Saudi Cultural Missions Theses & Dissertations
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Item Restricted Investigating Methotrexate Associated Adverse Events in Patients with Rheumatoid Arthritis(Saudi Digital Library, 2023-11-17) Sherbini, Ahmad; Verstappen, SBackground: Methotrexate (MTX) is the recommended first-line treatment for patients with rheumatoid arthritis (RA) due to its cost-effectiveness. Although used in most patients with new onset RA, adverse events (AEs) experienced by patients who receive MTX treatment are known to lead to treatment interruption, a decrease in adherence, and/or permanent discontinuation, and therefore posing challenges to achieving optimal disease control and positive outcomes. Aim and objectives: The overarching aim of this thesis is to provide an in-depth understanding of the occurrence and factors associated with the development of AEs in patients with RA starting MTX for the first time. This aim is addressed through four specific objectives: i) to summarise systematically the existing knowledge about the rates and predictors of AEs in patients receiving MTX; ii) to estimate the rates of AEs occurrence and identify baseline factors associated with subsequent AEs; iii) to illustrate the rates and temporal patterns of patient-recorded AEs; and iv) to examine the relationship between AEs and patient-reported health-related quality of life (HRQoL). Methods: First, the rates and factors associated with AEs were summarised in a systematic review of published literature between 2005 and 2019 with meta-analyses of reported AEs in MTX-naïve patients. The remaining three objectives were assessed using data from the Rheumatoid Arthritis Medication Study (RAMS), a national cohort of patients commencing MTX for the first time. Prevalence rates of AEs were estimated over the first year of treatment (collected by a researcher at 6- and 12-month visits) and weekly (self-recorded by patients in diaries). The associations between baseline factors and AEs were assessed using multivariable logistic regression models. Finally, the associations between the occurrence of nausea/headache and change in EQ-5D (a measure of HRQoL) were explored using random effects linear regression models. Results: Gastrointestinal AEs were the most common AEs reported in the literature with a pooled estimate of 32.7%, and while pooled estimates of neurological, mucocutaneous, and pulmonary AEs were 24.7%, 24.7%, and 30.7%, respectively. The review also identified several factors associated with AEs, such as increased BMI, higher disability, and positive auto antibody status. The estimated AEs in RAMS were comparable with the existing literature. Baseline factors associated with AEs included female gender, alcohol consumption, increased BMI, higher disability and disease activity scores, and lower MTX starting dose. An evaluation of the weekly patterns of patient-recorded AEs found that reporting peaked in the early few weeks of treatment for some AEs, such as nausea (14%) and headache (5%), but the number of patients reporting these AEs gradually declined over the year of study. Contrary to this, alopecia was reported in less than 1% of patients in the first few weeks of starting MTX but increased over the study period to a peak of 2.5%. Lastly, assessment of the relationship between AEs (nausea and headache) and HRQoL found that the experience of AEs had negative effects on HRQoL. Although less common, headache had almost double the negative impact on HRQoL compared to nausea. Conclusions: The findings presented in this thesis provide an up-to-date account on rates and factors associated with AE occurrence in patients starting MTX and highlight their potential impact on patient HRQoL.20 0Item Restricted Nurses’ Safety Attitudes and their impact on Nursing-Sensitive Patient Outcomes(Saudi Digital Library, 2023-10-09) Alanazi, Faisal Khalaf; Sim, Jenny; Lapkin, Samuel; Molloy, LukeBackground: Nurses represent the largest proportion of healthcare workers and are in close contact with patients. Each nurse has a unique set of attitudes towards their duties and roles. Understanding nurses’ attitudes towards safety allows organisations to identify individual practices and behaviours that may have an impact on patient outcomes. Nursing-sensitive patient outcomes, such as patient falls and pressure injuries, significantly impact patients and healthcare organisations. Therefore, nursing unit characteristics, such as safety attitudes, quality of care, missed care, and staffing levels, might improve patient outcomes. To date, evidence on the association between these characteristics and nursing-sensitive patient outcomes, using empirical patient data, is limited and inconsistent. Aim: The aim of this project was to examine the impact of nurses’ attitudes towards safety, quality of care, missed care and staffing levels, on four nursing-sensitive patient outcomes, collected from two sources of data in five acute Ministry of Health (MOH) hospitals in the Kingdom of Saudi Arabia (KSA). The four nursing-sensitive patient outcomes included patient falls, pressure injuries, healthcare-associated infections, and inpatient mortality. The project also explored the relationship between nursing-sensitive patient outcomes using two data sources, namely, nurses’ perceptions of the frequency of adverse patient outcomes in their units reported in a cross-sectional survey, and the incidence of nursing-sensitive patient outcomes reported in administrative data. Methods: A multi-site multi-source, cross-sectional project was conducted. The data were collected from 35 nursing units in five acute hospitals in two regions of the Kingdom of Saudi Arabia. In phase one, an online nurse survey gathered a comprehensive range of data, including the Safety Attitudes Questionnaire (SAQ), quality of care, missed care, nurse staffing levels, and nurses’ perceptions of the frequency of adverse patient outcomes. In phase two, secondary administrative datasets on patient falls, pressure injuries, healthcare-associated infections, and inpatient mortality for the years 2018, 2019, 2020, and 2021 were analysed for each participating hospital. Data from phases one and two were merged in phase three to address the project’s aim. A variety of descriptive analyses were performed, and inferential statistics, including logistic regression and Generalized Linear Models (GLM), were fitted to examine the association between project variables. Results: The SAQ mean score was 61.48 (SD = 12.9), suggesting that nurses had less than positive attitudes towards safety. The highest mean score was in safety behaviour (Mean = 66.25, SD = 18.6), and the lowest mean score was in working conditions (Mean = 52.2, SD = 21.4). Most nurses (n = 444, 72%) reported that at least 1 of the 13 nursing care activities had been missed on their last shift due to lack of time to complete it. The most frequently missed activity by nurses was comfort/talk with patients (n = 246, 37.7%). The average patient-to-nurse ratio was highest in surgical units (Mean = 5.87, SD = 0.88) and lowest in critical care units (Mean = 1.95, SD = 0.40). However, the results indicated that a strong overall safety culture score, safety behaviour (collaborations between nurses, physicians and pharmacists), safety climate (attitude towards organisation commitment to safety), and job satisfaction (attitudes towards work experience) were significantly associated with better nursing-sensitive patient outcomes. Similarly, higher hospital quality of care and lower missed care were associated with decreased adverse nursing-sensitive patient outcomes. Higher patient numbers per nurse were positively associated with higher incidence of Healthcare-Associated Infections (HAI) and nurses’ perceptions of the frequency of adverse patient outcomes. In addition, nurses’ perceptions of the frequency of adverse patient outcomes were associated positively with higher incidence rates of nursing-sensitive patient outcomes reported in administrative datasets. Conclusion: This project investigated the characteristics of nursing units and their impact on four nursing-sensitive patient outcomes in five acute hospitals in the Kingdom of Saudi Arabia. The project highlighted the importance of promoting a positive safety culture, improving the quality of care in nursing units, reducing missed care, and providing adequate staffing levels to enhance better patient outcomes. In addition, nurses’ perceptions of the frequency of adverse patient outcomes were reflective of the actual incidence rates of nursing-sensitive patient outcomes. Therefore, understanding nurses’ perceptions of adverse patient outcomes and addressing their concerns can be crucial in improving patient outcomes and promoting a positive safety culture in nursing units.44 0