Patients' experiences of cannulation of arteriovenous access for haemodialysis: A qualitative systematic review.

INTRODUCTION: Cannulation is an essential part of haemodialysis with arteriovenous access. Patients' experiences of cannulation for haemodialysis are problematic but poorly understood. This review aims to synthesise findings related to patients' experiences of cannulation for haemodialysis from qualitative studies, providing a fuller description of this phenomenon. METHODS: Eligibility criteria defined the inclusion of studies with a population of patients with end-stage kidney disease on haemodialysis. The phenomena of interest was findings related to patients' experiences of cannulation for haemodialysis and the context was both in-centre and home haemodialysis. MedLine, CINAHL, EMBASE, EMCARE, BNI, PsycInfo and PubMed were last searched between 20/05/2019 and 23/05/2019. The quality of studies was assessed using the using Joanna Briggs Critical Appraisal Checklist for Qualitative Research. Meta-aggregation was used to synthesise findings and CERQual to assess the strength of accumulated findings. RESULTS: This review included 26 studies. The subject of included studies covered cannulation, pain, experiences of vascular access, experiences of haemodialysis and a research priority setting exercise. From these studies, three themes were meta-aggregated: (1) Cannulation for haemodialysis is an unpleasant, abnormal and unique procedure associated with pain, abnormal appearance, vulnerability and dependency. (2) The necessity of cannulation for haemodialysis emphasises the unpleasantness of the procedure. Success had multiple meanings for patients and patients worry about whether the needle insertion will be successful. (3) Patients survive unpleasant, necessary and repetitive cannulation by learning to tolerate cannulation and exerting control over the procedure. Feeling safe can help them tolerate cannulation better and the cannulator can invoke feeling safe. However, some patients still avoid cannulation, due to its unpleasantness. CONCLUSIONS: Cannulation is a pervasive procedure that impacts on patients' experiences of haemodialysis. This review illuminates further patients' experiences of cannulation for haemodialysis, indicating how improvements can be made to cannulation. REGISTRATION: PROSPERO (CRD42019134583).

The role of resistance exercise training for improving cardiorespiratory fitness in healthy older adults: a systematic review and meta-analysis.

BACKGROUND: Declines in cardiorespiratory fitness (CRF) and muscle mass are both associated with advancing age and each of these declines is associated with worse health outcomes. Resistance exercise training (RET) has previously been shown to improve muscle mass and function in the older population. If RET is also able to improve CRF, as it has been shown to do in younger populations, it has the potential to improve multiple health outcomes in the expanding older population. METHODS: This systematic review aimed to identify the role of RET for improving CRF in healthy older adults. A search across CINAHL, MEDLINE, EMBASE and EMCARE databases was conducted with meta-analysis performed on eligible papers to identify improvements in established CRF parameters (VO2 peak, aerobic threshold (AT), 6-minute walking distance test (6MWT) following RET intervention. Main eligibility criteria included older adults (aged over 60), healthy cohorts (disease-specific cohorts were excluded) and RET intervention. RESULTS: Thirty-seven eligible studies were identified. Meta-analysis revealed a significant improvement in VO2 peak (MD 1.89 ml/kg/min; 95% confidence interval (CI) 1.21-2.57 ml/kg/min), AT (MD 1.27 ml/kg/min; 95% CI 0.44-2.09 ml/kg/min) and 6MWT (MD 30.89; 95% CI 26.7-35.08) in RET interventions less than 24 weeks. There was no difference in VO2 peak or 6MWT in interventions longer than 24 weeks. DISCUSSION: This systematic review adds to a growing body of evidence supporting the implementation of RET in the older population for improving whole-body health, particularly in time-limited timeframes.

Measuring the impact of information skills training: a survey of health libraries in England.

BACKGROUND: The lack of robust research measuring the impact of NHS based information skills training prompted the West Midlands Regional Trainers' Forum to conduct a post-training survey. METHODS: This is a multi-centred study which collected data from over 60 separate organisations. Survey questionnaires were completed by learners a few weeks after the training event. RESULTS: Five hundred and thirty-four responses were received. 82% of information skills training recipients indicated that they had implemented learning or changed practice as a result of the training. 70% of recipients indicated there had been an impact on patient care. DISCUSSION: The beneficial results from information skills training manifest in a multitude of ways. The results of this study indicate that the learning from information skills training is being used to reduce problems and address the key issues in modern health care. CONCLUSION: The results clearly demonstrate the value of information skills training and its beneficial impact on patient care, lifelong learning and other key NHS functions. This study shows information skills training as an important activity which supports the information literacy agenda, and has a positive impact across the four key functions of library and knowledge services within the NHS.