Manual Washington de especialidades clínicas. Nefrología.
All patients received s. Secondary outcomes included: mean change in Perceived Competence for Anemia Scale PCAS , mean ATSQ-C change version at Record 2, change in self administration rate, change in Hb levels, compliance defined as the percentage of prescribed injections that were actually administered and incidence of adverse reactions to DA or device.
In the ATSQ-C version used to overcome possible ceiling effects 16 , the global score has a range of highest loss in satisfaction to 18 maximum gain. Addendum 1 A and B. Addendum 2 A and B. Addendum 3 A and B. The primary outcome was analysed in the subset of patients who had both the baseline and at least one post-baseline ATSQ-S score. Psychometric analyses of the ATSQ-S, ATSQ-C, and PCAS scales included: internal consistency Cronbach's alpha ; factor analysis, using a varimax rotation to verify that the adapted questionnaires have the same number of factors than the original questionnaires ; test-retest reliability analyzed between Record 1 and Record 2 in the subset of patients already self-administering the drug at all records ; intraclass correlation coefficient; longitudinal validity Pearson correlation between ATSQ-C at Record 2 and change in ATSQ-S between Records 2 and 0.
Changes over time were assessed using Mc Nemar tests or paired t-tests. This study was conducted following the Declaration of Helsinki. Study protocol was approved by the Independent Review Board of the participating Institutions. The study enrolled evaluable patients Table 1. Six patients were excluded from the analysis of the primary outcome 2 patients were lost to follow up, 3 patients died due to non-treatment related reasons, 1 patient discontinued due to adverse reaction. Median follow-up time Q1;Q3 was 5. Only three patients were self-administering DA but required assistance for insulin administration.
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Main population characteristics a 48 treated with insulin, 29 of whom Satisfaction with treatment, perceived competence and self-administration degree. Figure 1. Figure 2. Self-administration of DA was significantly increased Table 2. Table 2. Compliance with treatment and persistence with device. At Records 1 and 2, No significant changes in Hb level were observed during the follow-up baseline mean SD of The increase in satisfaction and perceived competence was also associated with non-self-administration of insulin at baseline record, and with DA monthly administration frequency at Record 2 data not shown.
Figure 3. No significant relationship was found between mean change in ATSQ-S or mean change in PCAS and the following variables: age, gender, compliance, iron administration data not shown. The three questionnaires had high internal consistency Cronbach's alpha coefficients at Record 2 of 0. In the analysis of test-retest reliability, intraclass correlation coefficients were 0. There were two adverse events probably related to treatment or device 1. Only one of these patients discontinued prematurely due to the adverse reaction.
Both the competence and autonomy of patients for managing their anemia were significantly increased with prefilled pens. The PCAS showed a relative increase of These two measures of patient empowerment were interrelated. It is possible that the specific training performed by nurses or pharmacists at the baseline visit contributed to these positive results, but other studies with similar devices demonstrated that most patients achieve self-administration, even if they are not specifically trained within the setting of a clinical trial. At the end of the study, the need of assistance of a nurse to administer the injection had decreased by 13 percentage points, and the need of a relative was decreased in the same proportion.
Our study indicates that the tolerability of the device was good. This figure is lower than the 3. Our study has some limitations. First, its observational, non-randomised design precludes drawing firm conclusions, however provides insight into the results that may be seen in the clinical practice setting. Second, the fact that the patients were being observed as part of a study could influence their preference. However, the fact that the baseline ATSQ-S score was quite high in our cohort suggests that enrolled patients were already quite satisfied with the use of prefilled syringes.
These benefits could be associated with a high compliance rate. Future randomized controlled trials are needed to confirm our results. Research on relationship-centered care and healthcare outcomes from the Rochester Biopsychosocial Program: a self-determination theory integration. Testing a self-determination theory process model for promoting glycemic control through diabetes self-management.
Health Psychol ;23 1 Supporting autonomy to motivate patients with diabetes for glucose control.
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Manual Washington de especialidades clínicas. Nefrología.
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Manual de Tratamiento de La Enfermedad Renal Cronica
Table 6. The results of this study confirmed that EKD increases with age, given that the prevalence was nearly 5 times higher in subjects over 60years old than in those under 40years old. This deterioration of renal function with age is supported by data available in the literature. In any case, it confirms that EKD is a common disease in Spain, especially in elderly subjects.. Furthermore, the risk of EKD doubled when a subject had 1 criterion of MS, and progressively increased to 6.
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These data coincide with the data previously described for advanced KD, with an absolute risk difference of between 1. In addition, the difference between both prevalence rates is more significant in each age group compared to the previous one. It must be noted that there was a prevalence of This shows the synergistic effect of age and MS on the deterioration of kidney function.
Therefore, and given the high prevalence of MS in Spain, 19 , 20 , 21 we believe that a large number of patients at high risk of EKD could be selected for a combined measurement of glomerular filtration rate and ACR.. Although it is well documented that low level of HDL is a risk factor for the deterioration of the glomerular filtration rate, its association with the presence of microalbuminuria has not been proven.
The presence of high levels of triglycerides tripled the risk of EKD. This association is described for advanced KD, with an OR of between 1. These results showed that obesity doubles the risk of EKD. Obesity has been associated with an increased risk of developing advanced or end-stage KD, with an increased risk of between 1. This observation coincides with the literature, given that high blood pressure rates are currently considered to be a continuous risk factor for the progression of kidney failure. The results of this study indicate that there is a significant connection between the level of IR and the prevalence of EKD.
In addition, the risk of EKD in subjects with IR was significantly higher compared with insulin-sensitive subjects. The connection between advanced KD and IR can be gathered from some population-based studies, 31 , 40 but its association with EKD had not been reported.. Carotid IMT is a useful and noninvasive method of assessing early carotid arteriosclerosis and is even considered a predictor of vascular events.
In the multivariate analysis adjusted for age and sex, EKD acted as an independent risk marker in the development of subclinical arteriosclerosis even after adjusting for MS.