Attention Functions in Children with Pediatric Chronic Kidney Disease

Children with chronic kidney disease (CKD) can evidence a variety of general and specific neurocognitive deficits, but little is known regarding the effects of pediatric CKD on specific domains of attention. Using a variety of measures tapping specific domains (e.g., Focus/Execute, Sustain, Stability, Shift, Encode), the current study compared attention outcomes for school-age children with CKD to those of a typicallydeveloping control group. The study addressed the following research questions: 1) Do specific domains of attention in children and adolescents with CKD differ significantly from those measured in typically-developing children and adolescents? 2) Do pediatric patients with CKD differ significantly from typically-developing children in their observed proportion of attention problems? 3) What functional- (e.g., recent school absences, IQ), family- (e.g., socioeconomic status), and disease-related (e.g., disease severity, age of onset, duration of disease) characteristics predict attention domain scores? Significant differences on group means were revealed between the CKD (n = 30) and control (n = 41) groups on the Focus/Execute, Sustain, Stability, and Encode attention domains; no group differences were evident on the Shift domain. The CKD group also had a larger proportion of children with attention domain scores one standard deviation or more below the mean on the Shift and Encode domains. The CKD and iv control groups did not differ with respect to the proportion of scores falling one standard deviation or more below the mean on the Focus/Execute, Sustain, or Shift domains. Correlational data indicated that IQ scores and socioeconomic status were positively correlated with all five attention domains, while disease severity was negatively correlated with the attention domains. Exploratory regression analyses indicated that IQ scores were a significant predictor of the Stability and Encode attention domains. No predictors emerged for the Focus/Execute, Sustain, or Shift attention domains. In exploratory analyses with a subdivided CKD group, the end-stage renal disease (ESRD, i.e., kidney failure) group was found to have a higher proportion of attention scores one standard deviation or more below the mean on the Focus/Execute, Sustain, and Stability domains. Exploratory univariate comparisons of children with ESRD versus those with mild/moderate CKD further suggested a potential effect of disease severity on attention. Findings suggested that children with CKD may be vulnerable to subtle, specific deficits in domains of attention relative to their typically-developing peers. Results also suggested that this finding of specific attention problems may be particularly relevant for children with more severe levels of CKD. Facets of the current study, such as small sample size and other limitations, precluded broad generalizations of these findings to the pediatric CKD population as a whole. Future research should utilize regression analyses to develop a model of risk using predictor variables when screening for neurocognitive deficits. Using larger sample sizes and longitudinal analyses in future research may help to distinguish subtle attention problems in this population. Limitations and suggestions for future research are discussed

The nervous system and chronic kidney disease in children

This paper provides a review of the literature on the nervous system involvement incurred by children and adolescents with chronic kidney disease (CKD), with a particular focus on neuropsychological functioning. In addition to an historical overview of earlier literature, published studies from the past 14 years that address both central and peripheral nervous system function in children with CKD are reviewed (1990–2003). These studies span work in neuroimaging, electrophysiology, and neuropsychology. A key focus for this review is on variables that might affect neurodevelopmental status in these children. The paper concludes with suggestions for achieving progress in the understanding of this complication of kidney disease in children

Differential Attention Functioning in Pediatric Chronic Kidney Disease

Objective To compare specific attention functions for school-age children with chronic kidney disease (CKD) to those of a typically developing control group. Methods A cross-sectional study examined attention dimensions for children and adolescents with CKD (n = 30) in comparison to a typically developing control group (n = 41). The CKD group consisted of those receiving maintenance dialysis (n = 15) and those with mild/moderate CKD treated conservatively (n = 15). Measures aligning with Mirsky’s conceptual multidimensional model of attention were selected to compare groups across five dimensions of attention: Focus/Execute, Sustain, Stability, Shift, and Encode. Results Significant group differences were revealed, with the CKD group performing worse than controls on the Focus/Execute, Sustain, and Encode dimensions. The CKD group also had a larger proportion of children with scores one standard deviation or more below the mean on the Shift and Encode domains, suggesting an at-risk level of functioning in these dimensions. Secondary analyses showed disease severity to be correlated with worse attention functions for children with CKD. Conclusion Children with CKD may be vulnerable to subtle, specific deficits in numerous attention dimensions relative to their typically developing peers, particularly for those with more severe disease

Technology-Enabled Remote Monitoring and Self-Management - Vision for Patient Empowerment Following Cardiac and Vascular Surgery: User Testing and Randomized Controlled Trial Protocol.

BACKGROUND: Tens of thousands of cardiac and vascular surgeries (CaVS) are performed on seniors in Canada and the United Kingdom each year to improve survival, relieve disease symptoms, and improve health-related quality of life (HRQL). However, chronic postsurgical pain (CPSP), undetected or delayed detection of hemodynamic compromise, complications, and related poor functional status are major problems for substantial numbers of patients during the recovery process. To tackle this problem, we aim to refine and test the effectiveness of an eHealth-enabled service delivery intervention, TecHnology-Enabled remote monitoring and Self-MAnagemenT-VIsion for patient EmpoWerment following Cardiac and VasculaR surgery (THE SMArTVIEW, CoVeRed), which combines remote monitoring, education, and self-management training to optimize recovery outcomes and experience of seniors undergoing CaVS in Canada and the United Kingdom. OBJECTIVE: Our objectives are to (1) refine SMArTVIEW via high-fidelity user testing and (2) examine the effectiveness of SMArTVIEW via a randomized controlled trial (RCT). METHODS: CaVS patients and clinicians will engage in two cycles of focus groups and usability testing at each site; feedback will be elicited about expectations and experience of SMArTVIEW, in context. The data will be used to refine the SMArTVIEW eHealth delivery program. Upon transfer to the surgical ward (ie, post-intensive care unit [ICU]), 256 CaVS patients will be reassessed postoperatively and randomly allocated via an interactive Web randomization system to the intervention group or usual care. The SMArTVIEW intervention will run from surgical ward day 2 until 8 weeks following surgery. Outcome assessments will occur on postoperative day 30; at week 8; and at 3, 6, 9, and 12 months. The primary outcome is worst postop pain intensity upon movement in the previous 24 hours (Brief Pain Inventory-Short Form), averaged across the previous 14 days. Secondary outcomes include a composite of postoperative complications related to hemodynamic compromise-death, myocardial infarction, and nonfatal stroke- all-cause mortality and surgical site infections, functional status (Medical Outcomes Study Short Form-12), depressive symptoms (Geriatric Depression Scale), health service utilization-related costs (health service utilization data from the Institute for Clinical Evaluative Sciences data repository), and patient-level cost of recovery (Ambulatory Home Care Record). A linear mixed model will be used to assess the effects of the intervention on the primary outcome, with an a priori contrast of weekly average worst pain intensity upon movement to evaluate the primary endpoint of pain at 8 weeks postoperation. We will also examine the incremental cost of the intervention compared to usual care using a regression model to estimate the difference in expected health care costs between groups. RESULTS: Study start-up is underway and usability testing is scheduled to begin in the fall of 2016. CONCLUSIONS: Given our experience, dedicated industry partners, and related RCT infrastructure, we are confident we can make a lasting contribution to improving the care of seniors who undergo CaVS

Multiple Sclerosis Susceptibility Genes: Associations with Relapse Severity and Recovery

Objective:Patients with early multiple sclerosis (MS) have stereotyped attack severity and recovery. We sought to determine if polymorphisms in MS susceptibility genes are associated with these attack features or with the risk of a second attack.Methods:5

Association of Multiple Sclerosis Susceptibility Variants and Early Attack Location in the CNS

Objective:The anatomic location of subsequent relapses in early multiple sclerosis (MS) appears to be predicted by the first attack location. We sought to determine if genetic polymorphisms associated with MS susceptibility are associated with attack loca

Multiple Sclerosis Susceptibility Genes: Associations with Relapse Severity and Recovery

Objective:Patients with early multiple sclerosis (MS) have stereotyped attack severity and recovery. We sought to determine if polymorphisms in MS susceptibility genes are associated with these attack features or with the risk of a second attack.Methods:5