Dialysis initiation and clinical outcomes in chronic kidney disease : role of education and biomarkers

For patients with chronic kidney disease (CKD) who develop kidney failure, renal replacement therapy (RRT) with kidney transplantation is the best treatment option. But if this is not possible due to lack of organs or medical factors, dialysis initiation with haemodialysis (HD) or peritoneal dialysis (PD) is required. Unplanned start (UPS) of dialysis using in-centre HD with central venous catheter (CVC) as default option is common and associates with increased mortality and lower chance of receiving PD. Educating and providing PD to UPS patients is possible and with clinical outcomes comparable to UPS with HD. As RRT patients have increased cardiovascular disease (CVD) related mortality - due to not only traditional risk factors but also non-traditional risk factors such as inflammation, oxidative stress, endothelial dysfunction and protein energy wasting – there is a need to identify biomarkers reflecting such risk factors. This thesis consists of three studies aimed to improve the knowledge about patient education in conjunction with dialysis initiation and in particular the effect of the unplanned education programme (UPS-EP) on clinical outcomes of UPS patients, and two studies of the predictive role of two putative clinically useful biomarkers (S100A12 and pentosidine) which are components of AGE-RAGE pathway. In Study I we evaluated the feasibility and impact of UPS-EP to allow modality choice in 270 patients. Patients completing UPS-EP were more likely to select PD as their preferred modality. Patient survival in patients choosing and/or receiving PD was similar to HD despite age and comorbidity disadvantages of the PD patients. In Study II, factors influencing three key steps in the UPS patient educational pathway: (1) referral to and receiving UPS-EP, (2) making decision on dialysis modality, (3) receiving preferred dialysis modality after decision making were analyzed. Older age reduced probability of receiving UPS-EP but not the chance of making modality decision. Cultural country factors had strong influence on probability of receiving education and making modality decision. In Study III we compared UPS patients commencing dialysis with PD catheter or CVC, described characteristics of patients switching modality, evaluated patient outcomes such as PD technique failure and investigated predictors of permanent vascular access formation and clinical outcomes of patients undergoing HD during follow up. Older patients and those with congestive heart failure had lower chances receive arteriovenous fistula (AVF). Patients with AVF had better 1-year survival than those remaining on CVC. In Study IV we investigated circulating S100A12 and soluble RAGE (sRAGE) in relation to peripheral or cerebrovascular disease (PCVD), inflammation, nutritional status, and mortality risk in PD patients. Plasma S100A12 and sRAGE were markedly elevated and sRAGE was inversely related to body mass indices while S100A12 associated with increased inflammation, PCVD, and mortality, suggesting that S100A12 may identify PD patients at high risk for vascular disease and increased mortality. In Study V we evaluated factors linked to increased plasma pentosidine and associations with mortality in patients with different stages and treatment of CKD. Plasma pentosidine was markedly elevated and associated with low GFR, oxidative stress and inflammation, and it predicted all-cause and CVD mortality. Despite exposure to glucose containing dialysis fluids in PD patients, their plasma pentosidine concentrations were not higher than in HD patients indicating that other factors than glucose exposure matters

The Errors-in-Variable Model in the Optimal Portfolio Construction

In the paper we consider a modification of Sharpe’s method used in classical portfolio analysis for optimal portfolio building. The conventional theory assumes there is a linear relationship between asset’s return and market portfolio return, while the influence of all the other factors is not included. We propose not to neglect them any more, but include them into a model. Since the factors in question are often hard to measure or even characterize, we treat them as a disturbances on random variables used by classical Sharpe’s method.The key idea of the paper is the modification of the classical approach by application of the errors-in-variable model. We assume that both independent (market portfolio return) as well as dependent (given asset’s return) variables are randomly distributed values related with each other by linear relationship and we build the model used for parameters’ estimation.To verify the model, we performed an analysis based on archival data from Warsaw Stock Exchange. The results are also included

Wiedza i postawy wobec padaczki wśród mieszkańców województwa śląskiego. Badanie ankietowe

Background and purpose Epilepsy is one of the most frequent neurological diseases. Social acceptance is very important for people with epilepsy and their relatives. The aim of the study was to assess public knowledge and attitudes towards epilepsy in Silesia. Material and methods We examined 419 people, inhabitants of Silesia, at the mean age of 34 ± 15 years. The study was performed using a questionnaire containing 15 questions evaluating knowledge about epilepsy and attitudes towards people with epilepsy. Results 43.2% of the respondents knew an epileptic person themselves. 44.7% had witnessed an epileptic seizure; 68.8% would help a person during an epileptic seizure, but most of them (73.4%) would do it incorrectly (by putting an object into the mouth to prevent biting the tongue). 94.5% of respondents had nothing against friendship with an epileptic person, but 12.1% suggested that children with epilepsy should attend special schools. 85.9% of all those examined said that people with epilepsy should inform others about their disease, 81.9% would mention the existence of an epileptic person in their family. 40.5% of respondents believe that people with epilepsy can do the same jobs as healthy people, 75.3% would employ an epileptic person themselves. Conclusions The knowledge about epilepsy and first aid during epileptic seizure is still insufficient among inhabitants of Silesia. Most of the responders, especially better educated ones, declare acceptance and tolerance of people with epilepsy. More effort should be made to improve public knowledge of epilepsy by preparing wide-spread educational programmes.Wstęp i cel pracy Padaczka to jedna z najczęstszych przewlekłych chorób układu nerwowego. Społeczna akceptacja jest bardzo ważna dla osób chorujących na padaczkę i ich rodzin. Celem pracy była ocena wiedzy na temat padaczki oraz postaw wobec osób nią dotkniętych wśród mieszkańców województwa śląskiego. Materiał i metody W badaniu wzięło udział 419 mieszkańców województwa śląskiego, w średnim wieku 34 ± 15 lat. Zastosowano kwestionariusz składający się z 15 pytań dotyczących wiedzy i postaw wobec padaczki. Wyniki Spośród ankietowanych 43,5% stwierdziło, że zna lub znała osobę chorującą na padaczkę. 44,7% badanych była wcześniej świadkiem napadu padaczkowego. Większość (68,8%) deklarowała chęć udzielenia pomocy w trakcie napadu, lecz aż 73,4% uczyniłoby to niewłaściwie (poprzez włożenie jakiegoś przedmiotu między zęby osoby chorej). Aż 94,5% ankietowanych nie miałoby nic przeciwko temu, aby w grupie przyjaciół znalazła się osoba chora na padaczkę, a 12,1% uważało, że dzieci chore na padaczkę powinny chodzić do specjalnych szkół. 85,9% badanych twierdziło, że osoby chore na padaczkę powinny informować otoczenie o swojej chorobie, nieco mniej (81,9%) powiedziałoby innym, gdyby w rodzinie była osoba chora. 40,5% ankietowanych jest zdania, że chorujący na padaczkę mogą pracować w tych samych zawodach co osoby zdrowe, aż 70,5% zatrudniłoby taką osobę osobiście. Wnioski Wiedza na temat padaczki oraz znajomość zasad udzielania pierwszej pomocy osobie w trakcie napadu padaczkowego jest wciąż niedostateczna wśród mieszkańców Śląska. Większość badanych, zwłaszcza lepiej wykształconych, deklaruje postawę akceptacji oraz tolerancji wobec osób chorujących na padaczkę. Istnieje potrzeba przygotowania i rozpowszechnienia programu edukacyjnego, który zawierałby podstawowe informacje na temat choroby i postępowania z osobą chorą w trakcie napadu

Ponowne operacje chorych z glejakami wysoko zróżnicowanymi położonymi w okolicach elokwentnych mózgu lub w pobliżu okolic elokwentnych mózgu

Background and purpose Reoperations of patients with recurrent low-grade gliomas (LGG) are not always recommended due to a higher risk of neurological deficits when compared to initial surgery. The purpose of the present study was to evaluate surgical outcomes of patients operated on for recurrent LGG. Material and methods Sixteen patients who had surgery for recurrent LGG out of 68 LGG patients who underwent surgery at the Department of Neurosurgery in Sosnowiec, Poland between 2005 and 2011 were enrolled in the study. Results A large tumour volume prior to the initial surgery was the most significant parameter influencing LGG progression (96.6 cm3 vs. 47.9 cm3, p = 0.01). Increased incidence of epileptic seizures and decreased mental ability according to Karnofsky score were the most common symptoms associated with tumour recurrence. In the group of patients with malignant transformation, the relative cerebral blood volume (rCBV) was considerably increased (1.21 vs. 2.41, p < 0.01). No statistically significant difference was found in terms of the extent of resection between initial surgery and reoperation. Similarly, no significant difference was found in the number of patients with a permanent neurological deficit after initial surgery and reoperation. Conclusions Reoperations of the patients with recurrent LGG are not burdened with a higher risk of neurological sequelae when compared to initial surgery. The extent of resection during the surgery for LGG recurrence is comparable to initial surgery. The increase of rCBV seems to be a significant biomarker that indicates malignant transformation.Wstęp i cel pracy Ponowne operacje chorych z odrostem wysoko zróżnicowanego glejaka mózgu (WGM), zwłaszcza zlokalizowanego w obszarach elokwentnych mózgu, nie zawsze są zalecane. Powodem tego jest przekonanie, że ryzyko wystąpienia deficytów neurologicznych jest większe niż podczas pierwszej operacji. Celem pracy była ocena wyników leczenia chorych operowanych ponownie z powodu odrostu WGM. Materiał i metody W okresie od 2005 r. do 2011 r. w Klinice Neurochirurgii w Sosnowcu operowanych było 68 chorych z rozpoznaniem WGM. Do analizy włączono 16 chorych operowanych ponownie z powodu odrostu guza. Wyniki Jednym z najistotniejszych parametrów decydujących o progresji WGM była duża objętość guza przed pierwszą operacją (96,6 cm3 vs 47,9 cm3; p = 0,01). Głównym objawem odrostu guza była zwiększona częstość napadów padaczkowych oraz pogorszenie sprawności intelektualnej ocenianej w skali Karnofsky'ego. Wśród guzów, w przypadku których doszło do zezłośliwienia odrostu, obserwowano istotny wzrost względnej mózgowej objętości krwi (rCBV) (1,21 vs 2,41; p < 0,01). Nie stwierdzono statystycznie istotnej różnicy pod względem doszczętności resekcji między pierwszą i ponowną operacją. Nie stwierdzono statystycznie istotnej różnicy w liczbie chorych z utrwalonym deficytem neurologicznym po pierwszym zabiegu i po ponownej operacji. Wnioski Ponowne operacje chorych z odrostem WGM, również tych zlokalizowanych w obszarach elokwentnych mózgu, nie są obarczone większym ryzykiem powikłań neurologicznych w porównaniu z pierwszą operacją. Stopień resekcji osiągany przy operacjach odrostu WGM jest porównywalny z zakresem resekcji po pierwszej operacji. Istotnym parametrem wskazującym na zezłośliwienie procesu nowotworowego jest wzrost rCBV

Impact of a social marketing intervention on general practitioners’ antibiotic prescribing practices for acute respiratory tract complaints in Malta

Introduction: Antibiotics are commonly prescribed in primary care for acute respiratory tract complaints (aRTCs), often inappropriately. Social marketing interventions could improve prescribing in such settings. We evaluate the impact of a social marketing intervention on general practitioners’ (GPs’) antibiotic prescribing for aRTCs in Malta.Methods: Changes in GPs’ antibiotic prescribing were monitored over two surveillance periods between 2015 and 2018. Primary outcome: change in antibiotic prescription for aRTCs. Secondary outcomes: change in antibiotic prescription: (i) for immediate use, (ii) for delayed antibiotic prescription, (iii) by diagnosis, and (iv) by antibiotic class. Data were analysed using clustered analysis and interrupted time series analysis (ITSA).Results: Of 33 participating GPs, 18 successfully completed the study. Although clustered analyses showed a significant 3% decrease in overall antibiotic prescription (p = 0.024), ITSA showed no significant change overall (p = 0.264). Antibiotic prescription decreased significantly for the common cold (p < 0.001), otitis media (p = 0.044), and sinusitis (p = 0.004), but increased for pharyngitis (p = 0.015).Conclusions: The intervention resulted in modest improvements in GPs’ antibiotic prescribing. A more top-down approach will likely be required for future initiatives to be successful in this setting, focusing on diagnostic and prescribing support like rapid diagnostic testing, prescribing guidelines, and standardised delayed antibiotic prescriptions.peer-reviewe

Preface : “Practical Research on Gamification in Education (2)”

<p>(A) Areas under the curves (AUC) of receiver operating characteristics (ROC) in 746 patients for pentosidine in relation to all-cause mortality.(B) Areas under the curves (AUC) of receiver operating characteristics (ROC) in 746 patients for pentosidine in relation to CVD-mortality.</p

Containment of Antibiotic REsistance-measures to improve antibiotic use in pregnancy, childbirth and young children (CAREChild): a protocol of a prospective, quasiexperimental interventional study in Lao PDR.

INTRODUCTION: Antibiotics are essential to treat infections during pregnancy and to reduce both maternal and infant mortality. Overall use, but especially non-indicated use, and misuse of antibiotics are drivers of antibiotic resistance (ABR). High non-indicated use of antibiotics for uncomplicated vaginal deliveries is widespread in many parts of the world. Similarly, irrational use of antibiotics is reported for children. There is scarcity of evidence regarding antibiotic use and ABR in Lao PDR (Laos). The overarching aim of this project is to fill those knowledge gaps and to evaluate a quality improvement intervention. The primary objective is to estimate the proportion of uncomplicated vaginal deliveries where antibiotics are used and to compare its trend before and after the intervention. METHODS AND ANALYSIS: This 3-year, prospective, quasiexperimental study without comparison group includes a formative and interventional phase. Data on antibiotic use during delivery will be collected from medical records. Knowledge, attitudes and reported practices on antibiotic use in pregnancy, during delivery and for children, will be collected from women through questionnaires. Healthcare providers' knowledge, attitudes and practices of antibiotics administration for pregnant women, during delivery and for children, will be collected via adapted questionnaires. Perceptions regarding antibiotics will be explored through focus group discussions with women and individual interviews with key stakeholders. Faecal samples for culturing of Escherichia coli and Klebsiella spp. and antibiotic susceptibility testing will be taken before, during and 6 months after delivery to determine colonisation of resistant strains. The planned intervention will comprise training workshops, educational materials and social media campaign and will be evaluated using interrupted time series analysis. ETHICS AND DISSEMINATION: The project received ethical approval from the National Ethics Committee for Health Research, Ministry of Health, Laos. The results will be disseminated via scientific publications, conference presentations and communication with stakeholders. TRAIL REGISTRATION NUMBER: ISRCTN16217522; Pre-results

Antibiotic knowledge, attitudes and reported practice during pregnancy and six months after birth: a follow- up study in Lao PDR.

BACKGROUND: Antibiotics are important medicines to prevent maternal and child morbidity and mortality. Women's knowledge and attitudes towards antibiotic use influence their practice. When they become mothers, this may be mirrored in the use of antibiotics for their newborn children. The current study aimed to assess knowledge, attitudes, and reported practice of pregnant women regarding antibiotic use and antibiotic resistance as well as their approach towards antibiotic use for their newborn babies. METHODS: This was a follow-up study with data collected via structured interviews between September 2019 and August 2020 in Feuang (rural) and Vangvieng (urban) districts in Vientiane province, Lao PDR. We identified and invited all women attending antenatal care in their third trimester of pregnancy in the selected areas. Using a structured questionnaire at third trimester of pregnancy we captured data on knowledge regarding antibiotic use and resistance. We collected information on attitudes and reported practice at two time points: (i) at third trimester of pregnancy and (ii) 6 months after birth. Univariate analysis and frequency distributions were used to study pattern of responses. Chi-square and Mann-Whitney tests were used to compare categorical and continuous variables respectively. P value < 0.05 was considered statistically significant. RESULTS: We surveyed 539 women with a mean age of 25 years. Two oral antibiotics, i) ampicillin and ii) amoxicillin were correctly identified by 68 and 47% of participants respectively. Only 24% of women (19% in Feuang and 29% in Vangvieng) answered correctly that antibiotics are effective against bacterial infections. The most prevalent response was "I don't know" suggesting the questions were challenging. Significantly less women would use antibiotics from a previous illness for their child than for themselves (16% vs 29%), however they would be more willing to use antibiotics for their baby even in case of mild symptoms (29% vs 17% while pregnant). The majority of antibiotics were prescribed by healthcare providers and 46% of children with the common cold received antibiotics. CONCLUSIONS: Women's knowledge was sub-optimal, still, they manifested appropriate attitudes towards antibiotic use during pregnancy and for their child. Nearly half of children received antibiotics for the common cold. There is a need for context adapted programs aiming at improving women's knowledge, as well as healthcare providers, emphasising rational antibiotic prescribing during pregnancy and for children