Creel, Liza M

ABSTRACT Introduction Urinary tract infections (UTIs) are the most common infectious complication in kidney transplant (KT) recipients. UTI risk is associated with frailty in older adults, and UTIs may exacerbate frailty. However, this relationship has not been described in KT recipients who are at both greater risk of frailty and UTIs. Methods We conducted a retrospective chart review of 90 KT recipients aged ≥ 50 years who underwent KT between January and July 2021 and had ≥ 12 months of post‐transplant follow‐up. UTIs were identified at the time of each occurrence. Frailty was assessed at baseline using the modified Rockwood‐20 frailty index (mFI); scores ≥ 0.25 were considered frail, 0.08–0.24 pre‐frail, and < 0.08 non‐frail. The primary outcome was cumulative UTI occurrence based on frailty status, analyzed using Cox proportional hazards regression. Results Among 90 KT recipients, 33 (37%) developed ≥ 1 UTI. Notably, 45% of KT recipients with UTIs were frail, compared to 25% of KT recipients without UTIs. Compared to non‐frail KT recipients, frail KT recipients had a significantly higher risk of UTIs (HR 8.13, 95% CI 1.89, 34.91; p = 0.005), as did pre‐frail KT recipients (HR 4.51, 95% CI 1.02, 19.92; p = 0.047). Frail KT recipients also experienced earlier UTI onset, with 12 out of 21 total UTIs (57%) occurring within the first 30 days post‐KT. Conclusion Frailty and prefrailty are associated with increased UTI risk in KT recipients. These findings highlight the importance of frailty assessment in post‐transplant care and suggest the need for targeted interventions to reduce UTI risk in this vulnerable population. image

Objective Present the rationale for the development of a new, patient-facing vital sign for adult hearing. Study Design Structured A3 process. Setting Fourteen virtual meetings and two in-person meetings held between May 2021 and June 2022. Main Outcome Measure(s) Identification and refinement of a countermeasure to develop and imbed a hearing health vital sign for adult hearing. Results Through a rigorous, structured A3 process, the Hearing Health Collaborative identified and refined the rationale for and the qualities associated with a public-facing vital sign for adult hearing loss. Specifically, such a vital sign must embody five qualities: simple, accessible, stable, inclusive, and meaningful. These qualities together would ensure that a hearing health vital sign would be useful not only as a screening tool but also as an instrument to guide next steps in workup and potentially treatment. Conclusions Successful identification and implementation of a hearing metric or “vital sign” for the presence of adult hearing loss, using precedent convention of other medical diseases, may help reframe public perceptions surrounding hearing loss, improve awareness and literacy regarding the presence of the disease, and prompt action to seek diagnostic assessment.