Selsun shampoo should also be used in conjunction with the Monistat or Micatin in tinea versicolor bacteria doubles every 20 minutes buy discount cyclidox 200 mg on line. The treatment of any toenail fungal infection should be referred to a dermatologist as therapeutic results are frequently disappointing antibiotic resistance natural selection activity purchase 100mg cyclidox otc. Impetigo is usually caused by B-hemolytic streptococci; and treating uti yourself buy cheap cyclidox 200 mg line, is frequently associated with Staphylococcus aureus antibiotics for acne yahoo buy 100 mg cyclidox visa. Topical bacitracin-neomycin cream and pHisoHex soap should be used in conjunction with the oral antibiotics. A folliculitis-like acne condition may be seen on the thighs, buttocks, and arms of a patient who works in an oil-contaminated area, especially one who is exposed to the halogenated hydrocarbons in a machine shop. A tropical-like acne frequently develops on the trunk due to the macerating effect of prolonged exposure to wet clothing. If deep papules or cysts exist, the patient will need long-term tetracycline 10-3 U. Initially, there may be an irritating effect with the above treatment, followed by slow improvement. If the condition is severe, the patient should be removed from hot, humid, or greasy areas. Occasionally, a keloidal acne occurs on the sternum, scalp, or nape area of Black persons. These lesions will require intralesional injections of Kenalog (5 mg/cc) and cautious hygiene. On rare occasions a Gram-negative rod infection will develop in a patient on long-term tetracycline. This is easily identified by the clinical appearance of multiple superficial pustules. Except for this rare complication, all acne patients should be considered noninfectious; and, no waivers prohibiting haircuts or mess cooking should be considered. Additional Common Dermatological Diseases Pseudofolliculitis barbae (pfb) is an inherent problem associated with Black males who shave. The intruding hair acts as a foreign body and an infectious or granulomatous condition develops. Corpsmen can be taught to treat warts with weekly paring, application of trichloroacetic acid, and 40 percent salicylic plasters. Podophyllin (20 percent in tincture of benzoin) should be reserved for venereal warts in uncircumcized sailors and on the perirectal area. Dandruff or seborrheic dermatitis can flare under the stress of a cruise and usually presents no problem for diagnosis. The same medications can be applied to the scalp of psoriatic patients along with a topical Aristocort preparation for the skin lesions. This would include pyodermas, infected lesions, as well as allergic, and inflammatory diseases. Once a lesion becomes dry, soaks or compresses should be reduced and appropriate cream or ointment therapy should be initiated. Venereal warts Molluscum contagiosm Herpes simplex Scabies Crab lice Erythrasma Treatment: Tinea cruris Monilia Venereal warts, Molluscum contagiosum Keep dry; miconazole or griseofulvin. Scabies, lice Erythrasma All others Contact dermatitis Neurodermatitis Treatment: Tinea pedis Keep dry; cotton socks; powders; miconazole or griseofulvin. Keep clean and dry, avoid contact with offending agents, topical steroid cream, antihistamines, I. Bacterial infection Eczema, dyshidrosis, contact dermatitis, neurodermatitis 10-6 Dermatology Itching Differential Diagnosis: Urticaria Positive history, lesions moving around within 24 hours. History of deodorant soap or detergent use, or recent change in brand used; noted in morning, especially if member sweats profusely. Drug eruption Neuroses Soap/detergent/bleach/ clothes softener contact dermatitis Scabies Miliaria rubra Erythema multiforme Treatment: Urticaria Keep cool; Atarax; epinephrine; topical steroids (systemic if severe). Discontinue offending soap, detergent, bleach, or softener; use tepid showers; topical steroids; Atarax. Elbows, knees, and scalp frequently involved; chronic, erythematous plaques with silvery scales, usually nonpruritic. Lesions on penis, mouth, wrist, and ankles; violaceous or white color, pruritic, Koebner reaction. Tinea versicolor Pityriasis rosea Seborrheic dermatitis Secondary syphilis Eczema, neurodermatitis Psoriasis Contact dermatitis, dermatitus medicamentosa Lichen planus Lupus erythematoses 10-8 Dermatology Treatment: Tinea Pityriasis rosea Keep dry; miconazole or griseofulvin. Topical steroids, creams for small areas, lotions for large or hair covered areas. Tinea versicolor Seborrheic dermatitis, eczema, contact dermatitis, neurodermatitis, lichen planus Lupus erythematosus Topical or systemic steroids; sun screens; a biopsy is indicated; refer to medical officer. Blisters Psoriasis Dermatitis medicamentosa Secondary syphilis Differential Diagnosis: Herpes simplex Herpes zoster Varicella Tinea Contact dermatitis Impetigo On lips or genitalia; recurrent; painful. Positive culture; positive Gram stain; may have crusting, bullous, or weeping lesions. Pyodermas Varicella Contact dermatitis Drug eruption Tinea Impetigo Dermatitis herpetiformis Differential Diagnosis: Acne Oily skin; not infectious, obvious comedones or scarification. Folliculitis Impetigo Pseudofolliculitis barbae 10-10 Dermatology Furuncles, carbuncles Deep; painful, usually more than 1 cm in diameter. Cellulitis, erysipelas Treatment: Acne Tetracycline; benzoyl peroxide; Fostex shampoo, good hygiene, avoid self manipulation of comedones. Discontinue use of hair straighteners, hot comb, hair pic, excessive brushing, alkaline shampoos, traction (corn-row). Dermatology Medications Dermatology preparations or medications are predictably redundant and obsolete aboard a carrier. Creams are most often used for the acute inflammatory lesion, and an ointment is best for the chronic scaly dermatoses. A steroid spray may be indicated for first or second degree burns or arthropod bites; 90-gram cans of Valisone, Deca, or Kenalog spray are recommended. Occasionally an intraoral medication is indicated such as Kenalog in Orabase (five-gram unit). If a parenteral steroid is indicated, and if the condition requires more than two weeks of treatment, prednisone should be avoided in favor of I. A similar quantity of Celestone will react initially in a few hours and will hold the patient for approximately three weeks. The equivalent dosage of oral prednisone needed for similar clinical response will be in the 30 mg per day range and may induce more adrenal suppression, even with single, daily doses. The steroid should be given deep intramuscularly (hip) with at least a 1 l/4 inch needle. Parenteral Kenalog, diluted with xylocaine to 5 mg/cc, can be injected intralesionally into thick patches of neurodermatitis, psoriasis, or into areas of alopecia areata. Its combination of steroid, antimonilial, and antibacterial agents requires many stabilizers and preservatives which can potentially produce a contact allergy. A pharmacy technician should be able to compound any two or three active ingredients as needed. It is better to become familiar with a few drugs and methods of treatment than to attempt the use of many. The area is rapidly evolving into a subspecialty in its own tight: genitourinary medicine. In Great Britian there are departments and clinics devoted solely to this subspecialty. Sexually transmitted diseases encompass 25 or more entities which are usually transmitted by some type of sexual intercourse. Many agents are transmitted among adults exclusively, or nearly so, by intimate sexual contact in all its myriad forms. The spectrum of sexually transmitted diseases includes: bacterial agents (Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma hominis, Ureaplasma Urealyicum, Gardnerella vaginalis Treponema pallidum, Hemophilus ducreyi, Chlamydia granulomatus, group B streptococci, Shigella species: viruses (herpes, hepatitis A, hepatitis B, pox virus (Molluscum contagiosum, human papilloma virus, cytomegalovirus, human immunedeficiency virus); fungi: (Candida albicans); protozoa (Trichomonas vaginalis, Entamoeba histolytica, Giardia lamblia); and ectoparasites (Phthirus pubis, Sarcoptes scabiei). The emphasis is on what is treatable, and what is likely to be seen in an operational setting, with the concomitant constraints on diagnostic and treatment modalities. These are particularly useful for administrative issues, but sometimes are not current with the latest treatment recommendations.
The objective was to compare the concordance between clinical and histological response on proliferative lupus nephritis patients antibiotics obesity 200 mg cyclidox mastercard. Methods: this retrospective study included patients between June 2010 and May 2017 with proliferative lupus nephritis who had a control biopsy after induction treatment treatment for uti burning 100mg cyclidox fast delivery. The control biopsy was performed between 6 to 12 months after the start of the treatment virus fbi purchase 100 mg cyclidox amex. Conclusions: the study show a low concordance between clinical and histological response in proliferative lupus nephritis antibiotics no dairy quality cyclidox 200 mg. We hypothesized that her acute anasarca led to her inability to absorb tacrolimus. We therefore treated her aggressively with 5 sessions of intermittent ultrafiltration, 5 sessions of plasma exchange therapy with albumin replacement, and pulse oral dexamethasone (40 mg/week). Results: In total 503 different proteins were identified with at least two peptides (with peptide and protein threshold of 95% with a false discovery rate of 0. Background: Patients with monoclonal gammopathy can develop a variety of related renal lesions or possibly have kidney disease unrelated to their monoclonal gammopathy. We characterized the spectrum of renal diseases associated with monoclonal gammopathy and unrelated renal diseases. Methods: Hospitalized patients in Peking Union Medical College Hospital who underwent renal biopsy between January, 2013 and December, 2015. Various renal lesions related/unrelated to hematologic malignancy were seen in third subgroup, including light chain cast nephropathy (n=3, 27. Conclusions: the significance of monoclonal gammopathy in patients with renal disease should be evaluated by other clinical data, as well as renal pathology. Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medicine Sciences & Peking Union Medical College, Beijing, China. Results: the diagnoses were: IgA nephropathy (n=28), focal segmental glomerulosclerosis (n=16), minimal change disease (n=10) and membranous nephropathy (n=20). After treatment with renin-angiotensin blockers and/or immune-modulating agents, 38 patients (51. Background: M2 macrophages contribute to crescentic formation in various types of glomerulonephritis. Results: Plasma pharmacokinetics displayed the expected 2 compartment model of a vascular-tissue equilibrium phase followed by renal excretion only. Multivariate analyses and hypothesis testing were used to determine the metabolites that best differentiated the phenotypic groups, and logistic regression using a stepwise variable selection method were used model the odds of steroid resistance at presentation. Metabolites affected by treatment included lipoproteins, adipate, tyrosine, valine, alanine, glutamine, glucose, pyruvate and creatine. Conclusions: Known effects of corticosteroid treatment were observed providing a proof-of-concept. Background: to account for glomerular filtration rate, urinary creatinine is routinely used for the normalization of urine biomarkers related to disease. Because of the small size of this metabolite, antibodies are difficult and expensive to develop, limiting the applications of disease-specific urine protein biomarkers for antibody-based point of care applications. Results: the screen uncovered 18 proteins that correlated well with urinary creatinine but were similar in patients with or without nephritis. Secondary renal diseases associated with collagen diseases and diabetes were excluded. The accuracy of model prediction for the prospectively collected dataset of 63 patients was 61. Meanwhile, the algorithm identified 17 of 33 variables as contributing strongly to type of renal pathology. Conclusions: the method has high precision and can be used to help those patients who are not suitable for renal biopsy to predict the pathologic type of primary nephrotic syndrome, which can guide the diagnosis, choice of treatment and evaluation of prognosis of primary nephrotic syndrome. Medicine, Division of Nephrology, Fatima Memorial School of Health Sciences, University of health Sciences, Lahore, Pakistan. Background: 24 hours urinary protein excretion is considered gold standard for the estimation of daily urinary protein loss, although cumbersome. Methods: this was an observational, cross sectional study carried out at Fatima Memorial Hospital Lahore, Pakistan over four years from January 2013. Sixty-seven (67) patients who were persistently dipstick positive for protein were included and informed consent was obtained. The patients were required to collect a twenty-four hours urine sample according to standard recommendations for protein and creatinine measurement. None of the patient was on renal replacement therapy at the time of cross section. Background: Podocyte depletion causes glomerulosclerosis, and persistent podocyte loss drives progression to end-stage kidney disease in most forms of glomerular diseases. Podocytes are resident on the urinary space side of the glomerular basement membrane, so that as they detach or die, their products can be identified in urine. Thus, the podocyte products in urine might be potential biomarkers to monitor glomerular disease activity and progression. However, differences in these markers between various pathologies have not yet been investigated. Background: Renal biopsy is the gold standard to determine the pathologic type of primary nephrotic syndrome. Based on this, we tried to using a machine learning algorithm to predict the pathologic type in primary nephrotic syndrome patients without renal biopsy. Methods: Clinical data and pathologic types of 203 patients with primary nephrotic syndrome were collected. We trained and validated a machine learning algorithm using data from 203 patients. Then the model was tested prospectively on another 63 biopsyconfirmed patients with primary nephrotic syndrome. Thirdly, Compared with the pathologic results of renal biopsy, the predictive effectiveness of the model was further verified. Results: Overall accuracy of prediction from the retrospective set of 203 patients was 62. Blood was flushed in and out of each lumen twice weekly in order to mimic dialysis and assess for the onset of dysfunctional flow. Compacted fibrin sheaths were present in all sacrificed animals (Figure), together with jugular and central venous wall thickening. Importantly, the bacterial profile correlated with standard human data, showing growth of Klebsiella, Pseudomonas and Beta hemolytic strep (and from an earlier study Staphylococcus aureus). This suggests that duplex ultrasound leads to an incorrect clinical diagnosis when hemodialysis patients present with a swollen arm, and suggests patients may be receiving inappropriate anticoagulation. Background: Central venous catheters have traditionally provided haemodialysis access when a fistula is declined or not achieved, but are increasingly advocated as an acceptable option for older or more comorbid patients. Methods: All patients starting haemodialysis in a single centre between December 2005 and February 2015 were prospectively identified. There was no significant effect of ethnicity, but in older patients (over 70 at dialysis initiation, 35. The implementation of a pre-emptive protocol during the preimplantation period and maintenance care could reduce the rate, although there is no consensus in the bibliography. Since 2006, our department has had a preimplantatory protocol, developed by nephrologists and infectologists, it includes nasal decolonization in case of staphylococcal aureus colonization, complete cleansing with chlorhexidine gel and prophylactic cefazolin before the procedure. Methods: Our protocol has been implemented in 246 tunneled catheters, implanted in 107 patients. Incidence of bacteremia, time of appearance of the bacteremia after the implantation, bacteria types and associated complications were analyzed. Warneri 4%, pantoea agglomerans 4%, strep viridans 4%, candida 2%, pseudomonas 2%, cloacae 2%, klebsiella 2%, corynebacterium 2%, serratia 2%. Results: Forty eight consenting patients contributed a total of 252 observations that were allocated to either group A (2 mg) or group B (1mg) based on randomization. Given the clustered nature of the observation, randomization was observation-based as opposed to patient-based. There were only six catheter removals; three of which were related to catheter malfunction.
Ophthalmic ointments work well bacteria 3d purchase cyclidox 100 mg line, but treatment must be continued for two or three weeks after symptoms disappear to prevent recurrences antibiotics effective against strep throat 200 mg cyclidox sale. Furunculosis of the vestibule is also common and usually associated with digital trauma and nose blowing antibiotics qt interval buy cyclidox 100mg on-line. Most infections localize antibiotics for sinus infection and uti purchase cyclidox 100 mg with visa, but occasionally they may become a spreading cellulitis. Squeezing or incising the area is dangerous, as it may cause spread to the cavernous sinus. Treatment consists of a "hands off" policy, adequate doses of appropriate antibiotics, hot, moist packs, and good analgesics. Rhinitis can develop as a complication of an upper respiratory infection if symptoms last longer than seven to ten days. Thick yellow or greenish nasal drainage, fever, throat and ear pain, and productive cough suggest complications. Excessive blowing of the nose, which forces bacteria into the sinuses and Eustachian tube and traumatizes the sinus orifices, and severe coughing, which strips the cilia from the bronchial lining, are the most common causes. Treatment should place emphasis on maintaining good nasal and sinus drainage, good tissue hydration, and rest; antibiotics are used for bacterial infections or complications. The penicillins, erythromycin, or the tetracyclines, in order of preference, handle most complications, but cultures should be taken to provide help in resistant cases. Even a slight amount of nasal congestion and tissue edema may be enough to interfere with pressure equalization of the sinuses and ears, leading to aerotitis, aerosinusitis, or barometric vertigo. The flight surgeon should strongly advise against self-medication and frequently reiterate the many predictable, immeasurable factors, such as level of awareness and performance, that may be affected by disease or medication. Before personnel are allowed to return to flight status, a careful examination of the ears, nose, and throat should be made. Symptoms are often gone several days before the tissues return to normal and before essential functions return sufficiently to handle the many different and rapid environmental changes associated with flying. Allergic rhinitis, a very unpredictable and difficult problem in aviation, may be acute or chronic, seasonal or perennial. Common symptoms are nasal obstruction, clear rhinorrhea, sneezing, itching of the eyes, soft palate, and nose, and occasional associated headache, mostly frontal. Some cases of allergic rhinitis are similar to a cold, but they usually last only one or two days or else 10 days and are more frequent than viral upper respiratory infections. Perennial rhinitis can be quite variable with no pattern, or it may be nearly constant. Allergies may be caused by house dust, molds, dog dander, wool, feathers, tobacco pollutants, or food. Avoidance, if possible, is the best method of control; however, desensitization may be effective for dusts and molds. Examination of the nasal mucosa often reveals edema and pallor of the turbinates, especially the inferior turbinates and the anterior tips of the middle turbinates. The posterior turbinate tips may protrude into the nasopharynx or become irregular and look like mulberries. Red or inflamed mucosa has also been noted, especially if the allergen is a pollutant. Avoid milk and egg products; other foods can be eliminated, one at a time, a week apart. Severe allergy attacks may require a short course of systemic steroids for control. Milder cases that create obstruction of the nasal airway and sinus orifices can often be helped by topical steroids in an aerosol form, such as Beclamethazone, Flunisolide or nasal cromolyn sodium. Nonallergic rhinitis, often included under the term of vasomotor rhinitis, has as the most common symptoms chronic, intermittent, often alternating nasal stuffiness or obstruction, and postnasal drip. In the course of treatment, it is important to rule out allergies, to explain the physiology of the nose to the patient, and to prevent the overuse of nose drops or inhalers that may cause a rhinitis medicamentosa. Once rhinitis medicamentosa develops, it can only be cured by complete abstinence from nose drops. Humidification of the house or bedroom, or the use of Proetz solution or ointments to prevent drying of the mucosa is often helpful. Thyroid function may be a factor in some cases; for borderline hypothyroid states, thyroid extract or Cytomel has been effective. Certain emotional states cause nasal symptoms, and they often respond when this problem has been explored or treated. Certain antihypertensive and birth control pills may cause nasal congestion; decrease or change in the drugs often improves or cures the problem. When the nasal mucosa, and in some cases the sinus mucosa, reacts to allergies or inflammation, edema develops due to increased capillary permeability and transudation of fluid into the cell and extracellular spaces. Air conditioners may contain much dust and mold, causing more trouble for a person with allergies to these substances. Humidification is good for the dry nasal mucosa but it also increases the growth of molds in the house. Over a period gravity, this tissue may elongate to form nasal polyps, especially in meatus and maxillary sinus ostia. In some cases, the anterior tip of the remain edematous, and this condition is called polypoid degeneration, tissue may lose some of its cilia and is replaced with goblet cells. Occasionally, polyps are found within the maxillary sinus; these polyps eventually move out of the sinus ostium and into the nasopharynx, where they expand in size. These polyps are called antrochoanal or choanal polyps, and their removal requires a Caldwell-Luc antrostomy to remove the base and prevent recurrence. Polyps in the maxillary sinuses are disqualifying for aviation candidates, as is nasal polyposis. A possible exception can be made for a single, small polyp on one side in an asymptomatic, nonallergic candidate. Recurrence of polyps after removal is common; this is especially true when the disease remains in the ethmoid sinuses. In some cases, the use of short courses of broad spectrum antibiotics and topical steroids may reduce the size of the polyps. A common dose schedule is two sprays in each nostril, twice daily for one week, then one spray in each nostril twice daily for four days, finishing with one spray daily in each nostril for the remainder of the week or longer, if desired. The use of topical steroids may be irritating to the mucosa; otherwise there are essentially no side effects. Common causes are air drying, violent sneezing or blowing the nose, and picking the nose. Severe bleeding, especially high anterior and posterior bleeding, occurs from the ethmoid artery, a branch of the internal carotid, and the sphenopalatine artery, a branch of the external carotid artery. In general, treatment of simple anterior bleeding should first be direct pressure, for at least five or ten minutes, against the anterior septum. Pledgets of cotton moistened in a vasoconstrictor, such as one percent Neo-Synephrine, one percent epinephrine, or one to four percent cocaine, along with pressure, are even more effective; large clots should be gently suctioned away. If bleeding is controlled, the bleeding site may be cauterized with 25 to 50 percent trichloroacetic acid, five percent chromic acid, or silver nitrate in a 50 percent solution or on a stick applicator. These solutions should be applied with a small, moist applicator under direct vision. Anterior bleeding sites not controlled by direct pressure or chemical cautery should be infiltrated with Xylocaine and epinephrine, using both the tissue wheal and the epinephrine effect for control. The site may then be cauterized by chemical or electrocautery; deep burns or cauterization of adjacent structures, such as the ala or vestibule, must be avoided. If the coagulated fluid and blood stick to the tip of the cautery and are pulled off with the coagulum, the bleeding may restart. In those cases where bleeding cannot be controlled, one might attempt cautery with a suction tip electrode; if this fails, the nose can be packed with Vaseline and antibiotic ointment impregnated 8-28 Otorhinolaryngology in half-inch selvage gauze. It is best to pack both sides to prevent loss of the pack by shifting of the septal cartilage from a one-sided pressure. The pack should be left in place for at least 24 hours, but usually never more than 72 hours. All raw or cauterized surfaces should be lightly covered with an antibiotic ointment, and a small piece of compressed Gelfoam over the anterior septum further protects against air trauma. Posterior bleeding, usually in the older age group, is a serious condition, and, if coupled with hypertension, it requires aggressive medical and rhinological management. The patient should be admitted to sickbay, sedated, and kept in a head- elevated position. After vasoconstrictor and topical anesthestic application to both nasal passages, an attempt can be made to control the posterior bleeding by the use of a specifically designed postnasal balloon, or a common, 15 cc-size Foley catheter.
No differences in post-biopsy complications such as hematoma virus removal free download buy 200mg cyclidox overnight delivery, hematuria antibiotic resistance meat buy cyclidox 200mg otc, need for transfusion or intervention bacteria 60 degrees buy 100 mg cyclidox otc, analgesic use virus software buy discount cyclidox 200mg on-line, emergency room visits, infection/sepsis, or patient death were observed between the groups. Inclusion criteria: age 18 or over, and all dialysis modalities except peritoneal dialysis. Admission diagnoses were sepsis (26%), cardiac (31%), surgical (18%) and renal (15%). These include nephrotoxic medications, iodinated contrast dye, potassium supplementation, and hypertension management. Background: Few quantitative assessments have been undertaken to assess the disaster preparedness of kidney transplant patients, a population at risk due to their dependence on immunosuppression. Methods: We recruited 200 kidney transplant recipients from the waiting room of the transplant clinic. They answered short pencil and paper questionnaires assessing their level of preparedness as well as what barriers they faced in becoming adequately prepared. Preparedness was scored based on the response to 7 different items and an index created. We created average scores of preparedness for various counties in California and geocoded them on maps created with Google Fusion Tables. A significant minority of patients (at least 40% of patients or more) were unprepared with lists of medications, important phone numbers and disaster kits. There were no major associations between preparedness and different participant characteristics such as age, race, gender, number of years since transplant or various clinical variables including type of immunosuppression or other comorbid conditions. Thirty-one of the 34 counties sampled were from California, of which Monterey County was the most prepared with an average preparedness score of 4. Conclusions: Patients of all demographic and clinical backgrounds should be educated on the importance of disaster preparation. Since most deficiencies in preparedness are in general items, there should be a concerted effort on the part of city and medical services to address specialized populations in general preparedness planning. Background: Patients with pre-existing advanced renal disease admitted in emergency to hospital are managed by the admitting team. Renal specialists are involved at a late stage depending upon the mode of communication and rely on admitting team for notification. Delays in specialist input contribute to increased morbidity, length of stay, untoward incidences and even mortality. Methods: We carried out a retrospective analysis of patients admitted within several weeks between July-August 2016 with advanced renal disease. Teaching strategies optimized human-computer interaction and content retention; audio, animation, and clinical vignettes reinforced themes. Of 318 total tasks there were 3 non-critical errors (1%) and 6 critical errors (2%). All usability testing recommendations were incorporated into the final version of the educational program. Future studies will explore its impact on health outcomes in this high-risk population. Royal Liverpool & Broadgreen University Hospitals Trust, Liverpool, United Kingdom. Patient distress was recorded at week 2, 4 and 8 using the validated Patient Distress Thermometer (Renal). Our prospective pilot recruits patients from July 2016-June 2017, and we report 90 day follow-up data. Conclusions: these data suggest improvements in patient experience and outcomes using this novel intervention. It reported a non-significant protective treatment effect of pre-emptive correction on access loss and a significant protective effect on thrombosis rates conferred by pre-emptive correction. We revisit this analysis, including data extraction and effects of heterogeneous study populations. Methods: We repeated data extraction from referenced publications, and corrected event counts where applicable. We assessed the prevalence of depressive symptoms among hemodialysis and peritoneal dialysis patients at West area of Puerto Rico. A systematic assessment of depression in hemodialysis patients would supply information about patient feelings of well being. Existing data suggest that screening for depression may help identify patients at higher risk for death and hospitalization. Methods: this cross-sectional study was represented with a sample of 146 hemodialysis patients selected from 3 dialysis centers of West Area at Puerto Rico. We used this scale of 21 short answer question for assess degree of depression in studied patients. Our study analyzed and compared the 2 methods with respect to concordance, and implications for incorporating into clinical practice. The difference is most marked for those who are heavier, older and are female, particularly non-black females. Conclusions: Discrepancies in allowable contrast doses based on published formulae may lead to different and higher contrast exposure for some patients. The incidence of hematologic toxicity (grade 3/4) was not significantly different between the groups. Multivariate analysis revealed no statistically significant association between having a solitary kidney and severe hematologic toxicities. Background: Guideline attainment in diabetes and early diabetic nephropathy is difficult. Search criteria were: diabetes mellitus, hypertension or blood pressure >140/90 mmHg, albuminuria >30 mg/g, and not being on an Ac/Ar. On the other hand, the pharmacy team identified patients and placed referrals to a pharmacy clinic. The primary pharmacist made decisions on drug initiation, monitoring, titration and laboratory tests based on the same recommendations. Results: A total of 34 patients were found in the provider group and 19 patients in the pharmacy group. There was a trend towards increased efficacy in the pharmacy led team (58%) over the provider led team (41%). A post study survey showed that majority of participants favored that pharmacists identify, start and manage recommendations. Conclusions: A pharmacy led intervention was no more effective than a provider led intervention in implementing current standards of care for diabetic patients. On the pharmacy arm, patients were more likely to have follow-up appointments if they were by telephone rather than in person. Telephone intervention is less burdensome and may lead to more successful interventions and continuity of care. Pharmacists are just as effective, are more accessible health care practitioners and are well positioned to implement appropriate medication use. Background: There is little information on renal safety to cisplatin-based chemotherapies in patients with a solitary kidney after nephroureterectomy. Methods: We retrospectively reviewed patients treated between August 2007 and December 2016. Incidences of renal insufficiency and hematologic toxicities were examined and compared between the groups. Background: Medication errors are one of the leading preventable causes of adverse patient outcomes. Dialysis patients have increased risk with polypharmacy of up to 5-10 medications/patient. We attempt to enable the patient himself to carry the information for their own care in a qualityimprovement project using medication wallets. Method: Project consisted of 3 phases: Phase 1: Identify patients for participation. Phase 3: Introduce intervention (Dialysis Wallet) and monitor its effectiveness through a questionnaire-based survey at each clinic visit.
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