Serum cystatin C as an early marker of nephropathy among type 2 diabetics: A meta-analysis.

AIM: The varying views as to the usefulness of serum cystatin C (CysC) as an early marker of diabetic nephropathy (DN) prompted us to investigate existing literature to determine whether serum CysC can be used as an early marker of DN using a meta-analysis approach. MATERIALS AND METHODS: Twelve studies written in English were retrieved from PubMed using various key search terms. Data were extracted from the included studies by two of the authors and was subjected to statistical analysis using Review Manager 5.3 and Meta-Essentials. Levels of serum CysC were compared between the study groups using the standardized mean difference (SMD) and 95% confidence interval (CI). RESULTS: Overall outcomes indicate that serum CysC levels are higher among those with microalbuminuria (MI) and macroalbuminuria (MA) than those in the control group (CN) and those with normoalbuminuria (NO). However, these findings were heterogeneous, which warranted an investigation using the Galbraith plot. Heterogeneity was either reduced or lost in the post-outlier outcomes indicating combinability of the studies. CONCLUSION: Serum CysC is shown to be a superior biomarker in the early diagnosis of DN. However, further studies are still needed to verify our claims.

Telemedicine for Interfacility Nurse Handoffs.

OBJECTIVE: To compare nurse preparedness and quality of patient handoff during interfacility transfers from a pretransfer emergency department to a PICU when conducted over telemedicine versus telephone. DESIGN: Cross-sectional nurse survey linked with patient electronic medical record data using multivariable, multilevel analysis. SETTING: Tertiary PICU within an academic children's hospital. PARTICIPANTS: PICU nurses who received a patient handoff between October 2017 and July 2018. INTERVENTIONS: None. MAIN RESULTS AND MEASUREMENTS: Among 239 eligible transfers, 106 surveys were completed by 55 nurses (44% survey response rate). Telemedicine was used for 30 handoffs (28%), and telephone was used for 76 handoffs (72%). Patients were comparable with respect to age, sex, race, primary spoken language, and insurance, but handoffs conducted over telemedicine involved patients with higher illness severity as measured by the Pediatric Risk of Mortality III score (4.4 vs 1.9; p = 0.05). After adjusting for Pediatric Risk of Mortality III score, survey recall time, and residual clustering by nurse, receiving nurses reported higher preparedness (measured on a five-point adjectival scale) following telemedicine handoffs compared with telephone handoffs (3.4 vs 3.1; p = 0.02). There were no statistically significant differences in both bivariable and multivariable analyses of handoff quality as measured by the Handoff Clinical Evaluation Exercise. Handoffs using telemedicine were associated with increased number of Illness severity, Patient summary, Action list, Situation awareness and contingency planning, Synthesis by receiver components (3.3 vs 2.8; p = 0.04), but this difference was not significant in the adjusted analysis (3.1 vs 2.9; p = 0.55). CONCLUSIONS: Telemedicine is feasible for nurse-to-nurse handoffs of critically ill patients between pretransfer and receiving facilities and may be associated with increased perceived and objective nurse preparedness upon patient arrival. Additional research is needed to demonstrate that telemedicine during nurse handoffs improves communication, decreases preventable adverse events, and impacts family and provider satisfaction.