Home

Peritoneal dialysis management

The original clinical practice tool (Peritoneal Dialysis Prescription Management Decision Tree, Baxter Healthcare Corporation, 1997) focused on the peritoneal dialysis prescription in terms of small solute removal to optimize clinical outcomes . These initial recommendations were based largely on observational data from th Peritoneal dialysis Peritoneal dialysis (per-ih-toe-NEE-ul die-AL-uh-sis) is a way to remove waste products from your blood when your kidneys can't adequately do the job any longer. This procedure filters the blood in a different way than does the more common blood-filtering procedure called hemodialysis

In patients on peritoneal dialysis (PD), complications may accelerate with treatment using conventional glucose-containing solutions. Strategies for proper glycemic control in diabetic PD patients are therefore essential to prevent complications and to maintain a good quality of life EXTRANEAL is intended for intraperitoneal administration only. Not for intravenous injection. Aseptic technique should be used throughout the peritoneal dialysis procedure. Encapsulating peritoneal sclerosis (EPS), sometimes fatal, is a complication of peritoneal dialysis therapy and has been reported in patients using EXTRANEAL Peritoneal dialysis (PD) is a treatment for peoplewho have kidney failure. Kidney failure is stagefive of chronic kidney disease (CKD). Healthykidneys clean wastes from blood and removeextra fluid from the body. But when your kidneysare not working well, wastes and extra fluidcan build up in your blood and make you sick.This can cause

Nephrology : 315 Peritoneal dialysis patient or parent

A peritoneal dialysis catheter is placed in the patient's abdomen, and is used to fill and drain fluid from the peritoneal cavity. This can usually be placed on an outpatient basis and be used.. Peritoneal dialysis complications. Peritonitis is a serious and significant complication of peritoneal dialysis (PD), which can result in death. Symptoms of peritonitis include abdominal pain, tenderness, nausea, vomiting, diarrhoea, chills and fever

Peritoneal dialysis - Mayo Clini

  1. ate all the junk from the body into the potty through the urinary tract
  2. Peritoneal dialysis (PD) is a procedure that can be used by people whose kidneys are no longer working effectively. It does not cure or treat the underlying kidney disease. It is intended to replace as many functions of the failing kidneys as possible
  3. Peritoneal dialysis is a reasonable option for a majority of people with CKD who have diabetes. Proper monitoring and management will help in achieving acceptably controlled sugar levels with few complications
  4. Peritoneal dialysis is a treatment for patients with severe chronic kidney failure Wastes and water are removed from the blood inside the body using the peritoneal membrane as a natural semipermeable membrane

Clinical observations continue to document suboptimal fluid management across peritoneal dialysis populations. In a retrospective review, Tazamaloukas et al observed a 25% incidence of symptomatic fluid retention among 262 patients treated predominantly with continuous ambulatory peritoneal dialysis (CAPD) patients (95%) 1 ISPD guidelines for peritoneal dialysis in acute kidney injury: 2020 update 2020. Cardiovascular & Metabolic. ISPD Cardiovascular and Metabolic Guidelines in Adult Peritoneal Dialysis Patients. - Part I - Assessment and Management of Various Cardiovascular Risk Factors. - Part II - Management of Various Cardiovascular Complications The two types of peritoneal dialysis differ mainly in the schedule of exchanges. In continuous ambulatory peritoneal dialysis (CAPD), the patient empties a fresh bag of dialysis solution into the abdomen. After 4 to 6 hours of dwell time, the patient returns the solution containing wastes to the bag

INTRODUCTION The goal of peritoneal dialysis is to remove solute and water so that the patient does not accumulate uremic solutes or excess fluid. The volume status of individual patients changes continuously and requires ongoing adjustment of the dialysis regimen Taking Care of Your Peritoneal Dialysis (PD) Catheter | National Kidney Foundation Taking Care of Your Peritoneal Dialysis (PD) Catheter Taking good care of the PD catheter and the skin around it (called the exit site) is the most important way to keep the catheter working well and to lower the chance for infection evel s, which was defined as a level < 4.5 mmol /L, occurred more commonly in PD than in HD patients and was found to be an independent predictor of survival in overall dialysis, especially in PD patients. Thus, the authors concluded that the management of dialysis patients should be focused on reducing the risk of hypokalemia in addition to reducing that of hyperkalemia Peritonitis is a common and severe complication in peritoneal dialysis (PD). Detailed recommendations on the prevention and treatment of PD-associated peritonitis have been published by the International Society for Peritoneal Dialysis (ISPD), but there is a substantial variation in clinical practice among dialysis units Peritoneal Dialysis Peritoneal Dialysis - combined with Remote Patient Management - offers the potential to improve renal patients' clinical outcomes and increase lifestyle flexibility. Hemodialysis Hemodialysis is the predominant therapy for end-stage kidney disease, and can be delivered through multiple therapy options. HD

Strategies for managing diabetic patients on peritoneal

Background:Peritoneal dialysis (PD) management is a fundamental nephrology skill, especially with the recent emphasis on home dialysis. We report a prospective multicentre cohort study of a formati.. Renal replacement therapy (RRT) is the most important supportive measure used in the management of acute kidney injury (AKI). Peritoneal dialysis (PD) is a safe, simple and inexpensive procedure and has been used in pediatric AKI patients, ranging from neonates to adolescents Advances in Peritoneal Dialysis, Vol. 18, 2002 Hypotension in Patients on Chronic Peritoneal Dialysis: Etiology, Management, and˚Outcome From: 1Division of Nephrology and Peritoneal Dialysis Program, The Toronto Western Hospital, University Healt

Anemia is an important complication in patients with chronic kidney disease. Peritoneal dialysis (PD) is one of the most common modalities of kidney replacement therapy for patients with end-stage kidney disease. PD is particularly prevalent in the Asian Pacific region. Among the different countries and regions, including mainland China, Hong Kong, Japan, Malaysia, Singapore, South Korea, and. Interventional radiology (IR) is an underutilized resource for the placement and management of tunneled peritoneal dialysis (PD) catheters, as only about 5% of PD catheters are placed by using IR. PD is a cost-effective and physiologically beneficial alternative to hemodialysis (HD) with an increased survival benefit and lower complication rate. Malfunctioning Peritoneal Dialysis Catheter and Current Treatment. Catheter malfunction, defined as mechanical failure in dialysate inflow or outflow, is not . uncommon in Peritoneal Dialysis (PD) patient. Outflow failure occurs in 4%-34.5% of PD patients [1]. Ever since the first permanent silicone catheter was introduced in 1968, a wide.

lipid management in PD patients - the International Society for Peritoneal Dialysis (ISPD) guidelines24 and the Kidney Disease Outcomes Quality Initiative (K-DOQI) guidelines.25 Both recommend treatment for all chronic kidney disease patients with dyslipidemia, but both sets of guidelines were written before the 4D study. Thus, clinical. Peritoneal Dialysis-Associated Peritonitis: Suggestions for Management and Mistakes to Avoid Peritonitis is a common complication of peritoneal dialysis that is associated with substantial morbidity and mortality. Peritonitis increases treatment costs and hospitalization events and is the most common reason for transfer to hemodialysis Peritoneal Dialysis (PD) (Guidelines PD 4.1 - 4.5) Guideline 4.1 - PD : Ultrafiltration and Fluid Management We recommend that peritoneal membrane function should be monitored regularly (6 weeks afte

Peritoneal Dialysis: Indications & Patient Management

5. MANAGEMENT OF THE EXIT SITE 5.1 EXIT SITE INFECTION PROPHYLAXIS All patients on peritoneal dialysis should be prescribed mupirocin nasal ointment 2% to apply to exit site daily or alternate day after cleaning. If the patient has a history of Pseudomonas exit site infection or allergy to mupirocin, the management of peritoneal dialysis patients Tan BK, et al. Kidney Int. 2016;89, 487-497 . The value of longitudinal bioimpedance study on fluid management of peritoneal dialysis patients •Non-anuric patients: there were no significant changes in body composition over the 12-month study perio Peritoneal dialysis (PD) is a treatment for people who have kidney failure. Kidney failure is stage five of chronic kidney disease (CKD). Healthy kidneys clean wastes from blood and remove extra fluid from the body. But when your kidneys are not working well, wastes and extra flui

Advances in Peritoneal Dialysis, Vol. 22, 2006 Perioperative Management of Peritoneal Dialysis Patients: Review of Abdominal Surgery On abdominal computed tomography scan for evaluation of hematuria, the index patient, a 23-year-old male, was found to have multiple renal cysts bilaterally. He had been on peritoneal dialy Volume control and peritoneal dialysis. The very nature of peritoneal dialysis (PD) avoids many of the complications inherent in thrice-weekly in-center hemodialysis (IHD), 1 including allowing for gentle ultrafiltration during all hours—day and night. 2 Volume overload, however, is common with PD and should be addressed. 3 Avoiding interdialytic symptoms associated with IH Peritoneal Dialysis Prescription Handbook of Dialysis, fourth edition, 2006, John T. Daugirdas, Peter G. Blake, Todd S. Ing Clearance Targets-A consensus target Kt/V for all modalities of PD is 1.7 per week. KDOQI guidelines suggest that peritoneal and renal Kt/V can be added to achieve the target PERITONEAL DIALYSIS (PD) - PERITONITIS MANAGEMENT AND TREATMENT Cross References (including NSW Health/ SESLHD policy directives) NSW Health PD2013_043 Medication Handling in NSW Public Health Facilities NSW Health PD2017_013 Infection Prevention and Control Policy SGH CLIN Peritoneal Dialysis. Management of patients on peritoneal dialysis (PD) Determining adequacy of prescription Initial factors to consider when planning for a PD prescription (incident or prevalent patient) include: 1.

Dialyse im vertrauten Umfeld - Fresenius Medical Care

Dialysis: management - The Pharmaceutical Journa

Peritoneal dialysis (PD) is an alternative to hemodialysis in patients with end-stage renal disease (ESRD). The main function of a peritoneal dialysis catheter is to permit consistent bidirectional flow of dialysate into intraabdominal peritoneal cavity without obstruction or undue discomfort [1]. Most catheters are flexible tubes with multiple. Fluid management and bioimpedance study in peritoneal dialysis. Ng JK (1), Li PK. (1)Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong. PURPOSE OF REVIEW: Maintaining euvolaemia is an essential yet challenging. 50 Intraperitoneal vancomycin is the first line therapy in the management of peritoneal dialysis-related 51 peritonitis. However, due to the paucity of data, vancomycin dosing for peritonitis in patients on 52 automated peritoneal dialysis (APD) is empiric and based on clinical experience rather than evidence

Nursing Management and Risks of Peritoneal Dialysis

Peritoneal dialysis accomplishes the removal of waste and excess fluid by using the abdominal lining, called the peritoneal membrane, as a filter a membrane across which fluids and dissolved substances (electrolytes, urea, glucose, albumin and other small molecules) are exchanged from the blood During PD, I provided one-on-one nursing care and management (FIGURE 7). For each PD infusion, I ensured strict sterility and accurate record keeping (volume in [medications, nutrition], dialysate in, dialysate out, urine output). I closely monitored the peritoneal catheter insertion site dressing for change in position or strikethrough

Any questions, please contact the St George Hospital Peritoneal Dialysis team ph 02 9113 3770 Adequacy. Kt/V and Creatinine Clearance SGH WPI 096 2020; PET (Peritoneal Equilibration Test) SGH WPI 097 2020; After Hours Contacts and After Hours Numbers 2019; After Hours Management of PD patients SGSHHS CLIN 238 201 Issue 3: Special issue: Prescribing High Quality Goal-Directed Peritoneal Dialysis - a new guideline from the International Society for Peritoneal Dialysis, May 2020 , pp. 243-352. Issue 2, March 2020 , pp. 111-239. Issue 1_suppl: Abstracts from the 40th Annual Dialysis Conference Held in Kansas City, Missouri, 8-11 February 2020, February 2020. Management of Hernias in the Context of Peritoneal Dialysis. Retrospective studies reported a prevalence of abdominal wall hernias in polycystic kidney disease between 45% and 61% [ 7, 19 ]. The increased intra-abdominal pressure or the increased inside-out pressure on the abdominal wall due to large polycystic kidneys and/or primary collagen. Peritoneal Dialysis Current UF Management Hampered by Complexity Dietary counseling v Compliance issues v May complicate management Limiting renal excretion 1 v Gradual decline to anuria v Failure to respond to diuretics Peritoneal Ultrafiltration (UF) v Challenge of the long dwell Medcalf, et al. Kidney Int. 2001; 59: 1128 -1133

PERITONEAL dialysis was introduced in 1923 as a treatment for acute and chronic renal failure. Since that time it has been useful for the management of congestive heart failure, drug intoxications, Reye's syndrome, hyaline membrane disease, hemorrhagic pancreatitis, and psoriasis. In 1967 Lash et.. bacteremia than are peritoneal dialysis patients while PD patients are at risk for peritonitis.2 Growth of peritoneal dialysis is hampered by the continuing problem of peritonitis. Peritonitis not only is the leading cause of technique failure but also contributes to mortality.3-15 In a single center study of a PD cohort of 51

PPT - Medical Nutrition Therapy for Renal Disorders

UpToDat

Managing Diabetes and Peritoneal Dialysis DaVita Kidney Car

Abdominal hernias in continuous peritoneal dialysis; Garcia-Urena MA, Rodriguez CR, Vega Ruiz V, Carnero Fernandez FJ, Fernandez-Ruiz E, Vazquez Gallego JM, Velasco Garcia M. Prevalence and management of hernias in peritoneal dialysis patients. Perit Dial Int. 2006 Mar-Apr;26(2):178-8 Introduction:The burden of chronic kidney disease (CKD) is increasing in Kenya and is a significant cause of morbidity and mortality. While definitive treatment is renal transplantation, many patie..

Dialysis Nursing Care Plan & Management - RNpedi

Approach to fluid management in peritoneal dialysis: A

The principles of peritoneal dialysis are based on the physiological processes and their driving forces which permit the exchange of water (by ultrafiltration and fluid absorption) and solutes (by diffusion and convective transport) between the peritoneal microvasculature and the dialysate. In peritoneal dialysis, the peritoneal transport system—mesenchymal cells, interstitium. Peritoneal dialysis in the emergency management of severe neonatal hyperammonemia secondary to citrullinemia type 1 Jose Ramon Fernandez-Fructuoso , Corresponding Autho

ISPD Guidelines - International Society for Peritoneal

Video: Peritoneal Dialysis: Dose & Adequacy NIDD

Management of hypervolemia in peritoneal dialysis patients

Information on Infection Control for Peritoneal Dialysis (PD) Patients After a Disaster. Peritoneal dialysis (PD) is a practical and widespread treatment for kidney failure. Because a soft tube (catheter) is present in the abdominal cavity for this treatment, special care must be taken by PD patients and their medical providers to prevent infection, especially following natural disasters 3-5 times per day (exchanges) while awake. CCPD (Continuous Cycler-assisted Peritoneal Dialysis) or APD (Automated Peritoneal Dialysis) A machine is used to cycle the fluid in and out of the peritoneal cavity. Usually done overnight. Patient preference based on their lifestyle/insurance Benefits of Peritoneal Dialysis (PD) Peritoneal dialysis (PD) may be the right treatment for you if you work, study or travel regularly and if it suits your lifestyle and medical and physical condition. Doing peritoneal dialysis (PD) at home increases the flexibility and independence of your life on dialysis 14 Peritoneal Dialysis Pros and Cons. Peritoneal dialysis is a treatment option for kidney failure that involves the use of a person's abdomen lining. It also uses a cleaning solution, which is called dialysate, to help clean the blood of waste products that build up and extra fluids. The peritoneum serves as a filter for this process Dialysis can remove most of this extra fluid, but not all. Large weight changes can cause blood pressure changes, headaches, leg cramps, breathing problems and other issues. To prevent these problems, you may need to drink or eat less than 4 to 5 cups of fluid a day. Some people lose weight before starting treatment

Process steps in the preparation of fluids for dialysis

Peritoneal dialysis (PD) is associated with a number of potential complications that affect technique and patient survival. Understanding their etiology, presentation, and management frequently enables their prevention, correction, or amelioration. These complications can be separated into mechanical aspects relating to the PD technique and the. Peritoneal dialysis associated infections: An update on diagnosis and management. World J Nephrol. 2012 Aug 6; 1(4): 106-122. ↑ Manley HJ, Bailie GR, Frye RF, McGoldrick MD. Intravenous vancomycin pharmacokinetics in automated peritoneal dialysis patients. Perit Dial Int 2001;21 :378-8 Each bag of peritoneal dialysis solution contains dextrose, which is a form of sugar. Depending on how much urine you still make and how much fluid you need to remove, you will either use the 1.5%, the 2.5% or the 4.25% solution. The 1.5% solution is the lowest in sugar and calories Keywords: COVID-19, Hemodialysis and peritoneal dialysis, Management, Outcome, Chronic kidney disease Introduction Severe acute respiratory syndrome-corona virus (SARS-CoV)-2 was first described in China in December 2019, and the COVID-19 outbreak was later declared as a pandemic by the WHO

Approach and management of chronic kidney disease sandeepSetting Up a Home Hemodialysis Program - Renal and UrologyDiabetic+Nephropathy

According to the United States Renal Data System, there were 636,905 cases of ESRD in the U.S. as of December 31, 2012, which was a 3.7% increase compared to the previous year. The number of people receiving hemodialysis (HD) or peritoneal dialysis (PD) has reached 449,342, a 57.4% increase compared to 2000 [1] Peritonitis in Peritoneal Dialysis. This course provides up-to-date information on the classification, diagnosis and treatment of peritonitis in peritoneal dialysis (PD) patients according to the updated 2016 ISPD guideline recommendations. It also covers patient and treatment-related factors that can impact peritonitis and discusses prevention. should be managed according to the International Society of Peritoneal Dialysis guidelines 3. Peritoneal Dialysis (PD) (Guidelines PD 3.1 - 3.2) Guideline 3.1 - PD: Solute Clearance Both residual urine and peritoneal dialysis components of small solute clearance should be measured at least six monthly or more frequently if clinically indicated

Peritoneal Dialysis. Peritoneal dialysis (per-ih-tuh-NEE-ul di-AL-uh-sis) is a way to remove waste products from the blood when the kidneys can no longer do their job adequately. During peritoneal dialysis, blood vessels in the stomach's abdominal lining, the peritoneum, filter much like the kidneys with the help of a dialysate fluid that. This book covers some special issues relevant to peritoneal dialysis and is a guide to the clinical practice of peritoneal dialysis. A team of international experts presents the latest information about novel peritoneal solutions, pharmacological preservation of peritoneal membrane, peritoneal dialysis catheters, assessment of volume status in PD patients, management of exit-site infection.

Pulling or movement of the catheter causes excoriation and precipitates infection. The distal end should be secured. - Reliance on strong dialysate causes sclerosing of the peritoneum, membrane thickening, adhesions, possible small bowel obstruction and loss of permeability. - Constipation hinders drainage and potassium excretion A decade ago, it was found that 50% of long-term dialysis patients reported suffering from chronic pain. 3 Musculoskeletal pain is the most common type of pain reported, but neuropathy and peripheral vascular pain also is quite common. 3,4 Approximately 75% of patients on dialysis describe their pain management as inadequate, with 55% reporting. Handbook of Peritoneal DialysisSecond EditionSteven Guest M.D. This book is a guide to the clinical practice of Peritoneal Dialysis. Chapters provide the core curriculum for expertise in PD therapy and address relevant clinical challenges faced by caregivers However, dialysis management of AKI from COVID-19 has not gained much attention. The key question is whether peritoneal dialysis (PD) can be used in COVID-19 AKI, as it often severely affects the respiratory system TREATMENT OF PERITONEAL DIALYSIS (PD) RELATED PERITONITIS Page 1 of 7 WA HOME DIALYSIS PROGRAM (WAHDIP) GUIDELINES General Principles 1. PD related peritonitis is an EMERGENCY - early empiric treatment followed by close review is essential INITIAL EMPIRIC MANAGEMENT O

Management of paediatric patients on peritoneal dialysis. Routine Tenckhoff exit site dressing. To be changed daily or every second day if exit site is well healed, free of infection and approved by the renal CNS Peritoneal dialysis has successfully been performed by octagenarians and nanogenarians. The risk of infectious and non-infectious complications are no different than that observed in younger age. Peritoneal dialysis (PD) is one type of dialysis treatment for kidney failure. It uses a fluid that is put in your belly and then removed to clean your blood. Learn how this treatment option for managing kidney failure may work for you Peritoneal dialysis (PD) uses the lining of your own abdomen, called the peritoneal membrane, to filter and clean your blood. This lining is where peritoneal dialysis (PD) gets its name. During peritoneal dialysis (PD), a fluid called dialysis solution (or dialysate) passes into your abdomen through a catheter What is Peritoneal Dialysis? PD is an alternative type of dialysis for those who do not want to use the traditional method of hemodialysis to filter blood. PD uses the peritoneal membrane (inside lining of the abdomen) and a dialysate solution to remove the waste and excess fluid from your body

Peritoneal dialysis is done to remove wastes, chemicals, and extra fluid from your body. A liquid called dialysate is put into your abdomen through a catheter (thin tube). The liquid stays in your abdomen for several hours at a time. This is called dwell time. The dialysate pulls wastes, chemicals, and extra fluid from your blood through the. The biggest difference in hemodialysis vs peritoneal dialysis is that hemodialysis requires an artificial kidney machine to filter blood while peritoneal dialysis does not. Rather than using a machine, peritoneal dialysis uses the lining on the inside of the belly as a natural filter for blood. During peritoneal dialysis, the dialysate flows. Peritoneal dialysis waste products disposal for medical centers. The ISS (Integrated Sterilizer and Shredder) is a steam sterilizer with an integrated shredder and sterilization chamber intended for the treatment of biohazard waste in small clinics, medical centers, hospital departments, and dialysis centers A number of factors have been associated with an increased risk of hernia in patients on peritoneal dialysis (PD). In terms of the presence of weaker abdominal walls and hernia- prone sites, these factors include female sex and multiparity (multiple pregnancies), older age, polycystic kidney disease (PKD), and previous abdominal surgeries Instructions: Write an essay on the nurses role in facilitating the patient to cope and promote self management during peritoneal dialysis. discuss the following issues, one issue of each page 1) peritoneal dialysis self care/management. 2) Depression & 3) body image and how nurses can help patients cope and manage with peritoneal dialysis

Chronic kidney disease-mineral bone disorder (CKD-MBD) is a systemic disorder of mineral and bone metabolism. In patients undergoing peritoneal dialysis (PD), serum levels of calcium (Ca), phosphate (P), and parathyroid hormone (PTH) remain relatively constant, irrespective of the timing of treatment. This is because PD is a continuous blood purification procedure, and in this respect differs. DIABETES MANAGEMENT IN PERITONEAL DIALYSIS PROGRAMS iii Abstract Ontario's Chronic Disease and Prevention Framework (CDPM) is a framework aimed at improving health outcomes and reducing costs. Currently, there is a paucity of data examining diabetes management (DM) in peritoneal dialysis (PD) programs. Thi How peritoneal dialysis (PD) works. Peritoneal dialysis is a way of cleaning your blood by using the peritoneal membrance (inside of the belly) and dialysis fluid. You will need to have a catheter surgically placed in your belly before you begin dialysis. Dialysis fluid is exchanged in the belly multiples times to clean blood At every interruption of therapy, calcium levels trended upward. A thorough literature review yielded the finding of a sole case report from 1966 presented at the Third International Congress of Nephrology, in which peritoneal dialysis was used in the management of vitamin D toxicity and hypercalcemia

We aimed to evaluate blood pressure change and anti‐hypertensive needs of patients within 1 year after the changeover to remote monitoring automated peritoneal dialysis (RM‐APD) and compare the effect of RM‐APD and continuous ambulatory peritoneal dialysis (CAPD) on peripheral and central haemodynamic parameters, volume status of patients. Peritoneal Dialysis: Nursing management & Risks - YouTube. Saved by Debbie Fisher. Nursing Management Peritoneal Dialysis Nclex Health Care Youtube Videos Youtubers Youtube Movies Health Peritoneal dialysis (PD) is the major established form of renal replacement therapy that is performed primarily at home. Until recently, the prevalent rate of PD patients in the United States was declining, reaching a low of 6.9% in 2009. Since then, there has been a striking increase in PD use, with a prevalence rate of 9.7% in 2014. Consequently, since the original Core Curriculum on PD. Introduction . Hypokalemia is common in patients undergoing peritoneal dialysis (PD). It is associated with increased cardiovascular and all-cause mortality. Treatment usually includes oral potassium supplements, which are poorly tolerated. Our aim was to evaluate the prevalence of hypokalemia in PD patients in Qatar and to improve treatment measures. <i>Methods</i>