Articles: chronic.
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Acute kidney injury (AKI) after cardiac surgery is associated with increased morbidity and mortality. The long-term association between AKI and end-stage renal disease (ESRD) in an Asian population is unknown. Given the high prevalence of diabetes and a younger age of presentation for cardiac surgery, it is important to track this progression of kidney disease. Therefore, we studied the long-term risk of ESRD and mortality in our Asian patients who developed AKI after cardiac surgery. ⋯ AKI is associated with ESRD and mortality after cardiac surgery in our Asian population. The trajectory from AKI to ESRD is rapid within 5 years of cardiac surgery. A concerted periodic follow-up assessment is advocated for AKI patients post-cardiac surgery.
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Clin J Am Soc Nephrol · Feb 2017
Integrating Quality Improvement Education into the Nephrology Curricular Milestones Framework and the Clinical Learning Environment Review.
The Accreditation Council for Graduate Medical Education requires that trainees show progressive milestone attainment in the practice-based learning and systems-based practice competencies. As part of the Clinical Learning Environment Review, sponsoring hospitals must educate trainees in health care quality improvement, provide them with specialty-specific quality data, and ensure trainee participation in quality improvement activities and committees. Subspecialty-specific quality improvement curricula in nephrology training programs have not been reported, although considerable curricular and assessment material exists for specialty residencies, including tools for assessing trainee and faculty competence. ⋯ Fellow quality improvement projects have improved nephrology clinical care within the institution and introduced new educational and assessment tools to the training program. All have been opportunities for quality improvement scholarship. The curriculum prepares fellows to apply quality improvement principals in independent clinical practice-while showing milestone advancement and divisional compliance with Clinical Learning Environment Review requirements.
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Int J Obstet Anesth · Feb 2017
Observational StudyPersistent pain after caesarean section and its association with maternal anxiety and socioeconomic background.
Pain, both from the surgical site, and from other sources such as musculoskeletal backache, can persist after caesarean section. In this study of a predominantly socially deprived population we have sought to prospectively examine the association between antenatal maternal anxiety and socioeconomic background and the development of persistent pain of all sources after caesarean section. ⋯ Persistent pain from a variety of sources after caesarean section is common. Our findings do not support the use of antenatal anxiety scoring to predict persistent pain in this setting, but suggest that persistent pain is influenced by acute pain, postnatal depression and socioeconomic deprivation.
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Two-stage exchange arthroplasty remains the preferred method for treating a chronic periprosthetic joint infection (PJI) in North America. However, infection recurrence may occur. Previously, recurrent infections have been classified as persistent (same isolated pathogen) or new (different pathogen identified). We sought to determine (1) recurrence rates among patients with chronic hip and knee PJI, treated with 2-stage exchange arthroplasty; (2) risk factors for infection recurrence; and (3) risk factors for developing persistent vs new infection. ⋯ Female gender, heart disease, and psychiatric disorders increase the risk of hip and knee PJI recurrence. Patients with PJI of the hip and with heart disease are at higher risk of infection persistence.
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Semin Respir Crit Care Med · Feb 2017
ReviewAcute Pulmonary Embolism after Discharge: Duration of Therapy and Follow-up Testing.
Pulmonary embolism (PE) is a frequent cause of death and serious disability with a risk extending far beyond the acute phase of the disease. Anticoagulant treatment reduces the risk for death and recurrent VTE after a first PE. The optimal duration of anticoagulation after a first episode of PE remains controversial and should be made on an individual basis, balancing the estimated risk for recurrence without anticoagulant treatment against bleeding risk under anticoagulation. ⋯ If the favorable safety profile of direct oral anticoagulants from clinical trials would be confirmed in real-life, extension of anticoagulation could be reconsidered in large proportions of patients after an unprovoked PE. The most feared late sequela of PE is chronic thromboembolic pulmonary hypertension. Although there has been progress in both the diagnosis and management of this disease in recent years, further data are needed to provide recommendations regarding long-term follow-up after PE.