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Resumen: En los últimos años se ha modificado el significado de adecuación en diálisis peritoneal. Hemos asistido a una transición desde un concepto de adecuación enfocado esencialmente a la obtención de unos objetivos en determinados parámetros —aclaramiento de solutos y ultrafiltración— a una aproximación más holística centrada en la calidad de vida del paciente. El propósito de este documento es proporcionar a sus destinatarios recomendaciones, actualizadas y centradas en nuestro entorno sociosanitario, para la adecuación y la prescripción de la diálisis peritoneal. El documento se ha estructurado en tres grandes apartados: adecuación, función renal residual y prescripción en diálisis peritoneal continua ambulatoria y diálisis peritoneal automática. Recientemente se ha publicado una guía sobre el mismo tema, elaborada por un Comité de Expertos de la Sociedad Internacional de Diálisis Peritoneal (ISPD) (2020). En consideración a las aportaciones del grupo de expertos de la ISPD y a la cuasi simultaneidad de los dos proyectos se hacen referencias a esta guía en los apartados pertinentes. Se ha seguido una metodología sistemática (GRADE), que especifica el nivel de evidencia y la fuerza de las sugerencias y recomendaciones propuestas, y facilita actualizaciones futuras de la guía. Abstract: In recent years, the meaning of adequacy in peritoneal dialysis has changed. We have witnessed a transition from an exclusive achievement of specific objectives —namely solute clearances and ultrafiltration— to a more holistic approach more focused to on the quality of life of these patients. The purpose of this document is to provide recommendations, updated and oriented to social and health environment, for the adequacy and prescription of peritoneal dialysis. The document has been divided into three main sections: adequacy, residual kidney function and prescription of continuous ambulatory peritoneal dialysis and automated peritoneal dialysis. Recently, a guide on the same topic has been published by a Committee of Experts of the International Society of Peritoneal Dialysis (ISPD 2020). In consideration of the contributions of the group of experts and the quasi-simultaneity of the two projects, references are made to this guide in the relevant sections. We have used a systematic methodology (GRADE), which specifies the level of evidence and the strength of the proposed suggestions and recommendations, facilitating future updates of the document.

الملخص: أهداف البحث: يساعد غسيل الكلى المناسب في الحفاظ على الوظيفة الطبيعية للكلى عن طريق إزالة السموم والنفايات الأخرى لدى المرضى الذين يعانون من مرض الكلى في المرحلة النهائية. تهدف هذه الدراسة إلى تحديد مدى انتشار ومؤشرات كفاية غسيل الكلى ونتائج المرضى الذين يعانون من مرض الكلى في المرحلة النهائية. طريقة البحث: كانت هذه دراسة تحليلية طولية قائمة على المستشفى تم إجراؤها في مركزين لغسيل الكلى في مدينة دودوما، تنزانيا في الفترة من فبراير إلى يوليو 2020. وتم قياس كفاية غسيل الكلى باستخدام مجموعة واحدة من (ك ت/ف) وصيغ معدل تخفيض اليوريا. تم استخدام تحليل الانحدار اللوجستي الثنائي تحت التحليل متعدد المتغيرات لتقييم تنبئ مستقل بكفاية غسيل الكلى. النتائج: تم تضمين ما مجموعه 100 مريض بمتوسط عمر 50.6 ± 15.0 سنة في التحليل. كان معدل انتشار كفاية غسيل الكلى لمعدل خفض اليوريا 72% ولـ (اس بي-ك ت/ف) 75%. إن وجود أقل من 12 شهرا منذ بدء غسيل الكلى، وإجراء أقل من 3 جلسات غسيل كلوي أسبوعيا، والإصابة بفقر الدم الشديد، كانت تنبئ بعدم تحقيق غسيل الكلى المناسب وفقا لمعادلة معدل خفض اليوريا. ارتبط إجراء أقل من 3 جلسات غسيل كلوي أسبوعيا بشكل كبير بعدم وجود غسيل كلوي كاف وفقا لصيغة (اس بي-ك ت/ف). كان معدل الوفيات 11.2%، وكانت أمراض القلب والأوعية الدموية ومتلازمة اليوريمي مسؤولة عن معظم الوفيات. الاستنتاجات: أظهرت هذه الدراسة نسبة عالية من كفاية غسيل الكلى بين المرضى الذين يعانون من مرض الكلى في المرحلة النهائية. إن إجراء أقل من 3 جلسات غسيل كلوي أسبوعيا، والبدء المتأخر لغسيل الكلى بعد تشخيص مرض الكلى في المرحلة النهائية، وفقر الدم الشديد، كانت تنبئ بالفشل في تحقيق غسيل الكلى المناسب بين المرضى. Abstract: Objectives: Adequate haemodialysis helps maintain normal renal function by removing toxins and other waste products in patients with end-stage kidney disease. This study was aimed at determining the prevalence and predictors of adequacy of haemodialysis and outcomes in patients with end-stage kidney disease. Methods: This longitudinal analytical hospital-based study was conducted at two dialysis centres in Dodoma city, Tanzania, between February and July of 2020. Adequacy of haemodialysis was measured with single-pool (sp) Kt/V and urea reduction rate (URR) formulae. Binary logistic regression and multivariable analysis were used to assess the independent predictors of adequacy of haemodialysis. Results: The analysis included 100 patients with a mean age of 50.6 ± 15.0 years. The prevalence of adequacy of haemodialysis according to URR and sp-Kt/V was 72 % and 75 %, respectively. Having

Pre-service teachers are required to join the teaching profession with reasonable knowledge and skills of the subject they teach. The training that they take in colleges should also enable them confront the reality at schools. Therefore, this study explored the relationship between the training expectations of pre-service English teachers of Amhara region of Ethiopia and the training that they received. Then data was gathered from the trainees of Kemissie teacher education college using questionnaire and interviews. The results indicate that some courses and/or contents were not expected by the teachers prior their entry to college and have less contribution to teach at primary schools. There is also weak correlation between the participants' expectations and the training they received. The training is also deficient of practical sessions. The relationship between these variables was also found statistically insignificant. Hence, more relevant courses should be added. Trainees should also be engaged in more peer-teaching and reflective practice sessions. Furthermore, language teacher training programs should consider trainees’ needs.

The rising competition for scarce land and water resources and the need to satisfy the global food demand from an ever-growing population necessitates novel methods to monitor irrigation scheme performance for improved water use efficiency. The traditional methods employed in sub-Saharan Africa to assess irrigation performance are point-based, expensive, and time-consuming, making monitoring and evaluation of these capital-intensive projects difficult. This study aimed at employing satellite data with high spatial and temporal resolution in assessing the performance of Doho Rice Irrigation Scheme through estimations of actual evapotranspiration. Actual evapotranspiration (ETa) was modelled from Landsat 7 imagery using the surface energy balance system algorithm on five clear days between January and April 2020. Using equity and adequacy metrics, the derived ETa was used to assess the irrigation performance of the scheme. Results showed that the equity indicator was generally fair, with the coefficient of variation between 0.11 and 0.08, close to the 0.10 threshold implying irrigation water is fairly distributed within the scheme. The average adequacy was 0.87, above the 0.65 threshold, indicating adequate water supply throughout the scheme. The study's findings can be used in future research and benchmarking with other irrigation schemes to address the country's water resource management challenges.

Resumen: La hemodiálisis domiciliaria (HDD) con monitores de bajo flujo de líquido de diálisis ha ganado popularidad en los últimos años gracias a su sencillez de diseño, portabilidad y capacidad de desplazamiento. No obstante, existen dudas respecto a la adecuación que este tipo de técnica ofrece, pues utiliza monitores con baño a flujos bajos y lactato. El objetivo de este estudio fue demostrar los beneficios clínicos de la HDD con el monitor NxStage System One® introducido recientemente en España.Presentamos los resultados de un estudio observacional, retrospectivo que incluyó de manera no seleccionada a los primeros pacientes con HDD corta mediante este monitor en 12 centros en España. Se analizó la evolución clínica de 86 pacientes a 0, 6 y 12 meses, incluyendo datos relacionados con la prescripción, evolución de parámetros analíticos de dosis de diálisis, anemia, metabolismo óseo-mineral, evolución de la diuresis residual, utilización de fármacos y datos relacionados con permanencia en la técnica, y causas de salida a lo largo del seguimiento. Pudimos demostrar que este monitor proporcionó una adecuada dosis de diálisis, con tasa óptima de ultrafiltración, con mejoría de los principales marcadores bioquímicos de adecuación en diálisis. El uso de esta técnica se asoció con una disminución de antihipertensivos, captores del fósforo y agentes eritropoyéticos, observándose, además, muy buenos resultados de supervivencia tanto del paciente como de la técnica. La sencillez de este monitor unida a sus buenos resultados clínicos debería facilitar el crecimiento y utilización de la HDD, tanto en pacientes incidentes como prevalentes. Abstract: Home hemodialysis (HHD) with low-flow dialysate devices has gained popularity in recent years due to its simple design, portability, and ability to provide greater freedom of movement for our patients. However, there are doubts about the adequacy that this technology offers, since it uses monitors with low-flow bath and lactate. The aim of this study was to demonstrate the clinical benefits of low-flow HHD with the NxStage System One® recently introduced in Spain. We present the results of an observational, retrospective cohort study that included the first patients who started short daily HHD with this device in 12 Spanish centers. We analyzed the evolution of 86 patients at 0, 6 and 12 months, including data related to prescription, and evolution of biochemical parameters related to dialysis dose, anemia, mineral-bone metabolism; evolution of residual renal function, medication usage, and causes of withdrawal during the followup. We were able to demonstrate that this NxStage System One® monitor, in patients with HHD, have provided an adequate dialysis dose, with optimal ultrafiltration rate, with improvement of main biochemical markers of dialysis adequacy. The usage of this technique was associated to a decrease of antihypertensive drugs, phosphate binders and erythropoietin agents, with very good results both patient and technique survival. The simplicity of the technique, together with its good clinical outcomes, should facilitate the growth and utilization of HHD, both in incident and prevalent patients.

Resumen: Introducción: La inflamación crónica y la subyacente comorbilidad cardiovascular aún son problemas vigentes en los pacientes en hemodiálisis crónica. Existen pocos estudios que comparen la «dosis de diálisis» (Kt/V) con el grado de inflamación del paciente. Nuestro objetivo principal fue determinar si existe una relación entre los niveles séricos de proteína C reactiva (PCR) y el Kt/V utilizando la dialisancia iónica. Métodos: Estudio transversal multicéntrico. Se incluyeron 536 pacientes prevalentes en hemodiálisis crónica. Se recogieron los niveles de PCR, el índice neutrófilo-linfocito y el índice plaqueta-linfocito. Se obtuvo el Kt por dialisancia iónica y el volumen de distribución de la urea mediante la fórmula de Watson. Se dividió la muestra en 2 grupos tomando como punto de corte la mediana de PCR y se comparó la adecuación de diálisis en cada uno. Finalmente, se realizó un modelo de regresión logística para determinar las variables de mayor influencia. Resultados: La mediana de PCR fue 4,10 mg/L (q25-q75: 1,67-10). El Kt/V medio fue de 1,48 ± 0,308. El Kt/V fue menor en los pacientes incluidos en el grupo de inflamación alta (p = 0,01). En la regresión logística multivariante, los niveles «altos» de PCR tuvieron una correlación directa con el Log índice neutrófilo-linfocito (p

Objectives: Hospital-acquired bloodstream infections (HA-BSI) in the intensive care unit (ICU) are common life-threatening events. We aimed to investigate the association between early adequate antibiotic therapy and 28-day mortality in ICU patients who survived at least 1 day after the onset of HA-BSI., Methods: We used individual data from a prospective, observational, multicentre, and intercontinental cohort study (Eurobact2). We included patients who were followed for ≥1 day and for whom time-to-appropriate treatment was available. We used an adjusted frailty Cox proportional-hazard model to assess the effect of time-to-treatment-adequacy on 28-day mortality. Infection- and patient-related variables identified as confounders by the Directed Acyclic Graph were used for adjustment. Adequate therapy within 24 hours was used for the primary analysis. Secondary analyses were performed for adequate therapy within 48 and 72 hours and for identified patient subgroups., Results: Among the 2418 patients included in 330 centres worldwide, 28-day mortality was 32.8% (n = 402/1226) in patients who were adequately treated within 24 hours after HA-BSI onset and 40% (n = 477/1192) in inadequately treated patients (p < 0.01). Adequacy within 24 hours was more common in young, immunosuppressed patients, and with HA-BSI due to Gram-negative pathogens. Antimicrobial adequacy was significantly associated with 28-day survival (adjusted Hazard Ratio (aHR), 0.83; 95% CI, 0.72-0.96; p 0.01). The estimated population attributable fraction of 28-day mortality of inadequate therapy was 9.15% (95% CI, 1.9-16.2%)., Discussion: In patients with HA-BSI admitted to the ICU, the population attributable fraction of 28-day mortality of inadequate therapy within 24 hours was 9.15%. This estimate should be used when hypothesizing the possible benefit of any intervention aiming at reducing the time-to-appropriate antimicrobial therapy in HA-BSI., (Copyright © 2024 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)

Introduction: Previous studies suggest that the adequacy rate of thyroid aspirates can be improved by altering the adequacy criteria of the Bethesda System. We sought to measure the performance of these altered criteria in a prospective fashion., Materials and Methods: Over a 6-year period, cases with 1 to 59 follicular cells were prospectively classified as "nondiagnostic, favor benign" or "scant but adequate". "Scant but adequate" cases were classified as either benign (Bethesda category 2) or atypia of undetermined significance (AUS) (Bethesda category 3). Bethesda category 3 cases were referred for Afirma testing (Veracyte, San Francisco, CA)., Results: Of 5147 cases, 131 (3%) were classified as "nondiagnostic, favor benign"; 45 (65%) of these had follow-up with a risk of malignancy of 2.6%. Additionally, 436 (8%) of all 5147 cases were classified as "scant but adequate" and "benign"; 49 (11%) of these had follow-up with a risk of malignancy of 0%. Lastly, 197 (4%) of all 5147 cases were classified as "scant but adequate" with AUS; 177 (90%) of these 197 cases had an adequate Afirma result. The "suspicious" rate was not significantly different than that of cases classified as "adequate" and AUS (Bethesda category 3 and 4) (35 of 197 [18%] versus 140 of 848 [17%] P = 0.67), and there was no significant difference in the risk of malignancy for these 2 categories ("scant but adequate" 9 of 18, "adequate" 50% versus 27 of 85, 32%, P = 0.10). Overall, the modified Bethesda criteria reduced the nondiagnostic rate from 22% to 10% (P <0.001) without lowering the sensitivity of the test., Conclusions: Modified Bethesda adequacy criteria can significantly lower nondiagnostic rates without lowering sensitivity., (Copyright © 2024 American Society of Cytopathology. Published by Elsevier Inc. All rights reserved.)

This is a comparative study on the adequacy of cervical smears obtained using the Papcone® sampling device or wooden Ayre’s spatula conducted from two tertiary health facilities –– Nnamdi Azikiwe University Teaching Hospital Nnewi and Chukwuemeka Odumegwu Ojukwu University Teaching Hospital Awka, in Anambra State, Nigeria. Slides from smears obtained using both devices were read by a cytopathologist blinded for the study. The primary outcome was the proportion of smears with an adequate endocervical component. Significantly higher adequate cervical smears were obtained in 177/192 (92.2%) women using the Papcone® sampling device, compared to 152/192 (79.2%) using wooden Ayre’s spatula (p

Resumen: Objetivo: Evaluar la adecuación de las peticiones de vitamina D (VD). Analizar la relación entre niveles séricos y presencia de factores de riesgo de déficit de VD. Emplazamiento: Servicio de atención primaria que atiende a 441.198 personas mayores de 14 años. Participantes: Personas mayores de 14 años con una determinación de VD en 2016. Diseño: Estudio observacional descriptivo retrospectivo. Mediciones principales: Edad, género, fecha de petición. Factores de riesgo: institucionalización, paciente en atención domiciliaria (ATDOM), obesidad, enfermedad renal crónica (ERC), hepatopatía crónica, malabsorción (MA), tratamiento con antiepilépticos o corticoides. Otras variables: osteoporosis, tratamiento con antiosteoporóticos, niveles de VD.Se consideraron adecuadas las peticiones en pacientes con algún factor de riesgo. Déficit VD

Introduction: Nutrition plays an essential role in the recovery of critical illness. In the post-Intensive Care Unit (ICU) period, patients typically return to oral nutrition gradually. However, studies quantifying nutritional intake in the post-ICU hospitalization period are scarce and formal guidelines are lacking. This study aims to describe energy and protein intake in detail over the entire post-ICU hospitalization period and explore associations between protein intake and clinical outcomes., Methods: A prospective observational single-center cohort study was conducted amongst post-ICU patients in general wards after a minimum ICU-stay of 72 h and who received (par)enteral feeding for ≥24 h in the ICU. Oral intake was assessed daily using food order lines and digital photography of meal leftovers. Other data, including amounts of (par)enteral nutrition, were collected from electronic medical records. The primary outcome was to identify energy and protein intake, and reached targets, in the post-ICU period. In addition, length of hospital stay after ICU discharge, readmission and mortality rates were compared between patients meeting protein targets or not., Results: In total, 48 patients were included. Complete nutritional data of 34 patients were analyzed in the current study, adding up to a total number of 484 observational days, 1681 photos and 6634 food order lines. Inter-rater agreement was excellent (ICC 0.878). Overall mean energy and protein adequacy for all nutritional groups was 82.3% (SD 18.3) and 83.1% (SD 19.8). Only 51.2% of the study participants (n = 21) reached overall >90% of prescribed protein targets during their entire post-ICU ward stay. The lowest intake was seen in the patient group with exclusively oral intake (median protein adequacy 75.5%), whereas patients with (supplemental) enteral nutrition (EN) all met >90% of their protein targets. Prescribed targets were below recommendations, and prescribed calories and proteins were neither ordered nor consumed. Discontinuation of EN resulted in immediate marked drops in energy (44.1%) and protein intake (50.7%). Subsequently, patients needed up to six days to reach protein targets again. No differences in clinical outcomes were observed., Conclusion: Most patients did not meet energy and protein targets in the post-ICU hospitalization period. Nutrition performance was highly dependent on the route of nutrition and was lowest among patients with oral intake only (despite of food fortification strategies and/or oral nutritional supplements). The best intake was observed in patients receiving (supplemental) EN. However, cessation of EN posed an immediate nutritional risk. No differences in clinical outcomes were found in this study. Our findings stress the need for follow-up studies to close the gap with individualized nutritional support in the post-ICU period to reach protein and energy targets., Competing Interests: Conflict of interest Prof. Dr A.R.H. van Zanten reported receiving honoraria for advisory board meetings, lectures, research, and travel expenses from Baxter, Braun, Cardinal Health, Danone-Nutricia, Dim-3, Fresenius Kabi, Mermaid, Lyric, and Nestle-Novartis. The other authors have nothing to declare., (Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Introduction: Rapid on-site evaluation (ROSE) performed during endobronchial ultrasound-guided fine needle aspiration (EBUS-FNA) has shown significant value. However, ROSE may not be available for some pulmonary centers. Performing ROSE can be challenging and stressful due to time constrains for preparing, staining and reviewing the cytology slides between passes., Materials and Methods: A retrospective cytology report review of EBUS-FNA procedures performed between October 2014 and May 2019 revealed 516 cases that were included in the study. The number of passes for each procedure was documented. The adequacy rates were assessed at 4 different study points; ≤3 passes, ≤5 passes, at odd passes only, and the even passes only. The study groups results were compared to the overall ROSE and the final cytology adequacy., Results: The overall ROSE interpretation was adequate in 370 (71.7%) and inadequate in 146 (28.3%). After reviewing the Papanicolaou stained slides and cell blocks, the final cytology results were adequate in 473 (91.7%) and inadequate in 43 (8.3%) of the cases. The number of passes per procedure ranged from 1 to 17. Our results showed that ROSE evaluation of the first 5 passes during the EBUS-FNA procedure could achieve the similar adequacy rate compared to the overall ROSE evaluation of all the passes., Conclusions: To achieve the most benefits of ROSE and to reduce the procedure time for EBUS-FNA, we recommend performing ROSE for ≤5 passes depending on the adequacy, and save all additional passes for cell blocks preparation if more than 5 passes are attempted., (Copyright © 2022 American Society of Cytopathology. Published by Elsevier Inc. All rights reserved.)

Twice-weekly hemodialysis, as part of incremental initiation, has reported benefits including preservation of residual kidney function (RKF). To explore this, we initiated a randomized controlled feasibility trial examining 55 incident hemodialysis patients with urea clearance of 3 ml/min/1.73 m 2 or more across four centers in the United Kingdom randomized to standard or incremental schedules for 12 months. Incremental hemodialysis involved twice-weekly sessions, upwardly adjusting hemodialysis dose as RKF was lost, maintaining total (Dialysis+Renal) Std Kt/V above 2. Standard hemodialysis was thrice weekly for 3.5-4 hours, minimum Dialysis Std Kt/V of 2. Primary outcomes were feasibility parameters and effect size of group differences in rate of loss of RKF at six months. Health care cost impact and patient-reported outcomes were explored. Around one-third of patients met eligibility criteria. Half agreed to randomization; 26 received standard hemodialysis and 29 incremental. At 12 months, 21 incremental patients remained in the study vs 12 in the standard arm with no group differences in the urea clearance slope. Ninety-two percent of incremental and 75% of standard arm patients had a urea clearance of 2 ml/min/1.73 m 2 or more at six months. Serious adverse events were less frequent in incremental patients (Incidence Rate Ratio 0.47, confidence interval 0.27-0.81). Serum bicarbonate was significantly lower in incremental patients indicating supplementation may be required. There were three deaths in each arm. Blood pressure, extracellular fluid and patient-reported outcomes were similar. There was no signal of benefit of incremental hemodialysis in terms of protection of RKF or Quality of Life score. Median incremental hemodialysis costs were significantly lower compared to standard hemodialysis. Thus, incremental hemodialysis appears safe and cost-saving in incident patients with adequate RKF, justifying a definitive trial., (Copyright © 2021 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.)

Background: Fine-needle aspiration (FNA) and core biopsy (CB) are used to diagnose liver lesions. Rapid onsite evaluation (ROSE) can improve the adequacy of the procedures and help triage diagnostic material appropriately. There are very few studies evaluating the role of ROSE for CB and FNA of mass lesions of the liver., Methods: Liver cases with ROSE material from 2007 to 2017 were retrieved and reviewed. The ROSE material was re-evaluated by 2 cytopathologists who were blinded to the final diagnosis. Data including age, number of lesions, number of passes, adequacy assessed at time of procedure, and diagnosis made by cytopathologist on ROSE material at time of re-review was compiled., Results: A total of 82 cases were identified; 33 were primary lesions (group A) and 49 were metastatic lesions (group B). ROSE done by cytotechnologist at time of procedure showed an adequacy rate of 84%. During re-review of ROSE material by cytopathologists, the overall adequacy rates were similar, although the adequacy rates in group B increased (to 100% from 92%) and it dropped in group A (from 73% to 52%). The overall accuracy rate was 90%. Hepatocellular adenoma, regenerative nodules, well-differentiated hepatocellular carcinoma, and angiosarcoma were not possible to diagnose on smears alone during ROSE., Conclusions: ROSE for liver lesions is useful for assessing adequacy. Certain lesions cannot be accurately diagnosed on ROSE alone. ROSE material when assessed by cytopathologist can improve adequacy rate and possibly decrease number of nondiagnostic specimens in group A, though the cost effectiveness needs to be assessed., (Copyright © 2018 American Society of Cytopathology. Published by Elsevier Inc. All rights reserved.)

Introduction: Incorporating urine volume into adequacy assessment was recommended by The Paris System for Reporting Urinary Cytology. The concept was relatively new, however, and supportive studies were sparse. We accordingly aimed to determine the role of urine volume in adequacy assessment and cutoff values for urine samples using ThinPrep (Hologic, Inc, MA) processing., Material and Methods: Archived consecutive urine cytology cases (n = 2117) were analyzed. Patient age, sex, collection method, urine volume and fixative (CytoLyt, Hologic, Inc) added, adequacy and diagnoses were documented. Adequate samples were defined as samples with >50 well-preserved, well-visualized urothelial cells. Diagnoses of suspicious and positive for high-grade urothelial carcinoma were combined for analysis. Statistical analysis was performed using IBM SPSS Statistics for Windows., Results: There was a correlation between urine volume and the unsatisfactory/less than optimal cellularity versus satisfactory samples (P ≤ 0.001) in voided urine specimens. A minimum of 10 mL of fresh voided urine was found to be a reasonable cutoff to achieve sufficient cellularity. Cutoff values of 30 mL for voided urine for the high-risk diagnosis were associated with the highest χ 2 statistic, although this was not statistically significant., Conclusions: Urine volume was justified as an adequacy criterion in voided urine. Although 10 mL of fresh voided urine might achieve sufficient cellularity, higher volume (≥30 mL) is recommended in order to maximize the chance of detecting a high-risk diagnosis. Nevertheless, the presence of high-grade urothelial carcinoma can still be detected in low-volume (<20 mL) specimens. Hence, correlation of clinical information with voided urine volume cutoff values for individual cases might also be beneficial., (Copyright © 2018 American Society of Cytopathology. Published by Elsevier Inc. All rights reserved.)

Introduction: The Paris System for Reporting Urinary Cytology (TPS) currently includes a volume recommendation for voided urine specimens of 30 mL based on observations of performance with BD SurePath preparation system. Given that many labs use the Hologic ThinPrep methods for voided urines, an analysis of data acquired with this system is undertaken in this study., Materials and Methods: We identified a total of 744 voided urine specimens. All specimens were processed fresh by ThinPrep at a large academic center that had incorporated a tiered urine cytology reporting template prior to TPS. To determine the optimum binary cutoff thresholds for voided urine volume, the fraction of high-risk cytologic diagnoses-suspicious for high-grade urothelial carcinoma (SHGUC) or worse-was compared below and above various volumes cutpoints., Results: The cytology diagnosis was inadequate in 1.5%, negative for high-grade urothelial carcinoma in 64%, atypical urothelial cells in 14.2% SHGUC in 6.6%, high-grade urothelial carcinoma (HGUC) in 11.3%, low-grade urothelial neoplasm in 1.9%, and other malignancies in 0.5%. High-risk cytology was diagnosed in 19.1% of specimens ≥25 mL and in 13.5% of specimens <25 mL (P = 0.090). Volume of ≥25 mL was associated with the optimum cutoff for diagnosing SHGUC or HGUC., Conclusions: A specimen volume of ≥25 mL is associated with higher rates of diagnosis of HGUC or SHGUC in voided urine specimens processed by ThinPrep. This is similar to the 30 mL cutoff determined for SurePath preparation that was incorporated into TPS and may provide helpful information for ThinPrep labs that are in the process of adopting TPS., (Copyright © 2017 American Society of Cytopathology. Published by Elsevier Inc. All rights reserved.)

Achieving an adequate dialysis dose is one of the key goals for dialysis treatments. Here we assessed whether patients receiving the current cleared plasma volume (Kt), individualized for body surface area per recommendations, had improved survival and reduced hospitalizations at 2 years of follow-up. Additionally, we assessed whether patients receiving a greater dose gained more benefit. This prospective, observational, multicenter study included 6129 patients in 65 Fresenius Medical Care Spanish facilities. Patients were classified monthly into 1 of 10 risk groups based on the difference between achieved and target Kt. Patient groups with a more negative relationship were significantly older with a higher percentage of diabetes mellitus and catheter access. Treatment dialysis time, effective blood flow, and percentage of on-line hemodiafiltration were significantly higher in groups with a higher dose. The mortality risk profile showed a progressive increase when achieved minus target Kt became more negative but was significantly lower in the group with 1 to 3 L clearance above target Kt and in groups with greater increases above target Kt. Additionally, hospitalization risk appeared significantly reduced in groups receiving 9 L or more above the minimum target. Thus, prescribing an additional 3 L or more above the minimum Kt dose could potentially reduce mortality risk, and 9 L or more reduce hospitalization risk. As such, future prospective studies are required to confirm these dose effect findings., (Copyright © 2016 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.)

Introduction: Early molecular characterization with Kirsten rat sarcoma factor, epidermal growth factor, and anaplastic lymphoma kinase are critical to manage pulmonary adenocarcinoma. Fine-needle aspiration (FNA) of lesions <2 cm are routine in our institution and are used in molecular analysis. We report our experience., Materials and Methods: We searched our databank for primary pulmonary adenocarcinomas diagnosed by FNA between January 2009 and April 2013. Size of the lesion aspirated, molecular results, and sample source (FNA versus surgical specimen) were recorded. We compared the frequency of mutations identified by FNA versus surgical specimens and the frequency of mutations in lesions by size (<1 cm, 1-2 cm, >2 cm)., Results: We identified 397 primary pulmonary adenocarcinomas. Molecular studies were requested by the clinician in 89 (22%) of primary adenocarcinomas. FNAs were used in 55 cases; 51 (93%) yielded sufficient material for molecular studies; surgical tissue were used in 34 cases; 33 (97%) yielded sufficient material for molecular studies. The insufficient specimens came from 2 FNAs of 0.6 cm nodules, an FNA of a 2 cm nodule, and a core biopsy., Conclusions: FNA was adequate for molecular analysis of small nodules. In nodules greater than 0.6 cm, the adequacy is comparable to surgical tissue. There was no statistically significant change in mutation rate by size (53%-58%). Importantly, FNA of small lesions for cytological diagnosis and molecular analysis is encouraged by our data and experience in order to provide early treatment., (Copyright © 2016 American Society of Cytopathology. Published by Elsevier Inc. All rights reserved.)

Background: The Canadian Health Measures Survey (CHMS) is an ongoing cross-sectional national survey that includes a measure of 25-hydroxyvitamin D [25(OH)D] by immunoassay. For cycles 1 and 2, the collection period occurred approximately every 2 y, with a new sample of ∼5600 individuals., Objective: The goal was to standardize the original 25(OH)D CHMS values in cycles 1 and 2 to the internationally recognized reference measurement procedures (RMPs) developed by the US National Institute for Standards and Technology (NIST) and Ghent University, Belgium., Design: Standardization was accomplished by using a 2-step procedure. First, serum samples corresponding to the original plasma samples were remeasured by using the currently available immunoassay method. Second, 50 serum samples with known 25(OH)D values assigned by the NIST and Ghent reference method laboratories were measured by using the currently available immunoassay method. The mathematical models for each step-i.e., 1) YCurrent = XOriginal and 2) YNIST-Ghent = XCurrent -were estimated by using Deming regression, and the 2 models were solved to obtain a single equation for converting the "original" values to NIST-Ghent RMP values., Results: After standardization (cycles 1 and 2 combined), the percentage of Canadians with 25(OH)D values <40 nmol/L increased from 16.4% (original) to 19.4% (standardized), and values <50 nmol/L increased from 29.0% (original) to 36.8% (standardized). The 25(OH)D standardized distributions (cycles 1 and 2 analyzed separately) were similar across age and sex groups; slightly higher values were associated with cycle 2 in the young and old. This finding contrasts with the original data, which indicated that cycle 2 values were lower for all age groups., Conclusion: The shifts in 25(OH)D distribution brought about by standardization indicate its importance in drawing correct conclusions about potential population deficiencies and insufficiencies and in permitting the comparison of distributions between national surveys., (© 2015 American Society for Nutrition.)

Background: The impact of protein intake on outcomes in pediatric critical illness is unclear., Objective: We examined the association between protein intake and 60-d mortality in mechanically ventilated children., Design: In a prospective, multicenter, cohort study that included 59 pediatric intensive care units (PICUs) from 15 countries, we enrolled consecutive children (age: 1 mo to 18 y) who were mechanically ventilated for ≥48 h. We recorded the daily and cumulative mean adequacies of energy and protein delivery as a percentage of the prescribed daily goal during the PICU stay ≤10 d. We examined the association of the adequacy of protein delivery with 60-d mortality and determined variables that predicted protein intake adequacy., Results: We enrolled 1245 subjects (44% female) with a median age of 1.7 y (IQR: 0.4, 7.0 y). A total of 985 subjects received enteral nutrition, 354 (36%) of whom received enteral nutrition via the postpyloric route. Mean ± SD prescribed energy and protein goals were 69 ± 28 kcal/kg per day and 1.9 ± 0.7 g/kg per day, respectively. The mean delivery of enteral energy and protein was 36 ± 35% and 37 ± 38%, respectively, of the prescribed goal. The adequacy of enteral protein intake was significantly associated with 60-d mortality (P < 0.001) after adjustment for disease severity, site, PICU days, and energy intake. In relation to mean enteral protein intake <20%, intake ≥60% of the prescribed goal was associated with an OR of 0.14 (95% CI: 0.04, 0.52; P = 0.003) for 60-d mortality. Early initiation, postpyloric route, shorter interruptions, larger PICU size, and a dedicated dietitian in the PICU were associated with higher enteral protein delivery., Conclusions: Delivery of >60% of the prescribed protein intake is associated with lower odds of mortality in mechanically ventilated children. Optimal prescription and modifiable practices at the bedside might enhance enteral protein delivery in the PICU with a potential for improved outcomes. This trial was registered at clinicaltrials.gov as NCT02354521., (© 2015 American Society for Nutrition.)

Background: Despite well established clinical guidelines, performance of long-term oxygen therapy (LTOT) programs shows marked variability among territories. The current study assessed the LTOT program and the health status of patients on LTOT prior to the deployment of community-based integrated care in an urban health district of Barcelona (Spain)., Aims: To assess: i) the LTOT program and health status of the patients on LTOT in the health district; ii) their frailty profile; and, iii) the requirements for effective deployment of integrated care services for these patients., Methods: Cross-sectional observational study design including all patients (n = 406) on LTOT living in the health district. Health status, frailty, arterial blood gases, forced spirometry and hand-grip muscle strength were measured. Network analysis of frailty was carried out., Results: Adequacy of LTOT prescription (n = 362): 47% and 31% of the patients had PaO2 ≤ 60 mmHg and ≤55 mmHg, respectively. Adherence to LTOT: 31% of all patients used LTOT ≥15 h/d; this figure increased to 67% in those with PaO2≤60 mmHg. Assessment of frailty: Overall, LTOT patients presented moderate to severe frailty. Care complexity was observed in 42% of the patients., Conclusions: Adequacy and adherence to LTOT was poor and many patients were frail and complex. The outcomes of the network analysis may contribute to enhance assessment of frailty in LTOT patients. These observations suggest that an integrated care strategy has the potential to improve the health outcomes of these patients., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Introduction: Adequacy criteria are well established in some areas of cytopathology to prevent false negative diagnoses. To date, no such criteria have been proposed and validated for urinary tract specimens. Our aim was to determine a cellularity cutoff point that significantly affects the sensitivity of detecting high-grade or in situ urothelial carcinoma (HGUC or UCIS) in bladder barbotage/washing specimens., Materials and Methods: Bladder barbotage specimens collected in liquid-based media were selected. Specimens diagnosed as "positive for HGUC" (with histologic confirmation) composed the study group, with negative cases as control specimens. Samples were serially diluted and ThinPrep slides of decreasing cellularity were made and reviewed for diagnosis and cellularity. In a retrospective validation study, we identified cases with a "negative for malignancy" bladder barbotage/washing and a surgical pathology diagnosis of UCIS or HGUC (ie, false negative cytology). Cellularity was assessed., Results: A distinct difference in sensitivity was noted at a cutoff point of 2644 (20 per 10 high-power fields) urothelial cells. Sensitivities increased for atypical or higher (68.3% versus 100%) and HGUC (43.3% versus 88.0%) after application of this cutoff point with high statistical significance (P = 0.001 and 0.0001, respectively). For the retrospective review, cases below the cutoff point were reclassified as unsatisfactory, and sensitivity rose from 76.3% to 84.8% (P = 0.0027)., Conclusions: Our results indicate that, in the absence of atypical or malignant cells, an adequate bladder barbotage specimen should have a minimum of 2644 (20 per 10 high-power fields) well-visualized, well-preserved urothelial cells to increase the positive predictive value of this test., (Copyright © 2015 American Society of Cytopathology. Published by Elsevier Inc. All rights reserved.)

Aims: Prognosis of esophageal cancer (EC) is poor. Population-based studies regarding EC survival and adequacy of cancer surgery (ACS) from developing countries are lacking. We aimed to evaluate EC patients' survival and ACS in a population-based setting for the first time from Iran., Methods: We randomly selected 409 cases from all 3048 newly diagnosed EC patients who were registered in the nationwide cancer registry in calendar year 2005-2006 and followed them until 2009. An expert panel in Cancer Institute of Iran reviewed adequacy of esophageal cancer surgery on a national basis., Results: Overall three-year survival rate was 17%. The median (95% CI) survival time of all patients and cases who underwent surgery alone were 8.5 (6.9-10.1) and 6.0 (3.1-8.9) months, respectively. The hospital mortality was 27.8% among the operated patients. Only 6.8% of cases had documented free circumferential resection margin and merely 4.0% of patients experienced resection of more than 15 lymph nodes during surgery., Conclusions: In Iran, the overall survival of EC patients with different treatment modalities are slightly less than those reported from high-income countries, but cases with surgery alone as the main treatment had worse outcome compared with their counterparts in developed countries. Surgery with curative intent has not been performed in most cases in Iran. It seems current clinical outcome of EC patients could be improved with surgical quality improvement and/or more use of chemoradiation in Iran., (Copyright © 2013 Elsevier Ltd. All rights reserved.)