Assessing the performance at self-management of patients with CKD is essential for effective strategies to safeguard care. We evaluated the use of a sick-day protocol with structured usability testing by patients with CKD. The Sick-Day Protocol is a selfmanagement protocol developed by National Health Service Highland in Scotland to prevent AKI, and it is made available through the Scottish Patient Safety Program on a "Medicine Sick Day Rules" card (1). The Sick-Day Protocol card describes a gastrointestinal or fever-related and volume-depleting illness; then, it directs patients to withhold specified medications and resume them when well (after 24-48 hours of eating and drinking normally). Five medication classes and examples are listed, including angiotensinconverting enzyme inhibitors, angiotensin receptor blockers, diuretics, nonsteroidal anti-inflammatory drugs, and metformin. We recruited volunteers with stages 3-5 CKD from the Safe Kidney Care program (2). All participants independently scheduled and completed testing. The protocol was deemed exempt by the University of Maryland Baltimore Institutional Review Board. Usability testing sessions were conducted in a private room by a moderator and recorder. Participants were educated about the purpose of the Sick-Day Protocol and qualifying illnesses. The moderator presented the card to all participants and requested each to summarize it in their own words. The study team developed four scenarios representing commonly encountered medical problems. All were reviewed and adjudicated by two physicians (C.J.D. and J.C.F.) for clinical validity and population suitability. Participants were presented the scenarios, including one for which the Sick-Day Protocol would be appropriately activated (index) and one with nonqualifying illnesses, including nephrolithiasis, congestive heart failure, and a "minor" gastrointestinal illness. One half of the sample had scenarios presented in a fixed sequence, starting with the index. The remainder had the scenarios presented randomly. The moderator reviewed the mock patient's medications and comorbidities in each scenario and then, provided mock medication bottles. Participants were asked about the appropriateness of the Sick-Day Protocol, if any of the mock medications should be withheld in each scenario, and if so, which ones. Completion of each task was classified as a success or error. After completing
The BinaxNOW rapid antigen COVID-19 test had a sensitivity of nearly 92% in both symptomatic and asymptomatic children when performed at a high-throughput setting during the more transmissible delta variant dominant period. The test may play an invaluable role in asymptomatic screening and keeping children safe in school.
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