Practice variations in antibiotic administration for the management of peritonitis in patients on automated peritoneal dialysis in Australia and New Zealand

2022 ◽  
pp. 089686082110692
Author(s):  
Chau Wei Ling ◽  
Kamal Sud ◽  
Connie Van ◽  
Gregory M Peterson ◽  
Rahul P Patel ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Clinical Practice ◽  
New Zealand ◽  
Nursing Staff ◽  
Dwell Time ◽  
Online Survey ◽  
Antibiotic Administration ◽  
Automated Peritoneal Dialysis ◽  
Cross Sectional ◽  
Practice Variations

In the absence of guidelines on the management of peritoneal dialysis (PD)-associated peritonitis in patients on automated peritoneal dialysis (APD), variations in clinical practice potentially exist between PD units that could affect clinical outcomes. This study aimed to document the current practices of treating PD-associated peritonitis in patients on APD across Australia and New Zealand and the reasons for practice variations using a cross-sectional online survey. Of the 62 PD units, 34 medical leads (55%) responded to the survey. When treating APD-associated peritonitis, 21 units (62%) continued patients on APD and administered intraperitoneal (IP) antibiotics in manual daytime exchanges; of these, 17 (81%) considered allowing at least 6 h dwell time for adequate absorption of the IP antibiotics as an important reason for adding manual daytime exchange. Nine units (26%) temporarily switched patients from APD to continuous ambulatory peritoneal dialysis (CAPD); of these, five (55%) reported a lack of pharmacokinetic (PK) data for IP antibiotics in APD, four (44%) reported a shortage of APD-trained nursing staff to perform APD exchanges during hospitalisation and three (33%) reported inadequate time for absorption of IP antibiotics on APD as important reasons for their practice. Four units (12%) continued patients on APD and administered IP antibiotics during APD exchanges; of these, three (75%) believed that PK data available in CAPD could be extrapolated to APD. This study demonstrates wide variations in the management of APD-associated peritonitis in Australia and New Zealand; it points towards the lack of PK on antibiotics used to treat peritonitis as an important reason underpinning practice variations.

scholarly journals Rotator cuff disorders: a survey of current (2016) UK physiotherapy practice

2017 ◽  
Vol 10 (1) ◽  
pp. 52-61 ◽  
Author(s):  
Julie Bury ◽  
Chris Littlewood
Keyword(s):  
Clinical Practice ◽  
Rotator Cuff ◽  
Management Strategy ◽  
Online Survey ◽  
Exercise Prescription ◽  
Current Evidence ◽  
Positive Finding ◽  
Cross Sectional ◽  
Initial Management ◽  
Physiotherapy Practice

Background Shoulder pain is a common musculoskeletal presentation, with disorders of the rotator cuff (RC) regarded as the most frequent cause. Conservative treatment is often the initial management; however, findings from a previous survey showed considerable variations in clinical practice, including the use of modalities that are not supported in the literature, suggesting that research is not impacting on practice. The present study aimed to survey current UK physiotherapy practice for the management of RC disorders and to determine whether this has changed over the 5-year period since the last survey was conducted. Methods A cross-sectional online survey of UK physiotherapists was conducted. Results One hundred and ninety-one respondents completed the survey which showed that advice/education and some form of exercise therapy are most commonly used as a management strategy for RC disorders. There is a lack of agreement however regarding exercise prescription. The survey suggests less use of passive modalities, indicating that practice has advanced over the last 5 years in line with the current evidence. Conclusions The present study has highlighted that the clinical practice of the survey respondents was in line with current recommendations from research. Hence, in contrast to the survey conducted 5 years previously, research appears to be impacting on practice, which is a positive finding.

Evaluation of the Peritoneal Equilibration Test in Children on Chronic Peritoneal Dialysis

1993 ◽  
Vol 13 (2_suppl) ◽  
pp. 260-262 ◽  
Author(s):  
Alberto Edefonti ◽  
Marina Picca ◽  
Raffaele Galato ◽  
Sophie Guez ◽  
Marisa Giani ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Dwell Time ◽  
Glucose Solution ◽  
Transport Rate ◽  
Chronic Peritoneal Dialysis ◽  
Automated Peritoneal Dialysis ◽  
Peritoneal Equilibration Test ◽  
Blood Samples ◽  
Mean Values ◽  
Significant Difference

The peritoneal equilibration test (PET) is routinely performed in adults treated with chronic peritoneal dialysis to assess the peritoneal transport rate and to optimize treatment prescription. Only a few and not well-standardized studies on the PET have been reported in children. Twenty-six PETs were performed In 16 children, mean age 10.9±4.9 years, mean body weight (BW) 26.8±11.9 kg, treated with nightly intermittent peritoneal dialysis (NIPD). The PET was performed according to Twardowski. Forty mL/kg BW of 2.27% glucose solution were Infused at a rate of 10 mL/kg BW every 2 minutes. In the simplified test, dialysate samples were taken at dwell times 0, 2 and 4 hours for glucose and creatinine. A blood sample was taken after a 2-hour dwell time for the same parameters. The standard PET (8 patients) consisted of dialysate samples at 0, 15, 30, 60, 120, and 240 minutes and blood samples at 0 and 240 minutes. Mean DIP ratio for corrected creatinine and DIDo ratio for glucose at 2 hours were 51.6±11.6 and 50.4±9, respectively; at 4 hours 69.6± 12 and 34.4±9.8, respectively. There was good correlation between DIP creatinine and DIDo glucose at 4 hours (p<0.0001). Patients were classified as high (3 cases), high-average (5), low-average (6), and low (2) transporters. A statistically significant difference was found between the curves obtained by the simplified PET and those of the standard PET In the first hour (r=0.66; p<0.05). In conclusion, the PET, modified for use in children, gave reliable and reproducible results. Mean values of DIP creatinine for children were higher and DIDo glucose lower than those of adults as reported by Twardowskl. A consistent percentage of children had, nevertheless, a low-average or low transport rate. Standard PET is required in case of automated peritoneal dialysis prescription.

Practice of Peritoneal Dialysis Catheter Flushing in Australia and New Zealand: Multi-Center Cross-Sectional Survey

2017 ◽  
Vol 38 (2) ◽  
pp. 98-103 ◽  
Author(s):  
Yeoungjee Cho ◽  
Neil Boudville ◽  
Suetonia C. Palmer ◽  
Josephine S.F. Chow ◽  
Carmel M. Hawley ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
New Zealand ◽  
Clinical Care ◽  
Peritoneal Dialysis Catheter ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Effective Interventions ◽  
Catheter Obstruction ◽  
Catheter Malfunction ◽  
On Line

Background Evidence of effective interventions to prevent peritoneal dialysis (PD) catheter malfunction before first use is presently insufficient to guide clinical care. Regular flushing of the PD catheter (e.g. before PD commencement) has been adopted by some practitioners in the belief that it will prevent catheter obstruction and/or malfunction. The aim of this study was to characterize and evaluate PD catheter flushing practices across Australian and New Zealand PD units. Methods An on-line survey was distributed to all 62 PD units in Australia (12 August 2016; n = 51) and New Zealand (2 February 2017; n = 11), with questions relating to PD catheter flushing practices, audit, and outcomes. Results Forty-nine units of variable size (< 16 to > 100 patients) completed the survey (79% response rate). All centers flushed PD catheters at some stage after insertion as routine unit practice. Forty-one units (84%) routinely flushed during periods of PD rest at varying intervals ranging from alternate daily to monthly. The type and volume of solution used to flush varied between units. Units that practised routine flushing of PD catheters were almost twice as likely to audit their catheter-related outcomes (66% vs 38%, p = 0.23) and more likely to have reported blocked catheters in the preceding 12 months (84% vs 0%, p = 0.01) compared with those units that did not routinely flush PD catheters. Thirty units (61%) regularly audited and monitored catheter-related outcomes. Conclusions This study identified a wide variation in center practices relating to PD catheter flushing. Drawing conclusions about any relationship between flushing practices and clinical outcomes was impeded by the relatively low uptake of regular auditing and monitoring of catheter-related outcomes across surveyed units. Evaluation of the benefits and harms of standardized PD catheter flushing practices on patient outcomes in a randomized trial is needed to guide practice.

scholarly journals Implementing medical revalidation in the United Kingdom: Findings about organisational changes and impacts from a survey of Responsible Officers

2017 ◽  
Vol 110 (1) ◽  
pp. 23-30 ◽  
Author(s):  
Kieran Walshe ◽  
Alan Boyd ◽  
Marie Bryce ◽  
Kayleigh Luscombe ◽  
Abigail Tazzyman ◽  
...  
Keyword(s):  
Quality Assurance ◽  
United Kingdom ◽  
Clinical Practice ◽  
Online Survey ◽  
Poor Performance ◽  
Cross Sectional ◽  
The United Kingdom ◽  
Professional Contexts

Objective To describe the implementation of medical revalidation in healthcare organisations in the United Kingdom and to examine reported changes and impacts on the quality of care. Design A cross-sectional online survey gathering both quantitative and qualitative data about structures and processes for medical revalidation and wider quality management in the organisations which employ or contract with doctors (termed ‘designated bodies’) from the senior doctor in each organisation with statutory responsibility for medical revalidation (termed the ‘Responsible Officer’). Setting United Kingdom Participants Responsible Officers in designated bodies in the United Kingdom. Five hundred and ninety-five survey invitations were sent and 374 completed surveys were returned (63%). Main outcome measures The role of Responsible Officers, the development of organisational mechanisms for quality assurance or improvement, decision-making on revalidation recommendations, impact of revalidation and mechanisms for quality assurance or improvement on clinical practice and suggested improvements to revalidation arrangements. Results Responsible Officers report that revalidation has had some impacts on the way medical performance is assured and improved, particularly strengthening appraisal and oversight of quality within organisations and having some impact on clinical practice. They suggest changes to make revalidation less ‘one size fits all’ and more responsive to individual, organisational and professional contexts. Conclusions Revalidation appears primarily to have improved systems for quality improvement and the management of poor performance to date. There is more to be done to ensure it produces wider benefits, particularly in relation to doctors who already perform well.

scholarly journals Screening and follow-up care for cognitive and emotional problems after transient ischaemic attack and ischaemic stroke: a national, cross-sectional, online survey among neurologists in the Netherlands

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e046316
Author(s):  
Jos Slenders ◽  
Renske Van den Berg-Vos ◽  
Johanna Visser-Meily ◽  
Caroline van Heugten ◽  
Vincent Kwa
Keyword(s):  
Clinical Practice ◽  
Ischaemic Stroke ◽  
Transient Ischaemic Attack ◽  
Online Survey ◽  
Emotional Problems ◽  
Information Provision ◽  
Cross Sectional ◽  
Follow Up Care ◽  
Ischaemic Attack

BackgroundAfter stroke, many patients experience cognitive and/or emotional problems. While national guidelines recommend screening for these problems, actual screening rates might be limited.ObjectiveThis study aimed to examine the clinical practice at neurology departments regarding screening, information provision and follow-up care for cognitive and emotional problems after transient ischaemic attack (TIA) and ischaemic stroke.MethodsA nationwide, cross-sectional, online survey was conducted between October 2018 and October 2019 among neurologists in all hospitals in the Netherlands.ResultsNeurologists in 78 hospitals were invited to join the survey, and 52 (67%) of them completed it. Thirty-one (59%) neurologists reported that screening for cognitive problems after TIA and ischaemic stroke was mostly or always performed. When cognitive screening was performed, 42 (84%) used validated screening instruments. Twenty-nine (56%) of the respondents reported that screening for emotional problems was mostly or always performed. When emotional screening was performed, 31 (63%) reported using validated screening instruments. Timing of screening and information provision was highly variable, and the majority reported that there was no protocol for follow-up care when cognitive or emotional problems were found.ConclusionsThis study demonstrates that clinical practice at neurology departments is highly variable regarding screening, information provision and follow-up care for cognitive and emotional problems in patients after TIA or ischaemic stroke. Approximately half of the participating neurologists reported that screening was performed only sometimes or never for cognitive and emotional problems after TIA and ischaemic stroke.

scholarly journals The Changing Clinical Landscape in Acupuncture for Women’s Health: A Cross-Sectional Online Survey in New Zealand and Australia

2021 ◽  
Author(s):  
Sandro Graca ◽  
Debra Betts ◽  
Caroline A. Smith ◽  
Mike Armour ◽  
Kate Roberts
Keyword(s):  
New Zealand ◽  
Chinese Medicine ◽  
Women’S Health ◽  
Women's Health ◽  
Online Survey ◽  
Health Conditions ◽  
Health Practice ◽  
Sources Of Information ◽  
Cross Sectional ◽  
Referral Networks

Abstract Background Acupuncture is growing in popularity as a treatment option for women’s health worldwide with reported increasing usage in the last ten years. A significant number of clinical trials and meta-analysis are now published on aspects of women’s health treatment with acupuncture. The aim of this survey was to explore if, how and why, aspects of acupuncture practice has changed since our last survey in 2013. Method An online cross-sectional survey of registered acupuncturists and Chinese Medicine practitioners in Australia and New Zealand. Questions covered the practitioner demographics and training, women’s health conditions commonly treated, modalities used, sources of information and continuing education (CE) (e.g. webinars), changes in clinical practice, and referral networks. Results One hundred and seventy registered practitioners responded to this survey, with 93% reporting treating women’s health in the last 12 months. The majority of respondents were from Australia (60%), held a bachelors level qualification (60%), and used a traditional Chinese medicine framework (86%). Most practitioners incorporated other modalities in addition to acupuncture. Most practitioners’ referral networks were predominantly based on word of mouth for menstrual, fertility and pregnancy related conditions, with referrals from medical practitioners being much less common. More than half (57%) reported having changed their women’s health practice in the past 12 months; just over a quarter of those who changed treatment (27%) reported it was due to research findings. The most commonly used sources of information/CE used to inform treatment were webinars and conferences, while peer-reviewed journal articles were the least commonly used source. Conclusion Acupuncture practitioners in Australia and New Zealand commonly treat women’s health conditions, but this is usually the result of women seeking them out, rather than being referred from a medical practitioner. The majority of practitioners did report changing their women’s health practice, but peer reviewed academic articles alone are not an ideal medium to convey this information since practitioners favour knowledge obtained from webinars and conferences. Academics and other clinician researchers should consider alternative means of disseminating knowledge beyond traditional academic publications and conferences, special interest groups may assist in this and also help improve research literacy.

scholarly journals Caring for depression in the dying is complex and challenging – survey of palliative physicians

2022 ◽  
Vol 21 (1) ◽  
Author(s):  
Wei Lee ◽  
Sungwon Chang ◽  
Michelle DiGiacomo ◽  
Brian Draper ◽  
Meera R. Agar ◽  
...  
Keyword(s):  
Palliative Care ◽  
New Zealand ◽  
Online Survey ◽  
Symptom Assessment ◽  
Depression Care ◽  
Clinical Practices ◽  
Cross Sectional ◽  
Training And Research ◽  
Screening Assessment ◽  
Patient Burden

Abstract Background Depression is prevalent in people with very poor prognoses (days to weeks). Clinical practices and perceptions of palliative physicians towards depression care have not been characterised in this setting. The objective of this study was to characterise current palliative clinicians’ reported practices and perceptions in depression screening, assessment and management in the very poor prognosis setting. Methods In this cross-sectional cohort study, 72 palliative physicians and 32 psychiatrists were recruited from Australian and New Zealand Society of Palliative Medicine and Royal Australian and New Zealand College of Psychiatrists between February and July 2020 using a 23-item anonymous online survey. Results Only palliative physicians results were reported due to poor psychiatry representation. Palliative physicians perceived depression care in this setting to be complex and challenging. 40.0% reported screening for depression. All experienced uncertainty when assessing depression aetiology. Approaches to somatic symptom assessment varied. Physicians were generally less likely to intervene for depression than in the better prognosis setting. Most reported barriers to care included the perceived lack of rapidly effective therapeutic options (77.3%), concerns of patient burden and intolerance (71.2%), and the complexity in diagnostic differentiation (53.0%). 66.7% desired better collaboration between palliative care and psychiatry. Conclusions Palliative physicians perceived depression care in patients with very poor prognoses to be complex and challenging. The lack of screening, variations in assessment approaches, and the reduced likelihood of intervening in comparison to the better prognosis setting necessitate better collaboration between palliative care and psychiatry in service delivery, training and research.

scholarly journals Why do pharmacists leave the profession? A mixed-method exploratory study

2021 ◽  
Vol 19 (2) ◽  
pp. 2332
Author(s):  
Trudi J. Aspden ◽  
Pushkar R. Silwal ◽  
Munyaradzi Marowa ◽  
Rhys Ponton
Keyword(s):  
New Zealand ◽  
Mixed Method ◽  
Online Survey ◽  
Career Pathways ◽  
Structured Interviews ◽  
Cross Sectional ◽  
Policy Documents ◽  
Pharmacy Profession ◽  
Wide Range ◽  
Professional Environment

Background: Recent New Zealand policy documents aim for pharmacists to be retained, and promote the provision of extended clinical pharmacy services. However, younger pharmacists have expressed dissatisfaction with the profession on informal social for a. Objectives: To explore the characteristics, and perspectives of pharmacy as a career, of recent Bachelor of Pharmacy (BPharm, four-year degree) graduates who have left, or are seriously considering leaving the New Zealand pharmacy profession in the near future and where they have gone, or plan to go. Methods: We conducted a cross-sectional study with a mixed-method explanatory sequential design. An anonymous online survey among those who completed their pharmacy undergraduate degree (BPharm or equivalent) in 2003 or later and who had left or who were seriously considering leaving the New Zealand pharmacy profession in the next five years, was open from 1st December 2018 to 1st February 2019. Recruitment occurred via University alumni databases, pharmacy professional organisations, pharmaceutical print media, social media and word-of-mouth. Ten semi-structured interviews were then conducted with a purposive sample of survey respondents. Descriptive statistics were generated from the quantitative data and qualitative data were analysed using manifest content analysis. Results: We received 327 analysable surveys of which 40.4% (n=132) were from those who had already left the New Zealand pharmacy sector at the time of the data collection and the rest (59.6% n=195) were those working within the sector, but seriously considering leaving the profession. Reasons most commonly reported for studying pharmacy were having an interest in health and wanting to work with people. The most common reasons for leaving, or wanting to leave, were dissatisfaction with the professional environment, including inadequate remuneration, and a perceived lack of career pathways or promotion opportunities. A wide range of career destinations were declared, with medicine being most frequently reported. Conclusions: Most of the reasons for leaving/considering leaving the profession reported relate to the values and features of the pharmacy profession such as the professional environment, remuneration and career pathways. These findings are consistent with other studies and may represent a barrier to achieving the aims of recent health policy documents.

scholarly journals The reliability and success of peritoneal dialysis during the COVID-19 pandemic

2020 ◽  
Author(s):  
Hasan Haci Yeter ◽  
Ebru Gok Oguz ◽  
Omer Faruk Akcay ◽  
Refika Karaer ◽  
Emre Yasar ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Parathyroid Hormone ◽  
Clinical Assessment ◽  
Mineral Metabolism ◽  
Severe Depression ◽  
Depression And Anxiety ◽  
Automated Peritoneal Dialysis ◽  
Laboratory Findings ◽  
Cross Sectional ◽  
Total Study Population

Abstract Aim: This study aimed to evaluate the symptoms, changes in laboratory findings during the COVID-19 pandemic, and the effect of depression on symptoms associated with end-stage kidney disease in patients with peritoneal dialysis (PD).Methods: This was an observational and cross-sectional study. The patients underwent three different PD modalities, including continuous ambulatory PD, automated peritoneal dialysis, and remote monitoring automated peritoneal dialysis (RM-APD). All patients were asked to complete the clinical assessment form and Beck depression and anxiety inventory. Additionally, the last two laboratory evaluations during this period were examined.Results: A total of 123 patients undergoing PD were included. None of the patients were diagnosed with COVID-19 infection. Serum ferritin, creatinine, phosphorus, albumin and parathyroid hormone levels were significantly elevated in the total study population (p=0.03, p=0.01, p=0.02, p=0.02 and p=0.05, respectively). While calcium, phosphorus, and parathyroid hormone tended to increase in patients with APD or CAPD, they remained stable in patients performing RM-APD. Most of the patients did not experience dyspnea, pitting edema, difficulty in blood pressure control, palpitation, bone muscle pain, or peritonitis. Moderate to severe depression was associated with dyspnea, weight gain, fatigue, palpitation, and increased anxiety.Conclusion: PD is a reliable and successful form of dialysis and can be safely administered even if hospital access is restricted. PD is a safe method of renal replacement therapy to protect patients from COVID-19 infection. Additionally, RM-APD may be a better choice because it provides more stable bone mineral metabolism. Moreover, evaluating depression and anxiety at phone visits may be necessary for accurate clinical assessment.

scholarly journals A Cross-Sectional Description of Parental Perceptions and Practices Related to Risky Play and Independent Mobility in Children: The New Zealand State of Play Survey

2019 ◽  
Vol 16 (2) ◽  
pp. 262 ◽  
Author(s):  
Charlotte Jelleyman ◽  
Julia McPhee ◽  
Mariana Brussoni ◽  
Anita Bundy ◽  
Scott Duncan
Keyword(s):  
New Zealand ◽  
Online Survey ◽  
Health And Safety ◽  
Future Research ◽  
Emotional Wellbeing ◽  
Independent Mobility ◽  
Cross Sectional ◽  
Risky Play ◽  
Nationally Representative ◽  
Stranger Danger

The potential for risky play and independent mobility to increase children’s physical activity, and enhance cognitive development and emotional wellbeing has been recognised for some time. The aim of this study was to describe the attitudes of New Zealand parents towards such risky play practices and independent mobility, the barriers preventing them from allowing their children to participate, and how often their children engaged in risky play activities. An online survey comprised mostly of validated scales and standardised questions was completed by a nationally representative sample of 2003 parents. We found that parents had neutral feelings about the risk of injury to their child through play, rather they were concerned about road safety and “stranger danger”. There was strong agreement that there are multiple benefits to be gained from exposure to risk and challenge, and that health and safety rules are too strict. However, 73% of respondents stated that their 5–12 year old child seldom or never engaged in four or more risky activities, and only 14.3% engaged in four or more often or always. While parents agree that their child is likely to benefit from risky play, they do not have the confidence to allow their children to engage in such activities. Future research should address barriers and fears when implementing strategies to facilitate risky play.

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