No abstract

This pilot study examined associations among patterns of gastric myoelectrical activity, symptoms of gastroparesis, years of diabetes, months of dialysis, and use of gastrointestinal medications in gastroparetic kidney-pancreas (KP) transplant recipients. Electrogastrography (EGG) and gastric symptom data were obtained from 42 transplant recipients before and after transplant (6, 12, and 24 months). Recipients were 38 +/- 7 yr of age, 88% Whites, and 60% male; 97% had hypertension. All had functioning grafts post-transplant (mean creatinine, 1.59 +/- 0.66 mg/dL, and serum glucose 91.97 +/- 24.92 mg/dL). Sixteen subjects had normal EGG (2.7-3.2 cycles per minute, cpm); two were tachygastric (>3.2 cpm) at all time points; one remained bradygastric (<2.7 cpm) throughout the study period. Following transplant, symptoms lessened and were associated with 6-month normalization of EGG (r = 0.41, p = 0.02). A small change in the percentage of patients with normal EGG was observed from baseline to 24 months (67% vs. 69% respectively); however, there was a shift from bradygastria (29% to 15% respectively) to tachygastria (5% to 15% respectively). Prescribed prokinetic and antisecretory medications use increased over the study period from 13 (31%) subjects at baseline to 32 (86%) at 6 months; 21 (78%) at 12 months; and 12 (92%) at 24 months. Although symptoms diminish following transplant, gastroparesis remains a significant problem for transplant patients. Normalization of EGG and shifts from bradygastria to tachygastria occur post-transplant. Our results suggest that serial EGGs and frequent assessment of symptoms can be used to follow gastroparesis in KP recipients.

BackgroundGastroparesis (Gp) is a poorly understood chronic gastrointestinal medical condition for which patient reported outcomes (PRO) are lacking. Previously developed symptoms scoring has been used for several decades. Using symptoms scores as a basis for documentation, 12 years of support/focus group patient feedback from the nearly 1000 attendees were integrated with medical care and recommendations for treatment were developed. Early attenders of the support group were compared with non-attendees for illness acuity, disability, and duration and number of office phone calls.MethodsPatients cared for in an academic medical practice were assessed for patient-derived PRO symptoms, coupled with standardized Health Related Quality of Life (HRQOL) measures. Based on factors identified by the patients via support/focus groups, a diagnostic and prognostic tool was developed.ResultsThe new tool utilized PRO symptoms and included provider assessments of medical illnesses as well as resource utilization. This ‘post PRO’ tool has been applied in a variety of settings for patients with the symptoms of Gp over the last two decades. The ‘pre-PRO’ factors from the support/focus groups were compared to the PRO measures as well as the ‘post-PRO’ scale to assess their usefulness. Using methods that combine chart data, including electronic medical records (EMR), with PRO symptoms may have design implications for PRO assessment. The resultant scales, as part of a new tool, can allow for sharing of PRO derived scores in a chronic gastrointestinal (GI), illness with different practitioners.ConclusionsThese newly-derived scales offer a potentially useful tool for clinical decision-making, tailoring treatment to patient subgroups and engaging both patients and their families and caregivers in more active partnerships with providers to improve health outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/s12876-016-0523-3) contains supplementary material, which is available to authorized users.

These findings are important in assisting nurses and other healthcare professionals in identifying patients with diabetes with low treatment satisfaction who may present a greater risk for poor well-being. Additionally, they lend support to developing policies for frequent screenings and special therapeutic interventions that are needed to maximize patients' treatment satisfaction and well-being in the Middle East and elsewhere.

Studies on parents' participation in care of a hospitalized child are rare and have not sufficiently addressed the factors prompting parents' participation in their child's care. This study investigated the relative contributions and predictive value of parents' and children's demographics on parents' participation in care. A convenience sample of 294 parents participated from four major hospitals in a metropolitan area in Amman. Parents completed two sets of measures, a socio-demographic form and the Arabic version of the Index of Parent Participation/Hospitalized Child. A series of bivariate analyses were completed to investigate associations between socio-demographic variables and parents' participation in care. The multiple regression analysis identified four variables as the optimal set of predictors for parent participation in the care of a hospitalized child: hospital experience, type of illness, child's age and type of hospital. The importance of interpreting these findings in a cultural context is discussed.