Evaluation of Usability and Learning Motivation of e-Learning Courses for People With Chronic Kidney Disease.

Nurses need to increase patient education opportunities so that more people with chronic kidney disease can understand the disease accurately from its early stages. We developed an e-learning course based on the Dick and Carey system approach model and the attention, relevance, confidence, satisfaction model for people with chronic kidney disease. People with chronic kidney disease, on average, are aged around 50 to 60 years, and this population tends to lack perceived susceptibility toward and concern for the disease owing to the asymptomatic nature of early chronic kidney disease. Therefore, e-learning should be easy to use and motivate learning. This study aimed to evaluate the usability and learning motivation of this course. The participants included 10 outpatients (mean age, 51.2 years) with chronic kidney disease whose mastery percentage of learning objectives was compared by the knowledge tests immediately before and after the course. We also observed the participants' operation status and measured their motivation for using instructional materials with a questionnaire. The results demonstrated that this course facilitates independent operation, improves postcourse performance, and motivates participants in all areas of learning motivation. Thus, this e-learning course can be recommended as easy to use and motivating for people with chronic kidney disease.

The Dietary Patterns of Japanese Hemodialysis Patients: A Focused Ethnography.

The relationship between diet and kidney disease outcomes has been established, and as a result, hemodialysis patients are required to modify their diet. However, there is a gap in understanding how diet is influenced by social factors, particularly among Japanese patients whose diet is known to be high in salt. The purpose was to explore the dietary patterns of Japanese hemodialysis patients and better understand the challenges they face in adhering to dietary restrictions. A focused ethnography, employing observational methods with six Japanese hemodialysis patients was undertaken. Fieldwork included observations, informal interviews, and weekly formal interviews for 6 weeks. Five categories were identified during the process of data analysis. This study highlights the strong influence of culture, tradition, and family on the dietary patterns of Japanese hemodialysis patients, which has rarely been acknowledged by Japanese health professionals. The translated abstract was prepared by the author based on the accepted English version of the original abstract. Only light additional review of the translation has been completed by the journal.

Effectiveness of an educational intervention (the Encourage Autonomous Self-Enrichment Program) in patients with chronic kidney disease: A randomized controlled trial.

BACKGROUND: Self-management is an important step toward preventing and impeding the progression of chronic kidney disease. However, patients with chronic kidney disease may have few or no subjective symptoms and therefore might consider self-management to be unnecessary. Effective support and encouragement of self-management in patients with chronic kidney disease is therefore required. OBJECTIVES: This study tested the effectiveness of the Encourage Autonomous Self-Enrichment patient education program, which supports patient autonomy and intrinsic motivations with the aim of improving self-efficacy and sustaining self-management, on perceived self-efficacy, self-management behaviors, and physiological endpoints (blood pressure and renal function parameters) in patients with chronic kidney disease. DESIGN: This was a randomized, controlled, single-blind trial with one-to-one allocation into two groups. SETTINGS: The study was conducted at 13 Japanese clinics or general hospitals that specialize in internal medicine and urology. PARTICIPANTS: Participants included patients who were diagnosed with chronic kidney disease and were not receiving dialysis. Patients were recruited from among those attending follow-up visits at participating institutions. METHODS: A total of 65 participants were randomly allocated into the intervention (n=33) and control (n=32) groups. The intervention group followed the Encourage Autonomous Self-Enrichment program action plan for 12 weeks. The control group received standard education provided by nurses who distributed leaflets in accordance with physicians' instructions, provided auxiliary medical services, and answered patients' questions. RESULTS: Except for 1 participant who died after 4 weeks, all 33 members of the intervention group continued the Encourage Autonomous Self-Enrichment program for 12 weeks. This program intervention yielded significant improvements in perceived self-efficacy (U=318.5, p=0.035, effect size r=0.27) and self-management behaviors (U=310.0, p=0.026, effect size r=0.29). There were no differences in blood pressure or renal function between the groups; however, serum potassium levels decreased in the intervention group and increased in the control group (t (58)=1.047, p=0.299, effect size d=1.49). No intervention-related adverse events, such as worsening of patients' test results, were observed. CONCLUSIONS: These findings indicate that the Encourage Autonomous Self-Enrichment program yielded improvements in perceived self-efficacy and self-management behaviors in patients with chronic kidney disease not treated with dialysis.

Awareness of pre-alcoholic status and changes in such awareness: analysis of narratives by male Japanese patients and their families.

In this study, we investigated the extent of awareness on the part of alcoholic people with regard to their alcoholism and changes in such awareness over time. We conducted qualitative, descriptive analysis of data obtained during semistructured interviews of alcoholic people and family members with whom they lived during the pre-alcoholic stage. The awareness of pre-alcoholic people was found to involve seven elements and to undergo changes at three stages of alcohol consumption (when enjoying the effects of alcohol, when escaping from a reality difficult to face directly, and when alcohol began to cause health problems). The results suggest that professional support for pre-alcoholic people should be tailored to the stage of alcohol use of each individual case and should include advice on appropriate alcohol consumption. In addition, identification and follow-up of problematic drinkers and short-term intervention are required.

Defining the culture and attitude towards dietary management actions in people undergoing haemodialysis.

OBJECTIVES: The present study was designed to clarify the structure of culture and the three components of attitude in a desirable attitude toward dietary management actions in outpatient haemodialysis patients who are in the maintenance phase of treatment. METHODS: The participants in the study included nine patients undergoing chronic maintenance haemodialysis who have received guidance related to diet and had good test results. Ethnography, by means of participant observation and semi-structured interviews, was chosen as the research method. FINDINGS: Desirable attitude of haemodialysis patients in dietary management actions was found to have a chronological progression in one of the components of attitude: propensity of behaviour. Change in behaviour was influenced by affect and cognition. At the base of the structure of attitude lay three factors: valuing cooking with seasonal ingredients and creating special meals for seasonal occasions; family draws near, shows care and gives support; and belief in information perceived to be good for the health, which was influenced by three components of attitude: affect, cognition, and propensity of behaviour, as well as culture. CONCLUSION: Participants continue to value the food culture that they grew up with, which involves their affect towards, and cognition of, dietary management.

Structural visualization of expert nursing: Dialysis patient education program "PD catheter management".

Structural visualization was implemented on catheter management education for peritoneal dialysis (PD) patients requiring expert nursing. An education program utilizing electronic images was proposed as a method of monitoring the exit site, which is of high importance in PD catheter self-management. Recording images of the exit site and utilizing them as part of the education program encouraged a common understanding of the exit site between nurses and patients, and helped to achieve a better quality of patient education. It is thought that visualization of nursing practice and the thinking processes of expert nurses which have not been expressly stated previously can become a foundation for more advanced nursing care throughout the profession.

Structural visualization of expert nursing: Dialysis patient education program "vascular access management".

Structural visualization was implemented on vascular access management education for dialysis patients requiring expert nursing. As listening to and recording the sound of the Vascular access is important, an education program involving the electronic recording of sounds was proposed. Recording the Vascular access sounds and utilizing them as part of the education program encouraged a common understanding of the sounds between nurses and patients and helped to achieve a better quality of patient education. It is thought that the visualization of nursing practice and the thinking processes of expert nurses which have not been expressly stated previously can become a foundation for more advanced nursing care throughout the profession.

Structural visualization of expert nursing: Hemodialysis patient education program "behavior modification program for hemodialysis patients".

Behavior modification programs (BMP) have been suggested to be useful for the self-management of hemodialysis (HD) patients. To provide more systematic care, we structured the procedure of the thinking process and care in BMPs as an algorithm. BMP developers produced a temporary algorithm based on previous studies, discussed it with nurses with BMP experience, and added and revised necessary items. As a result, an algorithm of BMP with high reproducibility that allows maintenance of consistent quality for the self-management of HD patients could be developed.

Quantitation of glutathione S transferase-pi in the urine of preterm neonates.

BACKGROUND: Glutathione S transferases (GSTs) are widely distributed enzymes found in highly varying amounts in tissues of the human body. The enzyme GST-pi in urine has been used as a marker of renal distal tubular cell damage. The present study was intended to evaluate urinary excretion of GST-pi and its relationship to other renal markers and to the status of oxidative stress in preterm neonates. METHODS: Levels of urinary GST-pi, N-acetyl-beta-glucosaminidase (a marker of proximal tubular damage), albumin (a marker of glomerular damage) and 8-hydroxy-2'-deoxyguanosine (a marker of oxidative stress) and serum creatinine were measured in preterm neonates at 1 and 4 weeks of age. RESULTS: The results showed that urinary excretion of GST-pi is increased in preterm neonates compared with reported values for healthy adults. No significant relationship was detected between urinary GST-pi and other markers for renal function. Urinary GST-pi showed significantly positive correlation with urinary 8-hydroxy-2'-deoxyguanosine at 1 and 4 weeks. Sick neonates treated with supplemental oxygen and mechanical ventilation showed significantly higher levels of GST-pi as well as 8-hydroxy-2'-deoxyguanosine than clinically stable neonates did at 4 weeks. CONCLUSIONS: These results indicate the potential effect of systemic oxidative stress on urinary excretion of GST-pi. Further studies are necessary to explore the effect of oxidative conditions on expression of GST-pi in distal tubules in the human kidney.

The effects of a cognitive behavioural therapy programme for self-care on haemodialysis patients.

A nurse-delivered haemodialysis patient education programme incorporating cognitive behavioural therapy (CBT) was developed. The effects of the CBT programme were compared with those of a standard patient education (SPE) programme on patients' salt intake and weight gain using a quasi-experimental design. There were 22 participants (11 CBT, 11 SPE) undergoing outpatient haemodialysis therapy at one clinic. Daily weight gain rates decreased in the intervention period compared with the baseline period in both the CBT and SPE groups. This effect lasted for 12 weeks in the CBT group but for only eight weeks in the SPE group. In addition, daily salt intake decreased in the intervention period compared with the baseline period in both the CBT and SPE groups, persisting for 12 weeks. From these results, both programmes were shown to be effective, but CBT had a longer effect.

Kidney disease quality of life of Japanese dialysis patients who desire administration of sildenafil and the treatment of erectile dysfunction using sildenafil.

Erectile dysfunction (ED) is common among patients on dialysis therapy. In the present study, we attempted administration of sildenafil to Japanese patients undergoing dialysis. In order to diagnose ED before prescribing sildenafil, we assessed the hemodialysis patients who desired sildenafil by using the five items version of the International Index of Erectile Function (IIEF-5). In addition, the characteristics of the quality of life in Japanese hemodialysis patients who desired sildenafil were assessed using the kidney disease quality of life (KDQOL). To all 37 male subjects (mean age of 53.8 +/- 10.4 years) attending the Outpatient Hemodialysis Unit at Atsugi Clinic (Atsugi City, Japan), it was explained by their primary doctor that the treatment of ED with sildenafil was possible. As a result, 10 patients (27.0%) desired the treatment. For eight patients, ED was diagnosed by IIEF-5 prior to prescription of sildenafil. The mean IIEF-5 scores were 6.13 +/- 4.67 points. Sildenafil was prescribed to five patients (three diabetic, two non-diabetic) and sexual function was improved in three cases. The main adverse effect was found to be ventricular arrhythmia in one case. As for KDQOL, the group desiring sildenafil showed significantly high values in Dialysis Staff Encouragement and Patient Satisfaction. Among the other nine dialysis patients (five diabetic, four non-diabetic; mean age of 58.1 +/- 8.9 years) who visited the ED department of Ishida Hospital (Asahikawa City, Japan), sildenafil was effective for all non-diabetic patients (100%) and for only one diabetic patient (20%). Among all 14 patients at Atsugi Clinic and Ishida Hospital, sildenafil efficacy rates were 83.3% for non-diabetic patients and 37.5% for diabetic patients. Non-diabetic patients without the side-effects were all responders for the sildenafil treatment. The patients who relied on the dialysis staff and were more satisfied with the general treatment in the dialysis institute desired the administration of sildenafil under the present circumstances wherein the dialysis population had few experiences of sildenafil treatment. Diabetic status is thought to be a negative factor for the response of sildenafil treatment in dialysis patients.