The session-to-session variation in URR and Kt/V is small in stable hemodialysis patients. Nevertheless, the averaged value of two to three measurements is required to assess the dose of dialysis reliably. Assessment of dietary intake requires at least three PCR measurements or food records for at least one week. Basing clinical decisions on a single dialysis adequacy assessment is an unjustified practice that should be abandoned.
Recently, chicken meat was identified as a plausible source of extended-spectrum β-lactamase (ESBL) -producing Escherichia coli in humans. We investigated the relatedness of ESBL-producing Klebsiella spp. in chicken meat and humans. Furthermore, we tested the performance of SpectraCell RA(®) (River Diagnostics), a new typing method based on Raman spectroscopy, in comparison with multilocus sequence typing (MLST) for Klebsiella pneumoniae. Twenty-seven phenotypically and genotypically confirmed ESBL-producing Klebsiella spp. isolates were typed with MLST and SpectraCell RA. The isolates derived from chicken meat, human rectal swabs and clinical blood cultures. In the 22 ESBL-producing K. pneumoniae isolates, CTX-M15 was the predominant genotype, found in five isolates of human origin and in one chicken meat isolate. With MLST, 16 different STs were found, including five new STs. Comparing the results of SpectraCell RA with MLST, we found a sensitivity of 70.0% and a specificity of 81.8% for the new SpectraCell RA typing method. Therefore, we conclude that SpectraCell RA is not a suitable typing method when evaluating relationships of ESBL-producing Klebsiella spp. at the population level. Although no clustering was found with isolates of chicken meat and human origin containing the same ESBL genes, MLST showed no clustering into distinctive clones of isolates from chicken meat and human origin. More studies are needed to elucidate the role of chicken meat in the rise of ESBL-producing Klebsiella spp. in humans.
BackgroundTelehealth has the potential to improve patients’ health outcomes and patient empowerment by increasing access to care and medical information.1,2 As patients with rheumatic diseases are known to experience drug-related problems at various moments along their patient journey,3 this population can benefit from more continuous information about their medication and healthcare provider support to manage drug-related problems. To most effectively employ telehealth for this purpose, it is important that offered technologies match with patients’ needs and preferences.ObjectivesIdentify factors influencing the preference of patients with rheumatic diseases regarding telehealth applications.MethodsA qualitative descriptive study was performed in the Netherlands between May and June 2021. Using a semi-structured interview guide, patients with a rheumatic disease were interviewed face-to-face. First, patients were presented four telehealth applications (frequently asked questions page, digital human, and chatting and video calling with healthcare providers). Second, patients were asked to use each application to answer one medication-related question predefined by the research team. During the process of finding an answer to the question, patients were asked to think aloud and were questioned on which factors influenced their experience and preference for each application. Third, patients were given additional hypothetical questions after which they were asked to explain their preferred application for answering the question, to elicit additional factors influencing preference. Interviews were audio recorded, transcribed verbatim and analysed thematically.ResultsFifteen patients (aged 19 – 73 years, 53% female) participated. Three domains influenced patients’ preference for telehealth applications. First, preference for telehealth applications was influenced by factors related to individual patients such as medication-related information needs, literacy, and skills with digital applications. Second, preference was influenced by factors related to the specific applications such as speed of answer, level of interaction, extent of privacy, the perceived usefulness of an application, and usability of the application. Third, preference was influenced by factors related to the context in which telehealth applications are offered, such as the support from healthcare providers in using telehealth applications, reliability of information source, and potential of telehealth to save time for healthcare providers.ConclusionPatients’ preference for telehealth applications is influenced by patient-related, application-related and context-related factors. To effectively support patients with rheumatic diseases, telehealth applications should match with these patients’ preferences. Furthermore, it is important to offer a variety of telehealth applications as preferences differ among patients and circumstances.References[1]Wootton, R. Twenty years of telemedicine in chronic disease management-an evidence synthesis. J. Telemed. Telecare18, 211–220 (2012).[2]Barbosa, W., Zhou, K., Waddell, E., Myers, T. & Dorsey, E. R. Improving Access to Care: Telemedicine across Medical Domains. in Annual Review of Public Health vol. 42 463–481 (Annual Reviews, 2020).[3]Haegens, L. L., Huiskes, V. J. B., Smale, E. M., Bekker, C. L. & van den Bemt, B. J. F. Drug-related problems experienced by patients with rheumatic diseases: A longitudinal observational study. Unpublished manuscript. (2021).Disclosure of InterestsNone declared
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