Structured patient handoff on an internal medicine ward: A cluster randomized control trial.

Background: The effect of a multi-faceted handoff strategy in a high volume internal medicine inpatient setting on process and patient outcomes has not been clearly established. We set out to determine if a multi-faceted handoff intervention consisting of education, standardized handoff procedures, including fixed time and location for face-to-face handoff would result in improved rates of handoff compared with usual practice. We also evaluated resident satisfaction, health resource utilization and clinical outcomes.

The Change in Living Kidney Donation in Women and Men in the United States (2005-2015): A Population-Based Analysis.

The factors underlying the decline in living kidney donation in the United States since 2005 must be understood to inform strategies to ensure access to this option for future patients. Population-based estimates provide a better assessment of donation activity than do trends in the number of living donor transplants. Using data from the Scientific Registry of Transplant Recipients and the United States Census, we determined longitudinal changes in living kidney donation between 2005 and 2015, focusing on the effect of sex and income.

Temporal trends in stroke incidence in South Asian, Chinese and white patients: A population based analysis.

Background: Little is known about potential ethnic differences in stroke incidence. We compared incidence and time trends of ischemic stroke and primary intracerebral hemorrhage in South Asian, Chinese and white persons in a population-based study.

Methods: Population based census and administrative data analysis in the provinces of Ontario and British Columbia, Canada using validated ICD 9/ICD 10 coding for acute ischemic and hemorrhagic stroke (1997-2010).

Cold ischemia time up to 16 hours has little impact on living donor kidney transplant outcomes in the era of kidney paired donation.

In living donor transplantation, cold ischemia time is a concern in transplants involving kidney paired donation. The impact of cold ischemia time over eight hours is unknown. Here we examined the association of cold ischemia time with delayed graft function and allograft loss among 48,498 living recipients in the Scientific Registry of Transplant Recipients registry.

Implementing standardized performance indicators to improve hypertension control at both the population and healthcare organization levels.

The ability to reliably evaluate the impact of interventions and changes in hypertension prevalence and control is critical if the burden of hypertension-related disease is to be reduced. Previously, a World Hypertension League Expert Committee made recommendations to standardize the reporting of population blood pressure surveys. We have added to those recommendations and also provide modified recommendations from a Pan American Health Organization expert meeting for "performance indicators" to be used to evaluate clinical practices.

The risk of allograft failure and the survival benefit of kidney transplantation are complicated by delayed graft function.

Concern about the long-term impact of delayed graft function (DGF) may limit the use of high-risk organs for kidney transplantation. To understand this better, we analyzed 29,598 mate kidney transplants from the same deceased donor where only 1 transplant developed DGF. The DGF associated risk of graft failure was greatest in the first posttransplant year, and in patients with concomitant acute rejection (hazard ratio: 8.

Risk Factors for BK Polyoma Virus Treatment and Association of Treatment With Kidney Transplant Failure: Insights From a Paired Kidney Analysis.

Background: Identification of risk factors for BK polyoma virus (BKPyV) without confounding by donor factors and era effects in paired analysis may inform strategies to prevent BKPyV.

Methods: In this analysis of 21,575 mate kidney pairs in the Scientific Registry of Transplant Recipients between 2004 and 2010, the presence of a treatment code for BKPyV virus in follow-up forms was used to identify pairs in which 1 of 2 mate kidneys was treated (discordant treatment) or both mate kidneys were treated (concordant treatment).

Results: Among 1975 discordant pairs, younger than 18 years or 60 years or older, male sex, HLA mismatch or 4 greater, acute rejection, and depleting antibody induction had a higher odds of treatment, whereas diabetes and sirolimus had a lower odds of treatment, and treatment was associated with a higher risk of allograft failure (hazards ratio, 2.

A Lifetime of Allograft Function with Kidneys from Older Donors.

Strategies to increase expanded criteria donor (ECD) transplantation are needed. We quantified the extent to which ECD kidneys provide recipients with a lifetime of allograft function by determining the difference between patient survival and death-censored allograft survival (graft survival). Initial analyses compared 5-year outcomes in the Eurotransplant Senior Program (European) and the United States Renal Data System.

Willingness of Directed Living Donors and Their Recipients to Participate in Kidney Paired Donation Programs.

Background: Participation of compatible living donors and recipients in kidney paired donation (KPD) could double the number of KPD transplants. We determined the willingness of previous directed donors and their recipients to participate in KPD and identified the association of various factors, including financial incentives, with willingness to participate.

Methods: Survey of previous directed living kidney donors and their recipients in a single Canadian center between 2001 and 2009.

The Canadian kidney paired donation program: a national program to increase living donor transplantation.

Background: Establishment of a national kidney paired donation (KPD) program represents a unique achievement in Canada's provincially organized health care system.

Methods: Key factors enabling program implementation included consultation with international experts, formation of a unique organization with a mandate to facilitate interprovincial collaboration, and the volunteer efforts of members of the Canadian transplant community to overcome a variety of logistical barriers.

Results: As of December 2013, the program had facilitated 240 transplantations including 10% with Calculated panel reactive antibody (cPRA) ≥97%.

Antihypertensive medication adherence and mortality according to ethnicity: a cohort study.

Background: Few studies have evaluated adherence to antihypertensive medication in Chinese and South Asian populations and little is known about the long-term outcome. Our objectives were to compare adherence to antihypertensive medications and assess the association of adherence and long-term mortality in Chinese, South Asian, and white patients with newly diagnosed hypertension.

Methods: We conducted a retrospective cohort study of patients with hypertension who were new users of antihypertensive medications (1997-2005) using administrative data and a province-wide prescription database from British Columbia, Canada.

Population income and longitudinal trends in living kidney donation in the United States.

Living kidney donation is declining in the United States. We examined longitudinal trends in living donation as a function of median household income and donor relation to assess the effect of financial barriers on donation in a changing economic environment. The zip code-level median household income of all 71,882 living donors was determined by linkage to the 2000 US Census.

Impact of work schedules on sleep duration of critical care nurses.

Background: Sleep deprivation leads to reduced vigilance and potentially impairs work performance. Nurses may work long shifts that may contribute to sleep deprivation.

Objective: To assess how nurses' sleep patterns are affected by work schedules and other factors.

Hypertension as a risk factor for ischemic stroke in women.

Women have a high lifetime risk of stroke, and hypertension (HTN) is a major stroke risk factor. We conducted a literature review of studies evaluating blood pressure (BP) and ischemic stroke risk in women; 18 studies were identified. The stroke risk increases in a graded manner with BP levels above 115/75 mm Hg.

Differential association of body mass index with access to kidney transplantation in men and women.

Background And Objectives: Obese patients encounter barriers to medical care not encountered by lean patients, and inequities in access to care among obese patients may vary by sex. This study aimed to determine the association of body mass index (BMI) with access to kidney transplantation in men and women.

Design, Setting, Participants, & Measurements: In this retrospective analysis of 702,456 incident ESRD patients aged 18-70 years (captured in the US Renal Data System between 1995 and 2007), multivariate time-to-event analyses were used to determine the association of BMI with likelihood of transplantation from any donor source, transplantation from a living donor, and transplantation from a deceased donor, as well the individual steps in obtaining a deceased donor transplant (activation to the waiting list, and transplantation after wait-listing).

Pulsatile perfusion reduces the risk of delayed graft function in deceased donor kidney transplants, irrespective of donor type and cold ischemic time.

Background: The role of pulsatile perfusion (PP) across different cold ischemic times (CIT) within different donor groups is unclear. This study examined the association of PP with delayed graft function (DGF) in all (n=94,709) deceased donor kidney transplants in the US between 2000 and 2011, as a function of CIT and donor type.

Methods: Using the Scientific Registry of Transplant Recipients data, all adult standard criteria donors (SCD, n=71,192), expanded criteria donors (ECD, n=15,122), and donors after circulatory death (DCD, n=8,395) kidney transplant recipients were identified.

Outcomes after acute myocardial infarction in South Asian, Chinese, and white patients.

Background: Cardiac mortality rates vary substantially between countries and ethnic groups. It is unclear, however, whether South Asian, Chinese, and white populations have a variable prognosis after acute myocardial infarction (AMI). To clarify this association, we compared mortality, use of revascularization procedures, and risk of recurrent AMI and hospitalization for heart failure between these ethnic groups in a universal-access healthcare system.