Feasibility and Acceptability of Using Wireless Limited Polysomnography to Capture Sleep Before, During, and After Hospitalization for Patients With Planned Cardiothoracic Surgery.

BACKGROUND: Sleep disruption, a common symptom among patients requiring cardiovascular surgery, is a potential risk factor for the development of postoperative delirium. Postoperative delirium is a disorder of acute disturbances in cognition associated with prolonged hospitalization, cognitive decline, and mortality. OBJECTIVE: The aim of this study was to evaluate the feasibility and acceptability of using polysomnography (PSG) to capture sleep in patients with scheduled cardiothoracic surgery. METHODS: Wireless limited PSG assessed sleep at baseline (presurgery at home), postoperatively in the intensive care unit, and at home post hospital discharge. Primary outcomes were quality and completeness of PSG signals, and acceptability by participants and nursing staff. RESULTS: Among 15 patients, PSG data were of high quality, and mean percentage of unscorable data was 5.5% ± 11.1%, 3.7% ± 5.4%, and 3.7% ± 8.4% for baseline, intensive care unit, and posthospitalization measurements, respectively. Nurses and patients found the PSG monitor acceptable. CONCLUSIONS: Wireless, limited PSG to capture sleep across the surgical continuum was feasible, and data were of high quality. Authors of future studies will evaluate associations of sleep indices and development of postoperative delirium in this high-risk population.

Clinician-Patient Relationships in Virtual Care: A Dimensional Analysis of the Symbolic World of Cancer Care.

Rapid uptake of telehealth technologies has shifted clinician-patient relationships, a well-studied topic of sociological inquiry. The purpose of this dimensional analysis study was to understand the symbolic interaction of clinicians and patients within virtual supportive cancer care. Seventeen clinicians, eighteen patients, and three care partners receiving or providing care at a multi-site cancer center in the United States participated in interviews. Our analysis of supportive cancer care experiences reveals a key tension: clinicians need to rely on patients in order to share clinical tasks in a virtual care setting but can be reluctant to do so. We posit that dimming the light on cancer is a process that enables clinicians to overcome their reluctance to engage in clinician-patient task sharing by strengthening the relationship. Taken together, these findings reconceptualize the symbolic interaction of the clinician-patient relationship and highlight opportunities to actualize models of relationship-centered virtual care. We discuss implications for clinical practice, ethical relational care, and the literature on clinician-patient relationships and trust.

The impact and implications of virtual supportive cancer care during the COVID-19 pandemic: integrating patient and clinician perspectives.

PURPOSE: Many cancer centers made rapid shifts in supportive care delivery modalities at the onset of the COVID-19 pandemic. Improving virtual supportive cancer care requires deeply understanding both patient's and clinician's experiences. We aimed to integrate the perspectives of clinicians and patients to describe the transition to virtual supportive cancer care during COVID-19. METHODS: In clinical-academic partnership between a multi-site cancer care center in the Northeastern USA and a school of nursing, we conducted a study using dimensional analysis method. Theoretical sampling drove recruitment of patients and clinicians who engaged in virtual supportive cancer care from March 15, 2020 to December 15, 2020. In this sub-analysis, we coded the dimensional analysis data from semi-structured interviews using a descriptive approach with inductive conventional content analysis. RESULTS: We interviewed 17 clinicians, 18 patients, and 3 care partners about their experiences. We integrate patient and clinician perspectives in four in vivo categories: "When COVID hit," "Not an IT expert," "Those little moments," and "The mothership." CONCLUSION: The findings uncover shared patient and clinician fears of missing or sub-optimal care at the onset of COVID-19, technological and relational challenges to engaging in care, and the mixed impacts of virtual care on access, convenience, and efficiency. This analysis suggests concrete action items to improve virtual supportive care for patients and clinicians. The findings corroborate the importance of convenience, access, and efficiency as care quality indicators and suggest potential to emphasize the clinician-patient relationship as an additional indicator of care quality.

Exploring the Evidence: Symptom Burden in Chronic Kidney Disease.

Chronic kidney disease (CKD) is more prevalent in individuals with obesity, diabetes mellitus, or hypertension. Individuals with CKD are prone to kidney failure, with symptom experiences that rival those of patients with cancer. We explored symptom burden in individuals with CKD via a systematic review of 30 quantitative and qualitative articles. The most common CKD symptoms were fatigue, weakness, pain, sleep disturbances and itchy skin. Instruments used to assess symptoms were the Kidney Disease Quality of Life (KDQOL)-36, the Palliative Outcome Symptom-Scale renal (POS-r)-13, and the Dialysis Symptom Index (DSI)-10. The included qualitative studies expand and expound on the quantitative data presented. This article describes the prevalence of symptom burden in individuals with CKD in relation to psychosocial and demographic factors and discuss the importance of symptom management.

An integrative review: Chronic kidney disease awareness and the social determinants of health inequities.

BACKGROUND: Chronic kidney disease is a common and prevalent condition in the United States. However, 90% of individuals with chronic kidney disease are unaware of their diagnosis. AIMS: To summarize the empirical and theoretical literature to provide a comprehensive understanding of the social determinants of health inequities associated with CKD awareness. Social determinants of health inequities are underlying pathways that shape the health opportunities of individuals based on their social position. DESIGN: Integrative review. DATA SOURCES: (May 2020 through July 2020) Data sources included PubMed, sociological abstracts, ScienceDirect, CINAHL and Google Scholar. REVIEW METHODS: Quantitative, qualitative and theoretical articles describing the association of social determinants of health inequities and chronic kidney disease awareness were included. RESULTS: A total of 19 articles were reviewed: two qualitative, one theoretical and 16 quantitative. CONCLUSION: Findings from this review revealed that socioeconomic status, education, race and gender are consistently associated with patient chronic kidney disease awareness. These findings should serve as a basis for further research on interventions to improve chronic kidney disease awareness as well as guide nurses and health care professionals in caring for this population.

Disparities in chronic kidney disease-the state of the evidence.

PURPOSE OF REVIEW: The purpose of this review was to assess the prevalence of United States chronic kidney disease (CKD) health disparities, focusing on racial/ethnic groups, immigrants and refugees, sex or gender, and older adults. RECENT FINDINGS: There are major racial/ethnic disparities in CKD, with possible contributions from the social determinants of health, socioeconomics, and racial discrimination. Racial/ethnic minority patients experience faster progression to end-stage kidney disease (ESKD) and higher mortality predialysis, however, once on dialysis, appear to live longer. Similarly, men are quicker to progress to ESKD than women, with potential biological, behavioral, and measurement error factors. There is a lack of substantial evidence for intersex, nonbinary, or transgender patients. There are also strikingly few studies about US immigrants or older adults with CKD despite the fact that they are at high risk for CKD due to a variety of factors. SUMMARY: As providers and scientists, we must combat both conscious and unconscious biases, advocate for minority patient populations, and be inclusive and diverse in our treatment regimens and provision of care. We need to acknowledge that sufficient evidence exists to change treatment guidelines, and that more is required to support the diversity of our patient population.