Survival benefit of a third dose of the COVID-19 vaccine among hemodialysis patients: A prospective cohort study.

BACKGROUND: Hemodialysis (HD) patients are particularly vulnerable to severe coronavirus disease 2019 (COVID-19) due to their immunocompromised state and comorbid conditions. Timely vaccination could be the most effective strategy to reduce morbidity and mortality. However, data on the survival benefit of the COVID-19 vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and death among HD patients are limited, especially during the Omicron-dominant period. METHODS: In this prospective hospital-based cohort study, we identified HD patients from July 1, 2021, to April 29, 2022. The patients were divided into fully vaccinated and partially vaccinated groups. We compared the humoral response, risk of developing SARS-CoV-2 infection, and all-cause mortality between the two groups. RESULTS: Among the 440 HD patients included, 152 patients were fully vaccinated, and 288 patients were partially vaccinated. Patients in the fully vaccinated group exhibited higher anti-spike protein receptor-binding domain (S protein RBD) antibody levels and lower risks of all-cause mortality (adjusted hazard ratio, 0.35; 95% confidence interval, 0.17-0.73; p = 0.005) than the partially vaccinated group. However, the risk for SARS-CoV-2 infection did not significantly differ between the two groups. Irrespective of the number of vaccinations, the risk of all-cause mortality was lower in patients with anti-S protein RBD antibody levels in the higher tertile. CONCLUSION: A third dose of the COVID-19 vaccine was associated with a decreased risk of all-cause mortality among HD patients during the Omicron-dominant period. A higher post-vaccination anti-S protein RBD antibody level was also associated with a lower risk of mortality.

End-user developed workflow-based hemodialysis nursing record system.

We reported how we decided to build our own Hemodialysis nursing record system using the end user computing strategy with Excel VBA. The project took one year to complete since we used our off-duty time and started everything from the grounds. We are proud of the final system which tightly meets our workflow and clinical needs. Its interface was carefully designed to be easy to use with a style.

Thiazolidinediones and Risk of Long-Term Dialysis in Diabetic Patients with Advanced Chronic Kidney Disease: A Nationwide Cohort Study.

Thiazolidinediones (TZDs) reduce urinary albumin excretion and proteinuria in diabetic nephropathy. The effect of TZDs on hard renal outcome in diabetic patients with chronic kidney disease (CKD) is unknown. We investigate the association of TZDs and risk of long-term dialysis or death in diabetic patients with advanced CKD. The nationwide population-based cohort study was conducted using Taiwan's National Health Insurance Research Database. From January 2000 to June 2009, 12350 diabetic patients with advanced CKD (serum creatinine levels greater than 6 mg/dL but not yet receiving renal replacement therapy) were selected for the study. We used multivariable Cox regression models and a propensity score-based matching technique to estimate hazard ratios (HRs) for development of long-term dialysis and the composite outcome of long-term dialysis or death for TZD users (n=1224) as compared to nonusers (n=11126). During a median follow-up of 6 months, 8270 (67.0%) patients required long-term dialysis and 2593 (21.0%) patients died before starting long-term dialysis. Using propensity score matched analysis, we found TZD users were associated with a lower risk for long-term dialysis (HR, 0.80; 95% confidence interval [CI], 0.74-0.86) and the composite outcome of long-term dialysis or death (HR, 0.85; 95% CI, 0.80-0.91). The results were consistent across most patient subgroups. Use of TZDs among diabetic patients with advanced CKD was associated with lower risk for progression to end-stage renal disease necessitating long-term dialysis or death. Further randomized controlled studies are required to validate this association.

Nursing work stress: the impacts of social network structure and organizational citizenship behavior.

BACKGROUND: The nursing workplace imposes significantly more stress on its employees than other workplace settings. Organizational resources, both physical and psychological, have been recognized in prior studies as important alleviators of nursing workplace stress. Whereas physical resources are less difficult to manipulate because of their tangibility, psychological resources, particularly psychological support from colleagues, are typically not deployed to greatest effect. PURPOSE: This article investigated the alleviation of nursing work stress using resources already extant in coworker social networks. METHODS: Researchers conducted a survey in a dialysis department at a medical center located in Taipei City, Taiwan. This survey measured nurse work stress, satisfaction, organizational citizenship behavior (OCB) and social network structures. Researchers employed UCINET to analyze the network structure data, which were in dyadic matrix format to estimate nurse network centralities and used partial least squares analysis to estimate research construct path coefficients and test extrapolated hypotheses. RESULT: The level of OCB induced by nurse social ties was satisfactory and did not only directly increased work satisfaction but also alleviated work stress, which indirectly boosted work satisfaction. CONCLUSIONS: Findings suggest that managers may be able to use social network analysis to identify persons appropriate to conduct the distribution of organizational resources. Choosing those with multiple social connections can help distribute resources effectively and induce higher OCB levels within the organization. In addition, staff with strong friendship network connections may provide appropriate psychological resources (support) to coworkers. If those with high friendship network centrality receive proper counseling training, they should be in a good position to provide assistance when needed.