Time and Difficulty with Tasks and Illness Characteristics Among Caregivers of Individuals Receiving Daily Home Hemodialysis

poster abstractEnd Stage Renal Disease (ESRD) affected approximately 594,374 people in 2010. Patients receiving dialysis often need help with activities of daily living and tasks outside dialysis treatments. The burden of providing assistance and support for such patients can be overwhelming for caregivers, regardless of the modality. This study examined several factors that may be associated with time and difficulty of tasks experienced by caregivers of individuals receiving daily home hemodialysis (HHD). Examining relationships between caregivers age, caregiver income, length of time on dialysis, and patient co-morbidities with perceived time and difficulty with tasks may assist with focusing interventions within specific demographic groups. The purpose of this study is to examine these relationships. This study used existing data from a mixed-methods study. The original study examined needs, concerns, strategies, and advice of daily home hemodialysis caregivers. Participants included 16 caregivers, recruited from a large daily home hemodialysis program in a Mid-western city. There was no relationship between length of time the patient was receiving HHD and time or difficulty with tasks. There was no relationship between age of the caregiver and time or difficulty with tasks. There was no relationship between income and time or difficulty with tasks. There was no relationship between the number of patient comorbidities and time or difficulty with tasks. One important limitation of this study, and possibly the reason that no significant results were discovered, is the small sample size. This study was designed to look at possible factors that may increase perceived caregiver burden. Although there were no relationships found between selected demographic or clinical variables and perceived time expenditure and difficulty with tasks, future research should examine other variables such as relationship of caregiver to patient, caregiver health and comorbidities, and level of involvement of home dialysis staff

Medication-taking behaviours in chronic kidney disease with multiple chronic conditions: a meta-ethnographic synthesis of qualitative studies

Aims and objectives To identify behaviours associated with taking medications and medication adherence reported in qualitative studies of adults with chronic kidney disease and coexisting multiple chronic conditions. Background To inform medication adherence interventions, information is needed to clarify the nature of the relationships between behaviours that support medication-taking and medication adherence in multiple chronic conditions. Design Meta-ethnographic review and synthesis. Methods CINAHL Complete, MEDLINE and PsycINFO databases were searched. Five qualitative studies met the inclusion criteria. A meta-ethnographic approach was used for synthesis. Medication-taking behaviours were abstracted from study findings and synthesised according to the contexts in which they occur and interpreted within a new developing framework named the Medication-taking Across the Care Continuum and Adherence-related Outcomes. Results Twenty categories of medication-taking behaviours occurred in three main contexts: (1) patient–provider clinical encounters, (2) pharmacy encounters and (3) day-to-day management. These behaviours are distinctly different, multilevel and interrelated. Together they represent a process occurring across a continuum. Conclusions Future medication adherence research should consider using a multilevel ecological view of medication management. Clinical practice and policy development can benefit from further understanding socio-contextual behaviours that occur across the continuum. Nurses should have greater presence in chronic disease management and be positioned to support the day-to-day home management of patients' medications

When do we eat? An evaluation of food items input into an electronic monitoring application

We present a formative study that examines what, when, and how participants in a chronic kidney disease (stage 5) population input food items into an electronic intake monitoring application. Participants scanned food item barcodes or voice recorded food items they consumed during a three week period. The results indicated that a learning curve was associated with barcode scanning; participants with low literacy skills had difficulty describing food items in voice recordings; and participants input food items depending on when they had dialysis treatment. Participants thought this electronic self monitoring application would be helpful for chronically ill populations in their first year of treatmen

Skills Included in Self-Management Interventions to Help People with Chronic Kidney Disease

Slowing the progression of chronic kidney disease (CKD) is a major goal of medical therapy and requires significant and complex self-management behaviors from patients. Similar to other chronic conditions, patients must have the knowledge, confidence, and skills to self-manage the disease in daily living. The core self-management skills of problem-solving, decision making, resource utilization, patient-provider partnerships, action planning, and self-tailoring will help patient perform key behaviors associated with slowed progression. These key behaviors include the avoidance of nonsteroidal anti-inflammatory drugs (NSAIDS), diet modifications, glycemic control, regular exercise, systolic blood pressure control, tobacco avoidance, and adherence to angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin receptor blocker (ARB) medications. The purpose of this literature review was to review the components of tested CKD self-management interventions to identify the self-management skills that were included in the published studies and how the interventions were delivered. A search for literature was performed using multiple databases. Articles were selected for review if they were written in English, included adults 18 years of age who had Stage 1-4 CKD, and tested a self-management intervention using a quasiexperimental or experimental design. A total of eight research articles met the inclusion criteria. Action planning, problem-solving and enhancing patient-provider partnerships were included in some interventions; there was no evidence of decision-making, resource utilization, or self-tailoring. All of the interventions were delivered using face-to-face educational programs and none used information technology. Data from this review provides important information for designing future interventions that will improve CKD self-management programs. In addition, findings suggest additional methods are needed when delivering interventions so programs are readily available to underserved areas

Formative evaluation of a mobile liquid portion size estimation interface for people with varying literacy skills

Chronically ill people, especially those with low literacy skills, often have difficulty estimating portion sizes of liquids to help them stay within their recommended fluid limits. There is a plethora of mobile applications that can help people monitor their nutritional intake but unfortunately these applications require the user to have high literacy and numeracy skills for portion size recording. In this paper, we present two studies in which the low- and the high-fidelity versions of a portion size estimation interface, designed using the cognitive strategies adults employ for portion size estimation during diet recall studies, was evaluated by a chronically ill population with varying literacy skills. The low fidelity interface was evaluated by ten patients who were all able to accurately estimate portion sizes of various liquids with the interface. Eighteen participants did an in situ evaluation of the high-fidelity version incorporated in a diet and fluid monitoring mobile application for 6 weeks. Although the accuracy of the estimation cannot be confirmed in the second study but the participants who actively interacted with the interface showed better health outcomes by the end of the study. Based on these findings, we provide recommendations for designing the next iteration of an accurate and low literacy- accessible liquid portion size estimation mobile interface

Patient Activation with Knowledge, Self-Management, and Confidence in Chronic Kidney Disease

Background Chronic kidney disease is a growing health problem on a global scale. The increasing prevalence of chronic kidney disease presents an urgent need to better understand the knowledge, confidence and engagement in self-managing the disease. Objectives This study examined group differences in patient activation and health-related quality of life, knowledge, self-management and confidence with managing chronic disease across all five stages of chronic kidney disease. Design The study employed a descriptive correlational design. Settings Participants were recruited from five primary care, three nephrology clinics and one dialysis centre in two Midwestern cities in the United States. Participants The convenience sample included 85 adults with hypertension, diabetes mellitus and chronic kidney disease, including kidney failure, who spoke English. Measurements Seven measurements were used to collect data via telephone interviews with participants not receiving haemodialysis, and face-to-face interviews with those receiving haemodialysis at the beginning of their treatment session. Results Analyses indicated that half the participants were female (50.58%), the mean age was 63.21 years (SD = 13.11), and participants with chronic kidney disease stage 3 were the most activated. Post hoc differences were significant in patient activation and blood pressure self-management and anxiety across chronic kidney disease stages, excluding stage 5. Conclusion Engaging patients in the self-management of their health care and enhancing patients’ ability to self-manage their blood pressure may work to preserve kidney health. Healthcare providers should collaborate with patients to develop strategies that will maintain patients’ health-related quality of life, like reducing anxiety as kidney disease progress

Knowledge and Awareness Among Patients with Chronic Kidney Disease Stage 3

Knowledge is a prerequisite for changing behavior, and is useful for improving outcomes and reducing mortality rates in patients diagnosed with chronic kidney disease (CKD). The purpose of this article is to describe baseline CKD knowledge and awareness obtained as part of a larger study testing the feasibility of a self-management intervention. Thirty patients were recruited who had CKD Stage 3 with coexisting diabetes and hypertension. Fifty-four percent of the sample were unaware of their CKD diagnosis. Participants had a moderate amount of CKD knowledge. This study suggests the need to increase knowledge in patients with CKD Stage 3 to aid in slowing disease progression

Self-management interventions in stages 1 to 4 chronic kidney disease: an integrative review

The prevalence, effect on health outcomes, and economic impact of chronic kidney disease (CKD) have created interest in self-management interventions to help slow disease progression to kidney failure. Seven studies were reviewed to identify knowledge gaps and future directions for research. All studies were published between 2010 and 2013; no investigations were conducted in the United States. Knowledge gaps included the focus on medical self-management tasks with no attention to role or emotional tasks, lack of family involvement during intervention delivery, and an inability to form conclusions about the efficacy of interventions because methodological rigor was insufficient. Educational content varied across studies. Strategies to improve self-management skills and enhance self-efficacy varied and were limited in scope. Further development and testing of theory-based interventions are warranted. There is a critical need for future research using well-designed trials with appropriately powered sample sizes, well-tested instruments, and clear and consistent reporting of results

Period and chemical evolution of SC stars

The SC and CS stars are thermal-pulsing AGB stars with C/O ratio close to unity. Within this small group, the Mira variable BH Cru recently evolved from spectral type SC (showing ZrO bands) to CS (showing weak C2). Wavelet analysis shows that the spectral evolution was accompanied by a dramatic period increase, from 420 to 540 days, indicating an expanding radius. The pulsation amplitude also increased. Old photographic plates are used to establish that the period before 1940 was around 490 days. Chemical models indicate that the spectral changes were caused by a decrease in stellar temperature, related to the increasing radius. There is no evidence for a change in C/O ratio. The evolution in BH Cru is unlikely to be related to an on-going thermal pulse. Periods of the other SC and CS stars, including nine new periods, are determined. A second SC star, LX Cyg, also shows evidence for a large increase in period, and one further star shows a period inconsistent with a previous determination. Mira periods may be intrinsically unstable for C/O ~ 1; possibly because of a feedback between the molecular opacities, pulsation amplitude, and period. LRS spectra of 6 SC stars suggest a feature at wavelength > 15 micron, which resembles one recently attributed to the iron-sulfide troilite. Chemical models predict a large abundance of FeS in SC stars, in agreement with the proposed association.Comment: 14 pages, 20 figures. MNRAS, 2004, accepted for publication. Janet Mattei, one of the authors, died on 22 March, 2004. This paper is dedicated to her memor