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Article ; Online: MoCA: Turn Your Mind to It.

Jassal, Sarbjit V / Farragher, Janine F

Journal of the American Society of Nephrology : JASN

2020 Volume 31, Issue 4, Page(s) 672–673

MeSH term(s)	Cognition Disorders ; Cognitive Dysfunction ; Humans ; Renal Dialysis
Language	English
Publishing date	2020-03-04
Publishing country	United States
Document type	Editorial ; Research Support, Non-U.S. Gov't ; Comment
ZDB-ID	1085942-1
ISSN	1533-3450 ; 1046-6673
ISSN (online)	1533-3450
ISSN	1046-6673
DOI	10.1681/ASN.2020020173
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Article: Knowledge Translation in Glomerulonephritis: Successes in Translational Research From the Bench to Bedside.

Yau, Kevin / Wang, Carol / Al Batran, Rami / Macphee, Anne / Beaucage, Mary / Farragher, Janine F

Canadian journal of kidney health and disease

2023 Volume 10, Page(s) 20543581231191839

Abstract: Purpose of review: Glomerulonephritis refers to a rare group of diseases characterized by glomerular inflammation, which collectively are a common cause of kidney failure. Until recently, there was a lack of high-quality clinical trials to inform the ... ...

Abstract	Purpose of review: Glomerulonephritis refers to a rare group of diseases characterized by glomerular inflammation, which collectively are a common cause of kidney failure. Until recently, there was a lack of high-quality clinical trials to inform the care of patients with glomerulonephritides. We identified examples of successful translational research spanning from basic science to clinical applications, and highlight gaps in implementation science. Sources of information: The focus of our review was derived from discussions between health care professionals, researchers, and patient partners. We also performed literature searches pertaining to the treatment of glomerulonephritis in PubMed and Google Scholar. Methods: Examples of successful knowledge translation were generated through review of new evidence in the past 5 years and by iterative discussions by the authors. We then conducted a narrative review of several themes related to knowledge translation in glomerulonephritis. This was complemented by an interview with a patient partner to provide an example of a patient's perspective living with glomerulonephritis. Key findings: We summarized selected recent advances in glomerulonephritis and its knowledge translation in the following domains: (1) identification of auto-antibodies in membranous nephropathy and minimal change disease; (2) clinical trials of novel targeted therapies for IgA nephropathy and lupus nephritis, which have led to approval of new treatments; (3) developments in research networks and clinical trials in glomerulonephritis; (4) recognition of the importance in developing standardized patient reported outcome measures in clinical trials; and (5) barriers in knowledge translation including access to medication. Limitations: A systematic search of the literature and formal assessment of quality of evidence were beyond the scope of this review.
Language	English
Publishing date	2023-08-23
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2765462-X
ISSN	2054-3581
ISSN	2054-3581
DOI	10.1177/20543581231191839
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Article ; Online: Living with paradox: A qualitative study of colorectal cancer patients' experiences in managing their health after cancer treatment.

Cuthbert, Colleen A / Farragher, Janine F / Farrer, Christie L / Cheung, Winson Y

European journal of cancer care

2021 Volume 30, Issue 3, Page(s) e13416

Abstract: Objectives: Managing one's health after colorectal cancer may present specific challenges given long-term impacts to biopsychosocial functioning. Understanding experiences of managing one's health post-treatment is important to informing patient-centred ...

Abstract	Objectives: Managing one's health after colorectal cancer may present specific challenges given long-term impacts to biopsychosocial functioning. Understanding experiences of managing one's health post-treatment is important to informing patient-centred supportive care. Methods: A qualitative study with 19 patients who had completed treatment for colorectal cancer to explore the experience of managing one's health. Following Thorne's Interpretive Description, we conducted interviews using either focus groups or individual interviews. Transcribed data were analysed following Thorne's approach. Sociodemographic and clinical characteristics were also collected. Results: The metaphor of living with paradox was the main theme characterising the experiences of managing one's health in the post-treatment period. Participants described the ambiguity of health, their need to accept the new normal, losing control and taking back control, experiencing positive and negative life changes, and the need to continually reframe their perspectives to focus on the positives. Conclusion: Our findings suggest that providing patient-centred care to colorectal cancer survivors post-treatment involves recognising their changing and sometimes conflicting experiences. Their ability to manage their health may fluctuate and their supportive care needs may not fit with a particular trajectory. Cancer care systems should strive for flexibility in the structure and timing of support available.
MeSH term(s)	Cancer Survivors ; Colorectal Neoplasms/therapy ; Focus Groups ; Humans ; Patient-Centered Care ; Qualitative Research ; Survivors
Language	English
Publishing date	2021-01-28
Publishing country	England
Document type	Journal Article
ZDB-ID	1303114-4
ISSN	1365-2354 ; 0961-5423 ; 1360-5801
ISSN (online)	1365-2354
ISSN	0961-5423 ; 1360-5801
DOI	10.1111/ecc.13416
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Article: The Association Between Estimated Glomerular Filtration Rate and Hospitalization for Fatigue: A Population-Based Cohort Study.

Farragher, Janine F / Zhang, Jianguo / Harrison, Tyrone G / Ravani, Pietro / Elliott, Meghan J / Hemmelgarn, Brenda

Canadian journal of kidney health and disease

2021 Volume 8, Page(s) 20543581211001224

Abstract: Background: Fatigue is a pervasive symptom among patients with chronic kidney disease (CKD) that is associated with several adverse outcomes, but the incidence of hospitalization for fatigue is unknown.: Objective: To explore the association between ... ...

Abstract	Background: Fatigue is a pervasive symptom among patients with chronic kidney disease (CKD) that is associated with several adverse outcomes, but the incidence of hospitalization for fatigue is unknown. Objective: To explore the association between estimated glomerular filtration rate (eGFR) and incidence of hospitalization for fatigue. Design: Population-based retrospective cohort study using a provincial administrative dataset. Setting: Alberta, Canada. Patients: People above age 18 who had at least 1 outpatient serum creatinine measurement taken in Alberta between January 1, 2009, and December 31, 2016. Measurements: The first outpatient serum creatinine was used to estimate GFR. Hospitalization for fatigue was identified using International Classification of Diseases, Tenth Revision (ICD-10) code R53.x. Methods: Patients were stratified by CKD category based on their index eGFR. We used negative binomial regression to determine if there was an increased incidence of hospitalization for fatigue by declining kidney function (reference eGFR ≥ 60 mL/min/1.73m Results: The study cohort consisted of 2 823 270 adults, with a mean age of 46.1 years and median follow-up duration of 6.0 years; 5 422 hospitalizations for fatigue occurred over 14 703 914 person-years of follow-up. Adjusted rates of hospitalization for fatigue increased with decreasing kidney function, across all age strata. The highest rates were seen in adults on dialysis (adjusted incident rate ratios 24.47, 6.66, and 3.13 for those aged 18 to 64, 65 to 74, and 75+, respectively, compared with eGFR ≥ 60 mL/min/1.73m Limitations: Fatigue hospitalization codes have not been validated; reference group limited to adults with at least 1 outpatient serum creatinine measurement; remaining potential for residual confounding. Conclusions: Declining kidney function was associated with increased incidence of hospitalization for fatigue. Further research into ways to address fatigue in the CKD population is warranted. Trial registration: Not applicable (not a clinical trial).
Language	English
Publishing date	2021-03-16
Publishing country	England
Document type	Journal Article
ZDB-ID	2765462-X
ISSN	2054-3581
ISSN	2054-3581
DOI	10.1177/20543581211001224
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Article ; Online: A pilot randomised controlled trial of an energy management programme for adults on maintenance haemodialysis: the fatigue-HD study.

Farragher, Janine F / Ravani, Pietro / Manns, Braden / Elliott, Meghan / Thomas, Chandra / Donald, Maoliosa / Verdin, Nancy / Hemmelgarn, Brenda R

BMJ open

2022 Volume 12, Issue 2, Page(s) e051475

Abstract: Background: Identifying interventions to reduce fatigue and improve life participation are top research priorities of people on maintenance haemodialysis.: Objective: Our primary objective was to explore the feasibility of conducting a randomised ... ...

Abstract	Background: Identifying interventions to reduce fatigue and improve life participation are top research priorities of people on maintenance haemodialysis. Objective: Our primary objective was to explore the feasibility of conducting a randomised controlled trial of an energy management programme for people on maintenance haemodialysis. Design: Parallel-arm, 1:1, blinded, pilot randomised controlled trial. Participants: Participants were recruited from 6 dialysis units in Calgary, Canada. Eligible patients were on maintenance haemodialysis, clinically stable and reported disabling fatigue on the Fatigue Severity Scale items 5, 7, 8 and 9. Randomisation: Participants were randomised using a computer-generated random number sequence according to permuted blocked randomisation, stratified by dialysis unit. Blinding: Participants were blinded to treatment allocation. Interventions: Participants received an attention control (general disease self-management education) or the Personal Energy Planning (PEP) programme, a tailored, web-supported 7-9 weeks energy management programme. Outcomes: Eligibility, recruitment and attrition rates were recorded, and standardised intervention effects (Hedge's G) were calculated for fatigue and life participation questionnaires at one1-week postintervention and 12-week postintervention. Results: 159 of 253 screened patients were eligible to be approached. 42 (26%) had fatigue, were interested and consented to participate, of whom 30 met eligibility criteria and were randomised (mean age 62.4 years (±14.7), 60% male). 22 enrolled participants (73%) completed all study procedures. Medium-sized intervention effects were observed on the Canadian Occupational Performance Measure (COPM)-Performance Scale, Global Life Participation Scale and Global Life Participation Satisfaction Scale at 1-week postintervention follow-up, compared with control. At 12-week follow-up, large and very large intervention effects were observed on the COPM-Performance Scale and COPM-Satisfaction Scale, respectively. Conclusion: It is feasible to enrol and follow patients on haemodialysis in a randomised controlled trial of an energy management intervention. As the intervention was associated with improved life participation on some measures, a larger trial is justified.
MeSH term(s)	Aged ; Canada ; Fatigue/prevention & control ; Fatigue/therapy ; Female ; Humans ; Male ; Middle Aged ; Pilot Projects ; Renal Dialysis
Language	English
Publishing date	2022-02-10
Publishing country	England
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2021-051475
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Article: A Proof-of-Concept Investigation of an Energy Management Education Program to Improve Fatigue and Life Participation in Adults on Chronic Dialysis.

Farragher, Janine F / Polatajko, Helene J / McEwen, Sara / Jassal, Sarbjit V

Canadian journal of kidney health and disease

2020 Volume 7, Page(s) 2054358120916297

Abstract: Background: Fatigue and its negative impact on life participation are top research priorities of people on chronic dialysis therapy. Energy management education (EME) is a fatigue management approach that teaches people to use practical strategies (eg, ... ...

Abstract	Background: Fatigue and its negative impact on life participation are top research priorities of people on chronic dialysis therapy. Energy management education (EME) is a fatigue management approach that teaches people to use practical strategies (eg, prioritizing, using efficient body postures, organizing home environments) to manage their energy expenditure during everyday life. Objective: The aim of this study is to explore whether EME is associated with improvements in fatigue and life participation in adults on chronic dialysis. Design: Five single-case interrupted time-series AB studies, and follow-up qualitative interviews. Setting: The hemodialysis and peritoneal dialysis units at an academic hospital in Toronto, Canada. Patients: In total, 5 patients on chronic dialysis therapy were purposively selected to represent diversity in age, gender, and modality. Measurements: Brief questionnaires assessing fatigue and life participation were administered weekly during the baseline and intervention periods. Additional validated questionnaires (the Fatigue Impact Scale, 36-Item Short-Form Health Survey [SF-36] Vitality Scale, and Canadian Occupational Performance Measure) were also administered at baseline and post-intervention. Methods: All participants underwent "The PEP Program," a personalized, web-supported EME program designed to meet the needs of people on dialysis. During the program, participants complete 2 brief web modules about energy management, and then use energy management principles and a problem-solving framework to work on 3 life participation goals during sessions with a trained program administrator. Data were analyzed using visual analysis and the Tau- Results: Three of 5 participants displayed a consistently positive response to the Personal Energy Planning (PEP) program across multiple measures of fatigue and life participation. Tau- Limitations: An exploratory, proof-of-concept study that used a small set of participants and lacked an active control comparison. Conclusions: The PEP program might have potential for improving fatigue-related outcomes in people on chronic dialysis. Larger, controlled studies of the program are warranted.
Language	English
Publishing date	2020-04-16
Publishing country	England
Document type	Journal Article
ZDB-ID	2765462-X
ISSN	2054-3581
ISSN	2054-3581
DOI	10.1177/2054358120916297
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Article: Have We Just Scratched the Surface? A Narrative Review of Uremic Pruritus in 2020.

Martin, Claire E / Clotet-Freixas, Sergi / Farragher, Janine F / Hundemer, Gregory L

Canadian journal of kidney health and disease

2020 Volume 7, Page(s) 2054358120954024

Abstract: Purpose of review: Uremic pruritus is a highly prevalent and debilitating symptom in patients with chronic kidney disease (CKD) and end-stage kidney disease (ESKD). The purpose of this review is to examine current evidence on the mechanisms and ... ...

Abstract	Purpose of review: Uremic pruritus is a highly prevalent and debilitating symptom in patients with chronic kidney disease (CKD) and end-stage kidney disease (ESKD). The purpose of this review is to examine current evidence on the mechanisms and treatments of pruritus in CKD and highlight promising areas for future research. Sources of information: Published literature, including randomized controlled trials, cohort studies, case reports, and review articles, was searched for evidence pertaining to the pathophysiology and treatment of uremic pruritus. Methods: A comprehensive narrative review was conducted to explore the molecular mechanisms underlying uremic pruritus, as well as the evidence (or lack thereof) supporting pharmacological and nonpharmacological treatments for uremic pruritus. The potential role of patient sex in the pathophysiology and management of uremic pruritus is also discussed. Key findings: The pathophysiology of uremic pruritus involves a complex interplay of uremic toxins, systemic inflammation, mast cell activation, and imbalance of opioid receptors. Classic treatment strategies for uremic pruritus include optimization of dialysis parameters, amelioration of CKD-related mineral and bone disease, topical emollients and analgesics, antihistamines, the anticonvulsant medications gabapentin and pregabalin, and ultraviolet light B (UV-B) phototherapy. Strong data to support many of these classical treatments for uremic pruritus are limited. Newly evolving treatment approaches for uremic pruritus include opioid receptor modulators, neurokinin-1 inhibitors, and cannabinoids. Further studies regarding their efficacy, pharmacodynamics, and safety in the CKD and ESKD population are needed before these agents are accepted into widespread use. Additional nonpharmacological strategies aimed at treating uremic pruritus include psychotherapy, acupuncture, omega-3 fatty acids, and exercise. Finally, sex differences may exist regarding uremic pruritus, but studies directly addressing sex-specific mechanisms of uremic pruritus remain absent. Limitations: High-quality evidence in the management of uremic pruritus remains lacking. Most recommendations are based on expert opinion or studies involving small numbers of patients. In addition, our understanding of the pathophysiological mechanisms behind uremic pruritus is incomplete and continues to evolve over time. Implications: Uremic pruritus is a common symptom which reduces quality of life in CKD and ESKD. The identification of novel targeted treatment approaches may ease the burden of uremic pruritus in the future.
Language	English
Publishing date	2020-10-15
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2765462-X
ISSN	2054-3581
ISSN	2054-3581
DOI	10.1177/2054358120954024
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Article ; Online: The Relationship Between Fatigue and Depression in Adults With End-Stage Renal Disease on Chronic In-Hospital Hemodialysis: A Scoping Review.

Farragher, Janine F / Polatajko, Helene J / Jassal, Sarbjit V

Journal of pain and symptom management

2017 Volume 53, Issue 4, Page(s) 783–803.e1

Abstract: Context: Fatigue and depression are two prominent concerns in patients on in-hospital hemodialysis (IHHD) that have recently been identified as research priorities in the nephrology community. Although they are often reported to co-exist, no synthesis ... ...

Abstract	Context: Fatigue and depression are two prominent concerns in patients on in-hospital hemodialysis (IHHD) that have recently been identified as research priorities in the nephrology community. Although they are often reported to co-exist, no synthesis of the literature examining their relationship is available. Objective: The aim of this study was to characterize the literature on the relationship between fatigue and depression in IHHD patients. Methods: A scoping review as described by Arksey and O'Malley was conducted. Seven electronic databases were searched for relevant literature using search terms pertaining to fatigue, depression, and IHHD. Key journals and article reference lists were also hand searched to identify relevant literature. Articles were examined for relevance, and data were extracted to describe the nature and scope of the literature and to characterize the relationship between fatigue and depression. Findings were grouped thematically and summarized descriptively. Results and conclusions: Current literature on this topic is dominated by cross-sectional studies, which support the existence of an association between fatigue and depression in IHHD patients in various practice settings and subpopulations. Numerous multivariable analyses have been performed which suggest the association remains after adjustment for confounding factors. However, there is generally a dearth of longitudinal or interventional literature to clarify the nature of the relationship over time. Current literature is sufficient to justify routine screening for depression in IHHD patients who present with fatigue. Future research should aim to clarify the nature of the relationship over time in IHHD patients, explore mediators and modifiers of the relationship, and investigate the effects of interventions.
MeSH term(s)	Depression/complications ; Fatigue/complications ; Hospitalization ; Humans ; Kidney Failure, Chronic/psychology ; Kidney Failure, Chronic/therapy ; Renal Dialysis/psychology
Language	English
Publishing date	2017
Publishing country	United States
Document type	Journal Article ; Review ; Research Support, Non-U.S. Gov't
ZDB-ID	639142-4
ISSN	1873-6513 ; 0885-3924
ISSN (online)	1873-6513
ISSN	0885-3924
DOI	10.1016/j.jpainsymman.2016.10.365
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Article ; Online: Longitudinal Changes in the Use of PD Assistance for Patients Maintained on Peritoneal Dialysis.

Fonseca-Correa, Jorge I / Farragher, Janine F / Tomlinson, George / Oliver, Matthew J / Jain, Arsh / Flanagan, Susan / Koyle, Kathleen / Jassal, Sarbjit V

Kidney360

2021 Volume 2, Issue 3, Page(s) 469–476

Abstract: Background: Home dialysis therapies, such as peritoneal dialysis (PD), offer flexibility and improved well-being, particularly for older individuals. However, a substantial proportion require assistance with personal care and health care-related tasks. ... ...

Abstract	Background: Home dialysis therapies, such as peritoneal dialysis (PD), offer flexibility and improved well-being, particularly for older individuals. However, a substantial proportion require assistance with personal care and health care-related tasks. We hypothesized that patients and families would require less PD assistance as they became more familiar with PD-related tasks. The study objective was to assess whether the nature of, and need for, PD assistance decreased over time. Methods: Using a multicentered, prospective, observational study design, patients aged ≥50 years were recruited from those starting PD. Patients underwent formal evaluation using validated components of a Comprehensive Geriatric Assessment at baseline, and they were followed monthly and administered a questionnaire about the need for assistance with PD-related tasks. Results: A total of 111 patients (age 69±10 years, 68% men, and 56% diabetic) were followed for a total of 609 patient-months. Of those who needed help, 40% had help from a family member, and 33% were helped by nurses. Both the quantity and nature of help received by patients remained generally stable throughout follow-up and did not vary according to age, frailty, functional dependence, or cognitive impairment ( Conclusions: Older patients initiating PD in the outpatient setting have a high need for assistance with PD-related tasks, which seems to persist over the initial 6-month period.
MeSH term(s)	Aged ; Female ; Frailty/etiology ; Geriatric Assessment ; Hemodialysis, Home ; Humans ; Male ; Middle Aged ; Peritoneal Dialysis/adverse effects ; Prospective Studies
Language	English
Publishing date	2021-01-12
Publishing country	United States
Document type	Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
ISSN	2641-7650
ISSN (online)	2641-7650
DOI	10.34067/KID.0006622020
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Article ; Online: Training clinicians in a problem-solving fatigue programme for patients receiving maintenance haemodialysis.

Farragher, Janine F / Davis, Jane A / Polatajko, Helene J / Thomas, Chandra / Ravani, Pietro / Manns, Braden / Elliott, Meghan J / Hemmelgarn, Brenda R

Journal of renal care

2021 Volume 48, Issue 4, Page(s) 272–282

Abstract: Background: Personal Energy Planning is a problem-solving based programme that guides people receiving maintenance haemodialysis treatment to use energy management strategies to address life participation challenges. The feasibility of training dialysis ...

Abstract	Background: Personal Energy Planning is a problem-solving based programme that guides people receiving maintenance haemodialysis treatment to use energy management strategies to address life participation challenges. The feasibility of training dialysis clinicians to become Personal Energy Planning coaches (i.e., programme administrators) is currently unknown. Objectives: To explore the feasibility of training dialysis clinicians to administer the Personal Energy Planning programme. Design: Feasibility study involving an adherence evaluation of two trained dialysis clinician coaches' problem-solving facilitation skills, and one qualitative interview with each coach. Participants: Two Personal Energy Planning coaches with nursing backgrounds who administered the programme to 10 patients receiving maintenance haemodialysis treatment over a total of 34 sessions. Approach: Audio recordings of one session per treatment recipient (n = 10) were evaluated using an established treatment adherence checklist. The proportion of treatment sessions where the item was observed by two adherence raters was calculated. In addition, coaches were interviewed about their experiences learning and administering the programme; interviews were analysed using inductive thematic analysis. Findings: Some core facilitation skills (e.g., patient-centred goal setting and analysis of performance breakdowns) were consistently used; however, other facilitation skills (e.g., guided discovery and global problem-solving strategy) were not regularly implemented. The coaches discussed challenges (e.g., supporting patient problem-solving and fluctuating patient health) with administering the intervention. Certain training resources (e.g., coaching handbook and expert consultation) were identified as valuable to their learning. Conclusions: With modifications to training materials, it might be feasible to train dialysis clinicians to administer Personal Energy Planning with people receiving maintenance haemodialysis treatment.
MeSH term(s)	Humans ; Renal Dialysis ; Fatigue ; Cognitive Behavioral Therapy
Language	English
Publishing date	2021-09-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	2375362-6
ISSN	1755-6686 ; 1755-6678 ; 1019-083X
ISSN (online)	1755-6686
ISSN	1755-6678 ; 1019-083X
DOI	10.1111/jorc.12398
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