1
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Rich SN, Richards V, Mavian C, Rife Magalis B, Grubaugh N, Rasmussen SA, Dellicour S, Vrancken B, Carrington C, Fisk-Hoffman R, Danso-Odei D, Chacreton D, Shapiro J, Seraphin MN, Hepp C, Black A, Dennis A, Trovão NS, Vandamme AM, Rasmussen A, Lauzardo M, Dean N, Salemi M, Prosperi M. Application of Phylodynamic Tools to Inform the Public Health Response to COVID-19: Qualitative Analysis of Expert Opinions. JMIR Form Res 2023; 7:e39409. [PMID: 36848460 PMCID: PMC10131930 DOI: 10.2196/39409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 11/26/2022] [Accepted: 12/27/2022] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND In the wake of the SARS-CoV-2 pandemic, scientists have scrambled to collect and analyze SARS-CoV-2 genomic data to inform public health responses to COVID-19 in real time. Open source phylogenetic and data visualization platforms for monitoring SARS-CoV-2 genomic epidemiology have rapidly gained popularity for their ability to illuminate spatial-temporal transmission patterns worldwide. However, the utility of such tools to inform public health decision-making for COVID-19 in real time remains to be explored. OBJECTIVE The aim of this study is to convene experts in public health, infectious diseases, virology, and bioinformatics-many of whom were actively engaged in the COVID-19 response-to discuss and report on the application of phylodynamic tools to inform pandemic responses. METHODS In total, 4 focus groups (FGs) occurred between June 2020 and June 2021, covering both the pre- and postvariant strain emergence and vaccination eras of the ongoing COVID-19 crisis. Participants included national and international academic and government researchers, clinicians, public health practitioners, and other stakeholders recruited through purposive and convenience sampling by the study team. Open-ended questions were developed to prompt discussion. FGs I and II concentrated on phylodynamics for the public health practitioner, while FGs III and IV discussed the methodological nuances of phylodynamic inference. Two FGs per topic area to increase data saturation. An iterative, thematic qualitative framework was used for data analysis. RESULTS We invited 41 experts to the FGs, and 23 (56%) agreed to participate. Across all the FG sessions, 15 (65%) of the participants were female, 17 (74%) were White, and 5 (22%) were Black. Participants were described as molecular epidemiologists (MEs; n=9, 39%), clinician-researchers (n=3, 13%), infectious disease experts (IDs; n=4, 17%), and public health professionals at the local (PHs; n=4, 17%), state (n=2, 9%), and federal (n=1, 4%) levels. They represented multiple countries in Europe, the United States, and the Caribbean. Nine major themes arose from the discussions: (1) translational/implementation science, (2) precision public health, (3) fundamental unknowns, (4) proper scientific communication, (5) methods of epidemiological investigation, (6) sampling bias, (7) interoperability standards, (8) academic/public health partnerships, and (9) resources. Collectively, participants felt that successful uptake of phylodynamic tools to inform the public health response relies on the strength of academic and public health partnerships. They called for interoperability standards in sequence data sharing, urged careful reporting to prevent misinterpretations, imagined that public health responses could be tailored to specific variants, and cited resource issues that would need to be addressed by policy makers in future outbreaks. CONCLUSIONS This study is the first to detail the viewpoints of public health practitioners and molecular epidemiology experts on the use of viral genomic data to inform the response to the COVID-19 pandemic. The data gathered during this study provide important information from experts to help streamline the functionality and use of phylodynamic tools for pandemic responses.
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Affiliation(s)
- Shannan N Rich
- Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
- Department of Epidemiology, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Veronica Richards
- Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
- Department of Epidemiology, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Carla Mavian
- Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Brittany Rife Magalis
- Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Nathan Grubaugh
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States
| | - Sonja A Rasmussen
- Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
- Department of Epidemiology, College of Medicine, University of Florida, Gainesville, FL, United States
- Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Simon Dellicour
- Spatial Epidemiology Lab, Université Libre de Bruxelles, Bruxelles, Belgium
- Department of Microbiology, Immunology and Transplantation, Rega Institute, KU Leuven, Bruxelles, Belgium
| | - Bram Vrancken
- Spatial Epidemiology Lab, Université Libre de Bruxelles, Bruxelles, Belgium
- Department of Microbiology, Immunology and Transplantation, Rega Institute, KU Leuven, Bruxelles, Belgium
| | - Christine Carrington
- Department of Preclinical Sciences, University of the West Indies, St Augustine, Trinidad and Tobago
| | - Rebecca Fisk-Hoffman
- Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
- Department of Epidemiology, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Demi Danso-Odei
- Florida Department of Health in Alachua County, Gainesville, FL, United States
| | - Daniel Chacreton
- Division of Disease Control and Health Protection, Florida Department of Health, Tallahassee, FL, United States
| | - Jerne Shapiro
- Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
- Department of Epidemiology, College of Medicine, University of Florida, Gainesville, FL, United States
- Florida Department of Health in Alachua County, Gainesville, FL, United States
| | - Marie Nancy Seraphin
- Division of Infectious Diseases and Global Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Crystal Hepp
- Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, AZ, United States
- School of Informatics, Computing, and Cyber Systems, College of Engineering, Informatics, and Applied Sciences, Northern Arizona University, Flagstaff, AZ, United States
- Pathogen and Microbiome Division, Translational Genomics Research Institute, Flagstaff, AZ, United States
| | - Allison Black
- Chan Zuckerberg Initiative, Redwood City, CA, United States
| | - Ann Dennis
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Nídia Sequeira Trovão
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD, United States
| | - Anne-Mieke Vandamme
- Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Clinical and Epidemiological Virology, KU Leuven, Leuven, Belgium
- Center for Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Angela Rasmussen
- Vaccine and Infectious Disease Organization, University of Saskatchewan, Saskatoon, SK, Canada
| | - Michael Lauzardo
- Division of Infectious Diseases and Global Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Natalie Dean
- Department of Biostatistics, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
- Department of Biostatistics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Marco Salemi
- Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Mattia Prosperi
- Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
- Department of Epidemiology, College of Medicine, University of Florida, Gainesville, FL, United States
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2
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Lee L, Locklin J, Patel T, Lu SK, Hillier LM. Recruitment of participants for dementia research: interprofessional perspectives from primary care-based memory clinics. Neurodegener Dis Manag 2022; 12:117-127. [PMID: 35377732 DOI: 10.2217/nmt-2021-0053] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To understand clinician attitudes and the barriers that impede research recruitment from specialized primary care-based memory clinics. Materials & methods: Clinicians completed a survey on attitudes and barriers to research recruitment from memory clinics. Results: Comfort and willingness to recruit for research were low to moderate and were lower for drug trials than for observational and non-drug trials. Respondents believed that it is important to have a standardized recruitment process. Identified barriers provide some insights into the factors that contribute to discomfort and lack of willingness to recruit research participants. Discussion: Findings can inform future efforts to develop a recruitment process that addresses identified barriers, while also providing an opportunity to increase participant recruitment in dementia research.
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Affiliation(s)
- Linda Lee
- Centre for Family Medicine Family Health Team, 10B Victoria Street South, Kitchener, Ontario, N2G 1C5, Canada.,Department of Family Medicine, McMaster University, 100 Main Street West, Hamilton, Ontario, L8P 1H6, Canada.,Schlegel-University of Waterloo Research Institute for Aging, 250 Laurelwood Drive, Waterloo, Ontario, N2J 0E2, Canada
| | - Jason Locklin
- Centre for Family Medicine Family Health Team, 10B Victoria Street South, Kitchener, Ontario, N2G 1C5, Canada
| | - Tejal Patel
- Centre for Family Medicine Family Health Team, 10B Victoria Street South, Kitchener, Ontario, N2G 1C5, Canada.,School of Pharmacy, University of Waterloo, 10A Victoria Street South, Waterloo, Ontario, N2G 1C5, Canada
| | - Stephanie K Lu
- Centre for Family Medicine Family Health Team, 10B Victoria Street South, Kitchener, Ontario, N2G 1C5, Canada
| | - Loretta M Hillier
- GERAS Centre for Aging Research, 88 Maplewood Ave, Hamilton, Ontario, L8M 1W9, Canada
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3
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Gates E, Hole B, Hayward S, Chesnaye NC, Meuleman Y, Dekker FW, Evans M, Heimburger O, Torino C, Porto G, Szymczak M, Drechsler C, Wanner C, Jager KJ, Roderick P, Caskey F. Converting from face-to-face to postal follow-up and its effects on participant retention, response rates and errors: lessons from the EQUAL study in the UK. BMC Med Res Methodol 2022; 22:44. [PMID: 35148682 PMCID: PMC8832416 DOI: 10.1186/s12874-021-01453-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 10/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prospective cohort studies are challenging to deliver, with one of the main difficulties lying in retention of participants. The need to socially distance during the COVID-19 pandemic has added to this challenge. The pre-COVID-19 adaptation of the European Quality (EQUAL) study in the UK to a remote form of follow-up for efficiency provides lessons for those who are considering changing their study design. METHODS The EQUAL study is an international prospective cohort study of patients ≥65 years of age with advanced chronic kidney disease. Initially, patients were invited to complete a questionnaire (SF-36, Dialysis Symptom Index and Renal Treatment Satisfaction Questionnaire) at research clinics every 3-6 months, known as "traditional follow-up" (TFU). In 2018, all living patients were invited to switch to "efficient follow-up" (EFU), which used an abbreviated questionnaire consisting of SF-12 and Dialysis Symptom Index. These were administered centrally by post. Response rates were calculated using returned questionnaires as a proportion of surviving invitees, and error rates presented as the average percentage of unanswered questions or unclear answers, of total questions in returned questionnaires. Response and error rates were calculated 6-monthly in TFU to allow comparisons with EFU. RESULTS Of the 504 patients initially recruited, 236 were still alive at the time of conversion to EFU; 111 of these (47%) consented to the change in follow-up. In those who consented, median TFU was 34 months, ranging from 0 to 42 months. Their response rates fell steadily from 88% (98/111) at month 0 of TFU, to 20% (3/15) at month 42. The response rate for the first EFU questionnaire was 60% (59/99) of those alive from TFU. With this improvement in response rates, the first EFU also lowered errors to baseline levels seen in early follow-up, after having almost trebled throughout traditional follow-up. CONCLUSIONS Overall, this study demonstrates that administration of shorter follow-up questionnaires by post rather than in person does not negatively impact patient response or error rates. These results may be reassuring for researchers who are trying to limit face-to-face contact with patients during the COVID-19 pandemic.
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Affiliation(s)
- Emer Gates
- Centre for Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK. .,Southmead Hospital, North Bristol NHS Trust, Bristol, UK.
| | - Barnaby Hole
- Centre for Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Southmead Hospital, North Bristol NHS Trust, Bristol, UK.,UK Renal Registry, Southmead Hospital, Bristol, UK
| | - Samantha Hayward
- Centre for Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Southmead Hospital, North Bristol NHS Trust, Bristol, UK.,UK Renal Registry, Southmead Hospital, Bristol, UK
| | - Nicholas C Chesnaye
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Yvette Meuleman
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marie Evans
- Renal Unit, Department of Clinical Intervention and technology (CLINTEC), Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Olof Heimburger
- Renal Unit, Department of Clinical Intervention and technology (CLINTEC), Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Claudia Torino
- Institute of Clinical Physiology, National Research Council, Reggio Calabria, Italy
| | - Gaetana Porto
- GOM Bianchi Melacrino Morelli, Reggio Calabria, Italy
| | - Maciej Szymczak
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | | | - Christoph Wanner
- Division of Nephrology, University Hospital of Wurzburg, Wurzburg, Germany
| | - Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Paul Roderick
- School of Primary Care Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Fergus Caskey
- Centre for Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Southmead Hospital, North Bristol NHS Trust, Bristol, UK
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Natale P, Gutman T, Howell M, Dansie K, Hawley CM, Cho Y, Viecelli AK, Craig JC, Jesudason S, Chapman JR, Johnson DW, Murphy L, Reidlinger D, Crowe S, Duncanson E, Muthuramalingam S, Scholes-Robertson N, Williamson A, McDonald S, Wong G, Teixeira-Pinto A, Strippoli GFM, Tong A. Recruitment and retention in clinical trials in chronic kidney disease: report from national workshops with patients, caregivers and health professionals. Nephrol Dial Transplant 2020; 35:755-764. [PMID: 32240311 DOI: 10.1093/ndt/gfaa044] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Slow recruitment and poor retention jeopardize the reliability and statistical power of clinical trials, delaying access to effective interventions and increasing costs, as commonly observed in nephrology trials. Involving patients in trial design, recruitment and retention is infrequent but potentially transformational. METHODS We conducted three workshops involving 105 patients/caregivers and 43 health professionals discussing patient recruitment and retention in clinical trials in chronic kidney disease. RESULTS We identified four themes. 'Navigating the unknown'-patients described being unaware of the research question, confused by technical terms, sceptical about findings and feared the risk of harm. 'Wary of added burden'-patients voiced reluctance to attend additional appointments, were unsure of the commitment required or at times felt too unwell and without capacity to participate. 'Disillusioned and disconnected'-some patients felt they were taken for granted, particularly if they did not receive trial results. Participants believed there was no culture of trial participation in kidney disease and an overall lack of awareness about opportunities to participate. To improve recruitment and retention, participants addressed 'Building motivation and interest'. CONCLUSIONS Investigators should establish research consciousness from the time of diagnosis, consider optimal timing for approaching patients, provide comprehensive information in an accessible manner, emphasize current and future relevance to them and their illness, involve trusted clinicians in recruitment and minimize the burden of trial participation. Participation in clinical trials was seen as an opportunity for people to give back to the health system and for future people in their predicament.
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Affiliation(s)
- Patrizia Natale
- Sydney School of Public Health, University of Sydney, New South Wales, Sydney, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, New South Wales, Westmead, Australia.,Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Talia Gutman
- Sydney School of Public Health, University of Sydney, New South Wales, Sydney, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, New South Wales, Westmead, Australia
| | - Martin Howell
- Sydney School of Public Health, University of Sydney, New South Wales, Sydney, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, New South Wales, Westmead, Australia
| | - Kathryn Dansie
- Australia and New Zealand Dialysis and Transplant Registry, SA Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Carmel M Hawley
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Queensland, Australia.,Translational Research Institute, Brisbane, Queensland, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Yeoungjee Cho
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Queensland, Australia.,Translational Research Institute, Brisbane, Queensland, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Andrea K Viecelli
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Queensland, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Jonathan C Craig
- Sydney School of Public Health, University of Sydney, New South Wales, Sydney, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, New South Wales, Westmead, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Shilpanjali Jesudason
- Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Kidney Health Australia, Victoria, Melbourne, Australia.,Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Jeremy R Chapman
- Westmead Clinical School, Westmead Institute for Medical Research, New South Wales, Westmead, Australia
| | - David W Johnson
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Queensland, Australia.,Translational Research Institute, Brisbane, Queensland, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Lisa Murphy
- Kidney Health Australia, Victoria, Melbourne, Australia
| | - Donna Reidlinger
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Queensland, Australia.,Translational Research Institute, Brisbane, Queensland, Australia
| | | | - Emily Duncanson
- Australia and New Zealand Dialysis and Transplant Registry, SA Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Shyamsundar Muthuramalingam
- Sydney School of Public Health, University of Sydney, New South Wales, Sydney, Australia.,Australia and New Zealand Dialysis and Transplant Registry, SA Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Nicole Scholes-Robertson
- Sydney School of Public Health, University of Sydney, New South Wales, Sydney, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, New South Wales, Westmead, Australia
| | - Amber Williamson
- BEAT-CKD Consumer Advisory Board, Sydney, New South Wales, Australia.,Kidney Health Australia, Queensland Consumer Consultative Committee, Brisbane, Queensland, Australia
| | - Stephen McDonald
- Australia and New Zealand Dialysis and Transplant Registry, SA Health and Medical Research Institute, Adelaide, South Australia, Australia.,Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Germaine Wong
- Sydney School of Public Health, University of Sydney, New South Wales, Sydney, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, New South Wales, Westmead, Australia.,Westmead Clinical School, Westmead Institute for Medical Research, New South Wales, Westmead, Australia
| | - Armando Teixeira-Pinto
- Sydney School of Public Health, University of Sydney, New South Wales, Sydney, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, New South Wales, Westmead, Australia
| | - Giovanni F M Strippoli
- Sydney School of Public Health, University of Sydney, New South Wales, Sydney, Australia.,Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.,Cochrane Kidney and Transplant, Centre for Kidney Research, Children's Hospital at Westmead, New South Wales, Westmead, Australia
| | - Allison Tong
- Sydney School of Public Health, University of Sydney, New South Wales, Sydney, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, New South Wales, Westmead, Australia
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Bondurant-David K, Dang S, Levy S, Sperlea D, Vanier MC, Gerardi S, David PM. Issues with deprescribing in haemodialysis: a qualitative study of patient and provider experiences. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2020; 28:635-642. [PMID: 33094884 DOI: 10.1111/ijpp.12674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 09/01/2020] [Accepted: 09/21/2020] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Patients undergoing haemodialysis receive on average 10-17 medications, which increase the risk of falls, adverse drug reactions and hospitalizations. Supervised discontinuation of potentially inappropriate medications may lower these risks. Although many calls have been made for deprescribing in the haemodialysis setting, little is known about how patients and providers in this setting experience it. The aim of this study is to explore patient and provider experiences and perceptions of one of the rare deprescribing intervention in haemodialysis. METHODS Ten semi-structured interviews were held with patients, and a focus group was done with dialysis clinic team members at a Montreal area health network's haemodialysis clinic after the implementation of a standardized deprescribing intervention using the patient-as-partner approach. The interviews and focus group were recorded, and verbatims were coded to determine emerging themes. Grounded theory was used for interview guide design and data analysis. RESULTS The three emerging themes were (1) ambivalence towards medication creating a favourable context for deprescribing, (2) the empowering elements of the deprescribing process and (3) the uncertain future of deprescribing in the clinics even though the intervention was considered successful. CONCLUSION Haemodialysis patients and providers viewed deprescribing favourably, believed the intervention was valuable, and offered suggestions for long term implementation while expressing concerns about feasibility. Notwithstanding the underlying uncertainties, a structured and integrated approach in routine practice involving all members of the care team may facilitate the continuity of deprescribing as an intervention in the setting of a haemodialysis clinic.
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Affiliation(s)
- Kaitlin Bondurant-David
- Faculté de Pharmacie, Université de Montréal, Montréal, Canada.,Département de Pharmacie, Hôpital de la Cité-de-la-Santé, CISSS de Laval, Laval, Canada
| | - Sébastien Dang
- Faculté de Pharmacie, Université de Montréal, Montréal, Canada.,Département de Pharmacie, Hôpital de la Cité-de-la-Santé, CISSS de Laval, Laval, Canada
| | - Shirel Levy
- Faculté de Pharmacie, Université de Montréal, Montréal, Canada.,Département de Pharmacie, Hôpital de la Cité-de-la-Santé, CISSS de Laval, Laval, Canada
| | - David Sperlea
- Faculté de Pharmacie, Université de Montréal, Montréal, Canada.,Département de Pharmacie, Hôpital de la Cité-de-la-Santé, CISSS de Laval, Laval, Canada
| | - Marie-Claude Vanier
- Faculté de Pharmacie, Université de Montréal, Montréal, Canada.,Département de Pharmacie, Hôpital de la Cité-de-la-Santé, CISSS de Laval, Laval, Canada
| | - Savannah Gerardi
- Département de Pharmacie, Hôpital de la Cité-de-la-Santé, CISSS de Laval, Laval, Canada
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6
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Finderup J, Crowley A, Søndergaard H, Lomborg K. Involvement of patients with chronic kidney disease in research: A case study. J Ren Care 2020; 47:73-86. [PMID: 32869408 DOI: 10.1111/jorc.12346] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/09/2020] [Accepted: 08/03/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Knowledge about best practices of patient involvement in research among patients with chronic kidney disease is sparse, with little information about barriers to and facilitators of this process. The purpose of this study is to evaluate the process and outcomes of patient involvement in a particular chronic kidney disease research project. OBJECTIVES To describe how patients with chronic kidney disease were involved in the research; to explain what occurred when patients with chronic kidney disease were involved; to identify facilitators of and barriers to patient involvement in research. PARTICIPANTS Two patients with chronic kidney disease who have both been involved in a previous research project. MEASUREMENTS A retrospective embedded case study of patient involvement in research with the shared decision-making and dialysis choice project inspired by Yin (2012, Case Study Methods), using document analysis and semistructured individual interviews. Data were analysed with specific research questions in mind. RESULTS Two patients participated in four research meetings covering all substudies of a research project and all six phases of the research process. Eight facilitators and barriers were identified. CONCLUSIONS Patients with chronic kidney disease were involved in all the six phases of the research process but were more highly involved in some phases than others. Important facilitators of patient involvement in chronic kidney disease research include working as a team, being a part of the process, and being prepared for the work. Important barriers to patient involvement include patient vulnerability and uremic symptoms, both of which must be taken into account.
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Affiliation(s)
- Jeanette Finderup
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,ResCenPI - Research Centre for Patient Involvement, Aarhus University & the Central Denmark Region, Aarhus, Denmark
| | | | | | - Kirsten Lomborg
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Steno Diabetes Center, Copenhagen, Denmark
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7
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Lee EJ, Patel A, Acedillo RR, Bachynski JC, Barrett I, Basile E, Battistella M, Benjamin D, Berry D, Blake PG, Chan P, Bohm CJ, Clemens KK, Cook C, Dember L, Dirk JS, Dixon S, Fowler E, Getchell L, Gholami N, Goldstein C, Hahn E, Hogeterp B, Huang S, Hughes M, Jardine MJ, Kalatharan S, Kilburn S, Lacson E, Leonard S, Liberty C, Lindsay C, MacRae JM, Manns BJ, McCallum J, McIntyre CW, Molnar AO, Mustafa RA, Nesrallah GE, Oliver MJ, Pandes M, Pandeya S, Parmar MS, Rabin EZ, Riley J, Silver SA, Sontrop JM, Sood MM, Suri RS, Tangri N, Tascona DJ, Thomas A, Wald R, Walsh M, Weijer C, Weir MA, Vorster H, Zimmerman D, Garg AX. Cultivating Innovative Pragmatic Cluster-Randomized Registry Trials Embedded in Hemodialysis Care: Workshop Proceedings From 2018. Can J Kidney Health Dis 2019; 6:2054358119894394. [PMID: 31903190 PMCID: PMC6933546 DOI: 10.1177/2054358119894394] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 10/24/2019] [Indexed: 12/12/2022] Open
Abstract
Hemodialysis is a life-sustaining treatment for persons with kidney failure. However, those on hemodialysis still face a poor quality of life and a short life expectancy. High-quality research evidence from large randomized controlled trials is needed to identify interventions that improve the experiences, outcomes, and health care of persons receiving hemodialysis. With the support of the Canadian Institutes of Health Research and its Strategy for Patient-Oriented Research, the Innovative Clinical Trials in Hemodialysis Centers initiative brought together Canadian and international kidney researchers, patients, health care providers, and health administrators to participate in a workshop held in Toronto, Canada, on June 2 and 3, 2018. The workshop served to increase knowledge and awareness about the conduct of innovative, pragmatic, cluster-randomized registry trials embedded into routine hemodialysis care and provided an opportunity to discuss and build support for new trial ideas. The workshop content included structured presentations, facilitated group discussions, and expert panel feedback. Partnerships and promising trial ideas borne out of the workshop will continue to be developed to support the implementation of future large-scale trials.
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Affiliation(s)
| | | | - Rey R. Acedillo
- Division of Nephrology, Department of
Medicine, London Health Sciences Centre, ON, Canada
- Department of Epidemiology and
Biostatistics, Western University, London, ON, Canada
| | | | | | - Erika Basile
- Office of Human Research Ethics, Western
University, London, ON, Canada
| | - Marisa Battistella
- Department of Pharmacy, University
Health Network, Toronto, ON, Canada
- Leslie Dan Faculty of Pharmacy,
University of Toronto, ON, Canada
| | - Derek Benjamin
- Royal Victoria Regional Health Centre,
Barrie, ON, Canada
| | - David Berry
- Algoma Regional Renal Program, Sault
Area Hospital, Sault Ste. Marie, ON, Canada
| | - Peter G. Blake
- Division of Nephrology, Department of
Medicine, London Health Sciences Centre, ON, Canada
- Ontario Renal Network, Cancer Care
Ontario, Toronto, Canada
| | - Patricia Chan
- Division of Nephrology, Department of
Medicine, Michael Garron Hospital, Toronto, ON, Canada
| | - Clara J. Bohm
- Department of Internal Medicine, Max
Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Kristin K. Clemens
- ICES, ON, Canada
- Department of Epidemiology and
Biostatistics, Western University, London, ON, Canada
- Division of Endocrinology and
Metabolism, Department of Medicine, Western University, London, ON, Canada
- St. Joseph’s Health Care London, ON,
Canada
| | - Charles Cook
- Transplant Ambassador Program, Grand
River Hospital, Kitchener, ON, Canada
| | - Laura Dember
- Renal, Electrolyte and Hypertension
Division, Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Stephanie Dixon
- ICES, ON, Canada
- Department of Epidemiology and
Biostatistics, Western University, London, ON, Canada
| | | | | | | | - Cory Goldstein
- Rotman Institute of Philosophy,
Western University, London, ON, Canada
| | | | | | - Susan Huang
- Division of Nephrology, Department of
Medicine, London Health Sciences Centre, ON, Canada
| | | | - Meg J. Jardine
- Innovation & Kidney Research, The
George Institute for Global Health, UNSW Sydney, Newtown, NSW, Australia
| | | | | | | | | | | | | | - Jennifer M. MacRae
- Division of Nephrology, Department of
Medicine, University of Calgary, AB, Canada
| | - Braden J. Manns
- Department of Medicine, Cumming School
of Medicine, University of Calgary, AB, Canada
| | - Janice McCallum
- Ontario Renal Network, Cancer Care
Ontario, Toronto, Canada
- Renal Services, London Health Sciences
Centre, ON, Canada
| | - Christopher W. McIntyre
- Kidney Clinical Research Unit, Lawson
Health Research Institute, London, ON, Canada
- Department of Medical Biophysics,
Schulich School of Medicine and Dentistry, Western University, London, ON,
Canada
| | - Amber O. Molnar
- ICES, ON, Canada
- Division of Nephrology, Department of
Medicine, McMaster University, Hamilton, ON, Canada
| | - Reem A. Mustafa
- Division of Nephrology and
Hypertension, Department of Internal Medicine, University of Kansas Medical Center,
Kansas City, USA
| | - Gihad E. Nesrallah
- Division of Nephrology, Department of
Medicine, Humber River Hospital, Toronto, ON, Canada
| | - Matthew J. Oliver
- Division of Nephrology, Department of
Medicine, University of Toronto, ON, Canada
| | | | | | | | | | | | - Samuel A. Silver
- Division of Nephrology, Kingston
Health Sciences Center, Queen’s University, Kingston, ON, Canada
| | - Jessica M. Sontrop
- ICES, ON, Canada
- Division of Nephrology, Department of
Medicine, London Health Sciences Centre, ON, Canada
- Kidney Clinical Research Unit, Lawson
Health Research Institute, London, ON, Canada
| | - Manish M. Sood
- ICES, ON, Canada
- Division of Nephrology, Department of
Medicine, University of Ottawa, ON, Canada
| | - Rita S. Suri
- Division of Nephrology, Department of
Medicine, McGill University, Montreal, QC, Canada
- Canadian Nephrology Trials Network,
Canada
| | - Navdeep Tangri
- Chronic Disease Innovation Centre,
Winnipeg, MB, Canada
- Department of Internal Medicine,
University of Manitoba, Winnipeg, Canada
| | - Daniel J. Tascona
- Ontario Renal Network, Cancer Care
Ontario, Toronto, Canada
- Orillia Soldiers’ Memorial Hospital,
ON, Canada
| | | | - Ron Wald
- St. Michael’s Hospital, Toronto, ON,
Canada
- Division of Nephrology, Department of
Medicine, University of Toronto, ON, Canada
| | - Michael Walsh
- Division of Nephrology, Department of
Medicine, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute,
Hamilton, ON, Canada
| | - Charles Weijer
- Department of Epidemiology and
Biostatistics, Western University, London, ON, Canada
- Rotman Institute of Philosophy,
Western University, London, ON, Canada
| | - Matthew A. Weir
- ICES, ON, Canada
- Division of Nephrology, Department of
Medicine, London Health Sciences Centre, ON, Canada
- Kidney Clinical Research Unit, Lawson
Health Research Institute, London, ON, Canada
| | - Hans Vorster
- Ontario Renal Network, Cancer Care
Ontario, Toronto, Canada
| | - Deborah Zimmerman
- Division of Nephrology, Department of
Medicine, University of Ottawa, ON, Canada
| | - Amit X. Garg
- ICES, ON, Canada
- Division of Nephrology, Department of
Medicine, London Health Sciences Centre, ON, Canada
- Department of Epidemiology and
Biostatistics, Western University, London, ON, Canada
- Kidney Clinical Research Unit, Lawson
Health Research Institute, London, ON, Canada
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8
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Byham-Gray LD, Peters EN, Rothpletz-Puglia P. Patient-Centered Model for Protein-Energy Wasting: Stakeholder Deliberative Panels. J Ren Nutr 2019; 30:137-144. [PMID: 31447304 DOI: 10.1053/j.jrn.2019.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 05/28/2019] [Accepted: 06/02/2019] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Integrating the patient's voice into research prioritization is essential for solving problems that patients care the most about in terms of health, symptom management, and survival. We used deliberative processes for adapting the existing model of protein-energy wasting (PEW) to one that includes stakeholder priorities, addressing gaps from the initial concept. DESIGN AND METHODS From September 2015- to December 2017, two diverse, deliberative panels of stakeholders (one for patients and one for clinicians) were recruited from local communities and national networks and met four times to provide an insight into developing a patient-centered model for PEW. After each stakeholder meeting, the research team added the factors and outcomes that reached consensus, using a content analysis. The stakeholder members were then able to confirm what had been collected from an earlier panel discussion and offer additional feedback. The final model was approved by stakeholders. RESULTS There were eight patient and twelve clinician stakeholders who participated in the panels. Factors and outcomes were only added or modified to the existing model, but none were deleted from the original PEW model. Critical factors identified by the stakeholders were ones related to lifestyle, treatment, and psychosocial aspects. The most important outcomes selected by stakeholders were living longer, staying out of the hospital, and being able to do more. CONCLUSIONS The approved patient-centered model for PEW represents a testable model for researchers which incorporates the patient's voice. Garnering this insight should assist in the prioritization of projects for a maximal value to patients and their families by future investigators.
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Affiliation(s)
- Laura D Byham-Gray
- Department of Clinical and Preventive Nutrition Sciences, Rutgers University, School of Health Professions, Newark, New Jersey.
| | - Emily N Peters
- Department of Clinical and Preventive Nutrition Sciences, Rutgers University, School of Health Professions, Newark, New Jersey
| | - Pamela Rothpletz-Puglia
- Department of Clinical and Preventive Nutrition Sciences, Rutgers University, School of Health Professions, Newark, New Jersey
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9
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Perceptions, Barriers, and Experiences With Successful Aging Before and After Kidney Transplantation: A Focus Group Study. Transplantation 2019; 104:603-612. [PMID: 31283666 DOI: 10.1097/tp.0000000000002848] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND End-stage kidney disease (ESKD) patients are living longer, often into older age, and commonly pursue kidney transplantation. Successful aging, a multidimensional construct of physical and social wellbeing, has been expanded and adapted for patients with chronic disease. However, perceptions of, barriers to, and experiences with successful aging among adults with ESKD are unclear and likely differ based on whether they have received a kidney transplant. METHODS Ten focus groups were held with 39 total ESKD patients aged ≥50 years (19 transplant candidates, 20 transplant recipients). Transcriptions were analyzed thematically by 2 independent coders using an inductive, constant comparative approach. RESULTS The mean age was 64.8 (SD = 7.5); 51% were African American and 64% were males. Six themes were identified: familiarity with successful aging, perceptions of successful aging after ESKD diagnosis, barriers to successful aging, experiences with successful aging among transplant candidates, experiences with successful aging among transplant recipients, and suggested interventions. While all participants sought to achieve successful aging while living with ESKD, experiences with successful aging differed between candidates and recipients. Candidates struggled with the limitations of dialysis; some viewed transplantation as an opportunity to age successfully, while others were resigned to the drawbacks of dialysis. In contrast, transplant recipients were optimistic about their ability to age successfully, believing their transplant facilitated successful aging. Participants believed support groups for adults with ESKD and more thoughtful health care for aging adults would promote successful aging. CONCLUSIONS Adults with ESKD may benefit from discussions with their clinicians and caregivers about goals, barriers, and strategies regarding successful aging.
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10
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Ji PY, Li ZY, Wang H, Dong JT, Li XJ, Yi HL. Arsenic and sulfur dioxide co-exposure induce renal injury via activation of the NF-κB and caspase signaling pathway. CHEMOSPHERE 2019; 224:280-288. [PMID: 30825854 DOI: 10.1016/j.chemosphere.2019.02.111] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/02/2019] [Accepted: 02/17/2019] [Indexed: 06/09/2023]
Abstract
Although emerging evidence suggests positive association of arsenic (As) or sulfur dioxide (SO2) exposure with human diseases, reports concerning the effects of co-exposure of As and SO2 are lacking. Moreover, there is insufficient information in the literature about As and SO2 co-exposure to renal injury. In this study, we focus on the environmental problems of excessive As and SO2 that co-exist in many coal consumption areas. We used both C57BL/6 mice and 293T cells to detect toxicities of As and SO2 exposure alone or in combination. Our results showed that co-exposure significantly increased the hazard compared with exposure to As or SO2 alone. Mouse kidney tissue slices showed that co-exposure caused more severe diffuse sclerosing glomerulonephritis than As and SO2 exposure alone. Meanwhile experiments showed that apoptosis was aggravated by co-exposure of As and SO2 in 293T cells. Because As and SO2 cause cell toxicity through increasing oxidative stress, next we detected ROS and other oxidative stress parameters, and the results showed oxidative stress was increased by co-exposure compared with the other three groups. The expression levels of downstream genes in the NF-κB and caspase pathways were higher in the co-exposure group than in the groups of As or SO2 exposure alone in mice and 293T cells. Based on the above results, co-exposure could induce higher toxicity in vitro and in vivo compared with single exposure to As or SO2, indicating that people living in places that contaminated by As and SO2 may have higher chance to get renal injury.
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Affiliation(s)
- Peng-Yu Ji
- School of Life Science, Shanxi University, Taiyuan, China; College of Environmental and Resource, Shanxi University, Taiyuan, China
| | - Zhuo-Yu Li
- School of Life Science, Shanxi University, Taiyuan, China
| | - Hong Wang
- School of Life Science, Shanxi University, Taiyuan, China; Monell Chemical Senses Center, Philadelphia, PA, USA
| | - Jin-Tang Dong
- School of Life Science, Shanxi University, Taiyuan, China; Emory University Winship Cancer Insititute, Atlanta, GA, USA
| | - Xiu-Juan Li
- School of Life Science, Shanxi University, Taiyuan, China; College of Environmental and Resource, Shanxi University, Taiyuan, China
| | - Hui-Lan Yi
- School of Life Science, Shanxi University, Taiyuan, China.
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11
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Clarke AL, Jhamb M, Bennett PN. Barriers and facilitators for engagement and implementation of exercise in end‐stage kidney disease: Future theory‐based interventions using the Behavior Change Wheel. Semin Dial 2019; 32:308-319. [DOI: 10.1111/sdi.12787] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Amy L. Clarke
- Unit of Academic Primary Care, Division of Health Sciences, Warwick Medical School University of Warwick Coventry UK
| | - Manisha Jhamb
- Department of Medicine, Renal‐Electrolyte Division University of Pittsburgh School of Medicine Pittsburgh Pennsylvania
| | - Paul N. Bennett
- Satellite Healthcare San Jose California
- Deakin University Melbourne Vic. Australia
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12
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Flythe JE, Narendra JH, Hilliard T, Frazier K, Ikeler K, Amolegbe A, Mitchell D, Dorough A, Lee SYD, Ordish A, Wilkie C, Dember LM. Cultivating a Research-Ready Dialysis Community. J Am Soc Nephrol 2019; 30:375-380. [PMID: 30737271 PMCID: PMC6405153 DOI: 10.1681/asn.2018101059] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Jennifer E Flythe
- Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina School of Medicine, University of North Carolina Kidney Center, Chapel Hill, North Carolina;
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina
| | - Julia H Narendra
- Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina School of Medicine, University of North Carolina Kidney Center, Chapel Hill, North Carolina
| | | | - Karen Frazier
- American Institutes for Research, Chapel Hill, North Carolina
| | - Kourtney Ikeler
- American Institutes for Research, Chapel Hill, North Carolina
| | - Andrew Amolegbe
- American Institutes for Research, Chapel Hill, North Carolina
| | - Denise Mitchell
- American Institutes for Research, Chapel Hill, North Carolina
| | - Adeline Dorough
- Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina School of Medicine, University of North Carolina Kidney Center, Chapel Hill, North Carolina
| | - Shoou-Yih Daniel Lee
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan
| | | | | | - Laura M Dember
- Renal-Electrolyte and Hypertension Division, Department of Medicine, and
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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13
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Organizational Readiness to Implement the Chronic Disease Self-Management Program in Dialysis Facilities. Geriatrics (Basel) 2018; 3:geriatrics3020031. [PMID: 31011069 PMCID: PMC6319202 DOI: 10.3390/geriatrics3020031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/05/2018] [Accepted: 06/07/2018] [Indexed: 12/26/2022] Open
Abstract
A gap exists between the development and uptake of evidence-based health promotion programs in health care settings. One reason for this gap is lack of attention to organizational readiness. The objective of this study was to assess organizational readiness to implement the Chronic Disease Self-Management Program in dialysis facilities. Survey data were collected from dialysis staff using a semi-structured Organizational Readiness for Implementing Change questionnaire. Change efficacy and change commitment scale ratings were all above 3.0, indicating a moderate level of readiness among staff. Profession and level of education were significantly associated with mean change efficacy scale ratings. Textual data revealed benefits to patients, implementation barriers and facilitators, and the influence of facility environment and culture. The findings of the current study suggest that additional efforts to advance the implementation of evidence-based health promotion programs in dialysis facilities are needed.
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