Peritoneal dialysis (PD) technique training: what features influence learning time?

BACKGROUND: Within peritoneal dialysis (PD) complications, peritonitis remains a primary challenge for the long-term success of the technique. Proper technique training is essential, since it reduces peritonitis rates, but the adequacy of training has not been standardized. Furthermore, factors influencing training duration have not been well identified. METHODS: We retrospectively analyzed all consecutive training sessions of incident PD patients in our Unit from January 2001 to December 2018. RESULTS: Our analysis included 135 patients, 25.9% were diabetic and median Charlson index (CCI) was 4 (IQR 2-6). Above 13 sessions was chosen as the cut off between usual and prolonged training, as it was our cohort's 75th percentile: 23% (31) had an extended training duration as per our study definition and 77% (104) had a usual training duration. The number of training sessions required increased with age (Spearman Rho 0.404; p = 0.000001), diabetic status (p = 0.001), unemployment status (p = 0.046) and CCI (Spearman Rho 0.369; p = 0.00001). Neither gender, cohabitation status, scheduled PD start, education level nor referral origin, were significant factors impacting training duration. Requiring longer training (> 13 sessions) was a significant risk factor for higher peritonitis risk, but extended training was not related to a shorter technique survival. CONCLUSION: Number of PD training sessions depends on the patient's age and comorbidities, but is not related to social, educational or employment status. Prolonged training duration was a statistically significant predictor of higher peritonitis risk, but it was not related to shorter permanence in PD in our series. Identifying these patients since the training period would be useful to adapt training schedule as an early prevention strategy to minimize the risk of peritonitis and plan a preemptive retraining.

Field Resistance to Verticillium Wilt in Selected Olive Cultivars Grown in Two Naturally Infested Soils.

The resistance of 11 olive cultivars to Verticillium dahliae was assessed in two experimental field trials. One-year-old rooted olive cuttings from the World Olive Germplasm Bank (IFAPA research center, Córdoba, Spain) were planted in a heavily infested field in Utrera (Sevilla province) and in a moderately infested field in Andújar (Jaén province) of southern Spain. Plants were assessed for Verticillium wilt resistance during 22 months based on disease severity and tree growth. Severe disease symptoms were observed 6 months after planting in both trials. Twenty months after planting in the heavily infested soil, V. dahliae had killed nearly all of the trees of 'Bodoquera', 'Cornicabra', 'Manzanilla de Sevilla', and 'Picual', demonstrating the elevated risk of planting susceptible cultivars in a soil heavily infested with V. dahliae. 'Arbequina', 'Koroneiki', 'Sevillenca', and especially 'Frantoio', 'Empeltre', and 'Changlot Real' showed a high level of disease resistance. However, all of them were affected by the disease. Although the field results confirmed the level of resistance previously obtained for these olive genotypes under controlled conditions, there were some discrepancies. This information will be useful in managing the disease and also in selecting new cultivars for the breeding of Verticillium wilt resistance.

Identifying gaps in the cascade of care for latent TB infection in a low-incidence setting.

BACKGROUND: The End TB Strategy calls for the global scale-up of treatment for latent TB infection (LTBI). We aimed to evaluate a nurse-led care programme for LTBI by identifying gaps in the care cascade in a low-incidence TB setting.METHODS: We included people at risk of TB over a 15-year period. We define three main outcomes in the LTBI care cascade: 1) attendance at the first appointment, 2) completion of the evaluation process, and 3) completion of treatment.RESULTS: We identified 6,126 individuals (2,369 TB contacts, 1,749 biological therapy candidates, and 2,008 transplant candidates). Overall, 5,938 (96.9%) attended, 5,872/5,938 (98.9%) completed the evaluation and 1,624/1,847 (87.9%) completed treatment. Pre-biological (aOR 2.32, 95% CI 1.54-3.49) and pre-transplant (aOR 1.82, 95% CI 1.20-2.76) candidates were more likely to attend the first appointment, while age was associated with completing the evaluation process (aOR 1.02, 95% CI 1.003-1.04). Female sex (aOR 1.47, 95% CI 1.08-1.99) was associated with completing the treatment.CONCLUSION: Successful assessment and treatment of LTBI is achievable when delivered as a part of a comprehensive, nurse-led, patient-centred programme in specialist TB clinics.