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Background:High response rates for patient surveys are required in medical literature to ensure non-response bias is minimised. It is often difficult to achieve a satisfactory response rate as patient engagement in surveys is decreasing. A major barrier to phone surveys is getting patients to answer calls from unknown numbers.Purpose:To design a methodology which boosts response rates for telephone-based patient surveys.Research Design:We prospectively analysed the effectiveness of our methodology for increasing patient participation using caller ID and text messanging.Study Sample:Two waves totalling 1313 patients were contacted for participation in a patient survey for a descriptive quantitative and qualitative cohort study using our developed methadology.Data Analysis:We analysed the timepoints at which successful contact was made when using caller ID and text messanging.Results:We achieved a call answer rate of 85.4%, which was a 70.8% increase when compared to a similar patient cohort contacted via blocked caller ID (i.e. with privacy settings).Conclusion:We have developed a simple, inexpensive methodology which, when tested outside the Australian setting and for other projects, shows promise for increasing patient survey response rate.

Video Abstract1_8srg1a64Kaltura

BACKGROUND: Acute renal failure has long been associated with severe Rocky Mountain spotted fever (RMSF). Despite many descriptions of the protean manifestations of this disease, relatively little is known concerning the risk factors for acute renal failure. Only a few studies have examined the outcome of patients infected with Rickettsia rickettsii who develop renal insufficiency, and these studies had methodological problems. OBJECTIVE: To study the incidence, risk factors, and outcomes of acute renal failure in a large group of hospitalized patients with definite or probable RMSF. METHODS: The clinical records of 114 patients with definite or probable RMSF were retrospectively reviewed to identify clinical and biochemical abnormalities at the time of admission that were associated with the development of acute renal failure and subsequent mortality. Renal failure was defined as a serum creatinine (Cr) above 2 mg/dL. Logistic regression was used to study the association between these variables and the outcomes during hospitalization: death and the development of acute renal failure. RESULTS: The mortality rate in this series was 14%; 19% of the patients developed acute renal failure. The development of acute renal failure increased the odds ratio (OR) of dying by a factor of 17 (P = 0.0001). Factors at the time of hospitalization that were associated at a univariate level with subsequent mortality included elevated serum Cr, increased age, increased level of AST, increased level of bilirubin, decreased serum sodium and platelet count, the presence of neurological involvement, and being male. Both the presence of neurological involvement and an elevated serum Cr at presentation were independently associated with increased mortality by multivariate analysis. Three patients developed acute renal failure that required hemodialysist and only 1 of these 3 patients survive ultimately discharged with a normal serum Cr. Factors at presentation that were associated with the development of acute renal failure included increased bilirubin, increasing age, thrombocytopenia, and the presence of neurological involvement. Both age and decreased platelet count at presentation were independently associated with the development of acute renal failure by multivariate analysis. CONCLUSION: Acute renal failure was a frequent complication of RMSF in this series of patients from a tertiary referral medical center. The presence of acute renal failure was strongly associated with death. Clinical and biochemical variables are useful in predicting which patients will develop acute renal failure. 1996 by Excerpta Medica, Inc. Am J Med. 1996;101:621-626.

The preservation of small, independent family practices within a changed health care delivery environment is a goal worth pursuing. Properly organized, such practices would maintain the special fiduciary relationship between [...]

The rates of oropharyngeal squamous cell carcinoma have continued to rise secondary to the increasing prevalence of the human papillomavirus (HPV). HPV-related disease is typically found in younger patients who do not have the traditional risk factors for malignancy. General dental practitioners (GDPs) often examine patients regularly and may therefore have an opportunity to identify oropharyngeal malignancies at an early stage. However, many GDPs are unfamiliar with oropharyngeal anatomy, pathology and clinical examination. This review summarises the key points in identifying patients with oropharyngeal malignancy who necessitate urgent referral.

Colorectal cancer is the third most common cancer worldwide. Almost half of those that have a potentially curative resection go on to develop metastatic disease. A recognized risk for recurrence is perioperative systemic inflammation and sepsis. Neutrophil extracellular traps have been implicated as promotors of tumor progression. We aimed to examine the evidence in the literature for an association between neutrophil extracellular traps and postoperative metastasis in colorectal cancer.

Neil Besougloff's editorial 'How tall to make a layout,' in the April 2011 Model Railroader was very interesting. I've been in a wheelchair for the last 27 years and I've [...]

Cardiovascular disease (CVD) is common and overall graft survival is suboptimal among kidney transplant recipients. Although albuminuria is a known risk factor for adverse outcomes among persons with native chronic kidney disease, the relationship of albuminuria with cardiovascular and kidney outcomes in transplant recipients is uncertain.

Mild hyperphosphatemia is a putative risk factor for cardiovascular disease [CVD], loss of kidney function, and mortality. Very limited data are available from sizable multicenter kidney transplant recipient (KTR) cohorts assessing the potential relationships between serum phosphorus levels and the development of CVD outcomes, transplant failure, or all-cause mortality.

Because bone marrow contains a large portion of mobile protons in fat and water in blood cell producing spongy tissue it is ideally suited for study with magnetic resonance (MR) imaging. Areas of bone marrow abnormality can be detected with MR, but the use of MR to specifically diagnose marrow abnormalities is unknown. Researchers used quantitative MR imaging of the lumbar spine (lower curve) to characterize hematologic (blood) disorders in 30 patients with clinically and biopsy-proven disorders and 15 healthy control subjects. Images of the patients with infiltrative bone marrow disorders showed longer T1 (spin-lattice) times than the control subjects. However, MR imaging did not demonstrate diagnostic capabilities in evaluating diffuse bone marrow infiltrates. The researchers report that quantitative MR imaging of the lumbar spine may be of value in the detection of focal (centralized) marrow abnormalities in lymphomas (abnormal growth in the lymphatic system), such as Hodgkin's disease. Preliminary results of the use of quantitative MR imaging in childhood and adult leukemia patients who are receiving bone marrow suppression therapy have also been encouraging. The role of quantitative MR imaging for following treatment responses in diseases that focally affect marrow has yet to be fully assessed.

I approached Parkinson's Disease: A Guide for Patient and Family from the perspective of a family member, as my father suffers from the disease. The preface promised an up-to-date book [...]

Epidemiologic studies have yielded conflicting results regarding the role of heavy metal exposure in recent epidemics of chronic kidney disease (CKD). In this issue of Kidney International, Tsai et al.examined the combined effects of chromium, lead, and cadmium on kidney function using data from the Nutrition and Health Survey in Taiwan. We add this report to our growing understanding of contemporary epidemics of CKD and highlight considerations for exposure analysis in CKD epidemiologic studies.

Sham feeding has been shown to hasten the return of GI function following colorectal surgery, before the advent of enhanced recovery after surgery protocols. Few data exist regarding the efficacy of sham feeding in the modern era, with rapid postoperative feeding.

There are increasing concerns relating to the ionizing effects of computed tomography imaging in infants with benign conditions. Magnetic resonance imaging (MRI) is a potential alternative to ionizing radiation when determining patency of the cranial sutures; however, there is no documentation in the literature on the appearance of normal cranial sutures in infants on MRI. This study reviews the appearance of the cranial sutures, their widths, and accuracy of identification in the first year of life on MRI.

The optimal sympathomimetic drug to support blood pressure without adverse vasoconstriction of free flap circulation remains unknown. This study examined the effects of four agents (epinephrine, norepinephrine, dobutamine, and dopexamine) on free flaps following resection of head and neck cancer.

Surgical site infection following colorectal surgery is a frequent and costly problem. Barrier protection at the time of this form of surgery has been used with varying results. The aim of this randomized study was to examine the efficacy of barrier retractional wound protection in the prevention of surgical site infections in open, elective colorectal surgery.

Several letters to the editor are presented in response to articles in previous issues on topics including SDP40F diesel-electric locomotive, review of the Bowser HO-scale Baldwin AS-l6s model railroad, and G-scale cars, and also includes response on these letters.

This article describes how a competency-based curriculum is implemented at the Warren Alpert Medical School of Brown University. A competency-based curriculum can be implemented in either a traditional discipline-oriented curriculum or an integrated, case-based curriculum. Restructuring learning activities, assuring adequate numbers of faculty, and training faculty to assess competencies are essential for success. Schools of veterinary medicine must ensure that their graduates possess a wide range of abilities, in additional to scientific knowledge, if they are to practice successfully. A competency-based curriculum is the best means to do so.

Postinfectious glomerulonephritis (PIGN) is a rare etiology of de novo glomerulonephritis following kidney transplantation. To date, there have only been eight cases reported in the literature. We report an additional three patients transplanted at our institution between January 2000 and October 2004 who had clinical and pathologic findings consistent with posttransplant PIGN. All three patients were type 1 diabetics. One had received a cadaveric kidney transplant, one a simultaneous kidney-pancreas transplant, and the third a living related kidney transplant followed by a pancreas transplant. All patients were on triple immunosuppressive therapy with tacrolimus, mycophenolate mofetil, and prednisone. In each case, an acute decline in allograft function developed in association with a known or suspected infectious process, and renal biopsies revealed an immune complex glomerulonephritis with features of PIGN. All regained renal function with treatment of their known or suspected infections and without specific therapies for their glomerulonephritis, including corticosteroids.

The incidence, predictors and clinical significance of acute renal failure (ARF) after lung transplantation are not well described. We retrospectively collected data on 296 patients transplanted at our center between April 1992 and December 2000; follow-up was extended until December 2002. Patients were initially divided into two groups: ARF (doubling of baseline creatinine within 2 weeks after surgery) and NoARF. The ARF group was subdivided into ARFD (dialyzed) and ARFnD (not dialyzed). The incidence of ARF was 56% (166/296), but most cases were ARFnD (n = 143). Independent predictors of ARFD (n = 23) were: baseline GFR (OR 0.98, CI 0.96–0.99, p = 0.012), pulmonary diagnosis other than COPD (OR 6.80, CI 1.5–30.89, p = 0.013), mechanical ventilation > 1 d (OR 6.16, CI 1.70–22.24, p = 0.006) and parenteral amphotericin B use (OR 3.04, CI 1.03–8.98, p = 0.045). Both ARFnD and ARFD were associated with longer duration of mechanical ventilation, increased hospital stay and increased early mortality. One-year patient survival was 92.3%, 81.8% and 21.7% in the NoARF, ARFnD and ARFD groups, respectively (p < 0.0001). After controlling for important covariates, ARFD remained associated with an increased hazard of dying (HR 6.77, CI 4.00–11.44, p < 0.0001). In conclusion, ARF occurs commonly after lung transplantation and affects important clinical outcomes, especially when dialysis is required.

In vitro data suggest that calcium plays an important role in normal and disordered erythropoiesis. The purpose of this study is to determine whether there is an association between serum calcium, various hormone levels, and the development of post transplant erythrocytosis (PTE). Data were collected on 283 patients who underwent renal transplantation between 1994 and 1998. The relationship between serum calcium and PTE development was tested using the chi-square test. Univariate and multivariable adjusted models were employed to determine predictors of maximum hematocrit. Selected patients underwent measurement of intact parathyroid hormone (PTH), 1,25-dihydroxy vitamin D, and erythropoietin (EPO). Seventy-three patients (26%) developed PTE. Post transplant erythrocytosis was more common in patients with hypercalcemia compared with patients with normal serum calcium (34% vs. 18%, p = 0.002). In multivariable analyses, serum calcium was a strong independent predictor of maximum hematocrit post transplant, even after adjustment for renal function. A serum calcium of ≥10.2 mg/dL was associated with greater than two-fold increased odds of PTE. There were no differences in hormone levels between subjects with hypercalcemia and PTE, subjects with PTE alone, and subjects with hypercalcemia alone. Hypercalcemia is associated with the development of PTE in renal transplant recipients.

Acute humoral rejection (AHR) has been associated with enhanced graft loss. Our study compared the renal allograft survival of patients with AHR treated with plasmapheresis (PP) and intravenous immunoglobulin (IVIG) with allograft survival in patients with acute cellular rejection (ACR).

A racial disparity in graft survival for renal transplant recipients has been documented for both cadaveric and living-donor transplants. In the present single-center study we analyzed graft survival by race for recipients of living-donor kidney transplants in three eras: 1985–89, 1990–94, and 1995–2000. There was an intensification of the immunosuppressant regimen beginning in 1996, such that all patients received cyclosporine or tacrolimus with mycophenolate and prednisone. Graft survival was analyzed using the Cox proportional hazards model. There were 79 black recipients and 210 white recipients with no difference in mean age, degree of HLA matching, or proportion of recipients with diabetes as the cause of end-stage renal disease. Using all data from 1985 to 2000, graft survival was significantly better for whites vs. blacks adjusted for age, gender, diabetes, era of the transplant, and haplotype match (p = 0.05). However, when analyzed by era, there was a temporal trend for a progressive decrease in the racial disparity in graft survival. In confirmation of this effect, there was a significant race–era interaction (p = 0.01) on multivariable Cox proportional hazards analysis. The most recent data from the United States Renal Data System (USRDS) show a similar decrease in the racial difference in 1-year graft survival. We conclude that the influence of race on living-donor graft survival is diminishing over time.

Viral infections are a leading cause of posttransplantation morbidity and mortality. A number of recent developments have altered our understanding and management of these disorders. The pathogenetic roles of several viruses, including human herpesviruses 6 and 8, have been newly established. Molecular-based diagnostic tests now make more rapid diagnosis possible. The licensing of new potent antiviral agents offers a wider choice of drugs for viral prophylaxis and treatment. The use of more potent immunosuppressive agents is responsible in part for the increasing incidence of some viral infections, but this varies among drugs, and individual viruses differ in their sensitivity to immunosuppressive agents. This review summarizes the natural history, diagnosis, prevention, and treatment of many common viral infections after renal transplantation.

Interstitial nephritis caused by BK polyomavirus is a recognized complication of renal transplantation. A study of renal transplant recipients at Duke University Medical Center was undertaken to evaluate diagnostic modalities and assess clinical outcomes in transplant polyomavirus infections.

To evaluate whether decoupling improved signal-to-noise ratio and frequency resolution of in vivo kidney spectra, and to compare native and well-functioning transplant kidneys.

Medical students at four regional medical schools were administered a questionnaire regarding drug, alcohol, and tobacco use, and involvement in sensation-seeking sports and activities. Results of the study indicated that tobacco use was minimal, drug use was moderately low, and alcohol use was extensive. Increased alcohol use was strongly correlated with heavy drinking patterns in parents and male students while decreased drinking was strongly correlated with frequent religious attendance patterns. Students actively using drugs were more likely to have heavy drinking parents and to attend church infrequently. Protestant students and black students were least likely to be involved in drug use. Drug, alcohol, and tobacco use were significantly correlated. Those who use drugs tend to be heavy drinkers and smokers. Preventive education programs can utilize the results in medical school to inform students of potential problem areas based on sociodemographic influences.

Although medical student research has been advocated as a valuable learning experience and specific programs have been developed to offer research opportunities, only a minority of students have participated in these programs. We report a student research program that is integrated into a required six week clinical clerkship in Community Health, thus ensuring that all students participate in a research project. The program offers the additional advantage that research projects are student initiated and executed. Although the limited time frame usually results in pilot or exploratory studies, the program introduces students to all facets of a research project within a community setting and promotes independent learning. The program has been well received by students and may stimulate further research interests in some students.

The medical records of 412 residents of three southeastern Massachusetts nursing homes were reviewed to examine the frequency and medical management of urinary incontinence and the indications for chronic urinary catheterization. The mean age of the patients was 84.1 years. In this study 9.7% of the patients were managed with a urinary catheter, while an indication for catheterization was recorded in the medical records of only 27.5% of these patients. Half of the noncatheterized nursing home patients were transiently or permanently incontinent of urine, but were not catheterized. Incontinent patients without catheters were more likely to require assistance in toileting (75.5 v26.1%) or to have bacteriuria (60.1 v26.1%) than continent patients. Despite the frequency of urinary incontinence, this problem was included in the medical problem list of less than 5% of the incontinent nursing home patients. The authors conclude that urinary incontinence is a frequent medical problem in the nursing home population, but it is rarely recorded and evaluated as a medical problem. Furthermore, indications for urinary catheterization frequently are also not recorded. An explanation for this practice was not determined, but possibilities include a lack of physician knowledge of the evaluation and management of incontinence and a nonaggressive approach to such patients, given their other medical problems.

A modified thyroid-stimulating hormone (TSH) radioimmunoassay with particular sensitivity at the bottom end of the normal range was developed using dog serum in standard tubes and reduced quantities of TSH labeled with radioactive iodine (125I) and antiserum. The standard deviation of B0 points was 1%, implying an assay sensitivity of 0.1 μU/mL. This procedure was used to measure serum TSH levels in 32 normal subjects, 18 patients with hyperthyroidism, and seven patients with elevation of serum triiodothyronine (T ) levels. The range of values obtained from normal subjects was &lt;0.1 to 4.1 μU/mL, with 97% of the subjects' values greater than 0.2 μU/mL. All of the hyperthyroid patients had values less than or equal to 0.2 μU/mL. Hence, the modified TSH assay was thought to be of use in distinguishing hyperthyroid from normal subjects. The TSH levels in subjects with elevated T levels ranged from &lt;0.1 to 1.8 μU/mL. These results were thought to indicate heterogeneity within this group and suggest that only certain of these Individuals merit the diagnosis of "T3 toxicosis."(Arch Intern Med 139:757-760, 1979)

CsA nephrotoxicity in rats is associated with an increase in renal thromboxane production. Treatment with selective thromboxane synthase inhibitors or receptor antagonists improves renal function in these animal models. In humans, it is unclear whether intervention aimed at reducing the effects of thromboxane on the kidney will be clinically useful. However, we reported previously that thromboxane metabolite excretion is increased in CsA-treated renal allograft recipients with evidence of CsA toxicity and that 48-hr intravenous infusion of the selective thromboxane synthase inhibitor CGS 13080 improves renal function in such patients. We undertook the present study to determine the effect of more prolonged treatment with an oral thromboxane synthase inhibitor, CGS 12970, in renal transplant recipients taking CsA. We measured glomerular filtration rate and p-aminohippurate clearance before and after 4 weeks of treatment with CGS 12970 in 13 patients with renal allografts who had been treated with CsA for a mean 6.3 months and had mild renal insufficiency. Baseline serum creatinine was 1.8± 0.3. Treatment with CGS 12970 resulted in 83 inhibition of urinary thromboxane B2(TXB2), 93 inhibition of 2,3-dinor-TXB2, and 89 inhibition of 11-dehydro-TXB2, but no change in the urinary excretion of prostacyclin metabolites. However, suppression of urinary thromboxane metabolites to these levels did not significantly affect renal function. Glomerular filtration rate was 45±4 ml/min/1.73 m2at baseline and 43±4 ml/ min/1.73 m2after 4 weeks of treatment with CGS 12970. Estimated renal plasma flow was 272±21 ml/ min/1.73 m2at baseline and 251±38 ml/min/1.73 m2with thromboxane synthase inhibition. Thus, substantial suppression of thromboxane production with CGS 12970 did not improve renal function in CsA-treated renal allograft recipients.

Distraction osteogenesis with an external distraction device such as the rigid external distraction (RED) frame has become an established method for treating midface hypoplasia. It allows for greater advancement of the midface than achievable with traditional Le Fort III osteotomies; however, there are a number of problems associated with frame application such as pin site migration and need for frame removal.