Comorbidity and in-hospital mortality in peritoneal dialysis patients: data of the Emilia Romagna region of Italy.

OBJECTIVE: Kidney failure increases in-hospital mortality (IHM); however, comorbidity is crucial for predicting mortality in dialysis patients. Our aim was to evaluate the impact of comorbidity, assessed by modified Elixhauser index (mEI), Charlson Comorbidity Index (CCI), and age-adjusted CCI, on IHM in a cohort of peritoneal dialysis patients admitted to hospitals of the Emilia Romagna region (ERR) of Italy. PATIENTS AND METHODS: All hospital admissions of peritoneal dialysis patients recorded between 2007 and 2021 in the ERR database were analyzed. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) was used for detecting diagnoses and procedures, and the inclusion criterion was code 5498. Comorbidity burden was evaluated by three different scores, and hemodialysis (HD) treatment need was considered. IHM was our outcome. RESULTS: During the 15 years of the study, 3,242 hospitalized peritoneal dialysis patients (62.7% males) were evaluated. Mean age was 62.8±20.6 years, 9.6% underwent HD, and IHM was 5.9% (n=192). IHM mortality was stable throughout the study period. Deceased subjects were older, were hospitalized longer, had a higher comorbidity burden, and had a higher percentage of HD treatment needs than survivors. Age, male sex, comorbidity burden, and HD treatment were predictors of IHM. Receiver operating characteristics (ROC) analysis confirmed the impact of comorbidity burden on IHM, especially when age was considered. CONCLUSIONS: We conclude that in male, elderly hospitalized peritoneal dialysis patients with failing dialysis technique, comorbidity burden should be considered being a predictor of IHM.

Recovery of big sagebrush communities after burning in south-western Montana.

Prescribed burning of big sagebrush (Artemisia tridentata Nutt.) communities is conducted with the intention of increasing either the productivity of the understory plants or the big sagebrush. It was our objective to compare the recovery of big sagebrush communities from prescribed fire at as many sites as we could locate in south-western Montana with environmentally paired unburned portions. We located and sampled 13 sites that had been burned over a span of two to 32 growing seasons earlier. Big sagebrush canopy cover, density, and production of winter forage were significantly greater (P < or = 0.05) in the unburned portions in 34 of 38 comparisons. Canopy coverage of Idaho fescue (Festuca idahoensis Elmer), the dominant herbaceous species, was greater in the burned portion at only one site while it was less (P < or = 0.05) at four sites. Total perennial grass canopy coverage was not different (P < or = 0.05) between treatments over the 13 sites. Managers considering prescribed burning of big sagebrush communities should be aware that herbaceous plant responses may be minimal while shrub values will likely be lost for many years. The loss of the dominant shrubs in any ecosystem will affect many other organisms and severely impact species that have an obligate habit with the shrubs.

Dual effects of melatonin on barbiturate-induced narcosis in rats.

Melatonin affects the circadian sleep/wake cycle, but it is not clear whether it may influence drug-induced narcosis. Sodium thiopenthal was administered intraperitoneally into male rats pre-treated with melatonin (0.05, 0.5, 5 and 50 mg/kg). Melatonin pre-treatment affected in a dual manner barbiturate narcosis, however, no dose-effect correlation was found. In particular, low doses reduced the latency to and prolonged the duration of barbiturate narcosis. In contrast, the highest dose of melatonin (50 mg/kg) caused a paradoxical increase in the latency and produced a sustained reduction of the duration of narcosis, and a reduction in mortality rate. Melatonin 0.5 and 5 mg/kg influenced the duration but not the latency of ketamine- or diazepam-induced narcosis. Thus, the dual action of melatonin on pharmacological narcosis seems to be specific for the barbiturate mechanism of action.

Lead outside your comfort zone.

Successful leaders use their passion, values, and personal mission to create and maintain influence. Learn to define and develop a context that allows you to successfully lead nursing and non-nursing departments.