Young adults' experiences of dialysis or kidney transplant decision-making

Young adults with kidney failure experience disruptions in their education, growth development, building relationships and face employment problems during the journey of the disease (Murray et al., 2014). Once their kidneys fail, they need to make a choice about which dialysis treatment to have or whether they prefer the option of kidney transplant. So, they have to work with their health care professionals to make decisions to select their preferred dialysis or kidney transplant choice. This is known as shared decision-making. The three-talk model of shared decision making shown on the screen is used as a guide by health care professionals to encourage discussions of treatment options with patients during the shared decision-making process (Elwyn et al., 2018). A recent report by the renal registry highlighted that over 50% of young adults with kidney failure started haemodialysis as their first treatment option and less of them (14.1%) received a kidney transplant, although kidney transplantation is recommended as the best treatment (NICE, 2014). Evidence suggests that among adults with kidney failure, not all patients receive timely information on kidney failure treatment options to enable them share in the decision-making or make an informed choice, which falls short of the recommended guidelines. It matters because little is known about young adults with kidney failure experiences of dialysis or kidney transplant decision-making and how the decision to select a dialysis or kidney transplant choice may have impacted on their psychosocial and mental well-being. This is where my study plays an important role. Our involvement group who have dialysis and kidney transplant experiences as children and young adults, suggested that the study should focus on the impact of decision-making on the psychosocial and mental well-being of young adults as it was a neglected area and their views incorporated. My study will explore young adults’ experiences of decision-making to select a dialysis or kidney transplant choice. It will examine the impact of dialysis or kidney transplant decision-making on young adults psychosocial and mental well-being. Lastly it will seek to understand how young adults can be better supported during the decision-making process to enhance their coping abilities and participation in the decision-making process

Involvement of young people in a qualitative study that seeks to explore experiences of renal replacement therapy choice selection

Introduction: Patient and Public involvement (PPI) has become one of the drivers in health care and seen as an integral part of the research process. PPI promotes research questions that reflect the priorities and concerns of the relevant population and develops outcomes that are important to patients (INVOLVE, 2012; Evans et al, 2014; Hickey et al, 2018). Young adults with end-stage kidney disease are supported by clinicians and their families to make decisions about their preferred renal replacement therapy (NICE, 2018). However, they can become overwhelmed with the burden of long-term chronic illness and often struggle to accept diagnosis and prognosis and cope with the complex management of their condition (Coulter and Collins, 2011; Ritchie et al., 2012). They can consequently become disengaged with the service and less involved in their care (Ritchie et al, 2012; Robinski et al, 2014). The current study explores young people’s experiences of renal replacement therapy choice selection. The study team has involved young people in the study’s development. Aims and objectives: The aim of the involvement group in this study is to involve the young people in all stages of the research process: ensuring that the research question has the correct focus, that the participant information sheet is clear and that the recruitment strategy is appropriate. In due course, the young people’s group will be involved in qualitative data analysis and in dissemination of findings. Method: The involvement group comprised three people with experiences of dialysis and kidney transplant treatment as children and young adults. They were recruited via existing networks in the research team. A role description on what was to be expected of the group members was discussed, alongside what was expected from the research team (training and travel expenses for example). Communication is via face-to face meetings and also by email. This first face-to-face meeting discussed and shaped the research question, and the possible recruitment process. Further email discussions have explored the participant information sheet, consent forms plus the development of the video and poster advert to aid recruitment. Results: The impact of PPI on the research process is already providing valuable insights into how the research design should be conducted. The first face-to-face meeting with the group highlighted the difficulties that young people face when making choice of renal replacement therapy, especially psychosocial impact and mental well-being, so the impact the choice makes on well-being was added as a secondary research question. The acceptability of the recruitment method (via social media) was discussed and a video advert was developed for the recruitment process. Members also contributed to the review of some of the research documents; participant information sheet, consent forms, posters, research proposal and piloted a validation questionnaire for suitability. Impact: Involvement of patients helped situate the study to meet the current needs of young adults diagnosed with end stage renal disease who are faced with choosing dialysis or kidney transplantation

Bridging the Gap between Rural Water Supply and Demand using Harvestable Rainwater: A Case Study of Adansi-Fumso

Rainwater harvesting has several benefits including providing a valuable alternative source of water for households, reduction in flood flow to storm drains and settlement erosion as well as health benefits. The research aimed at assessing and confirming the available renewal water sources, determining the cost of developing a rainwater harvesting system and assessing the potential of rainwater as a supplement to water supply at Fumso. Using a systematic random sampling technique and a sample size of 100 respondents, it was discovered that rainwater harvesting in Adansi Fumso has the potential to conserve on-site potable water use, protect water quality and reduce the risk of flooding within the community. Rainwater was preferred by the community due to its easy accessibility, nature (clean, pure, healthier and tastier), cost and quality. An examination of the rainfall records at AngloGold Ashanti weather station at Obuasi revealed an average annual rainfall of 1449.2 mm with the drier months (November, December, January and February) receiving only a quarter of the average monthly rainfall. The relatively high rainfall means that rainwater harvesting system designs need to be taken as a priority in addressing the water shortage situation in the community. Geometrically uniform building shapes and the local hydrology can provide sufficient rainwater to serve buildings in the community. The cost of the proposed rainwater harvesting system is GH ¢ 389.00 ($256.00). Reasons have been given for the need for this project and recommendations made for its implementation at Adansi Fumso as the best alternative source of water to the fewer boreholes in the community

Primacy of effective communication and its influence on adherence to artemether-lumefantrine treatment for children under five years of age: a qualitative study.

BACKGROUND\ud \ud Prompt access to artemesinin-combination therapy (ACT) is not adequate unless the drug is taken according to treatment guidelines. Adherence to the treatment schedule is important to preserve efficacy of the drug. Although some community based studies have reported fairly high levels of adherence, data on factors influencing adherence to artemether-lumefantrine (AL) treatment schedule remain inadequate. This study was carried-out to explore the provider's instructions to caretakers, caretakers' understanding of the instructions and how that understanding was likely to influence their practice with regard to adhering to AL treatment schedule.\ud \ud METHODS\ud \ud A qualitative study was conducted in five villages in Kilosa district, Tanzania. In-depth interviews were held with providers that included prescribers and dispensers; and caretakers whose children had just received AL treatment. Information was collected on providers' instructions to caretakers regarding dose timing and how to administer AL; and caretakers' understanding of providers' instructions.\ud \ud RESULTS\ud \ud Mismatch was found on providers' instructions as regards to dose timing. Some providers' (dogmatists) instructions were based on strict hourly schedule (conventional) which was likely to lead to administering some doses in awkward hours and completing treatment several hours before the scheduled time. Other providers (pragmatists) based their instruction on the existing circumstances (contextual) which was likely to lead to delays in administering the initial dose with serious treatment outcomes. Findings suggest that, the national treatment guidelines do not provide explicit information on how to address the various scenarios found in the field. A communication gap was also noted in which some important instructions on how to administer the doses were sometimes not provided or were given with false reasons.\ud \ud CONCLUSIONS\ud \ud There is need for a review of the national malaria treatment guidelines to address local context. In the review, emphasis should be put on on-the-job training to address practical problems faced by providers in the course of their work. Further research is needed to determine the implication of completing AL treatment prior to scheduled time

The CannTeen study: verbal episodic memory, spatial working memory, and response inhibition in adolescent and adult cannabis users and age-matched controls

BACKGROUND: Preclinical and human studies suggest that adolescent cannabis use may be associated with worse cognitive outcomes than adult cannabis use. We investigated the associations between chronic cannabis use and cognitive function in adolescent and adult cannabis users and controls. We hypothesised user-status would be negatively associated with cognitive function and this relationship would be stronger in adolescents than adults. METHODS: As part of the 'CannTeen' project, this cross-sectional study assessed cognitive performance in adolescent cannabis users (n = 76; 16-17-year-olds), adolescent controls (n = 63), adult cannabis users (n = 71; 26-29-year-olds) and adult controls (n = 64). Users used cannabis 1-7 days/week. Adolescent and adult cannabis users were matched on cannabis use frequency (4 days/week) and time since last use (2.5 days). Verbal episodic memory (VEM) was assessed using the prose recall task, spatial working memory (SWM) was assessed using the spatial n-back task, and response inhibition was assessed with the stop-signal task. Primary outcome variables were: delayed recall, 3-back discriminability, and stop signal reaction time, respectively. RESULTS: Users had worse VEM than controls (F(1,268) = 7.423, p = 0.007). There were no significant differences between user-groups on SWM or response inhibition. Null differences were supported by Bayesian analyses. No significant interactions between age-group and user-group were found for VEM, SWM, or response inhibition. CONCLUSIONS: Consistent with previous research, there was an association between chronic cannabis use and poorer VEM, but chronic cannabis use was not associated with SWM or response inhibition. We did not find evidence for heightened adolescent vulnerability to cannabis-related cognitive impairment

Improved fisheries productivity and management in tropical reservoirs

“Improved fisheries productivity and management in tropical reservoirs” The objective of the project was to contribute to the current research on reservoirs enhancement fisheries in tropical countries through the implementation of a series of action-research activities implemented in two small reservoirs in the Indo-Gangetic basin in India, and two very large reservoirs in Africa, the Lake Nasser (Egypt), and the Volta Lake (Ghana). Socio-institutional analyses were also conducted in these reservoirs to improve our knowledge regarding some of the main social processes that influence reservoir productivity. Overall the results of the project stress that while the natural biophysical constraints of the reservoirs are important in defining the ecological production processes, it is the socio-economic settings characterizing the community/societies around the reservoirs that eventually shape the human production enhancement possibilities

A narrative review on pressure ulcer (PU) studies relevant to medical imaging

Pressure ulcers (PUs) are defined as localised injuries to the skin and/or underlying tissue as a result of pressure or pressure together with shear. PUs present significant health implications to patients; costing billions to manage and/or treat. The burden of PU prevention in hospitals must be the concern of all healthcare professionals, including radiographers. The purpose of this narrative review article is to identify and critically evaluate relevant literature and research conducted into pressure ulcers (PUs) relevant to medical imaging. It is expected that this review article will increase the level of awareness about PUs amongst radiographers and help to develop appropriate interventions to minimise the risk of PUs. A literature search was conducted in PubMed/Medline, Scopus, CINAHL, and Google Scholar to retrieve relevant articles. Also, books, professional body guidelines, magazines, grey and unpublished literatures were also searched. The search was limited to English Language articles. Only five articles were retrieved and reviewed. There are limited studies on PUs relevant to medical imaging. Available studies provide some evidence that radiographic procedures and settings subject patients attending for radiographic procedures to the risk of PUs. Further studies are needed into PU risk assessment, minimisation and management in medical imaging to help raise awareness and address the problem of the potential for PU development

Stakeholder perceptions of the benefits and barriers of implementing environmental management systems in the Nigerian construction industry

© 2016 Vilnius Gediminas Technical University (VGTU) Press. This study investigates stakeholder opinions of the major benefits and barriers of Environmental Management Systems (EMS) to the Nigerian construction industry, and the perceived issues to EMS adoption among organisations in the industry. The study highlights the environment as an important stakeholder in the industry because it affects and is affected by construction activities on a regular basis. It identifies the importance of ISO 14001 in ensuring adequate consideration for the environment is maintained on construction projects. The research adopts a quantitative approach by analysing responses from an online survey among construction industry professionals in Nigeria. The questions on the survey were drawn from a similar study carried out in Asia and the results were analysed using the Weighted Average and Standard Deviation statistical approach. Results reveal that the major benefits of EMS to the Nigerian construction industry were improved efficiency in waste management and environmental protection, as well as an overall increase in employee motivation due to better opportunities for training and development. Lack of technological support in organisations and the high cost of implementing EMS were viewed as the major barriers towards its uptake in construction companies. The findings also indicate that a feasible EMS implementation strategy must not ignore the unique nature of the Nigerian construction industry, which comprises mostly small and medium enterprises. The study concludes by recommending the use of a waste management plan based on the Reuse-Reduce-Recycle-Recover model and an employee training plan to ensure continuous improvement in the organisation’s environmental management strategy

Use of social audits to examine unofficial payments in government health services: experience in South Asia, Africa, and Europe

<p>Abstract</p> <p>Background</p> <p>Unofficial payments in health services around the world are widespread and as varied as the health systems in which they occur. We reviewed the main lessons from social audits of petty corruption in health services in South Asia (Bangladesh, Pakistan), Africa (Uganda and South Africa) and Europe (Baltic States).</p> <p>Methods</p> <p>The social audits varied in purpose and scope. All covered representative sample communities and involved household interviews, focus group discussions, institutional reviews of health facilities, interviews with service providers and discussions with health authorities. Most audits questioned households about views on health services, perceived corruption in the services, and use of government and other health services. Questions to service users asked about making official and unofficial payments, amounts paid, service delivery indicators, and satisfaction with the service.</p> <p>Results</p> <p>Contextual differences between the countries affected the forms of petty corruption and factors related to it. Most households in all countries held negative views about government health services and many perceived these services as corrupt. There was little evidence that better off service users were more likely to make an unofficial payment, or that making such a payment was associated with better or quicker service; those who paid unofficially to health care workers were not more satisfied with the service. In South Asia, where we conducted repeated social audits, only a minority of households chose to use government health services and their use declined over time in favour of other providers. Focus groups indicated that reasons for avoiding government health services included the need to pay for supposedly free services and the non-availability of medicines in facilities, often perceived as due to diversion of the supplied medicines.</p> <p>Conclusions</p> <p>Unofficial expenses for medical care represent a disproportionate cost for vulnerable families; the very people who need to make use of supposedly free government services, and are a barrier to the use of these services. Patient dissatisfaction due to petty corruption may contribute to abandonment of government health services. The social audits informed plans for tackling corruption in health services.</p