Improving management of needle distress during the journey to dialysis through psychological education and training-the INJECT study feasibility pilot protocol

BACKGROUND

Needle-related distress is a common yet poorly recognised and managed problem among haemodialysis (HD) patients. The aim of this pilot study is to test the feasibility and acceptability of the INJECT Intervention-an innovative psychology-based intervention to empower patients to self-manage needle distress with the support of dialysis nurses.

METHODS

This investigator-initiated, single-arm, non-randomised feasibility study will take place in a large dialysis service in Adelaide, Australia. Participants will include patients aged ≥ 18 years, commencing or already receiving maintenance HD, recruited through dialysis physicians and nursing staff as individuals believed to be at risk of needle distress. They will be screened for inclusion using the Dialysis Fear of Injection Questionnaire (DFIQ) and enrolled into the study if the score is ≥ 2. The multi-pronged intervention encompasses (i) psychologist review, (ii) patient self-management program and (iii) nursing education program. The primary aim is to evaluate feasibility and acceptability of the intervention from patient and dialysis nurse perspectives, including recruitment, retention, engagement with the intervention and completion. Secondary exploratory outcomes will assess suitability of various tools for measuring needle distress, evaluate acceptability of the nursing education program and measure cannulation-related trauma and vascular access outcomes.

CONCLUSION

The results will inform the protocol for larger trials addressing needle distress in HD patients.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621000229875, approved 4 April 2021, https://www.anzctr.org.au/ .

The colonic response to genotoxic carcinogens in the rat: regulation by dietary fibre

The apoptotic response to DNA damage appears to be an innate biological mechanism for protection against tumourigenesis. It is possible that agents that protect against colorectal cancer act by enhancing the apoptotic deletion of cells suffering DNA damage, with consequent removal of those with tumourigenic mutations. We examined the acute apoptotic response to genotoxic carcinogens ("AARGC") in colonic epithelium and the possibility that dietary fibres of different fermentability might regulate AARGC. To fully define the time-course and nature of AARGC in response to the carcinogen azoxymethane (AOM), a single injection of AOM (10 mg/kg) was given to rats and apoptosis monitored in the colon by light microscopy and terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labelling staining over a 72 h period. Having defined the site and time of maximum response, two groups of eight rats were fed diets containing 10% wheat bran fibre (WB; fermentable) or 10% methylcellulose (MC; poorly fermentable) for 4 weeks. Colonic AARGC was compared by light microscopy; lumenal short chain fatty acids (SCFAs) and pH were measured as indicators of the fermentative environment. AOM-induced AARGC was maximal at 8 h and greater in distal compared with proximal colon. Apoptotic cells were situated predominantly in the lower half of the crypt, with the median at position 9 indicating involvement of daughter as well as stem cells. There was no "second wave" of apoptosis within 72 h as follows irradiation in small intestine. Distal colonic AARGC in rats fed WB was twice that in rats fed MC (P < 0.01). Compared with MC, WB significantly lowered lumenal pH and increased all SCFAs including butyrate, while proliferation did not differ between the fibres. Certainly, dietary fibres can regulate AARGC and further studies are warranted to determine if this biological effect is the way in which dietary factors regulate tumourigenesis. Lumenal generation of butyrate may enhance AARGC as butyrate is proapoptotic in vitro.

Effect of high-amylose starch and oat bran on metabolic variables and bowel function in subjects with hypertriglyceridemia

We compared the effects of a diet in which approximately 25% of the carbohydrate was replaced by high-amylose starch with those of a similar diet high in oat bran or low-amylose starch in 23 hypertriglyceridemic subjects who were overweight mostly because of abdominal adiposity. Each diet was consumed for 4 wk in random order and in a crossover fashion. Overall, the diets were high in carbohydrate (> 55% of energy) and low in fat (< 30% of energy); the amount of resistant starch in the foods containing high-amylose starch was 17 g in women and 25 g in men. The metabolic effects of specific starches on plasma lipids, fasting and postprandial glucose and insulin profiles, and bowel function were assessed at the end of each intervention. Plasma triacylglycerols (triglycerides) were significantly lower after the oat bran diet than after the other two diets (P < 0.02). No other effects on fasting plasma lipids, glucose, or insulin were noted. However, when the high-amylose starch comprised 33% of the carbohydrate content in a test meal, there was a significant but biologically small reduction in the overall postprandial plasma insulin concentration by 17% relative to the low-amylose diet (P < 0.01). Both the oat bran and the high-amylose diet resulted in an increased frequency of bowel actions and lower fecal pH (P < 0.02) relative to the low-amylose diet. However, unlike the oat bran diet, the high-amylose diet increased short-chain fatty acid concentrations in fecal water by 32% (P < 0.001).