Shifting skin

AR[t] is published by the AR Lab. This article provides insight into the development of the exhibition 'Alison Bennett: Shifting Skin'

Onion-skin paper

A woman lives with her parents after her husband and sister are found in the woman's burnt out home.

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.