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Snelling P. Am I my students' nurse? Reflections on the nursing ethics of nursing education. Nurs Ethics 2024; 31:52-64. [PMID: 37769641 PMCID: PMC10898194 DOI: 10.1177/09697330231193858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Despite having worked in higher education for over twenty years, I am still, first and foremost, a practicing nurse. My employer requires me to be a nurse and my regulator regards what I do as nursing. My practice is regulated by the Code and informed by nursing ethics. If I am nurse, practicing nursing, does that mean that my students are my patients? This paper considers how the relationship that I have with my students can be informed by the ethics of the nurse/patient relationship. After some initial theoretical preparation concerning argument from analogy, the paper identifies some areas for comparison between the two relationships. Areas of similarity and difference identify two areas of concern: Nurse education and educators regularly engage in coercion and surveillance in an attempt to increase student success, both of which would be considered outside nursing ethics. It is concluded that these coercive practices are not conducive to an environment where character is cultivated. Despite current financial and workforce pressures, nurse lecturers and more especially their managers would do well to return to the professional ethics of nursing to question and guide their practice.
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Talbot B, Davies S, Burman J, Ritchie A, Snelling P, Lynch S, Park Y, Jones B, Garvey V, Jaure A, Jardine M, Perkovic V, Gallagher M, Brandwood A, Kaur N, Knight J. The Point-of-Care Peritoneal Dialysis System Early Evaluation Study (POC-PDEE): A pilot proof-of-principal study of the Ellen Medical Devices Point-of-Care affordable peritoneal dialysis system. Perit Dial Int 2024:8968608231209850. [PMID: 38179591 DOI: 10.1177/08968608231209850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024] Open
Abstract
The global unmet need for kidney replacement therapy means that millions of people die every year as they cannot afford treatment. Peritoneal dialysis (PD) offers comparable survival to haemodialysis and is often more affordable, but one barrier to increasing access is that conventional manufacturing and distribution of PD fluid is costly. Here we report the results from a pilot proof-of-principal study demonstrating for the first time that the Ellen Medical Devices Point-of-Care system can be used by patients to produce sterile PD fluid at the point-of-care. With further development, this low-cost system could offer a solution to the many millions of people around the world who currently cannot afford treatment for kidney failure.
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Affiliation(s)
- Benjamin Talbot
- Renal and Metabolic Division, The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Ellen Medical Devices, Sydney, Australia
- Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Simon Davies
- Renal Research Group, School of Medicine, Keele University, UK
- Renal Department, University Hospital of North Staffordshire NHS Trust, Stoke-on-Trent, UK
| | | | - Angus Ritchie
- Concord Repatriation General Hospital, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney, Australia
| | - Paul Snelling
- Renal Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | | | - Youn Park
- Renal Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Brian Jones
- Concord Repatriation General Hospital, Sydney, Australia
- Renal Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Vincent Garvey
- Renal and Metabolic Division, The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Ellen Medical Devices, Sydney, Australia
| | - Allison Jaure
- Sydney School of Public Health, The University of Sydney, Australia
| | - Meg Jardine
- Renal and Metabolic Division, The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Concord Repatriation General Hospital, Sydney, Australia
- NHMRC Clinical Trials Centre, The University of Sydney, Australia
| | - Vlado Perkovic
- Renal and Metabolic Division, The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Martin Gallagher
- Renal and Metabolic Division, The George Institute for Global Health, University of New South Wales, Sydney, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Arthur Brandwood
- Ellen Medical Devices, Sydney, Australia
- School of Biomedical Engineering, University of Sydney, Australia
| | | | - John Knight
- Renal and Metabolic Division, The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Ellen Medical Devices, Sydney, Australia
- Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney, Australia
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Athavale A, Miles N, Pais R, Snelling P, Chadban SJ. Transdermal Magnesium for the Treatment of Peripheral Neuropathy in Chronic Kidney Disease: A Single-Arm, Open-Label Pilot Study. J Palliat Med 2023; 26:1654-1661. [PMID: 37486715 DOI: 10.1089/jpm.2023.0229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Abstract
Introduction: Peripheral neuropathy is common in chronic kidney disease (CKD) and may be multifactorial in origin, resulting from uremia, hyperkalemia, and diabetes. Previous studies have suggested that magnesium plays a crucial role in chronic pain. Studies evaluating magnesium in neuropathy have demonstrated mixed results. Aims: To provide preliminary data on the effectiveness of transdermal magnesium in treating peripheral neuropathy related to CKD. Methods: Twenty participants with advanced CKD were enrolled from a major teaching hospital clinic in Sydney, Australia. Each participant was provided with a spray bottle containing magnesium chloride and instructed to apply five sprays to each limb affected by neuropathy daily for 12 weeks. Participants completed the Neuropathy Total Symptom Score-6 (NTSS-6) every 4 weeks during follow-up. Serum magnesium concentrations were measured at 4-week intervals. Results: Twenty participants were recruited, of which 14 completed the 12-week follow-up period. Mean age was 78.90 years, 80.00% were female and mean estimated glomerular filtration rate was 9.78 mL/min/1.73 m2. With intention to treat analysis (mean [95% confidence interval]), NTSS-6 was significantly reduced at weeks 8 (4.04 [2.43-5.65]) and 12 (4.26 [2.47-6.05]), compared with baseline (6.92 [5.29-8.55]), p < 0.05. Serum magnesium concentration did not change significantly during the study. Conclusion: This pilot study suggests that transdermal magnesium may be beneficial in reducing frequency and severity of peripheral neuropathic symptoms in patients with advanced CKD. Trial Registration: australianclinicaltrials.gov.au. Identifier: ACTRN12621000841875. Date first registered January 7, 2021.
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Affiliation(s)
- Akshay Athavale
- Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Natividad Miles
- Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Riona Pais
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Palliative Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Paul Snelling
- Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Steven J Chadban
- Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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Kang A, Arnold R, Gallagher M, Snelling P, Green J, Fernando M, Kiernan MC, Hand S, Grimley K, Burman J, Heath A, Rogers K, Bhattacharya A, Smyth B, Bradbury T, Hawley C, Perkovic V, Krishnan AV, Jardine MJ. Effect of Hemodiafiltration on the Progression of Neuropathy with Kidney Failure: A Randomized Controlled Trial. Clin J Am Soc Nephrol 2021; 16:1365-1375. [PMID: 34233923 PMCID: PMC8729572 DOI: 10.2215/cjn.17151120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 06/23/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Neuropathy is a common complication of kidney disease that lacks proven disease-modifying treatments. Hemodiafiltration improves clearance of uremic toxins and is associated with better nerve function than hemodialysis. We aimed to determine whether hemodiafiltration reduces the progression of neuropathy in people receiving hemodialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS The Filtration in the Neuropathy of End-Stage Kidney Disease Symptom Evolution (FINESSE) study was an open-label, blinded end point assessment, controlled trial that randomized maintenance hemodialysis recipients to hemodiafiltration or high-flux hemodialysis for 48 months or until death or cessation of dialysis at four study centers. The primary outcome was the mean change in the yearly modified total neuropathy score from baseline, with time points weighted equally. RESULTS A total of 124 participants were randomized and followed for a mean of 41 months. At baseline, neuropathy was present in 91 (73%) participants (modified total neuropathy score greater than or equal to two), and 38 (31%) had moderate to severe neuropathy (modified total neuropathy score 9-28). Convection volume in the hemodiafiltration arm was a median of 24.7 (interquartile range, 22.4-26.5) L. The mean modified total neuropathy score (SEM) worsened by 1.7 (0.4)/28 and 1.2 (0.4)/28 in the hemodiafiltration and hemodialysis groups, respectively, with a mean difference of 0.5 (95% confidence interval, -0.7 to 1.7; P=0.37). There was no difference in survival (hazard ratio, 1.24; 95% confidence interval, 0.61 to 2.51; log rank P=0.55) or any of the prespecified adverse events. There was no difference between groups in the number of participants who suffered an adverse event adjusted by follow-up time (relative risk, 1.05; 95% confidence interval, 0.83 to 1.32; P=0.68). CONCLUSIONS Neuropathy is still a common complication of kidney disease without disease-altering therapy. Hemodiafiltration did not affect neuropathy progression compared with hemodialysis. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER Filtration in the Neuropathy of End-Stage Kidney Disease Symptom Evolution (FINESSE), ACTRN12609000615280.
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Affiliation(s)
- Amy Kang
- Renal and Metabolic Division, The George Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia.,Department of Renal Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia.,Department of Medicine, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Ria Arnold
- Department of Medicine, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Martin Gallagher
- Renal and Metabolic Division, The George Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia.,Department of Renal Medicine, Concord Hospital, Sydney, New South Wales, Australia
| | - Paul Snelling
- Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Julianne Green
- Department of Renal Medicine, Sydney Adventist Hospital, Sydney, New South Wales, Australia
| | - Mangalee Fernando
- Department of Renal Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia.,Department of Medicine, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Matthew C Kiernan
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Samantha Hand
- Department of Renal Medicine, Concord Hospital, Sydney, New South Wales, Australia
| | - Kim Grimley
- Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Jenny Burman
- Department of Renal Medicine, Concord Hospital, Sydney, New South Wales, Australia
| | - Anne Heath
- Department of Renal Medicine, Sydney Adventist Hospital, Sydney, New South Wales, Australia
| | - Kris Rogers
- Statistics Division, The George Institute The George Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia.,Department of Statistics, University of Technology, Sydney, New South Wales, Australia
| | - Amritendu Bhattacharya
- Statistics Division, The George Institute The George Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Brendan Smyth
- Renal and Metabolic Division, The George Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia.,Kidney Health Division, National Health and Medical Research Council of Australia Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia.,Department of Renal Medicine, St. George Hospital, Sydney, New South Wales, Australia
| | - Thomas Bradbury
- Renal and Metabolic Division, The George Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Carmel Hawley
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Queensland, Australia
| | - Vlado Perkovic
- Renal and Metabolic Division, The George Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia.,Department of Medicine, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Arun V Krishnan
- Department of Medicine, University of New South Wales Sydney, Sydney, New South Wales, Australia.,Department of Neurology, Prince of Wales Hospital, Sydney, New South Wales, Australia
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Webb WA, Mitchell T, Snelling P, Nyatanga B. Life's hard and then you die: the end-of-life priorities of people experiencing homelessness in the UK. Int J Palliat Nurs 2021; 26:120-132. [PMID: 32275478 DOI: 10.12968/ijpn.2020.26.3.120] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND People experiencing homelessness often die young and without adequate support. In the UK, they fail to access palliative care services and their end-of-life priorities remain poorly understood. AIMS To explore the end-of-life concerns, fears, preferences and priorities of a sample of people experiencing homelessness in the UK. METHODS This is an interpretive phenomenology. Data collected through semi-structured, audio-recorded, face-to-face interviews with 21 homeless participants in the UK were analysed iteratively using thematic analysis. Findings have been interpreted through the lens of Merleau-Ponty's philosophy. RESULTS Eight themes are reported: spiritual concerns; practical concerns; fear of needing care; fear of being forgotten; preference for dying suddenly; preference for being somewhere comfortable where people know me; prioritising autonomy and self-determination; and prioritising authenticity. CONCLUSION A strengths-based, trauma-informed, person-centred, collaborative 'compassionate community' approach to care is recommended for people experiencing homelessness at end of life.
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Affiliation(s)
- Wendy Ann Webb
- Advanced Clinical Practitioner, University of Worcester, UK
| | | | - Paul Snelling
- Principal Lecturer in Adult Nursing, University of Worcester, UK
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Hudson R, Patel C, Hawley CM, O'Shea S, Snelling P, Ho G, Holman K, Bennetts B, Crawford J, Francis L, Simons C, Mallett A. Adult-Diagnosed Nonsyndromic Nephronophthisis in Australian Families Caused by Biallelic NPHP4 Variants. Am J Kidney Dis 2019; 76:282-287. [PMID: 31810733 DOI: 10.1053/j.ajkd.2019.08.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 08/29/2019] [Indexed: 11/11/2022]
Abstract
There is increasing appreciation of nephronophthisis (NPHP) as an autosomal recessive cause of kidney failure and earlier stages of chronic kidney disease among adults. We identified 2 families with presumed adult-diagnosed nonsyndromic NPHP and negative diagnostic genetic testing results from our Renal Genetics Clinic. Both had 2 affected siblings without extrarenal phenotypes. After informed consent, research whole-genome sequencing was undertaken. Biallelic NPHP4 variants were identified in trans and clinically confirmed in all 4 affected individuals, confirming a genetic diagnosis. Participant 1 of the first family (F1P1) had kidney failure diagnosed at 19 years of age. An affected younger sibling (F1P2) reached kidney failure at age 15 years after kidney biopsy suggested NPHP. Pathogenic variants detected in NPHP4 in this family were NM_015102.4:c.3766C>T (p.Gln1256*) and a 31-kb deletion affecting exons 12 to 16. In the second family, F2P3 reached kidney failure at age 27 years having undergone kidney biopsy suggesting NPHP. An affected younger sibling (F2P4) has chronic kidney disease stage 4 at age 39 years. The NPHP4 variants detected were NM_015102.4:c.1998_1999del (p.Tyr667Phefs*23) and c.3646G>T (p.Asp1216Tyr). The latter variant was initially missed in diagnostic sequencing due to inadequate NPHP4 coverage (94.3% exonic coverage). With these reports, we identify NPHP4 as an appreciable genetic cause for adult-diagnosed nonsyndromic NPHP that should be considered by adult nephrologists.
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Affiliation(s)
- Rebecca Hudson
- Department of Renal Medicine, Royal Brisbane and Women's Hospital, Herston, QLD
| | - Chirag Patel
- Genetic Health Queensland, Royal Brisbane and Women's Hospital, Herston, QLD; KidGen Collaborative, Australian Genomics Health Alliance, Parkville, VIC
| | - Carmel M Hawley
- Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, QLD; Translational Research Institute, Brisbane, Queensland; Australasian Kidney Trials Network, The University of Queensland, Queensland
| | | | - Paul Snelling
- KidGen Collaborative, Australian Genomics Health Alliance, Parkville, VIC; Department of Nephrology, Royal Prince Alfred Hospital, Camperdown, NSW
| | - Gladys Ho
- KidGen Collaborative, Australian Genomics Health Alliance, Parkville, VIC; Department of Molecular Genetics, Children's Hospital at Westmead, Westmead, NSW; Discipline of Genetic Medicine and Discipline of Child & Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW
| | - Katherine Holman
- KidGen Collaborative, Australian Genomics Health Alliance, Parkville, VIC; Department of Molecular Genetics, Children's Hospital at Westmead, Westmead, NSW
| | - Bruce Bennetts
- KidGen Collaborative, Australian Genomics Health Alliance, Parkville, VIC; Department of Molecular Genetics, Children's Hospital at Westmead, Westmead, NSW; Discipline of Genetic Medicine and Discipline of Child & Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW
| | - Joanna Crawford
- KidGen Collaborative, Australian Genomics Health Alliance, Parkville, VIC; Institute for Molecular Bioscience, The University of Queensland, St Lucia, QLD
| | - Leo Francis
- Department of Anatomical Pathology, Pathology Queensland, Herston, QLD
| | - Cas Simons
- KidGen Collaborative, Australian Genomics Health Alliance, Parkville, VIC; Institute for Molecular Bioscience, The University of Queensland, St Lucia, QLD; Murdoch Children's Research Institute, The Royal Children's Hospital Melbourne, Parkville, Melbourne, VIC
| | - Andrew Mallett
- Department of Renal Medicine, Royal Brisbane and Women's Hospital, Herston, QLD; KidGen Collaborative, Australian Genomics Health Alliance, Parkville, VIC; Institute for Molecular Bioscience, The University of Queensland, St Lucia, QLD; Department of Anatomical Pathology, Pathology Queensland, Herston, QLD; Faculty of Medicine, The University of Queensland, Herston, QLD, Australia.
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Smyth B, Krishnan AV, Gallagher M, Kiernan M, Snelling P, Hawley C, Fernando M, Hand S, Grimley K, Burman J, Heath A, Kang A, Perkovic V, Jardine MJ. Randomised controlled trial of the impact of haemodiafiltration on uraemic neuropathy: FINESSE study protocol. BMJ Open 2019; 9:e023736. [PMID: 30782714 PMCID: PMC6340424 DOI: 10.1136/bmjopen-2018-023736] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The majority of patients undergoing haemodialysis (HD) show evidence of uraemic neuropathy, a condition with no known disease-modifying treatments. The pathogenesis of uraemic neuropathy is poorly understood, but may be related to cumulative exposure to middle molecules or other solutes such as potassium. It is not known whether haemodiafiltration (HDF) reduces the progression of uraemic neuropathy. METHODS AND ANALYSIS Filtration In the Neuropathy of End-Stage kidney disease Symptom Evolution (FINESSE) is a multicentre, randomised, open-label, blinded endpoint assessment, controlled trial designed to assess the impact of HDF versus HD on uraemic neuropathy. Maintenance HD patients will be randomised in a 1:1 ratio to receive HDF or HD with high-flux membranes for 4 years. The primary endpoint is the difference in the mean change in Total Neuropathy Score (TNS)-a measure of peripheral neuropathy combining symptoms, signs and nerve conduction velocity-over the study period. Secondary outcomes include change at annual timepoints in the TNS and the Neuropathy Symptom Score; and in morbidity, mortality and safety events. ETHICS AND DISSEMINATION The FINESSE trial has been approved by the Ethics Review Committee of the Sydney South West Area Health Service (HREC/09/RPAH/268) and of Adventist HealthCare Limited (2012-027). When published in a peer-reviewed journal, it will be the largest and longest reported randomised trial aimed at reducing the incidence and severity of uraemic neuropathy. It will advance the understanding of the natural history of uraemic neuropathy and the influence of convective therapies on both neurophysiological and clinical outcomes. It will also allow refinement of current hypotheses surrounding the pathogenesis of uraemic neuropathy and, most importantly, may lead to improvements in the lives of the many patients affected by this debilitating condition. TRIAL REGISTRATION NUMBER ACTRN12609000615280.
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Affiliation(s)
- Brendan Smyth
- Renal and Metabolic, The George Institute for Global Health, UNSW, Newtown, New South Wales, Australia
| | - Arun V Krishnan
- Neurology, Prince of Wales Clinical School, UNSW, Sydney, New South Wales, Australia
| | - Martin Gallagher
- Renal and Metabolic, The George Institute for Global Health, UNSW, Newtown, New South Wales, Australia
- Renal Medicine, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Matthew Kiernan
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Paul Snelling
- Renal Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Carmel Hawley
- Renal Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Mangalee Fernando
- Renal Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Samantha Hand
- Renal Medicine, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Kim Grimley
- Renal Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Jenny Burman
- Renal Medicine, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Anne Heath
- Renal Medicine, Sydney Adventist Hospital, Sydney, New South Wales, Australia
| | - Amy Kang
- Renal and Metabolic, The George Institute for Global Health, UNSW, Newtown, New South Wales, Australia
| | - Vlado Perkovic
- Renal and Metabolic, The George Institute for Global Health, UNSW, Newtown, New South Wales, Australia
| | - Meg J Jardine
- Renal and Metabolic, The George Institute for Global Health, UNSW, Newtown, New South Wales, Australia
- Renal Medicine, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
- Renal Medicine, Sydney Adventist Hospital, Sydney, New South Wales, Australia
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8
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Tangirala N, Singer J, Snelling P, Wyburn K, Chadban S, Aouad L, Gracey DM. Emphysematous pyelonpehritis in a dual kidney transplant recipient. Nephrology (Carlton) 2018; 23:1064-1065. [PMID: 30362230 DOI: 10.1111/nep.13258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Nishanta Tangirala
- Renal Unit, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Julian Singer
- Renal Unit, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Paul Snelling
- Renal Unit, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Kate Wyburn
- Renal Unit, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia.,Central Clinical School, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Steve Chadban
- Renal Unit, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia.,Central Clinical School, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Leyla Aouad
- Renal Unit, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia.,Central Clinical School, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - David M Gracey
- Renal Unit, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia.,Central Clinical School, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
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Abstract
BACKGROUND: Spiritual care is a fundamental component of holistic end-of-life (EoL) care. AIM: To explore what is known about the spiritual concerns of people experiencing homelessness towards the EoL. METHODS: A narrative literature review was conducted from 1997 to June 2018 using CINAHL Complete, MEDLINE and PubMed. This identified just 11 relevant papers; eight papers report on studies based in the US, one paper reports on a study based in the Republic of Ireland (ROI), and two of the papers are literature reviews. RESULTS: Both the ROI and US studies report the primacy of religious beliefs and spiritual experience for people experiencing homelessness considering EoL issues. However, the findings of studies from the US and the ROI are not necessarily transferable to the other populations of people experiencing homelessness. Furthermore, it cannot be assumed that the spiritual needs of people experiencing homelessness mirror those of the housed population. CONCLUSION: There is a need for further research into the international perspective on the spiritual needs of homeless people towards the EoL, especially in secular countries.
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Affiliation(s)
- Wendy Ann Webb
- Doctoral Student, University of Worcester, Worcester, UK
| | - Theresa Mitchell
- Associate Professor of Nursing, University of Worcester, Worcester, UK
| | - Paul Snelling
- Principal Lecturer in Adult Nursing, University of Worcester, Worcester, UK
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10
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Ann Webb W, Mitchell T, Nyatanga B, Snelling P. Nursing management of people experiencing homelessness at the end of life. Nurs Stand 2018; 32:53-63. [PMID: 29488729 DOI: 10.7748/ns.2018.e11070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2018] [Indexed: 11/09/2022]
Abstract
Homelessness is a complex and multidimensional issue often involving a combination of personal vulnerability, the limitations of social housing, and inadequacies in welfare support. Providing palliative and end-of-life care to people experiencing homelessness is challenging, both to individuals receiving care and nurses aiming to meet their complex needs. This article discusses what is understood by the concept of 'homelessness' and examines the barriers to accessing effective healthcare for people who are homeless and have life-limiting conditions. The authors review the research into end of life care for people experiencing homelessness and identify areas for further investigation, notably the lack of evidence regarding the end of life care priorities of these individuals. There is a focus on the availability of healthcare services for people who are homeless at the end of life, as well as the factors that should be considered if evidence-based healthcare services for this group of people are to be improved in the future.
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Affiliation(s)
- Wendy Ann Webb
- Institute of Health and Society, St John's Campus, University of Worcester, Worcester, England
| | - Theresa Mitchell
- Institute of Health and Society, St John's Campus, University of Worcester, Worcester, England
| | - Brian Nyatanga
- Institute of Health and Society, St John's Campus, University of Worcester, Worcester, England
| | - Paul Snelling
- Institute of Health and Society, St John's Campus, University of Worcester, Worcester, England
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11
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Roberts M, Darssan D, Badve S, Carroll R, Fahim M, Haluska B, Hawley C, Isbel N, Marshall M, Pascoe E, Pedagogos E, Pilmore H, Snelling P, Stanton T, Tan KS, Tonkin A, Vergara L, Ierino F. Carvedilol and Cardiac Biomarkers in Dialysis Patients: Secondary Analysis of a Randomized Controlled Trial. Kidney Blood Press Res 2017; 42:1033-1044. [DOI: 10.1159/000485589] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 09/03/2017] [Indexed: 11/19/2022] Open
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Devitt J, Anderson K, Cunningham J, Preece C, Snelling P, Cass A. Difficult conversations: Australian Indigenous patients' views on kidney transplantation. BMC Nephrol 2017; 18:310. [PMID: 29020932 PMCID: PMC5637064 DOI: 10.1186/s12882-017-0726-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 09/26/2017] [Indexed: 02/07/2023] Open
Abstract
Background Indigenous Australians suffer a disproportionate burden of end stage kidney disease (ESKD) but are significantly less likely to receive a transplant. This study explores Indigenous ESKD patients’ views on transplantation as a treatment option. Methods The Improving Access to Kidney Transplants (IMPAKT) research program investigated barriers to kidney transplantation for Indigenous Australians. An interview study, conducted in 2005–2006, elicited illness experience narratives from 146 Indigenous patients, including views on transplant. Interviews were conducted at 26 sites that collectively treat the majority of Indigenous ESKD patients. Key themes were identified via team consensus meetings, providing a flexible framework and focus for continued coding. Results Four inter-related themes were identified in patient commentary: a very high level (90% of respondents) of positive interest in transplantation; patients experienced a range of communication difficulties and felt uninformed about transplant; family involvement in decision-making was constrained by inadequate information; and patients needed to negotiate cultural and social sensitivities around transplantation. Conclusions Indigenous ESKD patients demonstrated an intense interest in transplantation preferring deceased over living kidney donation. Patients believe transplant is the path most likely to support the re-establishment of their ‘normal’ family life. Patients described themselves as poorly informed; most had only a rudimentary knowledge of the notion of transplant but no understanding of eligibility criteria, the transplant procedure and associated risks. Patients experienced multiple communication barriers that - taken together - undermine their engagement in treatment decision-making. Families and communities are disempowered because they also lack information to reach a shared understanding of transplantation. Cultural sensitivities associated with transplantation were described but these did not appear to constrain patients in making choices about their own health. Transplant units and local treatment providers should collaborate to develop user-friendly, culturally informed and region-specific patient education programs. Quality improvement cycles should underpin the development of national guidelines for patient education. Noting Indigenous patients’ intense interest in transplantation, and nephrologists’ concerns regarding poor transplant outcomes, research should prioritise exploring the predictors of transplant outcomes for Indigenous Australians. Electronic supplementary material The online version of this article (10.1186/s12882-017-0726-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Kate Anderson
- Menzies School of Health Research, Darwin, Australia
| | | | | | | | - Alan Cass
- Menzies School of Health Research, Darwin, Australia
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Jose MD, Marshall MR, Read G, Lioufas N, Ling J, Snelling P, Polkinghorne KR. Fatal Dialysis Vascular Access Hemorrhage. Am J Kidney Dis 2017; 70:570-575. [DOI: 10.1053/j.ajkd.2017.05.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 05/28/2017] [Indexed: 11/11/2022]
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Snelling P. [Comparison of the codes of ethics in different countries]. Soins 2017; 62:29-32. [PMID: 28923447 DOI: 10.1016/j.soin.2017.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In most countries, nursing ethics are set out in a code written by the body regulating the profession or by a professional organisation. An examination of these texts shows that differences exist from one country to another, both in terms of the general orientation and the content.
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Affiliation(s)
- Paul Snelling
- Department of Nursing and Midwifery, University of Worcester, Henwick Grove, WR2 6AJ, Worcester, Royaume-Uni.
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15
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Wang AY, Sherrington C, Toyama T, Gallagher MP, Cass A, Hirakawa Y, Li Q, Sukkar L, Snelling P, Jardine MJ. Muscle strength, mobility, quality of life and falls in patients on maintenance haemodialysis: A prospective study. Nephrology (Carlton) 2017; 22:220-227. [DOI: 10.1111/nep.12749] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 01/20/2016] [Accepted: 02/11/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Amanda Y Wang
- The George Institute for Global Health, Sydney Medical School; University of Sydney; Sydney New South Wales Australia
| | - Catherine Sherrington
- The George Institute for Global Health, Sydney Medical School; University of Sydney; Sydney New South Wales Australia
| | - Tadashi Toyama
- The George Institute for Global Health, Sydney Medical School; University of Sydney; Sydney New South Wales Australia
| | - Martin P Gallagher
- The George Institute for Global Health, Sydney Medical School; University of Sydney; Sydney New South Wales Australia
- Sydney Medical School; University of Sydney; Sydney New South Wales Australia
- Concord Repatriation General Hospital; Sydney New South Wales Australia
| | - Alan Cass
- The George Institute for Global Health, Sydney Medical School; University of Sydney; Sydney New South Wales Australia
- Menzies School of Health Research; Darwin Northern Territory Australia
| | - Yochiro Hirakawa
- The George Institute for Global Health, Sydney Medical School; University of Sydney; Sydney New South Wales Australia
| | - Qiang Li
- The George Institute for Global Health, Sydney Medical School; University of Sydney; Sydney New South Wales Australia
| | - Louisa Sukkar
- The George Institute for Global Health, Sydney Medical School; University of Sydney; Sydney New South Wales Australia
| | - Paul Snelling
- Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - Meg J Jardine
- The George Institute for Global Health, Sydney Medical School; University of Sydney; Sydney New South Wales Australia
- Concord Repatriation General Hospital; Sydney New South Wales Australia
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16
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Zhang L, Badve SV, Pascoe EM, Beller E, Cass A, Clark C, de Zoysa J, Isbel NM, Liu X, McTaggart S, Morrish AT, Playford G, Scaria A, Snelling P, Vergara LA, Hawley CM, Johnson DW. Representativeness of Honeypot Trial Participants to Australasian PD Patients. Perit Dial Int 2016; 37:516-522. [PMID: 27935534 DOI: 10.3747/pdi.2016.00065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 10/01/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The HONEYPOT trial failed to establish the superiority of exit-site application of Medihoney compared with nasal mupirocin prophylaxis for the prevention of peritonitis in peritoneal dialysis (PD) patients. This study aimed to assess the representativeness of the patients in the HONEYPOT trial to the Australian and New Zealand PD population. METHODS This study compared baseline characteristics of the 371 PD patients in the HONEYPOT trial with those of 6,085 PD patients recorded on the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry. RESULTS Compared with the PD population, the HONEYPOT sample was older (standardized difference [d] = 0.19, p = 0.003), more likely to be treated with automated PD (d = 0.58, p < 0.001), had higher residual renal function (d = 0.26, p < 0.001) and a higher proportion of participants with end-stage kidney disease due to polycystic kidney disease (d = 0.17) and lower proportion due to diabetes (d = -0.17) and glomerulonephritis (d = -0.18) (p < 0.001), and lower proportions of indigenous people (d = -0.17, p < 0.001), current smokers (d = -0.10, p < 0.001), and people with prior histories of hemodialysis (d = -0.16, p < 0.001), diabetes mellitus (d = -0.18, p < 0.001), and coronary artery disease (d = -0.15, p < 0.001). CONCLUSIONS HONEYPOT trial participants tended to be healthier than the Australian and New Zealand PD patient population. Although the differences between the groups were generally modest, it is possible that their cumulative effect may have had some impact on external generalizability, which is not an uncommon occurrence in clinical trials.
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Affiliation(s)
| | - Lei Zhang
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.,Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Sunil V Badve
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.,Department of Nephrology, The St George Hospital, Sydney, Australia
| | - Elaine M Pascoe
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - Elaine Beller
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Australia
| | - Alan Cass
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.,Menzies School of Health Research, Darwin, Australia
| | - Carolyn Clark
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.,Department of Nephrology, Nambour Hospital, Nambour, Australia
| | - Janak de Zoysa
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.,Department of Renal Medicine, North Shore Hospital, Auckland, New Zealand
| | - Nicole M Isbel
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.,Department of Nephrology, The St George Hospital, Sydney, Australia
| | - Xusheng Liu
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Steven McTaggart
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.,Child & Adolescent Renal Service, Lady Cilento Children's Hospital, Brisbane, Australia
| | - Alicia T Morrish
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - Geoffrey Playford
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.,Infection Management Services, Princess Alexandra Hospital, Brisbane, Australia
| | - Anish Scaria
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - Paul Snelling
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.,Department of Nephrology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Liza A Vergara
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - Carmel M Hawley
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - David W Johnson
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia .,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
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Morton RL, Webster AC, McGeechan K, Howard K, Murtagh FE, Gray NA, Kerr PG, Germain MJ, Snelling P. Conservative Management and End-of-Life Care in an Australian Cohort with ESRD. Clin J Am Soc Nephrol 2016; 11:2195-2203. [PMID: 27697783 PMCID: PMC5142079 DOI: 10.2215/cjn.11861115] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 07/28/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES We aimed to determine the proportion of patients who switched to dialysis after confirmed plans for conservative care and compare survival and end-of-life care among patients choosing conservative care with those initiating RRT. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A cohort study of 721 patients on incident dialysis, patients receiving transplants, and conservatively managed patients from 66 Australian renal units entered into the Patient Information about Options for Treatment Study from July 1 to September 30, 2009 were followed for 3 years. A two-sided binomial test assessed the proportion of patients who switched from conservative care to RRT. Cox regression, stratified by center and adjusted for patient and treatment characteristics, estimated factors associated with 3-year survival. RESULTS In total, 102 of 721 patients planned for conservative care, and median age was 80 years old. Of these, 8% (95% confidence interval, 3% to 13%), switched to dialysis, predominantly for symptom management. Of 94 patients remaining on a conservative pathway, 18% were alive at 3 years. Of the total 721 patients, 247 (34%) died by study end. In multivariable analysis, factors associated with all-cause mortality included older age (hazard ratio, 1.55; 95% confidence interval, 1.36 to 1.77), baseline serum albumin <3.0 versus 3.7-5.4 g/dl (hazard ratio, 4.31; 95% confidence interval, 2.72 to 6.81), and management with conservative care compared with RRT (hazard ratio, 2.18; 95% confidence interval, 1.39 to 3.40). Of 247 deaths, patients managed with RRT were less likely to receive specialist palliative care (26% versus 57%; P<0.001), more likely to die in the hospital (66% versus 42%; P<0.001) than home or hospice, and more likely to receive palliative care only within the last week of life (42% versus 15%; P<0.001) than those managed conservatively. CONCLUSIONS Survival after 3 years of conservative management is common, with relatively few patients switching to dialysis. Specialist palliative care services are used more frequently and at an earlier time point for conservatively managed patients, a practice associated with better symptom management and quality of life.
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Affiliation(s)
- Rachael L. Morton
- National Health and Medical Research Council Clinical Trials Centre, Sydney Medical School and
| | - Angela C. Webster
- Sydney School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Kevin McGeechan
- Sydney School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Kirsten Howard
- Sydney School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Fliss E.M. Murtagh
- Cicely Saunders Institute, King’s College London, Denmark Hill, United Kingdom
| | - Nicholas A. Gray
- Sunshine Coast Clinical School, The University of Queensland and Renal Unit, Nambour General Hospital, Nambour, Australia
| | - Peter G. Kerr
- Department of Nephrology, Monash Medical Centre, Clayton, Australia
| | - Michael J. Germain
- Department of Medicine, Division of Nephology, Baystate Medical Center, Springfield, Massachusetts; and
| | - Paul Snelling
- Department of Renal Medicine Royal Prince Alfred Hospital, Camperdown, Australia
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18
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Snelling P. "The NMC needs to provide clearer guidance in its code". Nurs Times 2016; 112:11. [PMID: 27145651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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19
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Zhang L, Badve SV, Pascoe EM, Beller E, Cass A, Clark C, de Zoysa J, Isbel NM, McTaggart S, Morrish AT, Playford EG, Scaria A, Snelling P, Vergara LA, Hawley CM, Johnson DW. The Effect of Exit-Site Antibacterial Honey Versus Nasal Mupirocin Prophylaxis on the Microbiology and Outcomes of Peritoneal Dialysis-Associated Peritonitis and Exit-Site Infections: A Sub-Study of the Honeypot Trial. Perit Dial Int 2015. [PMID: 26224790 DOI: 10.3747/pdi.2014.00206] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
UNLABELLED ♦ BACKGROUND The HONEYPOT study recently reported that daily exit-site application of antibacterial honey was not superior to nasal mupirocin prophylaxis for preventing overall peritoneal dialysis (PD)-related infection. This paper reports a secondary outcome analysis of the HONEYPOT study with respect to exit-site infection (ESI) and peritonitis microbiology, infectious hospitalization and technique failure. ♦ METHODS A total of 371 PD patients were randomized to daily exit-site application of antibacterial honey plus usual exit-site care (N = 186) or intranasal mupirocin prophylaxis (in nasal Staphylococcus aureus carriers only) plus usual exit-site care (control, N = 185). Groups were compared on rates of organism-specific ESI and peritonitis, peritonitis- and infection-associated hospitalization, and technique failure (PD withdrawal). ♦ RESULTS The mean peritonitis rates in the honey and control groups were 0.41 (95% confidence interval [CI] 0.32 - 0.50) and 0.41 (95% CI 0.33 - 0.49) episodes per patient-year, respectively (incidence rate ratio [IRR] 1.01, 95% CI 0.75 - 1.35). When specific causative organisms were examined, no differences were observed between the groups for gram-positive (IRR 0.99, 95% CI 0.66 - 1.49), gram-negative (IRR 0.71, 95% CI 0.39 - 1.29), culture-negative (IRR 2.01, 95% CI 0.91 - 4.42), or polymicrobial peritonitis (IRR 1.08, 95% CI 0.36 - 3.20). Exit-site infection rates were 0.37 (95% CI 0.28 - 0.45) and 0.33 (95% CI 0.26 - 0.40) episodes per patient-year for the honey and control groups, respectively (IRR 1.12, 95% CI 0.81 - 1.53). No significant differences were observed between the groups for gram-positive (IRR 1.10, 95% CI 0.70 - 1.72), gram-negative (IRR: 0.85, 95% CI 0.46 - 1.58), culture-negative (IRR 1.88, 95% CI 0.67 - 5.29), or polymicrobial ESI (IRR 1.00, 95% CI 0.40 - 2.54). Times to first peritonitis-associated and first infection-associated hospitalization were similar in the honey and control groups. The rates of technique failure (PD withdrawal) due to PD-related infection were not significantly different between the groups. ♦ CONCLUSION Compared with standard nasal mupirocin prophylaxis, daily topical exit-site application of antibacterial honey resulted in comparable rates of organism-specific peritonitis and ESI, infection-associated hospitalization, and infection-associated technique failure in PD patients.
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Affiliation(s)
- Lei Zhang
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Sunil V Badve
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Elaine M Pascoe
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - Elaine Beller
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Australia
| | - Alan Cass
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia Menzies School of Health Research, Darwin, Australia
| | - Carolyn Clark
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia Department of Nephrology, Nambour Hospital, Nambour, Australia
| | - Janak de Zoysa
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia Department of Renal Medicine, North Shore Hospital, Auckland, New Zealand
| | - Nicole M Isbel
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Steven McTaggart
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia Child & Adolescent Renal Service, Royal Children's and Mater Children's Hospitals, Brisbane, Australia
| | - Alicia T Morrish
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - E Geoffrey Playford
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia Infection Management Services, Princess Alexandra Hospital, Brisbane, Australia
| | - Anish Scaria
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - Paul Snelling
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia Department of Nephrology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Liza A Vergara
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - Carmel M Hawley
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - David W Johnson
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
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Morton RL, Webster AC, Gray N, Kerr PG, Murtagh FEM, McGeechan K, Howard K, Snelling P. FP689CONSERVATIVE MANAGEMENT AND END OF LIFE CARE IN AUSTRALIA, THREE YEAR FOLLOW UP OF A NATIONAL INCIDENT COHORT WITH END STAGE KIDNEY DISEASE. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv183.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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21
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Foote C, Clayton PA, Johnson DW, Jardine M, Snelling P, Cass A. Impact of Estimated GFR Reporting on Late Referral Rates and Practice Patterns for End-Stage Kidney Disease Patients: A Multilevel Logistic Regression Analysis Using the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA). Am J Kidney Dis 2014; 64:359-66. [DOI: 10.1053/j.ajkd.2014.02.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 02/27/2014] [Indexed: 11/11/2022]
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22
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Snelling P. "Can you explain the friends and family test results to patients?". Nurs Times 2014; 110:7. [PMID: 24772794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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23
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Muir CA, Kotwal SS, Hawley CM, Polkinghorne K, Gallagher MP, Snelling P, Jardine MJ. Buttonhole cannulation and clinical outcomes in a home hemodialysis cohort and systematic review. Clin J Am Soc Nephrol 2013; 9:110-9. [PMID: 24370768 DOI: 10.2215/cjn.03930413] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES The relative merits of buttonhole (or blunt needle) versus rope ladder (or sharp needle) cannulation for hemodialysis vascular access are unclear. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Clinical outcomes by cannulation method were reviewed in 90 consecutive home hemodialysis patients. Initially, patients were trained in rope ladder cannulation. From 2004 on, all incident patients were started on buttonhole cannulation, and prevalent patients were converted to this cannulation method. Coprimary outcomes were arteriovenous fistula-attributable systemic infections and a composite of arteriovenous fistula loss or requirement for surgical intervention. Secondary outcomes were total arteriovenous fistula-related infections and staff time requirements. Additionally, a systematic review evaluating infections by cannulation method was performed. RESULTS Seventeen systemic arteriovenous fistula-attributable infections were documented in 90 patients who were followed for 3765 arteriovenous fistula-months. Compared with rope ladder, buttonhole was not associated with a significantly higher rate of systemic arteriovenous fistula-attributable infections (incidence rate ratio, 2.71; 95% confidence interval, 0.66 to 11.09; P=0.17). However, use of buttonhole was associated with a significantly higher rate of total arteriovenous fistula infections (incidence rate ratio, 3.85; 95% confidence interval, 1.66 to 12.77; P=0.03). Initial and ongoing staff time requirements were significantly higher with buttonhole cannulation. Arteriovenous fistula loss or requirement for surgical intervention was not different between cannulation methods. A systematic review found increased arteriovenous fistula-related infections with buttonhole compared with rope ladder in four randomized trials (relative risk, 3.34; 95% confidence interval, 0.91 to 12.20), seven observational studies comparing before with after changes (relative risk, 3.15; 95% confidence interval, 1.90 to 5.21), and three observational studies comparing units with different cannulation methods (relative risk, 3.27; 95% confidence interval, 1.44 to 7.43). CONCLUSION Buttonhole cannulation was associated with higher rates of infectious events, increased staff support requirements, and no reduction in surgical arteriovenous fistula interventions compared with rope ladder in home hemodialysis patients. A systematic review of the published literature found that buttonhole is associated with higher risk of arteriovenous fistula-related infections.
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Affiliation(s)
- Christopher A Muir
- Renal and Metabolic Division, The George Institute for Global Health, Sydney, Australia;, †Department of Medicine, Blacktown Hospital, Sydney, Australia;, ‡Sydney Medical School, University of Sydney, Sydney, Australia;, §Nephrology Department, Princess Alexandra Hospital, Brisbane, Australia;, ‖Department of Nephrology, Monash Medical Centre, Clayton, Australia;, ¶Departments of Medicine, Epidemiology, and Preventative Medicine, Monash University, Melbourne, Australia;, *Department of Renal Medicine, Concord Repatriation General Hospital, Sydney, Australia, ††Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, Australia
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Johnson DW, Badve SV, Pascoe EM, Beller E, Cass A, Clark C, de Zoysa J, Isbel NM, McTaggart S, Morrish AT, Playford EG, Scaria A, Snelling P, Vergara LA, Hawley CM. Antibacterial honey for the prevention of peritoneal-dialysis-related infections (HONEYPOT): a randomised trial. Lancet Infect Dis 2013; 14:23-30. [PMID: 24119840 DOI: 10.1016/s1473-3099(13)70258-5] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND There is a paucity of evidence to guide the best strategy for prevention of peritoneal-dialysis-related infections. Antibacterial honey has shown promise as a novel, cheap, effective, topical prophylactic agent without inducing microbial resistance. We therefore assessed whether daily application of honey at the exit site would increase the time to peritoneal-dialysis-related infections compared with standard exit-site care plus intranasal mupirocin prophylaxis for nasal carriers of Staphylococcus aureus. METHODS In this open-label trial undertaken in 26 centres in Australia and New Zealand, participants undergoing peritoneal dialysis were randomly assigned in a 1:1 ratio with an adaptive allocation algorithm to daily topical exit-site application of antibacterial honey plus standard exit-site care or intranasal mupirocin prophylaxis (only in carriers of nasal S aureus) plus standard exit-site care (control group). The primary endpoint was time to first infection related to peritoneal dialysis (exit-site infection, tunnel infection, or peritonitis). The trial is registered with the Australian New Zealand Clinical Trials Registry, number 12607000537459. FINDINGS Of 371 participants, 186 were assigned to the honey group and 185 to the control group. The median peritoneal-dialysis-related infection-free survival times were not significantly different in the honey (16·0 months [IQR not estimable]) and control groups (17·7 months [not estimable]; unadjusted hazard ratio 1·12, 95% CI 0·83-1·51; p=0·47). In the subgroup analyses, honey increased the risks of both the primary endpoint (1·85, 1·05-3·24; p=0·03) and peritonitis (2·25, 1·16-4·36) in participants with diabetes. The incidences of serious adverse events (298 vs 327, respectively; p=0·1) and deaths (14 vs 18, respectively; p=0·9) were not significantly different in the honey and control groups. 11 (6%) participants in the honey group had local skin reactions. INTERPRETATION The findings of this trial show that honey cannot be recommended routinely for the prevention of peritoneal-dialysis-related infections. FUNDING Baxter Healthcare, Queensland Government, Comvita, and Gambro.
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Affiliation(s)
- David W Johnson
- Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia; Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia; Translational Research Institute, Brisbane, QLD, Australia.
| | - Sunil V Badve
- Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia; Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Elaine M Pascoe
- Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia
| | - Elaine Beller
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, QLD, Australia
| | - Alan Cass
- Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia; Menzies School of Health Research, Darwin, NT, Australia
| | - Carolyn Clark
- Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia; Department of Nephrology, Nambour Hospital, Nambour, QLD, Australia
| | - Janak de Zoysa
- Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia; Department of Renal Medicine, North Shore Hospital, Auckland, New Zealand
| | - Nicole M Isbel
- Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia; Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Steven McTaggart
- Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia; Child and Adolescent Renal Service, Royal Children's and Mater Children's Hospitals, Brisbane, QLD, Australia
| | - Alicia T Morrish
- Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia
| | - E Geoffrey Playford
- Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia; Infection Management Services, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Anish Scaria
- Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia
| | - Paul Snelling
- Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia; Department of Nephrology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Liza A Vergara
- Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia
| | - Carmel M Hawley
- Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia; Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
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Chan R, Brooks R, Erlich J, Gallagher M, Snelling P, Chow J, Suranyi M. How do clinical and psychological variables relate to quality of life in end-stage renal disease? Validating a proximal–distal model. Qual Life Res 2013; 23:677-86. [DOI: 10.1007/s11136-013-0499-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2013] [Indexed: 10/26/2022]
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Kotwal SS, Lan P, MacLeod A, Jardine M, Snelling P, Craig J, Cass A, Gallagher M. Comparative efficacy of a team-led treatment protocol for the management of renal anaemia. Nephrology (Carlton) 2013; 18:649-54. [PMID: 23889845 DOI: 10.1111/nep.12144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2013] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the efficacy of a team-led anaemia management protocol based on current guidelines. METHODS The effect of a treatment protocol in implementing an anaemia guideline was evaluated in a large teaching hospital, encompassing three (two in-hospital and one satellite) dialysis facilities. Quarterly data were collected, over a 6-year period, on all patients dialysing in these facilities, before and after implementation of an anaemia management treatment protocol. This protocol was developed by a physician-led team and implemented by an anaemia coordinator assisted by the unit staff. The primary outcome measure was the proportion of patients receiving erythropoietin with ferritin levels within the national guidelines target range calculated using data on haemoglobin (Hb), iron studies, dry weight and erythropoietin dose. RESULTS Data was collected on >150 patients every quarter between 2005 and 2010 (inclusive). The proportion of patients within the primary outcome target range increased from a nadir of 17% to 51% with evidence of true systematic change. The proportion of patients with Hb values within the unit target range also increased from 46% to 56% (P = 0.25) between the first and last years of the project. These changes were also associated with reduced erythropoietin drug use down to 0.44 μg/kg per week. CONCLUSION Implementation of a treatment protocol for anaemia management in haemodialysis patients was associated with greater consistency with guideline evidence and lower drug use. Achieving such guideline recommendations for ferritin targets in more than 50% of patients appears feasible.
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Affiliation(s)
- Sradha S Kotwal
- Renal and Metabolic Division, The George Institute for Global Health, Sydney, New South Wales, Australia
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Gracey DM, Snelling P, McKenzie P, Strasser SI. Tenofovir-associated Fanconi syndrome in patients with chronic hepatitis B monoinfection. Antivir Ther 2013; 18:945-8. [PMID: 23839869 DOI: 10.3851/imp2649] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2013] [Indexed: 12/22/2022]
Abstract
Tenofovir disoproxil fumarate (TDF) is increasingly used in patients with chronic hepatitis B (CHB) infection. Although associated with renal toxicity in HIV-infected patients, renal dysfunction has been reported rarely in the monoinfected CHB population. To date, TDF-associated Fanconi syndrome has not been reported. Here, we present two cases of TDF-associated Fanconi syndrome with rapid resolution after its cessation. We then discuss risk factors for TDF nephrotoxicity and its implications for screening for renal disease in those patients with CHB monoinfection on TDF, and the use of TDF in at-risk populations.
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Affiliation(s)
- David M Gracey
- Renal Unit, Royal Prince Alfred Hospital, Sydney, Australia.
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Snelling P. Intentional rounding: a critique of the evidence. Nurs Times 2013; 109:19-21. [PMID: 23789144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Intentional rounding has been heavily promoted by the prime minister David Cameron and others and is being widely implemented in UK hospitals. It is claimed that the practice has a number of benefits, including reduction in call bell use, falls and pressure ulcers and increased satisfaction. In this article, I will submit these claims to close scrutiny and argue that the evidence base is too flimsy to support the claims. Similarly, the Friends and Family test is being implemented despite the absence of any supportive evidence. The Francis report stated that change cannot be implemented through top-down pronouncements, and yet this is exactly what is happening with rounding and the Friends and Family test. Individual nurses and nurse managers should look more to evidence than to political expedience when implementing nursing policies.
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Snelling P. "Rounding is an evidence-free idea driven by political whim". Nurs Times 2013; 109:9. [PMID: 23621076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Coentrao L, Ribeiro C, Santos-Araujo C, Neto R, Pestana M, Rahman E, Rahman H, Ahmed D, Mousa D, El Bishlawi M, Shibahara H, Shibahara N, Takahashi S, Dupuis E, Duval X, Dornic Q, Bonnal C, Lucet JC, Cerceau O, Randoux C, Balde C, Besson F, Mentre F, Vrtovsnik F, Koutroubas G, Malindretos P, Zagotsis G, Makri P, Syrganis C, Mambelli E, Mancini E, Elia C, Guadagno V, Facchini MG, Zucchelli A, Grazia M, Patregnani L, Santoro A, Stefan G, Stefan G, Stancu S, Capusa C, Ailioaiei OR, Mircescu G, Anwar S, Little C, Kingston R, Diwakar P, Kaikini R, Syrganis C, Koutroubas G, Zagotsis G, Malindretos P, Makri P, Nikolaou E, Loukas G, Sabry A, Alsaran K, Al Sherbeiny S, Abdulkader M, Kwak I, Song S, Seong E, Lee S, Lee D, Kim I, Rhee H, Silva F, Queiros J, Malheiro J, Cabrita A, Rocha A, Bamidis P, Bamidis P, Liaskos C, Chryssogonidis I, Frantzidis C, Papagiannis A, Vrochides D, Lasaridis A, Nikolaidis P, Malindretos P, Kotwal S, Muir C, Hawley C, Snelling P, Gallagher M, Jardine M, Shibata K, Shibata K, Toya Y, Umemura S, Iwamoto T, Ono S, Ikeda E, Kitazawa A, Kuji T, Koguchi N, Satta H, Nishihara M, Kawata S, Kaneda T, Yamada Y, Murakami T, Yanagi M, Yasuda G, Mathieu S, Yves D, Jean-Michel T, Nicolas Q, Jean-Francois C, Ibrahim M, Abdel Salam M, Awadalla A, Bichari W, Zaki S, Roca-Tey R, Samon R, Ibrik O, Roda A, Gonzalez-Oliva JC, Martinez-Cercos R, Viladoms J, Lin CC, Yang WC, Kim YO, Yoon SA, Yun YS, Song HC, Kim BS, Cheong MA, Ogawa T, Kiba T, Okazaki S, Hatano M, Iwanaga M, Noiri C, Matsuda A, Hasegawa H, Mitarai T, DI Napoli A, DI Lallo D, Tazza L, De Cicco C, Salvatori MF, Chicca S, Guasticchi G, Gelev S, Trajceska L, Srbinovska E, Pavleska S, Oncevski A, Dejanov P, Gerasomovska V, Selim G, Sikole A, Wilson S, Mayne T, Krishnan M, Holland J, Volz A, Good L, Nissenson A, Stavroulopoulos A, Aresti V, Maragkakis G, Kyriakides S, Rikker C, Rikker C, Juhasz E, Tornoci L, Tovarosi S, Greguschik J, Mag O, Rosivall L, Golebiowski T, Golebiowski T, Watorek E, Kusztal M, Letachowicz K, Letachowicz W, Madziarska K, Augustyniak Bartosik H, Krajewska M, Weyde W, Klinger M, Capitanini A, Lange S, Cupisti A, Schier T, Gobel G, Bosmuller C, Gruber I, Tiefenthaler M, Shipley T, Adam J, Sweeney D, Fenwick S, Mansy H, Ahmed S, Moore I, Iwamoto T, Shibata K, Yasuda G, Kaneda T, Murakami T, Kuji T, Koguchi N, Satta H, Nishihara M, Kawata S, Yanagi M, Yamada Y, Ono S, Ikeda E, Kitazawa A, Toya Y, Umemura S, Vigeral P, Saksi S, Flamant M, Boulanger H, Kim YO, Yoon SA, Yun YS, Song HC, Kim BS, Park WD, Cheong MA, Nikam M, Tavakoli A, Chemla E, Evans J, Malete H, Matyas L, Mogan I, Lazarides M, Ebner A, Shi Y, Shi Y, Zhang J, Cheng J, Frank LR, Melanie H, Dominique B, Michel G, Ikeda K, Yasuda T, Yotueda H, Nikam M, Ebah L, Jayanti A, Evans J, Kanigicherla D, Summers A, Manley G, Dutton G, Chalmers N, Mitra S, Checherita IA, Niculae A, Radulescu D, David C, Turcu FL, Ciocalteu A, Persic V, Persic V, Buturovic-Ponikvar J, Ponikvar R, Touam M, Touam M, Menoyo V, Drueke T, Rifaat M, Muresan C, Abtahi M, Koochakipour Z, Joly D, Baharani J, Rizvi S, Ng KP, Buzzi L, Sarcina C, Alberghini E, Ferrario F, Baragetti I, Santagostino G, Furiani S, Corghi E, Sarcina C, Terraneo V, Rastelli F, Bacchini G, Pozzi C, Adorati Menegato M, Mortellaro R, Locicero A, Romano A, Manzini PP, Steckiph D, Shintaku S, Kawanishi H, Moriishi M, Bansyodani M, Nakamura S, Saito M, Tsuchiya S, Barros F, Vaz R, Carvalho B, Neto R, Martins P, Pestana M, Likaj E, Likaj E, Seferi S, Rroji M, Idrizi A, Duraku A, Barbullushi M, Thereska N, Shintaku S, Kawanishi H, Moriishi M, Bansyodani M, Nakamura S, Saito M, Tsuchiya S. Vascular access. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Morton RL, Snelling P, Webster AC, Rose J, Masterson R, Johnson DW, Howard K. Dialysis modality preference of patients with CKD and family caregivers: a discrete-choice study. Am J Kidney Dis 2012; 60:102-11. [PMID: 22417786 DOI: 10.1053/j.ajkd.2011.12.030] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Accepted: 12/29/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND Dialysis modality preferences of patients with chronic kidney disease (CKD) and family caregivers are important, yet rarely quantified. STUDY DESIGN Prospective, unlabeled, discrete-choice experiment with random-parameter logit analysis. SETTING & PARTICIPANTS Adults with stages 3-5 CKD and caregivers educated about dialysis treatment options from 8 Australian renal clinics. PREDICTORS Preferences for and trade-offs between the dialysis treatment attributes of life expectancy, number of hospital visits per week, ability to travel, hours per treatment, treatment time of day, subsidized transport service, and flexibility of treatment schedule. OUTCOMES & MEASUREMENTS Results presented as ORs for preferring home-based or in-center dialysis to conservative care. RESULTS 105 predialysis patients and 73 family caregivers completed the study. Median patient age was 63 years, and mean estimated glomerular filtration rate was 18.1 (range, 6-34) mL/min/1.73 m(2). Median caregiver age was 61 years. Home-based dialysis (either peritoneal or home hemodialysis) was chosen by patients in 65% of choice sets; in-center dialysis, in 35%; and conservative care, in 10%. For caregivers, this was 72%, 25%, and 3%, respectively. Both patients and caregivers preferred longer rather than shorter hours of dialysis (ORs of 2.02 [95% CI, 1.51-2.70] and 2.67 [95% CI, 1.85-3.85] for patients and caregivers, respectively), but were less likely to choose nocturnal than daytime dialysis (ORs of 0.07 [95% CI, 0.01-0.75] and 0.03 [95% CI, 0.01-0.20]). Patients were willing to forgo 23 (95% CI, 19-27) months of life expectancy with home-based dialysis to decrease their travel restrictions. For caregivers, this was 17 (95% CI, 16-18) patient-months. LIMITATIONS Data were limited to stated preferences rather than actual choice of dialysis modality. CONCLUSIONS Our study suggests that it is rare for caregivers to prefer conservative nondialytic care for family members with CKD. Home-based dialysis modalities that enable patients and their family members to travel with minimal restriction would be strongly aligned with the preferences of both parties.
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Affiliation(s)
- Rachael L Morton
- Sydney School of Public Health, The University of Sydney, NSW, Australia.
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Morton RL, Snelling P, Webster AC, Rose J, Masterson R, Johnson DW, Howard K. Factors influencing patient choice of dialysis versus conservative care to treat end-stage kidney disease. CMAJ 2012; 184:E277-83. [PMID: 22311947 DOI: 10.1503/cmaj.111355] [Citation(s) in RCA: 138] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND For every patient with chronic kidney disease who undergoes renal-replacement therapy, there is one patient who undergoes conservative management of their disease. We aimed to determine the most important characteristics of dialysis and the trade-offs patients were willing to make in choosing dialysis instead of conservative care. METHODS We conducted a discrete choice experiment involving adults with stage 3-5 chronic kidney disease from eight renal clinics in Australia. We assessed the influence of treatment characteristics (life expectancy, number of visits to the hospital per week, ability to travel, time spent undergoing dialysis [i.e., time spent attached to a dialysis machine per treatment, measured in hours], time of day at which treatment occurred, availability of subsidized transport and flexibility of the treatment schedule) on patients' preferences for dialysis versus conservative care. RESULTS Of 151 patients invited to participate, 105 completed our survey. Patients were more likely to choose dialysis than conservative care if dialysis involved an increased average life expectancy (odds ratio [OR] 1.84, 95% confidence interval [CI] 1.57-2.15), if they were able to dialyse during the day or evening rather than during the day only (OR 8.95, 95% CI 4.46-17.97), and if subsidized transport was available (OR 1.55, 95% CI 1.24-1.95). Patients were less likely to choose dialysis over conservative care if an increase in the number of visits to hospital was required (OR 0.70, 95% CI 0.56-0.88) and if there were more restrictions on their ability to travel (OR=0.47, 95%CI 0.36-0.61). Patients were willing to forgo 7 months of life expectancy to reduce the number of required visits to hospital and 15 months of life expectancy to increase their ability to travel. INTERPRETATION Patients approaching end-stage kidney disease are willing to trade considerable life expectancy to reduce the burden and restrictions imposed by dialysis.
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Affiliation(s)
- Rachael L Morton
- Sydney School of Public Health, the University of Sydney, Sydney, Australia.
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Morton RL, Turner RM, Howard K, Snelling P, Webster AC. Patients who plan for conservative care rather than dialysis: a national observational study in Australia. Am J Kidney Dis 2011; 59:419-27. [PMID: 22014401 DOI: 10.1053/j.ajkd.2011.08.024] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Accepted: 08/08/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND It is unclear how many incident patients with stage 5 chronic kidney disease (CKD) referred to nephrologists are presented with information about conservative care as a treatment option and how many plan not to dialyze. STUDY DESIGN National observational survey study with random-effects logistic regression. SETTING & PARTICIPANTS Incident adult and pediatric pre-emptive transplant, dialysis, and conservative-care patients from public and private renal units in Australia, July to September 2009. PREDICTORS Age, sex, health insurance status, language, time known to nephrologist, timing of information, presence of caregiver, unit conservative care pathway, and size of unit. OUTCOMES & MEASUREMENTS The 2 main outcome measures were information provision to incident patients about conservative care and initial treatment regardless of planned conservative care. RESULTS 66 of 73 renal units (90%) participated. 10 (15%) had a formal conservative-care pathway. Of 721 incident patients with stage 5 CKD, 470 (65%) were presented with conservative care as a treatment option and 102 (14%) planned not to dialyze; median age was 80 years. Multivariate analysis for information provision showed that patients older than 65 years (OR, 3.40; 95% CI, 1.97-5.87) and those known to a nephrologist for more than 3 months (OR, 6.50; 95% CI, 3.18-13.30) were more likely to receive information about conservative care. Patients with conservative care as planned initial treatment were more likely to be older than 65 years (OR, 4.71; 95% CI, 1.77-12.49) and women (OR, 2.23; 95% CI, 1.23-4.02) than those who started dialysis therapy. Those with private health insurance were less likely to forgo dialysis therapy (OR, 0.40; 95% CI, 0.17-0.98). LIMITATIONS Cross-sectional design prohibited longer term outcome measurement. Excluded patients with stage 5 CKD managed in the community. CONCLUSIONS 1 in 7 patients with stage 5 CKD referred to nephrologists plans not to dialyze. Comprehensive service provision with integrated palliative care needs to be improved to meet the demands of the aging population.
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Chan R, Brooks R, Erlich J, Gallagher M, Snelling P, Chow J, Suranyi M. Studying psychosocial adaptation to end-stage renal disease: the proximal-distal model of health-related outcomes as a base model. J Psychosom Res 2011; 70:455-64. [PMID: 21511076 DOI: 10.1016/j.jpsychores.2010.11.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Revised: 11/18/2010] [Accepted: 11/18/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Studying psychosocial adaptation in end-stage renal disease (ESRD) is increasingly important, as it may explain the variability in health outcomes unaccounted for by clinical factors. The Brenner et al. proximal-distal model of health-related outcomes provides a theoretical foundation for understanding psychosocial adaptation and integrating health outcomes, clinical, and psychosocial factors (Brenner MH, Curbow B, Legro MW. The proximal-distal continuum of multiple health outcome measures: the case of cataract surgery. Med Care. 1995;33(4 Suppl):AS236-44). This study aims to empirically validate the proximal-distal model in the dialysis population and examine the impact of psychosocial factors on the model. METHODS A cross-sectional observational study was conducted with a sample of long-term dialysis patients (n=201). Eleven factors: quality of life (QoL), depression, positive affect, comorbidity, symptoms, physical functioning, disease accommodation, loss, self-efficacy, illness acceptance, and social support were measured by standardized psychometric scales. A three-month average of hemoglobin was used. Latent composite structural equation modeling was used to examine the models. RESULTS The proximal-distal model with slight modification was supported by fit statistics [χ(2)=16.04, df=13, P=.25, root mean square error of approximation (RMSEA)=0.024], indicating that the impact of clinical factors on QoL is mediated through a range of functional and psychological factors, except for hemoglobin which impacts directly on QoL. The model with additional psychosocial factors was also supported by fit statistics (χ(2)=43.59, df=41, P=.36, RMSEA=0.018). These additional factors mainly impact on symptom status, psychological states, and QoL components of the model. CONCLUSION The present study supported the proximal-distal model in the dialysis population and demonstrated the considerable impact of psychosocial factors on the model. The proximal-distal model plus psychosocial factors as a biopsychosocial model can be applied to studying psychosocial adaptation in ESRD.
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Affiliation(s)
- Ramony Chan
- Consultation Liaison Psychiatry, Liverpool Hospital, Sydney, Australia.
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Morton RL, Tong A, Webster AC, Snelling P, Howard K. Characteristics of dialysis important to patients and family caregivers: a mixed methods approach. Nephrol Dial Transplant 2011; 26:4038-46. [DOI: 10.1093/ndt/gfr177] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Morton RL, Howard K, Webster AC, Snelling P. Patient INformation about Options for Treatment (PINOT): a prospective national study of information given to incident CKD Stage 5 patients. Nephrol Dial Transplant 2010; 26:1266-74. [PMID: 20819955 DOI: 10.1093/ndt/gfq555] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Informed decision-making requires the presentation of all possible courses of action; however, it is unclear what proportion of Stage 5 chronic kidney disease (CKD) patients are routinely informed of all their treatment options. The aim of this study was to determine the effect of patient and unit characteristics on the type and timing of information provided. METHODS A prospective national multi-centre study of information was given to incident pre-emptive transplant, dialysis and conservatively managed patients in Australian renal units, over a 3-month period. RESULTS Sixty-six of 73 renal units participated in the study. Seven hundred and twenty-one incident CKD Stage 5 patients including 102 who chose not to dialyse were identified. Of these, 603 (84%) were presented with information about their options prior to commencing treatment. Three quarters (n = 543) were presented with home dialysis, one-third (n = 230) pre-emptive transplantation and 65% (n = 470) were informed about conservative care as an option. Patients were more likely to receive information prior to commencing treatment if they were known to a nephrologist for more than 3 months (OR 7.29, 95% CI 3.86-13.79) or were treated in small units with < 100 dialysis patients (OR 2.40, 95% CI 1.26-4.60). The mean estimated glomerular filtration rate at the time information was first presented was 13.3 mL/min/1.73 m(2) (95% CI 12.7-13.8) and mean serum creatinine was 449 μmol/L (95% CI 431-467). CONCLUSIONS Most Australian patients were informed of their treatment options prior to starting treatment, albeit in late stage CKD. Earlier education and support for informed decision-making may help optimize the uptake of pre-emptive transplantation and home dialysis therapies.
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Affiliation(s)
- Rachael L Morton
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.
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Chan R, Brooks R, Gallagher M, Erlich J, Snelling P, Chow J, Suranyi M. Measuring kidney disease-related loss in samples of predialysis and dialysis patients: validating the kidney disease loss scale. Clin J Am Soc Nephrol 2010; 5:1249-54. [PMID: 20498243 DOI: 10.2215/cjn.08361109] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Kidney disease-related loss is clinically significant in patients with ESRD and is related to depression and quality of life. The Kidney Disease Loss Scale (KDLS) was recently developed for long-term dialysis patients as a means of studying loss and applying it to clinical practice; however, its validity and usability in the other developmental stages of ESRD-predialysis and early dialysis-remain unknown. This study examined the validity and reliability of the KDLS in the long-term dialysis, early dialysis, and predialysis populations. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Four groups of participants were recruited from four large university teaching hospitals in the Sydney metropolitan area. Participants were long-term dialysis (n=151), early dialysis (n=163), and predialysis (n=111) patients. An additional independent group of dialysis (n=50) patients were recruited to measure the test-retest reliability. Multisample confirmatory factor analysis and correlational analysis were used. RESULTS Results demonstrated good internal consistency and test-retest reliability for KDLS. Multisample confirmatory factor analysis indicated that the factor structure of KDLS was invariant across samples and thus supported its construct validity. The convergent and discriminant validities of KDLS were supported by its correlations with scales that measure health-related quality of life, depression, and positive affect in the expected directions and magnitudes. The KDLS was sensitive to the developmental stages of ESRD. CONCLUSIONS These findings demonstrated that the concept of loss exists in dialysis patients. The KDLS is a reliable measure of loss in ESRD and valid in the developmental stages of ESRD.
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Affiliation(s)
- Ramony Chan
- Consultation Liaison Psychiatry, Renal Unit, Centre for Population mental Health Research, Liverpool Hospital, Locked Bag 7103, Liverpool BC, NSW 1871, Australia.
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Young P, Yates S, Rickaby C, Snelling P, Lipscomb M, Lockyer L. Researching student absence: methodological challenges and ethical issues. Nurse Educ Today 2010; 30:291-295. [PMID: 19758729 DOI: 10.1016/j.nedt.2009.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Revised: 07/07/2009] [Accepted: 08/03/2009] [Indexed: 05/28/2023]
Abstract
This article describes the challenges encountered in a research project aiming to explore non-attendance from the perspective of absent students. These students are nursing students in a Faculty of Health and Social Care, but the issues raised here are of wider interest. Although attendance at the sessions monitored for this project is stated to be compulsory, there is typically a non-attendance rate of around 20%. Previous studies within the Faculty have reported positively on students' views of the sessions, but have relied on data collected from students present in the university and attending the sessions. We felt it was important to correct this imbalance with the views of those students who do not attend. We hoped to access the views of students not present in the university by means of telephone interviews, carried out by a researcher independent from the course management. This article explores a number of ethical and methodological issues which arose from the research, focusing on the difficulties in gaining informed consent from students who do not attend, and the challenges in moving beyond surface responses to questions on reasons for non-attendance.
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Affiliation(s)
- Pat Young
- Faculty of Health and Life Sciences, University of the West of England, Bristol, Blackberry Hill, Bristol BS16 1DD, UK.
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Morton RL, Devitt J, Howard K, Anderson K, Snelling P, Cass A. Patient views about treatment of stage 5 CKD: a qualitative analysis of semistructured interviews. Am J Kidney Dis 2010; 55:431-40. [PMID: 20116914 DOI: 10.1053/j.ajkd.2009.11.011] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Accepted: 11/24/2009] [Indexed: 11/11/2022]
Abstract
BACKGROUND How patients choose between alternative treatments for kidney failure is poorly understood. Recent studies of chronic kidney disease report that clinical outcomes, such as life expectancy, are rarely reflected in a patient's decision for type of treatment compared with nonclinical outcomes, such as time on dialysis therapy, convenience, or impact on the family. METHODS A qualitative analysis using thematic synthesis of patient views about renal replacement therapy (RRT) was undertaken. As part of a national study of patients and renal health care providers, we interviewed 95 Australian dialysis and transplant patients to explore how they perceive these alternative treatments. RESULTS 52 patients were on satellite hemodialysis therapy, 8 patients were on incenter hemodialysis therapy, 8 patients were on continuous ambulatory peritoneal dialysis therapy, 5 patients were on automated peritoneal dialysis therapy, 4 patients were on home hemodialysis therapy, and 18 patients had a functioning transplant at the time of interview. Freedom, convenience, self-care, effectiveness, and simplicity were commonly cited positive characteristics, whereas confinement, risk, family burden, pain, and time commitment were negative characteristics associated with RRTs. Characteristics were not specific to dialysis modalities, and some (eg, self-care) were seen as both positive and negative. A limitation of the study was that only 17 of 77 (22%) dialysis patients interviewed were on a home-based therapy. CONCLUSIONS Patients preferred RRTs that enhanced their freedom and autonomy and were convenient, effective, and simple. Treatments that minimized confinement and risk also were viewed positively. Our analysis suggests that patients might choose between therapies based on their perception regarding which therapy most embodies particular characteristics that minimize impact on their lifestyle. Presentation of information regarding RRTs should focus on these characteristics and the potential impact of alternative treatments on the patients and how they wish to lead their lives.
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Affiliation(s)
- Rachael L Morton
- School of Public Health, University of Sydney, Sydney, Australia.
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Morton RL, Tong A, Howard K, Snelling P, Webster AC. The views of patients and carers in treatment decision making for chronic kidney disease: systematic review and thematic synthesis of qualitative studies. BMJ 2010; 340:c112. [PMID: 20085970 PMCID: PMC2808468 DOI: 10.1136/bmj.c112] [Citation(s) in RCA: 342] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/30/2009] [Indexed: 12/03/2022]
Abstract
OBJECTIVE To synthesise the views of patients and carers in decision making regarding treatment for chronic kidney disease, and to determine which factors influence those decisions. DESIGN Systematic review of qualitative studies of decision making and choice for dialysis, transplantation, or palliative care, and thematic synthesis of qualitative studies. DATA SOURCES Medline, PsycINFO, CINAHL, Embase, social work abstracts, and digital theses (database inception to week 3 October 2008) to identify literature using qualitative methods (focus groups, interviews, or case studies). Review methods Thematic synthesis involved line by line coding of the findings of the primary studies and development of descriptive and analytical themes. RESULTS 18 studies that reported the experiences of 375 patients and 87 carers were included. 14 studies focused on preferences for dialysis modality, three on transplantation, and one on palliative management. Four major themes were identified as being central to treatment choices: confronting mortality (choosing life or death, being a burden, living in limbo), lack of choice (medical decision, lack of information, constraints on resources), gaining knowledge of options (peer influence, timing of information), and weighing alternatives (maintaining lifestyle, family influences, maintaining the status quo). CONCLUSIONS The experiences of other patients greatly influenced the decision making of patients and carers. The problematic timing of information about treatment options and synchronous creation of vascular access seemed to predetermine haemodialysis and inhibit choice of other treatments, including palliative care. A preference to maintain the status quo may explain why patients often remain on their initial therapy.
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Affiliation(s)
- R L Morton
- Sydney School of Public Health, University of Sydney, Sydney, NSW 2006, Australia.
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Johnson DW, Clark C, Isbel NM, Hawley CM, Beller E, Cass A, de Zoysa J, McTaggart S, Playford G, Rosser B, Thompson C, Snelling P. The Honeypot Study Protocol: A Randomized Controlled Trial of Exit-Site Application of Medihoney Antibacterial Wound Gel for the Prevention of Catheter-Associated Infections in Peritoneal Dialysis Patients. Perit Dial Int 2009. [DOI: 10.1177/089686080902900315] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Objectives The primary objective of this study is to determine whether daily exit-site application of standardized antibacterial honey (Medihoney Antibacterial Wound Gel; Comvita, Te Puke, New Zealand) results in a reduced risk of catheter-associated infections in peritoneal dialysis (PD) patients compared with standard topical mupirocin prophylaxis of nasal staphylococcal carriers. Design Multicenter, prospective, open label, randomized controlled trial. Setting PD units throughout Australia and New Zealand. Participants The study will include both incident and prevalent PD patients (adults and children) for whom informed consent can be provided. Patients will be excluded if they have had ( 1 ) a history of psychological illness or condition that interferes with their ability to understand or comply with the requirements of the study; ( 2 ) recent (within 1 month) exit-site infection, peritonitis, or tunnel infection; ( 3 ) known hypersensitivity to, or intolerance of, honey or mupirocin; ( 4 ) current or recent (within 4 weeks) treatment with an antibiotic administered by any route; or ( 5 ) nasal carriage of mupirocin-resistant Staphylococcus aureus. Methods 370 subjects will be randomized 1:1 to receive either daily topical exit-site application of Medihoney Antibacterial Wound Gel (all patients) or nasal application of mupirocin if staphylococcal nasal carriage is demonstrated. All patients in the control and intervention groups will perform their usual exit-site care according to local practice. The study will continue until 12 months after the last patient is recruited (anticipated recruitment time is 24 months). Main Outcome Measures The primary outcome measure will be time to first episode of exit-site infection, tunnel infection, or peritonitis, whichever comes first. Secondary outcome measures will include time to first exit-site infection, time to first tunnel infection, time to first peritonitis, time to infection-associated catheter removal, catheter-associated infection rates, causative organisms, incidence of mupirocin-resistant microbial isolates, and other adverse reactions. Conclusions This multicenter Australian and New Zealand study has been designed to provide evidence to help nephrologists and their PD patients determine the optimal strategy for preventing PD catheter-associated infections. Demonstration of a significant improvement in PD catheter-associated infections with topical Medihoney will provide clinicians with an important new prophylactic strategy with a low propensity for promoting antimicrobial resistance.
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Affiliation(s)
- David W. Johnson
- Australasian Kidney Trials Network, University of Queensland
- Department of Nephrology, Princess Alexandra Hospital, Brisbane
| | - Carolyn Clark
- Australasian Kidney Trials Network, University of Queensland
- Department of Nephrology, Princess Alexandra Hospital, Brisbane
| | - Nicole M. Isbel
- Australasian Kidney Trials Network, University of Queensland
- Department of Nephrology, Princess Alexandra Hospital, Brisbane
| | - Carmel M. Hawley
- Australasian Kidney Trials Network, University of Queensland
- Department of Nephrology, Princess Alexandra Hospital, Brisbane
| | - Elaine Beller
- Australasian Kidney Trials Network, University of Queensland
| | - Alan Cass
- Australasian Kidney Trials Network, University of Queensland
- The George Institute for International Health, Sydney, Australia
| | - Janak de Zoysa
- Australasian Kidney Trials Network, University of Queensland
- Department of Renal Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Steven McTaggart
- Australasian Kidney Trials Network, University of Queensland
- Child&Adolescent Renal Service, Royal Children's and Mater Children's Hospitals
| | - Geoffrey Playford
- Australasian Kidney Trials Network, University of Queensland
- Infection Management Services, Princess Alexandra Hospital, Brisbane
| | - Brenda Rosser
- Australasian Kidney Trials Network, University of Queensland
| | | | - Paul Snelling
- Australasian Kidney Trials Network, University of Queensland
- Department of Nephrology, Royal Prince Alfred Hospital, Sydney, Australia
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Johnson DW, Clark C, Isbel NM, Hawley CM, Beller E, Cass A, de Zoysa J, McTaggart S, Playford G, Rosser B, Thompson C, Snelling P. The honeypot study protocol: a randomized controlled trial of exit-site application of medihoney antibacterial wound gel for the prevention of catheter-associated infections in peritoneal dialysis patients. Perit Dial Int 2009; 29:303-309. [PMID: 19458303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVES The primary objective of this study is to determine whether daily exit-site application of standardized antibacterial honey (Medihoney Antibacterial Wound Gel; Comvita, Te Puke, New Zealand) results in a reduced risk of catheter-associated infections in peritoneal dialysis (PD) patients compared with standard topical mupirocin prophylaxis of nasal staphylococcal carriers. DESIGN Multicenter, prospective, open label, randomized controlled trial. SETTING PD units throughout Australia and New Zealand. PARTICIPANTS The study will include both incident and prevalent PD patients (adults and children) for whom informed consent can be provided. Patients will be excluded if they have had (1) a history of psychological illness or condition that interferes with their ability to understand or comply with the requirements of the study; (2) recent (within 1 month) exit-site infection, peritonitis, or tunnel infection; (3) known hypersensitivity to, or intolerance of, honey or mupirocin; (4) current or recent (within 4 weeks) treatment with an antibiotic administered by any route; or (5) nasal carriage of mupirocin-resistant Staphylococcus aureus. METHODS 370 subjects will be randomized 1:1 to receive either daily topical exit-site application of Medihoney Antibacterial Wound Gel (all patients) or nasal application of mupirocin if staphylococcal nasal carriage is demonstrated. All patients in the control and intervention groups will perform their usual exit-site care according to local practice. The study will continue until 12 months after the last patient is recruited (anticipated recruitment time is 24 months). MAIN OUTCOME MEASURES The primary outcome measure will be time to first episode of exit-site infection, tunnel infection, or peritonitis, whichever comes first. Secondary outcome measures will include time to first exit-site infection, time to first tunnel infection, time to first peritonitis, time to infection-associated catheter removal, catheter-associated infection rates, causative organisms, incidence of mupirocin-resistant microbial isolates, and other adverse reactions. CONCLUSIONS This multicenter Australian and New Zealand study has been designed to provide evidence to help nephrologists and their PD patients determine the optimal strategy for preventing PD catheter-associated infections. Demonstration of a significant improvement in PD catheter-associated infections with topical Medihoney will provide clinicians with an important new prophylactic strategy with a low propensity for promoting antimicrobial resistance.
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Affiliation(s)
- David W Johnson
- Australasian Kidney Trials Network, University of Queensland, Australia.
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Cass A, Snelling P, Cunningham J, Wang Z, Hoy W. Timing of nephrology referral: a study of its effects on the likelihood of transplantation and impact on mortality. Nephrology (Carlton) 2008. [DOI: 10.1046/j.1440-1797.7.s.15.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Devitt J, Cass A, Cunningham J, Preece C, Anderson K, Snelling P. Study Protocol--Improving Access to Kidney Transplants (IMPAKT): a detailed account of a qualitative study investigating barriers to transplant for Australian Indigenous people with end-stage kidney disease. BMC Health Serv Res 2008; 8:31. [PMID: 18248667 PMCID: PMC2275237 DOI: 10.1186/1472-6963-8-31] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2007] [Accepted: 02/04/2008] [Indexed: 11/12/2022] Open
Abstract
Background Indigenous Australians are slightly more than 2% of the total Australian population however, in recent years they have comprised between 6 and 10% of new patients beginning treatment for end-stage kidney disease (ESKD). Although transplant is considered the optimal form of treatment for many ESKD patients there is a pronounced disparity between the rates at which Indigenous ESKD patients receive transplants compared with their non-Indigenous counterparts. The IMPAKT (Improving Access to Kidney Transplants) Interview study investigated reasons for this disparity through a large scale, in-depth interview study involving patients, nephrologists and key decision-making staff at selected Australian transplant and dialysis sites. Methods The design and conduct of the study reflected the multi-disciplinary membership of the core IMPAKT team. Promoting a participatory ethos, IMPAKT established partnerships with a network of hospital transplant units and hospital dialysis treatment centres that provide treatment to the vast majority of Indigenous patients across Australia. Under their auspices, the IMPAKT team conducted in-depth interviews in 26 treatment/service centres located in metropolitan, regional and remote Australia. Peer interviewing supported the engagement of Indigenous patients (146), and nephrologists (19). In total IMPAKT spoke with Indigenous and non-Indigenous patients (241), key renal nursing and other (non-specialist) staff (95) and a small number of relevant others (28). Data analysis was supported by QSR software. At each site, IMPAKT also documented educational programs and resources, mapped an hypothetical ‘patient journey’ to transplant through the local system and observed patient care and treatment routines. Discussion The national scope, inter-disciplinary approach and use of qualitative methods in an investigation of a significant health inequality affecting Indigenous people is, we believe, an Australian first. An exceptionally large cohort of Indigenous participants provided evaluative comment on their health services in relation to dialysis and transplant. Additionally, the data includes extensive parallel commentary from a cohort of specialists, nurses and other staff. The study considers a ‘patient journey’ to transplant within a diverse range of Australian treatment centre/workplace settings. The IMPAKT Interview study protocol may contribute to improvements in multi-disciplinary, flexible design health services research with hard to reach or vulnerable populations in Australia and elsewhere.
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Affiliation(s)
- Jeannie Devitt
- The George Institute for International Health, PO Box M201, Missenden Road Sydney, NSW, 2050 Australia.
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Snelling P. Death's Dominion. Ethics at the End of Life. J Adv Nurs 2007. [DOI: 10.1111/j.1365-2648.2007.04454_5.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Cass A, Cunningham J, Anderson K, Snelling P, Colman S, Devitt J, Preece C, Eris J. Decision-making about suitability for kidney transplantation: Results of a national survey of Australian nephrologists. Nephrology (Carlton) 2007; 12:299-304. [PMID: 17498127 DOI: 10.1111/j.1440-1797.2007.00784.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM This study aimed to elucidate the factors affecting nephrologists' decision-making on patients' suitability for kidney transplantation. Given the reduced access to transplantation for Indigenous Australians, the role of patient's ethnicity was of particular interest. METHODS A postal survey of practising nephrologists and trainees was undertaken in Australia. Each participant was provided with a unique set of 15 hypothetical patient descriptions, with demographic, clinical and behavioural factors randomly generated to ensure an overall balance of factors across the cases. The main outcome measure was whether kidney transplantation was recommended. RESULTS Responding nephrologists and trainees were more likely to recommend transplantation for hypothetical patients who were young, of normal weight and described as compliant. They were less likely to recommend transplantation for smokers, or for people with diabetes or heart disease. No significant differences related to the patients' sex or ethnicity. The geographical location of the respondent was a significant determinant, with differences according to their State/Territory and their metropolitan/non-metropolitan location. CONCLUSION When all other factors were held constant, nephrologists and trainees appear to base their decision-making regarding suitability for transplant on clinical and behavioural factors, rather than on the basis of ethnicity or sex. In practice, however, clinical and behavioural factors cluster with ethnicity, and this is likely to contribute to the current poor access to transplantation for Indigenous end-stage kidney disease patients. Apparent differences in decision-making according to the respondent's location may reflect variations in practice across the country.
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Affiliation(s)
- Alan Cass
- The George Institute for International Health, Central Clinical School, University of Sydney, and Statewide Renal Services, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
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Anderson K, Cass A, Cunningham J, Snelling P, Devitt J, Preece C. The use of psychosocial criteria in Australian patient selection guidelines for kidney transplantation. Soc Sci Med 2007; 64:2107-14. [PMID: 17368896 DOI: 10.1016/j.socscimed.2007.02.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2006] [Indexed: 10/23/2022]
Abstract
Psychosocial criteria are increasingly being included in practice guidelines for determining patient suitability for kidney transplantation. Although intended to promote evidence-based decision-making, if poorly defined, the inclusion of psychosocial criteria has the potential to reduce transparency in patient selection and equity of access. We reviewed all Australian practice guidelines concerning patient suitability for kidney transplantation and qualitatively analysed their inclusion of, and approach towards, psychosocial criteria. Transplant Directors from all Australian adult transplant units were invited to submit their unit's guidelines for this national research audit. All 16 units (100%) submitted some form of documentation. We analysed only those documents that were purposely structured tools for directing patient selection (eight guidelines used in 10 transplant units). Content analysis was performed on the abstracted psychosocial criteria. Psychosocial criteria--particularly non-compliance and smoking--were commonly included. In general, the psychosocial criteria were ill-defined and lacking in substantiating evidence and recommendations for assessment or action. Our results reveal that current Australian patient selection guidelines for kidney transplantation incorporate poorly defined psychosocial criteria that vary greatly. Furthermore, there appears to be a weak evidence base underpinning their inclusion. The use of psychosocial criteria in this manner decreases the transparency of patient selection and increases the potential for subjective estimates of social worth to influence patient selection. The priority given to such criteria in transplant guidelines requires attention and debate.
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Affiliation(s)
- Kate Anderson
- The George Institute, University of Sydney, Sydney, NSW, Australia.
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Snelling P. Ethical Issues in Palliative Care (second edition). J Adv Nurs 2007. [DOI: 10.1111/j.1365-2648.2007.04174.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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