Implementation of the kidney team at home intervention:Evaluating generalizability, implementation process, and effects

Research has shown that a home-based educational intervention for patients with chronic kidney disease results in better knowledge and communication, and more living donor kidney transplantations (LDKT). Implementation research in the field of renal care is almost nonexistent. The aims of this study were (1) to demonstrate generalizability, (2) evaluate the implementation process, and (3) to assess the relationship of intervention effects on LDKT-activity. Eight hospitals participated in the project. Patients eligible for all kidney replacement therapies (KRT) were invited to participate. Effect outcomes were KRT-knowledge and KRT-communication, and treatment choice. Feasibility, fidelity, and intervention costs were assessed as part of the process evaluation. Three hundred and thirty-two patients completed the intervention. There was a significant increase in KRT-knowledge and KRT-communication among participants. One hundred and twenty-nine out of 332 patients (39%) had LDKT-activity, which was in line with the results of the clinical trials. Protocol adherence, knowledge, and age were correlated with LDKT-activity. This unique implementation study shows that the results in practice are comparable to the previous trials, and show that the intervention can be implemented, while maintaining quality. Results from the project resulted in the uptake of the intervention in standard care. We urge other countries to investigate the uptake of the intervention

Guidelines for designing a realistic peripheral venous catheter insertion simulator: A literature review

International audienceA literature review was conducted to develop more realistic medical simulators that better prepare aspiring health professionals to perform a medical procedure in vivo. Thus, this review proposes an approach that might assist researchers design improved medical simulators, particularly new materials that would enhance the sensation of touch for skin substitutes. By targeting the current needs in the field of simulation learning, we concluded that peripheral venous catheter insertion (PVCI) simulators lack realistic haptic feedback. Enhanced PVCI simulators will accelerate the mastery of the medical procedure, thus decreasing the number of failures in patients and costs related to this procedure

Eggshell spot scoring methods cannot be used as a reliable proxy to determine pigment quantity

Eggshell maculation of most passerines is due to the deposition of the pigment protoporphyrin which is produced during biosynthesis of blood haem. Its functional signifi cance has only received empirical attention in recent years. Th is interest has generated a number of hypotheses of which some remain untested partly because the quantifi cation of protoporphyrin is analytically challenging and can be prohibitively expensive. Many studies have therefore used the extent of eggshell spotting as a proxy for total eggshell protoporphyrin concentration, although this has not been formally tested. Pigment scoring involves recording visible eggshell pigment attributes, such as spot intensity, distribution and size. Since even immaculate eggs can contain some protoporphyrin, there remains doubt over the degree to which visible pigment correlates with total pigment content of the shell. In this study, we test whether visible pigment scoring can be used as a proxy for protoporphyrin concentration of an eggshell. We use pigmented eggshells of two common British passerine species to compare eggshell spot intensity, distribution and spot size (as used by the visual pigment scoring method) with direct measures of eggshell protoporphyrin concentration. In addition, we compared an alternative method of pigment scoring, the pixel pigment scoring method, using a computer programme to quantify the number of pixels exceeding a specifi ed colour threshold. We demonstrate that although results from both scoring methods were positively correlated with eggshell protoporphyrin concentrations, the correlations were not suffi ciently strong to be used as surrogates in studies where actual pigment concentrations are required

Visual scoring of eggshell patterns has poor repeatability

Eggshell pattern scoring, a method to quantify the degree of surface maculation, can potentially be a quick, inexpensive and reliable method to obtain information on eggshell appearance and spot patterns. The key pigment responsible for red-brownish hues, protoporphyrin IX, is often localized as spots, either on the surface or in distinct layers within the eggshell. Heritable pigment spotting has been linked to factors such as breeding performance and eggshell strength. In this study, we investigated whether pigment scoring of eggshell patterns is repeatable within and between observers, by testing observers under standardised conditions, using the eggshells of two commonly studied passerines, Great Tits (Parus major) and Blue Tits (Cyanistes caeruleus). We found that repeatability of eggshell scores was poor, both within and between observers for both the species. We, therefore, encourage future studies to use alternative methods for quantifying spot patterns, such as digital image analysis, a technique which has already been used extensively.Kaat Brulez, Pankaj K. Choudhary, Golo Maurer, Steven J. Portugal, Rebecca L. Boulton, Simone L. Webber, Phillip Casse