Clearance and nutrition in neonatal continuous kidney replacement therapy using the Carpediem™ system.

BACKGROUND: Infants with kidney failure (KF) demonstrate poor growth partly due to obligate fluid and protein restrictions. Delivery of liberalized nutrition on continuous kidney replacement therapy (CKRT) is impacted by clinical instability, technical dialysis challenges, solute clearance, and nitrogen balance. We analyzed delivered nutrition and growth in infants receiving CKRT with the Cardio-Renal, Pediatric Dialysis Emergency Machine (Carpediem™). METHODS: Single-center observational study of infants receiving CKRT with the Carpediem™ between June 1 and December 31, 2021. We collected prospective circuit characteristics, delivered nutrition, anthropometric measurements, and illness severity Score for Neonatal Acute Physiology-II. As a surrogate to normalized protein catabolic rate in maintenance hemodialysis, we calculated normalized protein nitrogen appearance (nPNA) using the Randerson II continuous dialysis model. Descriptive statistics, Spearman correlation coefficient, Mann Whitney, Wilcoxon signed rank, receiver operating characteristic curves, and Kruskal-Wallis analysis were performed using SAS version 9.4. RESULTS: Eight infants received 31.9 (22.0, 49.7) days of CKRT using mostly (90%) regional citrate anticoagulation. Delivered nutritional volume, protein, total calories, enteral calories, nPNA, and nitrogen balance increased on CKRT. Using parenteral nutrition, 90 ml/kg/day should meet caloric and protein needs. Following initial weight loss of likely fluid overload, exploratory sensitivity analysis suggests weight gain occurred after 14 days of CKRT. Despite adequate nutritional delivery, goal weight (z-score = 0) and growth velocity were not achieved until 6 months after CKRT start. Most (5 infants, 62.5%) survived and transitioned to peritoneal dialysis (PD). CONCLUSIONS: Carpediem™ is a safe and efficacious bridge to PD in neonatal KF. Growth velocity of infants on CKRT appears delayed despite delivery of adequate calories and protein.

Lower limb squat biomechanics and select clinical measures in chronic ankle instability.

BACKGROUND: Individuals with chronic ankle instability often present with clinical and biomechanical abnormalities, however squat biomechanics have not been investigated. The purpose of this study was to compare select clinical assessments and squat biomechanics between individuals with and without chronic ankle instability. METHODS: Fifteen individuals with chronic ankle instability and a matched control group were studied. A weight-bearing dorsiflexion lunge test, foot posture, and an in-line half-kneeling motor control test for core stability were assessed. Lower limb 3D bilateral and unilateral squat biomechanics were captured. Groups, limbs and squat tasks were compared using an alpha of 0.05. FINDINGS: Individuals with chronic ankle instability had less static weight-bearing dorsiflexion and failed the core stability test more frequently, but did not differ in foot morphology compared to the controls. When squatting, those with chronic ankle instability demonstrated reduced peak ankle dorsiflexion angles and moments in the involved limb (p < 0.04) during single limb squats and had interlimb differences in ankle dorsiflexion angle as well as hip and knee kinetics (p < 0.04) during double limb squats. In those with chronic ankle instability, there was less overall motion, but higher kinetic demands in single limb versus double leg squatting (p < 0.03). INTERPRETATION: Individuals with chronic ankle instability had impaired weight-bearing dorsiflexion and showed impaired core stability more often, which accompanied altered squatting mechanics in both variations. Within the limbs with chronic ankle instability, single limb squats showed lesser kinematic demands but higher kinetic demands than double limb squatting.

Use of a PHQ-9 Heat Map to Facilitate Management Decisions in Patients With Depression.

BACKGROUND: Depression is a common concern for patients seeking medical care. The Patient Health Questionnaire-9 (PHQ-9) is a tool used to diagnose and manage depression. Tracking individual symptom scores rather than the sum of multiple symptom scores has been found to be more predictive of depression treatment response. METHODS: The records of 30 patients who had a follow-up visit in primary care were reviewed. We discuss 3 patient scenarios and present their PHQ-9 data as individual symptom scores, in the form of a color-coded heat map. RESULTS: In the cases presented, medication side effects, anxiety, a thyroid disorder, and fibromyalgia were identified as possible influencers of the PHQ-9 survey scores. DSICUSSION: A heat map helped clinicians understand the patient's clinical status in an efficient manner. We encourage the development of a PHQ-9 heat map in electronic medical record systems.

Patient Reported Outcome Measures in Adult Spinal Muscular Atrophy: A Scoping Review and Graphical Visualization of the Evidence.

BACKGROUND: Spinal Muscular Atrophy (SMA) is a hereditary neuromuscular disease with an estimated prevalence of 1/10 000 births. SMA is increasingly recognized as a multi-system disease with a need to study additional under-recognized health domains such as quality of life, fatigue, bulbar function, respiratory function, and independence. OBJECTIVE: Identify and assess reported evidence from the literature investigating Patient Reported Outcome Measures (PROMs) in adults with SMA. Develop a novel method drawing from network theory to graphically depict the literature, PROMs, and supporting psychometric evidence. METHODS: A scoping review was completed following PRISM-ScR, COSMIN and JBI scoping review guidelines. Literature investigating PROMs in adult SMA or neuromuscular disease was identified from peer-reviewed and grey databases. A network graph was derived from extracted data. RESULTS: 5292 articles were retrieved, 81 articles met inclusion criteria; corresponding to 31 unique PROMs. Only two PROMs were developed specifically for SMA. Few PROMs covered multiple domains of health. Most PROMs were incompletely validated, focusing on concurrent validity, and few assessed responsiveness or internal consistency. CONCLUSIONS: PROMs are emerging tools for monitoring and assessing adults with SMA. Despite their potential benefits, additional validation studies should be completed prior to their use for clinical decision-making. Network graphics may represent a technique to aid in the visualization of evidence supporting a scoping review.

In for the long haul: knowledge translation between academic and nonprofit organizations.

Although scientists are continually refining existing knowledge and producing new evidence to improve health care and health care delivery, far too little scientific output finds its way into the tool kits of practitioners. Likewise, the questions that clinicians would like to be answered all too rarely get taken up by researchers. In this article we focus on knowledge translation challenges accompanying a longitudinal research program with nonprofit organizations providing direct and indirect health and social services to disadvantaged groups in one region of Canada. Three essential factors influencing authentic and reciprocal knowledge transfer and utilization between nonprofit service providers and researchers are discussed: strong institutional partnerships, the use of skilled knowledge brokers, and the meaningful involvement of frontline personnel.

"I Don't Want to Go Anywhere Else": Patient Experiences of Abortion in Family Medicine.

BACKGROUND AND OBJECTIVES: Prior studies have demonstrated that most women are comfortable with the option of receiving early abortion care in the family medicine setting, and patients who received early abortion care in this context report satisfaction with their experience. There are few qualitative studies, however, that explore abortion experiences in the family medicine setting. This study aimed to better understand influential factors in women's choices and experiences of their family medicine setting for abortion care. METHODS: We conducted semi-structured interviews with 15 women who received early abortion care at an urban federally qualified health center offering full-spectrum family medicine. Transcripts were analyzed in NVivo, using editing and immersion/crystallization approaches. RESULTS: Women who received abortion care in this setting were highly satisfied. Though many were surprised when they learned abortion care was available, their responses were favorable, and their experiences were positive. Our results indicate that connection to the clinic setting and to the provider who performed the abortion created a context of trust and comfort. Further, women in our study appreciated the privacy offered by a general medical setting as well as the convenience and continuity of care afforded by accessing abortion care in their accustomed primary care setting. CONCLUSIONS: Women in our study reported high levels of satisfaction with care and would recommend this setting to others. In a context of increasing restrictions on abortion, family physicians are well-positioned to increase access by including abortion care in the range of reproductive health services offered in their primary care practice settings.