Peritoneal Dialysis-Related Peritonitis: Can We Predict It?

Peritonitis complicating peritoneal dialysis represents a major cause of technique failure, hospitalization, and increased mortality. Peritonitis tends to be recurrent and clustered within particular patients at risk. The aim of this review is to evaluate the potential predictive factors for development of peritoneal dialysis-associated peritonitis based on currently available evidence. Risk factors were divided into medical and non-medical ones, and characterized by a schema of fixed versus modifiable factors. A new direction in the landscape change of the risk factors of peritonitis appears to focus on psychosocial aspects and patient training. Identification of these factors have important clinical implications because of the hitherto lack of well-established strategies to prevent peritonitis complicating peritoneal dialysis. It is hoped that better understanding of the risk factors will allow us to take tangible steps toward minimizing the infectious burden from the Achilles' heel of peritoneal dialysis.

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Causes and risk factors of technique failure in peritoneal dialysis patients: a single unit study

10.26226/morressier.59a56f96d462b8028d895c4b ◽

2017 ◽

Author(s):

Lilia Ben Lasfar

Keyword(s):

Risk Factors ◽

Peritoneal Dialysis ◽

Single Unit ◽

Dialysis Patients ◽

Causes And Risk Factors ◽

Technique Failure

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Predicting Persistent Opioid Use, Abuse, and Toxicity Among Cancer Survivors

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/djz200 ◽

2019 ◽

Vol 112 (7) ◽

pp. 720-727 ◽

Cited By ~ 6

Author(s):

Lucas K Vitzthum ◽

Paul Riviere ◽

Paige Sheridan ◽

Vinit Nalawade ◽

Rishi Deka ◽

...

Keyword(s):

Risk Factors ◽

At Risk ◽

Cancer Survivors ◽

Critical Role ◽

Multivariable Analysis ◽

Area Under The Curve ◽

Opioid Abuse ◽

Opioid Use ◽

Multivariable Logistic Regression Model ◽

Patients At Risk

Abstract Background Although opioids play a critical role in the management of cancer pain, the ongoing opioid epidemic has raised concerns regarding their persistent use and abuse. We lack data-driven tools in oncology to understand the risk of adverse opioid-related outcomes. This project seeks to identify clinical risk factors and create a risk score to help identify patients at risk of persistent opioid use and abuse. Methods Within a cohort of 106 732 military veteran cancer survivors diagnosed between 2000 and 2015, we determined rates of persistent posttreatment opioid use, diagnoses of opioid abuse or dependence, and admissions for opioid toxicity. A multivariable logistic regression model was used to identify patient, cancer, and treatment risk factors associated with adverse opioid-related outcomes. Predictive risk models were developed and validated using a least absolute shrinkage and selection operator regression technique. Results The rate of persistent opioid use in cancer survivors was 8.3% (95% CI = 8.1% to 8.4%); the rate of opioid abuse or dependence was 2.9% (95% CI = 2.8% to 3.0%); and the rate of opioid-related admissions was 2.1% (95% CI = 2.0% to 2.2%). On multivariable analysis, several patient, demographic, and cancer and treatment factors were associated with risk of persistent opioid use. Predictive models showed a high level of discrimination when identifying individuals at risk of adverse opioid-related outcomes including persistent opioid use (area under the curve [AUC] = 0.85), future diagnoses of opioid abuse or dependence (AUC = 0.87), and admission for opioid abuse or toxicity (AUC = 0.78). Conclusion This study demonstrates the potential to predict adverse opioid-related outcomes among cancer survivors. With further validation, personalized risk-stratification approaches could guide management when prescribing opioids in cancer patients.

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Time-Dependent Reasons for Peritoneal Dialysis Technique Failure and Mortality

Peritoneal Dialysis International ◽

10.3747/pdi.2008.00277 ◽

2010 ◽

Vol 30 (2) ◽

pp. 170-177 ◽

Cited By ~ 87

Author(s):

Inna Kolesnyk ◽

Friedo W. Dekker ◽

Elisabeth W. Boeschoten ◽

Raymond T. Krediet

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Peritoneal Dialysis ◽

The Netherlands ◽

Patient Survival ◽

Time Dependent ◽

First Year ◽

Technique Survival ◽

Technique Failure

BackgroundPeritoneal dialysis (PD) technique failure is high compared to hemodialysis (HD). There is a lack of data on the impact of duration of PD treatment on technique survival and on whether there is a difference in risk factors with respect to early and late failure. The aim of this study was to clarify these issues by performing a time-dependent analysis of PD technique and patient survival in a large cohort of incident PD patients.MethodsWe analyzed 709 incident PD patients participating in the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD), who started their treatment between 1997 and 2007. We compared technique and patient survival on PD in 4 periods of follow-up: within the first 3 months, and after 3 – 12 months, 12 – 24 months, and 24 – 36 months of treatment. Cox proportional hazards model was used to analyze survival on PD and technique failure. Risk factors were also identified by comparing patients that were transferred to HD with those that remained on PD. Incidence rates for every cause of dropout for each period of follow-up were calculated to establish their trends with respect to PD treatment duration.ResultsThere was a significant increase in transplantation rate after the first year of treatment. The rate of switching to HD was highest during the first 3 months and decreased afterward. One-, 2- and 3-year technique survival was 87%, 76%, and 66%, respectively. Age, diabetes, and cardiovascular disease appeared to be risk factors for death on PD or switch to HD: a 1-year increase in age was associated with a relative risk (RR) of PD failure of 1.04 [95% confidence interval (CI) 1.003 – 1.06]; for diabetes, RR of stopping PD after 3 months of treatment increased from 1.8 (95% CI 1.1 – 3) during the first year to 2.2 (95% CI 1.3 – 4) after the second year; cardiovascular disease had a major impact in the earliest period (RR 2.5, 95% CI 1.2 – 5) and had a stable influence further on (RR 2, 95% CI 1.1 – 3.5). Loss of 1 mL/minute residual glomerular filtration rate (rGFR) appeared to be a significant predictor of PD failure after 3 months of treatment, but within the first 2 years, RR was 1.1 (95% CI 1.04 – 1.25).ConclusionsIn The Netherlands, transplantation is a main reason to stop PD treatment. The incidence of PD technique failure is at its highest during the earliest months after treatment initiation and decreases later due to fewer catheter and abdominal complications as well as less influence of psychosocial factors. Risk factors for PD discontinuation are those responsible for patient survival: age, cardiovascular disease, diabetes, and rGFR.

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Characterising the severity of treatment resistance in unipolar and bipolar depression

BJPsych Open ◽

10.1192/bjo.2021.1004 ◽

2021 ◽

Vol 7 (6) ◽

Author(s):

Rachael W. Taylor ◽

Rebecca Strawbridge ◽

Allan H. Young ◽

Roland Zahn ◽

Anthony J. Cleare

Keyword(s):

Risk Factors ◽

At Risk ◽

Bipolar Depression ◽

Antidepressant Treatment ◽

Age At Onset ◽

Treatment Resistance ◽

Patient Characteristics ◽

Patients At Risk ◽

Resistant Depression ◽

Depressive Episodes

Background Treatment-resistant depression (TRD) is classically defined according to the number of suboptimal antidepressant responses experienced, but multidimensional assessments of TRD are emerging and may confer some advantages. Patient characteristics have been identified as risk factors for TRD but may also be associated with TRD severity. The identification of individuals at risk of severe TRD would support appropriate prioritisation of intensive and specialist treatments. Aims To determine whether TRD risk factors are associated with TRD severity when assessed multidimensionally using the Maudsley Staging Method (MSM), and univariately as the number of antidepressant non-responses, across three cohorts of individuals with depression. Method Three cohorts of individuals without significant TRD, with established TRD and with severe TRD, were assessed (n = 528). Preselected characteristics were included in linear regressions to determine their association with each outcome. Results Participants with more severe TRD according to the MSM had a lower age at onset, fewer depressive episodes and more physical comorbidities. These associations were not consistent across cohorts. The number of episodes was associated with the number of antidepressant treatment failures, but the direction of association varied across the cohorts studied. Conclusions Several risk factors for TRD were associated with the severity of resistance according to the MSM. Fewer were associated with the raw number of inadequate antidepressant responses. Multidimensional definitions may be more useful for identifying patients at risk of severe TRD. The inconsistency of associations across cohorts has potential implications for the characterisation of TRD.

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The identification of post-acute patients at risk for hospital readmission: Clinical implications of the LACE index

Clinical Nursing Studies ◽

10.5430/cns.v4n3p32 ◽

2016 ◽

Vol 4 (3) ◽

Author(s):

Elizabeth Ritt ◽

Nathan P. Taylor

Keyword(s):

At Risk ◽

Hospital Readmission ◽

Clinical Implications ◽

Patients At Risk ◽

Acute Patients

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Computed-Tomography Body Composition Analysis Complements Pre-Operative Nutrition Screening in Colorectal Cancer Patients on an Enhanced Recovery after Surgery Pathway

Nutrients ◽

10.3390/nu12123745 ◽

2020 ◽

Vol 12 (12) ◽

pp. 3745

Author(s):

Pamela Klassen ◽

Vickie Baracos ◽

Leah Gramlich ◽

Gregg Nelson ◽

Vera Mazurak ◽

...

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Computed Tomography ◽

At Risk ◽

Cancer Patients ◽

Short Form ◽

Composition Analysis ◽

Nutrition Screening ◽

Patients At Risk ◽

Poor Outcomes

Pre-operative nutrition screening is recommended to identify cancer patients at risk of malnutrition, which is associated with poor outcomes. Low muscle mass (sarcopenia) and lipid infiltration to muscle cells (myosteatosis) are similarly associated with poor outcomes but are not routinely screened for. We investigated the prevalence of sarcopenia and myosteatosis across the nutrition screening triage categories of the Patient-Generated Subjective Global Assessment Short Form (PG-SGASF) in a pre-operative colorectal cancer (CRC) cohort. Data were prospectively collected from patients scheduled for surgery at two sites in Edmonton, Canada. PG-SGASF scores ≥ 4 identified patients at risk for malnutrition; sarcopenia and myosteatosis were identified using computed-tomography (CT) analysis. Patients (n = 176) with a mean age of 63.8 ± 12.0 years, 52.3% male, 90.3% with stage I–III disease were included. Overall, 25.2% had PG-SGASF score ≥ 4. Sarcopenia alone, myosteatosis alone or both were identified in 14.0%, 27.3%, and 6.4% of patients, respectively. Sarcopenia and/or myosteatosis were identified in 43.4% of those with PG-SGASF score < 4 and in 58.5% of those with score ≥ 4. Overall, 32.9% of the cohort had sarcopenia and/or myosteatosis with PG-SGASF score < 4. CT-defined sarcopenia and myosteatosis are prevalent in pre-operative CRC patients, regardless of the presence of traditional nutrition risk factors (weight loss, problems eating); therefore, CT image analysis effectively adds value to nutrition screening by identifying patients with other risk factors for poor outcomes.

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Electronic health record cue identifies epilepsy patients at risk for obstructive sleep apnea

Neurology Clinical Practice ◽

10.1212/cpj.0000000000000502 ◽

2018 ◽

Vol 8 (6) ◽

pp. 468-471 ◽

Cited By ~ 1

Author(s):

Martha A. Mulvey ◽

Aravindhan Veerapandiyan ◽

David A. Marks ◽

Xue Ming

Keyword(s):

Risk Factors ◽

At Risk ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Electronic Health Record ◽

Seizure Control ◽

Health Record ◽

Obstructive Sleep ◽

Patients At Risk ◽

Patients With Epilepsy

BackgroundPrior studies have reported that patients with epilepsy have a higher prevalence of obstructive sleep apnea (OSA) that contributes to poor seizure control. Detection and treatment of OSA can improve seizure control in some patients with epilepsy. In this study, we sought to develop, implement, and evaluate the effectiveness of an electronic health record (EHR) alert to screen for OSA in patients with epilepsy.MethodsA 3-month retrospective chart review was conducted of all patients with epilepsy >18 years of age who were evaluated in our epilepsy clinics prior to the intervention. An assessment for obstructive sleep apnea (AOSA) consisting of 12 recognized risk factors for OSA was subsequently developed and embedded in the EHR. The AOSA was utilized for a 3-month period. Patients identified with 2 or more risk factors were referred for polysomnography. A comparison was made to determine if there was a difference in the number of patients at risk for OSA detected and referred for polysomnography with and without an EHR alert to screen for OSA.ResultsThere was a significant increase in OSA patient recognition. Prior to the EHR alert, 25/346 (7.23%) patients with epilepsy were referred for a polysomnography. Postintervention, 405/414 patients were screened using an EHR alert for AOSA and 134/405 (33.1%) were referred for polysomnography (p < 0.001).ConclusionAn intervention with AOSA cued in the EHR demonstrated markedly improved identification of epilepsy patients at risk for OSA and referral for polysomnography.

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A Review of Cisplatin-Associated Ototoxicity

Seminars in Hearing ◽

10.1055/s-0039-1684041 ◽

2019 ◽

Vol 40 (02) ◽

pp. 108-121 ◽

Cited By ~ 7

Author(s):

Jessica Paken ◽

Cyril Govender ◽

Mershen Pillay ◽

Vikash Sewram

Keyword(s):

Quality Of Life ◽

Risk Factors ◽

At Risk ◽

Health Care Professionals ◽

Monitoring Program ◽

Clinical Signs ◽

Incidence Rates ◽

Cellular Mechanisms ◽

Patients At Risk

AbstractCisplatin, an effective antineoplastic drug used in the treatment of many cancers, has ototoxic potential, thus placing cancer patients, receiving this treatment, at risk of hearing loss. It is therefore important for health care professionals managing these patients to be aware of cisplatin's ototoxic properties and its clinical signs to identify patients at risk of developing a hearing impairment. Eighty-five English peer-reviewed articles and two books, from January 1975 to July 2015, were identified from PubMed, ScienceDirect, and EBSCOhost. An overview of cisplatin-associated ototoxicity, namely its clinical features, incidence rates, molecular and cellular mechanisms, and risk factors, is presented in this article. This review further highlights the importance of a team-based approach to complement an audiological monitoring program in reducing any further loss in the quality of life of affected patients, as there is currently no otoprotective agent routinely recommended for the prevention of cisplatin-associated ototoxicity.

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Abstract 16121: Wellness in Pediatric Cardiac Intensivists - How are We Doing?

Circulation ◽

10.1161/circ.142.suppl_3.16121 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

David K Werho ◽

leslie rhodes ◽

Robin Horak ◽

Bradley S Marino ◽

David S Cooper ◽

...

Keyword(s):

Risk Factors ◽

At Risk ◽

Critical Care ◽

Heart Surgery ◽

Well Being ◽

Congenital Heart Surgery ◽

Risk Category ◽

Physician Wellness ◽

Modifiable Factors ◽

Cardiac Critical Care

Introduction: Poor physician wellness is associated with detrimental effects on patient outcomes. There are no data on physician wellness in pediatric cardiac critical care. We aimed to define the prevalence of and risk factors for impaired wellness using a targeted survey of the North American pediatric cardiac critical care workforce. Methods: We developed a survey to examine physician wellness and potential risk factors, incorporating the Expanded Physician Well Being Index. Unit directors at 120 congenital heart surgery centers were contacted to provide faculty emails. The survey was distributed to each faculty with targeted reminders from June - September 2019. Univariate and multivariable logistic regression analyses were performed comparing the at-risk respondents to those not at risk for poor wellness. Results: Of the 477 faculty, 294 completed the survey (62%). Faculty reported working a median of 83 hours on service weeks and 50 hours on non-service weeks. Based on Well-Being scores, 34% were in the “at risk” category; 56% reported feeling burned out in the past month and 46% reported feeling overwhelmed. However, 96% felt their work was meaningful. Faculty reported a high incidence of developing unhealthy habits including poor nutrition (50%), infrequent exercise (56%), and lack of self-care (46%). Factors associated with well-being risk are shown in Table 1. Poor interpersonal experiences, higher work hours, and being primarily trained in critical care with an additional cardiac year were associated with risk of poor wellness. Working >100 hours per service week had a significant increase in risk (odds ratio 2.3, 95% confidence interval 1.31-4.40). Availability of wellness services was associated with reduced risk. Conclusion: Burnout and risk of poor wellness are common in pediatric cardiac critical care faculty. Modifiable factors, including wellness service availability and reduced hours of clinical service may improve wellness in the workforce.

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