Exploring the occupational lives of Syrians under temporary protection in Turkey.

INTRODUCTION: Persons who become displaced due to situations such as war and natural disasters face extreme challenges in maintaining their occupational repertoires. This study aimed to explore the occupational lives of Syrians under temporary protection in Turkey. METHODS: This mixed method study used a cross-sectional design with a predominantly qualitative focus. Syrians living under temporary protection in Turkey were interviewed using the Canadian Occupational Performance Measure (COPM) to identify their perceived performance problems in the areas of self-care, productivity, and leisure. Additional probes were used to explore participants' reasoning for the choice of occupations and scoring, and occupational changes since arriving in Turkey. Socio-demographics were collected on the participants' age, gender, educational level, marital status, monthly house budget, social security, and number of persons within the household. Thematic analysis was used to undercover themes from the qualitative data. RESULTS: Thirty Syrians living under temporary protection in Turkey in Hatay province participated in this study (mean age: 29.66 ± 7.97 years [range = 18 to 50 years]): 16 women (mean age: 28.64 ± 8.04 years) and 14 men (mean age: 30.56 ± 8.05 years). Participants identified more significant problems in their performance of productive and leisure occupations than in self-care occupations. The following themes emerged: (a) having a house of our own: meeting basic needs and completing activities of daily living; (b) no money for shopping: past everyday occupations now luxuries; (c) feeling valued and important: having the ability but no job; (d) living day to day: Education, career, and marriage on hold; and (e) enjoyment in life: leaving behind family, friends, and occupational spaces. CONCLUSION: Syrians living in temporary protection in Turkey experience uncertainty within their occupational lives. Participants were able to meet their basic needs; however, precarity of employment limited their participation in previous occupations contracting their repertoires.

The changing landscape of PAs and NPs in nephrology.

BACKGROUND: Physician assistants (PAs) and NPs have expanded roles in nephrology as both the patient load and acuity of care needed for this population have increased. PURPOSE: To evaluate the workforce patterns of PAs and NPs working in nephrology over the past decade. METHODS: Using the biannual survey from the National Kidney Foundation Council of Advanced Practitioners, data were collected and analyzed over the past decade. RESULTS: Surveys of nephrology practitioners show the evolution of the dialysis-focused practitioner to one encompassing all aspects of nephrology: hospital, ICU, research, office, and all types of dialysis. Salaries and benefits have increased to compensate for the expansion of responsibilities. CONCLUSIONS: PAs and NPs in nephrology have the opportunity to use their skills and training in caring for this high-risk population.

Reevaluating race and the glomerular filtration rate calculator.

ABSTRACT: Estimated glomerular filtration rate (eGFR) calculators have included a race adjustment to help approximate measured GFR. Over the past several years, as more attention has been directed toward uncovering racial bias, the appropriateness of including race in these calculators has been called into question. The American Society of Nephrology and the National Kidney Foundation convened an expert task force to review the inclusion of race in eGFR. The deliberative review showed that race can be removed from eGFR calculators without causing adverse reactions in any group of patients. This new, refitted CKD-EPI equation can be used immediately by all laboratories in the United States. The task force also recommended greater use of cystatin C nationally in eGFR calculations. This would enable the new CKD-EPI equation to incorporate both creatinine and cystatin C without race and would yield better accuracy than a calculator that uses creatinine alone.

Predicting the Benefits of Mine Water Treatment under Varying Hydrological Conditions using a Synoptic Mass Balance Approach.

Geochemical and hydrological data from abandoned mine watersheds demonstrated that (1) point sources of pollution fail to account for total receiving watercourse metal load at higher flows and (2) an inverse relationship exists between river flow and pH due to peatland runoff. Quantifying the varying importance of point and diffuse pollution sources enabled prediction of treatment benefits for a major point source of pollution in one watershed. Instream zinc load increases with river flow (∼3 to 14 kg Zn/d) due to diffuse groundwater and surface runoff pollution sources at higher flows. Lab tests demonstrated that metal release from the streambed, driven by pH decreases at higher flows, also contribute to increased downstream metal loads. Predicting point source treatment benefits demonstrates major instream improvements at low flow (zinc decreases from >800 to 120 µg Zn/L). At higher flows treatment benefits diminish (Zn decreases from 240 to only 200 µg Zn/L) due to the greater influence of diffuse sources. A quantitative understanding of the variable importance of point and diffuse sources of pollution, and instream processes of metal attenuation and release, is crucial to evaluating the benefits of treatment to downstream water quality.

Interventions for Women With Substance Abuse Issues: A Scoping Review.

OBJECTIVE: The aim of this scoping review was to describe the characteristics and features of substance abuse interventions for women in North America and discuss the findings from an occupational perspective. METHOD: A scoping review was conducted to examine North American peer-reviewed literature published between 2001 and 2014. Four databases were searched using terms related to intervention, substance abuse, and women only. Descriptive statistics of categorical groupings were used to describe the data sources and characteristics and features of the interventions. RESULTS: Forty-two articles met the inclusion criteria, with the majority citing a harm-reduction approach and using multifaceted interventions with various targets for change. CONCLUSION: Substance abuse interventions for women are typically multifaceted and follow a harm-reduction philosophy. Further research into the efficacy of interventions that more specifically target occupation beyond substance use is needed.

The ABCs of chronic kidney disease.

Management of patients with chronic kidney disease has evolved since the last Kidney Disease Improving Global Outcomes clinical practice guideline was published in 2012. This article reviews the most recent guidelines, common management issues in primary care, kidney risk and outcome calculators, and over-the-counter medications that may cause community-acquired acute kidney injury.

Acute kidney injury.

Acute kidney injury (AKI) complicates up to 20% of all hospital admissions. Responding to the increase in admissions, complications, mortality, morbidity, and cost of AKI, Kidney Disease: Improving Global Outcomes convened an expert panel to study the issue, review the literature, and publish guidelines to evaluate and treat patients with AKI in the acute setting. This article reviews those guidelines.

Improving treatment for patients with chronic kidney disease.

OBJECTIVE: Kidneys in a Box (KIB) was developed to identify the effect of a performance improvement CME (PI-CME) project on the management of patients with diabetes who are at risk for chronic kidney disease (CKD). The program provided nonnephrology practitioners with research-based interventions known to slow CKD progression. METHODS: PAs were given the KIB tool kit, which described the scope of CKD identified high-risk diagnoses such as diabetes, and listed six modifiable risk factors that have been shown to slow progression of diabetic kidney disease when implemented. The PAs self-selected the factor(s) and evaluated 10 charts of patients diagnosed with diabetes before implementing the modifications. After implementing changes for a minimum of 12 weeks, the PAs again self-selected 10 different charts and evaluated the extent of the intervention application. A preintervention/postintervention assessment and demographic sheet were then submitted to the American Academy of Nephrology PAs for CME credit. RESULTS: 302 PAs completed the program in the first 24 months, with full data available for 213 PAs. Statistically significant improvement was shown in five of the six areas: CKD staging, urine albumin-creatinine ratio (UACR), statin use, over-the-counter (OTC) yellow alert medications, and A1C. Improvement in smoking cessation interventions did not reach statistical significance. CONCLUSIONS: Known interventions to slow progression of diabetic kidney disease can be effective if implemented in early stages of the disease. KIB demonstrates that education focused on the nonnephrology PA can be effective in slowing CKD progression.

Kidney care beyond our borders.

Whether it is the heartland of America or a remote village in a developing country, one overriding theme to providing care for kidney patients is person power--or the lack of it. In the developed countries, notably the U.S., Australia, New Zealand and Europe, medical schools prepare advanced practitioners who can then fill the gap left by the lack of nephrologists. However in areas where physicians are in short supply, nurses often have only basic training and trained APs are not available. In the meantime, kidney disease is taking its toll on the best and the brightest.

Nursing homes: The new frontier.

As the population continues to age, we will see a larger percentage of end-stage CKD patients in nursing homes, both skilled and long-term facilities. This is a fragile population and will take buy-in from all practitioners to care for them. Even with the dietitian to manage a complicated and detailed menu, the social worker to manage the transportation and multiple issues with equipment, the therapy staff to protect against loss of ADLs, the recreational therapist to protect against loss of cognitive function and the medical staff (APs, nursing, physicians), this population will continue to present both challenges and opportunities.

Transplant in the 21st century.

Organ transplantation has enriched and prolonged the lives of many patients who otherwise would have died of organ failure. Many of these advances, which occurred in the later part of the 20th century, are due to improved techniques and pharmacological management. Today, almost every organ can be transplanted. However, donor and recipient criteria can vary widely according to the organ(s) in question. This article reviews the historical changes that have occurred in transplant along with current criteria for donors and recipients, and describes the newest outreach to increase the donor pool.

Managing hypertension in patients with chronic kidney disease.

Chronic kidney disease (CKD) and hypertension are intrinsically linked. Although 59% of the US population will be diagnosed with CKD during their lifetimes, mortality is usually due to a cardiovascular event. Sodium restriction and a combination of a renin-angiotensin-aldosterone medication and a calcium channel blocker are the most effective methods of managing hypertension in patients with CKD.

Staying up to date with the JNC 8 hypertension guideline.

The recently released JNC 8 guideline on hypertension management is a major departure from previous JNC guidelines in methodology, focus, and content. This article reviews the design and content of the new guideline as well as its similarities and differences from JNC 7 and other recently published hypertension guidelines.

Kidney disease education: A niche for PAs and NPs.

OBJECTIVE: This study evaluated the number of Stage 4 chronic kidney disease (CKD) education classes taught by physician assistants (PAs) and NPs. METHODS: Descriptive analysis of data from the CMS Public Use File were calculated for 2010-2011 kidney disease education classes with particular focus on PAs and NPs. RESULTS: In 2010, 4,580 individual and 1,612 group classes were held; one-third of individual classes and two-thirds of group classes were taught by PAs and NPs. In 2011, with a 32% increase in classes, the percentages of PA and NP instructors stayed the same. PAs and NPs predominantly teach home classes, group classes, and outpatient hospital classes. CONCLUSIONS: Less than 7% of eligible patients were offered education classes in 2010-2011. An examination of Medicare billing data shows PAs and NPs are underused in patient education, an area in which they are uniquely qualified.

Updated guidelines for managing chronic kidney disease.

Chronic kidney disease (CKD) is the most costly disease covered by Medicare, and two common causes of CKD, diabetes and hypertension, are increasing worldwide. More than 60% of Americans will develop CKD in their lifetimes. This article reviews updated guidelines for managing CKD in primary care.

Medication dosing in patients with chronic kidney disease.

Appropriate dosage adjustments for patients with chronic kidney disease (CKD) are critical for patient safety. This article reviews adjustments for common antidiabetic, antibiotic, analgesic, and antithrombotic medications, as well as important patient teaching information for over-the-counter (OTC) medications.

Revealing the Meaning of Cannabis Use as an Occupation: A Scoping Review.

Background: Occupational science and occupational therapy typically perceive occupations as promoting health and well-being. However, this perspective overlooks the many occupations that are viewed as illegal, unhealthy, or risky, such as drug use. Due to its negative association with health, drug use is perceived as not holding significance or meaning in people's lives. Objective: This study explores how individuals perceive and describe the meaning of their cannabis use in the context of their lives, from an occupational perspective. Methods: A scoping review was conducted using Levac et al.' modifications to Arksey and O'Malley's framework. To examine the peer-reviewed literature, 7 databases were searched using terms related to cannabis and meaning. Descriptive statistics were used to describe the selected studies, and reflexive thematic analysis identified cross-study themes. Results: Fourteen studies were selected. Most studies have been published since 2008, with 5 published in the last 2 years. Four themes were identified across the studies: (a) preserving life; (b) navigating the routines of everyday life; (c) understanding the self, identity, and belonging; and (d) expanding the view of the world. Conclusions: Cannabis use was revealed in this study as a support for navigating occupational routines and enhancing occupational repertoires and engagement, feelings of belonging, and collective user identities. As such, substance abuse treatment practices, including those provided by occupational therapists, should recognize the potential significance of cannabis use within people's lives. Using a harm reduction approach, occupational therapists can acknowledge the ways in which clients use cannabis to manage their daily routines, while also focusing on supporting clients to reduce the ill-effects of cannabis. As individuals become more engaged in occupations that are significant in their lives, their need for and meaning of cannabis use may change leading to a possible reduction in its use and a shift in their identity construction.