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Majorowicz RR, Kalantar-Zadeh K. Practical Use of Patient-Reported Outcome Measures in Chronic Kidney Disease-Associated Pruritus. J Ren Nutr 2024; 34:294-301. [PMID: 38286359 DOI: 10.1053/j.jrn.2024.01.002] [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: 11/27/2023] [Accepted: 01/08/2024] [Indexed: 01/31/2024] Open
Abstract
Regulatory and clinical stakeholders are increasingly advocating for the use of patient-reported outcome (PRO) measures; however, the use of PROs is still not widespread. Patient reports are often the best ways to diagnose and monitor the effect of treatment on symptoms when the symptoms are subjective, as with pruritus. While many PRO tools are available to assess the severity of pruritus and its impact on quality of life (e.g., sleep), these are not used in a consistent manner and their results may not translate into clinical action. In this article, we present an introduction to PROs and their use in the assessment of chronic kidney disease-associated pruritus, as well as a practical guide to some of the PRO tools currently available, to empower all members of the nephrology patient care team to use these tools appropriately for the benefit of the patient.
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Affiliation(s)
- Rachael R Majorowicz
- Dialysis Dietitian, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota.
| | - Kamyar Kalantar-Zadeh
- Adjunct Professor of Epidemiology, Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California
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Long B, Zhang H, Zhang H, Chen W, Sun Y, Tang R, Lin Y, Fu Q, Yang X, Cui L, Wang K. Deep learning models of ultrasonography significantly improved the differential diagnosis performance for superficial soft-tissue masses: a retrospective multicenter study. BMC Med 2023; 21:405. [PMID: 37880716 PMCID: PMC10601110 DOI: 10.1186/s12916-023-03099-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 09/29/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Most of superficial soft-tissue masses are benign tumors, and very few are malignant tumors. However, persistent growth, of both benign and malignant tumors, can be painful and even life-threatening. It is necessary to improve the differential diagnosis performance for superficial soft-tissue masses by using deep learning models. This study aimed to propose a new ultrasonic deep learning model (DLM) system for the differential diagnosis of superficial soft-tissue masses. METHODS Between January 2015 and December 2022, data for 1615 patients with superficial soft-tissue masses were retrospectively collected. Two experienced radiologists (radiologists 1 and 2 with 8 and 30 years' experience, respectively) analyzed the ultrasound images of each superficial soft-tissue mass and made a diagnosis of malignant mass or one of the five most common benign masses. After referring to the DLM results, they re-evaluated the diagnoses. The diagnostic performance and concerns of the radiologists were analyzed before and after referring to the results of the DLM results. RESULTS In the validation cohort, DLM-1 was trained to distinguish between benign and malignant masses, with an AUC of 0.992 (95% CI: 0.980, 1.0) and an ACC of 0.987 (95% CI: 0.968, 1.0). DLM-2 was trained to classify the five most common benign masses (lipomyoma, hemangioma, neurinoma, epidermal cyst, and calcifying epithelioma) with AUCs of 0.986, 0.993, 0.944, 0.973, and 0.903, respectively. In addition, under the condition of the DLM-assisted diagnosis, the radiologists greatly improved their accuracy of differential diagnosis between benign and malignant tumors. CONCLUSIONS The proposed DLM system has high clinical application value in the differential diagnosis of superficial soft-tissue masses.
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Affiliation(s)
- Bin Long
- Institute of Medical Technology, Peking University Health Science Center, Beijing, 100191, China
- Department of Diagnostic Ultrasound, Peking University Third Hospital, Beijing, China
| | - Haoyan Zhang
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China
| | - Han Zhang
- Department of Ultrasound, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wen Chen
- Department of Diagnostic Ultrasound, Peking University Third Hospital, Beijing, China
| | - Yang Sun
- Department of Diagnostic Ultrasound, Peking University Third Hospital, Beijing, China
| | - Rui Tang
- Institute of Medical Technology, Peking University Health Science Center, Beijing, 100191, China
- Department of Diagnostic Ultrasound, Peking University Third Hospital, Beijing, China
| | - Yuxuan Lin
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Qiang Fu
- Department of Ultrasound, Beijing Civil Aviation General Hospital, Beijing, China
| | - Xin Yang
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China
| | - Ligang Cui
- Institute of Medical Technology, Peking University Health Science Center, Beijing, 100191, China.
- Department of Diagnostic Ultrasound, Peking University Third Hospital, Beijing, China.
| | - Kun Wang
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China.
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China.
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Asghar MS, Avinash F, Singh M, Siddiqui MA, Hassan SA, Iqbal S, Irshad SG, Zehra M, Siddiqui K, Rasheed U. Associated Factors With Uremic Pruritus in Chronic Hemodialysis Patients: A Single-Center Observational Study. Cureus 2021; 13:e17559. [PMID: 34646616 PMCID: PMC8481143 DOI: 10.7759/cureus.17559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2021] [Indexed: 11/09/2022] Open
Abstract
Background and objectives Uremic pruritus is a recurrent and delicate manifestation in patients suffering from end-stage renal disease. It is a consequence of multiple factors, primarily comprising of metabolic factors and complement activation along with interleukins. The objective of our study was to find out the associated factors of uremic pruritus in chronic hemodialysis patients. The secondary aim was to obtain cut-off values of all the markers predicting pruritus. Materials and methods A cross-sectional observational study was conducted in the nephrology department of a tertiary care hospital including 135 patients. The current occurrence of pruritus was diagnosed on the basis of a validated and reliable scale of pruritus among chronic kidney disease (CKD) patients in the local language. Multivariate logistic regression and receiver operating characteristic analysis were conducted to decipher the required objectives. Results Study participants had a mean age of 56.29 ± 10.51 years with 56.3% males and 43.7% females. Hypertension was frequent comorbidity (75.6%) followed by diabetes (51.9%). Mean body mass index (BMI), duration of CKD diagnosis, and hemodialysis onset were 26.55 ± 5.37 kg/m2, 6.58 ± 3.65 years, and 3.32 ± 2.09 years respectively. Pruritus was reported in 37.0% of the study participants. On multivariate logistic regression, presence of skin allergy (aOR: 8.100 [2.926-22.420], p<0.001), phosphate >4.5 mg/dL (aOR: 3.889 [1.118-15.532], p=0.033), female gender (aOR: 3.592 [1.337-9.655], p=0.011), albumin <3.5 g/dL (aOR: 2.987 [1.156-7.716], p=0.024) and potassium >5.1 mEq/L (aOR: 2.934 [1.030-8.355], p=0.044) were found significantly associated with pruritus. Conclusion Many factors were linked to pruritus in hemodialysis patients in the current study. The current study also significantly correlated certain factors with pruritus independently.
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Affiliation(s)
| | - Fnu Avinash
- Medicine and Surgery, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Manjeet Singh
- Internal Medicine, Liaquat National Hospital and Medical College, Karachi, PAK
| | | | | | - Shahid Iqbal
- Forensic Medicine, Bacha Khan Medical College, Mardan, PAK
| | - Syeda Ghazala Irshad
- Internal Medicine, Dow University of Health Sciences, Dow International Medical College, Karachi, PAK
| | - Mahrukh Zehra
- Internal Medicine, Dow University of Health Sciences, Dow International Medical College, Karachi, PAK
| | - Kainat Siddiqui
- Internal Medicine, Dow University of Health Sciences, Dow International Medical College, Karachi, PAK
| | - Uzma Rasheed
- Internal Medicine, Liaquat National Hospital and Medical College, Karachi, PAK
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Reixach-Aumatell L, Cufí-Vallmajor M, Martín-Rabassa E, Rey-Miguel A. Efectividad de una intervención educativa con prescripción enfermera para el control del fósforo en pacientes en hemodiálisis. ENFERMERÍA NEFROLÓGICA 2021. [DOI: 10.37551/s2254-28842021027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introducción: El control del fósforo en pacientes en hemodiálisis es muy importante para la prevención de complicaciones. Objetivo principal: Evaluar los niveles de fósforo en sangre antes, durante y después de las intervenciones médica y enfermera-médica. Material y Método: Estudio cuantitativo, analítico, cuasi experimental, longitudinal y prospectivo en una población de pacientes en hemodiálisis hospitalaria. El estudio tuvo una duración de 18 meses donde enfermeras y médicos en diferentes meses controlaron la prescripción de los quelantes del fósforo. Se recogieron datos de los resultados analíticos y se reforzó la pauta dietética por parte de las enfermeras. Se administró el test de Morisky Green para valorar la adherencia al tratamiento, así como un “check list” para valorar los efectos secundarios de los quelantes. Resultados: Se estudiaron 19 pacientes. Los niveles de fósforo (mediana; rango intercuartílico) en los distintos periodos fueron de: (4,8; 1,3) mg/dl en el periodo previo, (4,5; 1,9) mg/dl en el periodo médico y (4,5; 0,9 mg/dl) en el periodo enfermera-médico. Se compararon los resultados entre los diferentes periodos y no se observaron diferencias estadísticamente significativas entre los niveles de fósforo. Tampoco se observaron diferencias en dichos niveles al separar los pacientes cumplidores de los no cumplidores. Conclusiones: Aunque los resultados no fueron estadísticamente diferentes, se observó una disminución del fósforo con el refuerzo de dieta continuo por parte de las enfermeras. Por lo que se concluye que las enfermeras, junto con el apoyo médico, podrían implicarse en la prescripción y el control de fósforo mensual de los pacientes.
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Affiliation(s)
- Laia Reixach-Aumatell
- Servicio de Nefrología. Fundació Salut Empordà. Hospital de Figueres. Girona. España
| | - Maria Cufí-Vallmajor
- Servicio de Nefrología. Fundació Salut Empordà. Hospital de Figueres. Girona. España
| | - Esther Martín-Rabassa
- Servicio de Nefrología. Fundació Salut Empordà. Hospital de Figueres. Girona. España
| | - Alicia Rey-Miguel
- Servicio de Nefrología. Fundació Salut Empordà. Hospital de Figueres. Girona. España
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Elías-Viramontes ADC, Casiquen-Casique L, Rodríguez-Loreto JE. La persona con enfermedad renal crónica: una revisión sistemática de las intervenciones de salud. ENFERMERÍA NEFROLÓGICA 2020. [DOI: 10.37551/s2254-28842020034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introducción: Existen intervenciones enfocadas a la educación y capacitación de las personas con enfermedad renal crónica sin embargo, muchas de ellas fragmentan a la persona al considerar sólo el incremento de conocimientos y/o conductas, por lo que al no existir una atención integral no se logran cambios favorables. Objetivo: identificar los aspectos teóricos y metodológicos considerados en el diseño e implementación de intervenciones de salud para las personas con enfermedad renal. Metodología: Se ha realizado una revisión sistemática a través de las bases de datos Biblioteca Virtual de la Salud y PubMed, analizando artículos en idioma inglés y español que hayan implementado una intervención a las personas con enfermedad renal crónica. Resultados: De un total de 218 artículos arrojados por las bases de datos sólo fueron seleccionadas 28 publicaciones. Para su análisis se consideró el tamaño de la muestra, el diseño y enfoque teórico de la intervención, los principales resultados y conclusiones. Existen investigaciones que involucran el aspecto psicológico, particularmente el área motivacional como eje central en el cambio conductual y consideran a Bandura como referente teórico, lo cual otorga mejoras en las conductas de salud de las personas con enfermedad renal. Conclusiones: Una intervención con bases teóricas definidas puede contribuir a la prevención en salud con un bajo costo y alto impacto en los estilos de vida de las personas. Además de ser un gran aporte al conocimiento de educación en salud y a la profesión como ciencia.
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Affiliation(s)
- Alma de Coral Elías-Viramontes
- Departamento de Enfermería y Obstetricia. División de Ciencias de la Salud e Ingenierías. Campus Celaya-Salvatierra. Universidad de Guanajuato. Celaya. México
| | - Leticia Casiquen-Casique
- Departamento de Enfermería y Obstetricia. División de Ciencias de la Salud e Ingenierías. Campus Celaya-Salvatierra. Universidad de Guanajuato. Celaya. México
| | - José Ernesto Rodríguez-Loreto
- Departamento de Enfermería Clínica Aplicada. División de Disciplinas Clínicas. Centro Universitario de Ciencias de la Salud. Universidad de Guadalajara. Guadalajara. México
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Morillo Gallego N, Merino Martínez RM, Sánchez Cabezas AM, Alcántara Crespo M. Alteraciones de la piel del paciente con enfermedad renal crónica avanzada. Una revisión sistemática. ENFERMERÍA NEFROLÓGICA 2019. [DOI: 10.4321/s2254-28842019000300002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Objetivo: Conocer las principales alteraciones de la piel, así como su prevalencia, en los pacientes con Enfermedad Renal Crónica Avanzada.
Material y Método: Se ha realizado una revisión sistemática a través de las bases de datos de PubMed, Cochrane, Scopus y Google Académico. Se incluyeron artículos científicos escritos en inglés y español. Se analizaron los artículos que trataban sobre las alteraciones en la piel en el paciente con Enfermedad Renal Crónica Avanzada y/o en tratamiento con diálisis.
Resultados: Se han incluido 32 artículos publicados entre el año 2008 y 2018: 7 revisiones sistemáticas, 3 de tipo experimental y 22 de tipo observacional. Las alteraciones cutáneas aparecen en la mayoría de los pacientes en prediálisis y en tratamiento con diálisis, en mayor o menor grado. La mayoría de alteraciones de la piel descritas han sido, xerosis, prurito e hiperpigmentación. La mayor complicación relacionada con la alteración de la piel ha sido la calcifilaxis; siendo las variables más influyentes en la aparición de estas lesiones, el tipo de tratamiento dialítico, las enfermedades asociadas y falta de adherencia a la dieta prescrita.
Conclusiones: Las alteraciones en la piel están presentes en la mayoría de los pacientes con Enfermedad Renal Crónica Avanzada y en diálisis, predominando la xerosis como la alteración más frecuente, siguiéndole el prurito y la hiperpigmentación. La complicación más grave relacionada con las alteraciones de la piel es la calcifilaxis, encontrándose asociada a altos niveles de fósforo sérico. No existen protocolos estandarizados para el manejo de las alteraciones cutáneas en estos pacientes.
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Tao X, Zhang H, Yang Y, Zhang C, Wang M. Daily dietary phosphorus intake variability and hemodialysis patient adherence to phosphate binder therapy. Hemodial Int 2019; 23:458-465. [PMID: 31328873 DOI: 10.1111/hdi.12769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 04/08/2019] [Accepted: 06/13/2019] [Indexed: 01/22/2023]
Affiliation(s)
- Xingjuan Tao
- School of NursingShanghai Jiao Tong University Shanghai China
| | - Haifen Zhang
- Department of Nephrology, Renji Hospital, School of MedicineShanghai Jiao Tong University Shanghai China
| | - Yan Yang
- Department of Nephrology, Renji Hospital, School of MedicineShanghai Jiao Tong University Shanghai China
| | - Caihong Zhang
- Department of Nephrology, Renji Hospital, School of MedicineShanghai Jiao Tong University Shanghai China
| | - Min Wang
- Department of Nephrology, Renji Hospital, School of MedicineShanghai Jiao Tong University Shanghai China
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Umeukeje EM, Mixon AS, Cavanaugh KL. Phosphate-control adherence in hemodialysis patients: current perspectives. Patient Prefer Adherence 2018; 12:1175-1191. [PMID: 30013329 PMCID: PMC6039061 DOI: 10.2147/ppa.s145648] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES This review summarizes factors relevant for adherence to phosphate-control strategies in dialysis patients, and discusses interventions to overcome related challenges. METHODS A literature search including the terms "phosphorus", "phosphorus control", "hemo-dialysis", "phosphate binder medications", "phosphorus diet", "adherence", and "nonadherence" was undertaken using PubMed, PsycInfo, CINAHL, and Embase. RESULTS Hyperphosphatemia is associated with cardiovascular and all-cause mortality in dialysis patients. Management of hyperphosphatemia depends on phosphate binder medication therapy, a low-phosphorus diet, and dialysis. Phosphate binder therapy is associated with a survival benefit. Dietary restriction is complex because of the need to maintain adequate protein intake and, alone, is insufficient for phosphorus control. Similarly, conventional hemodialysis alone is insufficient for phosphorus control due to the kinetics of dialytic phosphorus removal. Thus, all three treatment approaches are important contributors, with dietary restriction and dialysis as adjuncts to the requisite phosphate binder therapy. Phosphate-control adherence rates are suboptimal and are influenced directly by patient, provider, and phosphorus-control strategy-related factors. Psychosocial factors have been implicated as influential "drivers" of adherence behaviors in dialysis patients, and factors based on self-motivation associate directly with adherence behavior. Higher-risk subgroups of nonadherent patients include younger dialysis patients and non-whites. Provider attitudes may be important - yet unaddressed - determinants of adherence behaviors of dialysis patients. CONCLUSION Adherence to phosphate binders, low-phosphorus diet, and dialysis prescription is suboptimal. Multicomponent strategies that concurrently address therapy-related factors such as side effects, patient factors targeting self-motivation, and provider factors to improve attitudes and delivery of culturally sensitive care show the most promise for long-term control of phosphorus levels. Moreover, it will be important to identify patients at highest risk for lack of control, and for programs to be ready to deliver flexible person-centered strategies through training and dedicated resources to align with the needs of all patients.
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Affiliation(s)
- Ebele M Umeukeje
- Vanderbilt Center for Kidney Disease, Nashville, TN, USA,
- Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville TN, USA,
- Vanderbilt Center for Health Services Research, Nashville, TN, USA,
| | - Amanda S Mixon
- Vanderbilt Center for Health Services Research, Nashville, TN, USA,
- Section of Hospital Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kerri L Cavanaugh
- Vanderbilt Center for Kidney Disease, Nashville, TN, USA,
- Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville TN, USA,
- Vanderbilt Center for Health Services Research, Nashville, TN, USA,
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