1,720,996 research outputs found
Managing uncertainty in multidisciplinary renal team meetings: decision-making processes and complex challenges in kidney transplant listing
No full textMultidisciplinary team (MDT) meetings are common to many fields of medicine and widely established internationally. They are intended to ensure higher-quality decision-making and improved patient outcomes. For patients with end-stage kidney disease (ESKD), decisions on whether to place marginally suitable candidates on the kidney transplantation waiting list can be challenging and as such they are supported by MDT meetings. Uncertainty in terms of the best course of action can be linked with a dearth of knowledge or evidence on specific medical conditions and likely implications for successful transplantation, but also on unforeseen outcomes influenced by patient behaviours. In this project, we observed how MDT meetings work in practice in kidney transplant listing, unpacking issues of risk and uncertainty in transplant decision-making processes. Our findings indicate that a central value of MDT meetings is managing medical uncertainty and psychosocial risks, and distributing responsibility for complex transplant listing decisions to ensure equity of access to transplantation as well as an efficient use of scarce kidneys. This sheds light on strategies enacted to mitigate these risks and uncertainties, and the role played by different types of knowledge (experiential versus scientifically evidence-based) in the overall decision-making process.</p
Health literacy and patient outcomes in chronic kidney disease: a systematic review
No full textBackground: limited health literacy affects 25% of people with Chronic Kidney Disease (CKD), and may reduce self-management skills resulting in poorer clinical outcomes. By disproportionately affecting people with low socioeconomic status and non-white ethnicity, limited health literacy may promote health inequity.Methods: systematic review of quantitative studies of health literacy and clinical outcomes among adults with CKD.Results: 29 studies (13 articles; 16 conference abstracts) were included. One included non-USA patients. Five were cohort studies, 24 cross-sectional. 18,300 patients were studied: 4,367 non-dialysis CKD; 13,202 dialysis, 390 transplant; 341 unspecified. Median study size was 127 (IQR: 92-238), but 480 (IQR: 260-2392) for cohort studies. Median proportion of non-white participants was 48% (IQR: 17-70%). Six health literacy measures were used. Outcomes included patient attributes, care processes, clinical/laboratory parameters, and ‘hard’ clinical outcomes. Limited health literacy was significantly, independently associated with hospitalisations, emergency department use, missed dialysis sessions, cardiovascular events and mortality (in cohort studies). Study quality was high (1 study), moderate (3 studies) and poor (25 studies), limited by sampling methods, variable adjustment for confounders and reduced methodological detail given in conference abstracts.Conclusions: there is limited robust evidence of the causal effects of health literacy on patient outcomes in CKD. Available evidence suggests associations with adverse clinical events, increased healthcare use, and mortality. Prospective studies are required to determine the causal effects of health literacy on outcomes in CKD patients, and examine the relationships between socioeconomic status, comorbidity, health literacy and CKD outcomes. Intervention development and evaluation will determine whether health literacy is a modifiable determinant of poor outcomes in CKD
Inhalation of islet autoantigen derived peptides to induce tolerance in a murine islet transplant model
No full textEThOS - Electronic Theses Online ServiceGBUnited Kingdo
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Limited health literacy in advanced kidney disease
Get PDFLimited health literacy may reduce the ability of patients with advanced kidney disease to understand their disease and treatment and take part in shared decision making. In dialysis and transplant patients, limited health literacy has been associated with low socioeconomic status, comorbidity, and mortality. Here, we investigated the prevalence and associations of limited health literacy using data from the United Kingdom–wide Access to Transplantation and Transplant Outcome Measures (ATTOM) program. Incident dialysis, incident transplant, and transplant wait-listed patients ages 18 to 75 were recruited from 2011 to 2013 and data were collected from patient questionnaires and case notes. A score >2 in the Single-Item Literacy Screener was used to define limited health literacy. Univariate and multivariate analyses were performed to identify patient factors associated with limited health literacy. We studied 6842 patients, 2621 were incident dialysis, 1959 were wait-listed, and 2262 were incident transplant. Limited health literacy prevalence was 20%, 15%, and 12% in each group, respectively. Limited health literacy was independently associated with low socioeconomic status, poor English fluency, and comorbidity. However, transplant wait-listing, preemptive transplantation, and live-donor transplantation were associated with increasing health literacy
A propensity score–matched analysis indicates screening for asymptomatic coronary artery disease does not predict cardiac events in kidney transplant recipients
Get PDFScreening for asymptomatic coronary artery disease prior to kidney transplantation aims to reduce peri- and postoperative cardiac events. It is uncertain if this is achieved. We investigated whether pre-transplant screening with a stress test or coronary angiogram associates with any difference in major adverse cardiac events (MACE) up to 5 years post-transplantation. We examined a national prospective cohort recruited to the Access to Transplant and Transplant Outcome Measures study who received a kidney transplant between 2011-2017, and linked patient demographics and details of cardiac screening investigations to outcome data extracted from the Hospital Episode Statistics dataset and UK Renal Registry. Propensity score matched groups were analysed using Kaplan-Meier
and Cox survival analyses. Overall, 2572 individuals were transplanted in 18 centres; 51% underwent screening. The proportion undergoing screening by centre ranged from 5-100%. The incidence of MACE at 90 days, 1 and 5 years was 0.9%, 2.1% and 9.4% respectively. After propensity score matching based on the presence or absence of screening, 1760 individuals were examined (880 in screened and unscreened groups). There was no statistically significant association between screening and MACE at 90 days (hazard ratio [HR] 0.80, 95% CI 0.31-2.05), 1 year (HR 1.12, 95% CI
0.51–2.47) or 5 years (HR 1.31, 95% CI 0.86-1.99). Age, male sex and history of ischaemic heart disease were associated with MACE. There is no association between screening for asymptomatic coronary artery disease and MACE up to 5 years post-transplant. Practices involving unselected screening of transplant recipients should be reviewe
Vancomycin therapy in patients on high-flux HD: a single-centre experience
No full textVancomycin is a glycopeptide antibiotic used to treat serious infections with gram-positive bacteria that are resistant to other antibiotics. Patients receiving haemodialysis (HD) via central venous catheters are at an increased risk of gram-positive bacterial infections. Strains of staphylococci and enterococci resistant or only partially sensitive to vancomcyin have developed; therefore, appropriate controlled use of vancomycin is essential
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Health literacy and its relationship with process and outcome in advanced kidney disease
No full textIntroduction: Management of Chronic Kidney Disease (CKD) aims to reduce the risk of kidney failure and cardiovascular disease and, if appropriate, prepare patients for renal replacement therapy: dialysis or kidney transplantation. Kidney transplantation is superior to dialysis in terms of survival and quality of life, but donor organs are a limited resource. CKD care pathways are complex, and shared decision-making and self-care activities are promoted. Health literacy is an attribute facilitating access, understanding, appraisal and use of health-related information. Socioeconomic disparities exist in CKD care and outcomes. Low health literacy is associated with both low socioeconomic status (SES) and poorer health outcomes, so is hypothesised to mediate pathways which promote health inequity.Aims/Methods: This thesis investigates:• The prevalence of limited health literacy at different treatment stages of CKD, and associations with demographics and SES (systematic review and meta-analysis).• Associations between low health literacy and CKD outcomes (systematic review)• The prevalence and associations of limited health literacy in UK patients with advanced CKD in the Access to Transplant and Transplant Outcome Measures (ATTOM) study• Associations between limited health literacy and clinical outcomes, including deceasedand living-donor kidney transplantation, using prospective data from the ATTOM study.• Health literacy as a mediator in the relationship between low educational level and time to transplant wait-listing and deceased- or living-donor kidney transplantationResults: The pooled prevalence of limited health literacy among people with CKD was 25%. Prevalence was lower among transplanted patients compared to those with non-dialysis or dialysis CKD. Limited health literacy was consistently, independently associated with low SES and non-white ethnicity. Current evidence from peer-reviewed literature for associations between low health literacy and clinical outcomes was limited. In the ATTOM study, limited health literacy was independently associated with low socioeconomic status and increased comorbidity. Prevalence of limited health literacy was significantly lower among transplant recipients compared to dialysis or wait-listed patients, after adjustment for comorbidity. Limited health literacy was associated with reduced chance of transplant wait-listing, living-donor transplant or transplantation from any donor at 2 years from dialysis start. In mediation analysis, health literacy mediated 25-30% of the total effect of low educational level on increased time to deceased-donor transplant wait-listing, living-donor transplantation or transplantation from any donor type.Conclusions: A quarter or more of patients with CKD have limited health literacy, so are unlikely to be able to fully understand or appraise health-related information or navigate care pathways if standard communication methods are used. By mediating the relationship between low socioeconomic status and access to transplantation, health literacy differences may promote inequity. Interventions which successfully reduce these effects could improve patients’ understanding, reduce inequity and improve outcomes
- …
