Self-monitoring of blood glucose in Black Caribbean and South Asian Canadians with non-insulin treated Type 2 diabetes mellitus: a qualitative study of patients' perspectives

Background: To examine the views and current practice of SMBG among Black Caribbean and South Asian individuals with non-insulin treated Type 2 diabetes mellitus. Methods: Twelve participants completed semi-structured interviews that were guided by the Health Belief Model and analyzed using thematic network analysis. Results: The frequency of monitoring among participants varied from several times a day to once per week. Most participants expressed similar experiences regarding their views and practices of SMBG. Minor differences across gender and culture were observed. All participants understood the benefits, but not all viewed SMBG as beneficial to their personal diabetes management. SMBG can facilitate a better understanding and maintenance of self-care behaviours. However, it can trigger both positive and negative emotional responses, such as a sense of disappointment when high readings are not anticipated, resulting in emotional distress. Health care professionals play a key role in the way SMBG is perceived and used by patients. Conclusion: While the majority of participants value SMBG as a self-management tool, barriers exist that impede its practice, particularly its cost. How individuals cope with these barriers is integral to understanding why some patients adopt SMBG more than others

Learning to live with nephrotic syndrome: experiences of adult patients and parents of children with nephrotic syndrome

People living with nephrotic syndrome (NS) need to develop an in-depth understanding of their condition in order to participate in treatment decisions, develop self-management skills and integrate illness into daily life. However, the learning needs of adult patients and parents of children with NS are unknown. We therefore explored patient and parent perspectives on learning needs related to NS as part of a larger study to develop a shared learning tool for NS

Provider perspectives on treatment decision-making in nephrotic syndrome

Managing patients with nephrotic syndrome (NS) remains difficult for the practicing nephrologist. This often young patient population is faced with a debilitating, relapsing and remitting disease with non-specific treatment options that are often poorly tolerated. Clinicians managing these complex patients must attempt to apply disease-specific evidence while considering the individual patient's clinical and personal situation

Rituximab or Cyclosporine in the Treatment of Membranous Nephropathy

Background: B-cell anomalies play a role in the pathogenesis of membranous nephropathy. B-cell depletion with rituximab may therefore be noninferior to treatment with cyclosporine for inducing and maintaining a complete or partial remission of proteinuria in patients with this condition. Methods: We randomly assigned patients who had membranous nephropathy, proteinuria of at least 5 g per 24 hours, and a quantified creatinine clearance of at least 40 ml per minute per 1.73 m(2) of body-surface area and had been receiving angiotensin-system blockade for at least 3 months to receive intravenous rituximab (two infusions, 1000 mg each, administered 14 days apart; repeated at 6 months in case of partial response) or oral cyclosporine (starting at a dose of 3.5 mg per kilogram of body weight per day for 12 months). Patients were followed for 24 months. The primary outcome was a composite of complete or partial remission of proteinuria at 24 months. Laboratory variables and safety were also assessed. Results: A total of 130 patients underwent randomization. At 12 months, 39 of 65 patients (60%) in the rituximab group and 34 of 65 (52%) in the cyclosporine group had a complete or partial remission (risk difference, 8 percentage points; 95% confidence interval [CI], -9 to 25; P=0.004 for noninferiority). At 24 months, 39 patients (60%) in the rituximab group and 13 (20%) in the cyclosporine group had a complete or partial remission (risk difference, 40 percentage points; 95% CI, 25 to 55; P<0.001 for both noninferiority and superiority). Among patients in remission who tested positive for anti-phospholipase A(2) receptor (PLA2R) antibodies, the decline in autoantibodies to anti-PLA2R was faster and of greater magnitude and duration in the rituximab group than in the cyclosporine group. Serious adverse events occurred in 11 patients (17%) in the rituximab group and in 20 (31%) in the cyclosporine group (P=0.06). Conclusions: Rituximab was noninferior to cyclosporine in inducing complete or partial remission of proteinuria at 12 months and was superior in maintaining proteinuria remission up to 24 months. (Funded by Genentech and the Fulk Family Foundation; MENTOR ClinicalTrials.gov number, .) In a randomized, controlled trial involving patients with membranous nephropathy, rituximab was noninferior to cyclosporine in inducing complete or partial remission of proteinuria at 12 months and was superior in maintaining proteinuria remission for up to 24 months.Genentech; Fulk Family Foundation6 month embargo; published July 4, 2019This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Engulfment among adults with chronic renal disease, a study of self-loss and its correlates

grantor: University of TorontoThe purpose of this study was to examine engulfment at four phases of chronic renal disease (CRD). Engulfment was defined as the degree to which the self-concept is dominated by illness and was measured by the Modified Engulfment Scale (MES). Study subjects (n = 200) were divided equally among the four phases of CRD: chronic renal insufficiency, predialysis, early dialysis and long-term dialysis. Subjects in dialysis phases, were equally divided between hemodialysis and continuous ambulatory peritoneal dialysis (CAPD). In addition to the MES, the degree of Engulfment was measured using a semantic differential technique and visual analogue scales (VASs). Standardized instruments were used to measure fatigue, uremic symptoms, illness intrusiveness, and depression. Life satisfaction was measured using a VAS developed by the investigator. Focused interviews were conducted with a subsample of subjects representing each phase (n = 47). Engulfment scores were significantly, positively correlated with serum creatinine levels, number of comorbid conditions, uremic symptoms, fatigue, and illness intrusiveness. There was no significant difference in engulfment scores for subjects on hemodialysis as compared with CAPD. As predicted, engulfment scores differed significantly among the four phases. After controlling for the relevant clinical and sociodemographic variables, symptoms and illness intrusiveness contributed significantly to variance in MES scores; however, phase of CRD did not. The degree of engulfment was positively correlated with depression, negatively correlated with life satisfaction, and significantly contributed to these outcomes after controlling for all other variables of interest. Qualitative data supported the importance of symptoms and illness intrusiveness to the engulfing process and also highlighted potential challenges to the self-concept in CRD, such as transitional events, and strategies employed to minimize engulfment such as redefining the self, and maintaining hope. The results of this study indicate that engulfment provides a useful perspective for understanding the impact of chronic physical illness on the self-concept. Study results provide evidence of the reliability and validity of the MES for measuring the impact of illness on the self-concept in CRD. Additionally, the study identifies variables that may be related to engulfment and suggests directions for future research and clinical interventions in this area.Ph.D

Narrative Reflective Process: A Means to Whole Person Research Cluster Formation

Objectives:  As nursing faculty members of Health and Illness research cluster our focus is on promoting humanistic practices, such as person-centered care, for individuals and their families living with illness and its consequences. In keeping with this holistic focus we wanted to explore a non-traditional approach to building a productive professional collaboration.Methods:  In the early stages of our research cluster formation, we chose to engage in Schwind’s Narrative Reflective Process (NRP), a creative self-expression activity that is informed by the Connelly and Clandinin’s Narrative Inquiry research approach. Creative activities included storytelling, metaphors and drawing. We began the process by working in pairs, telling stories of our research experiences, both positive and negative. We then drew images that metaphorically represented each of these. Following, we described our images to the cluster group, while considering common narrative threads. The process ended by the group envisioning our interpretation of our collaborative cluster work. Throughout the year, our cluster met on a regular basis working on our common interest of person-centred care. One year later, we recreated our images to see how the view of our collaborative cluster work had evolved. This time we chose to create one large image together.Results:  We found that our creative experiential activities opened possibilities for trust and created a safe space for research cluster members to share their developing ideas. We felt that by sharing our personal experiences through drawings and metaphors allowed us to connect with one another as whole persons. It allowed us to recognize that we are more than just our professional roles.Conclusions:  Through the creative self-expression of NRP we engaged the research cluster members as whole persons. As a result, the cohesion, trust and collaboration resulted in increased research creativity and productivity, which would not have been possible to create alone

Overview of Self-Management Resources Used by Canadian Chronic Kidney Disease Clinics: A National Survey

Background: Chronic kidney disease (CKD) clinics across Canada provide tailored care for patients with CKD with an aim to slow progression and prevent complications. These clinics provide CKD self-management resources; however, there is limited information about what resources are being used by clinics. We undertook a survey of CKD clinics across Canada to identify self-management resources for adults aged 18 years and over with CKD categories 1 to 5 and not requiring dialysis or transplant. Objective: To identify and collate self-management resources (eg, strategies, tools, educational materials) used by CKD clinics across Canada for adults with CKD (categories 1 to 5, not requiring kidney replacement therapy). Design: Self-administered, semistructured electronic survey. Setting, participants: Canadian CKD clinics with previously identified contact information. Methods and measurements: We contacted 57 CKD English-speaking clinics and invited them to complete an online survey. The survey was available from October 2016 to January 2017 and consisted of 17 questions regarding the use and attributes of self-management resources including topic, delivery format, provider, target population, where the intervention was provided, and resource languages. Results: Forty-four clinics (77%) completed the survey. The most common topic was modality education provided in print format, by nurses. The most frequently used resource was the Kidney Foundation of Canada (KFOC) Living With Kidney Disease manual. We also identified that the majority of resources were available in English, targeting both patients and caregivers in the outpatient setting. Limitations: Our survey included Canadian adult CKD clinics, which may not be generalizability to other settings, such as care of people with CKD in primary care. Conclusions: Adult CKD clinics across Canada provide some similar resources, but also provide many different self-management resources. Even though some of the same resources were used by multiple clinics, the way they were provided them (ie, provider, location, delivery format) varied by the individual clinics. Knowledge of self-management resources currently provided in CKD clinics, along with synthesis of the literature and patient preferred self-management strategies, will inform the design and development of a novel self-management intervention that is patient-centric and adheres to the principles of self-management

Evaluation of Mindfulness-Based Cognitive Therapy to Reduce Psychological Distress and to Promote Well-Being

The objective of this study was to assess the effectiveness of an 8-week mindfulness-based cognitive therapy (MBCT) group intervention to reduce psychological distress as well as to strengthen self-esteem, resilience, and general well-being for individuals living with a chronic illness and/or other health challenges. This pilot study employed a pre–posttest design to evaluate the outcome of the intervention for individuals receiving care in a Community and Family Medicine department and a Women’s Health Centre located in an urban downtown hospital. A total of 42 patients were enrolled in the study and 35 participants completed the intervention. Thirty-five of 42 enrolled participants completed the intervention. Twenty-eight participants completed the pretest and posttest assessments, which demonstrated statistically significant improvement on most outcome measures, including the Center for Epidemiological Studies–Depression Rating Scale (CES-D), Depression Anxiety Stress Scale (DASS), Affect Balance Scale (ABS), the Resilience Scale (RS), and the Five-Item World Health Organization Well-Being Index (WHO-5). Large effect sizes were observed for the CES-D, the ABS, and the DASS Stress subscale. Observed improvements were sustained at 4 weeks posttreatment. Results are consistent with studies indicating that MBCT offers promise in alleviating psychological distress for those who are seeking care in primary health care settings. Continued focus on how to best implement MBCT in primary health care, particularly for those with comorbid physical and mental health conditions, supports the World Health Organization’s recommendation to integrate evidence-based mental health care within primary health care to promote equitable access to care for those most in need