Characterizing sleep disorders in chronic hemodialysis patients.

Forty-eight chronic hemodialysis (HD) patients (pts) completed questionnaires that used linear analogue scales (LAS), yes/no responses, and demographic data collection to characterize sleep disorders. Twenty-five pts (52%) reported problems sleeping. These pts graded sleep problems significantly higher than those without sleep problems (6.

Nephrologists' reported attitudes about factors influencing recommendations to initiate or withdraw dialysis.

A nationwide survey of nephrologists was performed to learn which patient factors and characteristics of nephrology fellowship training they reported as influencing their decisions to start or stop dialysis. One hundred seventy-four of 482 responses were received. Most respondents were men in private practice living in large communities (41% in communities over 1,000,000 population).

Thallium stress testing does not predict cardiovascular risk in diabetic patients with end-stage renal disease undergoing cadaveric renal transplantation.

Purpose: This study assessed the usefulness of thallium stress testing as a predictor of perioperative cardiovascular risk in diabetic patients with end-stage renal disease undergoing cadaveric renal transplantation. Demographic factors influencing the exercise performance in these patients were also examined.

Patients And Methods: The medical records of 189 consecutive patients with diabetic nephropathy who were evaluated for cadaveric renal transplantation were reviewed.

The utility of a structured evaluation of elderly patients for continuous peritoneal dialysis.

The elderly comprise an increasing proportion of chronic dialysis patients. Recruiting them for continuous peritoneal dialysis (CPD) would help CPD programs maintain a patient population. We retrospectively studied the ability of a prospective evaluation to predict success with CPD in elderly (age greater than 60 years) patients.

Catheter infections in insulin-dependent diabetics on continuous ambulatory peritoneal dialysis.

We compared a group of 60 insulin-dependent diabetics maintained on CAPD with 60 nondiabetic matched controls to determine if the diabetic patients were at increased risk for catheter-related infections. Although catheter infection rates were 17% higher in the diabetics (1.4/year versus 1.

Patient factors and the influence of nephrologists, social workers, and nurses on patient decisions to choose continuous peritoneal dialysis.

To determine which members of the health care team are viewed by ESRD patients as the most helpful in giving information and deciding on a dialysis modality, we surveyed 42 outpatients after they toured the dialysis facility. The tour included discussions with a social worker, PD and HD nurses, watching a videotape, and receipt of written materials. Nephrologists referred patients for tours.

Use of a silicone dual-lumen catheter with a Dacron cuff as a long-term vascular access for hemodialysis patients.

We evaluated our experience over a 4-year period with a silicone dual-lumen catheter with a Dacron cuff (SDLCDC) to determine if the catheter represents an alternative to the polytetrafluoroethylene graft for long-term vascular access for hemodialysis patients. Records of 131 patients who used 168 catheters were reviewed for catheter function, duration of use, and occurrence and response to treatment of complications. Eighty-five percent of catheters functioned adequately until their use was no longer required or the end of the study.

Methicillin-resistant staphylococcal infections in an outpatient peritoneal dialysis program.

In view of the increasing concern about hospital-acquired methicillin resistance, we examined the sensitivities and outcome of staphylococcal infections related to outpatient peritoneal dialysis over a 5-year period. Data on all episodes of peritonitis (n = 360) and catheter infections (n = 507) were gathered prospectively from January 1984 to December 1988. The numbers of patients on peritoneal dialysis each year ranged from 136 in 1984 to 109 in 1987.

Continuous cycling peritoneal dialysis is associated with lower rates of catheter infections than continuous ambulatory peritoneal dialysis.

Continuous cycling peritoneal dialysis (CCPD), unlike continuous ambulatory peritoneal dialysis (CAPD), provides freedom from daytime exchanges and is associated with lower rates of peritonitis. However, catheter infection (CI) rates have not been reported for CCPD. Previous data suggested that a CAPD disconnect system (Y-set) was associated with lower rates of CI.

Obesity as a risk factor following cadaveric renal transplantation.

Obesity has generally been thought to increase the risk of operative mortality and postoperative complications in surgical patients. No data examining obesity as a factor in cadaveric renal transplantation were available. We therefore matched obese patients undergoing cadaveric renal transplantation with nonobese control patients and retrospectively analyzed mortality, morbidity, and graft survival in each group.

Pharmacokinetics and metabolism of fenbendazole in channel catfish.

Fenbendazole (FBZ) was administered intravenously (1 mg/kg) and orally (5 mg/kg) to catheterized, confined channel catfish. Blood samples were collected for 72 h, and resulting FBZ plasma concentrations were pharmacokinetically modelled. Following intravenous administration t 1/2 alpha was 0.

Gram-negative arthritis with a simultaneous urinary tract infection in a renal transplant recipient.

Infections are common causes of morbidity in the renal transplant population, but infectious arthritis is rarely encountered. Gram-negative joint infections in the nontransplant population are often associated with simultaneous urinary tract infections. We report a case of Escherichia coli monoarthritis and a concomitant urinary tract infection in a renal transplant recipient and consider the possible predisposing factors for the infection.

Peritonitis following colonoscopy in a peritoneal dialysis patient.

A 65-year-old woman on continuous ambulatory peritoneal dialysis (CAPD) developed blood-tinged dialysate and bacterial peritonitis following a colonoscopic polypectomy. She grew multiple anaerobic organisms in her dialysate despite antibiotic prophylaxis with vancomycin and gentamicin prior to the procedure. This case confirms the need for broad spectrum antibiotic prophylaxis prior to colonoscopic procedures, especially if polypectomy is planned.

Airway management in patients with unstable cervical spine fractures.

We conducted a retrospective study of traumatic, unstable cervical spine fractures requiring operative repair to determine the airway management technique and whether any neurologic complication resulted from the intubation. One hundred thirty-three patients with 140 fractures were reviewed relative to fracture site, oral versus nasal route of intubation, and location of intubation (surgery versus emergency department or field). Fracture site incidence was determined as follows: C-1, ten (7.

Treatment of high blood pressure in the young.

Children with high normal or high BP should also be evaluated for other cardiovascular risk factors, and interventions should address overall cardiovascular risk. Nonpharmacologic interventions include weight reduction when appropriate, avoidance of dietary salt excess, and dynamic exercise. Drug treatment should be required in a minority of children with hypertension.

Ultrasound as a tool in the diagnosis and management of exit-site infections in patients undergoing continuous ambulatory peritoneal dialysis.

Ultrasonographic examination of the subcutaneous course and exit site of the Tenckhoff catheter in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) was performed to evaluate catheter-related infections. Real-time ultrasound studies were performed in 24 patients with initial exit-site infections; clinically suspected tunnel infections were excluded from analysis. A peri-catheter sonolucent fluid collection, considered a positive study, was demonstrated in 13 ultrasound examinations and tended to be organism-specific; eight of 12 Staphylococcus aureus exit-site infections and three of four gram-negative exit-site infections had positive studies.

Gestational hypercalciuria causes pathological urine calcium oxalate supersaturations.

Although normal pregnant women are more hypercalciuric than women with calcium oxalate nephrolithiasis (243 +/- 23 mg/day vs. 194 +/- 5 mg/day), pregnancy is not an established stone-forming state and pregnant women do not exhibit pathological crystalluria. One hypothesis to explain their lack of overt stone formation and pathological crystalluria is that pregnancy does not raise urine supersaturation with respect to stone forming salts such as calcium oxalate or calcium monohydrogen phosphate (brushite) to levels as high as in stone forming women.

Paying for your BSN degree: five steps to success.

Registered nurses confronted with the necessity of financing their BSN degree need to develop a careful plan to get the needed monetary support. The use of a logical five step model will facilitate the process involved in earning financial assistance from the government or private sources. Nurses can be creative in designing their own financial sources and support packages.

A prospective evaluation of blood culture versus standard plate techniques for diagnosing peritonitis in continuous ambulatory peritoneal dialysis.

Peritonitis remains a major cause of morbidity in patients treated with continuous ambulatory peritoneal dialysis (CAPD). Culture-negative episodes of peritonitis occur at rates of up to 20%, and in part may reflect inadequate culturing techniques of peritoneal effluent. Through a large, prospective study, the improved sensitivity of a blood culture system, when compared with a standard plate technique (P = 0.

Dialysis patients' attitudes about cardiopulmonary resuscitation and stopping dialysis.

Dialysis patients are a unique population because of their chronic dependence on complex medical technology. Furthermore, their illness forces them to make critical decisions about medical care (mode of dialysis, renal transplantation, withdrawal from dialysis). The reasons dialysis patients discontinue therapy are not well understood, nor is it known whether they view dialysis therapy differently from other life-support interventions.