What are the qualitative experiences of people affected by kidney failure receiving haemodialysis?

Background: People affected by kidney failure receiving haemodialysis experience complexity within their health condition unlike any other chronic illness or condition. Kidney failure impacts the individual in all areas of their life including relationships and activities of daily living. Objective: To conduct a meta‐aggregation of studies about the lived experiences of people with kidney failure receiving haemodialysis. Design: Using PRISMA Guidelines, six databases (CINAHL, ClinicalTrials.gov, Cochrane Library, MEDLINE, PsycINFO, and Scopus) were comprehensively searched using keywords and subject headings from January 1990 to October 2021. Articles were assessed according to prespecified eligibility criteria. Data extraction and quality appraisal was conducted. A meta‐aggregation of qualitative findings was conducted using the Joanna Briggs Institute methodology for meta‐aggregation. Results: Of the 9409 articles screened, 55 studies were included. This represented a total of 188 findings across 45 categories representing a range of unmet supportive care needs. The meta‐aggregation identified 11 synthesised findings broadly related to psychological/emotional needs, physical needs, social needs, interpersonal/intimacy needs, patient‐clinician communication needs, family related needs, health system/information needs, spiritual needs, daily living needs, practical needs and daily living needs. Conclusions: This meta‐aggregation has identified that people affected by kidney failure can experience a range of unmet supportive care needs. It was evident that living with kidney failure and receiving haemodialysis impacted a person's sense of self, introduced practical needs and other complex needs which were not being addressed in existing services. This review has highlighted important implications for clinical practice and future research directions

Exploring Women’s Mutuality in Confronting Care-Precarity: ‘Care Accounts’ – a Conceptual Tool

Exploring scholarship in reciprocity, gift and gendered social capital, and drawing upon research and analysis across 15 years (2003–2018), this article offers fresh theoretical insights into everyday practices of low-paid women with care responsibilities. Framing women’s pragmatic mutuality in confronting precarity in their care arrangements, we propose the concept of ‘Care Accounts’, articulating a practice of collaborative workplace problem solving. Women lodge and generate good will with colleagues by swapping or extending their shifts to cover for each other; generating capacity and continuity of care across unexpected family events or crises. Systems of reciprocal workplace mutuality – care/work micro-networks – build as women pool their capacity to respond. We highlight, however, an ensnarement effect of Care Accounts, as they further lock women into low paid jobs. We suggest priority attention must be given to the prevalence and urgency of ‘care-precarity’ and the dereliction in care planning that Care Accounts reveal

Identifying experiences of supportive care of children and young people affected by kidney failure: a qualitative systematic review.

Children and young people affected by kidney failure experience complexities in their care. Little is known about the unique needs of this young patient population group living with a long-term condition. A meta-aggregation of all qualitative studies was conducted to identify experiences of supportive care among children and young people living with kidney failure. A systematic review of qualitative studies was conducted following the Joanna Briggs Institute meta-aggregation method. This review has been reported according to the PRISMA statement guidelines. Six electronic databases (CINAHL, Cochrane Library, MEDLINE, Proquest, PsycINFO, and Scopus) were comprehensively searched by an expert systematic review librarian using keywords and subject headings, from inception to September 2022. All studies were accessed using a predetermined inclusion and exclusion criteria. Methodological quality assessment and data extraction performed. Qualitative findings accompanied by illustrative quotes from included studies were extracted and grouped into categories which created the overall synthesised findings. A total of 34 studies were included in this review representing a total of 613 children and young people affected by kidney failure. There was a total of 190 findings which created 13 categories representing experiences of supportive care. The meta-aggregation developed five synthesised findings namely: 'physical needs', 'information and technology', 'treatment and healthcare', 'social needs' and 'psychological impacts'. This systematic review identified that children and young people affected by kidney failure can experience a range of unmet supportive care needs in routine clinical services. Kidney failure impacted children and young people's self-identify, social and peer networks, introduced daily practical needs because of inherent physical and psychological burden due to the failure and associated treatments. Despite improvements in the medical management of kidney failure in children and young people, further attention is needed to optimise supported self-management in this young patient group

Keystone coleopterans? Colonization by wood-feeding elmids of experimentally immersed woods in south-eastern Australia

Macroinvertebrates on immersed woods in streams in montane south-eastern Australia respond to differences in wood taxa, according to a 4-month colonization study of experimentally positioned sticks. Xylophagous elmids (Coleoptera : Elmidae) strongly preferred local native Eucalyptus over other types of wood including non-native softer timbers (Pinus and Alnus). Where gouging elmids were abundant (in native forest streams with native riparian vegetation), immersed Eucalyptus wood supported high abundances of other macroinvertebrates; in their absence (in open grassland streams), Eucalyptus supported few other macroinvertebrates. Macroinvertebrate-gouged channels were present disproportionately on Eucalyptus sticks relative to other wood species. It is proposed that xylophagous elmid beetles are the principal macroinvertebrate modifiers of wood in these south-eastern Australian streams, where their gouging of channels increases surface area, thereby facilitating colonization by other macroinvertebrates and wood-decaying microorganisms and fungi

A Human Atrial Natriuretic Peptide Gene Mutation Reveals a Novel Peptide With Enhanced Blood Pressure-Lowering, Renal-Enhancing, and Aldosterone-Suppressing Actions

ObjectivesWe sought to determine the physiologic actions and potential therapeutic applications of mutant atrial natriuretic peptide (mANP).BackgroundThe cardiac hormone atrial natriuretic peptide (ANP) is a 28-amino acid (AA) peptide that consists of a 17-AA ring structure together with a 6-AA N-terminus and a 5-AA C-terminus. In a targeted scan for sequence variants within the human ANP gene, a mutation was identified that results in a 40-AA peptide consisting of native ANP(1-28)and a C-terminal extension of 12 AA. We have termed this peptide mutant ANP.MethodsIn vitro 3′,5′-cyclic guanosine monophosphate (cGMP) activation in response to mANP was studied in cultured human cardiac fibroblasts known to express natriuretic peptide receptor A. The cardiorenal and neurohumoral properties of mANP compared with ANP were assessed in vivo in normal dogs.ResultsWe observed an incremental in vitro cGMP dose response with increasing concentrations of mANP. In vivo with high-dose mANP (33 pmol/kg/min), we observed significantly greater plasma cGMP activation, diuretic, natriuretic, glomerular filtration rate enhancing, renin-angiotensin-aldosterone system inhibiting, cardiac unloading, and blood pressure lowering properties when compared with native ANP. Low-dose mANP (2 pmol/kg/min) has natriuretic and diuretic properties without altering systemic hemodynamics compared with no natriuretic or diuretic response with low-dose native ANP.ConclusionsThese studies establish that mANP activates cGMP in vitro and exerts greater and more sustained natriuretic, diuretic, glomerular filtration rate, and renal blood flow enhancing actions than native ANP in vivo