Few studies have evaluated whether histopathologic lesions on kidney biopsy provide prognostic information beyond clinical and laboratory data. We enrolled 676 individuals undergoing native kidney biopsy at three tertiary care hospitals into a prospective, observational cohort study. Biopsy specimens were adjudicated for semiquantitative scores in 13 categories of histopathology by two experienced renal pathologists. Proportional hazards models tested the association between histopathologic lesions and risk of kidney disease progression (≥40% eGFR decline or RRT). Mean baseline eGFR was 57.5±36.0 ml/min per 1.73 m During follow-up (median, 34.3 months), 199 individuals suffered kidney disease progression. After adjustment for demographics, clinicopathologic diagnosis, and laboratory values, the following lesions (hazard ratio; 95% confidence interval) were independently associated with progression: inflammation in nonfibrosed interstitium (0.52; 0.32 to 0.83), moderate and severe versus minimal interstitial fibrosis/tubular atrophy (2.14; 1.24 to 3.69 and 3.42; 1.99 to 5.87, respectively), moderate and severe versus minimal global glomerulosclerosis (2.17; 1.36 to 3.45 and 3.31; 2.04 to 5.38, respectively), moderate and severe versus minimal arterial sclerosis (1.78; 1.15 to 2.74 and 1.64; 1.04 to 2.60, respectively), and moderate and severe versus minimal arteriolar sclerosis (1.63; 1.08 to 2.46 and 2.33; 1.42 to 3.83, respectively). An 11-point chronicity score derived from semiquantitative assessments of chronic lesions independently associated with higher risk of kidney disease progression (hazard ratio per one-point increase, 1.19; 95% confidence interval, 1.12 to 1.27). Across a diverse group of kidney diseases, histopathologic lesions on kidney biopsy provide prognostic information, even after adjustment for proteinuria and eGFR.

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In rehabilitation nursing, the patient classification systems or acuity models and nurse‐staffing ratios are not supported by empirical evidence. Moreover, there are no studies published characterizing nursing hours per patient day, proportion of RN staff, and impact of agency nurses in inpatient rehabilitation settings. The purpose of this prospective observational study was to describe rehabilitation nurse staffing patterns, to validate the impact of rehabilitation nursing on patient outcomes, and to test whether existing patient measures on severity and outcomes in rehabilitation could be used as a proxy for burden of care to predict rehabilitation nurse staffing ceilings and daily nurse staffing requirements. A total of 54 rehabilitation facilities in the United States, stratified by geography, were randomly selected to participate in the study.

Objective:To determine the effectiveness of 8-week group functional balance training classes on balance outcomes in community-dwelling veterans at risk for falls.Design:Pre-test, post-test using retrospective data.Setting:VISN 8 Patient Safety Center at James A. Haley Veterans Hospital in Tampa, FL, USA.Participants:Fifty one community living veterans with mean age of 78 at risk for falls.Intervention:Participants received a weekly 1-hour functional balance training class for 8 weeks in a small group setting (4–5 participants).Measurements:Pre and post intervention measures included Berg Balance Scale, Limits of Stability (LOS) and modified Clinical Test of Sensory Interaction on Balance (mCTSIB).Results:Eighty four percent of the participants completed 5 or more weekly classes. Peripheral neuropathy was the most common risk factor among the participants. There was a significant improvement in the Berg (p < 0.0001) and Composite Reaction Time (p < 0.0004) after the intervention.Conclusion:An eight week group functional balance training class was safe and effective in improving balance outcomes in a cohort of elderly veterans at risk for falls.

The findings of this study indicate a high level of nurse satisfaction with the PRN role. Nurses with an interest and specialized knowledge in pain assessment and management at the unit level may greatly improve patient outcomes.

Objective: The purpose was to provide support for validity and reliability of the spinal cord impairment pressure ulcer monitoring tool (SCI-PUMT) to assess pressure ulcer (PrU) healing. Design: Expert panels developed a 30-item pool, including new items and items from two established PrU healing tools, to represent potential variables for monitoring PrU healing. Subjects were prospectively assessed weekly for each variable over a 12-week period. Setting: Data collection was conducted on a cohort of inpatients and outpatients in one Spinal Cord Injury/ Disorders Center in the Veterans' Health Administration. Subjects: A convenience sample of Veterans (n = 66) with spinal cord impairment (SCI) was recruited. Eligible subjects had at least one PrU (n = 167) and a history of SCI for longer than 1 year. Interventions: Not applicable. Outcome Measure: A change in PrU volume was calculated using VeV Measurement Documentation software and a digital imaging camera. Results: Content validity was established for a pool of items designed to gauge PrU healing. Exploratory factor analysis (construct validity) identified a parsimonious set of seven items for inclusion in the SCI-PUMT to assess PrU healing. The SCI-PUMT was found to explain 59% of the variance of the volume across the study. Inter-rater reliability was 0.79 and intra-rater reliability ranged from 0.81 to 0.99 among research assistants. Similar levels of reliability were subsequently established among registered nurses, who used the SCI-PUMT in the clinical setting. Conclusions: The final version of the SCI-PUMT was determined to be valid, reliable, and sensitive in detecting PrU healing over time in Veterans with SCI. The objective of this measurement study was to evaluate the psychometric properties of a new clinical assessment tool, the SCI Pressure Ulcer Monitoring Tool (SCI-PUMT). Research questions were: (1) Is there evidence to support the validity of the SCI-PUMT as a measure of PrU healing? (2) Is there evidence to support the reliability of the SCI-PUMT as a measure of PrU healing in the clinical setting? (3) How does the prediction of PrU healing by the SCI-PUMT compare with that of currently used clinical tools over time?Evaluating PrU healing in the SCI population has been challenging, making the quantitative effectiveness of treatment strategies that result in PrU changes over time difficult to measure. Practice to monitor PrU healing among VHA SCI centers ranged from using tools with established reliability and validity for non-SCI populations, using locally developed tools lacking psychometric testing, and using non-PrU wound assessments. Although determining the success of topical treatments, support surfaces, nutrition, and other interventions are based on the trajectory of PrU healing, methods to measure this have been inconsistent. formerly known as the Pressure Sore Status Tool (PSST). 9 The PUSH and BWAT provided a starting point for the development of SCI-PUMT and will be briefly discussed. Pressure Ulcer Scale for Healing (PUSH)The PUSH,...

Rationale & Objective Uric acid is excreted by the kidney and accumulates in acute kidney injury (AKI). Whether higher plasma uric acid level predisposes to AKI or its complications is not known. Study Design Prospective observational cohort study. Setting & Participants 2 independent cohorts of critically ill patients: (1) 208 patients without AKI admitted to the intensive care unit (ICU) at Brigham & Women’s Hospital between October 2008 and December 2016; and (2) 250 participants with AKI requiring renal replacement therapy (RRT) who had not yet initiated RRT enrolled in the Acute Renal Failure Trial Network (ATN) Study. Exposure Plasma uric acid level upon ICU admission and before RRT initiation in the ICU and ATN Study cohorts, respectively. Outcomes Incident AKI and 60-day mortality in the ICU and ATN Study cohorts, respectively. Analytical Approach Logistic regression models were used to test the association of plasma uric acid level with incident AKI and 60-day mortality. Results In the ICU cohort, median plasma uric acid level was 4.7 (interquartile range [IQR], 3.6-6.4) mg/dL, and 40 patients (19.2%) developed AKI. Higher plasma uric acid levels associated with incident AKI, but this association was confounded by serum creatinine level and was not significant after multivariable adjustment (adjusted OR per doubling of uric acid, 1.50; 95% CI, 0.80-2.81). In the ATN Study cohort, median plasma uric acid level was 11.1 (IQR, 8.6–14.2) mg/dL, and 125 participants (50.0%) died within 60 days. There was no statistically significant association between plasma uric acid levels and 60-day mortality in either unadjusted models or after multivariable adjustment for demographic, severity-of-illness, and kidney-specific covariates (adjusted OR per doubling of uric acid, 1.15; 95% CI, 0.71-1.86). Limitations Heterogeneity of ICU patients. Conclusions Plasma uric acid levels upon ICU admission or before RRT initiation are not independently associated with adverse clinical outcomes in critically ill patients.

The Veterans Health Administration (VHA) serves the health care needs of an adult, predominantly male, and aging population. The aging profile of VHA patients is 25% greater than the civilian sector (DVA 2001). Aged patients are at higher risk for falls. In February 2002, 6 VHA medical centers profiled their inpatients’ fall risk profile as one aspect of program initiatives targeted at reducing veterans’ fall risk and fall-related injuries, participating in a one-day collection of fall risk measurement using the Morse Fall Scale (MFS) for all inpatients (n=1819), acute and long-term care units. Data results are reported for age, MFS score, and the relationship between age and score, and by type of ward/unit, ie, predominately acute and critical care or long-term care. The results of this prevalence study documented that the veteran inpatient population are at high-risk for anticipated physiological falls. This Veteran Integrated Services Network-wide Deployment of an Evidence-based Program to Prevent Patient Falls study was completed as part of a nationally funded clinical initiative, National Program Initiative 20-006-1.