The effect of a novel, digital physical activity and emotional well-being intervention on health-related quality of life in people with chronic kidney disease: trial design and baseline data from a multicentre prospective, wait-list randomised controlled trial (kidney BEAM)

BACKGROUND

Physical activity and emotional self-management has the potential to enhance health-related quality of life (HRQoL), but few people with chronic kidney disease (CKD) have access to resources and support. The Kidney BEAM trial aims to evaluate whether an evidence-based physical activity and emotional wellbeing self-management programme (Kidney BEAM) leads to improvements in HRQoL in people with CKD.

METHODS

This was a prospective, multicentre, randomised waitlist-controlled trial, with health economic analysis and nested qualitative studies. In total, three hundred and four adults with established CKD were recruited from 11 UK kidney units. Participants were randomly assigned to the intervention (Kidney BEAM) or a wait list control group (1:1). The primary outcome was the between-group difference in Kidney Disease Quality of Life (KDQoL) mental component summary score (MCS) at 12 weeks. Secondary outcomes included the KDQoL physical component summary score, kidney-specific scores, fatigue, life participation, depression and anxiety, physical function, clinical chemistry, healthcare utilisation and harms. All outcomes were measured at baseline and 12 weeks, with long-term HRQoL and adherence also collected at six months follow-up. A nested qualitative study explored experience and impact of using Kidney BEAM.

RESULTS

340 participants were randomised to Kidney BEAM (n = 173) and waiting list (n = 167) groups. There were 96 (55%) and 89 (53%) males in the intervention and waiting list groups respectively, and the mean (SD) age was 53 (14) years in both groups. Ethnicity, body mass, CKD stage, and history of diabetes and hypertension were comparable across groups. The mean (SD) of the MCS was similar in both groups, 44.7 (10.8) and 45.9 (10.6) in the intervention and waiting list groups respectively.

CONCLUSION

Results from this trial will establish whether the Kidney BEAM self management programme is a cost-effective method of enhancing mental and physical wellbeing of people with CKD.

TRIAL REGISTRATION

NCT04872933. Registered 5th May 2021.

Reaching for the stars: Iranian nurses' perceptions of career success

AIM

The aim was to explore nurses' perceptions of career success.

INTRODUCTION

Career success is a concept which leads to improving professional behaviours. Research that focused on conceptualizing career success found it to be a complex, value-driven construct likely to be perceived differently across work and cultural contexts. It is not yet clear what constitutes career success, and how it is perceived by nurses in Iran. More comprehensive exploration of this concept in nursing is needed, so research and policymaking can advance in informed, data-driven manner.

METHOD

This is a qualitative descriptive study. The setting was teaching hospitals of Iran. Twenty-seven nurses participated in face-to-face interviews, and six field notes were collected. Data were analysed using conventional content analysis.

FINDINGS

Analyses identified five themes of career success: providing high-quality care, being exemplary employee, embarking on career growth, having positive personal attributes and being internally satisfied.

CONCLUSION

Findings confirmed that career success in Iranian nurses was a multidimensional concept that represented five internally and externally driven dimensions set within its cultural and religious context. Policymakers and clinical educators can now plan interventions aimed at fostering career success in nursing staff.

IMPLICATIONS FOR EDUCATION, NURSING AND HEALTH POLICIES

Future nurses could use these finding to reflect on their developed attributes throughout their studies and clinical placements and adjust their career preparation and learning to bridge any identified gaps. Organizational values and intervention for nursing staff could also be redesigned to align with the aspects of career success.

Evaluation of skin diseases and disorders in photographers

Occupational skin disease is very common and important among photographers due to the chemical substances used in photographic processes. In this cross-sectional study, 100 photographers were asked about their occupational exposures in their workplace. Physical examinations were done to find skin diseases and information about demographic factors and history of other skin diseases was collected via a questionnaire. This study examined 100 people, 86 men and 14 women; 37% of these 100 subjects were found to suffer from skin diseases and disorders: 24% contact dermatitis, 2% leukoderma, 3% nail hyperpigmentation. Less than half of these subjects (43%) were found to be working with nonmechanized (manual) printers whereas the other 57% worked with computerized printers. Employees working with nonmechanized printers were found to have a statistically meaningful increase in skin diseases compared with subjects who were working with computerized printers (Odds ratio = 7.4, 95% CI = 2.59−21.92, P = 0.001). Some (41%) of these subjects did not use gloves and were found to have a statistically significant increased incidence of skin diseases compared with the ones who used gloves (Odds ratio = 4.11, 95% CI = 1.72–13.21, P value = 0.002). Generally, it seems that adequate ventilation and protective gloves are necessary for decreasing the prevalence of occupational skin diseases among photographers. Also, educating the photographers about the risks of the chemical substances in their workplace is very important.

Lack of Association between Leber’s Hereditary Optic Neuropathy Primary Point Mutations and Multiple Sclerosis in Iran

The hypothesis that mitochondrial genes may implicate susceptibility to multiple sclerosis (MS) is supported by an increasing number of case reports on Leber's hereditary optic neuropathy (LHON)-associated mitochondrial DNA (mtDNA) point mutations in patients with MS. A number of mtDNA mutations with primary pathogenic significance for LHON, a maternally inherited disease causing severe bilateral visual loss predominantly in young men, have been detected in patients with an MS-like phenotype. To evaluate the link between MS and LHON primary point mutations, we investigated 31 non-related Iranian clinically definite MS patients (23 females and 8 males) with optic nerve involvement, as well as 25 patients (16 females and 9 males) without involvement of the optic nerve as controls. Three patients had severe bilateral visual loss without any recovery. We searched for the presence of LHON mitochondrial mutations at nucleotide positions (np) 11,778, 3,460, and 14,484 by mutation-specific polymerase chain reaction and restriction fragment length polymorphism. Our results suggest that there is no association between Iranian patients with MS and mtDNA point mutations at np 11,778, 3,460, and 14,484.