Effect of Coaching to Increase Water Intake on Kidney Function Decline in Adults With Chronic Kidney Disease: The CKD WIT Randomized Clinical Trial.

Importance: In observational studies, increased water intake is associated with better kidney function.

Objective: To determine the effect of coaching to increase water intake on kidney function in adults with chronic kidney disease.

Design, Setting, And Participants: The CKD WIT (Chronic Kidney Disease Water Intake Trial) randomized clinical trial was conducted in 9 centers in Ontario, Canada, from 2013 until 2017 (last day of follow-up, May 25, 2017).

Canadian Rural/Remote Primary Care Physicians Perspectives on Child/Adolescent Mental Health Care Service Delivery.

Introduction: Primary Care Physicians (PCP) play a key role in the recognition and management of child/adolescent mental health struggles. In rural and under-serviced areas of Canada, there is a gap between child/adolescent mental health needs and service provision.

Methods: From a Canadian national needs assessment survey, PCPs' narrative comments were examined using quantitative and qualitative approaches.

The next generation HydroCoil: initial clinical experience with the HydroFill embolic coil.

Background: Complete packing of intracranial aneurysms has demonstrated a significant decrease in aneurysm recurrence rates with increased volumetric filling. The HydroCoil Embolization System (HES) was developed to increase volumetric filling within the aneurysm sac to maintain long term occlusion. To further enhance ease of HES deployment, a new next generation embolic coil, the HydroFill coil, was developed.

Factors influencing vancomycin loading dose for hospitalized hemodialysis patients: prospective observational cohort study.

Background: The increasing use of vancomycin to treat methicillin-resistant Staphylococcus aureus (MRSA) has resulted in reduced susceptibility of MRSA to this drug. It is important to optimize vancomycin dosing in patients who are undergoing hemodialysis to attain a pre-hemodialysis serum concentration sufficient to eradicate MRSA, in accordance with recent guideline recommendations.

Objectives: To establish the optimal strategy for vancomycin loading dose in patients undergoing hemodialysis and to explore the determinants of pre-hemodialysis serum concentration of vancomycin measured in these patients.

Comparison of alteplase (tissue plasminogen activator) high-dose vs. low-dose protocol in restoring hemodialysis catheter function: the ALTE-DOSE study.

Hemodialysis catheter (HDC) dysfunction due to thrombosis is common, and dysfunction incidence can reach up to 50% within 1 year of use. Although administration of intraluminal alteplase (tissue plasminogen activator [tPA]) is the standard of practice to pharmacologically restore HDC function, there are no evidence-based guidelines concerning the optimal tPA dose. The purpose of this study was to compare the efficacy of 1.

Exploring the influence of enforcing infection control directives on the risk of developing healthcare associated infections in the intensive care unit: a retrospective study.

Background: Although strict adherence to infection control strategies is recognised as the simplest and most cost effective method to prevent the spread of healthcare associated infections (HAIs), measurement of the direct impact that such adherence may have on the risk of developing such infections has always been a challenge.

Purpose: The purpose of this study was to compare the risk of HAIs before and during the SARS outbreak. Such comparison is intended to provide a surrogate measure of the influence that strict enforcement of infection control strategies during the SARS outbreak may have had on the risk of HAIs.

The important role for nurses in supporting the Asian Hindu patient and family at end of life: providing culturally sensitive end-of-life care.

As cultural ecology of Canada evolves with daily arrival of new immigrants, Canadians welcome them and feel very proud of preserving their multicultural heritage. As minority groups, especially South Asian Hindus, continue to grow, there is a need to understand their cultural perspectives and accommodate their cultural preferences for end-of-life care. This article addresses end-of-life care from a point of view of Hindu culture and religion and provides a brief overview of their beliefs and rituals related to it.

Long-term efficacy of risperidone long-acting injectable in bipolar disorder with psychotic features: a prospective study of 3-year outcomes.

Bipolar disorder (BD) with psychotic features is a difficult-to-treat form of the illness that is associated with a poor prognosis. We hypothesized that treatment with adjunctive risperidone long-acting injectable (RLAI) is well-tolerated and efficacious in treating patients with psychotic BD. Ten patients with BDI or BDII with psychotic features who were refractory to earlier treatments were prescribed adjunctive open-label RLAI 25-62.

Red light-green light: from kids' game to discharge tool.

Lean manufacturing methods are being evaluated in the healthcare sector. Improving the flow of patients in acute care should the eliminate delays that contribute to the cost of healthcare. Our patient care unit uses the colours of a traffic light to visually identify the expected date of discharge.

Incidence of infectious complications after an ultrasound-guided intervention.

Objective: The objective of our study was to determine the incidence of infectious complications of common ultrasound-guided procedures including fine-needle aspiration (FNA), drain placement, biopsy, pseudoaneurysm thrombin injection, thoracentesis, and paracentesis.

Subjects And Methods: The infection prevention and control (IPAC) committee at the Mayo Clinic, Rochester, MN, conducts surveillance of selected infections including radiology procedures. When a positive culture, hospital admission, or operating room visit for infection is identified, the patient's electronic records are thoroughly reviewed by an infection control practitioner looking for information about prior interventions.

Applying the Lean principles of the Toyota Production System to reduce wait times in the emergency department.

Objective: In recognition of patient wait times, and deteriorating patient and staff satisfaction, we set out to improve these measures in our emergency department (ED) without adding any new funding or beds.

Methods: In 2005 all staff in the ED at Hôtel-Dieu Grace Hospital began a transformation, employing Toyota Lean manufacturing principles to improve ED wait times and quality of care. Lean techniques such as value-stream mapping, just-in-time delivery techniques, workplace organization, reduction of systemic wastes, use of the worker as the source of quality improvement and ongoing refinement of our process steps formed the basis of our project.

Examining the association between chest tube-related factors and the risk of developing healthcare-associated infections in the ICU of a community hospital: a retrospective case-control study.

Objectives: The study examined the association between chest tube-related factors and the risk for developing healthcare-associated infections (HAI).

Research Methodology: A case-control retrospective chart review was performed on 120 intensive care patients. Eligible patients were 18 years of age or older, had been in the intensive care unit (ICU) for 48 h or more, and had one or more chest tubes.

Depot risperidone in the outpatient management of bipolar disorder: a 2-year study of 10 patients.

Nonadherence with pharmacotherapy occurs frequently in bipolar patients, and is a common cause of relapse. Depot formulations of first-generation antipsychotic medications have been shown to reduce manic relapses during maintenance therapy in bipolar patients, but appear to increase liability for depressive episodes. A depot formulation of risperidone has recently become commercially available, but to date there is little evidence regarding its efficacy or safety in bipolar patients.

Repatriation of patients--a process to ensure a safe patient transfer.

To ensure the safe care of patients repatriated to HDGH, we have implemented a process that identifies patient needs prior to their repatriation. The process provides us with critical information regarding a patient's condition well before repatriation so our staff can confirm that we can safely meet the patient's needs. The process is simple and easy for both the sending and receiving facilities to adopt.

Wrong-sided and wrong-level neurosurgery: a national survey.

Object: Perhaps the single greatest error that a surgeon hopes to avoid is operating at the wrong site. In this report, the authors describe the incidence and possible determinants of incorrect-site surgery (ICSS) among neurosurgeons.

Methods: The authors asked neurosurgeons to complete an anonymous survey.

Case study: changing behaviours to improve documentation and optimize hospital revenue.

A deficit situation prompted Hôtel-Dieu Grace Hospital in Windsor, Ontario to examine aspects of the funding process. A review of charts suggested that the documentation in the patient record did not accurately reflect the care given. Improving the documentation could potentially improve hospital revenue.

Rapid on-site defibrillation versus community program.

Introduction: For patients who suffer out-of-hospital cardiac arrest, the time from collapse to initial defibrillation is the single most important factor that affects survival to hospital discharge. The purpose of this study was to compare the survival rates of cardiac arrest victims within an institution that has a rapid defibrillation program with those of its own urban community, tiered EMS system.

Methods: A logistic regression analysis of a retrospective data series (n = 23) and comparative analysis to a second retrospective data series (n = 724) were gathered for the study period September 1994 to September 1999.