time and the effect of any improvements in language proficiency on academic and clinical performance.

Teaching support in the behavioural sciences for non-english speaking background medical undergraduates.

INTRODUCTION: This paper reports on a teaching strategy designed to support first year undergraduate medical students from non-English speaking backgrounds in a behavioural science course taught at an Australian university. METHOD: The strategy is described, as is the language profile of students from two successive cohorts who participated in the teaching programme. The effectiveness of the intervention in improving students' academic performance is explored, as gauged by summative assessment and student perceptions. CONCLUSIONS: Findings suggest that students disadvantaged by difficulties with language and/or knowledge of Australian culture were able to perform at least as well as other students on a number of summative criteria. Non-English speaking background students perceived the behavioural science course to be difficult, and indicated that they found the teaching support offered to them to be useful. The methodological difficulties and limitations involved in the evaluation of a teaching programme such as this are discussed and the conclusions that can be validly drawn are considered.

Medical students' essay-writing skills: criteria-based self- and tutor-evaluation and the role of language background.

OBJECTIVES: An exercise is described which aimed to make clear to first-year undergraduate medical students the expected writing skills required for an essay examination in one discipline. SUBJECTS: Many students were from a non-English speaking background and over one-third of students, regardless of language background, had limited experience in this type of essay writing. PROCEDURE: For this exercise, a practice essay was written by each student for formative assessment. The essay was rated by a tutor and by the student according to well-defined criteria. This allowed for comparisons to be made in a structured and objective way between the judgements of the student and the assessor. RESULTS: Students found the exercise to be very useful, although whether essay writing skills actually improved could not be established. Students from non-English speaking backgrounds tended to be most harsh in their self-evaluations, yet tutor-evaluations generally showed these students to have better writing skills than other students. Indeed, correlations between self- and tutor-evaluations were quite low. CONCLUSIONS: It is evident that students and their educators may be unclear about each others' expectations. By making explicit the requirements of an exercise, misunderstandings may be minimized and it is possible that student performance could improve, though further research is required to verify these hypotheses. It is suggested that students should be encouraged to evaluate their own work and should be instructed in writing skills throughout their medical degree education.

Teaching colloquial Australian English to medical students from non-English speaking backgrounds.

Lack of fluency in the language of instruction can form a barrier to medical education. There has been an effort within Australian universities to teach English to students from non-English speaking backgrounds (NESB), but little systematic attention has been given to the teaching of informal or colloquial English. This paper provides evidence that colloquial language is a pervasive and important aspect of doctor-patient communication. It describes a teaching project for NESB medical students which aimed to introduce them to colloquial English, and to provide them with a contextual approach to learning this form of language. Forty-four first year medical students enrolled at the University of Adelaide were required to gather examples of colloquial language by interviewing a native English speaker. Ninety-four examples of colloquial sayings were recorded. These were compiled in the form of a handbook which served as a student resource. Student evaluation of this exercise was positive. The benefits of an interactive method of teaching local and setting-specific language are discussed, and the implications of this approach for clinical teaching and for medical practice are explored.

Clinical teachers' perceptions of medical students' English language proficiency.

Medical educators from the Faculty of Medicine at the University of Adelaide, South Australia, have expressed reservations about the adequacy of some undergraduate medical students' English language proficiency for satisfactory academic and clinical performance. This study explores the occurrence and nature of the comments made in writing by clinical teachers about the English language proficiency of 568 students over a period of 4 years. The frequency and nature of the comments made by clinicians have important implications for the planning and implementation of pedagogical strategies to support non-English-speaking background medical students experiencing difficulties with their course due to language. Although the University of Adelaide has introduced initiatives in response to some of the problems that have been identified, it is recommended that any teaching interventions require careful evaluation through a longitudinal research design to ensure that their aims are being achieved.

The evaluation of undergraduate students' written English language skills.

CONTEXT: Writing is an important skill for practitioners and students, yet this is a skill rarely taught in a formal capacity at medical school. At the University of Adelaide many students are from non-English speaking backgrounds and have varying proficiencies in English. We wished to devise a method and instrument which could identify students who may benefit from formative feedback and tuition in writing. OBJECTIVES AND METHOD: Students' written account of a short clinical interview with a standardized patient was assessed using a new instrument (the Written Language Rating Scale) designed especially for this study. The assessment of writing was made by one rater with qualifications in teaching English as a second language. SUBJECTS: 127 second-year medical students enrolled at the University of Adelaide, Australia. INSTRUMENTS AND RESULTS: The scale appeared to have good internal consistency, face and construct validity, and test security was not an issue. However, it had questionable concurrent validity with a standardized language test, although this may be partly due to the period of time which had elapsed between administration of the two tests. CONCLUSIONS: This study was useful in providing a means to objectively rate students' written English language skills and to target students in need of formative feedback and tuition. However, further research is necessary for both evaluation of medical writing and interventions for its improvement.

Evaluating the outcome of communication skill teaching for entry-level medical students: does knowledge of empathy increase?

BACKGROUND: While the literature shows the clinical value for medical practitioners of skill in communicating with patients in an empathetic manner, objective evaluations of methods to teach empathy are few. PURPOSES: This paper describes a method of teaching entry-level medical students the elements of effective communication with patients, in preparation for their first practical exercises. The paper focuses on how the outcomes of the teaching were evaluated with special attention to empathy. METHODS: Student evaluative ratings were collected after training, and students also completed a pencil-and-paper test of empathy, both before and after the training. While all data were anonymous, student pre- and post-training empathy scores could be compared to assess individual changes in knowledge of empathy after training. RESULTS: Most students (81%) felt better prepared to interview after the training. The pencil-and-paper measure of empathy has good reliability, both internal (alpha 0.83 and 0.91) and inter-rater (kappa 0.96). Overall, students made significant gains in their ability to make empathetic responses, although some (30%) showed no gains. CONCLUSIONS: Further research is required to identify students who fail to acquire skill in expressing empathy after undergoing training, and to validate the pencil-and- paper measure of empathy against real-life performance.

Language background, English language proficiency and medical communication skills of medical students.

Associations between language background, English language proficiency and medical communication skills were investigated in a group of 149 third year undergraduate medical students studying at an Australian university. Written and aural English proficiency were assessed with the Screening Test for Adolescent Language (STAL). Medical communication skills and the fluency of spoken language were scored during an Observed Structured Clinical Interview (OSCI), rated by a standardized patient and a clinician. An association was found between language background, performance on the STAL and spoken language proficiency. Satisfactory performance in medical communication skills was not associated with language background or overall performance on the STAL. In this study it was the global rating of unsatisfactory spoken language fluency that was associated with poorer performance in medical communication skills under examination conditions.

Initial responses of first-year medical students to problem-based learning in a behavioural science course: role of language background and course content.

A trial of problem-based learning (PBL) was conducted with first-year undergraduate medical students who had no background knowledge of behavioural science and who included a substantial proportion with a first language other than English. Responses to standardized and open-ended evaluation questions showed greater variability and there was no clear preference for PBL over traditional methods. Students found the PBL exercise time-consuming and felt they needed more guidance. Feedback from clinicians and working in groups were seen as positive aspects of the exercise. Students with a first language other than English reported that language, but not cultural background, was an impediment to effective participation. It is recommended that this group of students be offered extra support for PBL in a subject-based setting, and that all students would benefit from a formal induction session.