Association between person-centred care quality and advance care planning participation in haemodialysis.

OBJECTIVE: Person-centred care (PCC), which incorporates patients' preferences and values for medical care and their life, has been proposed in decision-making for promoting advance care planning (ACP) among patients with kidney failure. Therefore, we aimed to examine variations in PCC across facilities and the association between PCC and ACP participation. METHODS: This multicentre cross-sectional study included Japanese adults undergoing outpatient haemodialysis at six dialysis centres. The main exposure was PCC, measured using the 13-item Japanese version of the Primary Care Assessment Tool-short form. The main outcome was ACP participation as defined by discussion with the attending physician or written documentation or notes regarding treatment preferences. A general linear model was used to examine the covariates of the quality of PCC. Modified Poisson regression models were used to examine the associations of ACP participation. RESULTS: A total of 453 individuals were analysed; 26.3% of them participated in ACP. Higher PCC was associated with greater ACP participation in a dose-response manner (adjusted prevalence ratios for the first to fourth quartiles: 1.36, 2.31, 2.64 and 3.10, respectively) in respondents with usual source of care (USC) than in those without USC. Among the PCC subdomains, first contact, longitudinality, comprehensiveness (services provided) and community orientation were particularly associated with ACP participation. A maximum of 12.0 points of facility variation was noted in the quality of PCC. CONCLUSIONS: High quality of PCC was associated with ACP participation. The substantial disparity in PCC between facilities provides an opportunity to revisit the quality improvement in PCC.

Trust, Multidimensional Health Literacy, and Medication Adherence among Patients Undergoing Long-Term Hemodialysis.

BACKGROUND: Basic health literacy and trust in physicians can influence medication adherence in patients receiving dialysis. However, how high-order health literacy is associated with medication adherence and how trust in physicians mediates this association remain unclear. We assessed the inter-relationships between health literacy, trust in physicians, and medication adherence. We investigated the mediating role of trust in physicians in the relationship between health literacy and medication adherence. METHODS: This multicenter cross-sectional study included Japanese adults receiving outpatient hemodialysis at six dialysis centers. Multidimensional health literacy was measured using the 14-item Functional, Communicative, and Critical Health Literacy scale. Trust in physicians was measured using the five-item Wake Forest Physician Trust scale. Medication adherence was measured using the 12-item Adherence Starts with Knowledge scale. A series of general linear models were created to analyze the associations between health literacy and Adherence Starts Knowledge scores with and without trust in physicians. Mediation analysis was performed to determine whether trust in physicians mediated this association. RESULTS: In total, 455 patients were analyzed. Higher functional and communicative health literacies were associated with less adherence difficulties (per 1-point higher: -1.79 [95% confidence interval (CI): -2.59 to -0.99] and -2.21 [95% CI: -3.45 to -0.96], respectively), whereas higher critical health literacy was associated with greater adherence difficulties (per 1-point higher: 1.69 [95% CI: 0.44 to 2.94]). After controlling for trust in physicians, the magnitude of the association between health literacies and medication adherence decreased. Trust in physicians partially mediated the association between functional or communicative health literacy and medication adherence (especially beliefs) and completely mediated the association between critical health literacy and medication adherence (especially behaviors). CONCLUSIONS: Functional and communicative health literacies were positively associated with medication adherence, whereas critical health literacy was negatively associated with it. Each association was mediated by trust in physicians.

A five-wheel wheelchair with an active-caster drive system.

A novel wheelchair system with an active-caster drive mechanism is presented in this paper. A manual (hand propelled) wheelchair with an external single-wheel drive system forms a five-wheel configuration. The active-caster mechanism is applied to a drive system to motorize a manual wheelchair. Two electric motors which drive a wheel axis and a steering axis of a drive wheel independently are equipped on the active-caster. A coordinated control of the two motors enables the velocity vector on the steering shaft to direct in an arbitrary direction with an arbitrary magnitude. The generated velocity vector allows a wheelchair to go straight and/or rotate completely in a same way as a standard electric wheelchair. Namely 2DOF of the wheelchair can be controlled independently by a single drive wheel without any constraint, such as the orientation of the drive wheel which is well known as a non-holonomic constraint. In addition to the 2DOF mobility, the proposed system enables wheelchair users to change drive modes, a rear drive and a front drive. The drive wheel on the back side of the wheelchair is vertically actuated by a linear motor to change the height of the drive wheel that can vary load distribution and the number of wheels contacting to the ground. The five-wheel-contact makes the wheelchair to move as the normal mode in which the center of rotation is located at the midpoint of the main wheels. Depressing the drive wheel results in lost contacts of the main wheels from the ground in which the center of rotation is jumped at the midpoint of the front wheels, namely it performs as a front drive wheelchair. In this paper, kinematic models of the wheelchair and that with an active-caster drive system are analyzed and a control method by using a 2DOF joystick is derived. Based on the kinematic model, a prototype mechanism of the active-caster is designed and mounted on a manual wheelchair to realize the five-wheel wheelchair. In the experiments, the independent 2DOF motion can be achieved by the control of the active-caster in which the wheelchair shows successful translation, rotation and compound motions which include flip motions of the active-caster mechanism. Additionally, the two drive modes (front and rear) are tested by the prototype with a linear actuator.