Implementation of a 1-Day Living Kidney Donor Evaluation Program: A Qualitative Analysis of Donor Candidate and Stakeholder Perspectives.

Introduction: A lengthy donor evaluation process hinders living donor kidney transplantation (LDKT). At The Ottawa Hospital, 1-day evaluation process was recently developed, with a goal to accelerate the determination of donor suitability. The major objective of this study was to solicit feedback from donor candidates and key stakeholders who participated in the 1-day living kidney donor evaluation process, to determine the program's acceptability and factors influencing its implementation elsewhere. Methods: Semi-structured interviews were conducted with donor candidates who participated in the 1-day living kidney donor evaluation process, and with stakeholders who are instrumental to the implementation strategy. Interviews were conducted via videoconference or by telephone from May 2022 to December 2022. Directed content analysis was conducted using 2 unique frameworks for stakeholder and donor candidate interviews. Results: Our study included 13 stakeholders and 18 donor candidates, of whom 16 (89%) were women and 7 (39%) proceeded to kidney donation. Eighteen (100%) perceived the process to be both time-effective and cost-effective, due to reduced travel and missed work time. Thirteen (72%) felt that the 1-day evaluation may accelerate determination of donor suitability. Sequential virtual sessions with a nurse and social worker in advance of the evaluation day were seen as providing critical education and support. Among stakeholders, 11 (85%) emphasized donor candidate care and faster candidacy determinations. Conclusion: The 1-day evaluation process was preferred by most donor candidates, and was perceived as time-effective and cost-effective by most interviewees. An expedited, 1-day evaluation may accelerate determination of donor suitability and improve LDKT rates.

A Health Survey-Based Prediction Equation for Incident CKD.

BACKGROUND: Prediction tools that incorporate self-reported health information could increase CKD awareness, identify modifiable lifestyle risk factors, and prevent disease. We developed and validated a survey-based prediction equation to identify individuals at risk for incident CKD (eGFR <60 ml/min per 1.73 m2), with and without a baseline eGFR. METHODS: A cohort of adults with an eGFR ≥70 ml/min per 1.73 m2 from Ontario, Canada, who completed a comprehensive general population health survey between 2000 and 2015 were included (n=22,200). Prediction equations included demographics (age, sex), comorbidities, lifestyle factors, diet, and mood. Models with and without baseline eGFR were derived and externally validated in the UK Biobank (n=15,522). New-onset CKD (eGFR <60 ml/min per 1.73 m2) with ≤8 years of follow-up was the primary outcome. RESULTS: Among Ontario individuals (mean age, 55 years; 58% women; baseline eGFR, 95 (SD 15) ml/min per 1.73 m2), new-onset CKD occurred in 1981 (9%) during a median follow-up time of 4.2 years. The final models included lifestyle factors (smoking, alcohol, physical activity) and comorbid illnesses (diabetes, hypertension, cancer). The model was discriminating in individuals with and without a baseline eGFR measure (5-year c-statistic with baseline eGFR: 83.5, 95% confidence interval [CI], 82.2 to 84.9; without: 81.0, 95% CI, 79.8 to 82.4) and well calibrated. In external validation, the 5-year c-statistic was 78.1 (95% CI, 74.2 to 82.0) and 66.0 (95% CI, 61.6 to 70.4), with and without baseline eGFR, respectively, and maintained calibration. CONCLUSIONS: Self-reported lifestyle and health behavior information from health surveys may aid in predicting incident CKD. PODCAST: This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast.aspx?p=CJASN&e=2023_01_10_CJN05650522.mp3.

Sexual Health of Adolescent Patients Admitted to a Psychiatric Unit.

OBJECTIVE: To review sexual health screening practices during admission to an adolescent psychiatry unit. METHOD: Retrospective chart review of randomly selected youth admitted over a one-year period (2013). Data extracted included demographics, reasons for admission, sexual health history, as well as any comorbid behaviours noted. The main outcome measure was whether sexual health details were documented at any time during admission; if so, this information was extracted for analysis. Statistical analysis was done using univariate associations and logistic association. RESULTS: Mean age of subjects (n=99, 79 females and 20 males) was 15.24 years (SD = 1.30). Most common reasons for admission were suicidal gestures/self harm (n=57, 58%) and mood disorders (n=53, 54%). Thirty-seven patients (37%) had sexual health information documented in their charts. No demographic variables were significantly associated with being asked sexual health questions. Patients who had mood disorder diagnoses had 6 times the odds (95%CI: 1.18 to 29.96, P=0.03) of sexual health questions being documented compared to those not diagnosed with mood disorders. CONCLUSIONS: Screening for sexual health concerns is not being documented in the majority of adolescent psychiatry inpatients. Omitting sexual health screening during hospitalizations represents a missed opportunity for investigation and management of sexual health issues in this high-risk group. As many adolescents, particular those struggling with mental illness, do not attend preventative health visits, screening for pregnancy risk and other reproductive health needs is recommended at every adolescent encounter and in all settings.

OBJECTIF: Examiner les pratiques de dépistage de la santé sexuelle durant l'hospitalisation dans une unité de psychiatrie pour adolescents. MÉTHODE: Une revue rétrospective de dossiers d'adolescents choisis au hasard ayant été hospitalisés sur une période d'un an (2013). Les données extraites comprenaient des données démographiques, les raisons de l'hospitalisation, les antécédents de santé sexuelle, et tout comportement comorbide observé. La principale mesure de résultat était si les détails de la santé sexuelle étaient documentés à un moment de l'hospitalisation, si c'était le cas, cette information était extraite aux fins d'analyse. L'analyse statistique a été effectuée à l'aide d'associations univariées et d'association logistique. RÉSULTATS: L'âge moyen des sujets (n = 99, 79 filles et 20 garçons) était de 15,24 ans (ET = 1,30). Les raisons les plus communes de l'hospitalisation étaient les gestes suicidaires ou l'automutilation (n = 57, 58 %) et les troubles de l'humeur (n = 53, 54 %). Trente-sept patients (37 %) avaient de l'information sur la santé sexuelle documentée dans leur dossier. Aucune variable démographique n'était significativement associée au fait d'être interrogé sur la santé sexuelle. Les patients ayant des diagnostics de troubles de l'humeur avaient 6 fois plus de probabilités (IC à 95 % 1,18 à 29,96, P = 0,03) d'avoir des questions de santé sexuelle documentées que ceux n'ayant pas de ces diagnostics. CONCLUSIONS: Le dépistage des problèmes de santé sexuelle n'est pas documenté chez la majorité des adolescents hospitalisés en psychiatrie. L'omission du dépistage de la santé sexuelle durant les hospitalisations représente une occasion ratée d'investigation et de prise en charge des questions de santé sexuelle dans ce groupe à risque élevé. Comme bon nombre d'adolescents, en particulier ceux qui sont aux prises avec la maladie mentale ne font pas de visites de santé préventives, le dépistage du risque de grossesse et d'autres besoins de santé reproductive est recommandé pour toute rencontre avec un adolescent et dans tous les contextes.