First name
Brittney
Last name
Henderson

Title

Primary ablation versus urinary diversion in posterior urethral valve: Systematic review and meta-analysis.

Year of Publication

2023

Number of Pages

Date Published

02/2023

ISSN Number

1873-4898

Abstract

PURPOSE: To determine differences in long-term kidney and bladder outcomes in boys with posterior urethral valves (PUV) managed by a primary valve ablation or primary urinary diversion.

MATERIALS AND METHODS: A systematic search was performed in March 2021. Comparative studies were evaluated according to Cochrane collaboration recommendations. Assessed measures included kidney outcomes (chronic kidney disease, end-stage renal disease, kidney function) and bladder outcomes. Odds ratios (OR) and mean difference (MD) with 95% confidence interval (CI) were extrapolated from available data for quantitative synthesis. Random-effects meta-analysis and meta-regression were performed according to study design, and potential covariates were assessed with subgroup analysis. The systematic review was prospectively registered on PROSPERO (CRD42021243967).

RESULTS: Thirty unique studies describing 1547 boys with PUV were included in this synthesis. Overall effect estimates demonstrate that patients undergoing primary diversion have significantly increased odds of developing renal insufficiency [OR 0.60, 95% CI 0.44, 0.80; p < 0.001]. However, when adjusting for baseline kidney function between intervention groups, there was no significant difference in long term kidney outcomes [p = 0.09, 0.35], or the development of bladder dysfunction or requiring clean-intermittent catheterization with primary ablation rather than diversion [OR 0.89, 95% CI 0.49, 1.59; p = 0.68].

CONCLUSIONS: Current low-quality evidence suggests that medium-term kidney outcomes in children are similar between primary ablation and primary diversion after adjusting for baseline kidney function, while bladder outcomes are highly heterogenous. Further research with covariate control is warranted to investigate sources of heterogeneity.

LEVEL OF EVIDENCE: Level III.

DOI

10.1016/j.jpurol.2023.02.008

Alternate Title

J Pediatr Urol

PMID

36906479
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Title

The Tailored Adherence Incentives for Childhood Asthma Medications Randomized Trial: A Research Protocol for Children with High-Risk Asthma.

Year of Publication

2020

Number of Pages

Date Published

2020 Apr 07

ISSN Number

1929-0748

Abstract

<p><strong>BACKGROUND: </strong>Poor adherence to inhaled corticosteroid (ICS) medications for children with high-risk asthma is a well-documented and poorly understood problem with a disproportionate prevalence and impact on urban minority children. Financial incentives have been shown as a compelling method to engage a high-risk asthma population, but whether and how adherence can be maintained and lead to sustained high adherence trajectories is unknown.</p>

<p><strong>OBJECTIVE: </strong>To determine the marginal effects of a financial incentive-based ICS adherence intervention on adherence, healthcare system use, and costs in a prospective cohort of child-caregiver dyads.</p>

<p><strong>METHODS: </strong>Participants include 125 children aged 5-12 years who have had at least two hospitalizations or one hospitalization and one emergency room visit for asthma in the prior year and their caregivers. All participants have an electronic inhaler sensor that is linked to a smartphone app to track medication use for 7 months. After one month of observation, participants are randomized to one of three possible arms for a 3-month experiment. Participants in arm 1 receive daily text message reminders, feedback, and nominal gain-framed financial incentives; those in arm 2 receive daily text message reminders and feedback only and those in arm 3 receive no reminders, feedback, or incentives. All participants are then observed for an additional 3 months with no reminders, feedback, or incentives to assess for sustained effects.</p>

<p><strong>RESULTS: </strong>Study enrollment began in September 2019. Estimated primary completion date is June of 2022 and analyses will be completed by June of 2023.</p>

<p><strong>CONCLUSIONS: </strong>The present study will provide data on whether a financial incentive-based mobile-health intervention for promoting ICS use is efficacious in high-risk asthma patients over time.</p>

<p><strong>CLINICALTRIAL: </strong>Clinicaltrial.gov NCT03907410; https://clinicaltrials.gov/ct2/show/NCT03907410.</p&gt;

DOI

10.2196/16711

Alternate Title

JMIR Res Protoc

PMID

32459653
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Title

Association between Daily Water Intake and 24-hour Urine Volume Among Adolescents with Kidney Stones.

Year of Publication

2020

Number of Pages

Date Published

2020 Jan 28

ISSN Number

1527-9995

Abstract

<p><strong>OBJECTIVE: </strong>To determine the association between daily water intake and 24-hour urine volume among adolescents with nephrolithiasis in order to estimate a "fluid prescription", the additional water intake needed to increase urine volume to a target goal.</p>

<p><strong>METHODS: </strong>We conducted a secondary analysis of an ecological momentary assessment study that prospectively measured daily water intake of 25 adolescents with nephrolithiasis over 7 days. We identified 24-hour urine volumes obtained for clinical care within 12 months of water intake assessment. A linear regression model was fit to estimate the magnitude of the association between daily water intake and 24-hour urine volume, adjusting for age, sex, race, and daily temperature.</p>

<p><strong>RESULTS: </strong>Twenty-two participants completed fifty-seven 24-hour urine collections within 12 months of the study period. Median daily water intake was 1.4 L (IQR 0.67-1.94). Median 24-hour urine volume was 2.01 L (IQR 1.20-2.73). A 1 L increase in daily water intake was associated with a 710 mL increase in 24-hour urine output (95% CI 0.55-0.87). Using the model output, the equation was generated to estimate the additional fluid intake needed (fluid prescription; FP) to produce the desired increase in urine output (dUOP): FP=dUOP/0.71.</p>

<p><strong>CONCLUSIONS: </strong>The fluid prescription equation (FP = dUOP)/0.71), which reflects the relationship between water intake and urine volume, could be used to help adolescents with nephrolithiasis achieve urine output goals to decrease stone recurrence.</p>

DOI

10.1016/j.urology.2020.01.024

Alternate Title

Urology

PMID

32004558
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Title

Ecological Momentary Assessment of Factors Associated with Water Intake Among Adolescents with Kidney Stone Disease.

Year of Publication

2018

Number of Pages

Date Published

2018 Aug 01

ISSN Number

1527-3792

Abstract

<p><strong>BACKGROUND: </strong>Maintaining high water intake reduces kidney stone recurrence, but is difficult to do. Strategies to reduce stone recurrence among adolescents are lacking.</p>

<p><strong>METHODS: </strong>We conducted an ecological momentary assessment study to identify factors associated with water intake among 25 adolescents with nephrolithiasis. Over 7-days, participants used smart bottles to self-monitor water intake and received questionnaires randomly four times daily that were completed in real-time on mobile devices. The questionnaires ascertained awareness of water intake volume, awareness of water intake goals, perceived need to drink, access to water, alternative beverage consumption, and attitudes towards bathrooms. Linear mixed-effects models were fit to estimate the association between momentary responses and daily water intake.</p>

<p><strong>RESULTS: </strong>Over 175 person-days, 595 (85%) assessments were completed. Median daily water intake was 1304mL (IQR 848-1832); 20% of participants met their intake goal for ≥4 days. Unawareness of water intake volume was associated with drinking 690mL less water a day (p=0.04). A strong self-perceived need to drink more was associated with drinking 1954 mL less water each day compared to no need to drink more (p&lt;0.01). Unawareness of intake goals was weakly associated with drinking 1129 mL less water each day(p=0.1). Access to water, alternative beverage consumption, and bathroom aversion were not associated with water intake.</p>

<p><strong>CONCLUSIONS: </strong>Unawareness of water volume consumed and low responsiveness to the perceived need to drink more were associated with low water intake. Interventions that help adolescents recognize when and identify how to increase water intake may be effective in reducing stone recurrence.</p>

DOI

10.1016/j.juro.2018.07.064

Alternate Title

J. Urol.

PMID

30076905
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