Caregiver Burden, Anxiety, Depression, and Sleep Quality Differences in Caregivers of Hemodialysis Patients Compared With Renal Transplant Patients

BACKGROUND

We compared the caregivers of hemodialysis (HD) patients and caregivers of patients with renal transplantation (Tx) in terms of anxiety, depression, sleep quality, and caregiver burden. We believe that caregivers of HD have more difficult conditions than caregivers of the patients with Tx.

METHODS

This cross-sectional study analyzed the psychological status of caregivers of Tx patients compared with those of HD patients with using the Hospital Anxiety and Depression Scale, Zarit Burden Interview, and Pittsburg Sleep Quality Indexes. We recruited 133 caregivers-65 caregivers in the Tx group and 68 in the HD group.

RESULTS

Mean age was 43.1 ± 8.5 years. The age, sex, income level, and education level were similar between the 2 groups. Caregivers in the HD group had significantly higher rates of anxiety and depression compared with the Tx group (P = .007 and P < .001, respectively). Good sleep quality rates for caregivers in the Tx group and caregivers in the HD group were 92% (n = 60) and 63% (n = 43), respectively. Poor sleep quality was significantly higher in caregivers in the HD group compared with caregivers in the Tx group (P < .001). Caregiver burden scores were significantly higher for caregivers in the HD group compared with caregivers in the Tx group (P < .001).

CONCLUSIONS

We suggest that Tx is the more appropriate renal replacement therapy for caregivers who undertake the care of patients with end-stage renal disease and chronic kidney disease.

Serum brain-derived neurotrophic factor differences between the luteal and follicular phases in premenstrual dysphoric disorder

OBJECTIVE

We hypothesized that comparison of the serum brain-derived neurotrophic factor (BDNF) levels between women with premenstrual dysphoric disorder (PMDD) and women without PMDD in the luteal and follicular phases of their menstrual cycles would reflect the altered neuromodulator responses that compensate the underlying pathogenesis in PMDD.

METHOD

Twenty-nine participants without PMDD and 20 with PMDD were enrolled in the study. The serum BDNF, estrogen and progesterone levels were assessed at the follicular and luteal phases in their two consecutive menstrual cycles.

RESULTS

Participants with PMDD had significantly higher luteal serum BDNF levels than the control subjects. The serum BDNF levels were significantly higher in the luteal phase than in the follicular phase in women with PMDD. The difference in the serum BDNF levels between the luteal and follicular phases were significantly higher in the PMDD patients than in the control.

CONCLUSIONS

The higher serum BDNF levels in the luteal phase in the PMDD patients may reflect compensatory process that results in subsequent improvement of the PMDD-associated depressive symptoms in the follicular phase. The higher difference in the serum BDNF levels between the phases in PMDD patients may reflect an altered neuromodulator response.

Third Year Medical School Students' Experiences of Revealing Patients' Stories through Role Playing

OBJECTIVE

Studying medicine is hard and it takes longer time compared to other majors. In addition, medical students find medical education boring. It is now necessary to turn medical education into an enjoyable and interesting way. The aim of this study is to evaluate the impact of an educational program related to how to learn taking medical history and how an effective patient-doctor interview should be. The program is structured in various scenarios, on the students learning skills, by the "role playing" method.

MATERIALS AND METHODS

A scenario prepared by the lecturer was employed in this study. While one of the students acted in a doctor role, the other one played in the role of patient's relative. The lecturer always played in the role of patient. After performing the role playing, students' written and oral feedbacks were gathered. Data were analysed by using SPSS 20.0 program.

RESULTS

A total of 470 feedbacks (51.3% were given by the female students) were taken from the students. Thirty-three volunteer students, nineteen of them were male, took part in the role playing. In the patient-doctor interview, the field that students were best were greeting the patients and dealing only with patients during the examination. The mean scores were 3.81±0.95 and 3.79±0.94 respectively. The ability to "summarize" and to "address the patient with his/her name" had the lowest scores; the mean scores of the students in these areas were 2.94±1.11 and 2.70±1.31, respectively.

CONCLUSION

Medical education is a long and tough process. Therefore, it should be interesting, attention getting and cheerful. Role playing can be effective in meeting that need.

Peer teaching experience of the first year medical students from Turkey

OBJECTIVE

To document peer teaching activity performed by first-year medical students and their views on the teaching activity.

STUDY DESIGN

Survey.

PLACE AND DURATION OF STUDY

Medical Education Department, Ataturk University, Erzurum, Turkey, in the 2012 - 2013 academic year.

METHODOLOGY

Volunteer students were selected for peer teaching model by an academician from the Medical Education Department. Students were taught subjects selected from classes such as biochemistry and microbiology in the same way as the academicians do. Following each class activity, the teaching student was assessed by the other students on a 5-point rating scale. Written and verbal feedback was also obtained from both teaching students and participated students. Verbal feedbacks were noted by a faculty member and similar opinions were categorized. Data were analyzed by SPSS version 20 statistical program.

RESULTS

Eleven students took part in the program. Feedback was received from students 171 times. The mean number of students participated was 24.4 ± 14.3 in each program. Statistical analysis revealed that mean value for teaching materials, peer instructors and teaching environment were 4.62 ± 0.49, 4.63 ± 0.47 and 3.88 ± 1. 27 respectively.

CONCLUSION

Peer teaching method is a pretty good way of teaching for medical students. It is a practicable technique that can be used in medical training. Taking part in this program as a lecturer, student increased students' self-confidence in the learning and teaching activities. Quite positive feedbacks were received.

Self-assessment through videotaping compared with peer and trainer feedback

OBJECTIVE

To assess and compare three different types of feedback for presentation skills, self, peer and trainer feedback.

STUDY DESIGN

Cross-sectional study.

PLACE AND DURATION OF STUDY

Faculty of Medicine at Atatürk University, Erzurum, Turkey, from March 2012 to December 2012.

METHODOLOGY

Participants were faculty members and instructor nurses. Each participant gave a 10-minute presentation, which was rated by peers, course trainers and the presenter himself/herself using a thirteen-item questionnaire (designed as a 5-point Likert scale). Peers and trainers conducted the assessment during the presentation while the self-assessment was done later by watching a video recording of the presentation. Comparison of the points between the groups was made using the two-way ANOVA. Pearson correlation analysis was conducted to evaluate the relationship between the mean scores of self-assessment, peer and trainer assessment.

RESULTS

Ten faculty members, 27 instructor nurses and 4 trainers participated in the study. A total of 775 feedback reports were collected for 37 participants. There was no significant difference between the feedback scores of the evaluators as well as the occupation groups (p > 0.05). There was a strong positive and statistically significant correlation between trainer and peer (r = 0.73, p < 0.001).

CONCLUSION

Consequently, there were no differences in the evaluations of presentation skills between different stakeholders. Trainers should use the video recording method to self-evaluate their presentation skills, and they should invite their peers from time to time to improve their own personal development by using peer review methods.

Evidence based medicine: teaching, learning and practice: results of a cross-sectional study from Turkey

OBJECTIVE

To assess the level of understanding related to the significance of evidence-based medicine among physicians.

METHODS

The cross-sectional study was conducted between March and October 2012 using an online questionnaire that was sent out to physicians and academics working as faculty at training hospitals across Turkey. The questionnaire consisted of questions about the knowledge, attitude and behaviour towards evidence-based medicine. Seven of the questions pertained to the learning of evidence-based medicine, six were about teaching evidence-based medicine, and six were about its practice. SPSS 20 was used for statistical analyses.

RESULTS

The questionnaire was returned duly filled by 79 physicians. Of them, 41 (51.9%) were males; and 57 (72.2%) were part of the faculty. Only 1(1.2%) participant had attended a course about evidence-based medicine during undergraduate education, while 19 (24.05)had attended one after graduation. Besides, 26 (32.9%) academics were teaching some concepts of evidence-based medicine, and 21 (26.6%) were giving some information about clinical guidelines.

CONCLUSION

The study found that levels of learning and teaching of evidence-based medicine among physicians were inadequate. They should be emphasised at both pre- and post-graduate tiers.

What do trainers think about trainer training courses?

OBJECTIVE

To evaluate the effectiveness of the training-of-trainer courses given to medical school faculty members, and to ensure the standardisation of training..

METHODS

The study comprised faculty members attending seven training-of-trainer courses held at the Ataturk University, Turkey, from November 2010 to May 2011. Tests were administered to the participants evaluating their level of knowledge on course content before and after the five-day course, which covered topics including concepts of teaching/learning, curriculum development, assessment and evaluation, training methods, and training skills. Oral and written feedbacks were obtained from all participants on the last day of each course. Volunteers from among the participants evaluated the impact of training through a questionnaire after at least two months. SPSS 20 was used for statistical analysis.

RESULTS

A total of 136 faculty members participated in the 7 training-of-trainer courses. The mean scores for the pretest and post-test were 6.6 +/- 2.2 vs. 13.9 +/- 3.7, (p < 0.001). Questions with highest percentage of correct answers in the pre-test were those about learning style 78 (70.9%) and the one about presentation skills (66.4%).

CONCLUSION

A structured training-of-trainer course is effective in increasing faculty members' level of knowledge about training. Such programmes are necessary for faculty members who work in the academic field without receiving formal training in teaching as it is the case with medical education in several countries.

Psychological and emotional status, and caregiver burden in caregivers of patients with peritoneal dialysis compared with caregivers of patients with renal transplantation

OBJECTIVES

We sought to examine the relationship between caregivers of continuous ambulatory peritoneal dialysis (CAPD) and of renal transplant (Tx) patients with regard to sleep quality, anxiety, depression, and overall burden.

METHODS

This cross-sectional study of prevalent caregivers of CAPD patients and of renal Tx patients used a multidimensional instrument to assess the association of sleep quality, depression and anxiety symptoms, as well as burden using a Zarit Burden Interview. Among the 113 caregivers who participated in this study, 53 were in the Tx and 60 in the CAPD group.

RESULTS

The overall mean age was 40.7 ± 13.6 years. The proportions of age, gender, income, and education level were similar between the 2 groups. Caregivers of peritoneal dialysis patients had significantly higher rates of anxiety and depression compared with the Tx group (P = .039 and P = .003, respectively). Good sleep quality rates for caregivers of Tx versus CAPD patients were 88.7% (n = 47) and 61.7% (n = 37), respectively. Poor sleep quality was significantly higher among caregivers of CAPD compared with those for Tx patients (P = .001). Caregiver burden scores were significantly higher in caregivers of CAPD patients compared with Tx patients (P < .001). Upon logistic regression analysis, caregivers of CAPD patients were 2.61 times (95% confidence interval, 1.03-6.59; P = .043) higher than the caregiver burden risk than those for Tx patients.

CONCLUSIONS

This study indirectly indicated that renal Tx improves the life quality and decreases psychiatric symptoms among caregivers of ESRD patients.

Perceived self-efficacy and academic performance of medical students at Ataturk University, Turkey

OBJECTIVE

To determine the association of perceived self-efficacy with academic performance of pre-clinical medical students.

STUDY DESIGN

A cross-sectional analytical study.

PLACE AND DURATION OF STUDY

Medical Education Department, Ataturk University, Turkey, from March to May 2012.

METHODOLOGY

Participating students were members of the first to third year medical students class considered to be preclinical years at Ataturk University. A validated and reliable questionnaire consisted of 10 questions applied to assess the general self-efficacy of the medical students in pre-clinical years and evaluate whether their self-efficacy has relation to their academic performance. Responses and studied variables were compared using ANOVA and Pearson correlation test as applicable.

RESULTS

The mean scores of three consecutive examinations were compared with self-efficacy mean scores of three classes. A validated and reliable questionnaire was used for assessment of self-efficacy. There was no correlation found in between mean examination scores and self-efficacy mean scores in first year (r = -0.11, p = 0.276), second year (r = 0.20, p = 0.180), and third year (r = -0.040, p = 0.749). However, comparison of mean scores between male and female demonstrated significant difference (p = 0.001) and males dominant in self-efficacy scores.

CONCLUSION

The results illustrate in pre-clinical years at medical schools the general self-efficacy does not play any role in their performance.