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.