ABSTRACT
Increasing population obesity and associated metabolic consequences has led to increased number of obese patients with chronic kidney disease and end-stage renal disease. While obesity is associated with increased cardiovascular morbidity and mortality, obese dialysis patients present a seeming paradox for survival benefit, given other acute intervening illnesses for those on dialysis with loss of lean body mass overtime. Challenges remain in providing adequate renal replacement options and therapy for this growing segment of obese patients on dialysis which are discussed in this article.
Subject(s)
Epidemics , Kidney Failure, Chronic , Body Mass Index , Humans , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/epidemiology , Kidney Failure, Chronic/therapy , Obesity/complications , Obesity/epidemiology , Renal DialysisABSTRACT
BACKGROUND: Teaching methods in most residency and fellowship programs have not yet addressed the challenges of rapid dissemination of new scientific information. Our Northwell nephrology fellowship program used the smartphone application WhatsApp® to facilitate nephrology education. A qualitative study was conducted to explore perceptions of nephrology fellows and faculty using WhatsApp® as a teaching tool. METHODS: A WhatsApp® messenger group called 'Northwell Renal Forum' was created in 2018, which included all eight fellows and seven selected faculty members. Multiple choice questions on various nephrology topics were posted, about one to two per week. Fellows responded at their leisure. After 7 months, data were analyzed following two 1-h focus groups (one for faculty and one for fellows). Focus groups were moderated by two qualitative researchers, unknown to the participants, who asked open-ended questions about the WhatsApp® learning approach. RESULTS: Faculty feedback was generally positive. Three major themes arose: control over learning material, comfort being fostered between faculty and fellows and faculty perceptions of fellows. The fellows also reported an overall positive experience. Control and comfort were themes again identified in this focus group. Fellows reported feeling control over which faculty member was in the group and when to respond to questions. Fellows also felt comfort from learning without pressure. Variety was the third theme that arose. CONCLUSION: Focus group evaluations elucidated the strengths of using WhatsApp®, and the overall positive experience of both faculty and fellows. This inexpensive and easy-to-use tool can augment the learning of nephrology during fellowship.
ABSTRACT
To determine the best combination of parameters that would improve the diagnostic performance of exercise testing, coronary angiography plus exercise testing were done on 112 patients with angina pectoris and normal electrocardiogram. The univariate predictors of coronary artery disease included: age > or = 40 years, male sex, hypertension, smoking, development of exertional chest pain, decrease in systolic blood pressure (BP) > or = 10 mmHg or systolic BP 3 min post-exercise > 90% of peak, heart rate drop < 12 beats/min 1 min postexercise, exercise-induced ST-segment depression > or = 1 mm. Multivariate logistic regression analysis showed that using either ST depression > or = 1 mm or peak exercise QTDc > 70 ms significantly improved sensitivity and negative predictive value of the test without a significant decrease in specificity.
Subject(s)
Coronary Angiography/methods , Coronary Artery Disease/diagnosis , Data Interpretation, Statistical , Electrocardiography/methods , Exercise Test/methods , Age Distribution , Analysis of Variance , Angina Pectoris/etiology , Coronary Artery Disease/epidemiology , Coronary Artery Disease/etiology , Egypt/epidemiology , Female , Humans , Hypertension/complications , Logistic Models , Male , Middle Aged , Risk Factors , Sensitivity and Specificity , Sex Distribution , Smoking/adverse effects , Statistics, NonparametricABSTRACT
To determine the best combination of parameters that would improve the diagnostic performance of exercise testing, coronary angiography plus exercise testing were done on 112 patients with angina pectoris and normal electrocardiogram. The univariate predictors of coronary artery disease included: age >/= 40 years, male sex, hypertension, smoking, development of exertional chest pain, decrease in systolic blood pressure [BP] >/= 10 mmHg or systolic BP 3 min post-exercise > 90% of peak, heart rate drop < 12 beats/min 1 min post-exercise, exercise-induced ST-segment depression >/= 1mm. Multivariate logistic regression analysis showed that using either ST depression >/= 1mm or peak exercise QTDc > 70 ms significantly improved sensitivity and negative predictive value of the test without a significant decrease in specificity