17 research outputs found
A comparison of self‐reported quality of life for an Australian haemodialysis and haemodiafiltration cohort
No full textAims: Haemodiafiltration (HDF) has been widely studied for evidence of superior outcomes in comparison with conventional haemodialysis (HD), and there is increasing interest in determining if HDF confers any benefit in relation to quality of life. Studies have been conducted with randomized incident patients; however, little is known regarding HDF and quality of life for prevalent patients. This study examined and compared self–reported quality of life at two time points, 12 months apart in a cohort of satellite HD and HDF patients, using a disease specific questionnaire to determine if HDF conferred an advantage. Methods: A longitudinal study with a linear mixed‐effect model measuring quality of life in a cohort of 171 patients (HD, n = 85, HDF, n = 86) in seven South Australian satellite dialysis centres. Results: Factors associated with significant reduction across the Kidney Disease Quality Of Life™ domains measured were younger age (‐ 20 to ‐ 29) and comorbid diabetes (‐ 4.8 to ‐ 11.1). HDF was not associated with moderation of this reduction at either time point (P > 0.05). Baseline physical functioning was reported as very low (median 33.9) and further reduced at time point two. In addition, dialysing for more than 12 h per week in a satellite dialysis unit was associated with reduced quality of life in relation to the burden of kidney disease (‐ 13.69). Conclusion: This study has demonstrated that younger age and comorbid diabetes were responsible for a statistically significant reduction in quality of life, and HDF did not confer any advantage.Kathleen E Hill, Susan Kim, Susan Crail, Tony J Elias, Tiffany Whittingto
Studies of the function and regulation of vasodilator-stimulated phosphoprotein
No full textSepsis-induced renal failure is associated with damage to the proximal epithelial tubule and is associated with disruption of the actin cytoskeleton and cell shedding. Nitric oxide is associated with the changes induced by pro-inflammatory cytokines in early sepsis. We hypothesised that it acts via phosphorylation of vasodilator-stimulated phosphoprotein (VASP) altering its ability to act as a link between cell:cell and cell:matrix junctions and the actin cytoskeleton. Transfection of iNOS into epithelial cells was associated with a loss of VASP from its normal location at the cell membrane and with disruption of the actin cytoskeleton. Immunoblotting revealed that iNOS transfection was associated with a rise in the cGMP-dependent protein kinase preferred phosphorylation site at Ser239, a region close to G-actin binding and F-actin polymerising domains. We also showed that Ser239 phosphorylation was only seen when Seri57 phosphorylation had already occurred, that it was a transient effect and that it was nitric oxide dependent. We hypothesised that this was due to a conformational change in VASP and that Ser239 phosphorylation was dependent on the level of Serl57-phosphorylated VASP available. This was demonstrated in RAW 264.7 macrophages in which very high levels of Seri57 are achievable. Given the permissive effect of Seri57 phosphorylation on Ser239 phosphorylation, we investigated the effects of cAMP on this as the Seri57 site has been demonstrated to be preferentially phosphorylated via cAMP-dependent protein kinase. The addition of cAMP alone was not associated with an increase in Ser239 phosphorylation. However, when given to iNOS transfected cells, prolongation of the presence of the dually phosphorylated form of VASP was seen. We therefore proposed that the interaction of both cyclic nucleotide-dependent protein kinase pathways is important in the control of VASP phosphorylation. VASP is present at highly dynamic areas of the cell membrane such as lamellopodia and is important in cell motility. We hypothesised that it would be important in the formation of new epithelial sheets following injury. To investigate this we used a dominant-negative form of VASP (DN-VASP) consisting of amino acids 277-383 of the full-length protein. Expression of DN-VASP in a preformed epithelial monolayer did not appear to be associated with breakdown of the sheet even though it did disrupt actin fibres. However, expression of DN-VASP in a newly forming sheet did appear to be involved with cell loss and a reduced ability to adhere to the sub-stratum. Therefore, VASP may be of greater importance in the formation of an epithelial sheet than in maintenance of its integrity. The ability of the actin cytoskeleton to reorganise in response to external stimuli is also of crucial importance in T cell activation. A T cell adaptor protein, ADAP contains an EVH 1 binding domain and is therefore capable of binding VASP. ADAP and VASP are amongst a group of proteins that are localised to the T cell: antigen presenting cell interface. ADAP knockouts show a decreased ability to cluster the integrin LFA-1 to the immunological synapse following stimulation. We investigated the effects of disrupting VASP function in T cells via the use of DN-VASP. Transfection of DN-VASP into T cells was associated with an inability to polarise actin in response to TCR ligation and a significant decrease in interleukin-2 production. However it was not associated with a decrease in the ability to bind to beads coated with the LFA-1 ligand, ICAM-1. We further investigated the effects of DN-VASP transfection on signal transduction pathways and demonstrated that it appears to disrupt MAP kinase activation though not through phosphorylation of early steps of the cascade. It did not appear to have as great an effect on NFAT and NF-kB pathways. We hypothesised that VASP is important in T cell activation via its effects on signal transduction and that, in vivo these effects may be modulated through phosphorylation of VASP. In summary, this work shows that VASP is affected by NO-induced phosphorylation and that appears to be more complex than first expected, involving cAMP-dependent pathways also. VASP appears to be important in the formation of new epithelial sheets but is of less importance in a pre-formed monolayer. VASP also appears crucial to T cell activation and DN-VASP appears to induce T cell anergy, specifically disrupting MAP kinase pathways
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Implementing a radiation monitoring program at a solid waste landfill
No full textMore and more, modern society is incorporating the use of radioactive materials into everyday uses. And with society using more radioactive materials, the odds of it being accidentally disposed of into the solid waste stream increases.
There are several radiation systems available which market themselves as being complete and "ready to go". While it is true that a person could purchase one of these systems and would have coverage of the landfill, such a system does not provide the necessary education, response and liability protection programs. Indeed, it would be feasible to foresee a scenario where installing a systems could lead to an increase in liability and employee problems.
As a result, Coffin Butte Landfill worked with the author to establish a complete radiation monitoring program. This program encompasses everything from installment of the system to employee education and training. It also examined the myriad and murky depths of federal and state regulation dealing with solid and radioactive waste to help the landfill set an acceptance policy and minimize liability. This led the author to the belief that the combination of federal and state
regulations imply a requirement for landfills to have a working radiation monitoring program.
Future government action remains uncertain as pertaining to a requirement for landfills to maintain a radiation monitoring system. Indeed, current state regulations are out of sync with federal regulations regarding acceptable public exposures. It is hoped that, with this study's help, Coffin Butte Landfill and Oregon State University will continue with the established relationship and be prepared to respond to regulation changes
Indigenous patient experiences of returning to country: a qualitative evaluation on the Country Health SA Dialysis bus
No full textAbstract Background Rates of End-Stage Kidney Disease among Aboriginal and Torres Strait Islander (Indigenous) Australians in remote areas are disproportionately high; however, haemodialysis is not currently offered in most remote areas. People must therefore leave their ‘Country’ (with its traditions and supports) and relocate to metropolitan or regional centres, disrupting their kinship and the cultural ties that are important for their wellbeing. The South Australian Mobile Dialysis Truck is a service which visits remote communities for one to two week periods; allowing patients to have dialysis on ‘Country’, reuniting them with their friends and family, and providing a chance to take part in cultural activities. The aims of the study were to qualitatively evaluate the South Australian Mobile Dialysis Truck program, its impact on the health and wellbeing of Indigenous dialysis patients, and the facilitators and barriers to using the service. Methods Face to face semi-structured interviews were conducted with 15 Indigenous dialysis patients and 10 nurses who had attended trips across nine dialysis units. Realist evaluation methodology and thematic analysis established patient and nursing experiences with the Mobile Dialysis Truck. Results The consequences of leaving Country included grief and loss. Barriers to trip attendance included lower trip frequencies, ineffective trip advertisement, lack of appropriate or unavailable accommodation for staff and patients and poor patient health. Benefits of the service included the ability to fulfil cultural commitments, minimisation of medical retrievals from patients missing dialysis to return to remote areas, improved trust and relationships between patients and staff, and improved patient quality of life. The bus also provided a valuable cultural learning opportunity for staff. Facilitators to successful trips included support staff, clinical back-up and a co-ordinator role. Conclusions The Mobile Dialysis Truck was found to improve the social and emotional wellbeing of Indigenous patients who have had to relocate for dialysis, and build positive relationships and trust between metropolitan nurses and remote patients. The trust fostered improved engagement with associated health services. It also provided valuable cultural learning opportunities for nursing staff. This format of health service may improve cultural competencies with nursing staff who provide regular care for Indigenous patients
Quality of life among caregivers of people with end-stage kidney disease managed with dialysis or comprehensive conservative care
No full textBACKGROUND: To measure health-related and care-related quality of life among informal caregivers of older people with end-stage kidney disease (ESKD), and to determine the association between caregiver quality of life and care recipient's treatment type. METHODS: A prospective cross-sectional study was conducted. Three renal units in the UK and Australia were included. Informal caregivers of people aged ≥75 years with ESKD managed with dialysis or comprehensive conservative non-dialytic care (estimated glomerular filtration (eGFR) ≤10 mL/min/1.73m2) participated. Health-related quality of life (HRQoL) was assessed using Short-Form six dimensions (SF-6D, 0-1 scale) and care-related quality of life was assessed using the Carer Experience Scale (CES, 0-100 scale). Linear regression assessed associations between care-recipient treatment type, caregiver characteristics and the SF-6D utility index and CES scores. RESULTS: Of 63 caregivers, 49 (78%) were from Australia, 26 (41%) cared for an older person managed with dialysis, and 37 (59%) cared for an older person managed with comprehensive conservative care. Overall, 73% were females, and the median age of the entire cohort was 76 years [IQR 68-81]. When adjusted for caregiver sociodemographic characteristics, caregivers reported significantly worse carer experience (CES score 15.73, 95% CI 5.78 to 25.68) for those managing an older person on dialysis compared with conservative care. However, no significant difference observed for carer HRQoL (SF-6D utility index - 0.08, 95% CI - 0.18 to 0.01) for those managing an older person on dialysis compared with conservative care. CONCLUSIONS: Our data suggest informal caregivers of older people on dialysis have significantly worse care-related quality of life (and therefore greater need for support) than those managed with comprehensive conservative care. It is important to consider the impact on caregivers' quality of life when considering treatment choices for their care recipients
Additional file 1: of Indigenous patient experiences of returning to country: a qualitative evaluation on the Country Health SA Dialysis bus
No full textInterview Guide, List of interview questions used to guide interview. (DOCX 12 kb
Health-related quality of life and well-being in people over 75 years of age with end-stage kidney disease managed with dialysis or comprehensive conservative care: A cross-sectional study in the UK and Australia
No full text© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. Objective To measure health-related quality of life (HRQoL) and well-being in older people with end-stage kidney disease (ESKD) and to determine the association between treatment type and sociodemographic characteristics on these outcome measures. In addition, to assess the convergent validity between the HRQoL and well-being measure and their feasibility and acceptability in this population. Design Prospective cross-sectional study. Setting Three renal units in the UK and Australia. Participants 129 patients with ESKD managed with dialysis or with an estimated glomerular filtration ≤10 mL/min/1.73 m 2 and managed with comprehensive conservative, non-dialytic care. Outcome measures HRQoL and well-being were assessed using Short-Form six dimensions (SF-6D, 0-1 scale); Kidney Disease Quality of Life (KDQOL-36) (0-100 scale) and Investigating Choice Experiments Capability Measure-Older people (ICECAP-O, 0-1 scale). Linear regression assessed associations between treatment, HRQoL and well-being. Pearson's correlation coefficient assessed convergent validity between instruments. Results Median age of 81 years (IQR 78-85), 65% males; 83 (64%) were managed with dialysis and 46 (36%) with conservative care. When adjusted for treatment type and sociodemographic variables, those managed on dialysis reported lower mean SF-6D utility (-0.05, 95% CI-0.12 to 0.01); lower KDQOL Physical Component Summary score (-3.17, 95% CI-7.61 to 1.27); lower Mental Component Summary score (-2.41, 95% CI-7.66 to 2.84); lower quality of life due to burden (-28.59, 95% CI-41.77 to-15.42); symptoms (-5.93, 95% CI-14.61 to 2.73) and effects of kidney disease (-16.49, 95% CI-25.98 to-6.99) and lower overall ICECAP-O well-being (-0.07, 95% CI-0.16 to 0.02) than those managed conservatively. Correlation between ICECAP-O well-being and SF-6D utility scores was strong overall, 0.65 (
Management changes in the National Health Service : nursing and organisational theory in relation to the development of a new unit of health care.
No full textThis thesis gives an account of research into management
changes in the English NHS following the implementation of
the Griffiths' Report (1983). The research had three aims:
1. To describe and consider the effects of new management
philosophies plans and practices by conducting a case
study of one particular unit of health care.
2. To study theories of nursing and health care
organisation.
3. To assess the relationship, if any, between experience
and theory, suggesting ways to bring theory and
practice closer together.
The academic perspective is multidisciplinary, drawing on
literature from nursing, organisational 'theory and
behaviour, health service management, social science,
philosophy, history, economics and policy studies.
The thesis commences with a discussion of research
methodology, arguing the appropriateness of an interpretive
stance. An account of the development of the NHS and
nursing's place within it is followed by a detailed case
study of one unit, which lasted nine months and involved
more than a hundred interviews. Particular characteristics
of the case study are:-
Data analysis utilising grounded theory methodology
Inclusion of members of the organisational context
A system for participants to validate data pertaining
to themselves.
The style is naturalistic, qualitative and processual.
Presentation of the results recognises the existence of
multiple interpretations of organisational reality; a
metaphor likens the development of the Unit to the weaving
of a tapestry, where the backing is the structure of the
unit, and the pattern the perceptions, values and
aspirations of its staff, patients and context members.
Emerging themes in the thesis are:-
the complexity of the NHS
professional philosophies and their relationship to
management
organising as a process
growth of a distinctive unit culture.
A deliberate choice is made to expose the conflicts and
difficulties of naturalistic inquiry, by reflecting on
research method throughout the thesis, which is written in
the first person
