Hemodialysis Care Research Articles

Impact on health outcomes of hemodialysis patients based on the experience level of registered nurses in the hemodialysis department: a cross-sectional analysis.

The aim of the study is to improve the policy of health authorities regarding registered nurses (RNs) staffing by understanding how the health outcomes of hemodialysis (HD) patients vary depending on the level of HD nursing experience of at least 2 years. The study included 21,839 patients who started maintenance HD for 3 months in early 2013 in the same medical institutions. Demographic variables such as sex, age, and causes of HD; institutional variables such as type of institution and number of RNs; and health outcomes such as HD adequacy, systolic and diastolic blood pressure (SBP, DBP), hemoglobin (Hb), and serum albumin were collected through web-based questionnaires. To determine the relationship between variables, t-test, chi-square test, and ANOVA were employed. Binary logistic regression was used to examine the odds ratio. Institutions with 100% of experienced RNs with at least 2 years of experience in HD units were found to have higher NKF K-DOQI criteria satisfaction rate than Institutions with <50% of experienced RNs with at least 2 years of experience in HD units for all health outcomes, except DBP (42.9% vs. 38.8%, p < .001) and Hb (27.8% vs. 24.4%, p < .001). Four of the six health-related variables-HD adequacy (Kt/v, urea reduction rate, URR), SBP, and serum albumin-were higher in institutions with 100% of experienced RNs than those with less than 50%. In order to improve HD patients' health outcomes, HD institutions should prioritize recruiting RNs who are proficient in HD care. A higher proportion of skilled RNs results in a higher ability to prepare for emergencies and early detection of patient complications. RNs with extensive experience in HD nursing, therefore, promote quality management of HD patients.

Clinical-epidemiological characterization of patients submitted to hemodialysis according to the national kidney foundation, the kidney disease outcomes quality initiative – KDOQI in a hemodialysis reference center in the metropolitan region of São Paulo, Brazil

Introduction: hemodialysis is a treatment that helps in the survival of patients with renal failure, through an established cardiopulmonary bypass to carry out blood filtration, as a result, there is a need for a feasible, lasting and effective vascular access. There are two types of vascular access, arteriovenous fistulas, using autogenous veins or prostheses, and venous catheters. The indications for choosing the type of vascular access are related to the characteristics and restriction of use of each patient. Objective: to analyze the epidemiological, demographic and clinical profile of patients undergoing hemodialysis in two reference services in the metropolitan region of São Paulo, Brazil, and compare the clinical-surgical processes with those defined by the Kidney Guidelines disease Outcomes Quality Initiative (KDOQI). Methods: data were collected in two public hospitals, with patients undergoing hemodialysis, through registration forms and medical records, from August to December 2016. The volunteers were informed about the procedures and objectives of the study and, after agreeing, they signed a consent form. The variables age, gender, weight, height, body mass index, hemodialysis time, types of accesses already used , complications related to the accesses and underlying disease were analyzed. Patients with chronic renal failure undergoing hemodialysis of both genders, with no age restriction, were included. Patients not able to perform one of the techniques, arteriovenous fistula or catheter, were excluded . The collected data were compared with the Kidney guidelines disease Outcomes Quality Initiative (KDOQI). Results: a total of 252 individuals were included, of which 182 are patients undergoing reference hospital treatment in the city of São Bernardo do Campo, SP and 70 patients at the State University Hospital Mário Covas, a State reference in the clinical management of patients undergoing hemodialysis care. Conclusion: chronic kidney disease is highly prevalent with progression to end-stage chronic kidney failure (dialysis). The definition of the epidemiological profile of the population undergoing treatment, as well as the journey of venous accesses for hemodialysis (catheters and fistulas), are fundamental for the multidisciplinary team’s learning curve about complications throughout the course of the disease/treatment. Furthermore, the clinical-surgical management of this population is in line with the guidelines of the National Kidney Foundation. The treatment performed in these hemodialysis centers is efficient and in line with what the KDOQI recommends.

Does Hospitalist Care Enhance Palliative Care and Reduce Aggressive Treatments for Terminally Ill Patients? A Propensity Score-Matched Study.

Information on the use of palliative care and aggressive treatments for terminally ill patients who receive care from hospitalists is limited. This three-year, retrospective, case-control study was conducted at an academic medical center in Taiwan. Among 7037 patients who died in the hospital, 41.7% had a primary diagnosis of cancer. A total of 815 deceased patients who received hospitalist care before death were compared with 3260 patients who received non-hospitalist care after matching for age, gender, catastrophic illness, and Charlson comorbidity score. Regression models with generalized estimating equations were performed. Patients who received hospitalist care before death, compared to those who did not, had a higher probability of palliative care consultation (odds ratio (OR) = 3.41, 95% confidence interval (CI): 2.63-4.41), and a lower probability to undergo invasive mechanical ventilation (OR = 0.13, 95% CI: 0.10-0.17), tracheostomy (OR = 0.14, 95% CI: 0.06-0.31), hemodialysis (OR = 0.70, 95% CI: 0.55-0.89), surgery (OR = 0.25, 95% CI: 0.19-0.31), and intensive care unit admission (OR = 0.11, 95% CI: 0.08-0.14). Hospitalist care was associated with reductions in length of stay (coefficient (B) = -0.54, 95% CI: -0.62--0.46) and daily medical costs. Hospitalist care is associated with an improved palliative consultation rate and reduced life-sustaining treatments before death.

Effect of Resistance Exercise with Moderate and Low Intensity on Quality of Life and Mental Health in Maintenance Hemodialysis Patients

It was to explore the effects of resistance exercise with moderate and low intensity on quality of life (QoL) and mental health of patients with maintenance hemodialysis (MHD). From June 2022 to December 2022, 90 patients receiving MHD treatment in Blood Purification Center of XXX Hospital were randomly divided into observation group and controls, with 45 patients in each group. The controls received routine hemodialysis care, and observation group received resistance exercise with moderate and low inte in addition to routine hemodialysis care. QoL measurement tool adopted 36-Item Short Form Health Survey (SF-36), Hamilton Rating Scale for Depression (HAMD), and Hamilton Anxiety Scale (HAMA) to evaluate patients. The physical function was 67.64±25.62 and mental health was 71.68±28.55 in controls, and those was 71.11±25.42 and 73.48±13.59 in observation group; in terms of physical function and mental health in QoL, observation group was obviously higher; and HAMD and HAMA scores in observation group were clearly lower as against controls (P &lt; 0.05). The effect of resistance exercise with moderate and low inte was obvious on the physical function and mental state of QoL in MHD patients, but not obvious on other aspects. Resistance exercise with moderate and low inteis beneficial to improve patients’ mental health.

The Spectrum of Intradialysis Complications in Renal Patients Accessing Care in A Tertiary Hospital in South East Nigeria

Background: Haemodialysis (HD) is currently the most common mode of renal replacement therapy (RRT) in the Sub-Saharan Africa. It is however, fraught with many complications which sometimes cause morbidity and mortality outside the primary kidney problems. Hence, there must be concerted effort to identify them early. This would enable the clinician institute preventive measures or treat them efficiently when these adverse effects occur. Materials and Method: A prospective study was carried out among chronic kidney disease (CKD) and acute kidney injury (AKI) patients in failure assessing HD care at the Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi dialysis center. Subjects were one hundred and twenty six in number: 84 CKD and 42 AKI. Sixty five (65) were males while sixty one (61) were females. A total of three hundred and sixty nine (369) HD sessions were done. Sociodemographic data and medical history were obtained from each subject and relevant physical examinations and laboratory investigations were carried out prior to and intra dialysis for each subject. Results were analyzed using Statistical Package for Social Sciences (SPSS) software version 17. Results: Intradialytic complications occurred in 86 out of 126 subjects. The commonest intradialytic complication was hypotension (20.6% for patient-based analysis and 21.1% for session-based analysis). This was followed by hypertension (19.8% for patient-based analysis and 16.5% for session-based analysis). Other complications noted were fever (9.95%), chest pain (9.95%), cramps (1.0%) and seizure (1.0%). Conclusion: In this study population, intradialysis hypotension was the most common complication followed by intradialysis hypertension. Patients on HD should be assessed and monitored actively to identify and possibly prevent or treat these complications when they occur.

Exercise during Hemodialysis in Patients with Chronic Kidney Failure

BackgroundPatients with kidney failure undergoing hemodialysis experience physical deconditioning and multimorbidity. Exercise interventions may mitigate this outcome, but their clinical role is unclear.MethodsThis multicenter, cluster randomized controlled trial evaluated combined endurance and resistance exercise training during hemodialysis versus usual care in chronic kidney failure. It assessed physical functioning, quality of life, hospitalizations, and overall survival. The primary outcome was the change in the 60-second sit-to-stand test (STS60) between baseline and 12 months.ResultsA total of 1211 patients underwent randomization, 917 (65.9±14.4 years; 38.9% female) of whom were included in the full analysis (exercise intervention, n=446; usual care, n=471). At 12 months, the STS60 repetitions improved from 16.2±7.6 to 19.2±9.1 in the exercise group but declined from 16.2±7.1 to 14.7±7.9 in the usual care group (group difference, 3.85 repetitions; 95% confidence interval [CI], 2.22 to 5.48; P<0.0001). The timed up-and-go test (−1.1 seconds; 95% CI, −1.9 to −0.3) and the 6-minute walk test (37.5 m; 95% CI, 14.7 to 60.4) also differed in the exercise group versus usual care group. The physical summary score and vitality subscale of the quality of life questionnaire (i.e., the 36-item Short Form Health Survey) differed in the exercise group versus usual care group, but the other subscales did not change. Adverse events during dialysis sessions were similar in both groups. Median days spent in the hospital annually were 2 in the exercise group and 5 in the usual care group. Mortality and dialysis-specific adverse events were not affected.ConclusionsTwelve months of intradialytic exercise in patients with kidney failure significantly improved the STS60 compared with usual care. (Funded by the Innovation Fund, Federal Joint Committee; ClinicalTrials.gov number, NCT03885102.)

Discrepancy in responses to the surprise question between hemodialysis nurses and physicians, with focus on patient clinical characteristics: A comparative study.

The surprise question (SQ) "Would I be surprised if this patient died within the next xx months" can be used by different professions to foresee the need of serious illness conversations in patients approaching end of life. However, little is known about the different perspectives of nurses and physicians in responses to the SQ and factors influencing their appraisals. The aim was to explore nurses' and physicians' responses to the SQ regarding patients on hemodialysis, and to investigate how these answers were associated with patient clinical characteristics. This comparative cross-sectional study included 361 patients for whom 112 nurses and 15 physicians responded to the SQ regarding 6 and 12 months. Patient characteristics, performance status, and comorbidities were obtained. Cohen's kappa was used to analyze the interrater agreement between nurses and physicians in their responses to the SQ and multivariable logistic regression was applied to reveal the independent association to patient clinical characteristics. Proportions of nurses and physicians responding to the SQ with "no, not surprised" was similar regarding 6 and 12 months. However, there was a substantial difference concerning which specific patient the nurses and physicians responded "no, not surprised", within 6 (κ = 0.366, p < 0.001, 95% CI = 0.288-0.474) and 12 months (κ = 0.379, p < 0.001, 95% CI = 0.281-0.477). There were also differences in the patient clinical characteristics associated with nurses' and physicians' responses to the SQ. Nurses and physicians have different perspectives in their appraisal when responding to the SQ for patients on hemodialysis. This may reinforce the need for communication and discussion between nurses and physicians to identify the need of serious illness conversations in patients approaching the end of life, in order to adapt hemodialysis care to patient preferences and needs.

Efficacy and Safety of Prothrombin Complex Concentrates in Liver Transplantation: Evidence from Observational Studies.

The risk/benefit ratio of using prothrombin complex concentrates (PCCs) to correct coagulation defects in patients with end-stage liver disease is still unclear. The primary aim of this review was to assess the clinical effectiveness of PCCs in reducing transfusion requirements in patients undergoing liver transplantation (LT). This systematic review of non-randomized clinical trials was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The protocol was previously registered (PROSPERO:CRD42022357627). The primary outcome was the mean number of transfused units for each blood product, including red blood cells (RBCs), fresh frozen plasma, platelets, and cryoprecipitate. Secondary outcomes included the incidence of arterial thrombosis, acute kidney injury, and haemodialysis, and hospital and intensive care unit length of stay. There were 638 patients from 4 studies considered for meta-analysis. PCC use did not affect blood product transfusions. Sensitivity analysis, including only four-factor PCC, showed a significant reduction of RBC effect size (MD: 2.06; 95%CI: 1.27-2.84) with no true heterogeneity. No significant differences in secondary outcomes were detected. Preliminary evidence indicated a lack of PCC efficacy in reducing blood product transfusions during LT, but further investigation is needed. In particular, future studies should be tailored to establish if LT patients will likely benefit from four-factor PCC therapy.

Enhancing the Cardiovascular Safety of Hemodialysis Care Using Multimodal Provider Education and Patient Activation Interventions: Protocol for a Cluster Randomized Controlled Trial.

End-stage kidney disease (ESKD) is treated with dialysis or kidney transplantation, with most patients with ESKD receiving in-center hemodialysis treatment. This life-saving treatment can result in cardiovascular and hemodynamic instability, with the most common form being low blood pressure during the dialysis treatment (intradialytic hypotension [IDH]). IDH is a complication of hemodialysis that can involve symptoms such as fatigue, nausea, cramping, and loss of consciousness. IDH increases risks of cardiovascular disease and ultimately hospitalizations and mortality. Provider-level and patient-level decisions influence the occurrence of IDH; thus, IDH may be preventable in routine hemodialysis care. This study aims to evaluate the independent and comparative effectiveness of 2 interventions-one directed at hemodialysis providers and another for patients-in reducing the rate of IDH at hemodialysis facilities. In addition, the study will assess the effects of interventions on secondary patient-centered clinical outcomes and examine factors associated with a successful implementation of the interventions. This study is a pragmatic, cluster randomized trial to be conducted in 20 hemodialysis facilities in the United States. Hemodialysis facilities will be randomized using a 2 × 2 factorial design, such that 5 sites will receive a multimodal provider education intervention, 5 sites will receive a patient activation intervention, 5 sites will receive both interventions, and 5 sites will receive none of the 2 interventions. The multimodal provider education intervention involved theory-informed team training and the use of a digital, tablet-based checklist to heighten attention to patient clinical factors associated with increased IDH risk. The patient activation intervention involves tablet-based, theory-informed patient education and peer mentoring. Patient outcomes will be monitored during a 12-week baseline period, followed by a 24-week intervention period and a 12-week postintervention follow-up period. The primary outcome of the study is the proportion of treatments with IDH, which will be aggregated at the facility level. Secondary outcomes include patient symptoms, fluid adherence, hemodialysis adherence, quality of life, hospitalizations, and mortality. This study is funded by the Patient-Centered Outcomes Research Institute and approved by the University of Michigan Medical School's institutional review board. The study began enrolling patients in January 2023. Initial feasibility data will be available in May 2023. Data collection will conclude in November 2024. The effects of provider and patient education on reducing the proportion of sessions with IDH and improving other patient-centered clinical outcomes will be evaluated, and the findings will be used to inform further improvements in patient care. Improving the stability of hemodialysis sessions is a critical concern for clinicians and patients with ESKD; the interventions targeted to providers and patients are predicted to lead to improvements in patient health and quality of life. ClinicalTrials.gov NCT03171545; https://clinicaltrials.gov/ct2/show/NCT03171545. PRR1-10.2196/46187.

Moisture in hemodialysis catheter dressings and the risk of infection: an integrative review

Introduction: In hemodialysis care, the nurse is involved in most care for the patient using a double-lumen central venous catheter; in this regard, it is necessary to instruct the renal patient about measures to protect venous access regarding humidity during bathing, as a wet dressing over the device insertion site increases the risk of infection. Aim: To identify in the literature the relationship between moisture in hemodialysis catheter dressings and the risk of infection. Outlining: Integrative review performed in MEDLINE databases via PubMed, CINAHL, Web of Science, Scopus, Cochrane, BDENF, LILACS bibliographic index and references of the articles included. The sample consisted of 10 primary studies. The results were analyzed descriptively and organized into categories. Results: Six (60%) addressed the humidity related to the bath, three (30%) addressed the humidity related to perspiration and one (10%) discussed the humidity related to secretions from the ostium of the hemodialysis catheter. Implications: Wetting the hemodialysis catheter while bathing is not the best recommendation. Moisture resulting from perspiration was associated with risk of infection.

Nurses Practice and Associated Factors towards Hemodialysis Care in Addis Ababa, Ethiopia

Background: Patients on hemodialysis care are at a greater risk of developing infectious diseases that leads to life treating complications. The deficiency in practice of nurses when caring for patients who are in hemodialysis has a negative effect on the improvement of the patient’s condition. This study was conducted to determine nurse’s practices and associated factors towards dialysis care. Methods: An institution based cross-sectional study was employed in this study. A total of 62 nurses giving hemodialysis care were included. Statistical analysis was performed using SPSS version 26.0 software. Frequency with percentage was used to report categorical variables, while mean with standard deviation was used to report quantitative variables. Adjusted odds ratio with 95% confidence interval was used to identify factors associated with the outcome variable in the logistic regression model, considering P&lt;0.05 to declare statistical significance. Result: In this study, about 65% of nurses working in the dialysis unit had good practice. Nurses years of experience [AOR: 11; 95% CI(1.29-39.3)], having training [AOR: 8.5; (95% CI; 2.26-27.5)], knowledge [AOR: 1295% CI: 2.65-56.2)] were significantly associated with the practice of nurses regarding hemodialysis care. Conclusion: In this study we found that the nurse’s practice towards hemodialysis service was good. Training, experience and knowledge of nurses were significantly associated with the experience towards hemodialysis care. Thus, interventions should focus on improving experience, awareness and training of nurses to improve the practice of nurses regarding hemodialysis care.

Nurses Knowledge and Associated Factors towards Hemodialysis Care at Governmental Dialysis Units in Addis Ababa, Ethiopia

Hemodialysis is a process of purifying the blood of a person whose kidney is not working normally. Little is known about the nurses’ knowledge and associated factors while caring for patients undergoing hemodialysis. The aim of this study was to evaluate knowledge and associated factors of hemodialysis among nurses. Methods: Institution based cross-sectional survey design was conducted among dialysis care provider nurses. A total of 62 nurses giving hemodialysis care were included. Data were analyzed using SPSS version 26.0 software in logistic regression model. Descriptive statistics were expressed as percentage and frequency. Adjusted odds ratio with 95% confidence interval was used to measure factors associated with the outcome variable considering P&lt;0.05 to declare statistical significance. Result: Among the 62 nurses enrolled, about 70% were knowledgeable regarding hemodialysis. Nurses experience in working dialysis [AOR: 10.18 95% CI: 2.18, 47.40)], training of nurses (AOR=5 95% CI: 1.12-22.20) were significantly associated with the knowledge of nurses regarding hemodialysis care. Conclusion: In this study we found that nurses experience working in hemodialysis and years of work experience were factors affecting their knowledge towards hemodialysis service. Thus, interventions should focus on improving experience and training of nurses regarding hemodialysis care to improve the compressive knowledge of nurses.

Nurses Practice and Associated Factors towards Hemodialysis Care in Addis Ababa, Ethiopia

Background: Patients on hemodialysis care are at a greater risk of developing infectious diseases that leads to life treating complications. The deficiency in practice of nurses when caring for patients who are in hemodialysis has a negative effect on the improvement of the patient's condition. This study was conducted to determine nurse’s practices and associated factors towards dialysis care. Methods: An institution based cross-sectional study was employed in this study. A total of 62 nurses giving hemodialysis care were included. Statistical analysis was performed using SPSS version 26.0 software. Frequency with percentage was used to report categorical variables, while mean with standard deviation was used to report quantitative variables. Adjusted odds ratio with 95% confidence interval was used to identify factors associated with the outcome variable in the logistic regression model, considering P&lt;0.05 to declare statistical significance. Result: In this study, about 65% of nurses working in the dialysis unit had good practice. Nurses years of experience [AOR: 11; 95% CI (1.29-39.3)], having training [AOR: 8.5; (95% CI; 2.26-27.5)], knowledge [AOR: 12 95% CI: 2.65-56.2)] were significantly associated with the practice of nurses regarding hemodialysis care. Conclusion: In this study we found that the nurse’s practice towards hemodialysis service was good. Training, experience and knowledge of nurses were significantly associated with the experience towards hemodialysis care. Thus, interventions should focus on improving experience, awareness and training of nurses to improve the practice of nurses regarding hemodialysis care. Keywords: Hemodialysis, Nurses, practice, Associated factors DOI: 10.7176/JHMN/106-02 Publication date: March 31 st 2023

Glucarpidase for Treating Adults with Delayed Methotrexate Elimination Due to Impaired Renal Function: An Economic Simulation Analysis.

Glucarpidase is indicated for treating delayed methotrexate (MTX) elimination due to impaired renal function. Although glucarpidase is capable of rapidly eliminating MTX independent of renal clearance, its cost can be perceived as a barrier to use. However, no published economic analyses have evaluated glucarpidase relative to comparable treatments. To assess the economic value of glucarpidase for treating adult patients in the United States (US) who experience delayed MTX elimination due to impaired renal function. A decision tree model was developed to assess the economic value of glucarpidase. The short-term inpatient management of patients as well as long-term survival were simulated. Costs associated with the use of glucarpidase were compared against other methods for treating delayed MTX elimination due to impaired renal function under two scenarios: current practice (ie, mix of timely/delayed use of glucarpidase, hemodialysis, or supportive care [SC] alone) as compared with proposed practice (ie, timely glucarpidase administration within 60 hours for all eligible patients). Hypothetical practical scenarios for US institutions were also considered. For adult patients with delayed MTX elimination, proposed practice as compared to current practice was associated with an increased cost of $20,024 per patient, not considering any incremental reimbursement associated with glucarpidase administration. Importantly, early treatment with glucarpidase, within 60 hours, was shown to be less expensive per patient than delayed glucarpidase treatment or treating with hemodialysis, but more expensive than SC alone. However, proposed practice was associated with multiple clinical benefits, including shorter hospital length of stay. For hypothetical practical scenarios, minimal shifts in treatment patterns had minimal cost impacts. Treatment of all eligible patients with glucarpidase within 60 hours was associated with an increased cost per patient (relative to current practice) but substantial improvements in clinical outcomes. Timely glucarpidase use was less expensive than delayed glucarpidase or hemodialysis.

Effectiveness of video assisted teaching programme on knowledge and attitude regarding hemodialysis among patients with chronic renal failure

Chronic Renal Failure is a worldwide public health problem with an increasing incidence and prevalence, poor outcomes and high costs. The health teaching regarding hemodialysis and self care is important to improve the health and well being for patients with chronic renal failure. The aim of the study was to evaluate the effectiveness of video assisted teaching on knowledge and attitude regarding hemodialysis among patients with chronic renal failure. Pre experimental one group pretest post design was used. The setting of the study were out patient department at Dhanalakshmi Srinivasan Medical College and Hospital.50 samples were selected by non probability purposive sampling technique. After self introduction and explanation, the participants were given questionnaire to fill. The post test was done after the video assisted teaching, two weeks later. Result of the study were mean post test score of knowledge level 22.72 (SD±3.81)was significantly higher than the mean pre test score 14.31 (sd-3.67) and the mean difference were 8.38. Paired‘t’ value 28.28 (table value =2.02) which is significant ant p &lt;0.05 level, for attitude, the mean post test score 74.66 (SD±7.31) was significantly higher than the mean pre test score 65.82 (sd-6.92) and the mean difference was 8.84. Paired “t” value of knowledge and attitude, the finding revealed that the mean value of knowledge is 22.72 with SD (3.81) and the mean value of attitude is 74.66 with SD (7.31) project ‘r’ value of 0.329 (table value=0.273) which shows positively mild correlation. The result reveals that there is a significant association between the knowledge and the demographic variables of food habits, educational qualification and duration of dialysis and significant association between the attitude and the demographic variables of age and educational qualification (table value =3.84, p &lt;0.05). The finding revealed that there is a significant improvement in knowledge and attitude after intervention. Imprint Dhanalakshmi J, Malathi S. Effectiveness of video assisted teaching programme on knowledge and attitude regarding hemodialysis among patients with chronic renal failure.

A Process Evaluation of the National Implementation of a Bundle for Central Venous Catheter Care for Hemodialysis.

Implementation of a care bundle standardising insertion, management and removal practices to reduce infection related to central venous catheters used for haemodialysis was evaluated in a stepped wedge, cluster randomised controlled trial conducted at 37 Australian hospitals providing kidney services, with no reduction in catheter related blood stream infection detected. This process evaluation explored the barriers, enablers and unintended consequences of the implementation to explain the trial outcomes. Qualitative process evaluation using pre post semi-structured interviews with 38 (19 nursing, 19 medical) and 44 (25 nursing, 19 medical) Australian health professionals involved in haemodialysis central venous catheter management. Analysis was guided by the process implementation domain of the Consolidated Framework for Implementation Research. Key influences on bundle uptake were that clinicians were open to change that was evidence-based and driven by guidelines and had a desire to improve practice and patient outcomes. However, resistance to change in environments of low infection, working in silos of practice, and a need for individualised delivery of patient education created barriers to uptake. Unintended impacts of increased costs and lack of interoperability of systems for data collection were reported. As the trial was in progress at the time of qualitative data collection, perceptions of the bundle may have been influenced by the fact that practices of participants were being observed as a part of the trial. This national process evaluation revealed that health professionals who reported experiencing a benefit viewed the bundle positively. Those that already provided most of the recommended care or perceived that their patient population was not included in the research evidence that underpinned the interventions, resisted the implementation of the bundle. Potentially, formal change management processes using facilitation may improve implementation of evidence-based practice.

“You need a team”: perspectives on interdisciplinary symptom management using patient-reported outcome measures in hemodialysis care—a qualitative study

BackgroundPatient-reported outcome measures (PROMs) are standardized instruments used for assessing patients’ perspectives on their health status at a point in time, including their health-related quality of life, symptoms, functionality, and physical, mental, and social wellbeing. For people with kidney failure receiving hemodialysis, addressing high symptom burden and complexity relies on care team members integrating their expertise to achieve common management goals. In the context of a program-wide initiative integrating PROMs into routine hemodialysis care, we aimed to explore patients’ and clinicians’ perspectives on the role of PROMs in supporting interdisciplinary symptom management.MethodsWe employed a qualitative descriptive approach using semi-structured interviews and observations. Eligible participants included adult patients receiving intermittent, outpatient hemodialysis for > 3 months, their informal caregivers, and hemodialysis clinicians (i.e., nurses, nephrologists, and allied health professionals) in Southern Alberta, Canada. Guided by thematic analysis, team members coded transcripts in duplicate and developed themes iteratively through review, refinement, and discussion.ResultsThirty-three clinicians (22 nurses, 6 nephrologists, 5 allied health professionals), 20 patients, and one caregiver participated in this study. Clinicians described using PROMs to coordinate care across provider types using the resources available in their units, whereas patients tended to focus on the perceived impact of this concerted care on symptom trajectory and care experience. We identified 3 overarching themes with subthemes related to the role of PROMs in interdisciplinary symptom management in this setting: (1) Integrating care for interrelated symptoms (“You need a team”, conducive setting, role clarity and collaboration); (2) Streamlining information sharing and access (symptom data repository, common language for coordinated care); (3) Reshaping expectations (expectations for follow-up, managing symptom persistence).ConclusionsWe found that use of PROMs in routine hemodialysis care highlighted symptom interrelatedness and complexity and helped to streamline involvement of the interdisciplinary care team. Issues such as role flexibility and resource constraints may influence sustainability of routine PROM use in the outpatient hemodialysis setting.

Developing a Patient-centered Care Information System for Hemodialysis Clinic Services

BACKGROUND: Patient-centered care is a service process that focuses on the patient. All health workers collaborate in providing services to patients undergoing dialysis at risk of adverse events. The information system is very urgent to develop as a tool for monitoring hemodialysis (HD) services. System monitoring can prevent medical errors in the hospital. AIM: The aim of the study was to develop a Patient-Centered Care Information System at the HD clinic and make the monitoring systems for doctors and nurses. This study was conducted in Nitipuran Health Center of HD care specialists. The data were obtained from the interview in 12 participants consisting of nursing in Nitipuran Health Center of HD care specialist. METHODS: This was a qualitative research with a design case study with focus group discussion. RESULTS: An electronic medical record was built to provide better service for dialysis patients at HD clinics. According to the healthcare workers’ convenience, the system that could input PCs and tablets used two different approaches. A PC-based system is for doctors, and the tablet-based system is used by nurses who frequently monitor dialysis patients. CONCLUSION: The system built will make it easier for healthcare workers to monitor dialysis care from start to finish.

Improvement of hemodialysis care in the republic of Uzbekistan

Timely and full provision of all patients suffering from chronic renal failure with hemodialysis procedures is one of the priority areas for reforming the healthcare system in Uzbekistan. The article highlights the issues of providing the population with renal replacement therapy and, according to the opinion of the heads of medical institutions, the state of the hemodialysis service in Uzbekistan is disclosed.

Health Services Use and Outcomes for Hospital Admissions With a Major Cardiovascular Event Recorded in Health Care Administrative Data in Patients Receiving Maintenance Hemodialysis: A Retrospective Cohort Study.

Administrative data are used in studies of hemodialysis care to report cardiovascular-related hospitalizations. Showing recorded events are associated with significant health care resource use and poor outcomes would confirm that administrative data algorithms identify clinically meaningful events. The objective of this study was to describe the 30-day health service use and outcomes when a hospital admission with myocardial infarction, congestive heart failure, or ischemic stroke is recorded in administrative databases. This is a retrospective review of linked administrative data. Patients receiving maintenance in-center hemodialysis in Ontario, Canada, between April 1, 2013, and March 31, 2017, were included. Records from linked health care databases at ICES in Ontario, Canada were considered. We identified hospital admission with the most responsible diagnosis recorded as myocardial infarction, congestive heart failure, or ischemic stroke. We then assessed the frequency of common tests, procedures, consultations, post-discharge outpatient drug prescriptions, and outcomes within 30 days following the hospital admission. We used descriptive statistics to summarize results using counts and percentages for categorical variables and means with standard deviations or medians with quartile ranges for continuous variables. There were 14 368 patients who received maintenance hemodialysis between April 1, 2013, and March 31, 2017. The number of events per 1000 person-years was 33.5 for hospital admissions with myocardial infarction, 34.2 for congestive heart failure, and 12.9 for ischemic stroke. The median (25th, 75th percentile) duration of hospital stay was 5 (3-10) days for myocardial infarction, 4 (2-8) days for congestive heart failure, and 9 (4-18) days for ischemic stroke. The chance of death within 30 days was 21% for myocardial infarction, 11% for congestive heart failure, and 19% for ischemic stroke. Events, procedures, and tests recorded in administrative data can be misclassified compared with medical charts. In patients receiving maintenance hemodialysis, hospital admissions of major cardiovascular events routinely recorded in health administrative databases are associated with significant use of health service resources and poor health outcomes.