The futility of post-haemodialysis blood glucose levels: A retrospective cohort study.

BACKGROUND: Frequent blood glucose tests are performed for people with diabetes receiving haemodialysis. OBJECTIVES: To determine the rate of out-of-range post-haemodialysis blood glucose levels that are clinically acted upon, the intervention and outcome of each intervention, and the associations between post-haemodialysis blood glucose levels and relevant clinical predictors. DESIGN: 12-month retrospective cohort medical record review in one Australian haemodialysis centre. Post-haemodialysis blood glucose levels, prehaemodialysis blood glucose levels, time of treatment, diabetes medications, intradialytic fluid removal, dialysate dextrose concentration, clinical actions, interventions, and outcomes on out-of-range blood glucose levels were retrieved. PARTICIPANTS: 22 participants with a median time receiving dialysis 3.1 years (interquartile range 2.3-4.7). MEASUREMENTS AND RESULTS: The proportion of out-of-range post-haemodialysis blood glucose levels was 87.3% (95% confidence interval, 86.1%-88.5%). No out-of-range post-haemodialysis blood glucose levels were clinically acted upon. Out-of-range post-haemodialysis blood glucose levels were 4.6 times more likely if a higher dextrose bath was used (95% confidence interval: 3.3; 6.3. p < 0.001). The odds of the post-haemodialysis blood glucose levels increased by each 1 mmol/L. Intradialytic fluid removal, dialysate dextrose concentration, sex, dialysis time, anti-hyperglycaemic agents were also associated with out-of-range post-haemodialysis blood glucose levels. CONCLUSION: Routine post-haemodialysis blood glucose levels testing has limited clinical utility in care for people with diabetes receiving maintenance haemodialysis. Higher dextrose dialysate may require individual titration depending on prehaemodialysis blood glucose levels.

Patient activation in advanced chronic kidney disease: a cross-sectional study.

BACKGROUND: Patient activation refers to the knowledge, confidence and skills required for the management of chronic disease and is antecedent to self-management. Greater self-management in chronic kidney disease (CKD) results in improved patient experience and patient outcomes. AIM: To examine patient activation levels in people with CKD stage 5 pre-dialysis and determine associations with sociodemographic characteristics, treatment adherence and healthcare utilisation. METHODS/DESIGN: People with CKD stage 5 not receiving dialysis from one Australian kidney care service. Patient activation was measured using the 13-item Patient Activation Measure (PAM-13). Sociodemographic and clinical outcome data (emergency department visits, admissions) were collected from medical records. Morisky Medication Adherence Scale was used to determine self-report medication adherence. RESULTS: Two hundred and four participants completed the study. The mean PAM-13 score was 53.4 (SD 13.8), with 73% reporting low activation levels (1 and 2). Patient activation scores significantly decreased with increased age (P < 0.001) and significantly increased with higher educational levels (P < 0.001). Higher patient activation level was associated with fewer hospital emergency department visits (P = 0.03) and increased medication adherence (P < 0.001). CONCLUSION: Patient activation levels are low in people with CKD stage 5 not receiving dialysis suggesting limited ability for self-management and capacity for optimally informed decisions about their healthcare. Efforts to improve patient activation need to consider age and education level.

Supportive care needs of adults living with a peripherally inserted central catheter (PICC) at home: a qualitative content analysis.

BACKGROUND: Peripherally inserted central catheters (PICCs) are common vascular access devices inserted for adults undergoing intravenous treatment in the community setting. Individuals with a PICC report challenges understanding information and adapting to the device both practically and psychologically at home. There is a lack of research investigating the supportive care needs of individuals with a PICC to inform nursing assessment and the provision of additional supports they may require to successfully adapt to life with a PICC. The aim of this study was to identify the supportive care needs of adults with cancer or infection living with a PICC at home. METHOD: Qualitative, semi-structured interviews were used to identify supportive care needs of adults living with a PICC at home. Participants were recruited from cancer and infectious diseases outpatient units. Two researchers independently analysed transcripts using content analysis. RESULTS: A total of 15 participants were interviewed (30-87 years old). There were 5 males and 10 females interviewed, 9 participants had a cancer diagnosis and most lived in a metropolitan area. Many participants lived with a partner/spouse at home and three participants had young children. Participants identified supportive care needs in the following eight categories (i (i) Adapting daily life (ii) Physical comfort (iii) Self-management (iv) Emotional impact (v) Information content (vi) Understanding information (vii) Healthcare resources and (viii) Social supports. CONCLUSIONS: Adults living with a PICC at home report a broad range of supportive care needs. In addition to practical and information needs, health consumers may also require support to accept living with a device inside their body and to assume responsibility for the PICC. These findings may provide nurses with a greater understanding of individual needs and guide the provision of appropriate supports.

An International Survey of Peritoneal Dialysis Exercise Practices and Perceptions.

Introduction: Low activity levels and poor physical function are associated with technique failure and mortality in people receiving peritoneal dialysis (PD). Adequate levels of physical function are required to maintain independence for people choosing this predominantly home-based therapy. The objective of this study was to identify the exercise-related perceptions and practices of PD clinicians globally. Methods: We conducted a cross-sectional survey of PD clinicians from English-, Thai-, Spanish-, and Portuguese-speaking PD-prevalent countries exploring clinicians' perceptions and practices of swimming, activity following PD catheter insertion, lifting, and falls prevention. This study was convened by the International Society of Peritoneal Dialysis and Global Renal Exercise Network between July and December 2021. Results: Of 100 of the highest PD-prevalent countries, 85 responded and were represented in the findings. A total of 1125 PD clinicians (448 nephrologists, 558 nephrology nurses, 59 dietitians, and 56 others) responded from 61% high-income, 32% upper middle-income and 7% lower middle-income countries. The majority (n = 1054, 94%) agreed that structured exercise programs would be beneficial for people receiving PD. Most respondents believed people on PD could perform more exercise (n = 907, 81%) and that abdominal strengthening exercises could be safely performed (n = 661, 59%). Compared to clinicians in high-income countries, clinicians from lower middle-income status (odds ratio [OR], 5.57; 1.64 to 18.9) are more likely to promote participation in physical activity. Conclusion: Clinicians know the importance of physical activity in people receiving PD. Exercise counseling and structured exercise plans could be included in the standard care of people receiving PD to maintain independence.

The effectiveness of patient activation interventions in adults with chronic kidney disease: A systematic review and meta-analysis.

BACKGROUND: Chronic kidney disease (CKD) is a complex health condition that profoundly impacts an individual's general health and well-being throughout their entire lifetime. People with CKD require the knowledge, confidence, and skills to actively self-manage their health. This is referred to as patient activation. The efficacy of interventions to increase patient activation in the CKD population is unclear. AIM: This study aimed to examine the effectiveness of patient activation interventions on behavioral health-related outcomes among people with CKD stages 3-5. METHODS: A systematic review and meta-analysis of randomized controlled trials (RCTs) of patients with CKD stages 3-5 was performed. MEDLINE, EMCARE, EMBASE, and PsychINFO databases were searched between 2005 and February 2021. Risk of bias was assessed using the Joanna Bridge Institute critical appraisal tool. RESULTS: Nineteen RCTs that enrolled 4414 participants were included for synthesis. Only one RCT reported patient activation using the validated 13-item patient activation measure (PAM-13). Four studies demonstrated strong evidence that the intervention group developed a higher level of self-management compared to the control group (standardized mean differences [SMD] = 1.12, 95% CI [0.36, 1.87], p = .004). Eight RCTs led to a significant improvement in self-efficacy (SMD = 0.73, 95% CI [0.39, 1.06], p < .0001). There was weak to no evidence on the effect of the strategies shown on the physical component and mental components of health-related quality of life, and medication adherence. LINKING EVIDENCE TO ACTION: This meta-analysis highlights the importance of including tailored interventions using a cluster approach including patient education, goal setting with individualized action plan, and problem-solving to engage patients to be more actively involved in the self-management of their CKD.

Community-based Intravenous Treatment and Central Venous Access Devices: A Scoping Review of the Consumer and Caregiver Experience, Information Preferences, and Supportive Care Needs.

PURPOSE: Map existing research and describe the consumer/caregiver experience of community-based intravenous treatment, central venous access devices (CVADs), supportive care needs, and information preferences. DESIGN: Scoping review. METHODS: Five databases (Joanna Briggs Institute, Cochrane library, Emcare, Embase, and Medline) were searched. Screening and data extraction were performed independently by two reviewers. FINDINGS: Forty-eight studies were included. CONCLUSIONS: Although community-based intravenous treatment and CVADs have a significant impact on consumers and caregivers, there is scant research on their supportive care needs and information preferences. CLINICAL EVIDENCE: Some consumers and caregivers may require additional support while undergoing community-based intravenous treatment.

Managers' perception of older nurses and midwives and their contribution to the workplace-A qualitative descriptive study.

AIMS AND OBJECTIVES: The aim of this study was to explore healthcare managers' perceptions about older nurses' and midwives' and their contribution to the workplace. DESIGN: A qualitative descriptive methodology. METHOD: Twenty healthcare managers working in Australia participated in semi-structured interviews. Data were collected between April 2019 and April 2021. Interviews were recorded, transcribed and then analysed using thematic analysis. RESULTS: All healthcare managers said older nurses and midwives contributed to the workplace through their experience and knowledge. Managers viewed them as a different type of worker and while there were some positive aspects to this, it was mostly negative. Although managers identified a broad age range for the older nurses or midwives, there was a common perception that if they were no longer able to perform their duties, they should leave the workforce. CONCLUSION: Healthcare managers' perceptions towards older nurses and midwives are mostly negative, and their understanding of older workers' contribution is contradictory and poor. These negative views co-exist with the lack of agreement on who is the older worker, which explain the reluctance of healthcare organizations to invest in their older workforce. Future research is needed to better understand the unique contribution of older nurses and midwives in healthcare and how they can be supported at work. IMPACT: The global ageing population will result in a rise in complex age-related health issues and will require an experienced and knowledgeable workforce. Given the greater experience of older nurses and midwives they are an important part of the health workforce. Yet managers' perception of the contribution by older nurses and midwives were often negative. The findings of this study highlight the need for organizational change so that the contribution of older nurses and midwives is recognized and supported by managers.

The use of haemodialysis plastic cannula in prevalent patients with kidney failure: A feasibility crossover randomised trial study.

BACKGROUND: Haemodialysis plastic cannulae have been limited to incident arterio-venous fistulae cannulation or in those who require a more flexible in situ access device. The feasibility of plastic cannulae in prevalent patients on haemodialysis has not been reported. OBJECTIVE: To determine the feasibility of plastic cannulae in prevalent haemodialysis patients. DESIGN: Prospective feasibility crossover randomised control trial. PARTICIPANTS: Adults diagnosed with chronic kidney disease G5 requiring haemodialysis three or more times per week via a native arteriovenous fistula previously cannulated for at least 6 weeks. MEASUREMENTS: Cannulation success rate, cannulation manipulation type, arterial and venous needle pressure. Patient needle-related anxiety as measured by the 4-item Patient Health Questionnaire and Meditation in Dialysis Questionnaire and nurse satisfaction. RESULTS: Eight patients completed 12 weeks plastic canulae and metal needles. Plastic cannulae were less likely to be successful in cannulation compared to metal needles (odds ratio = 0.15; 95% confidence interval [CI]: 0.05-0.48; p = 0.001). There was no effect of type of needle on the change in arterial needle pressure or change in venous needle pressure and no effect of plastic needle on repositioning (relative risk [RR] = 1.09; 95% CI: 0.385, 3.089; p = .871) or gauze pillow application (RR = 0.936; 95% CI: 0.467, 1.874; p = .851) than metal needles, relative to no manipulation. There were low rates of psychological distress or needle-related anxiety towards plastic or metal needles. CONCLUSIONS: Plastic cannulae are feasible in prevalent haemodialysis patients, however, metal needles are still preferred in a haemodialysis center that has historically used metal needles.

Being an older nurse or midwife in the healthcare workplace- A qualitative descriptive study.

AIM: To explore the experiences of being an older nurse or midwife employed in the healthcare workplace. DESIGN: A qualitative descriptive study. METHOD: Semi-structured interviews were conducted with nurses and midwives who self-identified as older workers. All Australian states were represented and given recruitment was undertaken nationally, most interviews were conducted via telephone. Data were collected between November 2018 and October 2019. Audio recordings were transcribed verbatim and then thematically analysed. RESULTS: A total of 50 nurses and midwives were recruited, aged between 46 and 74 years. Three themes were identified. Ageing body: Being an older worker meant increased fatigue and physical changes affecting their ability to function at full capacity. Youth focus: For many, being an older worker was about being viewed as a poor-quality worker, with limited access to education and promotional opportunities because of their age. Wise worker: For a small number of older nurses and midwives, it was about being valued and respected for their knowledge, experience and skills. CONCLUSION: Participants self-identifying as older nurses or midwives represented a wide age range. Spanning across the age spectrum, many experienced fatigue, physical changes or loss of value to the workplace which often impacted on their working lives. The findings contributed to an understanding about what it is to be an older nurse or midwife in terms of how their contribution is regarded and valued by others in the workplace. IMPACT: This study highlighted there is a need for support of older nurses and midwives in managing age-related fatigue and physical changes. It also suggests consideration of a wise-worker model as a means to recognize the important contribution that older workers can offer.

"Outcomes of arteriovenous fistulae cannulation in the first 6 weeks of use: A retrospective multicenter observational study".

BACKGROUND: Arteriovenous fistula (AVF) management for haemodialysis (HD) is one of the most challenging aspects of clinical care. A successful cannulation outcome when an AVF or arteriovenous graft (AVG) is used for the first time can be influenced by many factors, including access maturity, staff skill, and patient factors. This study examined AVF/AVG outcomes at initiation of HD across two major metropolitan public hospitals. METHODS: Electronic medical records were reviewed to collect data retrospectively for a cohort of all newly commencing ESRD HD starts during 2018 to identify cannulation outcomes in the first 6 weeks. RESULTS: Of the 117 patients included, AVG use was low (5%). Twenty-four percent of patients required a surgical intervention to salvage a poorly functioning AVF prior to commencing HD. About 32.5% of the cohort had an uneventful start with all successful cannulations. For the remainder of the cohort the number of treatments with unsuccessful cannulation ranged from 1 to 4 or more. About 36% required a surgical intervention for a poorly functioning AVF after commencing HD. Commencing HD with a CVC is associated with a lower likelihood of subsequent successful cannulation (p < 0.001). CONCLUSION: Even in experienced centres, a subset of patients experienced complicated cannulation in the first 6 weeks of HD. Several areas of improvement could be considered for these patients; timely referral for access creation, post-operative surveillance to ensure AVF maturation inclusive of duplex ultrasonography, gentle induction using small gauge needles and low blood flows, and consideration of a single needle HD initiation pathway.

An examination of the relationship between sunlight exposure and hot flush in working women.

We examined whether sunlight affects hot flushes in working menopausal women and explored effect modification by shift work and season. In this prospective cohort study, daily hot flush score (outcome) was measured by the 7-day North Central Cancer Treatment Group Daily Vasomotor Symptoms Diary. Daily duration of sunlight (≥2000 lux) was recorded by the HOBO MX2202 pendant. Both variables were measured in two 7-day data collection phases. T0 data were collected during the Australian Summer (December 2017, January and February 2018); and T1 data were collected in the Australian winter (June, July and August 2018). Linear mixed effects model was used. Shift work and season were both confounders and effect modifiers. To detect a median effect size of R2 = 0.2, 34 women were required to achieve an effective sample size of 41. A total of 49 menopausal women were recruited, 11 shift and 38 day workers. Some 13 women had various missing observations. For shift workers, an hour increase in sunlight exposure was associated with a 1.4-point reduction in hot flush score (p = .016). This relationship was not significant for day workers (p = .185). The finding of this study suggests increased sunlight exposure might improve hot flushes in menopausal shift workers who are moderately bothered by hot flushes, but probably not in day workers. The possible role of shift-work associated circadian disruption on estrogen level in regard to elevated intensity and frequency of hot flush in menopausal women is discussed.

The Exercise Perceptions of People Treated with Peritoneal Dialysis.

BACKGROUND: Individuals receiving peritoneal dialysis (PD) report low levels of physical activity, which increases their risk of morbidity and mortality. Little is known about their perceptions towards barriers and benefits of exercise or physical activity. AIM: The aim of this study was to explore the perceptions of exercise among people receiving PD. STUDY DESIGN: Cross-sectional survey. PARTICIPANTS: Thirty-nine adults (12 female and 27 male) with a mean age of 65 years and a median of 8 months receiving PD from one Australian dialysis service. MEASUREMENTS: The 26-item Dialysis Patient-Perceived Exercise Benefits and Barriers Survey was adapted to PD in order to measure self-reported barriers and benefits of exercise for people being treated with PD. RESULTS: The majority of the respondents reported positive perceptions towards exercise with 84.6% of the participants agreeing that exercise prevents muscular wasting; 71.8% agreed that exercise can postpone a decline in body function; and 69.2% agreed that exercise improves general well-being. In terms of barriers, symptoms including tiredness (69.2%) and body pain (43.6%), worrying about a fall (33.3%) and lack of exercise-related information (25.6%) were the main perceived barriers to exercise. Only 10% agreed that exercise may affect their PD catheter with 23% agreeing that fluid in their peritoneum was a barrier to exercise. CONCLUSION: People on PD hold positive perceptions towards exercise but face a number of perceived barriers to physical activity. Clinicians can acknowledge these barriers and focus on helping people on PD to overcome their perceived barriers to encourage sustained exercise participation.

Revisiting the alerting effect of light: A systematic review.

Light plays an essential role in maintaining alertness levels. Like other non-image-forming responses, the alerting effect of light is influenced by its spectral wavelength, duration and intensity. Alertness levels are also dependent on circadian rhythm (process C) and homeostatic sleep pressure (process S), consistent with the classic two-process model of sleep regulation. Over the last decade, there has been increasing recognition of an additional process (referred to as the third process) in sleep regulation. This third process seems to receive sensory inputs from body systems such as digestion, and is usually synchronised with process C and process S. Previous studies on the alerting effect of light have been mostly conducted in laboratories. Although these studies are helpful in delineating the impact of process C and process S, their ability to assist in understanding the third process is limited. This systematic review investigated the factors that influence the alerting effect of light by examining randomised controlled trials and randomised or counterbalanced crossover studies. Factors that influence light's alerting effect were examined with reference to the three-process model. The post-illuminance alerting effect was examined separately due to its potential to offer flexible workplace-based light interventions to increase or maintain employees' alertness.

Exploring Sleep Quality and Related Factors in Chinese Midlife Women.

We investigated the percentage of women with poor sleep quality and its related factors among mainland Chinese women. Sleep quality and menopausal status were self-reported. We explored the contribution of possible risk factors, including sociodemographic characteristics, comorbidities, lifestyle, psychological status, stressful life events, and vasomotor symptoms. We found that 38.6% of midlife Chinese women were poor sleepers. This percentage was higher in comparison with women from other Asian countries. Our multiple logistic regression showed that anxiety, comorbidities, perceived stress, and vasomotor symptoms were risk factors for poor sleep quality.

Development of a nursing education program for improving Chinese undergraduates' self-directed learning: A mixed-method study.

OBJECTIVE: This paper demonstrates the establishment of an extra-curricular education program in Chinese context and evaluates its effectiveness on undergraduate nursing students' self-directed learning. METHODS: Zimmerman's self-directed learning model was used as the theoretical framework for the development of an education program. Mixed-method was applied in this research study. 165 undergraduate students from a nursing college were divided into experimental group (n=32) and control group (n=133). Pre- and post-tests were implemented to evaluate the effectiveness of this education program using the self-directed learning scale of nursing undergraduates. Qualitative interview was undertaken within participants from the experimental group to obtain their insights into the influence of this program. RESULTS: Both quantitative and qualitative analyses showed that the program contributed to nursing students' self-directed learning ability. In the experimental group, the post-test score showed an increase compared with pretest score (p<0.05). The score of experimental group was higher than control group (p<0.05) after 18months training, while there was no difference between them before this program. Qualitative results from 9 students' experience were formulated as three main thematic categories: influence on awareness, influence on learning activities and influence on learning environment. It can be found in the qualitative analysis that learners benefited from this program. CONCLUSION: The education program contributes to the improvement of nursing undergraduates' self-directed learning. Various pedagogic methods could be applied for self-directed learning.

A systematic review of the longitudinal relationships between subjective sleep disturbance and menopausal stage.

Sleep disturbance is a common complaint for women going through the menopausal transition. A previous systematic review and meta-analysis of cross-sectional studies showed a small but significant relationship between self-reported sleep disturbance and menopausal stage and highlighted a possible influence of culture. However, the longitudinal relationship between self-reported sleep disturbance and menopausal transition has not been explored. This paper aimed to review literature on the longitudinal relationship between self-reported sleep disturbance and menopausal transition among community dwelling midlife women. Multiple electronic databases were systematically searched. Literature published prior to 2013 was reviewed. A narrative synthesis was used to analyse the results due to high level of heterogeneity across the included studies. Overall, review of eligible studies showed a small increased risk of self-reported sleep disturbance as women go through the menopausal transition after adjustment of potential confounders. Although the methodological quality of the majority of included studies was classified as high, the impact of culture on this relationship could not be explored, as all of the included studies were conducted in western countries. Like vasomotor symptoms, self-reported sleep disturbance is one of the core menopausal symptoms. Management strategies should be put in place to help women manage sleep disturbance to prevent complications and to improve health related quality of life.

Examining the relationship between subjective sleep disturbance and menopause: a systematic review and meta-analysis.

OBJECTIVE: The purpose of this study was to conduct a systematic review and meta-analysis of the relationship between menopausal stages and sleep disturbance reported using subjective methods. Secondary aims included examining the influence of culture/ethnicity on the relationship between menopausal stages and sleep disturbance. METHODS: Multiple electronic databases were searched from the first available year to November 2013, and a manual search of the reference lists of review articles identified was also conducted. Twenty-four studies with a total of 63,542 midlife women were identified, coded, and analyzed. RESULTS: The crude and adjusted odds of experiencing sleep disturbance were small but statistically significant for perimenopausal and postmenopausal women, using premenopause as the reference group. The ethnicity of the samples influenced effect sizes; Asian and white women both experienced an increased rate of sleep disturbance at the perimenopausal and postmenopausal stages compared with the premenopausal stage, whereas Hispanic women experienced no change in sleep disturbance across the menopausal transition. CONCLUSIONS: The prevalence of sleep disturbance is higher in perimenopausal, postmenopausal, and surgical menopausal women than in premenopausal women. There is an independent relationship between menopausal stages and sleep disturbance beyond the effects of aging and other confounders, although the magnitude of the relationship is small. Culture, ethnicity, or both might affect the levels of sleep disturbance at various menopausal stages.

Health-related quality of life among Tianjin Chinese patients with type 2 diabetes: a cross-sectional survey.

The purpose of this study was to examine factors that influence the quality of life among Tianjin Chinese living with type 2 diabetes. In this study, the quality of life was assessed in 174 participants. The dependent variables included demographic and clinical data, depressive symptoms and lifestyle behavioral factors. Chi-square tests and logistic regression analysis were conducted to identify significant factors. Using multiple regression analyses, the odds ratios (ORs) of having low quality of life were 4.53 (95% confidence interval (CI) = 1.89-10.87), 2.83 (95% CI = 1.21-6.63), and 2.48 (95% CI = 1.03-5.96) for patients with microvascular complications, diabetic neuropathy, and peripheral vascular disease, respectively. Coronary heart disease, depression, and unhealthy eating habits were also found to have significant negative effects on quality of life. In addition, multiple regression analysis showed that regular exercise (OR = 0.29, 95% CI = 0.12-0.71) was a protective factor for health-related quality of life. The identification of these influencing factors will assist nurses to provide continuous care to people living with diabetes, thus to postpone or avoid complications as well as improve their quality of life.

The relationship between abdominal obesity and depression in the general population: A systematic review and meta-analysis.

SUMMARY: Obesity has been widely regarded as a public health concern because of its adverse impact on individuals' health. Systematic reviews have been published in examining the effect of obesity on depression, but with major emphasis on general obesity as measured by the body mass index. Despite a stronger effect of abdominal obesity on individuals' physical health outcomes, to our best knowledge, no systematic review was undertaken with regard to the relationship between abdominal obesity and depression. This paper reports the results of a systematic review and meta-analysis of cross-sectional studies examining the relationship between abdominal obesity and depression in a general population. Multiple electronic databases were searched until the end of September 2009. 15 articles were systematically reviewed and meta-analyzed. The analysis showed that the odds ratio of having depression for individuals with abdominal obesity was 1.38 (95% CI, 1.22-1.57) as compared to those who are not obese. Furthermore, it was found that this relationship did not vary with potential confounders including gender, age, measurement of depression and abdominal obesity, and study quality.: