No abstract

Research has shown that most patients with end-stage kidney failure prefer treatment by transplantation. This entails taking immunosuppressant drugs daily throughout the life of the kidney. Failure to do so causes transplant rejection and a return to dialysis, or sometimes even death. Up to 50% of transplanted patients report failing to take their medication as prescribed. This qualitative study used focus groups to explore patients' lived experience in relation to medication adherence. Data were analysed using thematic analysis. The main themes to emerge were: fear of kidney failure, loyalty to the renal team and donors, health beliefs, forgetting and side-effects. Reasons for adherence were to avoid kidney failure and to acknowledge their gratitude to the renal team and donors. Participants suggested that non-adherence was largely due to forgetting.

This qualitative study explores oral health beliefs and attitudes among Chinese resident in West Yorkshire using six focus groups differentiated by age and gender. Focus group discussions took place in community settings led by trained Chinese facilitators. All groups believed that they were susceptible to dental disease, and that bleeding gums and total tooth loss were 'normal'; apart from the elderly, tooth loss was seen as undesirable. The elderly and adult groups believed in traditional remedies and claimed that preventive oral health measures were ineffective. These groups lacked faith in dentists, and for them cost, language difficulties and lack of awareness were the main reported barriers to accessing dental services. Traditional Chinese oral health beliefs remain influential for the elderly and adult UK Chinese. In contrast, teenagers thought that toothbrushing and sugar restriction would help to prevent dental diseases. The appropriateness of the focus group and interview methods for exploring oral health beliefs for the Chinese are discussed, as are implications of the reported intergenerational differences for oral health promotion strategy in the UK.

Research has shown that transplantation improves quality of life for patients with end stage renal disease (ESRD), although it does not return to pre-kidney failure levels. This study used focus groups to explore the experience of living with a transplanted kidney. The data were analysed, using thematic analysis, and the following themes were identified: medicalization; fear; gratitude; and coping. These may necessitate constant vigilance, reduced spontaneity and preoccupation with self-care to maintain the kidney's health; being treated differently from others; pressure not to let themselves and others down; and the urge to increase their knowledge about their condition. It was found that these themes pervade the lives of the recipients and that the psychosocial effects of transplantation are long-lasting.

The UK health service sees around 160,000 total hip or knee replacements every year and this number is expected to rise with an ageing population. Expectations of surgical outcomes are changing alongside demographic trends, whilst aftercare may be fractured as a result of resource limitations. Conventional assessments of health outcomes must evolve to keep up with these changing trends. Health outcomes may be assessed largely by self-report using Patient Reported Outcome Measures (PROMs), such as the Oxford Hip or Oxford Knee Score, in the months up to and following surgery. Though widely used, many PROMs have methodological limitations and there is debate about how to interpret results and definitions of clinically meaningful change. With the development of a home-monitoring system, there is opportunity to characterise the relationship between PROMs and behaviour in a natural setting and to develop methods of passive monitoring of outcome and recovery after surgery. In this paper, we discuss the motivation and technology used in long-term continuous observation of movement, sleep and domestic routine for healthcare applications, such as the HEmiSPHERE project for hip and knee replacement patients. In this case study, we evaluate trends evident in data of two patients, collected over a 3-month observation period post-surgery, by comparison with scores from PROMs for sleep and movement quality, and by comparison with a third control home. We find that accelerometer and indoor localisation data correctly highlight long-term trends in sleep and movement quality and can be used to predict sleep and wake times and measure sleep and wake routine variance over time, whilst indoor localisation provides context for the domestic routine and mobility of the patient. Finally, we discuss a visual method of sharing findings with healthcare professionals.