scholarly journals SO087RISK OF INTRADIALYTIC HYPOTENSION BY DAY OF THE WEEK IN MAINTENANCE HEMODIALYSIS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Simon Correa ◽  
Xavier E Guerra-Torres ◽  
Sushrut S Waikar ◽  
Finnian R Mc Causland
Keyword(s):  
Regression Models ◽  
Maintenance Hemodialysis ◽  
Intradialytic Hypotension ◽  
Peripheral Vascular ◽  
Progressive Reduction ◽  
Ultrafiltration Rate ◽  
Logistic Regression Models ◽  
Monotonic Increase ◽  
Membrane Flux ◽  
Day Of The Week

Abstract Background and Aims Intradialytic hypotension (IDH) affects up to 50% of maintenance hemodialysis (HD) patients and is associated with a higher risk of cardiovascular (CV) events and mortality. CV events are more common on the days of dialysis and are most pronounced following the longer interdialytic interval. We wished to investigate if the rates of IDH differed according to dialysis day. Method We examined data from adult patients undergoing in-center thrice-weekly maintenance HD (N= 975 patients/n=59,004 sessions from a large dialysis organization [LDO] and N=1,838 patients/n=64,407 sessions from the Hemodialysis [HEMO] Study). We fit random effects logistic regression models to determine the association of day of HD (Mon/Tue [HD1]; Wed/Thu [HD2]; Fri/Sat [HD3]) with various definitions of IDH. Models were adjusted for age, sex, race, Kt/V, membrane flux, heart failure, peripheral vascular disease, diabetes, access type (catheter vs. fistula vs. graft), pre-dialysis blood urea nitrogen, ultrafiltration rate, pre-HD systolic blood pressure (SBP). IDH definitions included Nadir90 (nadir intra-HD SBP <90mmHg), Nadir90/100 (nadir intra-HD SBP <90mmHg if pre-HD SBP <160mmHg or <100mmHg if pre-HD SBP ≥160mmHg), Fall20 (pre-SBP minus nadir SBP ≥20mmHg) and Fall30 (pre-SBP minus nadir SBP ≥30mmHg). Results Mean age was 60 years, 44% were female and 38% were black in the LDO cohort, while mean age was 58 years, 56% were female and 63% were black in HEMO. Nadir90 occurred in 15% of LDO and 11% of HEMO sessions; Nadir90/100 occurred in 18% of LDO and 14% of HEMO sessions; Fall20 occurred in 76% of LDO and 68% of HEMO sessions; Fall30 occurred in 60% of LDO and 50% of HEMO sessions. Overall, a monotonic increase in the risk of IDH was observed for HD2 and HD3 compared with HD1 for all IDH definitions in both cohorts (see Table and Figure). Conclusion We observed a consistent monotonic increase in the risk of IDH for HD2 and HD3, compared with HD1 in two separate cohorts of maintenance HD patients. Potential explanations may relate to progressive reduction in post-HD weight during the dialytic week, or perhaps more aggressive ultrafiltration in advance of the longer interval. Further research to determine the underling mechanisms is necessary to guide practicing nephrologists when individualizing the HD prescription.

Association of Body Composition and Intradialytic Hypotension in Hemodialysis Patients

2020 ◽  
Vol 49 (3) ◽  
pp. 334-340
Author(s):  
Maolu Tian ◽  
Yan Zha ◽  
Shuwen Qie ◽  
Xin Lin ◽  
Jing Yuan
Keyword(s):  
Body Composition ◽  
Logistic Regression ◽  
Regression Models ◽  
Density Lipoprotein ◽  
Intradialytic Hypotension ◽  
Logistic Regression Models ◽  
Multifrequency Bioimpedance ◽  
Dialysis Vintage ◽  
The Difference ◽  
Adjusted Logistic Regression

Background/Aim: The relationship between body mass index (BMI) and intradialytic hypotension (IDH) has been inconsistently reported, but no further research has investigated the correlation between body composition and IDH so far. This study aimed to determine whether the lean tissue index (LTI), fat tissue index (FTI), or both derived from body composition monitoring (BCM) is associated with IDH defined as a nadir intradialytic systolic blood pressure of <90 mm Hg and ≥3 episodes hypotension per 10 hemodialysis (HD) treatments in patients undergoing prevalent HD. Methods: The observational cohort study comprised 1,463 patients receiving thrice-weekly HD from 13 dialysis centers. LTI and FTI were assessed using a BCM machine, a multifrequency bioimpedance spectroscopy device. Unadjusted and multivariable adjusted logistic regression models were fit to estimate the association of body composition with the odds of developing IDH. Results: One hundred and seven patients (7.3%) were diagnosed as IDH. The difference in dialysis vintage, BMI, FTI, LTI, high-density lipoprotein cholesterol, and C-reactive protein between IDH and non-IDH groups was statistically significant (all p < 0.05). The prevalence of diabetes among IDH patients was slightly higher than among non-IDH patients. In logistic regression models, low LTI and high FTI, but not high BMI were associated with greater odds of IDH (“high” as above median and “low” as below median). When patients were further stratified into 4 distinct body composition groups based on both the LTI and FTI, only the low LTI/high FTI group was connected with a significantly higher odds of IDH (OR 2.686, 95% CI 1.072–6.734; reference: low LTI/low FTI group). Conclusions: The LTI and FTI can provide better correlation of IDH occurrence than the BMI alone in prevalent HD patients. The low LTI/high FTI appears to be most associated with IDH. An optimal body composition for preventing the occurrence of IDH needs to be determined.

Risk of Intradialytic Hypotension by Day of the Week in Maintenance Hemodialysis

ASAIO Journal ◽  
2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Simon Correa ◽  
Xavier E. Guerra-Torres ◽  
Katherine Scovner Ravi ◽  
Suraj S. Mothi ◽  
Sushrut S. Waikar ◽  
...  
Keyword(s):  
Maintenance Hemodialysis ◽  
Intradialytic Hypotension ◽  
Day Of The Week

The impact of SPY angiography on intraoperative decision making and outcomes for post-mastectomy reconstruction

2019 ◽  
pp. 1-5
Keyword(s):  
Decision Making ◽  
Logistic Regression ◽  
Skin Necrosis ◽  
Regression Models ◽  
Multivariable Analysis ◽  
P Value ◽  
Flap Necrosis ◽  
Single Institution ◽  
Logistic Regression Models ◽  
The Impact

Objective: While the use of intraoperative laser angiography (SPY) is increasing in mastectomy patients, its impact in the operating room to change the type of reconstruction performed has not been well described. The purpose of this study is to investigate whether SPY angiography influences post-mastectomy reconstruction decisions and outcomes. Methods and materials: A retrospective analysis of mastectomy patients with reconstruction at a single institution was performed from 2015-2017.All patients underwent intraoperative SPY after mastectomy but prior to reconstruction. SPY results were defined as ‘good’, ‘questionable’, ‘bad’, or ‘had skin excised’. Complications within 60 days of surgery were compared between those whose SPY results did not change the type of reconstruction done versus those who did. Preoperative and intraoperative variables were entered into multivariable logistic regression models if significant at the univariate level. A p-value <0.05 was considered significant. Results: 267 mastectomies were identified, 42 underwent a change in the type of planned reconstruction due to intraoperative SPY results. Of the 42 breasts that underwent a change in reconstruction, 6 had a ‘good’ SPY result, 10 ‘questionable’, 25 ‘bad’, and 2 ‘had areas excised’ (p<0.01). After multivariable analysis, predictors of skin necrosis included patients with ‘questionable’ SPY results (p<0.01, OR: 8.1, 95%CI: 2.06 – 32.2) and smokers (p<0.01, OR:5.7, 95%CI: 1.5 – 21.2). Predictors of any complication included a change in reconstruction (p<0.05, OR:4.5, 95%CI: 1.4-14.9) and ‘questionable’ SPY result (p<0.01, OR: 4.4, 95%CI: 1.6-14.9). Conclusion: SPY angiography results strongly influence intraoperative surgical decisions regarding the type of reconstruction performed. Patients most at risk for flap necrosis and complication post-mastectomy are those with questionable SPY results.

Demographic factors associated with missed follow-up among solid tumor patients treated at a large multi-site academic institution

2020 ◽  
Vol 16 (32) ◽  
pp. 2635-2643
Author(s):  
Samantha L Freije ◽  
Jordan A Holmes ◽  
Saleh Rachidi ◽  
Susannah G Ellsworth ◽  
Richard C Zellars ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Odds Ratio ◽  
Regression Models ◽  
Tumor Patients ◽  
Logistic Regression Models ◽  
Factors Associated ◽  
Follow Up Care ◽  
Risk Patients ◽  
African American Race

Aim: To identify demographic predictors of patients who miss oncology follow-up, considering that missed follow-up has not been well studies in cancer patients. Methods: Patients with solid tumors diagnosed from 2007 to 2016 were analyzed (n = 16,080). Univariate and multivariable logistic regression models were constructed to examine predictors of missed follow-up. Results: Our study revealed that 21.2% of patients missed ≥1 follow-up appointment. African–American race (odds ratio [OR] 1.33; 95% CI: 1.17–1.51), Medicaid insurance (OR 1.59; 1.36–1.87), no insurance (OR 1.66; 1.32–2.10) and rural residence (OR 1.78; 1.49–2.13) were associated with missed follow-up. Conclusion: Many cancer patients miss follow-up, and inadequate follow-up may influence cancer outcomes. Further research is needed on how to address disparities in follow-up care in high-risk patients.

scholarly journals COVID-19 Preventive Behaviours in Cameroon: A Six-Month Online National Survey

2021 ◽  
Vol 18 (5) ◽  
pp. 2554
Author(s):  
Joseph Nelson Siewe Fodjo ◽  
Leonard Ngarka ◽  
Wepnyu Y. Njamnshi ◽  
Leonard N. Nfor ◽  
Michel K. Mengnjo ◽  
...  
Keyword(s):  
Regression Models ◽  
Health Personnel ◽  
Online Survey ◽  
Preventive Measures ◽  
Face Mask ◽  
Logistic Regression Models ◽  
Adherence Score ◽  
Preventive Behaviour ◽  
Predictors Of Adherence

Since March 2020, the Cameroonian government implemented nationwide measures to stall COVID-19 transmission. However, little is known about how well these unprecedented measures are being observed as the pandemic evolves. We conducted a six-month online survey to assess the preventive behaviour of Cameroonian adults during the COVID-19 outbreak. A five-point adherence score was constructed based on self-reported observance of the following preventive measures: physical distancing, face mask use, hand hygiene, not touching one’s face, and covering the mouth when coughing or sneezing. Predictors of adherence were investigated using ordinal logistic regression models. Of the 7381 responses received from all ten regions, 73.3% were from male respondents and overall mean age was 32.8 ± 10.8 years. Overall mean adherence score was 3.96 ± 1.11 on a scale of 0–5. Mean weekly adherence scores were initially high, but gradually decreased over time accompanied by increasing incidence of COVID-19 during the last study weeks. Predictors for higher adherence included higher age, receiving COVID-19 information from health personnel, and agreeing with the necessity of lockdown measures. Meanwhile, experiencing flu-like symptoms was associated with poor adherence. Continuous observance of preventive measures should be encouraged among Cameroonians in the medium- to long-term to avoid a resurgence in COVID-19 infections.

scholarly journals Behavioral and Attitudinal Correlates of Trusted Sources of COVID-19 Vaccine Information in the US

2021 ◽  
Vol 11 (4) ◽  
pp. 56
Author(s):  
Carl A. Latkin ◽  
Lauren Dayton ◽  
Jacob R. Miller ◽  
Grace Yi ◽  
Afareen Jaleel ◽  
...  
Keyword(s):  
Regression Models ◽  
Logistic Regression Models ◽  
The Public ◽  
Public Health Systems ◽  
Online Study ◽  
News Sources ◽  
The Us ◽  
Vulnerable People ◽  
Two Factors ◽  
Vaccine Information

There is a critical need for the public to have trusted sources of vaccine information. A longitudinal online study assessed trust in COVID-19 vaccine information from 10 sources. A factor analysis for data reduction revealed two factors. The first factor contained politically conservative sources (PCS) of information. The second factor included eight news sources representing mainstream sources (MS). Multivariable logistic regression models were used. Trust in Dr. Fauci was also examined. High trust in MS was associated with intention to encourage family members to get COVID-19 vaccines, altruistic beliefs that more vulnerable people should have vaccine priority, and belief that racial minorities with higher rates of COVID-19 deaths should have priority. High trust in PCS was associated with intention to discourage friends from getting vaccinated. Higher trust in PCS was also associated with participants more likely to disagree that minorities with higher rates of COVID-19 deaths should have priority for a vaccine. High trust in Dr. Fauci as a source of COVID-19 vaccine information was associated with factors similar to high trust in MS. Fair, equitable, and transparent access and distribution are essential to ensure trust in public health systems’ abilities to serve the population.

scholarly journals Effect of prostatic apex shape (Lee types) and urethral sphincter length in preoperative MRI on very early continence rates after radical prostatectomy

2021 ◽  
Author(s):  
Mike Wenzel ◽  
Felix Preisser ◽  
Matthias Mueller ◽  
Lena H. Theissen ◽  
Maria N. Welte ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Radical Prostatectomy ◽  
Regression Models ◽  
Urethral Sphincter ◽  
Anatomical Characteristics ◽  
Logistic Regression Models ◽  
Pad Test ◽  
Type D ◽  
Multivariable Logistic Regression ◽  
Type C

Abstract Purpose To test the effect of anatomic variants of the prostatic apex overlapping the membranous urethra (Lee type classification), as well as median urethral sphincter length (USL) in preoperative multiparametric magnetic resonance imaging (mpMRI) on the very early continence in open (ORP) and robotic-assisted radical prostatectomy (RARP) patients. Methods In 128 consecutive patients (01/2018–12/2019), USL and the prostatic apex classified according to Lee types A–D in mpMRI prior to ORP or RARP were retrospectively analyzed. Uni- and multivariable logistic regression models were used to identify anatomic characteristics for very early continence rates, defined as urine loss of ≤ 1 g in the PAD-test. Results Of 128 patients with mpMRI prior to surgery, 76 (59.4%) underwent RARP vs. 52 (40.6%) ORP. In total, median USL was 15, 15 and 10 mm in the sagittal, coronal and axial dimensions. After stratification according to very early continence in the PAD-test (≤ 1 g vs. > 1 g), continent patients had significantly more frequently Lee type D (71.4 vs. 54.4%) and C (14.3 vs. 7.6%, p = 0.03). In multivariable logistic regression models, the sagittal median USL (odds ratio [OR] 1.03) and Lee type C (OR: 7.0) and D (OR: 4.9) were independent predictors for achieving very early continence in the PAD-test. Conclusion Patients’ individual anatomical characteristics in mpMRI prior to radical prostatectomy can be used to predict very early continence. Lee type C and D suggest being the most favorable anatomical characteristics. Moreover, longer sagittal median USL in mpMRI seems to improve very early continence rates.

785 Reported Restful Sleep Predicting Emotional Distress: Does Exercise (and its modalities) moderate?

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A305-A306
Author(s):  
Jesse Moore ◽  
Ellita Williams ◽  
Collin Popp ◽  
Anthony Briggs ◽  
Judite Blanc ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Aerobic Exercise ◽  
Regression Models ◽  
Regression Analyses ◽  
Logistic Regression Models ◽  
The Past ◽  
Strengthening Exercise ◽  
Waking Up ◽  
The Relationship ◽  
Age And Sex

Abstract Introduction Literature shows that exercise moderates the relationship between sleep and emotional distress (ED.) However, it is unclear whether different types of exercise, such as aerobic and strengthening, affect this relationship differently. We investigated the moderating role of two types of exercise (aerobic and strengthening) regarding the relationship between ED and sleep. Methods Our analysis was based on data from 2018 National Health Interview Survey (NHIS), a nationally representative study in which 2,814 participants provided all data. Participants were asked 1) “how many days they woke up feeling rested over the past week”, 2) the Kessler 6 scale to determine ED (a score &gt;13 indicates ED), and 3) the average frequency of strengthening or aerobic exercise per week. Logistic regression analyses were performed to determine if the reported days of waking up rested predicted level of ED. We then investigated whether strengthening or aerobic exercise differentially moderated this relationship. Covariates such as age and sex were adjusted in the logistic regression models. Logistic regression analyses were performed to determine if subjective reporting of restful sleep predicted level of ED. We investigated whether strengthening exercise or aerobic exercise differentially moderated this relationship. Covariates such as age and sex were adjusted in the logistic regression models. Results On average, participants reported 4.41 restful nights of sleep (SD =2.41), 3.43 strengthening activities (SD = 3.19,) and 8.47 aerobic activities a week (SD=5.91.) We found a significant association between days over the past week reporting waking up feeling rested and ED outcome according to K6, Χ2(1) = -741, p= &lt;.001. The odds ratio signified a decrease of 52% in ED scores for each unit of restful sleep (OR = .48, (95% CI = .33, .65) p=&lt;.001.) In the logistic regression model with moderation, aerobic exercise had a significant moderation effect, Χ2(1) = .03, p=.04, but strengthening exercise did not. Conclusion We found that restful sleep predicted reduction in ED scores. Aerobic exercise moderated this relationship, while strengthening exercise did not. Further research should investigate the longitudinal effects of exercise type on the relationship between restful sleep and ED. Support (if any) NIH (K07AG052685, R01MD007716, K01HL135452, R01HL152453)

scholarly journals COVID-19 Vaccination Willingness among Chinese Adults under the Free Vaccination Policy

Vaccines ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 292
Author(s):  
Rugang Liu ◽  
Yuxun Zhang ◽  
Stephen Nicholas ◽  
Anli Leng ◽  
Elizabeth Maitland ◽  
...  
Keyword(s):  
Regression Models ◽  
Medical Insurance ◽  
Vaccine Safety ◽  
Decision Makers ◽  
Vaccination Policy ◽  
Chinese Adults ◽  
Logistic Regression Models ◽  
Ordered Logistic Regression ◽  
Professional Workers ◽  
Target Intervention

(1) Background: China will provide free coronavirus disease 2019 (COVID-19) vaccinations for the entire population. This study analyzed the COVID-19 vaccination willingness rate (VWR) and its determinants under China’s free vaccination policy compared to a paid vaccine. (2) Methods: Data on 2377 respondents were collected through a nationwide questionnaire survey. Multivariate ordered logistic regression models were specified to explore the correlation between the VWR and its determinants. (3) Results: China’s free vaccination policy for COVID-19 increased the VWR from 73.62% to 82.25% of the respondents. Concerns about the safety and side-effects were the primary reason for participants’ unwillingness to be vaccinated against COVID-19. Age, medical insurance and vaccine safety were significant determinants of the COVID-19 VWR for both the paid and free vaccine. Income, occupation and vaccine effectiveness were significant determinants of the COVID-19 VWR for the free vaccine. (4) Conclusions: Free vaccinations increased the COVID-19 VWR significantly. People over the age of 58 and without medical insurance should be treated as the target intervention population for improving the COVID-19 VWR. Contrary to previous research, high-income groups and professional workers should be intervention targets to improve the COVID-19 VWR. Strengthening nationwide publicity and education on COVID-19 vaccine safety and effectiveness are recommended policies for decision-makers.

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