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.

The fatigue, sleep and physical activity in postoperative patients with pituitary adenoma: what we can do.

BACKGROUND: To evaluate the current status of fatigue, sleep and physical activity in postoperative patients with pituitary adenoma (PA). METHODS: Postoperative patients undergoing PA resection from November 2017 to November 2018 were identified. A multi-centered survey was conducted with questionnaires on the characteristics of included PA patients, multidimensional fatigue inventory (MFI-20), the Pittsburgh sleep quality index (PSQI) questionnaire, and the international physical activity (IPA) questionnaire. The related scores and potentially influencing factors were analyzed accordingly. RESULTS: A total of 184 patients were included. The time course after operation, PSQI were correlated with the scores of general fatigue, physical fatigue, reduced activity and reduced motivation (all P<0.05); PSQI and IPA, the time course after operation and gender were the independent factors associated with the level of general fatigue (all P<0.05); PSQI, IPA and the time course after operation, adenoma size and gender were the independent factors influencing the level of physical fatigue (all P<0.05); the time course after operation, IPA, PSQI and gender were the independent factor influencing the level of reduced activity (all P<0.05); the time course after operation, IPA, PSQI and adenoma size were the independent factor influencing the level of reduced motivation (all P<0.05); the time course after operation was the independent factor influencing the level of mental motivation (P=0.030). CONCLUSIONS: Fatigue in PA patients after surgery is inversely associated with the time course after surgery and physical activity, future studies on the related interventions are warranted.