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A Survey Study of Self-Rated Patients' Knowledge About AKI in a Post-Discharge AKI Clinic.

ABSTRACT: Background:Survivors of acute kidney injury (AKI) are at risk of adverse outcomes. Post-discharge nephrology care may improve patients' AKI knowledge and prevent post-AKI complications. Objective:The purpose of this study was to examine patients' awareness about their AKI diagnosis and self-rated knowledge and severity of AKI before and after their first post-discharge AKI Clinic encounter. Design:We conducted a pre- and post-survey study among AKI survivors who attended a post-discharge AKI Clinic. Setting:AKI Clinic at the University of Kentucky Medical Center (October 2016 to December 2017). Education about AKI was based on transformative learning theory and provided through printed materials and interdisciplinary interactions between patients/caregivers and nurses, pharmacists, and nephrologists. Patients:A total of 104 patients completed the survey and were included in the analysis. Measurements:Three survey questions were administered before and after the first AKI Clinic encounter: Question 1 (yes-no) for awareness, and questions 2 and 3 (Likert scale, 1 = lowest to 5 = highest) for self-rated knowledge and severity of AKI. Methods:Two mixed-model analysis of variance (ANOVA) was used for between-group (AKI severity) and within-group (pre- and post-encounter) comparisons. Logistic regression was used to examine parameters associated with the within-group change in self-perceived knowledge. Results:Twenty-two out of 104 (21%) patients were not aware of their AKI diagnosis before the clinic encounter. Patients' self-ratings of their AKI knowledge significantly increased after the first AKI Clinic encounter (mean ± SEM: pre-visit = 1.94 ± 0.12 to post-visit = 3.88 ± 0.09, P = .001), even after adjustment for age, gender, Kidney Disease Improving Global Outcomes (KDIGO) severity stage, or poverty level. Patients with AKI stage 3 self-rated their AKI as more severe than patients with AKI stage 1 or 2. Limitations:Our study population may not be representative of the general AKI survivor population. Administered surveys are subject to response-shift bias. Conclusions:Patients' self-perceived knowledge about AKI significantly increased following the first post-discharge AKI Clinic encounter that included interdisciplinary education. This is the first survey study examining self-perceived AKI knowledge in AKI survivors. Further examination of AKI literacy in survivors of AKI and its effect on post-AKI outcomes is needed. Trial registration:Not applicable.

SUBMITTER: Ortiz-Soriano V

PROVIDER: S-EPMC6385327 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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A Survey Study of Self-Rated Patients' Knowledge About AKI in a Post-Discharge AKI Clinic.

Ortiz-Soriano Victor V Alcorn Joseph L JL Li Xilong X Elias Madona M Ayach Taha T Sawaya B Peter BP Malluche Hartmut H HH Wald Ron R Silver Samuel A SA Neyra Javier A JA

Canadian journal of kidney health and disease 20190221

<h4>Background</h4>Survivors of acute kidney injury (AKI) are at risk of adverse outcomes. Post-discharge nephrology care may improve patients' AKI knowledge and prevent post-AKI complications.<h4>Objective</h4>The purpose of this study was to examine patients' awareness about their AKI diagnosis and self-rated knowledge and severity of AKI before and after their first post-discharge AKI Clinic encounter.<h4>Design</h4>We conducted a pre- and post-survey study among AKI survivors who attended a ...[more]

PMID: 30815269

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Project description:BACKGROUND:Reducing delays in hospital discharge is important to improve transition processes and reduce health care costs. The recently proposed post-acute care discharge score focusing on the self-care abilities before hospital admission allows early identification of patients with a need for post-acute care. New limitations in self-care abilities identified during hospitalization may also indicate a risk. Our aim was to investigate whether the addition of the post-acute care discharge score and a validated self-care instrument would improve the prognostic accuracy to predict post-acute discharge needs in unselected medical inpatients. METHODS:We included consecutive adult medical and neurological inpatients. Logistic regression models with area under the receiver operating characteristic curve were calculated to study associations of post-acute discharge score and self-care index with post-acute discharge risk. We calculated joint regression models and reclassification statistics including the net reclassification index and integrated discrimination improvement to investigate whether merging the self-care index and the post-acute discharge score leads to better diagnostic accuracy. RESULTS:Out of 1342 medical and 402 neurological patients, 150 (11.18%) and 94 (23.38%) have reached the primary endpoint of being discharged to a post-acute care facility. Multivariate analysis showed that the self-care index is an outcome predictor (OR 0.897, 95%CI 0.864-0.930). By combining the self-care index and the post-acute care discharge score discrimination for medical (from area under the curve 0.77 to 0.83) and neurological patients (from area under the curve 0.68 to 0.78) could be significantly improved. Reclassification statistics also showed significant improvements with regard to net reclassification index (14.2%, p<0.05) and integrated discrimination improvement (4.83%, p<0.05). CONCLUSIONS:Incorporating an early assessment of patients' actual intrahospital self-care ability to the post-acute care discharge score led to an improved prognostic accuracy for identifying adult, medical and neurological patients at risk for discharge to a post-acute care facility.

Project description:ImportanceTransgender, gender nonbinary, and genderqueer people are at increased risk for negative health outcomes, and medical school education is currently lacking on inclusion of these topics. However, there is little evidence of an association of clinician knowledge with the health of transgender people.ObjectiveTo evaluate the associations of patients' perceptions of clinician knowledge with self-rated health and severe psychological distress among transgender people.Design, setting, and participantsIn this cross-sectional study, a secondary data analysis of the 2015 US Transgender Survey (a survey of transgender, gender nonbinary, and genderqueer adults conducted across 50 states) Washington, DC, US territories, and US military bases in 2015 was performed. Data were analyzed from February to November 2022.ExposuresPatients' perception of their clinician's knowledge about transgender health care.Main outcomes and measuresSelf-rated health, dichotomized as poor or fair vs excellent, very good, or good, and severe psychological distress (scoring a validated threshold of ≥13 on the Kessler Psychological Distress Scale).ResultsThe sample included a total of 27 715 respondents (9238 transgender women [33.3%; 55.1% weighted; 95% CI, 53.4%-56.7%], 22 658 non-Hispanic White individuals [81.8%; 65.6% weighted; 95% CI, 63.7%-67.5%], and 4085 individuals aged 45-64 years [14.7%; 33.8% weighted; 95% CI, 32.0%-35.5%]). Of 23 318 individuals who answered questions regarding their perceptions of their clinicians' level of knowledge, 5732 (24.6%) reported their clinician knows almost everything about transgender care, 4083 (17.5%) reported their clinician knows most things, 3446 (14.8%) reported their clinician knows some things, 2680 (11.5%) reported their clinician knows almost nothing, and 7337 (31.5%) reported they were unsure. Nearly 1 in 4 transgender adults (5612 of 23 557 individuals [23.8%]) reported having to teach their clinician about transgender people. In total, 3955 respondents (19.4%; 20.8% weighted; 95% CI, 19.2%-22.6%) reported fair or poor self-rated health and 7392 (36.9%; 28.4% weighted, 95% CI, 26.9%-30.1%) met the criteria for severe psychological distress. After adjusting for covariates, compared with individuals who reported their clinician knows almost everything about transgender care, exposure to clinicians with lower perceived levels of knowledge about transgender care was associated with significantly higher odds of fair or poor self-rated health (adjusted odds ratio [aOR] for knowing almost nothing, 2.63; 95% CI, 1.76-3.94; aOR for unsure, 1.81; 95% CI, 1.28-2.56) and severe psychological distress (aOR for knowing almost nothing, 2.33; 95% CI, 1.61-3.37; aOR for unsure, 1.37; 95% CI, 1.05-1.79). Respondents who had to teach a clinician about transgender people had higher odds of reporting fair or poor self-rated health (aOR, 1.67; 95% CI, 1.31-2.13) and severe psychological distress (aOR, 1.49; 95% CI, 1.21-1.83) compared with those who did not.Conclusion and relevanceThe findings of this cross-sectional study suggest that there is an association between perceived clinician knowledge about transgender people and self-rated health and psychological distress among transgender people. These results highlight the importance of integration and enhancement of transgender health in medical education curriculum as a necessary intervention to improve the health of transgender people.

Project description:IntroductionStroke is the leading neurological cause of adult long-term disability in Europe. Even though functional consequences directly related to neurological impairment are well studied, post-stroke trajectories of functional health according to the International Classification of Functioning, Disability and Health are poorly understood. Particularly, no study investigated the relationship between post-stroke trajectories of activities of daily living (ADL) and self-rated health (SRH). However, such knowledge is of major importance to identify patients at risk of unfavourable courses. This prospective observational study aims to investigate trajectories of ADL and SRH, and their modifying factors in the course of the first year after stroke.Methods and analysisThe study will consecutively enrol 300 patients admitted to a tertiary care hospital with acute ischaemic stroke or transient ischaemic attack (TIA; Age, Blood Pressure, Clinical Features, Duration of symptoms, Diabetes score ≥3). Patient inclusion is planned from May 2021 to September 2022. All participants will complete an interview assessing ADL, SRH, mental health, views on ageing and resilience-related concepts. Participants will be interviewed face-to-face 1-5 days post-stroke/TIA in the hospital; and will be followed up after 6 weeks, 3 months, 6 months and 12 months via telephone. The 12-month follow-up will also include a neurological assessment. Primary endpoints are ADL operationalised by modified Rankin Scale scores and SRH. Secondary outcomes are further measures of ADL, functional health, physical activity, falls and fatigue. Views on ageing, social support, resilience-related concepts, affect, frailty, illness perceptions and loneliness will be examined as modifying factors. Analyses will investigate the bidirectional relationship between SRH and ADL using bivariate latent change score models.Ethics and disseminationThe study has been approved by the institutional review board of the University Medicine Greifswald (Ref. BB 237/20). The results will be disseminated through scientific publications, conferences and media. Moreover, study results and potential implications will be discussed with patient representatives.Trial registration numberNCT04704635.

Dataset Information

A Survey Study of Self-Rated Patients' Knowledge About AKI in a Post-Discharge AKI Clinic.

Publications

A Survey Study of Self-Rated Patients' Knowledge About AKI in a Post-Discharge AKI Clinic.

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