Home-based family intervention increases knowledge, communication and living donation rates: a randomized controlled trial.

Our aim was to develop and test an educational program to support well-informed decision making among patients and their social network regarding living donor kidney transplantation (LDKT). One hundred sixty-three patients who were unable to find a living donor were randomized to standard care or standard care plus home-based education. In the education condition, patients and members of their social network participated in home-based educational meetings and discussed renal replacement therapy options. Patients and invitees completed pre-post self-report questionnaires measuring knowledge, risk perception, communication, self-efficacy and subjective norm. LDKT activities were observed for 6 months postintervention. Patients in the experimental group showed significantly more improvements in knowledge (p < 0.001) and communication (p = 0.012) compared with the control group. The invitees showed pre-post increases in knowledge (p < 0.001), attitude toward discussing renal replacement therapies (p = 0.020), attitude toward donating a kidney (p = 0.023) and willingness to donate a kidney (p = 0.039) and a decrease in risk perception (p = 0.003). Finally, there were significantly more inquiries (29/39 vs. 13/41, p < 0.001), evaluations (25/39 vs. 7/41, p < 0.001) and actual LDKTs (17/39 vs. 4/41, p = 0.003) in the experimental group compared with the control group. Home-based family education supports well-informed decision making and promotes access to LDKT.

Design and test of a new tracheostoma valve based on inhalation.

BACKGROUND: Tracheostoma valves are used to make hand-free speaking possible for persons who have undergone a laryngectomy. OBJECTIVE: To design and test a new tracheostoma valve to improve existing tracheostoma valves. METHODS: The tracheostoma valve closes by means of strong inhalation so that all the air that is exhaled is available for phonation. The device automatically stays in the"speaking position" until the patient deliberately changes the device to the "breathing position" by a fast expiration. If all the air that has been exhaled has been consumed during phonation, the patient can inhale again, without changing the device, because a small valve automatically opens, thus allowing phonation without time limits. An experimental setup with a computer-based acquisition program was used to measure the pressure at which the valve opened and the flow at which the valve closed. The pressure and flow needed to open and close the magnetic adjustable valve were measured for different positions and contained in the computer through a data acquisition program. Also, the airflow resistance coefficients for inhaling and exhaling were measured. RESULTS: The airflow necessary to close the tracheostoma valve ranges from 1.6 to 3.8 L/s. The opening pressure of the valve ranges from 1 to 7 kPa. The airflow resistance coefficient is 290 Pa x s2 x L(-2) for inhalation and 430 Pa x s(2) x L(-2) for exhalation. CONCLUSIONS: The device appears to function well in physiological ranges and is optimally adjustable. The airflow resistance coefficient lies in the range of the entire airway resistance (120-470 Pa x s(2) x L(-2)) in quiet breathing.

Teaching safer sex in a long-term psychiatric setting.

The trend toward normalizing life in mental health institutions poses a challenge to the facility's staff in the area of sexual relations among clients. In addition to their other duties, nurses now are being asked to discuss sexual feelings with the clients as well as teach sex education, AIDS information, and safer-sex practices. Such programs need to begin with retraining of staff and institution-wide classes to determine the clients' knowledge base. One model program experienced initial resistance among staff and patients, but worked well after an adjustment period. Different methods were used successfully on the female admission unit, the addiction unit, and the rehabilitation and release unit.

Criticism: a by-product of controlling infection.

The nature of the HE/ICP's work involves communicating improvements staff must make to provide a safe environment for patients. All too often this has resulted in the change agents being viewed as highly critical. HE/ICPs who are viewed positively will be able to execute change more smoothly and with less resistance. This article has outlined five guidelines for initiating change that enable HE/ICPs to be viewed in a positive rather than overly critical role.