KDIGO clinical practice guideline on the evaluation and care of living kidney donors

The 2017 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors is intended to assist medical professionals who evaluate living kidney donor candidates and provide care before, during and after donation. The guideline development process followed the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach and guideline recommendations are based on systematic reviews of relevant studies that included critical appraisal of the quality of the evidence and the strength of recommendations. However, many recommendations, for which there was no evidence or no systematic search for evidence was undertaken by the Evidence Review Team, were issued as ungraded expert opinion recommendations. The guideline work group concluded that a comprehensive approach to risk assessment should replace decisions based on assessments of single risk factors in isolation. Original data analyses were undertaken to produce a "proof-in-concept" risk-prediction model for kidney failure to support a framework for quantitative risk assessment in the donor candidate evaluation and defensible shared decision making. This framework is grounded in the simultaneous consideration of each candidate's profile of demographic and health characteristics. The processes and framework for the donor candidate evaluation are presented, along with recommendations for optimal care before, during, and after donation. Limitations of the evidence are discussed, especially regarding the lack of definitive prospective studies and clinical outcome trials. Suggestions for future research, including the need for continued refinement of long-term risk prediction and novel approaches to estimating donation-attributable risks, are also provided.

Palliative Care in Heart Failure: The PAL-HF Randomized, Controlled Clinical Trial.

BACKGROUND: Advanced heart failure (HF) is characterized by high morbidity and mortality. Conventional therapy may not sufficiently reduce patient suffering and maximize quality of life. OBJECTIVES: The authors investigated whether an interdisciplinary palliative care intervention in addition to evidence-based HF care improves certain outcomes. METHODS: The authors randomized 150 patients with advanced HF between August 15, 2012, and June 25, 2015, to usual care (UC) (n = 75) or UC plus a palliative care intervention (UC + PAL) (n = 75) at a single center. Primary endpoints were 2 quality-of-life measurements, the Kansas City Cardiomyopathy Questionnaire (KCCQ) overall summary and the Functional Assessment of Chronic Illness Therapy-Palliative Care scale (FACIT-Pal), assessed at 6 months. Secondary endpoints included assessments of depression and anxiety (measured via the Hospital Anxiety and Depression Scale [HADS]), spiritual well-being (measured via the FACIT-Spiritual Well-Being scale [FACIT-Sp]), hospitalizations, and mortality. RESULTS: Patients randomized to UC + PAL versus UC alone had clinically significant incremental improvement in KCCQ and FACIT-Pal scores from randomization to 6 months (KCCQ difference = 9.49 points, 95% confidence interval [CI]: 0.94 to 18.05, p = 0.030; FACIT-Pal difference = 11.77 points, 95% CI: 0.84 to 22.71, p = 0.035). Depression improved in UC + PAL patients (HADS-depression difference = -1.94 points; p = 0.020) versus UC-alone patients, with similar findings for anxiety (HADS-anxiety difference = -1.83 points; p = 0.048). Spiritual well-being was improved in UC + PAL versus UC-alone patients (FACIT-Sp difference = 3.98 points; p = 0.027). Randomization to UC + PAL did not affect rehospitalization or mortality. CONCLUSIONS: An interdisciplinary palliative care intervention in advanced HF patients showed consistently greater benefits in quality of life, anxiety, depression, and spiritual well-being compared with UC alone. (Palliative Care in Heart Failure [PAL-HF]; NCT01589601).

Summary of Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors.

Kidney Disease: Improving Global Outcomes (KDIGO) engaged an evidence review team and convened a work group to produce a guideline to evaluate and manage candidates for living kidney donation. The evidence for most guideline recommendations is sparse and many "ungraded" expert consensus recommendations were made to guide the donor candidate evaluation and care before, during, and after donation. The guideline advocates for replacing decisions based on assessments of single risk factors in isolation with a comprehensive approach to risk assessment using the best available evidence. The approach to simultaneous consideration of each candidate's profile of demographic and health characteristics advances a new framework for assessing donor candidate risk and for defensible shared decision making.

KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors.

The 2017 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors is intended to assist medical professionals who evaluate living kidney donor candidates and provide care before, during and after donation. The guideline development process followed the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach and guideline recommendations are based on systematic reviews of relevant studies that included critical appraisal of the quality of the evidence and the strength of recommendations. However, many recommendations, for which there was no evidence or no systematic search for evidence was undertaken by the Evidence Review Team, were issued as ungraded expert opinion recommendations. The guideline work group concluded that a comprehensive approach to risk assessment should replace decisions based on assessments of single risk factors in isolation. Original data analyses were undertaken to produce a "proof-in-concept" risk-prediction model for kidney failure to support a framework for quantitative risk assessment in the donor candidate evaluation and defensible shared decision making. This framework is grounded in the simultaneous consideration of each candidate's profile of demographic and health characteristics. The processes and framework for the donor candidate evaluation are presented, along with recommendations for optimal care before, during, and after donation. Limitations of the evidence are discussed, especially regarding the lack of definitive prospective studies and clinical outcome trials. Suggestions for future research, including the need for continued refinement of long-term risk prediction and novel approaches to estimating donation-attributable risks, are also provided.In citing this document, the following format should be used: Kidney Disease: Improving Global Outcomes (KDIGO) Living Kidney Donor Work Group. KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Transplantation. 2017;101(Suppl 8S):S1-S109.

Health of Hispanic Adults: United States, 2010-2014.

KEY FINDINGS: Data from the National Health Interview Survey, 2010-2014 •Overall, Puerto Rican adults consistently reported poorer health status than non-Hispanic adults. •Puerto Rican (19.2%) and Mexican (17.4%) adults were more likely than Central or South American (12.3%) and Cuban (14.7%) adults to be in fair or poor health. •Puerto Rican adults (27.3%) were more likely than Central or South American adults (16.6%) to have had multiple chronic conditions. •Puerto Rican adults (6.2%) were nearly twice as likely to report serious psychological distress in the past 30 days compared with Central or South American adults (3.3%). •Puerto Rican adults (11.4%) were more likely than Central or South American (2.9%), Cuban (3.9%), and Mexican (4.8%) adults to be unable to work due to health problems.

Prevalence and correlates of the perpetration of cyberbullying among in-school adolescents in Oyo State, Nigeria.

OBJECTIVE: Cyberharassment/cyberbullying is a global problem that has been inadequately investigated in developing countries. In this paper, we present findings on the prevalence and predictors of perpetration of cyberbullying among in-school adolescents in Oyo state, Nigeria. METHODS: A total of 653 students were selected via multi-stage sampling. Information on history of perpetrating harassment via an electronic medium in the 3-month period preceding the survey was obtained. RESULTS: Respondents' mean age was 14.2±2.2 years and 51.3% were females. All respondents had personal mobile phones and about half had Internet access. About 40% accessed the Internet every day while about 48% accessed it at least once to several times a week and <5% accessed it about once every 2 weeks. One hundred and fifty-six (23.9%) had harassed someone electronically, 260 (39.8%) had been victimized, and 137 (21.0%) were both victims and perpetrators. Common modes of harassment were via phone calls 99 (63.5%), chat rooms 70 (44.9%), and text messages 60 (38.5%). Students who had been victims of cyberbullying (OR=21.76, 95% CI=12.64-37.47) and those with daily Internet access (OR=2.32, 95% CI=1.28-4.19) had significantly higher Oods of being perpetrators. CONCLUSION: About a quarter of students were perpetrators of cyberbullying, and the correlates of perpetration were history of cyber victimization and daily Internet access. Intervention programs must be instituted for victims as well as frequent users of the Internet to curb the problem in the study area.

Health Care Access and Utilization Among Adults Aged 18-64, by Race and Hispanic Origin: United States, 2013 and 2014.

In 2014, U.S. adults could buy a private health insurance plan through the Health Insurance Marketplace or state-based exchanges established as part of the Affordable Care Act. Moreover, some states opted to expand Medicaid coverage to low-income adults. Data from the 2013 and 2014 National Health Interview Survey (NHIS) are used to describe recent changes in health insurance coverage and selected measures of health care access and utilization for adults aged 18­64, by race and Hispanic origin.

International note: awareness and context of cyber-harassment among secondary school students in Oyo state, Nigeria.

We determined the awareness and context of cyber-harassment among secondary school students (653 survey respondents and 18 in-depth interviewees) in Oyo state, Nigeria. Respondents' mean age was 14.2 ± 2.2 years and 53.9% were aware of cyber-harassment occurring in their school or among their friends. Cyber-harassment was often perpetrated via phone calls (62.5%), text messaging (36.9%), chat rooms (28.7%), through pictures or video clips sent via mobile phones (11.9%), emails (6.8%) or websites (5.9%). Cyber-harassment behaviours mentioned were the use of abusive words (25.4%), saying mean things or making fun of the victim (13.9%), solicitations for relationships (7.9%) or sex (6.8%) and spreading rumours about the victim (6.8%). In-depth interviewees recounted experiences of cyber-harassment suffered by their friends. Many were relationship-related, sexual solicitations and threats and corroborated quantitative findings. Respondents are aware of cyber-harassment occurring among students in the study area. Comprehensive interventions to address the problem need to be instituted.

The palliative care in heart failure trial: rationale and design.

BACKGROUND: The progressive nature of heart failure (HF) coupled with high mortality and poor quality of life mandates greater attention to palliative care as a routine component of advanced HF management. Limited evidence exists from randomized, controlled trials supporting the use of interdisciplinary palliative care in HF. METHODS: PAL-HF is a prospective, controlled, unblinded, single-center study of an interdisciplinary palliative care intervention in 200 patients with advanced HF estimated to have a high likelihood of mortality or rehospitalization in the ensuing 6 months. The 6-month PAL-HF intervention focuses on physical and psychosocial symptom relief, attention to spiritual concerns, and advanced care planning. The primary end point is health-related quality of life measured by the Kansas City Cardiomyopathy Questionnaire and the Functional Assessment of Chronic Illness Therapy with Palliative Care Subscale score at 6 months. Secondary end points include changes in anxiety/depression, spiritual well-being, caregiver satisfaction, cost and resource utilization, and a composite of death, HF hospitalization, and quality of life. CONCLUSIONS: PAL-HF is a randomized, controlled clinical trial that will help evaluate the efficacy and cost effectiveness of palliative care in advanced HF using a patient-centered outcome as well as clinical and economic end points.

Unaccompanied youth: school nurses caring for adolescent minors living without a parent or guardian.

There are many reasons that a child does not have a functional or legal guardian. The parent may be incarcerated, deceased, debilitated, deported, or have abandoned them. The teen may be a runaway or may have been exited from foster care. School nurses are challenged to find an adult who can legally consent to treatment when an unaccompanied minor needs health care. This article provides strategies for case management of these students. The school needs to be a stable and safe environment where the unaccompanied teen can thrive and succeed.

Patient- and trial-specific barriers to participation in cardiovascular randomized clinical trials.

OBJECTIVES: The purpose of this study was to quantitatively examine the association of patient- and trial-specific factors with participation in cardiovascular randomized clinical trials. BACKGROUND: Randomized clinical trials are central to evidenced-based medicine, but low patient participation rates and potentially modifiable barriers are not well understood. METHODS: At a large U.S. academic health system, we examined screening logs from December 1, 2005, to February 28, 2011, from 15 cardiovascular randomized clinical trials. We identified 655 patients who were screened and potentially eligible for participation in at least 1 trial. We used multivariable Poisson regression to quantify the risk of not participating in a trial associated with patient- and trial-specific factors. RESULTS: The median age was 63 years (interquartile range: 54 to 72), 35% were women, and the median Charlson Index was 2 (interquartile range: 1 to 5). Forty-two percent of patients did not participate in a trial. In multivariable regression (C-Index 0.85), trial-specific factors strongly associated with not participating included intensive trial-related testing (relative risk [RR]: 1.89; 95% confidence interval [CI]: 1.63 to 2.20) and anticipated trial participation >6 months (RR: 4.10; 95% CI: 2.30 to 7.29). Patient-specific factors associated with not participating included older age (RR: 1.23; 95% CI: 1.11 to 1.36, per 10-year increase if age ≥65 years), out-of-state residence (RR: 1.26; 95% CI: 1.04 to 1.54), and female sex (RR: 1.17; 95% CI: 1.01 to 1.35). Race was not associated with participation. CONCLUSIONS: While patient-specific factors were associated with not participating in cardiovascular trials, longer trial duration and intensive trial-related testing were most strongly associated with risk for patients not participating. Innovative trial designs fostering convenience may most enhance trial participation.

Summary health statistics for the U.S. population: National Health Interview Survey, 2012.

OBJECTIVES: This report presents both age-adjusted and unadjusted health statistics from the 2012 National Health Interview Survey (NHIS) for the civilian noninstitutionalized population of the United States. Estimates are disaggregated by sex, age, race, Hispanic origin, education, family income, poverty status, health insurance coverage (where appropriate), place of residence, and region of residence. The topics covered are respondent-assessed health status, limitations in activities, injury and poisoning episodes, health care access and utilization, and health insurance coverage. DATA SOURCE: NHIS is a household, multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the Centers for Disease Control and Prevention's National Center for Health Statistics. In 2012, household interviews were completed for 108,131 persons living in 42,366 households. SELECTED HIGHLIGHTS: Nearly 7 in 10 persons were in excellent or very good health in 2012. About 40 million persons (12%) were limited in their usual activities due to one or more chronic health conditions. About 5 million persons (2%) required the help of another person with activities of daily living, and about 10 million persons (4%) required the help of another person with instrumental activities of daily living. Among persons under age 65, about 45 million (17%) did not have any health insurance coverage. The most common reason for lacking health insurance was cost, followed by a change in employment.

Health behaviors of adults: United States, 2008-2010.

Objective-This report presents selected prevalence estimates for key health behaviors-alcohol use, cigarette smoking, leisure-time physical activity, body mass index, and sleep-among U.S. adults, using data from the 2008-2010 National Health Interview Survey (NHIS). NHIS is a continuous survey conducted annually by the Centers for Disease Control and Prevention's National Center for Health Statistics. Estimates are shown for several sociodemographic subgroups for both sexes combined and for men and women separately. Methods-Data representing the U.S. civilian noninstitutionalized population were collected using computer-assisted personal interviews. NHIS is a general purpose in-person household survey, collecting basic health, health care utilization, and demographic information on all household members with the Family questionnaire. Health behavior questions are asked in the Sample Adult survey component. This report is based on a total of 76,669 completed interviews with sample adults aged 18 and over. Statistics shown in this report were age adjusted to the projected 2000 U.S. population. Results-About 6 in 10 (64.9%) U.S. adults were current drinkers in 2008-2010; about 1 in 5 adults (20.9%) were lifetime abstainers. About one in five adults (20.2%) were current smokers and over one-half of adults (58.6%) had never smoked cigarettes. Less than one-half of current smokers (45.8%) attempted to quit smoking in the past year. Nearly one-half (46.1%) of adults met the federal guidelines for aerobic physical activity, about one-quarter (23.0%) of adults met the federal guidelines for muscle-strengthening physical activity, and about one in five adults (19.4%) met both guidelines. About 6 in 10 adults (62.1%) were overweight or obese (BMI ≥ 25), with about 4 in 10 (36.1%) adults being of healthy weight (18.5 ≤ BMI less than 25). About 7 in 10 adults (69.7%) met the Healthy People 2020 objective for sufficient sleep.

Reduction in body weight but worsening renal function with late ultrafiltration for treatment of acute decompensated heart failure.

OBJECTIVES: The safety, effectiveness and indications for ultrafiltration (UF) are not well established. We hypothesized that UF would not worsen renal function in patients with heart failure (HF) who were not responding to medical therapy. METHODS: Data was collected for patients who underwent UF between 2006 and 2010 (n = 72, median age 61 years, 54% males, 61% Caucasian, 54% left ventricular ejection fraction ≥ 40%). RESULTS: Baseline GFR was 38 ml/min/1.73 m2. All patients were initially treated with loop diuretics and 58% required a thiazide-like diuretic or vasoactive agent. UF resulted in total fluid removal of 11.3 liters and weight loss was 9.7 kg. The median decrease in eGFR during UF was 4.5 ml/min/m2 (IQR--13, 0; p < 0.01) and 43% of patients experienced a ≥ 20% decrease in eGFR. Ten percent of patients required dialysis and 13% died, received a ventricular assist device/cardiac transplant or were discharged to hospice. CONCLUSIONS: In a cohort of HF patients who did not respond to medical therapy, UF was associated not only with a significant reduction of body weight and fluid removal, but also acute worsening of renal function. Further research to identify the appropriate population for UF, long-term outcomes and the intensity of treatment is required if UF is to gain wide acceptance for HF management.

Oral health status and access to oral health care for U.S. adults aged 18-64: National Health Interview Survey, 2008.

OBJECTIVES: This report presents statistics from the 2008 National Health Interview Survey (NHIS) on selected measures of oral health status and oral health care access for adults aged 18-64. Estimates are presented by sex, age, race and ethnicity, nativity, education, poverty status, health and dental insurance status, region, place of residence, dentition status, current smoking status, current drinking status, and diabetes status. DATA SOURCE: NHIS is a multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the Centers for Disease Control and Prevention's National Center for Health Statistics, and is representative of the civilian noninstitutionalized population of the United States. Data are collected for all family members during face-to-face interviews with adults present at the time of interview. Additional health information is obtained from one randomly selected adult. If the selected adult is physically or mentally incapable of responding for himself or herself, a proxy respondent is used. SELECTED HIGHLIGHTS: Among adults aged 18-64, about three-quarters had very good or good oral health, 17% had fair oral health, and 7% had poor oral health. Adults with Medicaid were almost five times as likely as adults with private health insurance to have poor oral health. Adults with Medicaid (21%) were almost twice as likely as adults overall (12%) to not have had a dental visit in more than 5 years. Among adults aged 18-64, the main reason to forgo a dental visit for an oral health problem in the past 6 months was cost; 42% could not afford treatment or did not have insurance. Fear was the reason that 1 out of 10 adults did not visit the dentist for an oral health problem.

Smoking and oral health in dentate adults aged 18-64.

This report shows that among dentate adults aged 18­64 there are differences in oral health status and oral health care utilization among current smokers, former smokers, and never smokers. Overall, current smokers had a poorer oral health status and more oral health problems than either former smokers or never smokers. Current smokers were also more likely to delay routine dental visits. When current smokers experienced a mouth or tooth problem, they were less likely to visit a dental health professional because they were unable to afford dental care than former smokers or never smokers. However, current smokers were more likely to think that their oral health problem was important. The evidence for an association between tobacco use and oral diseases has been clearly shown in every Surgeon General's report on tobacco since 1964 (6). Tobacco use is a risk factor for oral cancers, periodontal diseases, and dental caries, among other diseases. Oral health problems may be early warning signs of other medical problems such as diabetes, HIV, heart disease, or stroke (6). Good oral health is integral to good general health.

Summary health statistics for the u.s. Population: national health interview survey, 2011.

Objectives-This report presents both age-adjusted and unadjusted health statistics from the 2011 National Health Interview Survey (NHIS) for the civilian noninstitutionalized population of the United States. Estimates are disaggregated by sex, age, race, Hispanic origin, education, family income, poverty status, health insurance coverage (where appropriate), place of residence, and region of residence. The topics covered are respondent-assessed health status, limitations in activities, special education or early intervention services, injury and poisoning episodes, health care access and utilization, and health insurance coverage. Data Source-NHIS is a household, multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the Centers for Disease Control and Prevention's National Center for Health Statistics. In 2011, household interviews were completed for 101,875 persons living in 39,509 households, reflecting a household response rate of 82.0%. Selected Highlights-Nearly 7 in 10 persons were in excellent or very good health in 2011. About 40 million persons (13%) were limited in their usual activities due to one or more chronic health conditions. About 5 million persons (2%) required the help of another person with activities of daily living, and about 10 million persons (4%) required the help of another person with instrumental activities of daily living. About 7% of children received special education or early intervention services. Among persons under age 65, about 45 million (17%) did not have any health insurance coverage. The most common reason for lacking health insurance was cost, followed by a change in employment.

Use of the internet for health information: United States, 2009.

Research has shown that 74% of all U.S. adults use the Internet, and 61% have looked for health or medical information on the Internet. Additionally, 49% have accessed a website that provides information about a specific medical condition or problem. In 2009, the National Health Interview Survey (NHIS) became the first nationally representative household survey to collect data on the use of health information technology when the U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation sponsored 10 questions that asked about use of the Internet to look up health information, refill a prescription, schedule a medical appointment, learn about health topics in online chat groups, and e-mail a health care provider. This report provides estimates, using 2009 NHIS data, about adult use of the Internet for health information in the past 12 months, by selected sociodemographic characteristics.

Site-based research in acute heart failure.

The conduct of clinical trials in acute heart failure has arrived at a critical point. Traditional systems used to conduct clinical trials have been described as inefficient, lacking infrastructure, and enormously expensive. In this article, the authors describe an alternative model: the development of a site-based research (SBR) unit, an operating business unit responsible for conducting a portfolio of research projects in a therapeutic area. The SBR is responsible for financial accountability, regulatory compliance, and academic productivity.