THE EFFECT OF A TOKEN ECONOMY ON DIETARY COMPLIANCE FOR CHILDREN ON HEMODIALYSIS

Adherence to dietary restrictions is a recurring problem for children on hemodialysis. The effect of behavior modification in maintaining dietary control is reported for four patients aged 11 to 18 years. Weight gain, potassium level, and blood urea nitrogen were utilized as criteria measures. A token reinforcement program implemented by the hemodialysis team resulted in significant changes in the dietary pattern of the children. The average weight gain between dialysis sessions for the four subjects during treatment was reduced by 45% and the degree of weight fluctuation was lessened. Potassium levels and BUN were controlled to their appropriate level for subjects who initially exceeded the criterion level. With the withdrawal of weight gain from the contingency system, increase of weight gain between dialysis sessions was noted for all subjects.     

USE OF A TOKEN ECONOMY TO INCREASE COMPLIANCE DURING HEMODIALYSIS

We report the effects of using a token economy to treat noncompliant behavior in a 10-year-old male hemodialysis patient. The results of an ABAB design indicated that the intervention increased compliant behavior during both treatment phases and that compliance was maintained at 3- and 6-month follow-up observations.     

Managing multiple chronic conditions in Singapore – Exploring the perspectives and experiences of family caregivers of patients with diabetes and end stage renal disease on haemodialysis

Objective: Diabetes mellitus (DM) is the commonest cause of end stage renal disease (ESRD). Despite increasing DM-ESRD prevalence and high dependency on care, there is a lack of literature on DM-ESRD caregivers. We sought to explore the perspectives and experiences of caregivers of patients with DM undergoing haemodialysis in Singapore.

Design: This study employed an exploratory, qualitative design comprising in-depth interviews with caregivers of DM-ESRD patients.

Methods: Semi-structured interviews were conducted with a sample of 20 family caregivers (54.2 ± 12.6 years; 75% female) of DM-ESRD patients. Data were analysed using Thematic Analysis.

Results: Key caregiving challenges identified were managing diet, care recipients’ emotions and mobility dependence. Patients’ emotional reactions caused interpersonal conflicts and hindered treatment management. Difficulties in dietary management were linked to patients’ erratic appetite, caregivers’ lack/poor understanding of the dietary guidelines and caregivers’ low perceived competence. Limited resources in terms of social support and finances were also noted. Physical and psychological well-being and employment were adversely affected by caregiving role.

Conclusion: This study highlights distinctive aspects of the DM-ESRD caregiving experience, which impact on caregivers’ health and challenge care. Disease management programmes should be expanded to support caregivers in dealing with multimorbidity.     

肾移植术后糖尿病临床高危险因素分析

探讨移植后糖尿病发生的高危因素。116例受者分为糖尿病组（22例）和非糖尿病组（94例）。对可能危险因素进行χ^2检验后显示术前肝功、糖耐量正常、术后用小量激素、CSA方案并血药浓度正常的患者糖尿病发生率低于相对应组,而性别、年龄、糖尿病家族史相比,P〉0．05。说明肝功能、糖耐量、激素量、免疫抑制剂及药物浓度是移植后糖尿病发生的危险因素。     

CysC在肾移植后急性排斥反应诊断中的价值

探讨CysC在肾移植术后诊断急性排斥反应中的价值。63例肾移植患者分为肾功能稳定组（49例）和排斥组（14例）,选10例单纯感染患者为对照组,检测CysC值,并与正常对照组（60例）比较。术后监测稳定组和排斥组CysC、BUN、SCr及CCr,对排斥组排斥前后CysC浓度变化以及CysC与SCr、CCr关系进行分析。结果为排斥组排斥前与排斥时CysC浓度差异有统计学意义（P〈0.01）;CCr在稳定组和排斥组与SCr、CysC均呈直线相关;感染组CysC与正常对照组差异无统计学意义（P〉0.05）。说明CysC可以用于肾移植术后急性排斥反应的早期诊断及与单纯感染鉴别诊断。     

胰岛素样生长因子结合蛋白3mRNA在肾癌中的表达

为探讨胰岛素样生长因子结合蛋白3（IGFBP-3）mRNA在肾癌（RCC）中的表达,采用半定量RT-PCR方法进行检测,检测56例RCC组织标本及56例癌旁组织标本中IGFBP-3的表达。结果显示RCC与癌旁组织之间IGFBP-3表达差异有显著性（P〈0.05）,IGFBP-3在透明细胞癌的强阳性表达,高于其他病理类型（P均〈0.05）,并与病理分级相关。因此,IGFBP-3在RCC组织中的表达具有显著性,其在肾透明细胞癌中的强阳性表达具有特异性。     

腹膜透析相关性腹膜炎诊治的临床决策

腹膜透析相关性腹膜炎的治疗以前主要着眼于抗生素的选择,但其防治应该是从腹透管置管开始的整体策略,包括预防性抗生素的使用、患者的强化培训、腹膜炎的早期快速诊断、给药途径与疗程,以及拔管指征等。肾科医师临床决策是需要根据最新的治疗指南及研究进展,结合患者的个体特点进行综合判断,以期达到最佳的治疗效果。     

腹膜透析技术的发展

腹膜透析是一门年轻的学科。随着科学技术的发展,人们对腹膜透析的认识越来越深入。随着新材料新方法不断应用于临床,腹膜透析技术逐渐完善起来,病人的生存期也越来越长,人数越来越多。但伴随腹膜透析的广泛应用又产生了很多问题,通过问题的解决,腹膜透析又会进一步发展。     

Body-image,quality of life and psychological distress: a comparison between kidney transplant patients and a matching healthy sample

The purpose of the current study was to assess the uniqueness of the condition of kidney transplant recipients in comparison to a sample of matching healthy peers in relation to body-image dissatisfaction and identification, quality of life and psychological distress. Participants were 45 kidney transplant recipients who were under follow-up care at a Transplant Unit of a major Medical Center, and a sample of 45 matching healthy peers. Measures were taken using self-report questionnaires [Body-Image Ideals Questionnaire (BIIQ), Body Identification Questionnaire (BIQ), Brief Symptoms Inventory (BSI), and the SF-12]. The major findings were the following: (i) kidney transplant recipients reported lower levels of quality of life and higher levels of PsD when compared to their healthy peers; (ii) no difference in body-image dissatisfaction was found between the two studied groups; (iii) significant correlations between body-image dissatisfaction quality of life and PsD were found only in the kidney transplant recipients. The kidney transplantation condition has a moderating effect in the association between body-image dissatisfaction PsD but not in the association between body-image dissatisfaction and quality of life; (iv) kidney transplant recipients experienced higher levels of body identification than did their healthy peers. Taken together, these findings highlight the unique condition of kidney transplant recipients, as well as the function that body-image plays within the self.     

The influence of different dialysis modalities on the quality of life of patients with end-stage renal disease: A systematic literature review

Objectives: This study aims to generate evidence regarding the relationships of different dialysis modalities with HR-QOL.

Design: A systematic review was conducted to investigate the HR-QOL of patients treated with different dialysis modalities.

Methods: A literature search was conducted for English language articles in the CINAHL, Medline and PubMed databases published from January 1990 through May 2016. Specifically, we sought articles that would compare the HR-QOL of hemodialysis (HD) and peritoneal dialysis (PD) patients in terms of physiological, psychological and social functioning, as well as disease symptoms. Thirty-four articles met the study inclusion criteria and were included into the analysis.

Results: The research results indicated no significant differences in HR-QOL between HD and PD treatment. However, a higher percentage of patients who received PD had a better HR-QOL in terms of physiological, psychological, social and disease symptoms.

Conclusions: Despite the fact that the results of this study showed no difference in HR-QOL between HD and PD treatment, its review of relevant references can serve as a reference for health professionals. However, patients’ conditions must still be taken into account when making suggestions about which dialysis modality a patient should use.