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- Hurtig, Caroline, 1984-
(författare)
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Patient Participation in Kidney Care : Patients’ and professionals’ perspectives
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Patient participation is central to modern healthcare, known to enhance both physical health and well-being. However, the way in which a person prefers to engage can vary depending on their condition, knowledge, and healthcare context. Person-centred care considers a person’s needs and preferences, thereby facilitating preference-based patient participation. Managing a long-term disease, such as chronic kidney disease (CKD), often necessitates regular contact with healthcare and engagement in symptom management in day-to-day life. What facilitates person-centred patient participation in kidney care is unknown, but a further understanding of patient participation when living with CKD is needed. The overall aim of this thesis was to investigate patient participation in kidney care and assess variations in levels of preferencebased patient participation over time.Method: This thesis comprises four studies and is part of a research intervention project on participation in kidney clinics in south-eastern Sweden. Data collection commenced in 2018 and was concluded in 2022. Study I was of a qualitative design, with group discussions of patients and professionals (n=42) in dialysis care. Studies II and III employed the 4Ps tool, a validated questionnaire on patient participation completed by patients with CKD stage 4 or 5 (n=358). Study II adopted a cross-sectional design and Study III employed a quasi-experimental design to examine changes in participation over time and the effects of two interventions directed at managers and some healthcare professionals. In Study III, data from before and after the interventions were compared. Study IV employed a mixed-methods design, encompassing qualitative and quantitative data. It entailed repeated individual interviews (n=19 patients, 17 professionals) and data from a systematic review of patient records (n=240). The qualitative data from Studies I and IV were addressed using content analysis, while the quantitative data from Studies II, III, and IV were subjected to statistical tests using IBM Statistical Package for Social Sciences (SPSS) and Stan software.Results: Both individuals living with CKD and healthcare professionals recognised the importance of patient participation in kidney care. Patient participation in CKD stage 4 and 5 involved understanding the disease and its management, as well as mutual exchange of knowledge. However, there was not always a shared understanding between patients and professionals as to what patient participation entails. While patients described comprehending their condition and being involved in mutual communication and treatment planning, professionals primarily emphasised treatment management as the key aspect. Moreover, the patient records predominantly documented the professionals' actions for and with their patients. The findings also showed that although most patients had good matches between their preferences and experiences, suggesting sufficient levels of preference-based participation, some patients had insufficient preference-based participation, indicated they had experienced either more or less conditions for participation than their preferences. The staff-directed interventions in the research project did not appear to improve preference-based participation.Conclusion: Living with CKD stage 4 or 5 requires patient engagement and participation, meaning that patients understand how to manage their illness in their day-to-day lives. The studies suggest that further efforts are required in the management of kidney failure to enable more patients to engage in person-centred participation. One potential key to achieving mutual understanding between patients and professionals is dialogue. The tool utilised in these studies may prove useful in facilitating such conversations: the 4Ps is a tool that can be used to identify preferences for and experiences of patient participation. As such, it can be employed to measure preference-based patient participation in clinical settings and research. However, the findings of this thesis indicate that additional efforts are necessary for its implementation and to promote person-centred participation. Therefore, further research is needed, as are strategies healthcare professionals can employ to better recognise and respond to patients' resources and needs.
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| 2. |
- Lindström, Stefan B, 1974-, et al.
(författare)
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Computer-Aided Evaluation of Blood Vessel Geometry From Acoustic Images
- 2018
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Ingår i: Journal of ultrasound in medicine. - : Wiley-Blackwell Publishing Inc.. - 0278-4297 .- 1550-9613. ; 37:4, s. 1025-1031
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Tidskriftsartikel (refereegranskat)abstract
- A method for computer-aided assessment of blood vessel geometries based on shape-fitting algorithms from metric vision was evaluated. Acoustic images of cross sections of the radial artery and cephalic vein were acquired, and medical practitioners used a computer application to measure the wall thickness and nominal diameter of these blood vessels with a caliper method and the shape-fitting method. The methods performed equally well for wall thickness measurements. The shape-fitting method was preferable for measuring the diameter, since it reduced systematic errors by up to 63% in the case of the cephalic vein because of its eccentricity.
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| 3. |
- Yngman Uhlin, Pia, 1964-, et al.
(författare)
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Sleep Quality, Fatigue, and Health-Related Quality of Life in Patients on Initial Peritoneal Dialysis and Multiple Modalities after Two Years : A Prospective Study
- 2019
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Ingår i: Nephrology Nursing Journal. - Pitman, NJ, United States : American Nephrology Nurses Association (ANNA). - 1526-744X .- 2163-5390. ; 46:6, s. 615-649
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this study was to investigate changes in sleep quality, fatigue, mental health, and health-related quality of life (HRQoL) over a two-year period among patients undergoing peritoneal dialysis treatment at home. We further explored the extent to which sleep quality, fatigue, and mental health predicted health-related quality of life outcomes. This prospective study included 55 patients. Sleep parameters changed over two years, independently of treatment. Sleep variables at baseline, to some extent, predicted sleep quality after two years. Daytime sleepiness can be a long-term problem. Findings indicate improvements in nocturnal sleep over a two-year time period, independently of dialysis treatment. In contrast, fatigue remained unchanged over the same time period. Transplantation seems to generally benefit the outcome of HRQoL. Strategies to improve sleep and HRQoL may include systematic risk factor modification and efforts to optimise symptomatic treatment.
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| 4. |
- Ahlström, Christer, 1977-, et al.
(författare)
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Noninvasive investigation of blood pressure changes using the pulse wave transit time : A novel approach in the monitoring of hemodialysis patients
- 2005
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Ingår i: Journal of Artificial Organs. - : Springer Science and Business Media LLC. - 1434-7229 .- 1619-0904. ; 8:3, s. 192-197
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Tidskriftsartikel (refereegranskat)abstract
- Severe blood pressure changes are well known in hemodialysis. Detection and prediction of these are important for the well-being of the patient and for optimizing treatment. New noninvasive methods for this purpose are required. The pulse wave transit time technique is an indirect estimation of blood pressure, and our intention is to investigate whether this technique is applicable for hemodialysis treatment. A measurement setup utilizing lower body negative pressure and isometric contraction was used to simulate dialysis-related blood pressure changes in normal test subjects. Systolic blood pressure levels were compared to different pulse wave transit times, including and excluding the cardiac preejection period. Based on the results of these investigations, a pulse wave transit time technique adapted for dialysis treatment was developed and tried out on patients. To determine systolic blood pressure in the normal group, the total pulse wave transit time was found most suitable (including the cardiac preejection period). Correlation coefficients were r = 0.80 ± 0.06 (mean ± SD) overall and r = 0.81 ± 0.16 and r = 0.09 ± 0.62 for the hypotension and hypertension phases, respectively. When applying the adapted technique in dialysis patients, large blood pressure variations could easily be detected when present. Pulse wave transit time is correlated to systolic blood pressure within the acceptable range for a trend-indicating system. The method's applicability for dialysis treatment requires further studies. The results indicate that large sudden pressure drops, like those seen in sudden hypovolemia, can be detected. © The Japanese Society for Artificial Organs 2005.
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| 6. |
- Hurtig, Caroline, et al.
(författare)
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Patient participation in end-stage kidney disease care : variation over time and effects of staff-directed interventions - a quasi-experimental study
- 2023
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Ingår i: BMC Nephrology. - : BioMed Central (BMC). - 1471-2369. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Among those elements establishing decent quality of care from a patient perspective, opportunities to participate in accord with one's individual needs and preferences are central. To date, little is known the extent of preference-based patient participation in kidney care, and what facilitates optimal conditions. This study investigated i) preference-based patient participation in kidney care over time, and ii) the effects of interventions designed to enhance person-centred patient participation.Methods A quasi-experimental study was conducted across nine kidney care sites in southeast Sweden. A cohort of 358 patients with stage IV chronic kidney disease (eGRF 15-19 ml/min) or V (eGRF < 15 mL/min) entered the study. Of these, 245 patients (with kidney replacement therapy or intermittent outpatient visits only) completed a survey on patient participation at four time points: every six months from August 2019 to May 2021, patients reported their preferences for and experiences of participation using the validated Patient Preferences for Patient Participation tool, the 4Ps. Between the first and second data collection points, interventions were provided for designated staff to facilitate person-centred participation, using two strategies for two subgroups at three sites each: the managers receiving a bundle of information via e-mail on patient participation in a standard dissemination procedure (three sites), or an additional half-year support program for implementation offered to 1-2 staff per site (three sites), with no intervention for a control group (three sites). The differences in 4Ps data between groups were analysed using multilevel ordinal regression.Results Over time and across all sites, most patients' experiences of participation fully or almost fully matched their engagement preferences (57%-90%). Still, up to 12% of patient reports indicated that their preferences and experiences were insufficiently matched: in these cases, the patients had preferred to be more involved than they had experienced, for example, in making healthcare plans and setting health-related goals. The interventions did not affect the levels of preference-based participation, but patients in the control group sites had slightly more consistent matches.Conclusions Living with kidney failure necessitates patient engagement, but opportunities to participate in accordance with one's preferences are not fully provided for all patients. Additional efforts to support a common understanding and to ensure person-centred patient participation is still needed.
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| 8. |
- Paats, Joosep, et al.
(författare)
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Serum Levels and Removal by Haemodialysis and Haemodiafiltration of Tryptophan-Derived Uremic Toxins in ESKD Patients
- 2020
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Ingår i: International Journal of Molecular Sciences. - : MDPI. - 1661-6596 .- 1422-0067. ; 21:4
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Tidskriftsartikel (refereegranskat)abstract
- Tryptophan is an essential dietary amino acid that originates uremic toxins that contribute to end-stage kidney disease (ESKD) patient outcomes. We evaluated serum levels and removal during haemodialysis and haemodiafiltration of tryptophan and tryptophan-derived uremic toxins, indoxyl sulfate (IS) and indole acetic acid (IAA), in ESKD patients in different dialysis treatment settings. This prospective multicentre study in four European dialysis centres enrolled 78 patients with ESKD. Blood and spent dialysate samples obtained during dialysis were analysed with high-performance liquid chromatography to assess uremic solutes, their reduction ratio (RR) and total removed solute (TRS). Mean free serum tryptophan and IS concentrations increased, and concentration of IAA decreased over pre-dialysis levels (67%, 49%, -0.8%, respectively) during the first hour of dialysis. While mean serum total urea, IS and IAA concentrations decreased during dialysis (-72%, -39%, -43%, respectively), serum tryptophan levels increased, resulting in negative RR (-8%) towards the end of the dialysis session (p < 0.001), despite remarkable Trp losses in dialysate. RR and TRS values based on serum (total, free) and dialysate solute concentrations were lower for conventional low-flux dialysis (p < 0.001). High-efficiency haemodiafiltration resulted in 80% higher Trp losses than conventional low-flux dialysis, despite similar neutral Trp RR values. In conclusion, serum Trp concentrations and RR behave differently from uremic solutes IS, IAA and urea and Trp RR did not reflect dialysis Trp losses. Conventional low-flux dialysis may not adequately clear Trp-related uremic toxins while high efficiency haemodiafiltration increased Trp losses.
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| 9. |
- Staaf, Karin, et al.
(författare)
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How to needle : A mixed methods study on choice of cannulation technique for arteriovenous fistula
- 2023
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 32:15-16, s. 4559-4573
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Tidskriftsartikel (refereegranskat)abstract
- Aims and objectives The aim of this study was to describe the basis for choosing a cannulation technique for arteriovenous fistula. Background Four cannulation techniques are relevant to cannulating an arteriovenous fistula: rope ladder, area puncture and buttonhole using blunt or sharp needles. The chosen technique may affect both the patency and number of complications. Design The study used a convergent mixed methods design and inductive approach. Methods A questionnaire and an inquiry of local guidelines were sent to nurses in all dialysis units in Sweden. Questionnaires were answered by nurses from 37 units, and 29 units included their local guidelines. The questionnaires were analysed using descriptive statistics and qualitative content analysis, and the guidelines were analysed using qualitative content analysis. The different analyses were combined in a final result. The study is based on GRAMMS guidelines. Results Local guidelines, patients and nurses own judgement, and consultation with colleagues were found to greatly influence the choice of cannulation technique. Buttonhole was the most preferred cannulation technique in the participating units and was favoured by nurses when choosing a cannulation technique. The process of choosing a cannulation technique was found to be influenced by the dedication to good cannulation technique and healthy arteriovenous fistulas, whether the technique is perceived as being easy to use and is expected to prevent complications and based on the experienced-based knowledge of each dialysis unit. Conclusions Choosing a cannulation technique is a process based on the nurse, local guidelines and the patient. Most dialysis nurses and units in Sweden consider buttonhole to be a good cannulation technique and use it as their standard technique. Relevance to clinical practice The results provide insight into why cannulation techniques are chosen differently in different units. The results also show the importance of evidence in making decisions on cannulation technique.
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