The COVID-19 pandemic forced us to face the growing realization that our expectations of staff redeployed to areas other than their usual role did not fully align with their perceptions of safety, ...competence, and teamwork. This mixed-methods study assessed perceptions of role, preparedness, and management among staff who were deployed from March through June 2020. Our findings support that the rapid reassignment of interprofessional role groups to respiratory illness clinics in the first wave, albeit necessary at the time, may not be the best response in future infectious disease outbreaks.
Background and objectives
Nephrotic syndrome (NS) in the first year of life is called congenital (CNS) if diagnosed between 0–3 months, or infantile (INS) if diagnosed between 3–12 months of age. The ...aim of this study was to determine if there were clinically meaningful differences between CNS and INS patients, regarding clinical presentation, management and outcomes.
Design, setting, participants, and measurements
Eleven Pediatric Nephrology Research Consortium sites participated in the study, using IRB-approved retrospective chart reviews of CNS and INS patients born between 1998 and 2019. Data were collected on patient characteristics, pertinent laboratory tests, provided therapy, timing of unilateral/bilateral nephrectomy and initiation of renal replacement therapy (RRT).
Results
The study included 69 patients, 49 with CNS and 20 with INS, with a median age at diagnosis of 1 and 6 months, respectively. Management for the two groups was similar regarding nutrition, thyroxin supplementation, immunoglobulin administration, and thrombosis prophylaxis. Within the first 2 months after diagnosis, daily albumin infusions were used more often in CNS
vs
. INS patients (79
vs
. 30%;
p
= 0.006), while weekly infusions were more common in INS patients (INS
vs
. CNS: 50
vs
. 3%;
p
= 0.001). During the 6 months preceding RRT, albumin infusions were more frequently prescribed in CNS
vs
. INS (51
vs
. 15%;
p
= 0.007). Nephrectomy was performed more often in CNS (78%) than in INS (50%;
p
= 0.02). End-stage kidney disease tended to be more common in children with CNS (80%)
vs
. INS (60%;
p
= 0.09).
Conclusion
Compared to INS, patients with CNS had a more severe disease course, requiring more frequent albumin infusions, and earlier nephrectomy and RRT. Despite center-specific variations in patient care, 20–40% of these patients did not require nephrectomy or RRT.
Interprofessional teams are useful in providing complex care to patients with substance use disorder. Predictors of treatment outcomes, such as age, socioeconomic status, and social supports, have ...been studied in addiction treatment. Individual contributions of the office-based addiction treatment nurse in the care of patients with opioid use disorder are not well understood. Through the lens of the Nursing Role Effectiveness Model, nursing interventions related to care coordination and transition management in patients on medication-assisted treatment were examined. Documentation from interprofessional team members was reviewed and collected in REDCap. Linear regression was conducted to identify significant factors in predicting time to stabilization, defined as achieving a third opiate-free toxicology screen. Logistic regression was used to identify significant associations between patient demographics, care team members, and documented interventions. Overall, patients' time to stability on buprenorphine was decreased by approximately five months when a recovery coach was on the nurses' team (p = 0.03) and by seven months when the patient was referred for and received counseling services (p = 0.001). Our results support the role of the nurse in care coordination involves bringing together clinicians, particularly those who can provide counseling, to support recovery efforts.
Celotno besedilo
Dostopno za:
CEKLJ, DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Background
Mycophenolate Mofetil (MMF) is an effective immunosuppressant used in kidney transplant recipients to prevent acute rejection. Complications such as diarrhea, leukopenia, and infections ...may necessitate the reduction or discontinuation of MMF. The objective of the study was to investigate the prevalence, timing, and reasons for MMF discontinuation and its association with outcomes in pediatric kidney transplant recipients.
Methods
Seven Pediatric Nephrology Research Consortium (PNRC) centers participated in a retrospective analysis of kidney transplant recipients <21 years of age. Characteristics and outcomes of patients in whom MMF was discontinued were compared to those who continued taking MMF throughout the first 2 years post‐transplant.
Results
The study population included 288 participants (mean age 11.2 years) from 7 North American transplant centers. MMF was discontinued in 93/288 (32%) of participants. Common reasons for discontinuation included infections (35%), diarrhea (32%), leukopenia (15%), and others (18%). Increased cumulative alloimmunity (55% vs. 42%, p = .02), increased number of hospitalizations (82% vs. 67%, p = .01), and viral replications (79% vs. 47%, p < .0001) were observed in the MMF discontinuation group compared to the continuation group. Greater eGFR decline also occurred in the MMF discontinuation group over 2 years of follow‐up (−7 vs. −1 mL/min/1.73 m2, p = .05).
Conclusions
Almost a third of pediatric kidney transplant recipients who begin MMF for maintenance immunosuppression have it discontinued within the first 2 years post‐transplant, and this subset of patients is more likely to experience adverse outcomes. New strategies are needed to manage MMF therapy and improve post‐transplant outcomes.
Introduction
Recurrent focal and segmental glomerulosclerosis (FSGS) in kidney transplant recipients is associated with lower graft survival and increased morbidity. There are limited data to guide ...the decision to re‐transplant patients with transplant failure due to FSGS recurrence. We aimed to evaluate outcomes in patients re‐transplanted after having initial graft failure due to recurrent FSGS and to study physician attitudes and practice patterns.
Methods
Retrospective data from 10 centers were collected on 20 patients transplanted between January 1997 and September 2018. A survey was sent to nephrologist members of the Pediatric Nephrology Research Consortium.
Results
Mean patient age (years) was 9.8 ± 4.8 at first transplant and 15.9 ± 4.9 at re‐transplantation. Pre‐transplant plasmapheresis was used in 1 (5.3%) primary transplant vs. 7 (38.9%) re‐transplants (p = .03). Nephrotic syndrome recurred in 14 patients (70%) after re‐transplantation and was severe in 21.1% vs. 64.7% after first transplant (p = .04). Graft survival was significantly higher in the second transplant (p .009) with 70% having functioning grafts at a median of 25.2 months. Thirty‐one physicians from 21 centers completed the survey, 94% indicated they would re‐transplant such patients, 44.4% preferred a minimum waiting period before re‐transplantation, 36.4% preferred living donors, and 22.2% indicated having protocols for re‐transplantation at their centers.
Conclusions
Consideration for re‐transplantation is high among pediatric nephrologists. Pre‐transplant plasmapheresis was more frequent in re‐transplanted patients. Nephrotic syndrome recurrence was less severe, with better graft survival. More data and a larger population are necessary to further evaluate outcome determinants and best practices in this special population.
In America, our military combat veterans are considered a vulnerable population, and in 2016, they were number four on the nation’s list of the top ten most disparate communities. The Vietnam War ...veteran leads by the numbers, partly due to negative publicity and unfair media portrayal. In 1998, World T.E.A.M. (The Exceptional Athlete Matters) Sports, an organization that works with differently-abled people in multiple settings creating amazing adventures, attempted to change this as they invited these veterans to join them and ride together with Vietnamese veterans from the same war. WTS hired Kartemquin Films to create a documentary film to record and air this adventure on public television, and the producers—Gordon Quinn, Peter Gilbert, Adam Singer and Jerry Blumenthall—realized this was going to be much more than a film as they had an opportunity to “show the complexity of humanity” itself through the participants’ physical and emotional experiences. Through analyzing the documentary, collecting oral history from several participants of this event, and researching archival records, this dissertation examines the workings of Sonja K. Foss and Cindy L. Griffin’s invitational rhetoric and its importance in our society. I first explain Mary Louise Pratt’s contact zones and the role invitational rhetoric plays in helping people with conflicting ideologies to enter into spaces where both parties may talk without fear of persecution or abuse. I then define and explain the term “rhetorical logistics,” and argue how this may help us understand people’s decisions on how they navigate themselves before and during interaction within contact zones while on this sixteen-day trip. By studying various examples of successful and seemingly unsuccessful invitational rhetoric, I claim that if one can yield the choice of change to the choice to understand, invitational rhetoric demonstrates various ways that we may create more of Burke’s consubstantiation and stronger communities within these disparate populations.
Skin cancer has reached epidemic proportions in the United States due to an increase in UV related health behaviors, particularly indoor tanning. As of 2009, the World Health Organization (WHO) ...updated its classification of indoor tanning to definitely carcinogenic to humans. Americans continue to tan despite this knowledge of skin cancer due to the deep cultural and social connection between tanned skin and beauty. Previous studies have shown the connection between the peer group and individual identifies with and beliefs about tanning and tanning behavior. However, little research has addressed peer group communication on tanning behavior. There is evidence from other health behavior research that peer communication does influence behavior. Studies addressing weight issues have highlighted this fact. Using that concept as a model and Social Cognitive Theory as a theoretical background, I addressed the impact of peer communication on tanning behavior. Five key peer groups were studied: athletes, academic achievers, populars, partiers, and regulars. Ten hypotheses were generated from the literature involving the respective peer groups and knowledge of skin cancer, discussion of health issues, discussion of image issues, tanning behavior, discussion of skin cancer, homophily of peer groups, and affirmations of tanning behavior. There were no significant differences in knowledge among groups; however, there were significant differences in discussion of health concerns, discussion of image concerns, and tanning behavior among groups. Greater frequency of discussion of image concerns was found to correlate with greater frequency of tanning behavior. A correlation was also found between discussion of health issues and tanning behavior, but image was a stronger indicator. Peer group acceptance was not found to have a relationship with discussion of concern for skin cancer or family history of skin cancer, but peer group homophily with regard to tanning was found to have a relationship with tanning behavior. Finally, affirmations of tan and tanning by an individual's social network was found to have an correlation with tanning behavior.
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