A Comparison of Peritoneal Equilibration Tests Performed 1 and 4 Weeks after PD Commencement

2004 ◽  
Vol 24 (5) ◽  
pp. 460-465 ◽  
Author(s):  
David W. Johnson ◽  
David W. Mudge ◽  
Sophie Blizzard ◽  
Mary Arndt ◽  
Amanda O'Shea ◽  
...  
Keyword(s):  
Prospective Observational Study ◽  
Clinical Decision Making ◽  
Tertiary Care ◽  
Clinical Decision ◽  
Glucose Measurement ◽  
Altman Analysis ◽  
Princess Alexandra Hospital ◽  
Peritoneal Equilibration Test ◽  
Bland Altman Analysis ◽  
Peritoneal Transport

Objective The aim of this study was to prospectively evaluate the ability of a peritoneal equilibration test (PET) performed in the first week of peritoneal dialysis (PD) to predict subsequent transport status, as determined by a PET at 4 weeks and >1 year after PD commencement. Design Prospective observational study of an incident PD cohort at a single center. Setting Tertiary-care institutional dialysis center. Participants The study included 50 consecutive patients commencing PD at the Princess Alexandra Hospital between 25/2/2001 and 14/5/2003 (mean age 60.9 ± 12.2 years, 54% male, 92% Caucasian, 38% diabetic). All patients were initially prescribed continuous ambulatory PD. Main Measurements Measurements performed during paired PETs included dialysate-to-plasma ratios of urea (D/P urea) and creatinine (D/P creatinine) at 4 hours, the ratio of dialysate glucose concentrations at 0 and 4 hours (D/D0 glucose), and drain volumes at 4 hours. Results When paired 1-week and 1-month PET data were analyzed, significant changes were observed in measured D/P urea (0.91 ± 0.07 vs 0.94 ± 0.07 respectively; p < 0.05), D/P creatinine (0.55 ± 0.12 vs 0.66 ± 0.11, p < 0.001), and D/D0 glucose (0.38 ± 0.08 vs 0.36 ± 0.10, p < 0.05). Using Bland–Altman analysis, the repeatability coefficients were 0.17, 0.20, and 0.13, respectively. Agreement between 1-week and 1-month PET measurements with respect to peritoneal transport category was moderate for D/D0 glucose (weighted κ 0.52), but poor for D/P urea (0.30), D/P creatinine (0.35), and drain volumes (0.20). The PET measurements performed more than 1 year following PD commencement ( n = 28) generally agreed closely with 1-month measurements, and poorly with 1-week measurements. Conclusions Peritoneal transport characteristics change significantly within the first month of PD. PETs carried out during this time should be considered preliminary and should be confirmed by a PET 4 weeks later. Nevertheless, performing an early D/D0 glucose measurement at 1 week predicted ultimate transport status sufficiently well to facilitate early clinical decision-making about optimal PD modality while patients were still receiving PD training. On the other hand, the widespread practice of using measured drain volumes in the first week to predict ultimate transport category is highly inaccurate and not recommended.

scholarly journals Analytical comparison between two automated biochemical analyzer systems: Roche Cobas 8000 and Mindray BS2000M

2021 ◽  
Author(s):  
Mingxing Chen ◽  
Simeng Qin ◽  
Sitao Yang ◽  
Huaping Chen ◽  
Liuyi Lu ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Altman Analysis ◽  
Serum Samples ◽  
Bland Altman Analysis ◽  
Systemic Error ◽  
Biochemical Analyzer ◽  
Two Machines ◽  
Roche Cobas

Summary Background. The values of biomarkers play a central role in routine clinical decision-making. Whereas, the performances of different automated chemical analyzers remain unclear. To determine the performances of different platforms, we evaluated the capability between Roche Cobas 8000 and Mindray BS2000M.  Methods. A total of 1869 remaining serum samples were collected. CK, LDH-1, RBP, Cys-c, IgA, IgM and IgG were assessed by using paired-t test, Passing-Bablok regression analysis and Bland Altman analysis according to CLSI EP5-A3. Results. There were significant in average bias of all items between two machines (P < 0.001). Due to the 95% confidence interval of intercept A included 0, CK, LDH-1, Cys-c and IgG were not show systemic error in Passing-Bablok regression analysis. Except for IgA, the r values and correlation coefficient of all items were higher than 0.91, which showed that the correlation and consistency is good. The Bland-Altman analysis showed that two instruments had more than 95% of the points apart from CK, LDH-1, and IgA. Conclusions. It can be considered that the two instruments have good correlation and consistency in CK, LDH-1, RBP, Cys-c, IgM and IgG, and the two instruments are interchangeable and can replace each other.

scholarly journals Sarcopenia as a Prognostic Factor for 90-Day and Overall Mortality in Patients Undergoing Spine Surgery for Metastatic Tumors: A Multicenter Retrospective Cohort Study

Neurosurgery ◽  
2020 ◽  
Vol 87 (5) ◽  
pp. 1025-1036 ◽  
Author(s):  
Hesham Mostafa Zakaria ◽  
Brandon Michael Wilkinson ◽  
Zach Pennington ◽  
Yamaan S Saadeh ◽  
Darryl Lau ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Spinal Metastasis ◽  
Tertiary Care ◽  
Spinal Metastases ◽  
Psoas Muscle ◽  
Clinical Decision ◽  
Tokuhashi Score ◽  
Tomita Score ◽  
Overall Mortality

Abstract BACKGROUND Novel methods in predicting survival in patients with spinal metastases may help guide clinical decision-making and stratify treatments regarding surgery vs palliative care. OBJECTIVE To evaluate whether the frailty/sarcopenia paradigm is predictive of survival and morbidity in patients undergoing surgery for spinal metastasis. METHODS A total of 271 patients from 4 tertiary care centers who had undergone surgery for spinal metastasis were identified. Frailty/sarcopenia was defined by psoas muscle size. Survival hazard ratios were calculated using multivariate analysis, with variables from demographic, functional, oncological, and surgical factors. Secondary outcomes included improvement of neurological function and postoperative morbidity. RESULTS Patients in the smallest psoas tertile had shorter overall survival compared to the middle and largest tertile. Psoas size (PS) predicted overall mortality more strongly than Tokuhashi score, Tomita score, and Karnofsky Performance Status (KPS). PS predicted 90-d mortality more strongly than Tokuhashi score, Tomita score, and KPS. Patients with a larger PS were more likely to have an improvement in deficit compared to the middle tertile. PS was not predictive of 30-d morbidity. CONCLUSION In patients undergoing surgery for spine metastases, PS as a surrogate for frailty/sarcopenia predicts 90-d and overall mortality, independent of demographic, functional, oncological, and surgical characteristics. The frailty/sarcopenia paradigm is a stronger predictor of survival at these time points than other standards. PS can be used in clinical decision-making to select which patients with metastatic spine tumors are appropriate surgical candidates.

scholarly journals Assessment of a laboratory critical risk result notification protocol in a tertiary care hospital and their use in clinical decision making

2019 ◽  
Vol 29 (3) ◽  
pp. 513-521
Author(s):  
Jose A. Delgado Rodríguez ◽  
Maria I. Pastor García ◽  
Cristina Gómez Cobo ◽  
Antonia R. Pons Más ◽  
Isabel Llompart Alabern ◽  
...  
Keyword(s):  
Decision Making ◽  
Medical Records ◽  
Clinical Decision Making ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Clinical Decision ◽  
Care Hospital ◽  
Online Questionnaire ◽  
Risk Result ◽  
The Impact

Introduction: Communication of laboratory critical risk results is essential for patient safety, as it allows early decision making. Our aims were: 1) to retrospectively evaluate the current protocol for telephone notification of critical risk results in terms of rates, efficiency and recipient satisfaction, 2) to assess their use in clinical decision making and 3) to suggest alternative tools for a better assessment of notification protocols. Materials and methods: The biochemical critical risk result notifications reported during 12 months by routine and STAT laboratories in a tertiary care hospital were reviewed. Total number of reports, time for the notification and main magnitudes with critical risk results were calculated. The use of notifications in clinical decision making was assessed by reviewing medical records. Satisfaction with the notification protocol was assessed through an online questionnaire to requesting physicians and nurses. Results: Critical result was yielded by 0.1% of total laboratory tests. Median time for notification was 3.2 min (STAT) and 16.9 min (routine). The magnitudes with a greater number of critical results were glucose and potassium for routine analyses, and troponin, sodium for STAT. Most notifications were not reflected in the medical records. Overall mean satisfaction with the protocol was 4.2/5. Conclusion: The results obtained indicate that the current protocol is appropriate. Nevertheless, there are some limitations that hamper the evaluation of the impact on clinical decision making. Alternatives were proposed for a proper and precise evaluation.

scholarly journals Taking the Pulse of POCUS: The State of Point-of-Care Ultrasound at a Pediatric Tertiary Care Hospital

POCUS Journal ◽  
2021 ◽  
Vol 6 (2) ◽  
pp. 80-87
Author(s):  
Peter Gutierrez ◽  
Tal Berkowitz ◽  
Lekha Shah ◽  
Stephanie G. Cohen
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Point Of Care ◽  
Tertiary Care ◽  
Clinical Decision ◽  
Program Directors ◽  
Training Data ◽  
Point Of Care Ultrasound ◽  
Care Hospital ◽  
Future Practice

We aim to quantify and categorize point-of-care ultrasound (POCUS) usage by pediatric practitioners and trainees at our tertiary care center, and assess the degree of interest from pediatric residents, fellows, and program leaders for integrating POCUS into their training. Data was collected via online survey, evaluating the current use of POCUS in clinical decision making, desire for further formal training, and opinions on the importance of POCUS to future clinical practice. In total, 14 program directors/assistant program directors (PD/APDs) representing 10 of 15 training programs, 30 of 95 fellows representing 9 of 15 fellowships, and 32 of 82 residents responded. From PD/APDs, only 2 of the programs reported active use POCUS for clinical decision making, but 13 of the fellows and 9 residents reported doing so. In regard to desire for a formal POCUS program, 30.8% of PD/APDs, 43.8% of fellows without current curricula, and 87.5% of residents were interested in participating in such a program. When considering specialty, some non-acute care-based PD/APDs and fellows at our institution felt that POCUS was important to future practice. Pediatric subspecialty PD/APDs and their fellows had divergent outlooks on the importance of POCUS in future practice. Finally, an overwhelming majority of residents at our institution expressed a desire to learn, and half believing it will be important to future practice. Based on the degree of interest, medicolegal considerations, and trajectory of patient care, pediatric residency and fellowship programs should strongly consider integrating POCUS education into their curricula.

DRIVERS OF THE DECISION TO BIOPSY AND FOLLOW-UP OF SMALL SUSPICIOUS THYROID NODULES

2020 ◽  
Vol 26 (8) ◽  
pp. 857-868 ◽  
Author(s):  
Natalia Genere ◽  
Maria Daniela Hurtado ◽  
Tiffany Cortes ◽  
Shobana Athimulam ◽  
Ruaa Al Ward ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Thyroid Nodules ◽  
Clinical Decision Making ◽  
Care Center ◽  
Tertiary Care ◽  
Clinical Decision ◽  
American Thyroid Association ◽  
Nodule Volume ◽  
Ultrasound Features

Objective: In 2015, the updated American Thyroid Association (ATA) guidelines recommended observation for suspicious subcentimeter thyroid nodules, based on their indolent course. We aimed to evaluate the frequency of biopsy in suspicious thyroid nodules since the introduction of these guidelines, including factors contributing to clinical decision-making in a tertiary care center. Methods: We conducted a retrospective study of patients in the Mayo Clinic, Rochester, Minnesota, with new, subcentimeter suspicious thyroid nodules (by report or by sonographic features) between March, 2015, and November, 2017, not previously biopsied. Results: We identified 141 nodules in 129 patients: mean age 58.1 ± 14.1 years, 74% female, 87% Caucasian. The frequency of biopsy in suspicious thyroid nodules was 39%. Ultrasound features that were the strongest predictors for biopsy on multivariate analysis included: nodule volume (odds ratio [OR] 37.3 [7.5–188.7]), radiology recommendation for biopsy (OR 2.6 [1.8–3.9]) and radiology report of the nodule as “suspicious” (OR 2.1 [1.4–3.2]). Patient’s age and degree of comorbidities did not change the likelihood for biopsy, nor did it vary by clinician type or how the nodule was initially found (incidentally or not incidentally). Among 86 nodules that were not biopsied, 41% had no specific follow-up recommendations. Conclusion: One third of suspicious thyroid nodules underwent biopsy since the release of updated ATA guidelines. Factors driving thyroid biopsy seem to be associated with nodule characteristics but not with patient factors including age and comorbidities. Further studies and development of decision aides may be helpful in providing individualized approaches for suspicious thyroid nodules. Abbreviations: ATA = American Thyroid Association; OR = odds ratio

scholarly journals A clinical study on diagnostic, clinicopathological correlation of acute cholecystitis

2018 ◽  
Vol 5 (6) ◽  
pp. 2228
Author(s):  
Gopalakrishnan Mohandhas ◽  
Vijayan Nallathambi ◽  
Srinivasan Ravi Iyenkar
Keyword(s):  
Acute Cholecystitis ◽  
Clinical Decision Making ◽  
Clinical Presentation ◽  
Tertiary Care ◽  
Age Groups ◽  
Acalculous Cholecystitis ◽  
Final Analysis ◽  
Clinical Decision ◽  
Management Options ◽  
Advantages And Disadvantages

Background: Acute cholecystitis (AC) one of the common surgical emergency. Thorough understanding of the profile of clinical presentation may help in clinical decision making in resource poor settings. Hence the present study is conducted with the objectives to study the clinico pathological profile of acute cholecystitis cases presenting to a tertiary care teaching hospital and to describe the management and complications.Methods: A prospective observational study was conducted in the department of emergency and general surgery of Dhanalakshmi Srinivas medical college and hospital. The study included 50 clinically confirmed cases of acute cholestasis presented between June 2017 to December 2017.Results: A total of 50 subjects were included in the final analysis. The highest proportion of subjects were in 46 to 50 years (28%) or 51 and above (26%) age groups. Females (56%) outnumbered males (44%). Right hypo chondral tenderness (100%) was the most common clinical presentation. The proportion of calculous and acalculous cholecystitis was 84% and 14% respectively, remaining 2% of cases were malignancies. The proportion of emergency and elective surgeries were 12% and 88% respectively. The most common organism cultured was E. coli in 24%, Staph, aureus in 14%, salmonella in 2% of the population. Post-operative wound infection was more commonly seen in culture positive cases.Conclusions: Health care practitioners at various levels need to have a good understanding of varied clinical presentation of acute cholecystitis and different management options, their advantages, and disadvantages to be able to treat the condition effectively. 

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