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Cheng CI, Lin WJ, Liu HT, Chen YT, Chiang CK, Hung KY. Implementation of artificial intelligence Chatbot in peritoneal dialysis nursing care: Experience from a Taiwan medical center. Nephrology (Carlton) 2023; 28:655-662. [PMID: 37698229 DOI: 10.1111/nep.14239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE Coronavirus disease pandemic makes high requirements in delivering remote and efficient communication, and patient education. Because of the increases of digital and social media applications in Taiwan, we aim to apply Artificial Intelligence of LINE Chatbot to improve the self-care ability of patients undergoing peritoneal dialysis. MATERIALS AND METHODS We conducted the project since 1 May 2021 to 30 April 2022. We designed an automatically replied Chatbot system, and divided into six scopes of interaction interfaces, including peritoneal dialysis technique operation video, clinical reminder, home caring, hospital registration service, dietary guideline, and Automatic Peritoneal dialysis guidance. We surveyed patients' satisfaction with the LINE Chatbot 3 months later by the Likert 1-5 score-based questionnaire and the higher score indicated higher satisfaction. RESULTS There were 440 patients who joined the PD AI Chatbot study and use the Chatbot, but the satisfaction questionnaire recovery rate was only 297 patients. We found that 91.7% of participants agreed 'Overall satisfaction with patient intelligent Chatbot application'. More than 4 points accounted for 86.6%. We traced every click in each section of the Chatbot and explored the potential scenario patients face. The Chatbot statistically significant reduced infection rate of exit site and tunnel infection before using (p = .049 and .024). Furthermore, peritonitis rate decreased from 0.93 to 0.8/100 patient month after using Artificial Intelligence technique. Peritoneal dialysis Artificial Intelligence Chatbot had similar effect with face-to-face education. CONCLUSION The innovative Chatbot allowed delivering remote and digital information's to improve patients' self-care ability. Peritoneal dialysis patients were highly recognized and satisfied with the tools. It deserves to further explore the long-term impact of Artificial Intelligence Chatbot in peritoneal dialysis care.
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Affiliation(s)
- Ching-I Cheng
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Woan-Jean Lin
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Hui-Ting Liu
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Ting Chen
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Division of Blood Purification, Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Kang Chiang
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Division of Blood Purification, Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Toxicology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Kung-Yu Hung
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, New Taipei City, Taiwan
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
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Liakopoulos V, Nikitidou O, Kalathas T, Roumeliotis S, Salmas M, Eleftheriadis T. Peritoneal dialysis-related infections recommendations: 2016 update. What is new? Int Urol Nephrol 2017; 49:2177-2184. [PMID: 28573488 DOI: 10.1007/s11255-017-1632-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 05/25/2017] [Indexed: 12/17/2022]
Abstract
In 2016, the International Society of Peritoneal Dialysis (ISPD) published guidelines that focus on the importance of both prevention and treatment of peritonitis. For once more, the need for annual reporting of peritonitis rates and recording of peritonitis and exit-site infections, isolated microorganism and antimicrobial susceptibilities as a central component of a quality improvement program is highlighted. Data on new antibiotic regimens, techniques for microorganism isolation and peritoneal dialysis solutions are included. Training of both peritoneal dialysis nurses and patients seems to be crucial, while the modifiable risk factors for peritonitis seem to be of great interest. In this article, we record the changes in the last ISPD (2016) guidelines compared to the previous ones published in 2010.
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Affiliation(s)
- Vassilios Liakopoulos
- Peritoneal Dialysis Unit, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 1 St. Kyriakidi Street, 54636, Thessaloniki, Greece.
| | - Olga Nikitidou
- Peritoneal Dialysis Unit, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 1 St. Kyriakidi Street, 54636, Thessaloniki, Greece
| | - Theofanis Kalathas
- Peritoneal Dialysis Unit, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 1 St. Kyriakidi Street, 54636, Thessaloniki, Greece
| | - Stefanos Roumeliotis
- Peritoneal Dialysis Unit, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 1 St. Kyriakidi Street, 54636, Thessaloniki, Greece
| | - Marios Salmas
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Cao XY, Zhou JH, Cai GY, Tan NN, Huang J, Xie XC, Tang L, Chen XM. Predicting one-year mortality in peritoneal dialysis patients: an analysis of the China Peritoneal Dialysis Registry. Int J Med Sci 2015; 12:354-61. [PMID: 26019685 PMCID: PMC4445016 DOI: 10.7150/ijms.11694] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 03/13/2015] [Indexed: 01/14/2023] Open
Abstract
This study aims to investigate basic clinical features of peritoneal dialysis (PD) patients, their prognostic risk factors, and to establish a prognostic model for predicting their one-year mortality. A national multi-center cohort study was performed. A total of 5,405 new PD cases from China Peritoneal Dialysis Registry in 2012 were enrolled in model group. All these patients had complete baseline data and were followed for one year. Demographic and clinical features of these patients were collected. Cox proportional hazards regression model was used to analyze prognostic risk factors and establish prognostic model. A validation group was established using 1,764 new PD cases between January 1, 2013 and July 1, 2013, and to verify accuracy of prognostic model. Results indicated that model group included 4,453 live PD cases and 371 dead cases. Multivariate survival analysis showed that diabetes mellitus (DM), residual glomerular filtration rate (rGFR), , SBP, Kt/V, high PET type and Alb were independently associated with one-year mortality. Model was statistically significant in both within-group verification and outside-group verification. In conclusion, DM, rGFR, SBP, Kt/V, high PET type and Alb were independent risk factors for short-term mortality in PD patients. Prognostic model established in this study accurately predicted risk of short-term death in PD patients.
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Affiliation(s)
- Xue-Ying Cao
- 1. Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing 100853, China
| | - Jian-Hui Zhou
- 1. Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing 100853, China
| | - Guang-Yan Cai
- 1. Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing 100853, China
| | - Ni-Na Tan
- 1. Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing 100853, China
| | - Jing Huang
- 1. Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing 100853, China
| | - Xiang-Cheng Xie
- 1. Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing 100853, China
| | - Li Tang
- 1. Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing 100853, China
| | - Xiang-Mei Chen
- 1. Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing 100853, China
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Spiliopoulou A, Papachristou E, Foka A, Kolonitsiou F, Anastassiou ED, Goumenos DS, Spiliopoulou I. Relapsing Bacillus cereus peritonitis in a patient treated with continuous ambulatory peritoneal dialysis. JMM Case Rep 2014; 1:e003400. [PMID: 28663812 PMCID: PMC5415935 DOI: 10.1099/jmmcr.0.003400] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 10/22/2014] [Indexed: 11/18/2022] Open
Abstract
Introduction: Peritonitis is a severe complication of peritoneal dialysis (PD) due to associated morbidity and mortality. Although Bacillus cereus is mostly considered as a contaminant, its role as a causative agent in a few cases of PD peritonitis has been documented. Peritonitis due to B. cereus has been associated with high rates of catheter removal and resistance to beta-lactam antibiotics. Case presentation: A case of relapsing peritonitis caused by B. cereus in a 69-year-old man with end-stage renal disease on continuous ambulatory PD for 3 years is described. B. cereus was recovered from the patient’s peritoneal fluid and was identified by phenotypic and molecular methods. The patient was treated, according to the susceptibility test, with tobramycin for 14 days. Cultures became sterile and the patient was discharged from hospital. Three days after discharge, the patient reported recurrence of abdominal pain and a new antibiotic regimen based on the previous culture results was initiated consisting of vancomycin and ciprofloxacin. The presence of B. cereus in the peritoneal fluid was confirmed, whereas repeated cultures for the next 15 days were positive. All B. cereus isolates produced biofilm. On day 16, the PD catheter was removed and the patient was transferred to haemodialysis. A review of previously reported cases is also presented. Conclusion: Since peritonitis is the most common cause of transition to haemodialysis, isolation of B. cereus from PD patients, even though rare, should not be considered as a contaminant. An appropriate antibiotic regimen and, whenever necessary, catheter removal should be applied.
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Affiliation(s)
| | - Evangelos Papachristou
- Department of Nephrology and Kidney Transplantation, School of Medicine, University of Patras, Patras, Greece
| | - Antigoni Foka
- Department of Microbiology, School of Medicine, University of Patras, Patras, Greece
| | - Fevronia Kolonitsiou
- Department of Microbiology, School of Medicine, University of Patras, Patras, Greece
| | | | - Dimitrios S Goumenos
- Department of Nephrology and Kidney Transplantation, School of Medicine, University of Patras, Patras, Greece
| | - Iris Spiliopoulou
- Department of Microbiology, School of Medicine, University of Patras, Patras, Greece
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Im H, Chae JD, Yoo M, Lee SY, Song EJ, Sung SA, Hwang YH, Shin JH, Cho YU. First case of continuous ambulatory peritoneal dialysis-related peritonitis caused by Cryptococcus arboriformis. Ann Lab Med 2014; 34:328-31. [PMID: 24982841 PMCID: PMC4071193 DOI: 10.3343/alm.2014.34.4.328] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 12/10/2013] [Accepted: 06/03/2014] [Indexed: 11/30/2022] Open
Affiliation(s)
- Hyungjun Im
- Department of Rehabilitation Medicine, Eulji General Hospital, College of Medicine, Eulji University, Seoul, Korea
| | - Jeong Don Chae
- Department of Laboratory Medicine, Eulji General Hospital, College of Medicine, Eulji University, Seoul, Korea
| | - Minseok Yoo
- Department of Internal Medicine, Eulji General Hospital, College of Medicine, Eulji University, Seoul, Korea
| | - So-Young Lee
- Division of Nephrology, Eulji General Hospital, College of Medicine, Eulji University, Seoul, Korea
| | - Eun Ju Song
- Division of Nephrology, Eulji General Hospital, College of Medicine, Eulji University, Seoul, Korea
| | - Su-Ah Sung
- Division of Nephrology, Eulji General Hospital, College of Medicine, Eulji University, Seoul, Korea
| | - Young Hwan Hwang
- Division of Nephrology, Eulji General Hospital, College of Medicine, Eulji University, Seoul, Korea
| | - Jeong Hwan Shin
- Department of Laboratory Medicine, Inje University College of Medicine, Busan, Korea
| | - Young-Uk Cho
- Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
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Wu HH, Li IJ, Weng CH, Lee CC, Chen YC, Chang MY, Fang JT, Hung CC, Yang CW, Tian YC. Prophylactic antibiotics for endoscopy-associated peritonitis in peritoneal dialysis patients. PLoS One 2013; 8:e71532. [PMID: 23936514 PMCID: PMC3731321 DOI: 10.1371/journal.pone.0071532] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Accepted: 06/29/2013] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Continuous ambulatory peritoneal dialysis (CAPD) peritonitis may develop after endoscopic procedures, and the benefit of prophylactic antibiotics is unclear. In the present study, we investigated whether prophylactic antibiotics reduce the incidence of peritonitis in these patients. PATIENTS AND METHODS We retrospectively reviewed all endoscopic procedures, including esophagogastroduodenoscopy (EGD), colonoscopy, sigmoidoscopy, cystoscopy, hysteroscopy, and hysteroscopy-assisted intrauterine device (IUD) implantation/removal, performed in CAPD patients at Chang Gung Memorial Hospital, Taiwan, between February 2001 and February 2012. RESULTS Four hundred and thirty-three patients were enrolled, and 125 endoscopies were performed in 45 patients. Eight (6.4%) peritonitis episodes developed after the examination. Antibiotics were used in 26 procedures, and none of the patients had peritonitis (0% vs. 8.1% without antibiotic use; p=0.20). The peritonitis rate was significantly higher in the non-EGD group than in the EGD group (15.9% [7/44] vs. 1.2% [1/81]; p<0.005). Antibiotic use prior to non-EGD examinations significantly reduced the endoscopy-associated peritonitis rate compared to that without antibiotic use (0% [0/16] vs. 25% [7/28]; p<0.05). Peritonitis only occurred if invasive procedures were performed, such as biopsy, polypectomy, or IUD implantation, (noninvasive procedures, 0% [0/20] vs. invasive procedures, 30.4% [7/23]; p<0.05). No peritonitis was noted if antibiotics were used prior to examination with invasive procedures (0% [0/10] vs. 53.8% [7/13] without antibiotic use; p<0.05). Although not statistically significant, antibiotics may play a role in preventing gynecologic procedure-related peritonitis (antibiotics, 0% [0/4] vs. no antibiotics, 55.6% [5/9]; p=0.10). CONCLUSION Antibiotic prophylaxis significantly reduced endoscopy-associated PD peritonitis in the non-EGD group. Endoscopically assisted invasive procedures, such as biopsy, polypectomy, IUD implantation/removal, and dilatation and curettage (D&C), pose a high risk for peritonitis. Prophylactic antibiotics for peritonitis prevention may be required in colonoscopic procedures and gynecologic procedures.
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Affiliation(s)
- Hsin-Hsu Wu
- Kidney Research Center, Department of Nephrology, Lin-Kou Chang Gung Memorial Hospital, Taiwan and Chang Gung University, Tao Yuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Tao Yuan, Taiwan
| | - I-Jung Li
- Kidney Research Center, Department of Nephrology, Lin-Kou Chang Gung Memorial Hospital, Taiwan and Chang Gung University, Tao Yuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Tao Yuan, Taiwan
| | - Cheng-Hao Weng
- Kidney Research Center, Department of Nephrology, Lin-Kou Chang Gung Memorial Hospital, Taiwan and Chang Gung University, Tao Yuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Tao Yuan, Taiwan
| | - Cheng-Chia Lee
- Kidney Research Center, Department of Nephrology, Lin-Kou Chang Gung Memorial Hospital, Taiwan and Chang Gung University, Tao Yuan, Taiwan
| | - Yung-Chang Chen
- Kidney Research Center, Department of Nephrology, Lin-Kou Chang Gung Memorial Hospital, Taiwan and Chang Gung University, Tao Yuan, Taiwan
| | - Ming-Yang Chang
- Kidney Research Center, Department of Nephrology, Lin-Kou Chang Gung Memorial Hospital, Taiwan and Chang Gung University, Tao Yuan, Taiwan
| | - Ji-Tseng Fang
- Kidney Research Center, Department of Nephrology, Lin-Kou Chang Gung Memorial Hospital, Taiwan and Chang Gung University, Tao Yuan, Taiwan
| | - Cheng-Chieh Hung
- Kidney Research Center, Department of Nephrology, Lin-Kou Chang Gung Memorial Hospital, Taiwan and Chang Gung University, Tao Yuan, Taiwan
| | - Chih-Wei Yang
- Kidney Research Center, Department of Nephrology, Lin-Kou Chang Gung Memorial Hospital, Taiwan and Chang Gung University, Tao Yuan, Taiwan
| | - Ya-Chung Tian
- Kidney Research Center, Department of Nephrology, Lin-Kou Chang Gung Memorial Hospital, Taiwan and Chang Gung University, Tao Yuan, Taiwan
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A single institutional experience of conversion of non-tunneled to tunneled hemodialysis catheters: a comparison to de novo placement. Int Urol Nephrol 2013; 45:1753-9. [PMID: 23877664 DOI: 10.1007/s11255-013-0508-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 06/26/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To compare the outcomes of conversion of non-tunneled to tunneled hemodialysis catheters with de novo placement of tunneled catheters and to determine the effect of time to conversion of non-tunneled to tunneled catheters on the incidence of complications. MATERIALS AND METHODS A retrospective data analyses was performed on 1,154 patients who had de novo placement of tunneled hemodialysis catheters (control group) and 254 patients who underwent conversion of non-tunneled to tunneled catheters (study group). The outcomes including technical complications, infection, and catheter dysfunction were compared between the two groups. RESULTS The technical success rate was 100 % in both the groups with no complications recorded at the time of procedure or within 24 h of insertion. The most common complication encountered in both the groups was catheter dysfunction (15.6 % in controls and 18.1 % in study). Infection rates/100 catheter days for the control and study groups were 0.17 and 0.19, respectively. Infection-free survival was not statistically different between the two groups. The time spent with non-tunneled catheter prior to conversion did not significantly alter the rates of catheter dysfunction and infection in the study group. CONCLUSION The efficacy and safety of conversion of non-tunneled to tunneled hemodialysis catheters are similar to de novo placement with no difference in the rates of technical success, catheter dysfunction, or infection. However, the exchange of non-tunneled to tunneled catheter can help in preservation of veins for future vascular access, which is of vital importance in patients with chronic renal disease.
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