Medicine non-adherence in kidney transplantation

Background: The increasing prevalence of chronic kidney disease, the relative shortage of kidney donors and the economic- and health-related costs of kidney transplant rejection make the prevention of adverse outcomes following transplantation a healthcare imperative. Although strict adherence to immunosuppressant medicine regimens is key to preventing kidney rejection, evidence suggests that adherence is sub-optimal. Strategies need to be developed to help recipients of kidney transplants adhere to their prescribed medicines. Findings: This review has found that a number of factors contribute to poor adherence, for example, attitudes towards medicine taking and forgetfulness. Few investigations have been conducted, however, on strategies to enhance medicine adherence in kidney transplant recipients. Strategies that may improve adherence include pharmacist-led interventions (incorporating counselling, medicine reviews and nephrologist liaison) and nurse-led interventions (involving collaboratively working with recipients to understand their routines and offering solutions to improve adherence). Strategies that have shown to have limited effectiveness include supplying medicines free of charge and providing feedback on a participant's medicine adherence without any educational or behavioural interventions. Conclusion: Transplantation is the preferred treatment option for people with end-stage kidney disease. Medicine non-adherence in kidney transplantation increases the risk of rejection, kidney loss and costly treatments. Interventions are needed to help the transplant recipient take all their medicines as prescribed to improve general well-being, medicine safety and reduce healthcare costs. © 2014 European Dialysis and Transplant Nurses Association/European Renal Care Association.

Adult cardiothoracic transplant nursing: an ISHLT consensus document on the current adult nursing practice in heart and lung transplantation.

The role of nurses in cardiothoracic transplantation has evolved over the last 25 years. Transplant nurses work in a variety of roles in collaboration with multidisciplinary teams to manage complex pre- and post-transplantation issues. There is lack of clarity and consistency regarding required qualifications to practice transplant nursing, delineation of roles and adequate levels of staffing.

Examining the preparation and ongoing support of adults to take their medications as prescribed in kidney transplantation.

RATIONALE, AIMS AND OBJECTIVES: The shortage of kidney donors and benefits of kidney transplantation make graft success imperative. Medication adherence is critical to prevent the risk of graft rejection. This paper examines how adults are prepared and supported by renal transplant co-ordinators and pharmacists to take their medications as prescribed in kidney transplantation. METHODS: Renal transplant co-ordinators and pharmacists of all five hospitals offering adult kidney transplantation in Victoria, Australia, were interviewed between November 2013 and February 2014. All data underwent qualitative descriptive analysis. RESULTS: Nine renal transplant co-ordinators and six pharmacists were interviewed. Although there was no standardized approach to education or other evidence-based strategies to facilitate medication adherence, there were similarities between sites. These similarities included printed information, pre-transplant education sessions, the use of medication lists and medication administration aids, intensive education in hospital and ensuring an adequate supply of medications post-discharge. CONCLUSIONS: Renal transplant co-ordinators and pharmacists recognized the importance of early patient education concerning immunosuppressant medication. However, each site had developed their own way of preparing a patient for kidney transplantation and follow-up in the acute hospital setting based on experience and practice. Other non-educational strategies involving behavioural and emotional aspects were less common. Differences in usual care reinforce the necessity for evidence-based health care for best patient outcomes.

Ultrafine wools: comfort and handle properties for next-to-skin knitwear and manufacturing performance

This study aimed to quantify the skin comfort and handle properties of a range of wool fabrics produced from ultrafine wool (13.7–15.1 µm) and in doing so determine if differences in fiber diameter and staple crimp frequency (5.3–7.1 crimps/cm) were important in these properties. The fabrics were evaluated using a range of subjective and objective measurement techniques, including the Wool ComfortMeter, the Wool HandleMeter and in wearer trials. This work indicated that single jersey fabrics made from ultrafine wool are approaching the limit of objective and subjective evaluation of next-to-skin comfort. The results from the Wool ComfortMeter, Wool HandleMeter and the wearer trial show that there were no significant effects that can be attributed to wool staple crimp (fiber curvature) in these ultrafine wool fabrics. The work also demonstrated a difference in the manufacturing response when knitted fabric made from wools of different fiber diameter (13.7–23.7 µm), and using yarns of the same count, resulted in a progressively higher fabric mass per unit area as mean fiber diameter was progressively reduced.

The influence of fiber diameter, fabric attributes and environmental conditions on wetness sensations of next-to-skin knitwear

This study investigated the relationships between the sensations of sweaty, damp, muggy and clingy, as assessed by human response from wearer trial garment assessment, and fiber type, fiber, yarn and fabric properties and instrumental fabric measurements of next-to-skin knitwear. Wearer trial assessment of 48 fabrics followed a strict 60 minute protocol including a range of environmental conditions and levels of exercise. Adjusted mean weighted scores were determined using linked garments. Instrumental fabric handle measurements were determined with the Wool HandleMeter (WHM) and Wool ComfortMeter. Data were analyzed using forward stepwise general linear modeling. Mean fiber diameter (MFD) affected the sweaty, damp, muggy and clingy sensation responses accounting for between 23.5% and 56.2% of the variance of these sensations. In all cases, finer fibers were associated with lower sensation scores (preferred). There were also effects of fiber type upon sweaty, muggy and clingy scores, with polyester fiber fabrics having higher scores (less preferred) compared with fabrics composed of wool, particularly for peak sweaty scores in hot and active environments. Attributes such as fabric density, yarn linear density, knitting structure and finishing treatments, but not fabric thickness, accounted for some further variance in these attributes once MFD had been taken into account. This is explained as finer fibers have a greater surface area for any given mass of fiber and so finer fibers can act as a more effective sink for moisture compared with coarser fibers. No fabric handle parameter or other attribute of fiber diameter distribution was significant in affecting these sensation scores.

Nephrologists' management of patient medications in kidney transplantation: results of an online survey

Rationale, aims and objectives: Medication adherence is essential in kidney transplant recipients to reduce the risk of rejection and subsequent allograft loss. The aim of this study was to delineate what 'usual care' entails, in relation to medication management, for adult kidney transplant recipients. Methods: An online survey was developed to explore how nephrologists promote and assess medication adherence, the management of prescriptions, the frequency of clinic appointments and the frequency of clinical screening tests. Nephrologists from all acute kidney transplant units in Victoria, Australia, were invited to participate. Data were collected between May and June 2014. Results: Of 60 nephrologists invited to participate, 22 completed the survey (response rate of 36.6%). Respondents had a mean age of 49.1±10.1 years, with a mean of 20.1±9.9 years working in nephrology and 14 were men. Descriptive analysis of responses showed that nephrologists performed frequent screening for kidney graft dysfunction that may indicate medication non-adherence, maintained regular transplant clinic visits with patients and emphasized the importance of medication education. However, time constraints during consultations impacted on extensive patient education and the long-term medication follow-up support was often delivered by the renal transplant nurse coordinator or pharmacist. Conclusions: This study highlighted that nephrologists took an active approach in the medication management of kidney transplant recipients, which may assist with facilitating long-term graft survival. Ultimately, promoting medication adherence needs to be patient centred, involving an interdisciplinary team of nephrologists, pharmacists and renal transplant nurse coordinators, working together with the patient to establish optimal adherence.

Individual prevention courses for occupational skin diseases: changes in and relationships between proximal and distal outcomes

BACKGROUND: To treat people with occupational contact dermatitis, the German Accident Prevention and Insurance Association in the Health and Welfare Services offers 2-day individual prevention (IP) seminars. OBJECTIVES: We investigated whether there are short-term and medium-term changes in proximal (e.g. behaviour) and distal (e.g. symptoms) outcomes after an IP seminar, whether changes in proximal outcomes are associated with changes in distal outcomes, and whether subgroups can be identified that benefit in particular. PATIENTS/MATERIALS/METHODS: In a prospective study, 502 participants of 85 IP courses completed the health education impact questionnaire (heiQ™) and skin symptom questionnaire (Skindex-29) at the start of the course, immediately thereafter, and after 6 months. Change was assessed according to standardized effect size. Regression techniques were used to analyse associations between proximal and distal outcomes. RESULTS: After 6 months, participants showed improved self-management skills and preventive behaviour, and less fear of job loss, disease-related symptoms, and emotional distress. Significant associations between proximal and distal outcomes were found. Participants who felt more limited by their skin disease showed greater effects. CONCLUSIONS: The results are consistent with the assumption that IP courses provide a range of benefits for people with occupational contact dermatitis. Changes in distal outcomes may be influenced by changes in proximal outcomes.

Transplantation of the heart after circulatory death of the donor: time for a change in law?

Australia has a shortfall in donated hearts for transplantation.Hearts are usually procured from brain dead donors, but procurement from circulatory dead donors is a potential additional source.However, heart transplantation after circulatory death of the donor may not conform to the dead donor rule.An amendment in law is required to permit heart procurement for transplantation after circulatory death.

Sky high, skin deep: dark technologies of mediation

Media has become responsive architecture. Intelligent media artefacts are now embedded into the very fabric of our existence; they have become the structure of society itself. Ubiquitous computing creates informational environments in which material structures of communication become alive with agency. McLuhan's light bulb is now everyware: [1] technology that mediates by its mere presence. Pervasive mediation, a combination of mobile networks and systems of material translation such as 3D printers and programmable matter--is our current regime of mediation.

Trials and tribulations with electronic medication adherence monitoring in kidney transplantation

Medication adherence in kidney transplantation is critical to prevent graft rejection. Testing interventions designed to support patients to take their prescribed medications following a kidney transplant require an accurate measure of medication adherence. In research, the available methods for measuring medication adherence include self-report, pill counts, prescription refill records, surrogate measures of medication adherence and medication bottles with a microchip-embedded cap to record bottle openings. Medication bottles with a microchip-embedded cap are currently regarded as the gold standard measure. This commentary outlines the challenges in measuring medication adherence using electronic medication monitoring of kidney transplant patients recruited from five sites. The challenges included obtaining unanimous stakeholder support for using this method, agreement on an index medication to measure, adequate preparation of the patient and training of pharmacy staff, and how to analyze data when periods of time were not recorded using the electronic adherence measure. Provision of this information will enable hospital and community pharmacists to implement approaches that promote the effective use of this adherence measure for optimal patient outcomes.

Sounding loneliness in under the skin

How one affectively sounds loneliness on screen is dependent on what instruments, melodies, voices and sound effects are used to create a sonic membrane that manifests as melancholy and malcontent. It is in the syncretic and synesthetic entanglement that sounding loneliness takes root. It is in the added value inherent in the “sound-image” – to draw upon Chion1 – that loneliness fully emerges like a black dahlia. So many lonely people, where do they all come from? And yet, as I will suggest, this sounding loneliness is not only textually specific, simply or singularly driven by narrative and generic concerns, but is historically contingent and nationally and culturally locatable. For example, the sounds of urban isolation of the American 1940s film noir are different from the Chinese peasant laments of Chen Kaige’s Yellow Earth (1984), or what I will presently argue are the British austere strings of sounding loneliness today. When one employs a “diagnostic critique”2, one undertakes to find the history in the text and the text in the history. It is in the interplay between sound and image that historical and political truth emerges. These contextualised and historicised soundings change across and within national landscapes and their related imaginings. We don’t just see the crumbling walls of the imagined nation state, but get to hear its desolate tunes: The Specials wailing “Ghost Town” – the anthem of/to Margaret Thatcher’s first wave of 1980s neo-liberalism – is a striking case in point. But what specifically is this contemporary “sounding loneliness”, and where does it come from? I would like to suggest that this age of loneliness is composed in, through and within the sonic vibrations found in the wretched politics of austerity. My case study will be the anomic soundings of Jonathan Glazer’s Under the Skin (2013).