Fluid Compliance Research Articles

#1899 Transitional care clinic for incident hemodialysis patients : the Singapore experience

Abstract Background and Aims The period of transition from chronic kidney disease (CKD) to End stage kidney disease (ESKD) presents significant morbidity and mortality risk to the patients. This higher mortality risk is largely contributed by cardiovascular factors and infection. The last 2 decades have seen a remarkable succession of programs to improve outcome in incident dialysis patients. One such initiative is the use of ‘fistula first’ policy. In Singapore, pre-emptive access creation among ESKD patients continues to be low, with up to 80% of incident dialysis patients being commenced on hemodialysis (HD) via a dialysis catheter. Ensuring that incident dialysis patients have definitive vascular access, early referral to transplantation and adequate psychosocial support, amongst other factors, is an important consideration in their journey towards improved health outcomes. In order to achieve this, meticulous care coordination and a multifaceted approach is required. This realization is what led to the inception of our transition care clinic (TCC) in 2019. Conducted bi-monthly by a multidisciplinary team of nephrologists and renal coordinators, with inputs from pharmacists and medical social workers as needed, the TCC engages patients within 4-6 weeks post-hospital discharge. Its focus includes vascular access, dietary and fluid compliance, blood pressure control, HD adherence, transplantation referral, and medication reconciliation. Method A retrospective analysis of 314 ESKD patients who initiated HD between September 2019 and September 2022 compared outcomes between TCC attendees (n=164) and non-attendees Results TCC attendees exhibited a lower 1- year mortality rate (p=0.002) and higher rates for vascular access creation within first 6 months (p=0.001) as compared to non-attendees. However, no statistical differences were observed in hospitalization rates in the first year (p=0.760) and kidney transplantation referrals (p=0.20) between the two groups. Conclusion While notable improvements were observed in mortality rates and vascular access creation, there was no significant difference in hospitalization rates or kidney transplantation referrals between the two groups. In spite of the limitations due to its retrospective nature, this study clearly demonstrates the effectiveness of TCC in enhancing patient outcomes during the critical initial phase of hemodialysis. The study highlights the importance of setting up, refinement and expansion of such services in improving the outcome of this vulnerable patient group.

Contributing Factors to Intradialytic Complications in Hemodialysis Patients

Introductioin : Intradialytic complications are still being debated among health workers in the Hemodialysis Unit in Hospitals, many factors can cause patients to experience complications during dialysis. This study aims to identify the factors that contribute to the incidence of intradialytic complications in order to minimize the incidence of complications.
 Methode : This study used a research design in the form of analytic descriptive with cross-sectional. The sampling technique was a consecutive sampling of 120 patients. The chi-square statistical test aims to examine differences in proportions. If the results of the bivariate test have p < 0.25, then these variables can be included in the multivariate model using multiple logistic regression analysis.
 Result : Candidate selection results, Hb (0,014), Fluid Compliance (0,221), Venous Access (0,236), IDWG (0,023), and Comorbid (0,006) have a p value less than 0.25. In the multivariate test obtained Comorbid (0,007; OR:2.361 ), IDWG (0,049;OR:-1,894), and Hb (0,047;OR: 0,922), it can be concluded that these three factors have a significant influence on the occurrence of intradialytic complications.The proportion of intradialytic problems that can be described by 5 variables, namely venous access, comorbidities, IDWG, HB, and adherence, is 24%, with the remaining 18% explained by other factors.
 Conclusion : Comorbid, interdialytic weight gain, and hemoglobin goal accomplishment all have a significant role in the occurrence of intradialytic complication. The findings of this study can be utilized to raise awareness of intradialytic consequences. This vulnerable population need effective management to manage the problems they are experiencing.

The Duration of Hemodialysis Treatment and comorbidity with Adherence to Fluid Restristion in patient Undergoing Hemodialysis: A Correlational Study

Background: To achieve successful hemodialysis, patients with End Stage Renal Disease (ESRD) must follow comprehensive treatment including: diet, medication use, fluid restriction and presence of hemodialysis. Previous research has identified that fluid restriction is the most difficult regimen to adherence.Limiting fluid intake is very important done For avoid complications excess fluid Which can cause interdialytic weight gain (IDWG) and has an impact on cardiovascular complications such as congestive heart failure, pulmonary edema and even death. Apart from complications due to excess fluid, patients are also at risk of experiencing complications from hypertension, anemia, decreased immunity and nervous disorders . This can influence patient perceptions and impact behavior on compliance with hemodialysis therapy regimens . Another thing that can affect compliance is ongoing psychosocial stress due to having to undergoing hemodialysis therapy for a long time, causing a negative impression or attitude towards fluid restriction management. Apart from that, other research stated that the duration of hemodialysis was correlated with non-compliance with fluid restrictions . Based on this phenomena, researchers are interested in analyzing the relationship between length of time undergoing hemodialysis and comorbidities with fluid restrictions in hemodialysis patients.Purpose : This study aims to determine the relationship between duration of hemodialysis treatment and comorbidity with adherence to fluid restrictions in patients hemodialysis.Methods: This study used a cross sectional design with consecutive sampling on 121 respondents. Data collection with demographic sheets and fluid compliance questionnaires. Next, a bivariate analysis was carried out using Chi-Square .Results : The majority of respondents were in the age range 41-60 years namely 82 respondents , the majority of respondents were men As many as 75 respondents , the education level of the respondents showed that most were at the high school level, around 59 respondent , The majority of respondents had undergoing hemodialysis within a period of 1-5 years. Characteristics respondents other is comorbidity where majority own comorbidity <3 as much as many as 100 respondents. bivariate analysis showed that there was a significant relationship between duration of hemodialysis treatment and adherence to fluid restrictions (p=0.033), however there was no significant relationship between comorbidities and adherence to fluid restrictions (p= 0.560 ) .Conclusion: there is a significant relationship between duration of hemodialysis treatment and adherence to fluid restrictions, but there is no significant relationship between comorbidities and adherence to fluid restrictions. Keywords : End Stage Renal Disease, Hemodialysis , Fluid adherence, comorbidity, Duration of Hemodialysis Treatment

Comprehensive study on structure, shielding properties of Ga-In-Sn-Bi-Zn alloys: potential use for low energy radiation

Low-melting point Ga-In-Sn-Bi-Zn alloys were prepared using a vacuum melting technique as a novel radiation shielding material. To evaluate the interaction between alloys and photons in the energy range of 1–10000 keV, the WinXCom and Phy-X procedures are used to determine the shielding parameters for the Ga-In-Sn-Bi-Zn alloys, such as the mass attenuation coefficient, linear attenuation coefficient, half-value layer, tenth-value layer, mean free path, effective atomic number. Simultaneously, the energy absorption and exposure buildup factors, fast neutron removal cross section values is also calculated and the comparative lead equivalent (M) and weight reduction over lead for the alloy samples are compared. It is observed that the Ga2In2Sn2Bi3Zn1 alloy have exhibit superior comprehensive radiation attenuation, with a weight reduction of 2.948% compared to lead for the same shielding performance in the 30–90 keV range. After being irradiated by 40 keV He + irradiation system for 120 h, the phase structure of Ga2In2Sn2Bi3Zn1 alloy remained unchanged and that it shows excellent radiation tolerance. Combined with field emission scanning electron microscopy, x-ray diffraction, differential scanning calorimetry and thermogravimetric analysis results indicate that Ga2In2Sn2Bi3Zn1 is a eutectic alloy with a five-phase complex-regular structure and a melting point of 66.95 °C. The alloy exhibits excellent fluid compliance in the molten state when blended with polymers to prepare composites. The alloy filler is uniformly and continuously distributed in the polymer matrix, which ensures the reliability of the radiation shielding properties of the composites.

Nursing Experience of Applying Swanson's Caring Theory in the Care for a Patient Who was Non-compliant with Hemodialysis

<p>本文旨在敘述一位不遵從血液透析治療療程病人之護理經驗。照護期間自2019年2月1日至6月3日，發現個案因飲食及水份自我控制差，導致透析過程中身體不適及影響透析品質，且由於個案無法接受增加透析次數，亦對未來感到無力、無助感，故以Gordon’s十一項功能性健康型態評估作為指引，歸納出主要健康問題為：體液容積過量、不遵從及無力感。筆者運用Swanson關懷理論中五個核心過程：「了解、在旁陪伴、為他做某些事、使他能夠、維持信念」，主動關懷個案需求，透過護理活動介入，協助個案獲得良好支持系統，以減輕個案內心之無力、無助感；加強對疾病深入認識了解，使其能以正向態度坦然並積極遵從血液透析治療，重建自我價值，提升對於未來的正向信念。建議對於處於疾病調適期的個案，醫護人員應該用正向角度看待個案，強調遵從的正向效果，誘發個案自我效能以重建信心。期望藉由此照護經驗，能提供護理人員對於血液透析病人照護之參考及運用。</p> <p> </p><p>This article aims to share our nursing experience of caring a noncompliant patient receiving maintenance hemodialysis. The patient had large interdialytic weight gain secondary to poor adherence to sodium and fluid restriction during February 1, 2019 to June 3, 2019. The frequent poor self-control of dietary water and inadequate dialysis made him extremely tired, uneasy, edematous, and despond. He was then in a depressive mood, feeling powerless and hopeless for the future.</p> <p>Gordon’s11 functional assessment tool was applied; we evaluated and categorized the patient’s health problems as fluid overload, noncompliance, and powerlessness. Based on Swanson’s Theory of Caring, the five key principles of care were knowing, being with, doing for, enabling, and maintaining belief. Through the patient-centered nursing process, we looked after his needs, utilized resources to get him a good support system, tried to regain his confidence in the fight against the illnesses, and alleviated his helplessness and powerlessness. By collaborating with the dialysis staff and handling the difficulties in a positive manner, the patient rebuilt his self-worth and optimistic attitude toward life.</p> <p>It is recommended that for patients with an adjustment disorder, the medical staff should treat them properly in a positive perspective, utilize available resources to develop a supportive system, reassure the importance of dietary and fluid compliance, and increase the patients’ self-confidence. We think that the nursing experience is a good example for professionals taking care of patients on hemodialysis.</p> <p> </p>

Sepsis Fluid Metric Compliance and its Impact on Outcomes of Patients with Congestive Heart Failure, End-Stage Renal Disease or Obesity.

Emergency physicians express concern administering a 30-cc/kg fluid bolus to septic shock patients with pre-existing congestive heart failure (CHF), end-stage renal disease (ESRD), or obesity, due to the perceived risk of precipitating a fluid overload state. Our aim was to determine whether there is a difference in fluid administration to septic shock patients with these pre-existing conditions in the emergency department (ED). Secondary objectives focused on whether compliance impacts mortality, need for intubation, and length of stay. We conducted a retrospective chart review of 470,558 ED patient encounters at a single urban academic center during a 5-year period. Of 847 patients with septic shock, 308 (36.36%) had no pre-existing condition and 199 (23.49%), 17 (2.01%), and 154 (18.18%) had the single pre-existing condition of CHF, ESRD, and obesity, respectively, and 169 (19.95%) had multiple pre-existing conditions. Weight-based fluid compliance was achieved in 460 patients (54.31%). There was a lower likelihood of compliance among patients with CHF (adjusted odds ratio [aOR] 0.35; 95% confidence interval [CI] 0.24-0.52; p < 0.001), ESRD (aOR 0.11, 95% CI 0.04-0.32; p < 0.001), and obesity (aOR 0.29, 95% CI 0.19-0.44; p < 0.001) compared with patients with no pre-existing conditions. Compliance decreased further in patients with multiple pre-existing conditions (aOR 0.49, 95% CI 0.33-0.72; p < 0.001). Compliance was not associated with mortality in patients with CHF and ESRD, but was protective in patients with obesity and those with no pre-existing conditions. Septic shock patients with pre-existing CHF, ESRD, or obesity are less likely to achieve compliance with a 30-cc/kg weight-based fluid goal compared with those without these pre-existing conditions.

DETERMINANTS OF DIET AND FLUID ADHERENCE AMONG END STAGE RENAL DISEASE PATIENTS UNDERGOING HAEMODIALYSIS AT MOI TEACHING AND REFERRAL HOSPITAL, UASIN GISHU COUNTY, KENYA

Purpose: This study was conducted to establish determinants of diet and fluid adherence among ERSD patients undergoing hemodialysis at Moi Teaching and Referral Hospital- Uasingishu county. Kenya.&#x0D; Methods: A descriptive cross-sectional study design was applied. Using Fisher’s formula, a sample size of 145 participants were conveniently recruited. Data collection was done by use of modified end stage renal disease adherence questionnaire (ESRD-AQ). Chi-square (χ2) was used to test statistical significance. Frequency tables and bar graphs were used for data presentation. SPSS version 22.0 was used for data analysis.&#x0D; Results: The study revealed that knowledge on nutritional requirements for renal patients was marginally associated with dietary and fluid intake with a higher proportion of those with low nutritional knowledge (83.6%) adhering to diet and a relatively smaller proportion in the same category (58.9%) complying with fluid intake. A significant relationship with dietary adherence was observed where participants practiced fluid restrictions (p=0.003) and the frequency in which health staff talk about the importance of following proper diet (p &lt;0.0001). On social support domain, a significant association was observed in patients who agreed that various social support aspects help improve depression, self-esteem, self-management, etc. and who adhered to diet scored a significantly higher mean of 5.6 (95% CI = 5.5 – 5.6) in contrast to non-adherent counterparts who had a mean of 5.5 (p = 0.0006). Among the economic factors with significant association with diet adherence were; use of bus for transport (p=0.02); income of less than KSH. 30,000 (p=0.006); treatment cost (p=0.007) and ability to access material support that helps in adherence (p=0.003). Those who claimed that lack of transport was the main reason for missing dialysis practiced fluid adherence (p=0.01) with a smaller proportion (44%) adhering to fluid restriction in comparison to 70.8% who had transport and were non- adherent.&#x0D; Unique contribution to theory, practice and policy: The study findings are unique to the study site and it’s hoped that it can be used to inform hospital policy makers in addressing adherence challenges in ESRD patients on hemodialysis. The study recommends a holistic study on determinants of adherence to hemodialysis, medication use, dietary, and fluid compliance among patients undergoing HD at MTRH should be conducted in order to produce generalized results.

KORELASI HEALTH BELIEF DENGAN KEPATUHAN PEMBATASAN CAIRAN DAN GARAM PADA PASIEN PENYAKIT GINJAL KRONIK YANG MENJALANI HEMODIALISA DI RUMAH SAKIT MURNI TEGUH MEDAN

know that they suffer from a disease, they will take more serious care for their health and take medication in accordance with doctors’ recommendation. However, there are still many patients with CKD do not comply with the doctors’ recommendation. Health belief is the belief adhered in undergoing medication will affect the believers’ health. The objective of this research was to analyze the correlation of health belief with fluid and salt restriction compliance in patients with CKD undergoing hemodialysis. This research employed quantitative design with cross sectional method. There were 150 patients with CKD undergoing hemodialysis in total that were taken as the samples. This research was conducted at Murni Teguh Hospital, Medan. The samples were selected by applying total accidental technique. The data were collected through questionnaires, and the analysis was made by using Pearson test. The results of Pearson test on the correlation of health belief with patients’ fluid and salt restriction compliance demonstrated value of p = 0.000. It indicated that health belief are correlated with the fluid and salt restriction compliance of patients with CKD undergoing hemodialysis. It is recommended that nurses improve their education quality and frequency by paying attention to patients.

Effect of fractionally damped compliance elements on amplitude sensitive dynamic stiffness predictions of a hydraulic bushing

Abstract Hydraulic bushings exhibit significant amplitude dependent behavior which cannot be captured with the linear time-invariant system theory. Accordingly, Fredette et al. (2016) have proposed a nonlinear model, but the amplitude sensitivity has not been adequately described as it is affected by multiple inherent design features. To further improve the predictive capability of nonlinear models, this article extends the prior work by including two key dissipation effects within the (elastomeric) fluid compliance chambers. First, the conventional fluid compliance element is replaced by an equivalent mechanical spring representing the nonlinear elasticity of the pumping chambers. Fractional calculus based and friction-type damping elements are added in parallel to the nonlinear spring elements of pumping chambers. Second, improved quasi-linear models are proposed at four sinusoidal excitation amplitudes, demonstrating amplitude sensitivity in model parameters. Third, new nonlinear models are proposed and numerically simulated, predicting dynamic stiffness magnitudes and loss angles at multiple excitation amplitudes. The sensitivity of dynamic properties to the fractional and frictional damping parameters is qualitatively evaluated. Finally, both quasi-linear and nonlinear models are experimentally validated and are found to be superior to the ones in the literature.

Lowering of Lactate Threshold for Severe Sepsis Did Not Impact Mortality

SESSION TITLE: Education, Research, and Quality Improvement II SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM PURPOSE: In 2015, NYU Lutheran Medical Center, a 450-bed academic teaching hospital sought to reduce mortality from sepsis. In October 2015 the criteria for severe sepsis were modified and the lactate level threshold was decreased from 2.3 mmol/L to 2.0 mmol/L. Furthermore, the diagnosis of sepsis was broadened to include organ dysfunction irrespective of lactate level. Our hospital also identified interdisciplinary teams for intensive education, including simulation training and interactive online modules, to promptly recognize sepsis. Nonetheless, the decreased lactate threshold remained the primary intervention to improve sepsis outcomes. We present a retrospective analysis that demonstrates no significant impact on mortality and and, unexpectedly, worse compliance with the recommended 30ml/kg initial fluids bolus. METHODS: Patients with DRG codes for severe sepsis and septic shock were identified through our EMR. We compared cumulative three-month mortality and compliance with guidelines to provide 30ml/kg initial fluid resuscitation prior and after the change. We used a chi square analysis to test the equality between proportions with the null hypothesis that there was no difference in mortality nor compliance with the fluid resuscitation guidelines for the 3 months prior to and after October 2015 RESULTS: Cumulative mortality from June to September 2015 was 43.9% with a total of 39 patients and mortality for October-December 2015 was 31% with a total of 49 patients. The change was statistically insignificant with a p-value of 0.19. Compliance with fluid resuscitation was 25% for the earlier quarter versus 10% for the later quarter. This change was also statistically insignificant with a p-value of 0.06. CONCLUSIONS: Our experience with lowering of the lactate threshold has not shown any mortality benefit. Although not statistically significant we see a trend of less compliance with the initial fluid resuscitation guidelines. Poor compliance with automated fluid administration is likely due to the lack of applicability of standard volume of fluid to disparate patient populations with variable hemodynamic profiles. Secondly, this analysis may be too premature to detect an impact on fluid compliance or mortality as only three months data reviewed after the change in lactate levels and larger data sets will need to be collected. CLINICAL IMPLICATIONS: Based on our experience, we advocate for individualized and ultrasound guided sepsis management as lowering the lactate threshold and fluid resuscitation compliance guidelines did not alter outcomes. DISCLOSURE: The following authors have nothing to disclose: Farshid Rafatnia, Ravindra Rajmane No Product/Research Disclosure Information

Impact of Fractures on CO2Storage Monitoring: Keys for an Integrated Approach

The monitoring of CO2 storage in fractured reservoirs (depleted hydrocarbon fields or brine aquifers) requires the study of the impact of fracturation and fluid substitution on seismic data. Seismic data can provide information about the additional compliance due to the fractures and the fluids through the analysis of seismic azimuthal anisotropy with an appropriate rock physics model. We introduce a rock physics model built in collaboration with geologists, providing a realistic description of fractured media. This model concerns fractured geological media in the presence of fluids characterized by some degree of matrix porosity, the presence of pore fluids, connected and/or non-connected fractures, the presence of several fracture sets, and an inherent seismic anisotropy. The direct application of this rock model shows that the P -wave anisotropy value measured through seismic data can be explained by several sets of different parameters such as the fracture density, the pore fluid compliance or the porosity. The presence of inherent layer-induced anisotropy can also modify the P -wave anisotropy and thus the interpretation of this value in terms of fluid substitution in a fractured porous medium. As far as fluid substitution monitoring is concerned, if seismic data are acquired before and after this substitution, a change in the P -wave anisotropy value can be linked to the modification of the compliance of the fluid content in the same medium exhibiting the same fracture network and the same porosity. This relative value can only be correctly interpreted in terms of fluid substitution provided we have some constraints on a few of the parameters involved in the P -wave anisotropy value such as the porosity, and a rough idea of the level of normalized fracture compliance. Then, a multidisciplinary approach is mandatory to constrain these parameters. For instance, borehole and outcrop geological information can give the upper limit of the fracture density expected at depth in the same formation. Furthermore, rock mechanics helps in understanding the fracturation state at depth to identify the predominant fractures in regard to the interpretation of seismic anisotropy in terms of fluid substitution inside the fracture network.

Oral Fluid Drug Testing of Chronic Pain Patients. I. Positive Prevalence Rates of Licit and Illicit Drugs

Oral fluid compliance monitoring of chronic pain patients is an analytical challenge because of the limited specimen volume and the number of drugs that require detection. This study evaluated oral fluid for monitoring pain patients and compared results to urine studies of similar populations. Oral fluid specimens were analyzed from 6441 pain patients from 231 pain clinics in 20 states. Specimens were screened with 14 ELISA assays and non-negative specimens were confirmed by LC-MS-MS for 40 licit and illicit drugs and metabolites. There was an 83.9% positive screening rate (n=5401) of which 98.7% (n=5329) were confirmed at ≥ LOQ concentrations for at least one analyte. The prevalence of confirmed positive drug groups was as follows: opiates > oxycodone > benzodiazepines > methadone ≈ carisoprodol > fentanyl > cannabinoids ≈ tramadol > cocaine > amphetamines ≈ propoxyphene ≈ buprenorphine > barbiturates > methamphetamine. Approximately 11.5% of the study population of pain patients apparently used one or more illicit drugs (cannabis, cocaine, methamphetamine and/or MDMA). Overall, the pattern of licit and illicit drugs and metabolites observed in oral fluid paralleled results reported earlier for urine, indicating that oral fluid is a viable option for use in compliance monitoring programs of chronic pain patients.

Semi-active engine mount design using auxiliary magneto-rheological fluid compliance chamber

Engine mounts are used in the automotive industry to isolate engine and chassis by reducing the noise and vibration imposed from one to the other. This paper describes modelling, simulation and design of a semi-active engine mount that is designed specifically to address the complicated vibration pattern of variable displacement engines (VDE). The ideal isolation for VDE requires the stiffness to be switchable upon cylinder activation/deactivation operating modes. In order to have a modular design, the same hydraulic engine mount components are maintained and a novel auxiliary magneto-rheological (MR) fluid chamber is developed and retrofitted inside the pumping chamber. The new compliance chamber is a controllable pressure regulator, which can effectively alter the dynamic performance of the mount. Switching between different modes happens by turning the electrical current to the MR chamber magnetic coil on and off. A model has been developed for the passive hydraulic mount and then it is extended to include the MR auxiliary chamber as well. A proof-of-concept prototype of the design has been fabricated which validates the mathematical model. The results demonstrate unique capability of the developed semi-active mount to be used for VDE application.

Dietary and fluid compliance: an educational intervention for patients having haemodialysis

This paper is a report of a study conducted to determine the effect of an educational intervention on dietary and fluid compliance in patients having haemodialysis. Many of the clinical problems experienced by patients having haemodialysis are related to their failure to eat appropriate foods and restrict their fluid intake. Educational intervention in patients having haemodialysis to improve their compliance with dietary and fluid restrictions appears to be effective. Sixty-three patients having haemodialysis in three general hospitals in Tehran, Iran, were allocated into two groups at random for oral and/or video education. They were asked to give demographic and medical data. Bimonthly average values of serum potassium, sodium, calcium, phosphate, albumin, creatinine, uric acid, and blood urea nitrogen and interdialytic weight gain were measured before and after the teaching programmes. The data were collected in 2007. Compliance in terms of biochemical parameters and interdialytic weight gain was observed in 63.5% and 76.2% of patients in the oral and video teaching groups respectively. Statistically significant correlations were observed between demographic variables (age, educational level and occupation) and dietary and fluid compliances (P < 0.001). There was no difference between the effectiveness of two educational interventions. Nurses should emphasize sodium compliance in patients having haemodialysis and explain its adverse effects, such as excessive weight gain, hypertension, and peripheral oedema.

Fluid compliance among patients having haemodialysis: can an educational programme make a difference?

This paper is a report of a study to examine the effectiveness of a patient education programme on fluid compliance as assessed by interdialytic weight gain, mean predialysis blood pressure and rate of fluid adherence. Patients with end stage renal disease who receive haemodialysis are often non-compliant with their treatment regime, especially adherence to fluid restrictions. An exploratory study was conducted in 2004-05 using a quasi-experimental, single group design to examine the effectiveness of patient education on fluid compliance in a dialysis centre located in a major teaching hospital in Kuala Lumpur, Malaysia. Twenty-six patients with an interdialytic weight gain of greater than 2.5 kg were identified as non-compliant and recruited to the study. The intervention was carried out over a 2-month period and included teaching and weekly reinforcement about diet, fluids and control of weight gain. Patients' mean interdialytic weight gain decreased following the educational intervention from 2.64 kg to 2.21 kg (P < 0.05) and adherence to fluid restrictions increased from 47% to 71% following the intervention. Predialysis mean blood pressure did not improve following the intervention, although the maximum recording for predialysis systolic pressure dropped from 220 mmHg to 161 mmHg. Whilst no statistically significant associations were detected between interdialytic weight gain and age, educational level, marital status or employment status, women demonstrated a greater decrease in mean interdialytic weight gain than men. Nephrology nurses often have long-term relationships with their patients and are ideally placed to provide ongoing education and encouragement, especially for those experiencing difficulties in adhering to fluid and dietary restrictions.

A continuous quality improvement (CQI) project: improve fluid compliance in chronic peritoneal dialysis (PD) patients

A continuous quality improvement (CQI) project: improve fluid compliance in chronic peritoneal dialysis (PD) patients

Effects of Diaphragm Compliance on Spring-Diaphragm Pressure Regulator Dynamics

A dynamical model is derived for a spring-diaphragm type automotive pressure regulator containing an annular membrane. Previous studies have generally assumed that the diaphragm was of constant area and that it remained flat. Central features of the model presented are the calculation of the deformed shape of the annular diaphragm and the effects of its resulting fluid compliance and force on the drain orifice cover plate. Elasticity theory is used to derive the diaphragm two-port compliance relation that is integrated into an overall regulator dynamic model. Effects of diaphragm elastic modulus on system dynamic response are studied. The model and its results may be used in other design parameter studies and as a component of a fueling system dynamic model.

Dietary and fluid compliance in Chinese hemodialysis patients

The current cross-sectional study examined dietary and fluid compliance behaviors in Chinese hemodialysis (HD) patients and identified variables related to compliance. Sixty-two chronic HD patients participated and information was obtained about their knowledge of dietary and fluid restrictions related to dialysis, health beliefs, personal and medical characteristics, and self-reported compliance. In addition, serum levels of potassium (K) and phosphate (PO 4) and interdialytic daily weight gain were retrieved from the medical records. Dietary and fluid compliance was observed in only 35.5% and 40.3% of the patients, respectively. No direct relationship was observed between dietary knowledge and any compliance measures. ‘Perceived barriers’ was the only variable of the health belief model that showed associations with the compliance measures, implying that patients who perceived less barriers in following the dietary instructions showed better compliance. Residual urine output volume was positively correlated with the level of fluid compliance. Patients with more hours on HD per week were found to be more fluid noncompliant. Working patients and those whose diet was prepared by someone else in the family were also more likely to be noncompliant. Health professionals should be aware of the factors behind noncompliance in HD patients and assist them in making life-style changes. Patient education with family involvement, identification of at-risk patients for noncompliance and assisting patients to identify and manage difficulties with life-style changes related to HD are important elements in promoting compliance.

The relationship between interdialytic weight gain and patient compliance. A single centred cohort study (n=21).

Haemodialysis patients are subject to many restrictions and face a lifetime attempting to adhere to various regimes. This small study was designed to explore the relationship between fluid gain, compliance and staff reinforcement. This was achieved by measuring dietetic and nursing educational input using interdialytic weight gain as a barometer of patient compliance. This study suggests renal nurses, dietitians and other members of the multi-disciplinary team may have less influence than previously assumed.

Psychosocial correlates of fluid compliance among Chinese haemodialysis patients.

The present study was designed to determine the psychosocial correlates of fluid compliance among patients receiving haemodialysis at two Hong Kong renal dialysis centres. There has been little consistency in the findings of correlations among any psychosocial variables and compliance behaviour. There is a need to further study these variables in an attempt to predict haemodialysis patient compliance to fluid restriction. Ninety-two Chinese haemodialysis patients completed the Center for Epidemiological Studies Depression Scale (CES-D), The Multidimensional Health Locus of Control Form C Scale (MHLC), the Social Support Questionnaire, Short Form Scale (SSQ6) and a self-designed socio-demographic questionnaire. Daily interdialytic weight gain (DIWG) measure was used as an indicator of fluid compliance. The prevalence of compliance behaviour of Chinese haemodialysis patients was higher than that reported in western studies. There were significant negative correlations found between DIWG and total score on internal health locus of control and social support satisfaction score. However, internal health locus of control did not predict a significant portion of the DIWG variance. Significant predictors of DIWG included satisfaction with social support, comorbidity and monthly family income. Satisfaction with social support was the largest predictor of DIWG. The present findings suggest that assessing family income, comorbidity, and satisfaction with social support may be useful in identifying haemodialysis patients potentially at risk for difficulties in compliance with fluid restriction.