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BackgroundNumerous free and low-cost mobile apps for the care management of kidney disease have become available in recent years. Although these appear to be promising tools, they have not been evaluated comparatively based on standard mobile app metrics, and thus, limited evidence is available regarding their efficacy. This study systematically cataloged and assessed mobile apps designed to assist medication compliance and nutrition tracking that are useful to the chronic kidney disease (CKD) and the end-stage renal disease (ESRD) patients who are on dialysis. ObjectiveThe objective of this study was to comprehensively evaluate mobile apps used for medication compliance and nutrition tracking for possible use by CKD and ESRD patients. MethodsA systematic review framework was applied to the search, screening, and assessment of apps identified and downloaded from the iOS and Android app stores. We selected apps using 13 relevant search terms, narrowed down based on a set of inclusion and exclusion criteria, and then used the Mobile App Rating Scale (MARS), a widely adopted app evaluation tool to assess the effectiveness of apps. The internal consistency and interrater reliability were tested using Cronbach alpha and interclass correlation coefficients (ICCs), respectively. ResultsThe MARS total score had excellent internal consistency (Cronbach alpha=.90) and a moderate level of interrater reliability (2-way mixed ICC 0.65). Overall, 11 out of the 12 reviewed apps met the minimum acceptable score of 3.0 in MARS rating. The 3 apps with the highest combined scores were My Kidneys, My Health Handbook (MARS=4.68); My Food Coach (MARS=4.48); and National Kidney Foundation Malaysia (MARS=4.20). The study identified 2 general weaknesses in the existing apps: the apps fell short of accommodating advanced interactive features such as providing motivational feedback and promoting family member and caregiver participations in the app utilization. ConclusionsThe MARS rating system performed well in the app evaluation. The 3 highest ranked apps scored consistently high across the 5 dimensions specified in MARS. These apps were developed in collaboration with reputable organizations and field experts, demonstrating the importance of expert guidance in developing medical apps.

Introduction: Atrial fibrillation (AF) in end-stage kidney disease (ESKD) and kidney transplant (KTx) recipients presents challenges in stroke risk management. This study aimed to compare hospitalization rates for ischemic and hemorrhagic cerebrovascular events in ESKD and KTx patients with and without AF. Methods: Using the National Inpatient Sample (2005–2019), retrospective analysis was conducted on hospitalizations for ESKD and KTx patients with and without AF. Baseline characteristics and hospitalization rates for five cerebral ischemic conditions and one hemorrhagic condition were compared. Descriptive statistics and t-tests were employed for analysis. Results: Among ESKD patients, those with AF exhibited significantly higher hospitalization rates for ischemic stroke, including 1)Cerebral infarction due to thrombosis, embolism, occlusion (0.11% vs. 0.08%,p<0.001), 2)Cerebral infarction due to thrombosis, embolism, and unspecified occlusion (1.93% vs. 1.51%, p<0.001), 3)Artery occlusion resulting in cerebral ischemia (1.37% vs. 0.93%,p<0.001), 4)Cerebral artery occlusion resulting in cerebral ischemia (0.48% vs. 0.42%,p<0.001), while experiencing lower rates of intraoperative and postprocedural cerebrovascular infarction (0.88% vs. 0.97%,p<0.001) compared to those without AF. Conversely, KTx patients with AF showed increased hospitalizations for hemorrhagic stroke, particularly nontraumatic intracranial hemorrhage (0.79% vs. 0.56%,p<0.001), compared to those without AF. However, they did not exhibit significant differences in hospitalization rates for most ischemic conditions, except for cerebral infarction due to thrombosis, embolism, and unspecific occlusion (1.62% vs. 1.11%,p<0.001) and artery occlusion resulting in cerebral ischemia (0.84% vs. 0.52%,p<0.001). Conclusion: Our findings reveal patterns in hospitalization rates between ESKD and KTx patients with AF compared to those without AF, with ESKD patients with AF exhibiting higher rates of ischemic stroke compared to ESKD patients without AF and KTx patients with AF showing increased hospitalizations for hemorrhagic stroke compared to those without AF. These findings demonstrate the impact of AF on hospitalization rates for ischemic and hemorrhagic cerebrovascular events in both ESKD and KTx patients. [ABSTRACT FROM AUTHOR]

This article applies Social Network Analysis (SNA) to illuminate the task forces created by US-based activists undertaking public relations on behalf of migrant caravan participants that travel from Honduras through Mexico toward the US. Four functional roles – influencers, messengers, support groups, and founding members – are identified and described in detail. When taking into account the characteristics of the individuals involved, these roles facilitate "bridge-actions": the mobilization of support across distinct political structures such as Native American tribal governments, international human rights venues, and US political parties. The result is a flexible public relations venture that has ability to influence diverse audiences – and extend beyond this particular mobilization effort. This has been most useful in the current American debate concerning restrictive US immigration policies and border security measures. [ABSTRACT FROM AUTHOR]

Introduction: Transplantation is a field with unique medical and administrative challenges that involve an equally diverse array of stakeholders. Expectantly, the litigation stemming from this field should be similarly nuanced. There is a paucity of comprehensive reviews characterizing this medicolegal landscape. Design: The Caselaw Access Project Database was used to collect official court briefs of 2053 lawsuits related to kidney, liver, heart, lung, and pancreas transplantation. A thematic analysis was undertaken to characterize grounds for litigation, defendant type, and outcomes. Cases were grouped into policy, discrimination, poor or unsuccessful outcome, or other categories. Results: One hundred sixty-four court cases were included for analysis. Cases involving disputes over policy coverage were the most common across all organ types (N = 55, 33.5%). This was followed by poor outcomes (N = 51, 31.1%), allegations of discrimination against prison systems and employers (N = 37, 22.6%) and other (N = 21, 12.8%). Defendants involved in discrimination trials won with the greatest frequency (N = 29, 90.62%). Defendants implicated in policy suits won 65.3% (N = 32), poor outcomes 62.2% (N = 28), and other 70% (N = 14). Of the 51 cases involving poor outcomes, plaintiffs indicated lack of informed consent in 23 (45.1%). Conclusion: Reconsidering the informed consent process may be a viable means of mitigating future legal action. Most discrimination suits favoring defendants suggested previous concerns of structural injustices in transplantation may not be founded. The prevalence of policy-related cases could be an indication of financial burden on patients. Future work and advocacy will need to substantiate these concerns and address change where legal recourse falls short. [ABSTRACT FROM AUTHOR]

Background: We hypothesized that alemtuzumab use is safe in pediatric kidney transplant recipients (KTRs) with equivalent long‐term outcomes compared to other induction agents. Methods: Using pediatric kidney transplant recipient data in the UNOS database between January 1, 2000, and June 30, 2022, multivariate logistic regression, multivariable Cox regression, and survival analyses were utilized to estimate the likelihoods of 1st‐year and all‐time hospitalizations, acute rejection, CMV infection, delayed graft function (DGF), graft loss, and patient mortality among recipients of three common induction regimens (ATG, alemtuzumab, and basiliximab). Results: There were no differences in acute rejection or graft failure among induction or maintenance regimens. Basiliximab was associated with lower odds of DGF in deceased donor recipients (OR 0.77 [0.60–0.99], p =.04). Mortality was increased in patients treated with steroid‐containing maintenance (HR 1.3 [1.005–1.7] p =.045). Alemtuzumab induction correlated with less risk of CMV infection than ATG (OR 0.76 [0.59–0.99], p =.039). Steroid‐containing maintenance conferred lower rate of PTLD compared to steroid‐free maintenance (HR 0.59 [0.4–0.8] p =.001). Alemtuzumab was associated with less risk of hospitalization within 1 year (OR 0.79 [0.67–0.95] p =.012) and 5 years (HR 0.54 [0.46–0.65] p <.001) of transplantation. Steroid maintenance also decreased 5 years hospitalization risk (HR 0.78 [0.69–0.89] p <.001). Conclusions: Pediatric KTRs may be safely treated with alemtuzumab induction without increased risk of acute rejection, DGF, graft loss, or patient mortality. The decreased risk of CMV infections and lower hospitalization rates compared to other agents make alemtuzumab an attractive choice for induction in pediatric KTRs, especially in those who cannot tolerate ATG. [ABSTRACT FROM AUTHOR]

Unintentional injury death (UID) is a leading cause of mortality worldwide, and individuals with chronic diseases are at higher risk. Though organ transplant can improve the lives of those with chronic disease, these individuals remain in suboptimal physical and mental health after surgery that predisposes them to UID. To quantify the scale of UID among solid organ transplant recipients, we performed a retrospective analysis using United Network of Organ Sharing data from adults who underwent kidney, liver or pancreas transplant between 2000-2021. Our study aimed to identify risk factors for UID in this cohort by comparing basic patient, donor, and transplant characteristics of the groups (UID or all other cause death). The largest proportion of UID was seen in the kidney group (.8%), followed by liver (.7%) and then pancreas (.3%). Male sex was the most significant risk factor among kidney and liver recipients. Whites had a higher risk for UID relative to their non-White counterparts in the kidney and liver groups. In both groups, advancing age conferred a protective effect, whereas higher functional status was a risk factor. Our findings shed new light on a significant source of mortality within the transplant population. [ABSTRACT FROM AUTHOR]

This study aimed to investigate both chronic health conditions and the utilization of patient portals, focusing particularly on caregivers responsible for individuals with Alzheimer's disease and related dementias (ADRD). Data from the Health Information National Trends Survey 2018–2020 were analyzed, involving a sample of 304 family and unpaid caregivers of individuals with ADRD. Among caregivers of individuals with ADRD, 77.6% had at least one chronic disease. A significant proportion (46.6%) of ADRD caregivers had never accessed their patient portals. The limited utilization of patient portals among caregivers responsible for individuals with ADRD, particularly those with lower education, advanced age, and few chronic conditions, becomes apparent due to challenges associated with digital literacy and discomfort with computers. Recognizing the crucial role caregivers play for individuals with ADRD and their health risks, there's a need for tailored training to enhance their health management skills and caregiving capabilities. [ABSTRACT FROM AUTHOR]

Introduction: IgA nephropathy (IgAN) can cause end‐stage kidney disease (ESKD). This study assesses the impact of induction and maintenance immunosuppression on IgAN recurrence, graft survival, and mortality in living and deceased donor kidney transplants (LDKT and DDKT). Methods: Retrospective analysis of the UNOS database in adults with ESKD secondary to IgAN who received kidney transplants between January 2000 and June 30, 2022. Patients with thymoglobulin (ATG), alemtuzumab, or basiliximab/daclizumab induction with calcineurin inhibitor (CNI) and mycophenolate mofetil (MMF) with or without prednisone maintenance were analyzed. Multivariate logistic regression was performed to identify factors correlated with IgA recurrence. Multivariable Cox regression analyses were performed for clinically suspected risk factors. Kaplan Meir Analysis was utilized for overall graft survival. Results: Compared to ATG with steroid maintenance, alemtuzumab with steroid increased the odds of IgAN recurrence in DDKTs (OR 1.90, p <.010, 95% CI [1.169–3.101]). Alemtuzumab with and without steroid increased the odds of recurrence by 52% (p =.036) and 56% (p =.005), respectively, in LDKTs. ATG without steroids was associated with less risk of IgAN recurrence (HR.665, p =.044, 95% CI [.447–.989]), graft failure (HR.758, p =.002, 95% CI [.633–.907]), and death (HR.619, p <.001, 95% CI [.490–.783]) in DDKTs. Recurrence was strongly associated with risks of graft failure in DDKTs and LDKTs and death in LDKTs. Conclusion: In patients with IgAN requiring a kidney transplant, Alemtuzumab induction correlates with increased IgAN recurrence. Relapse significantly affects graft survival and mortality. ATG without steroids is associated with the least graft loss and mortality. [ABSTRACT FROM AUTHOR]