Perceived life expectancy among dialysis recipients: a scoping review

Rationale & Objective: Greater prognostic understanding is associated with higher quality care at the end of life. We undertook a scoping review to explore how long dialysis recipients expect to live. Study Design: Scoping Review Setting and Study Population: People with kidney failure over 18 years old. Search Strategy & Sources: Studies were identified by searching Medline, Embase, APA PsycINFO, HMIC and ProQuest Database for terms related to “life expectancy”, “self -estimated” and “end stage kidney disease”. Data Extraction: Search strategies yielded 349 unique, potentially eligible studies, with 8 meeting the inclusion criteria after screening. Results: Significant mismatches between dialysis recipients and their healthcare provider estimations of prognosis were reported, with patients predicting significantly higher life expectancies than healthcare professionals and almost no agreement between patient and nephrologist estimates of one-year survival. Documented cognitive impairment did not affect 1- or 5-year prognosis estimates, neither did gender, age, time on dialysis or discussing perceived life expectancy. Dialysis recipients who thought they were on the transplant-list or self-identified as black had higher perceived life expectancy: people who were 75 years or older, or with fair/ poor self-reported health status had lower. Those with lower perceived life expectancy preferred care focusing on relieving pain and discomfort: people who thought they had a higher chance of survival were significantly more likely to prefer life-extending care. Limitations: There is a marked paucity of research in this area with most studies conducted in North American cohorts. Conclusions: Optimistic patient prognostic expectations persist in dialysis recipients. Given the effects of perceived life expectancy on treatment choices and subsequent quality of life, it is important that transparent discussions regarding prognosis are conducted with people receiving dialysis and their families

Rehabilitation impact indices and their independent predictors: A systematic review

10.1136/bmjopen-2013-003483BMJ Open39

Frailty and the psychosocial components of the edmonton frail scale are most associated with patient experience in older kidney transplant candidates – a secondary analysis within the kidney transplantation in older people (KTOP) study

© 2023 Thind, Levy, Wellsted, Willicombe and Brown. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). https://creativecommons.org/licenses/by/4.0/Background: Older people with end-stage kidney disease (ESKD) are vulnerable to frailty, which impacts on clinical and experiential outcomes. With kidney transplantation in older people increasing, a better understanding of patient experiences is necessary for guiding decision making. The Kidney Transplantation in Older People (KTOP):impact of frailty on outcomes study aims to explore this. We present a secondary analysis of the Edmonton Frail Scale (EFS) and its relationship with patient experience scores. Methods: The KTOP study is a single centre, prospective study, which began in October 2019. All ESKD patients aged ≥60 considered for transplantation at Imperial College Renal and Transplant Centre were eligible. Frailty was assessed using the EFS and 5 questionnaires assessed patient experience and quality of life (QoL) (Short Form-12(v2), Palliative Care Outcome Scale–Symptoms Renal, Depression Patient Health Questionnaire-9, Illness Intrusiveness Ratings Scale, Renal Treatment Satisfaction Questionnaire). The EFS was divided into 4 subdomains (psychosocial, physical function, medical status, and general health) and then compared with the questionnaire scores. Results: 210 patients have been recruited (aged 60-78), 186 of whom completed EFS assessments. 118 (63.4%) participants were not frail, 36 (19.4%) vulnerable, and 32 (17.2%) were frail. Worse frailty scores were associated with poorer patient experience and QoL scores across all questionnaires. Severe deficits in the EFS psychosocial subdomain showed a statistically significant association with higher depression screen scores (coefficient 4.9, 95% CI 3.22 to 6.59), lower physical (coefficient -4.35, 95% CI -7.59 to -1.12) and mental function scores (coefficient -8.33, 95% CI -11.77 to -4.88) from the Short Form-12(v2), and lower renal treatment satisfaction scores (coefficient -5.54, 95% CI -10.70 to -0.37). Deficits in the physical function and medical status EFS subdomians showed some association with patient experience scores. Conclusion: In the KTOP study cohort at recruitment vulnerable and frail candidates reported worse QoL and patient experiences. Severe deficits in the psychosocial subdomains of the EFS showed a strong association with patient experience and QoL, whilst physical function and medical status deficits showed a lesser association. This has highlighted specific EFS domains that may be suitable for targeted interventions to improve experiences and optimise outcomes.Peer reviewe

Perceptions about Probiotic Yogurt for Health and Nutrition in the Context of HIV/AIDS in Mwanza, Tanzania

Recently, the food and malnutrition issues have taken centre stage within the arena of HIV/AIDS epidemic, with several calls being made for context-specific health and nutrition interventions to deal with the emerging food insecurity and malnutrition issues in settings with high burdens of HIV/AIDS. The use of probiotics as nutritional supplements in HIV/AIDS-affected and resource-poor settings has also been advocated. This paper presents the results of a qualitative study on community knowledge and perceptions about probiotics and their potential impact on people's everyday life in the context of the HIV/AIDS epidemic. In-depth interviews (n=26) were conducted with residents in Mwanza, Tanzania. The results showed that people living with HIV/AIDS, who were using probiotic yogurt produced through a joint partnership of Western Heads East, Tanzania Medical Research Institute and the Tukwamune Women's Group, reported perceived beneficial effects, such as gain in weight and improved health and well-being. Yet, these beneficial effects might be resulting in growing misconceptions about probiotic yogurt being ‘medicine’ for the treatment of HIV/AIDS; this is leading some people living with HIV/AIDS to abandon taking their antiretroviral medications based on the view that the probiotic yogurt is making them feel much better. The findings illustrate the potential challenges with regard to the introduction of nutritional food supplements into new contexts plagued by malnutrition and infectious diseases. Public-health education and awareness programmes are needed when introducing novel foods into such contexts

Control methods for Dermanyssus gallinae in systems for laying hens: results of an international seminar

This paper reports the results of a seminar on poultry red mite (PRM), Dermanyssus gallinae. Eighteen researchers from eight European countries discussed life cycle issues of the mite, effects of mites on hens and egg production, and monitoring and control methods for PRM in poultry facilities. It was determined that PRM probably causes more damage than envisaged, with the cost in The Netherlands alone reaching 11 million euro per annum. However a great deal is still unknown about PRM (e.g. reproduction, survival methods, etc.) and that PRM monitoring is an important instrument in recognising and admitting the problem and in taking timely measures. Currently, the most promising control method combines heating the hen house in combination with chemical treatments. Future areas of development which show promise include the use of entomopathogenic fungi, vaccination and predatory mites. The final aim is to solve the problem of D. gallinae in housing systems for laying hens

Frailty and the psychosocial components of the edmonton frail scale are most associated with patient experience in older kidney transplant candidates – a secondary analysis within the kidney transplantation in older people (KTOP) study

BackgroundOlder people with end-stage kidney disease (ESKD) are vulnerable to frailty, which impacts on clinical and experiential outcomes. With kidney transplantation in older people increasing, a better understanding of patient experiences is necessary for guiding decision making. The Kidney Transplantation in Older People (KTOP):impact of frailty on outcomes study aims to explore this. We present a secondary analysis of the Edmonton Frail Scale (EFS) and its relationship with patient experience scores.MethodsThe KTOP study is a single centre, prospective study, which began in October 2019. All ESKD patients aged ≥60 considered for transplantation at Imperial College Renal and Transplant Centre were eligible. Frailty was assessed using the EFS and 5 questionnaires assessed patient experience and quality of life (QoL) (Short Form-12(v2), Palliative Care Outcome Scale–Symptoms Renal, Depression Patient Health Questionnaire-9, Illness Intrusiveness Ratings Scale, Renal Treatment Satisfaction Questionnaire). The EFS was divided into 4 subdomains (psychosocial, physical function, medical status, and general health) and then compared with the questionnaire scores.Results210 patients have been recruited (aged 60-78), 186 of whom completed EFS assessments. 118 (63.4%) participants were not frail, 36 (19.4%) vulnerable, and 32 (17.2%) were frail. Worse frailty scores were associated with poorer patient experience and QoL scores across all questionnaires. Severe deficits in the EFS psychosocial subdomain showed a statistically significant association with higher depression screen scores (coefficient 4.9, 95% CI 3.22 to 6.59), lower physical (coefficient -4.35, 95% CI -7.59 to -1.12) and mental function scores (coefficient -8.33, 95% CI -11.77 to -4.88) from the Short Form-12(v2), and lower renal treatment satisfaction scores (coefficient -5.54, 95% CI -10.70 to -0.37). Deficits in the physical function and medical status EFS subdomians showed some association with patient experience scores.ConclusionIn the KTOP study cohort at recruitment vulnerable and frail candidates reported worse QoL and patient experiences. Severe deficits in the psychosocial subdomains of the EFS showed a strong association with patient experience and QoL, whilst physical function and medical status deficits showed a lesser association. This has highlighted specific EFS domains that may be suitable for targeted interventions to improve experiences and optimise outcomes

Pathogenicity of Phaeoacremonium aleophilum and Phaeomoniella chlamydospora on Grape Berries in California

Injured and non-injured grape berries were inoculated with spore suspension of Phaeomoniella chlamydospora or Phaeoacremonium aleophilum under field (intact berries) and laboratory (detached berries) conditions. In one test, berries were injured by pricking the skin with a syringe needle to a depth of approximately 1.5 mm. Brown to purple lesions appeared 5 to 7 days after inoculation in both the injured intact and detached berries. Lesions on these berries were larger when inoculated earlier in the season indicating that young, immature berries are more susceptible to infection than mature berries. In another test, berries were injured by rubbing the skin with carborundum dust using a cotton-tipped applicator. Esca-like lesions developed in 4 to 5 days after inoculation of detached but not intact berries. Occasional infection of non-injured berries occurred which appeared as small dots to pin-head size lesions around the lenticels. Scanning electron microscopy observations of these lesions showed abundant hyphal growth on the surface with apparent penetration through lenticels; however, fungal structures were not detected with certainty beneath the lenticels or intact cuticle. In both tests, the fungi were re-isolated from the advancing margin of the lesions