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  • Online Resource  (14)
  • Ovid Technologies (Wolters Kluwer Health)  (14)
  • 1
    Online Resource
    Online Resource
    Natriuretic Peptide Testing for Heart Failure Therapy Guidance in the Inpatient and Outpatient Setting
    Ovid Technologies (Wolters Kluwer Health) ; 2009
    In:  American Journal of Therapeutics Vol. 16, No. 2 ( 2009-03), p. 171-177
    Details
    In: American Journal of Therapeutics, Ovid Technologies (Wolters Kluwer Health), Vol. 16, No. 2 ( 2009-03), p. 171-177
    Type of Medium: Online Resource
    ISSN: 1075-2765
    URL: Article
    DOI: 10.1097/MJT.0b013e318172797f
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2009
    detail.hit.zdb_id: 2026900-6
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  • 2
    Online Resource
    Online Resource
    Identifying Opportunities to Improve Early Referral for Hematuria with Concomitant Proteinuria in a Large Health System : SA-PO1110
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Journal of the American Society of Nephrology Vol. 34, No. 11S ( 2023-11), p. 1042-1042
    Details
    In: Journal of the American Society of Nephrology, Ovid Technologies (Wolters Kluwer Health), Vol. 34, No. 11S ( 2023-11), p. 1042-1042
    Type of Medium: Online Resource
    ISSN: 1046-6673
    URL: Article
    DOI: 10.1681/ASN.20233411S11042a
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 2029124-3
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  • 3
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    Online Resource
    Opening Residents’ Notes to Patients : A Qualitative Study of Resident and Faculty Physician Attitudes on Open Notes Implementation in Graduate Medical Education
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Academic Medicine Vol. 91, No. 3 ( 2016-03), p. 418-426
    Details
    In: Academic Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 91, No. 3 ( 2016-03), p. 418-426
    Type of Medium: Online Resource
    ISSN: 1040-2446
    URL: Article
    DOI: 10.1097/ACM.0000000000000993
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
    detail.hit.zdb_id: 2025367-9
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  • 4
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    Online Resource
    Communication Skills Training for Dialysis Decision-Making and End-of-Life Care in Nephrology
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Clinical Journal of the American Society of Nephrology Vol. 8, No. 4 ( 2013-04), p. 675-680
    Details
    In: Clinical Journal of the American Society of Nephrology, Ovid Technologies (Wolters Kluwer Health), Vol. 8, No. 4 ( 2013-04), p. 675-680
    Abstract: Nephrology fellows often face difficult conversations about dialysis initiation or withdrawal but are frequently unprepared for these discussions. Despite evidence that communication skills are teachable, few fellowship programs include such training. A communication skills workshop for nephrology fellows (NephroTalk) focused on delivering bad news and helping patients define care goals, including end-of-life preferences. This 4-hour workshop, held in October and November 2011, included didactics and practice sessions with standardized patients. Participants were nephrology fellows at Duke University and the University of Pittsburgh ( n =22). Pre- and post-workshop surveys evaluated efficacy of the curriculum and measured changes in perceived preparedness on the basis on workshop training. Overall, 14% of fellows were white and 50% were male. Less than one-third (6 of 22) reported prior palliative care training. Survey response rate varied between 86% and 100%. Only 36% (8 of 22) and 38% (8 of 21) of respondents had received structured training in discussions for dialysis initiation or withdrawal. Respondents (19 of 19) felt that communication skills were important to being a “great nephrologist.” Mean level of preparedness as measured with a five-point Likert scale significantly increased for all skills (range, 0.5–1.14; P 〈 0.01), including delivering bad news, expressing empathy, and discussing dialysis initiation and withdrawal. All respondents (21 of 21) reported they would recommend this training to other fellows. NephroTalk is successful for improving preparedness among nephrology fellows for having difficult conversations about dialysis decision-making and end-of-life care.
    Type of Medium: Online Resource
    ISSN: 1555-9041
    URL: Article
    DOI: 10.2215/CJN.05220512
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
    detail.hit.zdb_id: 2216582-4
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  • 5
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    Online Resource
    Sexual Function, Activity, and Satisfaction among Women Receiving Maintenance Hemodialysis
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Clinical Journal of the American Society of Nephrology Vol. 9, No. 1 ( 2014-01), p. 128-134
    Details
    In: Clinical Journal of the American Society of Nephrology, Ovid Technologies (Wolters Kluwer Health), Vol. 9, No. 1 ( 2014-01), p. 128-134
    Abstract: Past studies that demonstrated that sexual dysfunction is common among women receiving chronic hemodialysis did not distinguish sexual dysfunction/difficulty from sexual inactivity. This study sought to differentiate these in order to elucidate the prevalence of true “sexual dysfunction” in this population. Design, setting, participants, & measurements As part of a clinical trial of symptom management strategies in patients receiving chronic hemodialysis, female sexual function was prospectively assessed monthly for 6 months and quarterly thereafter using the Female Sexual Function Index, to which questions were added differentiating sexual dysfunction/difficulty from sexual inactivity. Beginning in month 7, patients were asked three questions about sexual activity, difficulty, and satisfaction monthly. Results Of the women enrolled in the clinical trial,125 participants completed 1721 assessments between 2009 and 2011. Scores on 574 of 643 (89%) quarterly Female Sexual Function Index assessments were consistent with sexual dysfunction, due largely to sexual inactivity, which was reported on 525 (82%) quarterly assessments. When reported ( n =1663), the most frequently described reasons for sexual inactivity were lack of interest in sex ( n =715; 43%) and lack of a partner ( n =647; 39%), but rarely sexual difficulty ( n =36; 2%). When reported ( n =1582), women were moderately to very satisfied with their sexual life on 1020 (64%) assessments and on 513 of 671 (76%) assessments in which lack of interest was cited as a reason for sexual inactivity. Women indicated an interest in learning about the causes of and treatment for sexual dysfunction on just 5% of all assessments. Conclusions Although many women receiving chronic hemodialysis are sexually inactive, few describe sexual difficulty. Most, including those with a lack of interest in sex, are satisfied with their sexual life and few wish to learn about treatment options. These findings suggest that true sexual dysfunction is uncommon in this population and that treatment opportunities are rare.
    Type of Medium: Online Resource
    ISSN: 1555-9041
    URL: Article
    DOI: 10.2215/CJN.05470513
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
    detail.hit.zdb_id: 2216582-4
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  • 6
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    Online Resource
    Post-Discharge Mortality and Rehospitalization among Participants in a Comprehensive Acute Kidney Injury Rehabilitation Program
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Kidney360 Vol. 2, No. 9 ( 2021-09), p. 1424-1433
    Details
    In: Kidney360, Ovid Technologies (Wolters Kluwer Health), Vol. 2, No. 9 ( 2021-09), p. 1424-1433
    Abstract: Using innovative, patient-centered interventions, 68% of eligible high-risk patients with AKI were enrolled and all came to nephrology follow-up. Participation was associated with improvement in 30-day postdischarge rehospitalization and mortality, with similar 90-day trends. The interventions present a roadmap for improving enrollment in AKI randomized controlled trials and should be tested further. Background Hospitalization-associated AKI is common and is associated with markedly increased mortality and morbidity. This prospective cohort study examined the feasibility and association of an AKI rehabilitation program with postdischarge outcomes. Methods Adult patients hospitalized from September 1, 2019 to February 29, 2020 in a large health system in Pennsylvania with stage 2–3 AKI who were alive and not on dialysis or hospice at discharge were evaluated for enrollment. The intervention included patient education, case manager services, and expedited nephrology appointments starting within 1–3 weeks of discharge. We examined the association between AKI rehabilitation program participation and risks of rehospitalization or mortality in logistic regression analyses adjusting for comorbidities, discharge disposition, and sociodemographic and kidney parameters. Sensitivity analysis was performed using propensity score matching. Results Among the high-risk patients with AKI who were evaluated, 77 of 183 were suitable for inclusion. Out of these, 52 (68%) patients were enrolled and compared with 400 contemporary, nonparticipant survivors of stage 2/3 AKI. Crude postdischarge rates of rehospitalization or death were lower for participants versus nonparticipants at 30 days (15% versus 34%; P =0.01) and at 90 days (31% versus 51%; P =0.01). After multivariable adjustment, participation in the AKI rehabilitation program was associated with lower risk of rehospitalization or mortality at 30 days (OR, 0.41; 95% CI, 0.16 to 0.93), with similar findings at 90 days (OR, 0.52; 95% CI, 0.25 to 1.05). Due to small sample size, propensity-matched analyses were limited. The participants’ rehospitalization or mortality was numerically lower but not statistically significant at 30 days (18% versus 31%; P =0.22) or at 90 days (47% versus 58%; P =0.4). Conclusions The AKI rehabilitation program was feasible and potentially associated with improved 30-day rehospitalization or mortality. Our interventions present a roadmap to improve enrollment in future randomized trials.
    Type of Medium: Online Resource
    ISSN: 2641-7650
    URL: Article
    DOI: 10.34067/KID.0003672021
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
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  • 7
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    Online Resource
    Prevalence and Demographic and Clinical Associations of Health Literacy in Patients on Maintenance Hemodialysis
    Ovid Technologies (Wolters Kluwer Health) ; 2011
    In:  Clinical Journal of the American Society of Nephrology Vol. 6, No. 6 ( 2011-06), p. 1354-1360
    Details
    In: Clinical Journal of the American Society of Nephrology, Ovid Technologies (Wolters Kluwer Health), Vol. 6, No. 6 ( 2011-06), p. 1354-1360
    Abstract: Although limited health literacy is estimated to affect over 90 million Americans and is recognized as an important public health concern, there have been few studies examining this issue in patients with chronic kidney disease. We sought to characterize the prevalence of and associations of demographic and clinical characteristics with limited health literacy in patients receiving maintenance hemodialysis. Design, setting, participants, & measurements As part of a prospective clinical trial of symptom management strategies in 288 patients treated with chronic hemodialysis, we assessed health literacy using the Rapid Estimate of Adult Literacy in Medicine (REALM). We defined limited health literacy as a REALM score ≤60 and evaluated independent associations of demographic and baseline clinical characteristics with limited health literacy using multivariable logistic regression. Results Of the 260 patients who completed the REALM, 41 demonstrated limited health literacy. African-American race, lower educational level, and veteran status were independently associated with limited health literacy. There was no association of limited health literacy with age, gender, serologic values, dialysis adequacy, overall symptom burden, quality of life, or depression. Conclusions Limited health literacy is common among patients receiving chronic hemodialysis. African-American race and socioeconomic factors are strong independent predictors of limited health literacy. These findings can help inform the design and implementation of interventions to improve health literacy in the hemodialysis population.
    Type of Medium: Online Resource
    ISSN: 1555-9041
    URL: Article
    DOI: 10.2215/CJN.09761110
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2011
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  • 8
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    Comparison of Symptom Management Strategies for Pain, Erectile Dysfunction, and Depression in Patients Receiving Chronic Hemodialysis : A Cluster Randomized Effectiveness Trial
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Clinical Journal of the American Society of Nephrology Vol. 8, No. 1 ( 2013-01), p. 90-99
    Details
    In: Clinical Journal of the American Society of Nephrology, Ovid Technologies (Wolters Kluwer Health), Vol. 8, No. 1 ( 2013-01), p. 90-99
    Abstract: Pain, erectile dysfunction (ED), and depression are common yet frequently untreated in chronic hemodialysis patients. This study compared two management strategies for these symptoms in this patient population. Design, setting, participants, & measurements Pain, ED, and depression were assessed monthly during an observation usual care phase. Patients were then randomized to 12-month participation in either a feedback arm in which these symptoms were assessed monthly, renal providers were informed of patients' symptoms, and treatment was left treatment at their discretion; or a nurse management arm in which symptoms were assessed monthly and trained nurses were used to evaluate patients and generate and facilitate the implementation of treatment recommendations. Results Of 288 patients enrolled into observation between January 1, 2009 and March 30, 2010, 220 (76%) were randomized. Compared with the feedback approach, the results (shown as Δ symptom score [95% confidence interval]) indicated that nurse management was not associated with improved pain (0.49 [−0.56, 1.54] ), ED (0.20 [−0.55, 0.95]), or depression (0.32 [−0.94, 1.58] ). Relative to their symptoms during observation, feedback patients experienced small, statistically significant improvements in pain (−0.98 [−1.67, −0.28]), ED (−0.98 [−1.54, −0.41] ), and depression (−1.36 [−2.19, −0.54]), whereas nurse management patients experienced small, statistically significant improvements in ED (−0.78 [−1.41, −0.15] ) and depression (−1.04 [−2.04, −0.04]). Conclusions Compared with informing renal providers of their patients' pain, ED, and depression and leaving management at their discretion, a nurse-implemented management strategy does not improve these symptoms. Both approaches modestly reduced symptoms relative to usual care.
    Type of Medium: Online Resource
    ISSN: 1555-9041
    URL: Article
    DOI: 10.2215/CJN.04450512
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
    detail.hit.zdb_id: 2216582-4
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  • 9
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    Targeting Patient and Health System Barriers To Improve Rates of Hemodialysis Initiation with an Arteriovenous Access
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Kidney360 Vol. 2, No. 4 ( 2021-04), p. 708-720
    Details
    In: Kidney360, Ovid Technologies (Wolters Kluwer Health), Vol. 2, No. 4 ( 2021-04), p. 708-720
    Abstract: • Targeting barriers to arteriovenous access through education, needs assessment, peer support, care navigation, and electronic supports was acceptable. • The program yielded improvements in patient self-efficacy and knowledge, and trends toward improvements in patient and provider confidence. Background Guidelines recommend pre-emptive creation of arteriovenous (AV) access. However, 〈 20% of US patients initiate hemodialysis (HD) with a functional AV access. We implemented a quality improvement (QI) program to improve pre-HD vascular access care. Methods After conducting qualitative research with key informants, we implemented a 7-month vascular access support QI program at Geisinger Health. The program targeted patient and health system barriers to AV access through education, needs assessment, peer support, care navigation, and electronic supports. We performed pre-, intra-, and postprogram stakeholder interviews to identify program barriers and facilitators and to assess acceptability. In a research substudy, we compared pre- and postprogram self-efficacy, knowledge, and confidence navigating vascular access care. Results There were 37 patient and 32 clinician/personnel participants. Of the 37 patients, 34 (92%) completed vascular access–specific education, 33 (89%) underwent needs assessment, eight (22%) engaged with peer mentors, 21 (57%) had vein mapping, 18 (49%) had an initial surgical appointment, 15 (40%) underwent AV access surgery, and six (16%) started HD during the 7-month program. Qualitative findings demonstrated program acceptability to participants and suggested that education provision and emotional barrier identification were important to engaging patients in vascular access care. Research findings showed pre- to postprogram improvements in patient self-efficacy (28.1–30.8, P =0.05) and knowledge (4.9–6.9, P =0.004), and trends toward improvements in confidence among patients (8.0–8.7, P =0.2) and providers (7.5–7.8, P =0.1). Conclusions Our intervention targeting patient and health system barriers improved patient vascular access knowledge and self-efficacy. Clinical Trial registry name and registration number: Breaking Down Care Process and Patient-level Barriers to Arteriovenous Access Creation Prior to Hemodialysis Initiation, NCT04032613
    Type of Medium: Online Resource
    ISSN: 2641-7650
    URL: Article
    DOI: 10.34067/KID.0007812020
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
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  • 10
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    Online Resource
    Associations of Depressive Symptoms and Pain with Dialysis Adherence, Health Resource Utilization, and Mortality in Patients Receiving Chronic Hemodialysis
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Clinical Journal of the American Society of Nephrology Vol. 9, No. 9 ( 2014-09), p. 1594-1602
    Details
    In: Clinical Journal of the American Society of Nephrology, Ovid Technologies (Wolters Kluwer Health), Vol. 9, No. 9 ( 2014-09), p. 1594-1602
    Type of Medium: Online Resource
    ISSN: 1555-9041
    URL: Article
    DOI: 10.2215/CJN.00220114
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
    detail.hit.zdb_id: 2216582-4
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