Predictors of Care Gaps in Home Dialysis: The Home Dialysis Virtual Ward Study

2019 ◽  
Vol 50 (5) ◽  
pp. 392-400
Author(s):  
Annie-Claire Nadeau-Fredette ◽  
Christopher T. Chan ◽  
Joanne M. Bargman ◽  
Michael A. Copland ◽  
S. Neil Finkle ◽  
...  
Keyword(s):  
Hospital Discharge ◽  
Scale Score ◽  
Rating Scale ◽  
Assessment Tool ◽  
Medical Procedure ◽  
Dialysis Patients ◽  
Home Dialysis ◽  
Increased Risk ◽  
Dialysis Vintage ◽  
Care Gaps

Background: Home dialysis patients may be at an increased risk of adverse events after transitional states. The home dialysis virtual ward (HDVW) trial was conducted in Canadian dialysis centers and aimed to evaluate potential care gaps and patient satisfaction during the HDVW. Methods: The HDVW was a multicenter single-arm trial including peritoneal dialysis and home hemodialysis patients after 4 different events (hospital discharge, medical procedure, antibiotics, completion of training). Telephone-led interviews using a standardized assessment tool were performed over a 2-week period to assess a patient’s care and adjust treatment as required. Upon completion, patients were surveyed to evaluate their perceived impact on domains of care using a rating scale; 1 not satisfied to 10 completely satisfied. Results: The HDVW trial included 193 patients with a median number of potential care gaps/interventions of 1 (0–2) per patient. Patients admitted to the HDVW after hospital discharge were at a higher risk of potential gaps in care (OR 2.16, 95% CI 1.29–3.62), while longer dialysis vintage was ­associated with a lower number of gaps/interventions (OR 0.97 per year, 95% CI 0.95–0.98). A total of 105/193 (54%) patients completed satisfaction surveys. Patients were highly satisfied with the HDVW (median rating scale score 8, IQR 2) and felt it had a positive impact (rating scale score ≥7) on their overall health, understanding of treatment and access to a nephrologist. Conclusion: The HDVW was effective at identifying several potential care gaps, and patients were satisfied across several domains of care. This intervention may be valuable in supporting home dialysis patients during care transitions.

Depression in Geriatric Inpatients: Correlations with Nutritional State and Cognitive Functions

2016 ◽  
Vol 33 (S1) ◽  
pp. S472-S472
Author(s):  
I. Bonfitto ◽  
G. Moniello ◽  
L. Ariano ◽  
M. Pascucci ◽  
M.D. Zanasi ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Depressive Symptoms ◽  
Nutritional Status ◽  
Rating Scale ◽  
Assessment Tool ◽  
Mini Nutritional Assessment ◽  
Average Score ◽  
Depressed Patients ◽  
Increased Risk ◽  
Geriatric Inpatients

BackgroundAlthough the prevalence of malnutrition is relatively low among elderly people, the risk increases significantly among inpatients and even more in those with mental deterioration.AimsTo evaluate the possible association between the severity of depressive symptoms, the nutritional status and the cognitive decline in a sample of geriatric inpatients.MethodsFifty-one geriatric inpatients completed the following tests:– Hamilton Depression Rating Scale (HAM-D), to assess the severity of depressive symptoms;– Mini Nutritional Assessment (MNA), as a nutrition screening and assessment tool;– Mini Mental State Examination (MMSE), to assess the cognitive impairment.ResultsThere is a negative proportional relationship between HAM-D and MMSE scores (P = 0.001) and between HAM-D and MNA scores (P = 0.023). Depressed patients found to have a greater cognitive impairment and a worse nutritional status. Considering a HAM-D cut-off point of 14, distinguishing mild than moderate depression, it shows a significant correlation with the MNA scores (P = 0.008). Patients with HAM-D scores ≥ 14 have an average MNA score of 19.8, while patients with HAM-D scores < 14 have an MNA average score of 23.6. Euthymic or mildly depressed patients are not at risk of malnutrition, while those with moderate or severe depression have an increased risk of malnutrition.ConclusionsOur study shows significant correlations between the severity of depressive symptoms and the risk of malnutrition or cognitive impairment. A mild depression state does not seem to be associated with an increased risk of malnutrition.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals White Matter Hyperintensity, Immediate Antihypertensive Treatment, and Functional Outcome After Acute Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (5) ◽  
pp. 1608-1612
Author(s):  
Shiguang Zhu ◽  
Sifan Qian ◽  
Tan Xu ◽  
Hao Peng ◽  
Ruiguo Dong ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
White Matter ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Hospital Discharge ◽  
Scale Score ◽  
Antihypertensive Treatment ◽  
White Matter Hyperintensity ◽  
Risk Of Death ◽  
Increased Risk

Background and Purpose— It remains unknown that whether white matter hyperintensity (WMH) severity influences the effect of antihypertensive treatment in acute ischemic stroke. We aimed to investigate the effects of early antihypertensive treatment on death and disability among patients with acute ischemic stroke according to WMH severities. Methods— This study was a secondary analysis of the data from CATIS (China Antihypertensive Trial in Acute Ischemic Stroke). Severity of WMH was evaluated using Fazekas rating scale score among 303 participants with available magnetic resonance imaging data and was categorized into none-mild WMH (Fazekas score 0–2) and moderate-severe WMH (Fazekas score 3–6). Functional outcome was death or major disability (modified Rankin Scale score of ≥3) at 14 days or hospital discharge and within 3 months. Results— WMH severity was significantly associated with an increased risk of death or major disability. Each 1 score increase in Fazekas score was associated with an adjusted odds ratio (95% CI) of 1.25 (1.03–1.51) for 14 days or hospital discharge and 1.39 (1.12–1.72) for 3-month functional outcome. There were no significant interactions between antihypertensive treatment and WMH severity (both P >0.1) on functional outcome at 14 days or hospital discharge and within 3 months. The neutral effects of immediate antihypertensive treatment were observed both in patients with moderate-severe WMH and none-mild WMH. Conclusions— Participants with higher WMH burden had increased risk of death or major disability after acute ischemic stroke. Early antihypertensive treatment had a neutral effect on clinical outcomes among acute ischemic stroke patients with a variety of WMH severities. Registration— URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01840072.

scholarly journals Quality and adequacy of sleep among dialysis patients

Biomedicine ◽  
2021 ◽  
Vol 40 (4) ◽  
pp. 543-546
Author(s):  
V. Daniel ◽  
S. Meetha ◽  
M. Jayakumar ◽  
Manikantan Sekar
Keyword(s):  
Sleep Quality ◽  
Sleep Disturbances ◽  
Cross Sectional Study ◽  
Maintenance Hemodialysis ◽  
Dialysis Patients ◽  
Cross Sectional ◽  
Increased Risk ◽  
Dialysis Vintage ◽  
Psychosocial Disability

Introduction and Aim: Chronic Kidney Disease (CKD) is a debilitating illness characterized by physical, mental, socioeconomic and psychosocial disability. Being a literature has documented evidences of increased risk of depression and sleep disturbances among these patients, which indirectly affect the quality of life. The present study was carried out to evaluate the burden of depression and sleep disturbances among dialysis patients.  Methods: This cross-sectional study was carried out among 160 patients on maintenance dialysis. A structured proforma was used to document the particulars regarding CKD care. Sleep Quality, Depression status of patients were assessed using Pittsburgh Sleep Quality Index (PSQI), Beck’s Depression Inventory (BDI) and Kt/V formula respectively.   Results: Hemodialysis inadequacy was prevalent among 79.4% of the participants. About 51.3% were suffering from moderate depression. Severe sleep disturbance was seen in 88.7% of the participants. The present study observed a statistically significant association between dialysis vintage and depression (p<0.05). Similar association was seen between frequency of dialysis and sleep disturbances (p<0.05).  Conclusion: The prevalence of sleep disturbances and depression was higher among the maintenance hemodialysis patients receiving dialysis for more than 2 years and also with a frequency of twice a week. It may be inferred that by increasingthe frequency and the dosage of dialysis in patients the quality of sleep can be adequately improved and thereby it may lower the depressive state in patients.

scholarly journals Are adverse events in newly trained home dialysis patients related to learning styles? A single-centre retrospective study from Toronto, Canada

BMJ Open ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. e033315 ◽  
Author(s):  
Bourne Lewis Auguste ◽  
Michael Girsberger ◽  
Claire Kennedy ◽  
Thatsaphan Srithongkul ◽  
Margaret McGrath-Chong ◽  
...  
Keyword(s):  
Adverse Event ◽  
Adverse Events ◽  
Learning Styles ◽  
Visual Learning ◽  
Secondary Outcome ◽  
Care Hospital ◽  
Dialysis Patients ◽  
Home Dialysis ◽  
Dialysis Vintage ◽  
Visual Learners

ObjectivesHome haemodialysis (HD) and peritoneal dialysis (PD) have seen growth in utilisation around the globe over the last few years. However, home dialysis, with its attendant technical complexity and risk of adverse events continues to pose challenges for wider adoption. We examined whether differences in patients’ learning styles are associated with differing risk of adverse events in both home HD and PD patients.DesignRetrospective cohort study.SettingTertiary care hospital in Toronto, Ontario, Canada.ParticipantsOne hundred and eighteen prevalent adult (≥18 years) home dialysis patients (40 PD and 78 home HD) were enrolled. Patients on home dialysis for less than 6 months or receiving home nursing assistance for dialysis were excluded from the study.InterventionsEnrolled patients completed (VARK) Visual, Aural, Reading-writing and Kinesthetic questionnaires to determine learning styles.Primary and secondary outcome measuresHome HD and PD adverse events were identified within 6 months of completing home dialysis training. Event rates were then stratified and compared according to learning styles.ResultsThirty patients had a total of 53 adverse events. We used logistic regression analysis to determine unadjusted and adjusted ORs for a single adverse event. Non-visual learners were 4.35 times more likely to have an adverse event (p=0.001). After adjusting for age, gender, dialysis modality, training duration, dialysis vintage, prior renal replacement therapy, visual impairment, education and literacy, an adverse event was still four times more likely among non-visual learners compared to visual learners (p=0.008). A subgroup analysis of home HD patients showed adverse events were more likely among non-visual learners (OR 11.1; p=0.003), whereas PD patients showed a trend for more adverse events in non-visual learners (OR: 1.60; p=0.694).ConclusionsDifferent learning styles in home dialysis patients exist. Visual learning styles are associated with fewer adverse events in home dialysis patients within the first 6 months of completing training. Individualisation of home dialysis training by learning style is warranted.

scholarly journals The COVID-19 Epidemic: Management and Outcomes of Hemodialysis and Peritoneal Dialysis Patients in Stockholm, Sweden

2021 ◽  
Vol 46 (2) ◽  
pp. 250-256
Author(s):  
Jessica Smolander ◽  
Annette Bruchfeld
Keyword(s):  
Peritoneal Dialysis ◽  
High Risk ◽  
Kidney Injury ◽  
Mitigation Strategies ◽  
High Morbidity ◽  
Dialysis Patients ◽  
Increased Risk ◽  
Dialysis Vintage ◽  
Long Term Prognosis

<b><i>Background:</i></b> The COVID-19 outbreak has been associated with a high morbidity, mortality, and a risk of long-term sequelae, and patients with severe COVID-19 are at increased risk of acute kidney injury. CKD patients are at high risk of being exposed to COVID-19 and suffer complications and poor outcome. In Sweden, mitigation strategies did not include lockdown. During March–April of 2020, wide-spread infection occurred in Stockholm. <b><i>Methods:</i></b> Management and outcomes in forty hemodialysis (HD) patients and 4 peritoneal dialysis (PD) patients, with symptomatic COVID-19 in greater Stockholm during March and April of 2020 are reported. <b><i>Results:</i></b> Twenty-four HD patients (60%) required medical care and hospitalization, whereas 16 patients (40%) were treated at home. Nine patients died (mortality rate of 22.5%), of whom 8 were men. The median age in non-survivors (78 years) was significantly higher than in survivors (<i>p</i> = 0.003). The median time in dialysis (11.5 years) was also significantly longer in non-survivors (<i>p</i> = 0.01). C-reactive protein (CRP) at diagnosis in 7 of non-survivors (median 213 mg/L, range 86–329 mg/L) was significantly higher than the CRP in 25 survivors (median 87 mg/L, range 1–328 mg/L) (<i>p</i> = 0.0003). Maximum CRP also indicated poorer outcome among hospitalized patients (<i>p</i> = 0.0004). The gender imbalance was striking with only men dying apart from 1 elderly woman. Only 4 PD patients were hospitalized with symptomatic COVID-19. One patient died, 2 were discharged, and 1 was treated at the intensive care unit and survived. <b><i>Conclusion:</i></b> HD patients &#x3e;70 years were reported with longer dialysis vintage, higher CRP, and males were at an increased risk of dying from COVID-19, whereas those &#x3c;70 years seemed to have a milder disease. Mitigation strategies to reduce rates of infection in high-risk populations remain essential. Follow-up focusing on long-term prognosis for extrapulmonary manifestations is likely to be important also in dialysis patients.

Palliative treatment of brain metastases with gamma knife

2001 ◽  
Vol 58 (7) ◽  
pp. 413-418 ◽  
Author(s):  
Jean Siegfried ◽  
G. Wellis ◽  
S. Scheib ◽  
D. Haller ◽  
A. M. Landolt ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Scale Score ◽  
Gamma Knife ◽  
Palliative Treatment ◽  
Rating Scale ◽  
Psychische Belastung ◽  
Performance Rating ◽  
Wird Eine

Das Gamma Knife ist ein stereotaktisch-radiochirurgisches Gerät, das erlaubt, radiologisch scharf begrenzte Hirntumore (oder arteriovenöse Missbildungen) mit einem Durchmesser von maximal 3,5 cm und einem Volumen von höchstens 25 cm3 zu behandeln. Diese Methode ist eine echte Alternative zur klassischen Behandlung von Hirnmetastasen mit operativer Entfernung und/oder Ganzhirnbestrahlung. Die Vorteile dieser Technik sind klar: die Methode ist nicht invasiv, die Behandlung benötigt nur eine Sitzung mit einer kurzen Hospitalisation von höchstens zwei bis drei Tagen, die physische und psychische Belastung ist gering, der Kopf wird weder rasiert noch verliert der Patient durch die Behandlung seine Haare; für eine befriedigende Überlebenszeit wird eine gute Lebensqualität erreicht und im Kostenvergleich mit alternativen Methoden (Operation und/oder anschließender Ganzhirnbestrahlung) wirtschaftlich günstiger. Von September 1994 bis Dezember 2000 wurden am Gamma Knife Zentrum in Zürich 140 an Hirnmetastasen leidende Patienten mit dieser Methode behandelt. Mit einer Überlebenszeit von durchschnittlich 263 Tagen und einem Maximum von drei Jahren entsprechen unsere Resultate denjenigen der Literatur mit weltweit über 30000 behandelten Patienten. Günstige Prognosen sind ein Karnofsky Performance Rating Scale Score zwischen 70 und 100, kleine Volumina der Metastasen, kontrollierter Primärtumor und fehlende oder stabile extrakranielle Metastasen.

Association Between Potentially Inappropriate Medications and 30-Day Post–Hospital Discharge Outcomes in US Veterans

2021 ◽  
pp. 106002802110320
Author(s):  
Heather G. Allore ◽  
Danijela Gnjidic ◽  
Melissa Skanderson ◽  
Ling Han
Keyword(s):  
Hospital Discharge ◽  
Adverse Drug Events ◽  
Primary Care Clinic ◽  
Care Utilization ◽  
Potentially Inappropriate Medications ◽  
Care Hospital ◽  
Care Clinic ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Reduced Risk

Background Potentially inappropriate medication (PIMs) use is common in older inpatients and it may lead to increased risk of adverse drug events. Objectives To examine prevalence of PIMs at hospital discharge and its contribution to health care utilization and mortality within 30-days of hospital discharge. Methods This was a prospective cohort of 117 570 veterans aged ≥65 years and hospitalized in 2013. PIMs at discharge were categorized into central nervous system acting (CNS) and non-CNS. Outcomes within 30-days of hospital discharge were: (1) time to first acute care hospital readmission, and all-cause mortality, (2) an emergency room visit, and (3) ≥3 primary care clinic visits. Results The cohort’s mean age was 74.3 years (SD 8.1), with 51.3% exposed to CNS and 62.8% to non-CNS PIMs. Use of CNS and non-CNS PIMs, respectively, was associated with a reduced risk of readmission, with an adjusted hazard ratio (aHR) of 0.93 (95% CI = 0.89-0.96) for ≥2 (vs 0) CNS PIMs and an aHR of 0.85 (95% CI = 0.82-0.88) for ≥2 (vs 0) non-CNS PIMs. Use of CNS PIMs (≥2 vs 0) was associated with increased risk of mortality (aHR = 1.37 [95% CI = 1.25-1.51]), whereas non-CNS PIMs use was associated with a reduced risk of mortality (aHR = 0.75 [95% CI = 0.69-0.82]). Conclusion and Relevance PIMs were highly common in this veteran cohort, and the association with outcomes differed by PIMs. Thus, it is important to consider whether PIMs are CNS acting to optimize short-term posthospitalization outcomes.

scholarly journals Early postoperative pain as a marker of anastomotic leakage in colorectal cancer surgery

2021 ◽  
Author(s):  
Petrus Boström ◽  
Johan Svensson ◽  
Camilla Brorsson ◽  
Martin Rutegård
Keyword(s):  
Colorectal Cancer ◽  
Postoperative Pain ◽  
Colorectal Surgery ◽  
Anastomotic Leakage ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Population Based ◽  
Colorectal Cancer Surgery ◽  
Increased Risk ◽  
Independent Marker

Abstract Purpose Even though anastomotic leakage after colorectal surgery is a major clinical problem in need of a timely diagnosis, early indicators of leakage have been insufficiently studied. We therefore conducted a population-based observational study to determine whether the patient’s early postoperative pain is an independent marker of anastomotic leakage. Methods By combining the Swedish Colorectal Cancer Registry and the Swedish Perioperative Registry, we retrieved prospectively collected data on 3084 patients who underwent anastomotic colorectal surgery for cancer in 2014–2017. Postoperative pain, measured with the numerical rating scale (NRS), was considered exposure, while anastomotic leakage and reoperation due to leakage were outcomes. We performed logistic regression to evaluate associations, estimating odds ratios (ORs) and 95% confidence intervals (CIs), while multiple imputation was used to handle missing data. Results In total, 189 patients suffered from anastomotic leakage, of whom 121 patients also needed a reoperation due to leakage. Moderate or severe postoperative pain (NRS 4–10) was associated with an increased risk of anastomotic leakage (OR 1.69, 95% CI 1.21–2.38), as well as reoperation (OR 2.17, 95% CI 1.41–3.32). Severe pain (NRS 8–10) was more strongly related to leakage (OR 2.38, 95% CI 1.44–3.93). These associations were confirmed in multivariable analyses and when reoperation due to leakage was used as an outcome. Conclusion In this population-based retrospective study on prospectively collected data, increased pain in the post-anaesthesia care unit is an independent marker of anastomotic leakage, possibly indicating a need for further diagnostic measures.

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