Patient engagement during the transition from nondialysis-dependent chronic kidney disease to dialysis: A meta-ethnography.

INTRODUCTION: Patient engagement, encompassing both patient experience and opportunities for involvement in care, has been associated with increased patient satisfaction and the overall quality of care. Despite its importance, there is limited knowledge regarding patient engagement in the transition from nondialysis-dependent chronic kidney disease (CKD) to dialysis-dependent treatment. This systematic review employs meta-ethnography to synthesize findings from qualitative studies examining patients' experiences of engagement during this transition, with the aim of developing a comprehensive theoretical understanding of patient engagement in the transition from nondialysis-dependent CKD to dialysis. METHODS: A systematic search of six databases, namely the Cochrane Library, PsycINFO, Scopus, Embase, PubMed and Web of Science was conducted to identify eligible articles published between 1990 and 2022. Meta-ethnography was utilized to translate and synthesize the findings and develop a novel theoretical interpretation of 'patient engagement' during the transition to dialysis. RESULTS: A total of 24 articles were deemed eligible for review, representing 21 studies. Patient engagement during a transition to dialysis was found to encompass three major domains: psychosocial adjustment, decision-making and engagement in self-care. These three domains could be experienced as an iterative and mutually reinforcing process, guiding patients toward achieving control and proficiency in their lives as they adapt to dialysis. Additionally, patient engagement could be facilitated by factors including patients' basic capability to engage, the provision of appropriate education, the establishment of supportive relationships and the alignment with values and resources. CONCLUSIONS: The findings of this review underscore the necessity of involving patients in transitional dialysis care, emphasizing the need to foster their engagement across multiple domains. Recommendations for future interventions include the provision of comprehensive support to enhance patient engagement during this critical transition phase. Additional research is warranted to explore the effects of various facilitators at different levels. PATIENT OR PUBLIC CONTRIBUTION: The studies included in our review involved 633 participants (547 patients, 14 family members, 63 healthcare providers and 9 managers). Based on their experiences, views and beliefs, we developed a deeper understanding of patient engagement and how to foster it in the future.

Association of recent major psychological stress with cardiac arrest: A case-control study.

OBJECTIVE: We hypothesized that major psychological stress can be a risk factor for cardiac arrest and that effects are modified by elapsed time from specific stressful events. METHODS: Case-control study was conducted using database for cardiac arrest and emergency department (ED) visiting. Cases included adult patients with cardiac arrest with presumed cardiac etiology. Controls were matched with sex and age and visiting day from unintentional injured patients in same ED. The occurrence of 9 major life events (MLEs) such as a divorce within 1year was used as a proxy measure of major psychological stress. A multivariable conditional logistic regression conducted to estimate the effect of MLEs on the risk of cardiac arrest according to the elapsed time from the MLEs. RESULTS: A total of 95 patients with cardiac arrest and 95 controls were assessed. In the case group, a total of 58 MLEs occurred, while 33 MLEs occurred in the control group during the same period. Recent MLEs were associated with a higher risk of sudden cardiac arrest (AOR 2.26 [95% CI:1.01-5.03]). The AORs of cardiac arrest were 4.65 (95% CI, 1.38-15.67) and 7.02 (95% CI, 2.03-24.48) among participants experiencing MLEs within the last 0-3months and those experiencing MLEs within the last 0-6months, respectively. Cardiac arrest and MLEs in participants experiencing MLEs between 7 and 12months prior showed no association (AOR 4.76 [95% CI, 0.97-18.36]). CONCLUSIONS: MLEs were associated with cardiac arrest occurrence, and the effect was modified by the elapsed time from the MLEs.

"Perhaps I will die young." Fears and worries regarding disease and death among Danish adolescents and young adults with cancer. A mixed method study.

PURPOSE: A cross-sectional national study was initiated in order to evaluate healthcare services and survivorship from the perspective of Danish adolescents and young adults (AYAs) with cancer. The purpose of the paper was to examine (Q1) to what extend Danish AYAs experienced fears and worries about dying; (Q2) with whom, if anyone, they had shared those worries; and finally, (Q3) how fears and worries influenced their daily life. The emphasis will be on Q3. METHODS: A 151-item questionnaire (including two closed- and one open-ended questions about fears of death and dying) was distributed among all 15-29-year-old Danes registered with a cancer diagnosis from 2009 to 2013. A total study population of 822 persons participated. Data was analyzed using a mixed design of descriptive statistics and qualitative content analysis. RESULTS: Q1: Almost 80 % of AYAs with cancer expressed some worries about death; hereof, more than half of them expressed quite a bit or very much. The analysis showed significant gender differences, whereas age and duration of disease did not have any significant impact on such thoughts. Q2: One third had not talked to anybody about his or her worries. Q3: The analysis resulted in three overall categories: fear of disease and death having little or no influence (n = 100), fear influencing in various ways (n = 215), and fear of disease and death having a substantial influence (n = 75). CONCLUSIONS: The majority of AYAs had experienced fears and worries about dying, but one third of them had not talked to anybody about those thoughts. It is an important clinical point that young age does not preclude fears and worries about dying in AYAs with cancer.

The Influence of COVID-19 Lockdown on Physical Activity, Sedentary Behavior and Social Support Specific to Physical Activity Among Belgian Adults.

In Belgium, lockdown measures were taken to counter the spread of COVID-19. This major life-change event may disrupt a person's daily routine and influence health behaviors. Although measures were restrictive, citizens were encouraged to engage in physical activity (PA) behavior in order to maintain well-being. Social support specific to PA (SSPA) had been highlighted as an important psychosocial factor in initiating and/or maintaining active behavior. The main aims of this study were to explore the influence of COVID-19 lockdown on PA and sedentary behavior, and on SSPA from family and from friends; and investigate the potential differences in terms of professional status. An online survey was distributed during the 1st weeks of the lockdown. A total of 272 Belgian adults responded to the survey. The findings show no significant difference between prior to and during lockdown with regard to the amount of PA. The results show a significant increase in sedentary behavior among the entire sample, workers and retirees. The findings also suggest that the support of other individuals is particularly useful for certain population groups such as retirees. Given the importance of the levels of PA and sedentariness as health behaviors preceding a major life-change event such as a lockdown, there is a need to promote these health behaviors during normal life in order for the population to remain active throughout their lifespan.

[The Lived Experience of Patients with Heart Transplantation: A Phenomenological Study].

PURPOSE: The purpose of this study was to describe the lived experience of patients with heart transplantation in Korea. METHODS: Individual indepth interviews and a focus group interview were used to collect the data from nine patients who had heart transplantations in 2015. All interviews were audio-taped and verbatim transcripts were made for the analysis. Data were analyzed using Colaizzi's phenomenological method. RESULTS: Among the nine participants, eight were men. Mean age was 57.30 years. Six theme clusters emerged from the analysis. 'Joy of rebirth obtained by good luck' describes the pleasure and expectation of new life after narrow survival. 'Suffering from adverse drug effects' illustrates various psychosocial difficulties, such as low self-esteem, helplessness, alienation, and burnout, arising from the side effects of medications. 'Body and mind of being bewildered' illustrates disintegrated health and haunting fear of death. 'Alienation disconnected with society' describes isolated feeling of existence due to misunderstandings from society. 'Suffering overcome with gratitude and responsibility' includes overcoming experience through various social supports and suitable jobs. Finally, 'acceptance of suffering accompanied with new heart' illustrate changed perspective of life itself. CONCLUSION: The findings in this study provide deep understanding and insights of the lived experience of heart related illness for these patients and should help in the development of tailored-interventions for patients with heart transplantation.

Remote community-based public health nursing during a disaster: an ethnographic case study in Japan.

BACKGROUND: The Great East Japan Earthquake that occurred on March 11, 2011 generated a tsunami that directly struck Japan. Public health nurses (PHNs) played important roles in this disaster response and community recovery. This research identified a PHN's experience in an affected area. METHODS: An ethnographic case study approach was used to obtain in-depth information regarding the experiences of one PHN, using semi-structured interviews, participant observation, and statistical documents. RESULTS: Six themes were identified and explored, including that the PHN undertook overwhelming responsibilities to protect the local residents, made several autonomous decisions, and had a strong sense of mission. These were based on the relationship-building that occurred with the local residents due to the geographical characteristics and her own preparations. CONCLUSIONS: The findings encourage PHNs to participate in simulations of disasters in preparation for major catastrophes and establish good collaborative efforts with residents by being a part of the community.