Journal of renal care最新文献_第9页

Patients' perspectives of fluid management: A multicentre comparative study of home and incentre haemodialysis 患者对液体管理的看法:家庭和中心血液透析的多中心比较研究

IF 1.9 4区医学 Q1 Nursing

Journal of renal care

Pub Date : 2022-05-30 DOI: 10.1111/jorc.12426

Megan Glyde BSc, Ed Sutherland PhD, Louise Dye PhD, Sandip Mitra MD, FRCP, David Keane PhD

Background

There is increasing worldwide interest in person-centred care in haemodialysis and home haemodialysis (HHD). Intradialytic fluid management is a vital component of haemodialysis, and often a shared decision, yet patients' perspectives and experience of related decisions are largely unexplored.

Objectives

To explore the perspectives of patients receiving home or incentre haemodialysis (IHD), in relation to intradialytic fluid management.

Design

A multicentre cross-sectional survey.

Participants

Eight hundred and thirty-nine patients receiving IHD and 99 patients receiving HHD, across six English renal units.

Measurements

Self-reported measures of understanding, experiences and control of fluid management, and willingness to achieve target weight. An objective test of patients' ability to relate common signs and symptoms to fluid overload or excessive ultrafiltration.

Results

Patients receiving HHD had greater knowledge than those receiving IHD (66.1% vs. 42.3%, p < 0.001) about causes of common signs and symptoms which remained when controlling for age, education and years since beginning haemodialysis. Patients receiving HHD felt more in control of and had greater self-reported adherence to fluid management (p < 0.01), yet knowledge gaps existed in both cohorts.

Conclusions

Greater patient knowledge and its practice in HHD may contribute to improved fluid balance and outcomes. Whilst patient selection may contribute towards these differences, the training patients receive when opting for HHD and subsequent experience are likely to be key contributing factors. Integrating aspects of education on fluid management from HHD training programmes should be considered in IHD, and further targeted, robust education remains an unmet need.

世界范围内对血液透析和家庭血液透析(HHD)的以人为中心的护理越来越感兴趣。透析液管理是血液透析的一个重要组成部分，通常是一个共同的决定，但患者的观点和相关决定的经验在很大程度上未被探索。目的探讨接受家庭或中心血液透析(IHD)的患者在透析液管理方面的观点。设计多中心横断面调查。参与者:来自英国6个肾科室的839名IHD患者和99名HHD患者。自我报告的对流体管理的理解、经验和控制，以及达到目标体重的意愿。对患者将常见体征和症状与液体超载或过度超滤联系起来的能力进行客观测试。结果在控制年龄、受教育程度和开始血液透析的时间后，HHD患者比IHD患者对常见体征和症状的原因了解程度更高(66.1%比42.3%，p < 0.001)。接受HHD治疗的患者感觉更能控制病情，并且自我报告的液体管理依从性更高(p < 0.01)，但两组患者都存在知识差距。结论:提高HHD患者的知识和实践可能有助于改善体液平衡和预后。虽然患者选择可能导致这些差异，但患者在选择HHD时接受的培训和随后的经验可能是关键因素。应在儿童发展方案中考虑整合儿童发展方案培训方案中有关流动管理的教育的各个方面，而进一步有针对性的、强有力的教育仍然是一个未得到满足的需求。

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引用次数: 0

Psychosocial factors in patients with kidney failure and role for social worker: A secondary data audit 肾功能衰竭患者的社会心理因素和社会工作者的作用:二次数据审计

IF 1.9 4区医学 Q1 Nursing

Journal of renal care

Pub Date : 2022-05-08 DOI: 10.1111/jorc.12424

Micaella Sotera Hansen BN, Wubshet Tesfaye BPharm, MSc, PhD, Kamal Sud MBBS, DNB, FRACP, Beena Sewlal BA, Bharati Mehta MSc, Lukas Kairaitis MBBS, PhD, FRACP, Surjit Tarafdar MBBS, FRACP, Katrina Chau MBBS, PhD, FRACP, Syed Tabish Razi Zaidi BPharm, PhD, Ronald Castelino BPharm, MPharm, PhD

Background

People with kidney failure face a multitude of psychosocial stressors that affect disease trajectory and health outcomes.

Objectives

To investigate psychosocial factors affecting people with kidney failure before or at start of kidney replacement therapy (KRT) and kidney supportive and palliative care (KSPC) phases of illness and to explore role of social worker during the illness trajectory.

Methods

We conducted a secondary data audit of patients either before or at start of KRT (Phase 1) and at the KSPC (Phase 2) of illness and had psychosocial assessments between March 2012 and March 2020 in an Australian setting.

Results

Seventy-nine individuals, aged 70 ± 12 years, had at least two psychosocial assessments, one in each of the two phases of illness. The median time between social worker evaluations in Phase 1 and Phase 2 was 522 (116−943) days. Adjustment to illness and treatment (90%) was the most prevalent psychosocial issue identified in Phase 1, which declined to 39% in Phase 2. Need for aged care assistance (7.6%−63%; p < 0.001) and carer support (7.6%−42%; p < 0.001) increased significantly from Phase 1 to Phase 2. There was a significant increase in psychosocial interventions by the social worker in Phase 2, including supportive counselling (53%−73%; p < 0.05), provision of education and information (43%−65%; p < 0.01), and referrals (28%−62%; p < 0.01).

Conclusion

Adults nearing or at the start of KRT experience immense psychosocial burden and adaptive demands that recognisably change during the course of illness. The positive role played by the nephrology social worker warrants further investigation.

肾衰竭患者面临多种影响疾病发展轨迹和健康结果的社会心理压力源。目的探讨影响肾衰竭患者在肾脏替代治疗(KRT)和肾脏支持与姑息治疗(KSPC)阶段前或开始时的社会心理因素，并探讨社会工作者在疾病发展过程中的作用。方法:在2012年3月至2020年3月期间，我们在澳大利亚对KRT治疗前或开始时(一期)和KSPC(二期)患者进行了二次数据审计，并进行了心理社会评估。结果79例患者，年龄70±12岁，至少进行了两次心理社会评估，在两个疾病阶段各一次。第一阶段和第二阶段社工评估之间的中位数时间为522(116−943)天。适应疾病和治疗(90%)是第一阶段确定的最普遍的社会心理问题，在第二阶段下降到39%。老年护理援助需求(7.6% - 63%;P < 0.001)和护理人员支持(7.6% - 42%;p < 0.001)从第一阶段到第二阶段显著增加。在第二阶段，社会工作者的心理社会干预显著增加，包括支持性咨询(53% - 73%;P < 0.05)，提供教育和信息(43% - 65%;P < 0.01)，转诊(28% - 62%;p < 0.01)。结论:接近或处于KRT开始阶段的成年人会经历巨大的心理社会负担和适应性需求，这些需求在疾病过程中会发生明显变化。肾脏学社工所发挥的积极作用值得进一步调查。

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引用次数: 0

Implementing a resistance training programme for patients on short daily haemodialysis: A feasibility study 对每日短期血液透析患者实施阻力训练计划:可行性研究

IF 1.9 4区医学 Q1 Nursing

Journal of renal care

Pub Date : 2022-05-08 DOI: 10.1111/jorc.12423

Heitor S. Ribeiro MSc, Vinícius A. Cunha MSc, Gustavo Í. Dourado MSc, Marvery P. Duarte MSc, Lucas S. Almeida BSc, Victor M. Baião BSc, Antônio J. Inda-Filho PhD, João L. Viana PhD, Otávio T. Nóbrega PhD, Aparecido P. Ferreira PhD

Background

Kidney failure patients receiving haemodialysis experience protein-energy wasting, muscle mass loss and physical function impairment. Intradialytic exercise interventions seem to modify these features, but they are often not implemented as a clinical routine.

Objective

To investigate the feasibility of implementing a supervised intradialytic resistance training programme as a clinical routine for patients receiving short daily haemodialysis.

Design

A prospective longitudinal study.

Participants

Eighteen patients in a supervised intradialytic resistance training programme for 8 months.

Measurements

It consisted of a warm-up, lower- and upper-limb resistance exercises and a cool-down. Patients performed the resistance training during the first half of haemodialysis, twice a week, supervised by exercise physiologists and physiotherapists. The feasibility was assessed by the total and partial adherences, the reasons for refusing or for not exercising and the intradialytic complications.

Results

From a total of 953 potential exercise sessions, 759 were performed, with a 79.6% adherence rate. In the first 9 weeks, the adherence rate was 86.6% and the lowest rate was in the 19–27 weeks (73.5%). The main intradialytic complication during exercise sessions was hypotension (n = 31; 4.1%). The highest number of complications was reported during the first 9 weeks (n = 27; 9.1%). The main reasons for refusing or for not performing the intradialytic exercise sessions were clinical complications previous to exercise time (n = 63; 32.5%) and self-reported indisposition (n = 62; 32.0%).

Conclusions

The intradialytic resistance training programme, supervised by exercise physiologists and physiotherapists, had very low complications, achieved a high long-term adherence rate and showed to be feasible as a clinical routine for patients receiving short daily haemodialysis.

接受血液透析的肾衰竭患者会经历蛋白质能量消耗、肌肉质量损失和身体功能损害。分析性运动干预似乎可以改变这些特征，但它们通常不作为临床常规实施。目的探讨对每日短时间血液透析患者实施有监督的透析阻力训练作为临床常规的可行性。设计前瞻性纵向研究。参与者18名患者接受为期8个月的透析阻力训练。它包括热身，下肢和上肢阻力练习和冷却。患者在血液透析的前半期进行阻力训练，每周两次，由运动生理学家和物理治疗师监督。通过完全和部分依从性、拒绝或不运动的原因以及分析内并发症来评估可行性。结果在总共953次潜在的锻炼中，759次进行了锻炼，坚持率为79.6%。前9周依从率为86.6%，19 ~ 27周依从率最低(73.5%)。运动期间的主要溶栓并发症是低血压(n = 31;4.1%)。前9周并发症发生率最高(n = 27;9.1%)。拒绝或不进行透析内运动的主要原因是运动前的临床并发症(n = 63;32.5%)和自我报告的不适(n = 62;32.0%)。结论:在运动生理学家和物理治疗师的指导下，透析阻力训练方案并发症发生率极低，长期依从率高，作为每日接受短时间血液透析的患者的临床常规是可行的。

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引用次数: 3

Examining social support, psychological status and health-related quality of life in people receiving haemodialysis 研究接受血液透析患者的社会支持、心理状况和健康相关生活质量

IF 1.9 4区医学 Q1 Nursing

Journal of renal care

Pub Date : 2022-05-03 DOI: 10.1111/jorc.12422

引用次数: 0

The art of improving the haemodialysis experience 改善血液透析体验的艺术

IF 1.9 4区医学 Q1 Nursing

Journal of renal care

Pub Date : 2022-05-03 DOI: 10.1111/jorc.12421

Claire Carswell RMN, PhD

引用次数: 0

Issue Information: Journal of Renal Care 2/2022 发行信息:Journal of Renal Care 2/2022

IF 1.9 4区医学 Q1 Nursing

Journal of renal care

Pub Date : 2022-05-03 DOI: 10.1111/jorc.12384

引用次数: 0

Effect of exercise on cognitive impairment in patients undergoing haemodialyses: A systematic review and meta-analysis of randomised controlled trials 运动对血液透析患者认知障碍的影响:随机对照试验的系统回顾和荟萃分析

IF 1.9 4区医学 Q1 Nursing

Journal of renal care

Pub Date : 2022-03-26 DOI: 10.1111/jorc.12420

Huan Liu, Yan Song PhD, Danyan Zhao, Minqi Zhan

Background

The influence of exercise on cognition in patients undergoing haemodialysis has been examined. However, evidence elucidating the effects in this patient group is scarce.

Objective

To examine the effect of exercise on cognitive impairment in patients undergoing haemodialysis and provide insight into the effects of various characteristics of exercise on cognitive impairment in this population.

Design

A systematic review and meta-analysis, following the guidance of PRISMA was undertaken.

Participants

Adult patients undergoing haemodialysis.

Results

This review found that exercise significantly improved cognitive impairment in patients undergoing haemodialysis (SMD = 0.37, 95% CI: 0.13, 0.60, p = 0.002). Subgroup analyses demonstrated that both intradialytic exercise (SMD = 0.82, 95% CI: 0.37, 1.26, p < 0.001) and interdialytic exercise (SMD = 0.24, 95% CI: 0.01, 0.47, p = 0.038), exercise for 16 weeks or over (SMD = 0.33, 95% CI: 0.07, 0.58, p = 0.012), and lasting for more than 30 minutes (SMD = 0.52, 95% CI: 0.17, 0.86, p = 0.004) significantly alleviated cognitive impairment. The effect of exercise on cognitive impairment in patients less than 65 years of age (SMD = 0.39, 95% CI: 0.10, 0.68, p = 0.009) was significantly better than those over 65.

Conclusion

Exercise significantly improves cognitive impairment in patients undergoing haemodialysis. Both Intradialytic and interdialytic exercise of at least 30 minutes duration, 3 times weekly, and at least for 16 weeks may play a significant role in alleviating cognitive impairment in patients under 65 years of age.

研究背景:研究了运动对血液透析患者认知能力的影响。然而，在这一患者群体中阐明效果的证据很少。目的探讨运动对血液透析患者认知功能障碍的影响，探讨不同运动特征对血液透析患者认知功能障碍的影响。设计在PRISMA的指导下进行系统回顾和荟萃分析。参与者:接受血液透析的成年患者。结果本综述发现，运动可显著改善血液透析患者的认知功能障碍(SMD = 0.37, 95% CI: 0.13, 0.60, p = 0.002)。亚组分析表明，溶内运动(SMD = 0.82, 95% CI: 0.37, 1.26, p < 0.001)和透析间运动(SMD = 0.24, 95% CI: 0.01, 0.47, p = 0.038)、16周或以上的运动(SMD = 0.33, 95% CI: 0.07, 0.58, p = 0.012)和持续30分钟以上的运动(SMD = 0.52, 95% CI: 0.17, 0.86, p = 0.004)均可显著减轻认知障碍。运动对65岁以下患者认知功能障碍的影响(SMD = 0.39, 95% CI: 0.10, 0.68, p = 0.009)明显优于65岁以上患者。结论运动能明显改善血液透析患者的认知功能障碍。在65岁以下患者中，至少持续30分钟的透析内和透析间运动，每周3次，至少持续16周，可能在缓解认知障碍方面发挥重要作用。

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引用次数: 2

Patient perspectives and experiences of remote consultations in people receiving kidney care: A scoping review 患者的观点和经验远程咨询的人接受肾脏护理:范围审查

IF 1.9 4区医学 Q1 Nursing

Journal of renal care

Pub Date : 2022-03-25 DOI: 10.1111/jorc.12419

Catriona Ewart MA, Jyoti Baharani MD, Martin Wilkie MD, Nicola Thomas PhD

Background

The coronavirus disease 2019 (COVID-19) pandemic resulted in a rapid and sometimes chaotic change in how clinical care was delivered for people living with kidney disease, with increased reliance on digital technologies and the introduction of remote services.

Objectives

To conduct a scoping review of studies about patients' experiences and perspectives in receipt of remote consultations for kidney care.

Design

Using Arksey and O'Malley's framework, three databases were searched on EBSCO (CINAHL, MEDLINE and Psych INFO). The search included studies published in English from August 2010 to August 2021.

Results

Eight studies met the scoping review criteria (two cross-sectional, two mixed-method and four qualitative). Five themes were identified: overall satisfaction with remote services, benefits to patients (convenience, involvement in care and patient safety), barriers to remote consultations (technical difficulties, digital literacy and loss of interpersonal communication), patient concerns (need for physical examination, privacy and confidentiality) and prerequisites for successful remote care (existing patient–practitioner relationship, stable illness phase and access to technology).

Conclusion

Remote consultations confer multiple advantages to patients; therefore, remote consultations should be offered as an option to patients living with kidney disease beyond the COVID-19 pandemic. However, there are several barriers to remote consultation that need to be addressed and understood before implementing remote care long-term. Future research should examine the impact of remote consultations on people living with kidney disease from under-served groups to identify barriers and ensure their suitability and accessibility to the wider population for a more patient-centred approach to kidney care.

2019年冠状病毒病(COVID-19)大流行导致肾病患者的临床护理方式发生了迅速、有时甚至是混乱的变化，人们越来越依赖数字技术并引入了远程服务。目的对接受肾脏护理远程会诊的患者的经验和观点进行范围综述。采用Arksey和O'Malley的框架，在EBSCO上检索三个数据库(CINAHL、MEDLINE和Psych INFO)。检索包括从2010年8月到2021年8月用英文发表的研究。结果8项研究符合范围评价标准(2项横断面研究、2项混合方法研究和4项定性研究)。确定了五个主题:对远程服务的总体满意度、对患者的益处(便利性、参与护理和患者安全)、远程咨询的障碍(技术困难、数字素养和人际沟通的丧失)、患者的担忧(需要体检、隐私和保密)以及远程护理成功的先决条件(现有的医患关系)。疾病稳定阶段和获得技术)。结论远程会诊对患者具有多重优势;因此，应向COVID-19大流行以外的肾脏疾病患者提供远程会诊。然而，在长期实施远程护理之前，需要解决和了解远程咨询的几个障碍。未来的研究应检查远程会诊对来自服务不足群体的肾病患者的影响，以确定障碍，并确保其适合性和可及性，以更广泛的人群为中心的肾脏护理方法。

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引用次数: 5

Experiences of a cognitive behavioural therapy (CBT) intervention for fatigue in patients receiving haemodialysis 认知行为疗法(CBT)干预血液透析患者疲劳的经验

IF 1.9 4区医学 Q1 Nursing

Journal of renal care

Pub Date : 2022-03-25 DOI: 10.1111/jorc.12418

Frances Waite MSc, Joseph Chilcot PhD, Rona Moss-Morris PhD, Ken Farrington MD, FRCP, Federica Picariello PhD

Background

A feasibility randomised-controlled trial found that a cognitive-behavioural therapy intervention for renal fatigue has the potential to reduce fatigue in patients receiving haemodialysis, but uptake was low.

Objectives

Nested in the randomised-controlled trial (RC) qualitative interviews were undertaken to understand the acceptability of renal fatigue, the facilitators of, and barriers to, engagement, and the psychosocial processes of change.

Design

The trial included 24 participants at baseline. Semi-structured interviews were conducted with nine participants from the intervention arm (n = 12). Approach Interviews were carried out immediately following treatment (3 months post-randomisation). Data were analysed using inductive thematic analysis.

Findings

Five main themes were formulated. The overarching theme was a sense of coherence (whether the illness, symptoms and treatment made sense to individuals), which appeared to be central to acceptability and engagement. Two themes captured the key barriers and facilitators to engagement, cognitive and illness/treatment burdens and collaboration with the therapist. Participants described changes related to their activity, thoughts and social identity/interactions, which shaped perceptions of change in fatigue. Lastly, participants discussed the optimal delivery of the intervention.

Conclusions

This study revealed the importance of patients' understanding of fatigue and acceptance of the treatment model for the acceptability of and engagement with a cognitive-behavioural therapy-based intervention for fatigue. Overall, there was an indication that such an intervention is acceptable to patients and the mechanisms of change align with the proposed biopsychosocial model of fatigue. However, it needs to be delivered in a way that is appealing and practical to patients, acknowledging the illness and treatment burdens.

一项可行性随机对照试验发现，认知行为疗法干预肾疲劳有可能减轻血液透析患者的疲劳，但摄取较低。在随机对照试验(RC)中，进行了定性访谈，以了解肾疲劳的可接受性，参与的促进因素和障碍，以及改变的心理社会过程。试验包括24名基线受试者。对来自干预组的9名参与者(n = 12)进行了半结构化访谈。治疗后立即进行访谈(随机分组后3个月)。数据分析采用归纳专题分析。研究结果:制定了五个主要主题。最重要的主题是连贯性(疾病、症状和治疗对个人是否有意义)，这似乎是可接受性和参与度的核心。两个主题抓住了参与的主要障碍和促进因素，认知和疾病/治疗负担以及与治疗师的合作。参与者描述了与他们的活动、思想和社会身份/互动相关的变化，这些变化形成了对疲劳变化的看法。最后，与会者讨论了干预的最佳交付。结论:本研究揭示了患者对疲劳的理解和对治疗模式的接受对于接受和参与基于认知行为治疗的疲劳干预的重要性。总的来说，有迹象表明这种干预对患者是可以接受的，并且改变的机制与提出的疲劳的生物心理社会模型一致。然而，它需要以一种对患者有吸引力和实用的方式提供，承认疾病和治疗负担。

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引用次数: 0

Violence and aggression prevention and management strategies in renal units: a survey after 10 years 肾内科暴力攻击预防与管理策略:10年后的调查

IF 1.9 4区医学 Q1 Nursing

Journal of renal care

Pub Date : 2022-03-24 DOI: 10.1111/jorc.12417

Ilaria de Barbieri PhD, Alessandra Buja MD, Helen Noble PhD, Veronica Strini MScN

Background

Nursing is considered the healthcare profession at most risk of violence. Violence in the workplace is a complex construct difficult to manage and against health workers has implications for the entire health system. A limited number of studies have evaluated this phenomenon in renal units, and there has been little related work since Zampieron's study of 2010.

Objectives

To describe prevention and management strategies 10 years after the last survey of Zampieron and to identify what has changed in the management of violence.

Design

An observational, cross-sectional study.

Participants

A convenience sample including all nurses participating in the European Dialysis and Transplant Nurses Association/European Renal Care Association Conference of 2019, who understand the English language and have a smartphone or tablet.

Measurements

A questionnaire developed by Zampieron was used. The first part collected data concerning the characteristics of the participants' workplace; the second part included closed questions focused on the strategies of management and prevention of violence.

Results

Violence is still a frequent event in renal units, despite measures adopted as education, training, formal incident reporting procedures and indoor safety measures. Much more has been invested in recent years in the prevention of violence in the workplace through specific courses, which have led to greater complaints and reporting of episodes.

Conclusions

This study shows how actions regarding prevention and management of violence towards nurses have been implemented in renal units over the last 10 years and it suggests the greatest investment in recent years has been made in terms of staff training and education.

护理被认为是最容易遭受暴力的保健职业。工作场所的暴力是一个难以管理的复杂结构，针对卫生工作者的暴力对整个卫生系统都有影响。有限的研究评估了肾脏单位的这一现象，自2010年Zampieron的研究以来，相关工作很少。目的描述Zampieron上次调查10年后的预防和管理战略，并确定暴力管理方面的变化。设计观察性横断面研究。方便样本包括所有参加2019年欧洲透析和移植护士协会/欧洲肾脏护理协会会议的护士，他们懂英语，有智能手机或平板电脑。测量方法采用Zampieron开发的问卷。第一部分收集了有关参与者工作场所特征的数据;第二部分包括集中讨论管理和预防暴力战略的封闭式问题。结果:尽管采取了教育、培训、正式的事件报告程序和室内安全措施等措施，但暴力事件仍然是肾脏部门的常见事件。近年来，在通过具体课程预防工作场所暴力方面投入了大量资金，这导致了更多的投诉和事件报告。结论:本研究显示了过去10年来肾脏科在预防和管理针对护士的暴力行为方面所采取的行动，并表明近年来在人员培训和教育方面投入了最大的资金。

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引用次数: 1