Sodium Removal in Patients Undergoing CAPD and Automated Peritoneal Dialysis

Objectives To compare sodium removal in continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD) patients, and to identify the main factors that modify Na removal in clinical practice in these patients. Design Study in three steps. Cross-sectional observational (Study A), and longitudinal interventional (Studies B and C). Patients and Methods First (Study A) we carried out a cross-sectional survey of Na removal in 63 patients on CAPD and 78 patients on APD. Second (Study B), we studied Na removal in 32 patients before and after changing from CAPD to APD therapy. Finally (Study C), we analyzed the impact on Na removal of introducing icodextrin for the long dwell in 16 patients undergoing CAPD or APD. Results In Study A, total Na removal averaged 210 mmol/day for CAPD patients and 91 mmol/day for APD patients ( p < 0.001); Na removal was < 100 mmol/day in 7.1% of CAPD patients and 56.4% of APD patients. Multivariate analysis identified ultrafiltration [B = 125 mmol/day, 95% confidence interval (CI) 110, 140], CAPD therapy (B = 60 mmol/day, 95%CI 37, 83), and residual diuresis (B = 51 mmol/L, 95%CI 34, 69) as independent predictors of Na removal (adjusted r2 = 0.76). For APD patients, longer nocturnal dwell times and performing a supplementary diurnal exchange were also independently associated with higher Na removal rates. In Study B, Na removal decreased from 192 to 92 mmol/day (median) after the change to APD ( p = 0.02). In Study C, peritoneal Na removal increased from 98 to 148 mmol/day (median) ( p = 0.04) after introducing icodextrin. Conclusions Standard APD schedules are frequently associated with poor Na removal rates. For any degree of ultrafiltration, Na removal is better in CAPD than in APD. Icodextrin, supplementary diurnal exchanges, and longer nocturnal dwell times improve Na removal in APD. Sodium removal can be estimated from ultrafiltration in patients on CAPD, but must be specifically monitored in patients on APD.

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Analysis of the Impact of the Confinement Resulting from COVID-19 on the Lifestyle and Psychological Wellbeing of Spanish Pregnant Women: An Internet-Based Cross-Sectional Survey

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17165933 ◽

2020 ◽

Vol 17 (16) ◽

pp. 5933 ◽

Cited By ~ 7

Author(s):

Gemma Biviá-Roig ◽

Valentina Lucia La Rosa ◽

María Gómez-Tébar ◽

Lola Serrano-Raya ◽

Juan José Amer-Cuenca ◽

...

Keyword(s):

Quality Of Life ◽

Pregnant Women ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Eating Pattern ◽

Before And After ◽

Related Quality ◽

Health Related ◽

The Impact

(1) Background: This study aimed to analyze the impact of the confinement due to the COVID-19 pandemics on the eating, exercise, and quality-of-life habits of pregnant women. (2) Methods: This was an internet-based cross-sectional survey which collected information about adherence to the Mediterranean diet, physical exercise, health-related quality of life (HRQoL), and perceived obstacles (in terms of exercise, preparation for delivery, and medical appointments) of pregnant women before and after the confinement. The survey was conducted in 18–31 May 2020. (3) Results: A total of 90 pregnant women participated in this study. There was a significant decrease in the levels of physical activity (p < 0.01) as well as in HRQoL (p < 0.005). The number of hours spent sitting increased by 50% (p < 0.001), 52.2% were unable to attend delivery preparation sessions because these had been cancelled. However, there were no significant differences in the eating pattern of these women (p = 0.672). Conclusions: These results suggest the need to implement specific online programs to promote exercise and reduce stress, thus improving the HRQoL in this population, should similar confinements need to occur again for any reason in the future.

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Impact of Lockdown on Tuberculosis Management during SARS-Cov-2 Pandemic: Urban & Rural Scenario of Surat

Healthline ◽

10.51957/healthline_217_2021 ◽

2021 ◽

Vol 12 (2) ◽

pp. 13-20

Author(s):

Parul Vadgama ◽

Bhoomika Patel ◽

J K Kosambiya ◽

Anas Patni ◽

U. C. Samudyatha ◽

...

Keyword(s):

Drug Resistance ◽

Treatment Success ◽

Case Fatality ◽

Secondary Data ◽

Simple Random Sampling ◽

Analysis Data ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Before And After ◽

The Impact

Introduction: India has highest burden of tuberculosis cases both drug sensitive as well as drug resistance in the world. Covid 19 pandemic had affected infectious diseases like TB, HIV, Malaria in developing countries like India. Here, we aimed to study the impact of lockdown on diagnosis and management of tuberculosis in Surat, Gujarat, India due to SARS Cov 2. Method: Cross sectional survey of Tuberculosis patients regarding problems faced during lockdown involving all 18 Tb unitof SMC was done, 15 patients were randomly selected by simple random sampling of line list of patients of each unitand secondary data analysis, data was collected from District Tuberculosis centre for rural part and SMC for urban part. Results: In this study we compared data 5 months before and after lockdown i.e. November 2019 to March 2020 and April 2020 to August 2020 , comparison of diagnostic tests like sputum examination by staining, CBNAAT, and first line Line Probe Assay (LPA) which shows significant reduction in number of test. Also the number of cases of pulmonary as well as drug sensitive, drug resistance and no of referral cases too were significantly decreased during and after lockdown. However, treatment success rate and case fatality rate remain the same as five months before and after the lockdown. Conclusion: Comparison of diagnostic test of TB showed significant reduction in number of tests done during and after lockdown. It was also observed that no major issues were faced by patients from health care provider side of National Tuberculosis Elimination Programme.

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Optimized vs. Standard Automated Peritoneal Dialysis Regimens (OptiStAR): Study Protocol for a Randomized Controlled Crossover Trial

10.21203/rs.2.24303/v2 ◽

2020 ◽

Author(s):

Karin Bergling ◽

Javier de Arteaga ◽

Fabián Ledesma ◽

Carl Mikael Öberg

Keyword(s):

Peritoneal Dialysis ◽

Clinical Investigation ◽

Glucose Absorption ◽

Treatment Session ◽

Crossover Fashion ◽

Diabetic Patients ◽

Automated Peritoneal Dialysis ◽

Open Label ◽

Sodium Removal ◽

Before And After

Abstract Background: It has been estimated that automated peritoneal dialysis (APD) is currently the fastest growing renal replacement therapy in the world. However, in light of the growing number of diabetic patients on peritoneal dialysis (PD), the unwanted glucose absorption during APD remains problematic. Recent results, using an extended 3-pore model of APD, indicated that large reductions in glucose absorption are possible by using optimized bi-modal treatment regimens, having “UF cycles” using a higher glucose concentration and “Clearance cycles” using a low concentration or, preferentially, no glucose. The present study is designed to test the theoretical prediction of a lower glucose absorption using these novel regimes.Methods: This study is a randomized single-center, open-label, prospective study. Prevalent PD patients between 18 to 75 years old without known catheter problems or recent peritonitis are eligible for inclusion. Patients are allocated to a first treatment session of either Standard APD (6 × 2 L 1.36% over 9 hours) or Optimized APD (7 × 2 L 2.27% + 5 × 2 L 0.1% over 8 hours). A second treatment session using the other treatment will be performed in a crossover fashion. Samples of the dialysis fluid will be taken before and after the treatment and the volume of the dialysate before and after the treatment will be carefully assessed. The primary endpoint is difference in glucose absorption between the Optimized and Standard treatment. Secondary endpoints are ultrafiltration, sodium removal, Kt/V urea and Kt/V Creatinine. The study will be closed when a total of 20 patients have successfully completed the interventions or terminated according to interim analysis. A Monte Carlo power analysis shows that the study has 80% power to detect a difference of 10 g (in line with that of theoretical results) in glucose absorption between the two treatments in 10 patients.Discussion: The present study is the first clinical investigation of optimized bi-modal treatments proposed by recent theoretical studies.Trial registration: ClinicalTrials.gov identifier: NCT04017572. Registration date: 12/07/2019, retrospectively registered. URL: https://clinicaltrials.gov/ct2/show/NCT04017572

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Effects of Two Simplified Methods of Dialysate Sampling on Estimations of Adequacy Indices in Automated Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.1177/089686080102100607 ◽

2001 ◽

Vol 21 (6) ◽

pp. 575-580 ◽

Cited By ~ 1

Author(s):

Ana Rodríguez–Carmona ◽

Miguel Pérez–Fontán

Keyword(s):

Peritoneal Dialysis ◽

Tertiary Care ◽

Reference Method ◽

Care Hospital ◽

Automated Peritoneal Dialysis ◽

Protein Loss ◽

Cross Sectional ◽

Sodium Removal ◽

Inaccurate Estimation ◽

Noninterventional Study

Objective To assess the effects of two simplified methods of dialysate sampling on the estimation of adequacy markers in automated peritoneal dialysis (APD). Design Cross-sectional noninterventional study. Setting Tertiary-care hospital. Patients Forty-nine patients undergoing standard APD therapy (36 nontidal, 13 tidal with low reserve volume). Intervention We estimated creatinine clearance (CCr), Kt/V urea, sodium removal, and peritoneal protein loss using two simplified methods. We calculated separate diurnal and nocturnal adequacies. Nocturnal concentrations of urea, creatinine, sodium, and proteins were extrapolated from dialysate samples taken after the first (method A) or the last (method B) cycle of the night. For the reference method, we estimated adequacy from a complete 24-hour dialysate collection. Results Spearman correlations versus the reference method were, for CCr, 0.82 for method A and 0.87 for method B; and for Kt/V, 0.78 (A) and 0.72 (B). Method A overestimated CCr by 19.6% (4.5 L/week)(median values) and Kt/V by 8.8% (0.12). Method B overestimated CCr by 5.0% (1.7 L/week) and Kt/V by 4.4% (0.06). Both methods estimated sodium removal accurately, but estimated protein loss poorly. Tidal APD was associated with a clear overestimation of adequacy indices with both methods. In fact, when only nontidal patients were considered, method B slightly underestimated CCr and Kt/V. Conclusions In APD, estimation of nocturnal adequacy from dialysate samples taken after the first cycle is inaccurate. Estimation from samples taken after the last cycle yields suboptimal but acceptable results; the deviation is small and the dose of dialysis delivered to the patients is not overestimated.

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Did the accuracy of oral amoxicillin dosing of children improve after British National Formulary dose revisions in 2014? National cross-sectional survey in England

BMJ Open ◽

10.1136/bmjopen-2017-016363 ◽

2017 ◽

Vol 7 (9) ◽

pp. e016363 ◽

Cited By ~ 2

Author(s):

Olivia Rann ◽

Mike Sharland ◽

Paul Long ◽

Ian C K Wong ◽

Anthony A Laverty ◽

...

Keyword(s):

British National Formulary ◽

Oral Antibiotic ◽

National Formulary ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Oral Amoxicillin ◽

Before And After ◽

The Impact ◽

Antibiotic Dosing ◽

British Children

ObjectivesInaccurate antibiotic dosing can lead to treatment failure, fuel antimicrobial resistance and increase side effects. The British National Formulary for Children (BNFC) guidance recommends oral antibiotic dosing according to age bands as a proxy for weight. Recommended doses of amoxicillin for children were increased in 2014 ‘after widespread concerns of under dosing’. However, the impact of dose changes on British children of different weights is unknown, particularly given the rising prevalence of childhood obesity in the UK. We aimed to estimate the accuracy of oral amoxicillin dosing in British children before and after the revised BNFC guidance in 2014.Setting and participantsWe used data on age and weights for 1556 British children (aged 2–18 years) from a nationally representative cross-sectional survey, the Health Survey for England 2013.InterventionsWe calculated the doses each child would receive using the BNFC age band guidance, before and after the 2014 changes, against the ‘gold standard’ weight-based dose of amoxicillin, as per its summary of product characteristics.Primary outcome measureAssuming children of different weights were equally likely to receive antibiotics, we calculated the percentage of the children who would be at risk of misdosing by the BNFC age bands.ResultsBefore 2014, 54.6% of children receiving oral amoxicillin would have been underdosed and no child would have received more than the recommended dose. After the BNFC guidance changed in 2014, the number of children estimated as underdosed dropped to 5.8%, but 0.5% of the children would have received too high a dose.ConclusionsChanges to the BNFC age-banded amoxicillin doses in 2014 have significantly reduced the proportion of children who are likely to be underdosed, with only a minimal rise in the number of those above the recommended range.

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Psychological Impacts of COVID-19 During the First Nationwide Lockdown in Vietnam: Web-Based, Cross-Sectional Survey Study (Preprint)

10.2196/preprints.24776 ◽

2020 ◽

Author(s):

Khanh Ngoc Cong Duong ◽

Tien Nguyen Le Bao ◽

Phuong Thi Lan Nguyen ◽

Thanh Vo Van ◽

Toi Phung Lam ◽

...

Keyword(s):

Psychological Distress ◽

General Population ◽

Psychological Health ◽

Online Survey ◽

Survey Study ◽

Limited Information ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Event Scale ◽

The Impact

BACKGROUND The first nationwide lockdown due to the COVID-19 pandemic was implemented in Vietnam from April 1 to 15, 2020. Nevertheless, there has been limited information on the impact of COVID-19 on the psychological health of the public. OBJECTIVE This study aimed to estimate the prevalence of psychological issues and identify the factors associated with the psychological impact of COVID-19 during the first nationwide lockdown among the general population in Vietnam. METHODS We employed a cross-sectional study design with convenience sampling. A self-administered, online survey was used to collect data and assess psychological distress, depression, anxiety, and stress of participants from April 10 to 15, 2020. The Impact of Event Scale-Revised (IES-R) and the Depression, Anxiety, and Stress Scale-21 (DASS-21) were utilized to assess psychological distress, depression, anxiety, and stress of participants during social distancing due to COVID-19. Associations across factors were explored using regression analysis. RESULTS A total of 1385 respondents completed the survey. Of this, 35.9% (n=497) experienced psychological distress, as well as depression (n=325, 23.5%), anxiety (n=195, 14.1%), and stress (n=309, 22.3%). Respondents who evaluated their physical health as average had a higher IES-R score (beta coefficient [B]=9.16, 95% CI 6.43 to 11.89), as well as higher depression (B=5.85, 95% CI 4.49 to 7.21), anxiety (B=3.64, 95% CI 2.64 to 4.63), and stress (B=5.19, 95% CI 3.83 to 6.56) scores for DASS-21 than those who rated their health as good or very good. Those who self-reported their health as bad or very bad experienced more severe depression (B=9.57, 95% CI 4.54 to 14.59), anxiety (B=7.24, 95% CI 3.55 to 10.9), and stress (B=10.60, 95% CI 5.56 to 15.65). Unemployment was more likely to be associated with depression (B=3.34, 95% CI 1.68 to 5.01) and stress (B=2.34, 95% CI 0.84 to 3.85). Regarding worries about COVID-19, more than half (n=755, 54.5%) expressed concern for their children aged <18 years, which increased their IES-R score (B=7.81, 95% CI 4.98 to 10.64) and DASS-21 stress score (B=1.75, 95% CI 0.27 to 3.24). The majority of respondents (n=1335, 96.4%) were confident about their doctor’s expertise in terms of COVID-19 diagnosis and treatment, which was positively associated with less distress caused by the outbreak (B=–7.84, 95% CI –14.58 to –1.11). CONCLUSIONS The findings highlight the effect of COVID-19 on mental health during the nationwide lockdown among the general population in Vietnam. The study provides useful evidence for policy decision makers to develop and implement interventions to mitigate these impacts. CLINICALTRIAL

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COVID-19 Psychological Impact on Health Care Workers in Saudi Arabia

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18116076 ◽

2021 ◽

Vol 18 (11) ◽

pp. 6076

Author(s):

Hasan S. Alamri ◽

Wesam F. Mousa ◽

Abdullah Algarni ◽

Shehata F. Megahid ◽

Ali Al Bshabshe ◽

...

Keyword(s):

Health Care ◽

Saudi Arabia ◽

Health Care Workers ◽

Psychological Impact ◽

Psychological Outcomes ◽

Cross Sectional Survey ◽

Online Questionnaire ◽

Cross Sectional ◽

Care Workers ◽

The Impact

Objective: Little is known about the impact of Coronavirus (COVID-19) among the health care workers in Saudi Arabia. Therefore, the present study aimed to assess the psychological impact of COVID-19 among the health care workers. Methods: A cross-sectional survey was conducted from May till mid-July among 389 health care workers from government and private hospitals in Saudi Arabia. Data was collected using a pre-structured online questionnaire that measured adverse psychological outcomes, including the Patient Health Questionnaire-9 (PHQ-9) scale and the Generalized Anxiety Disorder 7-item (GAD-7) scale. The Pearson chi-square test was used to assess the distribution of depression and anxiety among health care workers. Results: A high level of anxiety was recorded among the health care workers, and 69.3% of health care workers below the age of 40 were found to have depression. There was a significant increase in depression among staff with chronic health problems (72.1% vs. 61.9%; p = 0.048). High anxiety levels were detected among young staff compared to others (68.7% vs. 43.8%; p = 0.001). Moreover, 82.1% of the female staff were anxious, as compared to 55.6% of the males (p = 0.001). Conclusions: We found increased prevalence of adverse psychological outcomes among the health care workers in Saudi Arabia during the outbreak of COVID-19. Therefore, there is a need for proper screening and development of corresponding preventive measures to decrease the adverse psychological outcomes.

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Are e-learning Webinars the future of medical education? An exploratory study of a disruptive innovation in the COVID-19 era

Cardiology in the Young ◽

10.1017/s1047951120004503 ◽

2020 ◽

pp. 1-10

Author(s):

Colin J. McMahon ◽

Justin T. Tretter ◽

Theresa Faulkner ◽

R. Krishna Kumar ◽

Andrew N. Redington ◽

...

Keyword(s):

Deep Learning ◽

Carbon Footprint ◽

Quantitative Research ◽

Survey Design ◽

Hybrid Approach ◽

Disruptive Innovation ◽

Cross Sectional Survey ◽

Cross Sectional ◽

E Learning ◽

The Impact

Abstract Objective: This study investigated the impact of the Webinar on deep human learning of CHD. Materials and methods: This cross-sectional survey design study used an open and closed-ended questionnaire to assess the impact of the Webinar on deep learning of topical areas within the management of the post-operative tetralogy of Fallot patients. This was a quantitative research methodology using descriptive statistical analyses with a sequential explanatory design. Results: One thousand-three-hundred and seventy-four participants from 100 countries on 6 continents joined the Webinar, 557 (40%) of whom completed the questionnaire. Over 70% of participants reported that they “agreed” or “strongly agreed” that the Webinar format promoted deep learning for each of the topics compared to other standard learning methods (textbook and journal learning). Two-thirds expressed a preference for attending a Webinar rather than an international conference. Over 80% of participants highlighted significant barriers to attending conferences including cost (79%), distance to travel (49%), time commitment (51%), and family commitments (35%). Strengths of the Webinar included expertise, concise high-quality presentations often discussing contentious issues, and the platform quality. The main weakness was a limited time for questions. Just over 53% expressed a concern for the carbon footprint involved in attending conferences and preferred to attend a Webinar. Conclusion: E-learning Webinars represent a disruptive innovation, which promotes deep learning, greater multidisciplinary participation, and greater attendee satisfaction with fewer barriers to participation. Although Webinars will never fully replace conferences, a hybrid approach may reduce the need for conferencing, reduce carbon footprint. and promote a “sustainable academia”.

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