Christina E. Frandsen RN, MSc (Nursing), PhD student, Hans Dieperink MD, PhD, Bettina Trettin RN, MSc (Nursing), PhD,, Hanne Agerskov RN, MSc (health), PhD
Background
Patients with chronic kidney disease and their family members experience a number of lifestyle changes caused by the illness. The value of advance care planning includes understanding health status and options for future care, communication between close family members, and identification of wishes and preferences for care and treatment in relation to family and everyday life.
Objective
Explore how patients with chronic kidney disease and their families experience everyday life and how they experience having to make choices about treatment.
Design
An explorative study using a qualitative method with a phenomenological-hermeneutic approach.
Participants
Twelve patients with chronic kidney disease without kidney replacement therapy who were considering their treatment options and eight family members.
Approach
Individual semistructured interviews with a narrative approach were conducted between August 2021 and March 2022. The data were analysed using Ricoeur's interpretation theory on three levels: naïve reading, structural analysis and critical interpretation and discussion.
Findings
One main theme was generated: Family dynamics in a life-changing process. From this, three subthemes were derived: Living in an ordinary life placed in a waiting position, The dilemma of readiness to share and Feelings of being left alone.
Conclusion
There are changes in family roles and in identity and a desire to maintain the known and ordinary life. Living with chronic kidney disease as a part of daily life is managed differently in the family, which can lead to feelings such as sadness, frustration and loss of shared life and resilience.
{"title":"A life-changing process when living with chronic kidney disease: A qualitative study","authors":"Christina E. Frandsen RN, MSc (Nursing), PhD student, Hans Dieperink MD, PhD, Bettina Trettin RN, MSc (Nursing), PhD,, Hanne Agerskov RN, MSc (health), PhD","doi":"10.1111/jorc.12481","DOIUrl":"10.1111/jorc.12481","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Patients with chronic kidney disease and their family members experience a number of lifestyle changes caused by the illness. The value of advance care planning includes understanding health status and options for future care, communication between close family members, and identification of wishes and preferences for care and treatment in relation to family and everyday life.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Explore how patients with chronic kidney disease and their families experience everyday life and how they experience having to make choices about treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>An explorative study using a qualitative method with a phenomenological-hermeneutic approach.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Twelve patients with chronic kidney disease without kidney replacement therapy who were considering their treatment options and eight family members.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Approach</h3>\u0000 \u0000 <p>Individual semistructured interviews with a narrative approach were conducted between August 2021 and March 2022. The data were analysed using Ricoeur's interpretation theory on three levels: naïve reading, structural analysis and critical interpretation and discussion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>One main theme was generated: Family dynamics in a life-changing process. From this, three subthemes were derived: Living in an ordinary life placed in a waiting position, The dilemma of readiness to share and Feelings of being left alone.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>There are changes in family roles and in identity and a desire to maintain the known and ordinary life. Living with chronic kidney disease as a part of daily life is managed differently in the family, which can lead to feelings such as sadness, frustration and loss of shared life and resilience.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16947,"journal":{"name":"Journal of renal care","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jorc.12481","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41120825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The experience of loss and grief in patients' lives with life-long treatment in haemodialysis, and in their families' lives is a major cause of mental health problems. In practice, nurses often describe a lack of time and limited knowledge of how to provide nursing care in situations of loss and grief, thus finding out from nurses' perspectives of what competencies they need to provide care would be useful for the development of nursing practice.
Objectives
To develop knowledge in a nursing perspective of competencies to provide care for patients and their families, who experience grief linked to loss due to kidney failure, haemodialysis and/or death.
Design
The study took a phenomenological-hermeneutical approach. Semi-structured interviews were conducted 12 nurses caring for patients receiving haemodialysis with no kidney transplantation option and family members. Ricoeur's interpretation theory involving naïve reading, structural analysis and critical interpretation and discussion was used for analysis.
Results
Four themes emerged of nurse's experiences: (1) patient's loss and grief in everyday life, (2) dealing with supportive conversations when caring for patients, (3) families' losses are resulting in grief reactions and (4) importance of close relationships when caring for families.
Conclusions
To nurses, patients on haemodialysis and their families have multiple loss and grief experiences. Nurses' working in kidney care need to develop competencies to support patients and families to cope with grief and loss. Further research is needed to develop these competencies and then to implement in education and practice.
{"title":"Perceptions of haemodialysis nurses regarding patients' and families' loss and grief","authors":"Jette Marcussen RN, Ma. Edu. Psych, PhD, Post Doc, Rikke Madsen RN, PhD, Ann Bonner RN, PhD, Hanne Agerskov RN, PhD","doi":"10.1111/jorc.12479","DOIUrl":"10.1111/jorc.12479","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The experience of loss and grief in patients' lives with life-long treatment in haemodialysis, and in their families' lives is a major cause of mental health problems. In practice, nurses often describe a lack of time and limited knowledge of how to provide nursing care in situations of loss and grief, thus finding out from nurses' perspectives of what competencies they need to provide care would be useful for the development of nursing practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To develop knowledge in a nursing perspective of competencies to provide care for patients and their families, who experience grief linked to loss due to kidney failure, haemodialysis and/or death.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>The study took a phenomenological-hermeneutical approach. Semi-structured interviews were conducted 12 nurses caring for patients receiving haemodialysis with no kidney transplantation option and family members. Ricoeur's interpretation theory involving naïve reading, structural analysis and critical interpretation and discussion was used for analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Four themes emerged of nurse's experiences: (1) patient's loss and grief in everyday life, (2) dealing with supportive conversations when caring for patients, (3) families' losses are resulting in grief reactions and (4) importance of close relationships when caring for families.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>To nurses, patients on haemodialysis and their families have multiple loss and grief experiences. Nurses' working in kidney care need to develop competencies to support patients and families to cope with grief and loss. Further research is needed to develop these competencies and then to implement in education and practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16947,"journal":{"name":"Journal of renal care","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jorc.12479","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10289257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Emma Caton MSc, Shivani Sharma PhD, Enric Vilar PhD, Ken Farrington MD
Background
Dialysis is a life-sustaining treatment for patients with advanced kidney failure, but it is extremely burdensome. Despite this, there are very few tools available to assess treatment burden within the dialysis population.
Objective
To conduct a scoping review of generic and disease-specific measures of treatment burden in chronic kidney disease, and assess their suitability for use within the dialysis population.
Design
We searched CINAHL, MEDLINE and the Cochrane Library for kidney disease-specific measures of treatment burden. Studies were initially included if they described the development, validation or use of a treatment burden measure or associated concept (e.g., measures of treatment satisfaction, quality of life, illness intrusiveness, disease burden etc.) in adult patients with chronic kidney disease. We also updated a previous scoping review exploring measures of treatment burden in chronic disease to identify generic treatment burden measures.
Results
One-hundred and two measures of treatment burden or associated concepts were identified. Four direct measures and two indirect measures of treatment burden were assessed, using adapted established criteria, for suitability for use within the dialysis population. The researchers outlined eight key dimensions of treatment burden: medication, financial, administrative, lifestyle, health care, time/travel, dialysis-specific factors, and health inequality. None of the measures adequately assessed all dimensions of treatment burden.
Conclusion
Current measures of treatment burden in dialysis are inadequate to capture the spectrum of issues that matter to patients. There is a need for dialysis-specific burdens and health inequality to be assessed when exploring treatment burden to advance patient care.
{"title":"Measures of treatment burden in dialysis: A scoping review","authors":"Emma Caton MSc, Shivani Sharma PhD, Enric Vilar PhD, Ken Farrington MD","doi":"10.1111/jorc.12480","DOIUrl":"10.1111/jorc.12480","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Dialysis is a life-sustaining treatment for patients with advanced kidney failure, but it is extremely burdensome. Despite this, there are very few tools available to assess treatment burden within the dialysis population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To conduct a scoping review of generic and disease-specific measures of treatment burden in chronic kidney disease, and assess their suitability for use within the dialysis population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>We searched CINAHL, MEDLINE and the Cochrane Library for kidney disease-specific measures of treatment burden. Studies were initially included if they described the development, validation or use of a treatment burden measure or associated concept (e.g., measures of treatment satisfaction, quality of life, illness intrusiveness, disease burden etc.) in adult patients with chronic kidney disease. We also updated a previous scoping review exploring measures of treatment burden in chronic disease to identify generic treatment burden measures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>One-hundred and two measures of treatment burden or associated concepts were identified. Four direct measures and two indirect measures of treatment burden were assessed, using adapted established criteria, for suitability for use within the dialysis population. The researchers outlined eight key dimensions of treatment burden: medication, financial, administrative, lifestyle, health care, time/travel, dialysis-specific factors, and health inequality. None of the measures adequately assessed all dimensions of treatment burden.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Current measures of treatment burden in dialysis are inadequate to capture the spectrum of issues that matter to patients. There is a need for dialysis-specific burdens and health inequality to be assessed when exploring treatment burden to advance patient care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16947,"journal":{"name":"Journal of renal care","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jorc.12480","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10564640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Living with chronic kidney disease is stressful as the disease and its treatments impact on everyday physical, psychological, and social activities. As this disease has a long trajectory, it is important to understand everyday life experiences of those at different points along this trajectory.
Objectives
To explore the impact of chronic kidney disease and its treatment on everyday life.
Design
Descriptive qualitative design
Participants
Twenty-five adults with chronic kidney disease across various grades were purposively recruited.
Approach
Data were collected using semistructured interviews. Deductive content analysis informed by the revised Wilson and Cleary model was used to analyse data.
Findings
There were four themes. Theme 1, experiencing deterioration of kidney function, reflected the physical and psychological problems experienced by participants. Theme 2, changes that happened to me and my family, explained the subsequent limitations in their physical, social and role functioning. Theme 3, responding to a new normal, identified adjustments needed in everyday life to cope with the disease and its treatments. The final theme, thinking ahead and making a decision, captured the future plans and decisions needed while living with chronic kidney disease.
Conclusions
People with chronic kidney disease experience complex challenges such as greater symptom burden and functional limitations across the disease grades which impact on their everyday life. Nurses' recognition of these challenges is crucial for identifying and addressing unmet needs. Early individualised interventions, such as routine symptom assessment and management strategies that improve the wellbeing of people are needed.
{"title":"Impact of chronic kidney disease on everyday life: A descriptive qualitative study","authors":"Harith Eranga Yapa PhD, BScN (Hons), AFHEA, RN, Shirley Chambers PhD, BHlthSc (Hons), Louise Purtell PhD, Ann Bonner PhD, MA, BAppSc (Nurs), RN","doi":"10.1111/jorc.12478","DOIUrl":"10.1111/jorc.12478","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Living with chronic kidney disease is stressful as the disease and its treatments impact on everyday physical, psychological, and social activities. As this disease has a long trajectory, it is important to understand everyday life experiences of those at different points along this trajectory.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To explore the impact of chronic kidney disease and its treatment on everyday life.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Descriptive qualitative design</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Twenty-five adults with chronic kidney disease across various grades were purposively recruited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Approach</h3>\u0000 \u0000 <p>Data were collected using semistructured interviews. Deductive content analysis informed by the revised Wilson and Cleary model was used to analyse data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>There were four themes. Theme 1, experiencing deterioration of kidney function, reflected the physical and psychological problems experienced by participants. Theme 2, changes that happened to me and my family, explained the subsequent limitations in their physical, social and role functioning. Theme 3, responding to a new normal, identified adjustments needed in everyday life to cope with the disease and its treatments. The final theme, thinking ahead and making a decision, captured the future plans and decisions needed while living with chronic kidney disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>People with chronic kidney disease experience complex challenges such as greater symptom burden and functional limitations across the disease grades which impact on their everyday life. Nurses' recognition of these challenges is crucial for identifying and addressing unmet needs. Early individualised interventions, such as routine symptom assessment and management strategies that improve the wellbeing of people are needed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16947,"journal":{"name":"Journal of renal care","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9982013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Issue Information: Journal of Renal Care 3/2023","authors":"","doi":"10.1111/jorc.12432","DOIUrl":"https://doi.org/10.1111/jorc.12432","url":null,"abstract":"","PeriodicalId":16947,"journal":{"name":"Journal of renal care","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2023-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jorc.12432","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50145694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sintra Eyre Med. Lic., Jenny Stenberg PhD, Ola Wallengren PhD, David Keane PhD, Carla M. Avesani PhD, Ingvar Bosaeus MD, PhD, Naomi Clyne MD, PhD, Olof Heimbürger MD, PhD, Ainhoa Indurain MD, Ann-Cathrine Johansson MD, PhD, Bengt Lindholm MD, PhD, Fernando Seoane, Mia Trondsen MSc, for the SWEBIS network
In recent years the use of bioimpedance analysis (BIA) for assessment of fluid status as well as body composition as a mean to assess nutritional status in CKD has increased. The interest in the method is due to the associations between fluid overload and cardiovascular disease, and between fluid overload and malnutrition, both of which contribute to an increased risk of morbidity and mortality (Hur et al., 2013; Onofriescu et al., 2014). Moreover, BIA devices are suitable for clinical use, since they are portable, easy to use and, with a median to low price. However, the results can be difficult to interpret and integrate into routine clinical care, and although impedance measurements can contribute to an increased understanding of the patient's fluid balance, the results should be used with caution and in combination with other physiological parameters and clinical assessments (de Ruiter et al., 2020; Scotland et al., 2018). The aim of this editorial is to contribute to increased awareness of the benefits and limitations of using bioimpedance in patients with CKD with or without dialysis, and contribute to improving the measurement quality, facilitating interpretations, and highlighting possible sources of error.
BIA can be defined as the resistance measured by a weak alternating current when conducted through biological tissue. The conductivity differs between different tissues, which makes it possible to estimate body composition and fluid balance. BIA equipment measures impedance, which includes the reactance (capacitive impedance in cell membranes and other structures) and resistance (resistance due to extracellular [ECW] and intracellular water [ICW]). These variables can be measured with good precision and reproducibility between different devices (Kyle et al., 2004).
However, it is of fundamental importance to understand the limitations of BIA technology to avoid unrealistic expectations of measurement accuracy and precision (Ward, 2019). Deriving body composition information from impedance data includes estimated and assumed parameters and the use of population-averaged factors, such as body shape. Although it is plausible that prediction equations could be improved by including more individual-level information (e.g., the use of plasma sodium to improve estimations of tissue resistivity (Mitsides et al., 2020; Schneditz et al., 2023) this would have huge implications for the ease of use and applicability of the technology.
Variations in agreement between different impedance techniques and devices as well as with reference methods for measuring body composition can largely be attributed to the choice of method and device-specific software (Kyle, 2004; Kyle et al., 2004; Sheean et al., 2020). Also, each manufacturer of BIA equipment designs its own software for a
近年来，使用生物阻抗分析(BIA)来评估液体状态和身体成分，作为评估慢性肾病营养状况的一种手段已经增加。之所以对该方法感兴趣，是因为液体过量与心血管疾病之间以及液体过量与营养不良之间存在关联，这两者都导致发病率和死亡率风险增加(Hur等人，2013年;Onofriescu et al.， 2014)。此外，BIA装置适合临床使用，因为它们便携，易于使用，价格中位数到较低。然而，结果可能难以解释并融入常规临床护理，尽管阻抗测量有助于增加对患者液体平衡的了解，但应谨慎使用结果，并与其他生理参数和临床评估相结合(de Ruiter et al.， 2020;苏格兰等人，2018)。这篇社论的目的是提高人们对在CKD伴透析或不伴透析患者中使用生物阻抗的益处和局限性的认识，并有助于提高测量质量，促进解释，并强调可能的误差来源。BIA可以定义为弱交流电通过生物组织时测量的电阻。不同组织之间的电导率不同，这使得估计身体成分和液体平衡成为可能。BIA设备测量阻抗，包括电抗(细胞膜和其他结构中的电容阻抗)和电阻(由于细胞外[ECW]和细胞内水[ICW]引起的电阻)。这些变量可以在不同的设备之间以良好的精度和再现性进行测量(Kyle et al.， 2004)。然而，了解BIA技术的局限性是至关重要的，以避免对测量精度和精度的不切实际的期望(Ward, 2019)。从阻抗数据中获得身体成分信息包括估计的和假设的参数，以及使用人口平均因素，如体型。尽管通过包含更多个人层面的信息(例如，使用血浆钠来改进组织电阻率的估计)，预测方程可能会得到改进(Mitsides等人，2020;Schneditz et al.， 2023)这将对该技术的易用性和适用性产生巨大影响。不同阻抗技术和设备之间的一致性差异以及测量身体成分的参考方法在很大程度上可归因于方法和设备特定软件的选择(Kyle, 2004;Kyle et al.， 2004;Sheean et al.， 2020)。此外，每个BIA设备制造商都设计了自己的软件来分析和描述测量结果;这使得不同设备之间的直接比较不确定，并且很难给出关于如何在CKD患者的日常临床管理中使用生物阻抗的普遍建议。因此，尽管本文中的许多指导原则可以翻译为各种设备，但我们将主要参考身体成分监测器(BCM®;Bad Homburg)一种已在CKD患者中得到验证的设备(Davies等人，2017;Marcelli et al.， 2015;Wabel et al.， 2009)。随着肾衰竭从早期发展到终末期，身体成分受到越来越大的影响，包括液体潴留和肌肉量的减少。除非生物阻抗结果明显偏离参考值，否则单次测量提供的信息有限，但随着时间的推移重复测量提供最有价值的信息。如果测量条件偏离正常，有一个结构化和统一的方法是特别重要的。仔细进行的测量，随着时间的推移，可能反映出身体成分的实际变化(Kyle, 2004;Kyle et al.， 2004;van der Sande et al.， 2020)。在进行阻抗测量时，请注意表1中的建议。阻抗测量产生大量的数据。不同制造商的阻抗装置可能以不同的方式报告流体平衡和身体成分输出。对于用生物阻抗评估体液状态和营养状况，表2和表3中的变量是常用的:流行病学研究清楚地表明，在人群水平上，BIS测量与HD患者的重要结果之间存在关联。然而，临床试验结果表明，将BIS纳入常规临床管理是具有挑战性的。除非BIS测量结果明显偏离参考值，否则单次测量提供的信息有限。然而，随着时间的推移，仔细进行的测量可能反映出体液状态和身体成分的实际变化。 如果测量条件偏离正常，特别重要的是要有一个结构化和统一的跟踪方法，如果可能的话，进行重复测量或使用参考方法，例如双能x射线吸收测定法。我们认为，通过更好地理解生物阻抗装置之间的基本差异，测量原理以及将结果与临床评估结合起来作为决策支持工具的一部分，可以更好地支持在个人层面使用BIS。SWEBIS网络的成员同意将稿件提交给《肾脏护理杂志》。所有作者都符合ICMJE对作者身份的要求，并对稿件做出了贡献。Sintra Eyre和Jenny Stenberg是主要的项目负责人，负责手稿的主要起草，Ola Wallengren和David Keane做出了特殊的贡献、设计和协调。所有其他作者(Carla M. Avesani, Ingvar Bosaeus, Naomi Clyne, Olof heimb<e:1> rger, Ainhoa Indurain, ann - catherine Johansson, Bengt Lindholm, Fernando Seoane, Mia Trondsen)都进行了重要的修改，并参与了重要的知识内容，阅读并批准了最终的手稿。Jenny Stenberg:感谢阿斯利康，百特医疗和费森尤斯医疗的讲座。奥拉·瓦伦格伦:费森尤斯·卡比公司的个人演讲费，用于教育讲座。Carla M. Avesani: c.m.a.声明与当前论文没有利益冲突。c.m.a.收到来自Astra Zeneca、Fresenius Medical Care和Baxter healthcare的讲座报酬，并参加Astra Zeneca的顾问委员会。Olof heimbrger:感谢百特医疗、费森尤斯医疗、阿斯利康、ewimed和Vifor的讲座。安-凯瑟琳·约翰逊:费森尤斯公司个人演讲费本特·林德霍尔姆:隶属于百特医疗保健公司:以前的工作;拥有股票;百特Novum由百特医疗保健公司向卡罗林斯卡医学院提供资助。其余作者声明没有利益冲突。该指南是由瑞典生物阻抗网络(SWEBIS)制定的，该网络是一个对生物阻抗在慢性肾脏疾病(CKD)患者临床应用感兴趣的跨专业网络。该网络于2014年启动，由营养师(SE, CA, OW)，物理治疗师(MT)，护士(JS)，医生(ACJ, IB, NC, OH, AI, BL)和工程师/物理学家(DK, FS)组成。
{"title":"Bioimpedance analysis in patients with chronic kidney disease","authors":"Sintra Eyre Med. Lic., Jenny Stenberg PhD, Ola Wallengren PhD, David Keane PhD, Carla M. Avesani PhD, Ingvar Bosaeus MD, PhD, Naomi Clyne MD, PhD, Olof Heimbürger MD, PhD, Ainhoa Indurain MD, Ann-Cathrine Johansson MD, PhD, Bengt Lindholm MD, PhD, Fernando Seoane, Mia Trondsen MSc, for the SWEBIS network","doi":"10.1111/jorc.12474","DOIUrl":"10.1111/jorc.12474","url":null,"abstract":"<p>In recent years the use of bioimpedance analysis (BIA) for assessment of fluid status as well as body composition as a mean to assess nutritional status in CKD has increased. The interest in the method is due to the associations between fluid overload and cardiovascular disease, and between fluid overload and malnutrition, both of which contribute to an increased risk of morbidity and mortality (Hur et al., <span>2013</span>; Onofriescu et al., <span>2014</span>). Moreover, BIA devices are suitable for clinical use, since they are portable, easy to use and, with a median to low price. However, the results can be difficult to interpret and integrate into routine clinical care, and although impedance measurements can contribute to an increased understanding of the patient's fluid balance, the results should be used with caution and in combination with other physiological parameters and clinical assessments (de Ruiter et al., <span>2020</span>; Scotland et al., <span>2018</span>). The aim of this editorial is to contribute to increased awareness of the benefits and limitations of using bioimpedance in patients with CKD with or without dialysis, and contribute to improving the measurement quality, facilitating interpretations, and highlighting possible sources of error.</p><p>BIA can be defined as the resistance measured by a weak alternating current when conducted through biological tissue. The conductivity differs between different tissues, which makes it possible to estimate body composition and fluid balance. BIA equipment measures impedance, which includes the <i>reactance</i> (capacitive impedance in cell membranes and other structures) and <i>resistance</i> (resistance due to extracellular [ECW] and intracellular water [ICW]). These variables can be measured with good precision and reproducibility between different devices (Kyle et al., <span>2004</span>).</p><p>However, it is of fundamental importance to understand the limitations of BIA technology to avoid unrealistic expectations of measurement accuracy and precision (Ward, <span>2019</span>). Deriving body composition information from impedance data includes estimated and assumed parameters and the use of population-averaged factors, such as body shape. Although it is plausible that prediction equations could be improved by including more individual-level information (e.g., the use of plasma sodium to improve estimations of tissue resistivity (Mitsides et al., <span>2020</span>; Schneditz et al., <span>2023</span>) this would have huge implications for the ease of use and applicability of the technology.</p><p>Variations in agreement between different impedance techniques and devices as well as with reference methods for measuring body composition can largely be attributed to the choice of method and device-specific software (Kyle, <span>2004</span>; Kyle et al., <span>2004</span>; Sheean et al., <span>2020</span>). Also, each manufacturer of BIA equipment designs its own software for a","PeriodicalId":16947,"journal":{"name":"Journal of renal care","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2023-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jorc.12474","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10336487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
David McIntyre MN, NP, Amanda McGuire RN, PhD, Ann Bonner RN, PhD
Background
Nurse-sensitive indicators (NSI) assess the quality of nursing care provided to patients. These indicators assess the structures (supportive measures), processes (nursing actions) and outcomes of care. The McIntyre Audit Tool (MAT) was developed to measure haemodialysis NSIs.
Objectives
The objective of this study is to evaluate the feasibility and utility of the MAT in measuring haemodialysis NSIs in clinical practice.
Design
Multisite nonrandomized feasibility study.
Participants
A convenience sample of nurses (n = 30) were recruited from two haemodialysis units in Australia.
Measurements
Participants completed the MAT once daily for 1 week, to measure the extent the clinical indicators were being met. Feasibility data including utility and acceptability of the tool was collected once from each participant. Data were analysed descriptively.
Results
Participants completed a total of 97 audits. Results revealed the majority of structural (75%) and process indicators (73%) were being achieved although some variation between sites was observed. Results for the outcome indicators showed more variation (5.9%–94.1). Feasibility results found most nurses (79%) took <5 min to complete the MAT and found the tool easy to use (91.7%). Most participants (83.3%) reported audits could be completed during a shift and auditing was easily implemented (79.2%).
Conclusion
Use of the MAT in clinical practice is a feasible and acceptable way of auditing the quality of haemodialysis nursing practice. The tool could be used to establish minimum standards and improve the quality of nursing care in haemodialysis units, also enabling benchmarking between services.
{"title":"Feasibility of the McIntyre audit tool for haemodialysis nurses","authors":"David McIntyre MN, NP, Amanda McGuire RN, PhD, Ann Bonner RN, PhD","doi":"10.1111/jorc.12477","DOIUrl":"10.1111/jorc.12477","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Nurse-sensitive indicators (NSI) assess the quality of nursing care provided to patients. These indicators assess the structures (supportive measures), processes (nursing actions) and outcomes of care. The McIntyre Audit Tool (MAT) was developed to measure haemodialysis NSIs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The objective of this study is to evaluate the feasibility and utility of the MAT in measuring haemodialysis NSIs in clinical practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Multisite nonrandomized feasibility study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>A convenience sample of nurses (<i>n</i> = 30) were recruited from two haemodialysis units in Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measurements</h3>\u0000 \u0000 <p>Participants completed the MAT once daily for 1 week, to measure the extent the clinical indicators were being met. Feasibility data including utility and acceptability of the tool was collected once from each participant. Data were analysed descriptively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Participants completed a total of 97 audits. Results revealed the majority of structural (75%) and process indicators (73%) were being achieved although some variation between sites was observed. Results for the outcome indicators showed more variation (5.9%–94.1). Feasibility results found most nurses (79%) took <5 min to complete the MAT and found the tool easy to use (91.7%). Most participants (83.3%) reported audits could be completed during a shift and auditing was easily implemented (79.2%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Use of the MAT in clinical practice is a feasible and acceptable way of auditing the quality of haemodialysis nursing practice. The tool could be used to establish minimum standards and improve the quality of nursing care in haemodialysis units, also enabling benchmarking between services.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16947,"journal":{"name":"Journal of renal care","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jorc.12477","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9873784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In the section: observation (STAGE 1); A patient-held record was developed to facilitate the process, designed to complement the information they routinely record (Appendix 1). Appendix 1 was not attached.
We apologize for this error.
J Ren Care 2014 Sep;40(3):157-63. Debbie Sutton1, Susan Ovington2, Barbara Engel3, https://doi.org/10.1111/jorc.12056.
{"title":"Correction to “A Multi-Centre, Randomised Trial to Assess Whether Increased Dietary Fibre Intake (Using a Fibre Supplement or High-Fibre Foods) Produces Healthy Bowel Performance and Reduces Laxative Requirement in Free Living Patients on Peritoneal Dialysis”","authors":"","doi":"10.1111/jorc.12476","DOIUrl":"10.1111/jorc.12476","url":null,"abstract":"<p>In the section: observation (STAGE 1); A patient-held record was developed to facilitate the process, designed to complement the information they routinely record (Appendix 1). Appendix 1 was not attached.</p><p>We apologize for this error.</p><p>J Ren Care 2014 Sep;40(3):157-63. Debbie Sutton1, Susan Ovington2, Barbara Engel3, https://doi.org/10.1111/jorc.12056.</p>","PeriodicalId":16947,"journal":{"name":"Journal of renal care","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2023-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jorc.12476","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9874935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ginger Chu PhD, Carla Silva GDip MtlHith, Kelly Adams BN, Bobby Chacko MD, John Attia PhD, Nicole Nathan PhD, Rhonda Wilson PhD
Background
Technology, such as telehealth, is increasingly used to support home dialysis patients. The challenges patients and carers face when home dialysis nursing visits are provided via telehealth have yet to be explored.
Objectives
To explore patients' and carers' perspectives as they transition to telehealth-assisted home visits and identify the factors influencing their engagement in this modality.
Design
A mixed-methods approach, guideed by the behaviour change wheel using the capability, opportunity, motivation-behaviour model to explore individual's perceptions of telehealth.
Partcipants
Home dialysis patients and their carers.
Measuruements
Suveys and qualitative interviews.
Methods
A mixed-methods approach was undertaken, combining surveys and qualitative interviews. It was guided by the Behaviour Change Wheel using the Capability, Opportunity, Motivation- Behaviour model to explore individuals' perceptions of telehealth.
Results
Thirty-four surveys and 21 interviews were completed. Of 34 survey participants, 24 (70%) preferred face-to-face home visits and 23 (68%) had previously engaged in telehealth. The main perceived barrier identified in the surveys was knowledge of telehealth, but participants believed there were opportunities for them to use telehealth. Interview results revealed that the convenience and flexibility of telehealth were perceived as the main advantages of telehealth. However, challenges such as the ability to conduct virtual assessments and to communicate effectively between clinicians and patients were identified. Patients from non-English speaking backgrounds and those with disabilities were particularly vulnerable because of the many barriers they faced. These challenges may further entrench the negative view regarding technology, as discussed by interview participants.
{"title":"Exploring the factors affecting home dialysis patients' participation in telehealth-assisted home visits: A mixed-methods study","authors":"Ginger Chu PhD, Carla Silva GDip MtlHith, Kelly Adams BN, Bobby Chacko MD, John Attia PhD, Nicole Nathan PhD, Rhonda Wilson PhD","doi":"10.1111/jorc.12475","DOIUrl":"10.1111/jorc.12475","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Technology, such as telehealth, is increasingly used to support home dialysis patients. The challenges patients and carers face when home dialysis nursing visits are provided via telehealth have yet to be explored.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To explore patients' and carers' perspectives as they transition to telehealth-assisted home visits and identify the factors influencing their engagement in this modality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A mixed-methods approach, guideed by the behaviour change wheel using the capability, opportunity, motivation-behaviour model to explore individual's perceptions of telehealth.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Partcipants</h3>\u0000 \u0000 <p>Home dialysis patients and their carers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measuruements</h3>\u0000 \u0000 <p>Suveys and qualitative interviews.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A mixed-methods approach was undertaken, combining surveys and qualitative interviews. It was guided by the Behaviour Change Wheel using the Capability, Opportunity, Motivation- Behaviour model to explore individuals' perceptions of telehealth.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirty-four surveys and 21 interviews were completed. Of 34 survey participants, 24 (70%) preferred face-to-face home visits and 23 (68%) had previously engaged in telehealth. The main perceived barrier identified in the surveys was knowledge of telehealth, but participants believed there were opportunities for them to use telehealth. Interview results revealed that the convenience and flexibility of telehealth were perceived as the main advantages of telehealth. However, challenges such as the ability to conduct virtual assessments and to communicate effectively between clinicians and patients were identified. Patients from non-English speaking backgrounds and those with disabilities were particularly vulnerable because of the many barriers they faced. These challenges may further entrench the negative view regarding technology, as discussed by interview participants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study suggested that a blended model ","PeriodicalId":16947,"journal":{"name":"Journal of renal care","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2023-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jorc.12475","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9771410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Louise Birk Suder MSc, Per Ivarsen PhD, Lisbeth Førrisdahl MSc, Mette R. Christensen BSN, Lise Streubel-Kristensen BSN, Anni Sørensen MSc, Jeanette Finderup PhD
Background
Individual dietary recommendations change as loss of kidney function progresses. Adopting these recommendations in everyday life poses major challenges for patients. Individualising dietary counselling is crucial to easy accessibility.
Aim
To investigate patients’ needs with regard to a dietary app for patients with chronic kidney disease, patients’, and health professionals’ immediate responses to such a dietary app and suggestions for improvement and further development of a prototype.
Design
A prototype of the dietary app has been developed and demonstrates how all information it provides can be tailored to the individual patient according to stage of disease, anthropometrics, and phosphate and potassium levels. A qualitative evaluation of the prototype was conducted using the Consolidated Criteria for Reporting Qualitative Research checklist for reporting.
Approach
Seven individual interviews and four focus groups were analysed using interpretive description.
Participants
Individual interviews with seven patients who have stage 4 or 5 chronic kidney disease and are not on dialysis, and four focus groups: one with participants from the individual interviews, one with six patients on haemodialysis, one with 13 kidney dieticians and one with seven health professionals.
Findings
Both patients and healthcare professionals were positive about the app. Individualisation is necessary for the app to work in practice. The patients reported access to a diet diary and recipes as important elements.
Conclusion
There is a need to improve the tools we use today to enhance patient adherence to dietary recommendations. The development of an app for individual dietary counselling could be a useful solution.
{"title":"Dietary app for patients with kidney disease: Qualitative evaluation of a prototype","authors":"Louise Birk Suder MSc, Per Ivarsen PhD, Lisbeth Førrisdahl MSc, Mette R. Christensen BSN, Lise Streubel-Kristensen BSN, Anni Sørensen MSc, Jeanette Finderup PhD","doi":"10.1111/jorc.12473","DOIUrl":"10.1111/jorc.12473","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Individual dietary recommendations change as loss of kidney function progresses. Adopting these recommendations in everyday life poses major challenges for patients. Individualising dietary counselling is crucial to easy accessibility.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To investigate patients’ needs with regard to a dietary app for patients with chronic kidney disease, patients’, and health professionals’ immediate responses to such a dietary app and suggestions for improvement and further development of a prototype.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A prototype of the dietary app has been developed and demonstrates how all information it provides can be tailored to the individual patient according to stage of disease, anthropometrics, and phosphate and potassium levels. A qualitative evaluation of the prototype was conducted using the Consolidated Criteria for Reporting Qualitative Research checklist for reporting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Approach</h3>\u0000 \u0000 <p>Seven individual interviews and four focus groups were analysed using interpretive description.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Individual interviews with seven patients who have stage 4 or 5 chronic kidney disease and are not on dialysis, and four focus groups: one with participants from the individual interviews, one with six patients on haemodialysis, one with 13 kidney dieticians and one with seven health professionals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Both patients and healthcare professionals were positive about the app. Individualisation is necessary for the app to work in practice. The patients reported access to a diet diary and recipes as important elements.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>There is a need to improve the tools we use today to enhance patient adherence to dietary recommendations. The development of an app for individual dietary counselling could be a useful solution.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16947,"journal":{"name":"Journal of renal care","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jorc.12473","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9664595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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