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  • 1
    Online Resource
    Online Resource
    The Perioperative Surgical Home, Enhanced Recovery After Surgery and how integration of these models may improve care for medically complex patients
    CMA Impact Inc. ; 2021
    In:  Canadian Journal of Surgery Vol. 64, No. 4 ( 2021-07), p. E381-E390
    Details
    In: Canadian Journal of Surgery, CMA Impact Inc., Vol. 64, No. 4 ( 2021-07), p. E381-E390
    Type of Medium: Online Resource
    ISSN: 0008-428X , 1488-2310
    URL: Article
    DOI: 10.1503/cjs.002020
    Language: English
    Publisher: CMA Impact Inc.
    Publication Date: 2021
    detail.hit.zdb_id: 2026595-5
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  • 2
    Online Resource
    Online Resource
    Association of Initiation of Dialysis With Hospital Length of Stay and Intensity of Care in Older Adults With Kidney Failure
    American Medical Association (AMA) ; 2020
    In:  JAMA Network Open Vol. 3, No. 2 ( 2020-02-28), p. e200222-
    Details
    In: JAMA Network Open, American Medical Association (AMA), Vol. 3, No. 2 ( 2020-02-28), p. e200222-
    Type of Medium: Online Resource
    ISSN: 2574-3805
    URL: Article
    DOI: 10.1001/jamanetworkopen.2020.0222
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2020
    detail.hit.zdb_id: 2931249-8
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  • 3
    Online Resource
    Online Resource
    Derivation and Internal Validation of a Clinical Risk Prediction Tool for Hyperkalemia-Related Emergency Department Encounters Among Hemodialysis Patients
    SAGE Publications ; 2020
    In:  Canadian Journal of Kidney Health and Disease Vol. 7 ( 2020-01), p. 205435812095328-
    Details
    In: Canadian Journal of Kidney Health and Disease, SAGE Publications, Vol. 7 ( 2020-01), p. 205435812095328-
    Abstract: Approximately 10% of emergency department (ED) visits among dialysis patients are for conditions that could potentially be managed in outpatient settings, such as hyperkalemia. Objective: Using population-based data, we derived and internally validated a risk score to identify hemodialysis patients at increased risk of hyperkalemia-related ED events. Design: Retrospective cohort study. Setting: Ten in-center hemodialysis sites in southern Alberta, Canada. Patients: All maintenance hemodialysis patients (≥18 years) between March 2009 and March 2017. Measurements: Predictors of hyperkalemia-related ED events included patient demographics, comorbidities, health-system use, laboratory measurements, and dialysis information. The outcome of interest (hyperkalemia-related ED events) was defined by International Classification of Diseases (10th Revision; ICD-10) codes and/or serum potassium [K + ] ≥6 mmol/L. Methods: Bootstrapped logistic regression was used to derive and internally validate a model of important predictors of hyperkalemia-related ED events. A point system was created based on regression coefficients. Model discrimination was assessed by an optimism-adjusted C-statistic and calibration by deciles of risk and calibration slope. Results: Of the 1533 maintenance hemodialysis patients in our cohort, 331 (21.6%) presented to the ED with 615 hyperkalemia-related ED events. A 9-point scale for risk of a hyperkalemia-related ED event was created with points assigned to 5 strong predictors based on their regression coefficients: ≥1 laboratory measurement of serum K + ≥6 mmol/L in the prior 6 months (3 points); ≥1 Hemoglobin A1C [HbA1C] measurement ≥8% in the prior 12 months (1 point); mean ultrafiltration of ≥10 mL/kg/h over the preceding 2 weeks (2 points); ≥25 hours of cumulative time dialyzing over the preceding 2 weeks (1 point); and dialysis vintage of ≥2 years (2 points). Model discrimination (C-statistic: 0.75) and calibration were good. Limitations: Measures related to health behaviors, social determinants of health, and residual kidney function were not available for inclusion as potential predictors. Conclusions: While this tool requires external validation, it may help identify high-risk patients and allow for preventative strategies to avoid unnecessary ED visits and improve patient quality of life. Trial registration: Not applicable—observational study design.
    Type of Medium: Online Resource
    ISSN: 2054-3581 , 2054-3581
    URL: Article
    DOI: 10.1177/2054358120953287
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
    detail.hit.zdb_id: 2765462-X
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  • 4
    Online Resource
    Online Resource
    Small for date preterm infants and risk of higher blood pressure in later life: A systematic review and meta‐analysis
    Wiley ; 2023
    In:  Paediatric and Perinatal Epidemiology Vol. 37, No. 5 ( 2023-07), p. 458-472
    Details
    In: Paediatric and Perinatal Epidemiology, Wiley, Vol. 37, No. 5 ( 2023-07), p. 458-472
    Abstract: Historical reports suggest that infants born small for gestational age (SGA) are at increased risk for high blood pressure (BP) at older ages after adjustment for later age body size. Such adjustment may be inappropriate since adiposity is a known cause of cardiovascular and metabolic disease. Objectives To assess the association between SGA births and later BP among preterm births, considering potential background confounders and over‐adjustment for later body size. Methods A database search of studies up to October 2022 included MEDLINE, EMBASE and CINAHL. Studies were included if they reported BP (systolic [SBP] or diastolic [DBP] ) (outcomes) for participants born preterm with SGA (exposure) or non‐SGA births. All screening, extraction steps, and risk of bias (using the Risk of Bias In Non‐randomised Studies of Interventions [ROBINS‐I] tool) were conducted in duplicate by two reviewers. Data were pooled in meta‐analysis using random‐effects models. We explored potential sources of heterogeneity. Results We found no meaningful difference in later BP between preterm infants with and without SGA status at birth. Meta‐analysis of 25 studies showed that preterm SGA, compared to preterm non‐SGA, was not associated with higher BP at age 2 and older with mean differences for SBP 0.01 mmHg (95% CI −0.10, 0.12, I 2  = 59.8%, n  = 20,462) and DBP 0.01 mm Hg (95% CI −0.10, 0.12), 22 studies, ( I 2  = 53.0%, n  = 20,182). Adjustment for current weight did not alter the results, which could be due to the lack of differences in later weight status in most of the included studies. The included studies were rated to be at risk of bias due to potential residual confounding, with a low risk of bias in other domains. Conclusions Evidence indicates that preterm infants born SGA are not at increased risk of developing higher BP as children or as adults as compared to non‐SGA preterm infants.
    Type of Medium: Online Resource
    ISSN: 0269-5022 , 1365-3016
    URL: Issue
    URL: Article
    DOI: 10.1111/ppe.v37.5
    DOI: 10.1111/ppe.12955
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2008566-7
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  • 5
    Online Resource
    Online Resource
    Development and initial implementation of electronic clinical decision supports for recognition and management of hospital-acquired acute kidney injury
    Springer Science and Business Media LLC ; 2020
    In:  BMC Medical Informatics and Decision Making Vol. 20, No. 1 ( 2020-12)
    Details
    In: BMC Medical Informatics and Decision Making, Springer Science and Business Media LLC, Vol. 20, No. 1 ( 2020-12)
    Abstract: Acute kidney injury (AKI) is common in hospitalized patients and is associated with poor patient outcomes and high costs of care. The implementation of clinical decision support tools within electronic medical record (EMR) could improve AKI care and outcomes. While clinical decision support tools have the potential to enhance recognition and management of AKI, there is limited description in the literature of how these tools were developed and whether they meet end-user expectations. Methods We developed and evaluated the content, acceptability, and usability of electronic clinical decision support tools for AKI care. Multi-component tools were developed within a hospital EMR (Sunrise Clinical Manager™, Allscripts Healthcare Solutions Inc.) currently deployed in Calgary, Alberta, and included: AKI stage alerts, AKI adverse medication warnings, AKI clinical summary dashboard, and an AKI order set. The clinical decision support was developed for use by multiple healthcare providers at the time and point of care on general medical and surgical units. Functional and usability testing for the alerts and clinical summary dashboard was conducted via in-person evaluation sessions, interviews, and surveys of care providers. Formal user acceptance testing with clinical end-users, including physicians and nursing staff, was conducted to evaluate the AKI order set. Results Considerations for appropriate deployment of both non-disruptive and interruptive functions was important to gain acceptability by clinicians. Functional testing and usability surveys for the alerts and clinical summary dashboard indicated that the tools were operating as desired and 74% (17/23) of surveyed healthcare providers reported that these tools were easy to use and could be learned quickly. Over three-quarters of providers (18/23) reported that they would utilize the tools in their practice. Three-quarters of the participants (13/17) in user acceptance testing agreed that recommendations within the order set were useful. Overall, 88% (15/17) believed that the order set would improve the care and management of AKI patients. Conclusions Development and testing of EMR-based decision support tools for AKI with clinicians led to high acceptance by clinical end-users. Subsequent implementation within clinical environments will require end-user education and engagement in system-level initiatives to use the tools to improve care.
    Type of Medium: Online Resource
    ISSN: 1472-6947
    URL: Article
    DOI: 10.1186/s12911-020-01303-x
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 2046490-3
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  • 6
    Online Resource
    Online Resource
    Albuminuria, proteinuria, and dipsticks: novel relationships and utility in risk prediction
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Current Opinion in Nephrology & Hypertension Vol. 30, No. 3 ( 2021-05), p. 377-383
    Details
    In: Current Opinion in Nephrology & Hypertension, Ovid Technologies (Wolters Kluwer Health), Vol. 30, No. 3 ( 2021-05), p. 377-383
    Abstract: Albuminuria is associated with progression of kidney disease and is the accepted gold standard for screening, staging, and prognostication of chronic kidney disease. This review focuses on current literature that has explored applications of albuminuria as a surrogate outcome, variable used in kidney failure risk prediction for novel populations, and variable that may be predicted by other proteinuria measures. Recent findings Change in albuminuria shows promise as a surrogate outcome for kidney failure, which may have major implications for trial design and conduct. The kidney failure risk equation (KFRE) has been validated extensively to date and has now been applied to pediatric patients with kidney disease, advanced age, different causes of kidney disease, various countries, and those with prior kidney transplants. As albumin-to-creatinine ratios (ACRs) are not always available to clinicians and researchers, two recent studies have independently developed equations to estimate ACR from other proteinuria measures. Summary The utility of albuminuria and the KFRE continues to grow in novel populations. With the ability to convert more widely available (and inexpensive) proteinuria measures to ACR estimates, the prospect of incorporating kidney failure risk prediction into routine care within economically challenged healthcare jurisdictions may finally be realized.
    Type of Medium: Online Resource
    ISSN: 1062-4821 , 1473-6543
    URL: Article
    DOI: 10.1097/MNH.0000000000000698
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2029133-4
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  • 7
    Online Resource
    Online Resource
    Sex differences in COVID-19 symptoms and outcomes in people with kidney failure treated with dialysis: a prospective cohort study
    Springer Science and Business Media LLC ; 2022
    In:  Journal of Nephrology Vol. 36, No. 3 ( 2022-09-10), p. 851-860
    Details
    In: Journal of Nephrology, Springer Science and Business Media LLC, Vol. 36, No. 3 ( 2022-09-10), p. 851-860
    Type of Medium: Online Resource
    ISSN: 1724-6059
    URL: Article
    DOI: 10.1007/s40620-022-01448-0
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 1475007-7
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  • 8
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    Online Resource
    Cognitive interventions for adults with chronic kidney disease: protocol for a scoping review
    Springer Science and Business Media LLC ; 2020
    In:  Systematic Reviews Vol. 9, No. 1 ( 2020-12)
    Details
    In: Systematic Reviews, Springer Science and Business Media LLC, Vol. 9, No. 1 ( 2020-12)
    Abstract: Cognitive impairment is a common and frequently under-recognized complication of chronic kidney disease (CKD). Although there is extensive literature on cognitive interventions that can ameliorate cognitive impairment or associated negative outcomes in the general literature, the breadth and characteristics of cognitive interventions that have been studied in people with CKD are currently unclear. The objective of this scoping review is to identify and describe the literature on cognitive interventions for adults with CKD, including end-stage kidney disease (ESKD). Methods A scoping review following Joanna Briggs Institute methodology will be conducted. With assistance from an information specialist, we will search 5 electronic databases (MEDLINE [OVID], EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, and CINAHL Plus) using search terms that represent the target population (CKD) and concept (cognition), and conduct backward citation searching for additional literature. Eligible sources will be primary research studies (quantitative or qualitative) that investigate any intervention targeting cognition in adults (≥ 18 years) with CKD or ESKD, including those treated with dialysis. We will extract data about characteristics of interventions (e.g., type, underlying theory, design, location, and provider), populations (e.g., stage of CKD, age, sex, and type of cognitive impairment), and studies (e.g., authors, location, design, and reported findings). Article screening and data extraction will be performed by two to three reviewers. Data will be analyzed using descriptive statistics and narrative syntheses to characterize the literature on cognitive interventions for people with CKD. Discussion This study will provide a comprehensive overview of the cognitive interventions that have been studied for people with CKD. It will help identify research gaps within this population (e.g., types of interventions that have yet to be investigated; best practices in cognition research that have not been implemented) and inform the direction of future research in this field.
    Type of Medium: Online Resource
    ISSN: 2046-4053
    URL: Article
    DOI: 10.1186/s13643-020-01320-x
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 2662257-9
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  • 9
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    Improving Sexual Function in People With Chronic Kidney Disease: A Narrative Review of an Unmet Need in Nephrology Research
    SAGE Publications ; 2020
    In:  Canadian Journal of Kidney Health and Disease Vol. 7 ( 2020-01), p. 205435812095220-
    Details
    In: Canadian Journal of Kidney Health and Disease, SAGE Publications, Vol. 7 ( 2020-01), p. 205435812095220-
    Abstract: Sexual dysfunction occurs commonly in people with chronic kidney disease (CKD) and has been recognized as a research priority. We sought to evaluate the current state of the literature addressing sexual dysfunction in people with CKD and identify barriers and strategies to improve our management of this important symptom. Sources of information: OVID Medline and Google Scholar were searched for English, peer-reviewed studies using keywords and terms related to “Chronic Kidney Disease,” “sexuality,” and “sexual dysfunction OR function.” Methods: In this narrative review, we describe definitions of sexual dysfunction and contributors exacerbated by CKD, barriers to researching sexual dysfunction in people with CKD, and possible avenues for future research. Key findings: Sexual dysfunction is common in people with CKD and results from a combination of kidney disease itself, as well as its associated physical (ie, comorbidities) and nonphysical factors. Barriers to the study of sexual dysfunction in CKD include inconsistent disease definitions, stigma, variable efficacy and safety of established therapies, and evolving gender roles in sexual function. Potential avenues for future research to improve the sexual function in people with CKD may include evaluating the safety and efficacy of established therapies in people with CKD using a variety of observational and interventional study designs, engaging people with CKD and multidisciplinary team members in research, and using implementation science methods to translate what is known about sexual function into clinical practice. Concerted efforts are required to break down barriers and improve sexual function in people with CKD. Patients have identified this as an important research priority, and national networks need to direct efforts to reduce symptom burden. Limitations: This narrative review was limited by a paucity of high-quality studies examining sexual dysfunction specifically in people with kidney disease.
    Type of Medium: Online Resource
    ISSN: 2054-3581 , 2054-3581
    URL: Article
    DOI: 10.1177/2054358120952202
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
    detail.hit.zdb_id: 2765462-X
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  • 10
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    Reduction in Thrombolytic Usage in Hemodialysis Patients Following a Quality Assurance Review: A Research Letter
    SAGE Publications ; 2023
    In:  Canadian Journal of Kidney Health and Disease Vol. 10 ( 2023-01), p. 205435812311742-
    Details
    In: Canadian Journal of Kidney Health and Disease, SAGE Publications, Vol. 10 ( 2023-01), p. 205435812311742-
    Abstract: Catheter malfunction in hemodialysis (HD) is increasingly managed with recombinant tissue plasminogen activator (rt-PA, alteplase), though evidence of improved catheter function is lacking. Objective: To evaluate the effect of a standardized rt-PA administration protocol on rt-PA usage, catheter function, and adverse events. Design: Observational quality improvement study. Setting: Single, urban, community HD unit in Calgary, Alberta. Patients: Patients treated with maintenance in-center HD through central venous catheter. Outcomes: Incidence of rt-PA usage, catheter interventions, hospitalizations, and measures of dialysis efficacy. Methods: The rt-PA protocol was designed following a consultative and iterative design period with dialysis shareholders, which included focusing on standard objective criteria before use and targeting use to the problematic lumen. Protocol implementation occurred over a 6-month period in 2021. Patient and dialysis data were collected through our regional dialysis electronic health record. Results: Implementation of the rt-PA protocol resulted in decreased rt-PA use (standardized per 100 dialysis sessions) compared to the preprotocol period (incidence rate ratio [IRR] of 0.57, 95% confidence interval [CI] : [0.34, 0.94]). Line procedures were also less frequent (IRR = 0.42, 95% CI: [0.18, 0.89] ). Hospitalization rates and measures of dialysis efficacy were similar in both periods. Limitations: Small sample size with single dialysis center and short duration of follow-up. Conclusions: Implementation of a multidisciplinary designed rt-PA administration protocol decreased incident rt-PA usage
    Type of Medium: Online Resource
    ISSN: 2054-3581 , 2054-3581
    URL: Article
    DOI: 10.1177/20543581231174276
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2023
    detail.hit.zdb_id: 2765462-X
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