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Ang WS, Jamil TR, Kamaludin R, Mustafar R. CKD-CHECK toolkit to improve doctors' practice in managing chronic kidney disease rapid progressors: a pilot study in primary care setting. Med J Malaysia 2023; 78:721-732. [PMID: 38031213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
INTRODUCTION Chronic kidney disease (CKD) rapid progression is associated with higher risk of end-stage kidney disease and higher mortality rate. Monitoring and recognition of CKD rapid progression is still lacking, however interventions have been shown to improve this. Thus, this study aimed to evaluate the acceptability and feasibility of CKD-CHECK toolkit and preliminary measure the outcome of the CKD-CHECK toolkit in assisting primary care doctor to order further tests for CKD rapid progressors and trigger appropriate nephrology referral. MATERIALS AND METHODS The CKD-CHECK (CKD-CHECK EGFR Chart in Kidney disease) is a toolkit that was developed to auto-generate patients' eGFR trend using a line graph, displaying the trend visually over a year. It identifies patients with rapid CKD progression, triggers the doctors to order appropriate tests (proteinuria quantification or renal imaging) and helps in decision making (continued monitoring at primary care level or referral to nephrologist). The toolkit was piloted among medical officers practising in a hospital-based primary care clinic treating patients with eGFR<60ml/min/1.73m2 using an interventional before-after study design from February to May 2022. In the preintervention period, the CKD patients were managed based on standard practice. The doctors then used the CKDCHECK toolkit on the same group of CKD patients during the intervention period. The feasibility and acceptability of the toolkit was assessed at the end of the study period using the Acceptability of Intervention Measure (AIM) and Feasibility of Intervention Measure (FIM) questionnaires. All patients' clinical data and referral rate were collected retrospectively through medical files and electronic data systems. Comparison between the pre- and post-intervention group were analysed using paired t-test and McNemar test, with statistical significance p value of <0.05. RESULTS A total of 25 medical officers used the toolkit on 60 CKD patients. The medical officers found the CKD-CHECK toolkit to be highly acceptable and feasible in primary care setting. The baseline characteristics of the patients were a mean age of 72 years old, predominantly females and Chinese ethnicity. Majority of the CKD patients had diabetes mellitus, hypertension and dyslipidemia. The numbers of CKD rapid progressors was similar (26.7% in the preintervention group vs 33.3% in the post-intervention group). There were no significant differences in terms of proteinuria assessment and ultrasound kidney for CKD rapid progressors before and after the intervention. However, a significant number of CKD rapid progressors were referred to nephrologists after the use of CKD-CHECK toolkit (p=0.016). CONCLUSIONS CKD-CHECK toolkit is acceptable and feasible to be used in primary care. Preliminary findings show that the CKD-CHECK toolkit improved the primary care doctor's referral of rapid CKD progressors to nephrologists.
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Affiliation(s)
- W S Ang
- Universiti Kebangsaan Malaysia, Faculty of Medicine, Department of Family Medicine, Malaysia
| | - T R Jamil
- Universiti Kebangsaan Malaysia, Faculty of Medicine, Department of Family Medicine, Malaysia.
| | - R Kamaludin
- Klinik Primer HCTM Cheras, Hospital Canselor Tuanku Muhriz, Cheras, Kuala Lumpur, Malaysia
| | - R Mustafar
- Universiti Kebangsaan Malaysia, Faculty of Medicine, Department of Internal Medicine, Nephrology Unit, Malaysia
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Ahmed S, Karim A, Chowdhury TK, Pulock OS, Tamanna N, Akter M, Biswas P, Afroz F, Pinky SD, Alabbi AN, Jamil TR, Tasnim Z, Dev D, Marma M, Aziz TT, Hakim HAN, Basher AKMK, Shahin NHB, Banu T. Patients' characteristics and 30-day mortality for those undergoing elective surgeries during the COVID-19 pandemic in Bangladesh. PLoS One 2023; 18:e0289878. [PMID: 37578982 PMCID: PMC10424860 DOI: 10.1371/journal.pone.0289878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 07/28/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has significantly impacted the surgical practice throughout the world, including elective surgical care. This study investigated the characteristics of patients undergoing elective surgery, the prevalence of COVID-19 infection, the surgical procedures performed, and 30-day mortality in general and pediatric surgical settings in selected tertiary-level hospitals in Bangladesh from November 2020 to August 2021. METHODS This serial cross-sectional study included 264 patients scheduled for elective surgeries during the study period. All patients underwent COVID-19 real-time polymerase chain reaction (RT-PCR) testing within 24 hours before surgery. Data on age, sex, common comorbidities, surgical procedures, and 30-day mortality were collected and analyzed. Furthermore, comparisons were made between COVID-19 positive and negative patients. RESULTS The prevalence of COVID-19 infection among patients was 10.6%. Older age, a history of major surgery within the last three months, hypertension, and diabetes mellitus were significantly associated with COVID-19 infection. All COVID-19-negative patients underwent surgery, while only 46.4% of COVID-19-positive patients underwent surgery. The most common surgical procedures were related to the digestive system, breast, and urinary system. Only one patient (0.4%) died within 30 days after surgery among the COVID-19-negative patients, whereas two patients (7.1%) died among the COVID-19-positive patients: one before surgery and one after surgery. CONCLUSIONS This study provides valuable insights into the characteristics, burden of COVID-19 infection, and 30-day mortality of patients undergoing elective surgery in tertiary care centers in Bangladesh during the pandemic.
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Affiliation(s)
- Shakera Ahmed
- Chittagong Research Institute for Children Surgery, Chattogram, Bangladesh
- Chittagong Medical College and Hospital, Chattogram, Bangladesh
| | - Anwarul Karim
- Chittagong Research Institute for Children Surgery, Chattogram, Bangladesh
- School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Tanvir Kabir Chowdhury
- Chittagong Research Institute for Children Surgery, Chattogram, Bangladesh
- Chittagong Medical College and Hospital, Chattogram, Bangladesh
| | | | - Nowrin Tamanna
- Chittagong Research Institute for Children Surgery, Chattogram, Bangladesh
- University of South Carolina, Columbia, SC, United States of America
| | - Mastura Akter
- Chittagong Research Institute for Children Surgery, Chattogram, Bangladesh
- Department of Biomedical Sciences, City University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Puja Biswas
- Chittagong Medical College and Hospital, Chattogram, Bangladesh
| | - Fahmida Afroz
- Chittagong Medical College and Hospital, Chattogram, Bangladesh
| | | | | | | | - Zarin Tasnim
- Chittagong Medical College and Hospital, Chattogram, Bangladesh
| | - Dipa Dev
- Chittagong Medical College and Hospital, Chattogram, Bangladesh
| | - Mraching Marma
- Chittagong Medical College and Hospital, Chattogram, Bangladesh
| | | | | | | | | | - Tahmina Banu
- Chittagong Research Institute for Children Surgery, Chattogram, Bangladesh
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