The psychosocial adjustment of nine adolescents with end-stage renal disease (ESRD) was described by two standard psychologic tests; Piers-Harris Self-Concept Scale and Nowicki-Strickland Locus of Control. Life Events were recorded to evaluate the effect of stress at the time of testing. The mean self-concept scores were higher (p = .009) for the ESRD adolescents than the normative sample. However, the individual's scores did not differ significantly. The Life Events were comparable to the healthy population for age. The family members were assessd on the Family Assessment Measure (FAM) to assess the influence of family functioning on adolescent psychosocial adjustment. The standardized FAM scores were comparable to a normative sample. Cluster analysis of the ESRD adolescents revealed three groups differing significantly on: self-concept, locus of control, FAM self-rating and number of years from diagnosis to dialysis. Significant differences were maintained across the family members on FAM General Scale and FAM Self-Rating Scale. The adequate psychosocial adjustment of the adolescents with ESRD is consistent with recent studies suggesting that chronically ill children and adolescents do not differ from healthy children. However, the results also suggest that within the study group, a number of individuals may be experiencing problems of adjustment. / Education, Faculty of / Educational and Counselling Psychology, and Special Education (ECPS), Department of / Graduate

Introducción: La insuficiencia renal es una de las complicaciones extrapulmonares más frecuente en pacientes hospitalizados con COVID-19 condicionando peores desenlaces que podría afectar al sistema de salud en Perú. Sin embargo, estudios comparan pacientes con insuficiencia renal aguda (IRA) o crónica (ERC) con pacientes sanos. Objetivo: Determinar características clínicas de pacientes con COVID-19 e insuficiencia renal hospitalizados y evaluar el efecto del tipo de insuficiencia renal y el recibir hemodiálisis en los desenlaces clínicos negativos. Métodos:Cohorte descriptiva incluyó pacientes con algún tipo de insuficiencia renal y COVID-19 hospitalizados durante marzo y julio del 2020, que tuvieron una interconsulta con nefrología. La insuficiencia renal se clasificó como aguda, crónica, y crónica en estadio V con hemodiálisis crónica. Se recolectó información sobre mortalidad, uso de inotrópicos, ventilación mecánica y recibir hemodiálisis aguda. Resultados: Se analizó a 279 pacientes, 22.6% tenían IRA, 33.3% tenían ERC, y 44.1% tenían ERC V. Se describe una mortalidad general de 32.9%, y 27% usaron inotrópicos y recibieron ventilación mecánica. Entre los pacientes con IRA y ERC el 12.9% recibió hemodiálisis por primera vez. Los adultos con ERC y ERC V en HD estudiados tienen menor prevalencia de diabetes mellitus (23.7.3% y 43.9%, respectivamente) e hipertensión arterial (31.2% y 59.4%, respectivamente) en comparación con los adultos que desarrollan IRA (81.0% y 73%, respectivamente) (valor p<0.001). El desarrollo de IRA se asoció a ventilación mecánica (RPa: 6.46), uso de inotrópicos (RPa: 7.02) y morir (RPa: 2.41), en comparación con los que tenían sólo ERC. Entre quienes tenían IRA o ERC, aquellos que recibieron hemodiálisis por primera vez tienen mayor prevalencia de morir (RPa: 2.95; IC95%:2.20 a 3.94) en comparación con los que no recibieron hemodiálisis. La hemodiálisis aguda podría ser un modificador de efecto de la asociación entre tipo de insuficiencia renal (IRA o ERC) y desenlaces clínicos negativos (p<0.001). Conclusión: Es importante Identificar a pacientes hospitalizados por COVID-19 que desarrollan IRA y/o necesitan hemodiálisis aguda pues se encuentran en alto riesgo de tener una mala evolución clínica.

Objectives: To assess national trends of AP (acute pancreatitis) admissions, outcomes, prevalence of AKI (acute kidney injury) in AP, and impact of AKI on inpatient mortality. Methods: We queried the Nationwide Inpatient Sample database from 2003 to 2012 to identify AP admissions using ICD-9-CM codes. After excluding patients with missing information on age, gender, and inpatient mortality, we used ICD-9-CM codes to identify complications of AP, specifically AKI. We examined trends with survey-weighted multivariable regressions and analyzed predictors of AKI and inpatient mortality by multivariate logistic regression. Additionally, both AKI and non-AKI groups were propensity-matched and regressed against mortality. Results: A total of 3,466,493 patients (1.13% of all discharges) were hospitalized with AP, of which 7.9% had AKI. AP admissions increased (1.02%→1.26%) with rise in concomitant AKI cases (4.1%→11.7%) from year 2003–2012. Mortality rate decreased (1.8%→1.1%) in the AP patients with a substantial decline noted in AKI subgroup (17.4%→6.4%) during study period. Length of stay (LOS) and cost of hospitalization decreased (6.1→5.2 days and $13,654 to $10,895, respectively) in AKI subgroup. Complications such as AKI (OR: 6.08, p < 0.001), septic shock (OR: 46.52, p < 0.001), and acute respiratory failure (OR: 22.72, p < 0.001) were associated with higher mortality. AKI, after propensity matching, was linked to 3-fold increased mortality (propensity-matched OR: 3.20, P < 0.001). Conclusion: Mortality, LOS, and cost of hospitalization in AP has decreased during the study period, although hospitalization and AKI prevalence has increased. AKI is independently associated with higher mortality.

Doctor Educationis / Background: South Africa has the largest burden of HIV in the world with 7.9 million people living with HIV and 4.4 million registered on antiretroviral therapy (ART) in 2017. KwaZuluNatal is hardest hit by the HIV epidemic with a prevalence of 27% among adults aged 15 to 49 years old. With the widespread ART uptake, the spectrum of HIV related admissions in hospitals has changed over the last decade. Hypertension, diabetes, cardiovascular disease, and renal failure have become significant reasons for inpatient care. Increased life expectancy, rising non-communicable diseases (NCDs) and easier access to ART have played a significant change in the landscape of inpatients as compared to the pre-ART era. To provide integrated healthcare to the patient, it is necessary to understand the prevalence and patterns of HIV comorbidities for efficient and effective service delivery to HIV patients at facility-level. Aim: The current study aimed to describe the prevalence and patterns of HIV-related comorbidities in adult hospital admissions in iLembe, KwaZulu-Natal. Methodology: A retrospective, cross-sectional survey was conducted of all adult HIV-related admissions between 1st October and 31st December 2019. Clinical and demographic characteristics were extracted from admission and discharge records, and laboratory data was collected via the National Health Laboratory Services using Labtrack. Summative and inferential analyses were done using SPSS v 23.

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The nutritional needs of the renal patient vary as the renal function decreases. Little information exists concerning energy requirements for patients on hemodialysis. Renal failure has been called a wasting disease as evidenced by decreased body weight, body fat, arm circumference and serum proteins. This research was designed to help precisely define energy requirements for the hemodialysis subject. Resting energy expenditure (REE) was measured by indirect calorimetry in 17 male hemodialysis subjects whose mean age was 55 years at the Veterans Administration Medical Center in Hampton, Va. The Beckman MMC Horizon System, a portable device which permits the determination of heat production from gas exchange, oxygen consumption and carbon dioxide production was used. By regression analysis, the measured REE was compared to the basal energy expenditure (BEE): the ideal weight based on the Metropolitan Life Insurance tables, the current weight taken on day of indirect calorimetry, a non-dialysis day, and the post dialysis weight taken immediately after dialysis. A correlation analysis of the dependent variable, IEE, with the current, ideal and post dialysis BBE variable resulted in correlation coefficients of .3783, .0003, and .3946 respectively. None of these correlation coefficients were significantly correlated with the REE. The post dialysis variable had the highest correlation coefficient, and thus the strongest relationship to the REE. While any of the weights studied could be used to determine energy needs for the hemodialysis subject, post dialysis weight may be the most desirable choice. / M.S.

The scope of this project is an examination of medical compliance for the Hispanic patient with End State Renal Disease.

published_or_final_version / Social Work / Master / Master of Social Work