Papers by Brenda Gillespie
American Journal of Kidney Diseases, Jul 1, 2012
Investigative Ophthalmology & Visual Science, Apr 22, 2011
Investigative Ophthalmology & Visual Science, Sep 26, 2016
Asaio Journal, Mar 1, 2001
H3GlY6, Canada administration of genetically engineered cells can lower urea, uric acid, and crea... more H3GlY6, Canada administration of genetically engineered cells can lower urea, uric acid, and creatinine in uremic rats. The present study is to see whether this can lower K+, P, el-, and P in uremic rats. B) Methods used: Genetically engineered E. coli DH5 cells are encapsulated in artificial cells. The efficacy for the removal of electrolytes was analyzed in-vitro in batch bioreactors and in-vivo in daily oral administration to partially nephrectomized male Wistar rats. C) Results summary: In-vitro: Significant lowering of plasma K' , P, Na' , and CI-occurs in in-vitro experiments in batch bioreactors. In-vivo experiments in uremic rats show that oral administration also resulted in lowering of plasma electrolytes levels. For example, plasma K+ decreases from 5.66 +I. 15 (mmol/L) to 4.23 0.90 (mmol/L), plasma P from 2.44 2 0.56 (mmol/L) to 1.54 5 0.59 (mmoVL), plasmaNa+ 1462 6.30 (mmol/L) to 13 1.20+ 8.60 (mmol/L), plasma Cf from 206.00 5 49.70 (mmol/L) to 101.00 5 15.00 (mmol/L), and alkaline phosphatase from 212.33 5 63.21 (dl) to 87.66 24.54 (dl). On discontinuation of the therapy, electrolyte levels increased again. Ref.: www.artcell.mcgill.ca A) Purpose of study: We have shown earlier that oral Mean Arterial Blood Pressures during Extended Daily Dialysis (EDD) vs. Intermittent Hemodialysis in Intensive Care Unit (ICU) Patients.
JMIR Research Protocols, Feb 7, 2023
Background End-stage kidney disease (ESKD) is treated with dialysis or kidney transplantation, wi... more Background End-stage kidney disease (ESKD) is treated with dialysis or kidney transplantation, with most patients with ESKD receiving in-center hemodialysis treatment. This life-saving treatment can result in cardiovascular and hemodynamic instability, with the most common form being low blood pressure during the dialysis treatment (intradialytic hypotension [IDH]). IDH is a complication of hemodialysis that can involve symptoms such as fatigue, nausea, cramping, and loss of consciousness. IDH increases risks of cardiovascular disease and ultimately hospitalizations and mortality. Provider-level and patient-level decisions influence the occurrence of IDH; thus, IDH may be preventable in routine hemodialysis care. Objective This study aims to evaluate the independent and comparative effectiveness of 2 interventions—one directed at hemodialysis providers and another for patients—in reducing the rate of IDH at hemodialysis facilities. In addition, the study will assess the effects of interventions on secondary patient-centered clinical outcomes and examine factors associated with a successful implementation of the interventions. Methods This study is a pragmatic, cluster randomized trial to be conducted in 20 hemodialysis facilities in the United States. Hemodialysis facilities will be randomized using a 2 × 2 factorial design, such that 5 sites will receive a multimodal provider education intervention, 5 sites will receive a patient activation intervention, 5 sites will receive both interventions, and 5 sites will receive none of the 2 interventions. The multimodal provider education intervention involved theory-informed team training and the use of a digital, tablet-based checklist to heighten attention to patient clinical factors associated with increased IDH risk. The patient activation intervention involves tablet-based, theory-informed patient education and peer mentoring. Patient outcomes will be monitored during a 12-week baseline period, followed by a 24-week intervention period and a 12-week postintervention follow-up period. The primary outcome of the study is the proportion of treatments with IDH, which will be aggregated at the facility level. Secondary outcomes include patient symptoms, fluid adherence, hemodialysis adherence, quality of life, hospitalizations, and mortality. Results This study is funded by the Patient-Centered Outcomes Research Institute and approved by the University of Michigan Medical School’s institutional review board. The study began enrolling patients in January 2023. Initial feasibility data will be available in May 2023. Data collection will conclude in November 2024. Conclusions The effects of provider and patient education on reducing the proportion of sessions with IDH and improving other patient-centered clinical outcomes will be evaluated, and the findings will be used to inform further improvements in patient care. Improving the stability of hemodialysis sessions is a critical concern for clinicians and patients with ESKD; the interventions targeted to providers and patients are predicted to lead to improvements in patient health and quality of life. Trial Registration ClinicalTrials.gov NCT03171545; https://clinicaltrials.gov/ct2/show/NCT03171545 International Registered Report Identifier (IRRID) PRR1-10.2196/46187
BACKGROUND End-stage kidney disease (ESKD) is treated with dialysis or kidney transplantation, wi... more BACKGROUND End-stage kidney disease (ESKD) is treated with dialysis or kidney transplantation, with most patients with ESKD receiving in-center hemodialysis treatment. This life-saving treatment can result in cardiovascular and hemodynamic instability, with the most common form being low blood pressure during the dialysis treatment (intradialytic hypotension [IDH]). IDH is a complication of hemodialysis that can involve symptoms such as fatigue, nausea, cramping, and loss of consciousness. IDH increases risks of cardiovascular disease and ultimately hospitalizations and mortality. Provider-level and patient-level decisions influence the occurrence of IDH; thus, IDH may be preventable in routine hemodialysis care. OBJECTIVE This study aims to evaluate the independent and comparative effectiveness of 2 interventions—one directed at hemodialysis providers and another for patients—in reducing the rate of IDH at hemodialysis facilities. In addition, the study will assess the effects of interventions on secondary patient-centered clinical outcomes and examine factors associated with a successful implementation of the interventions. METHODS This study is a pragmatic, cluster randomized trial to be conducted in 20 hemodialysis facilities in the United States. Hemodialysis facilities will be randomized using a 2 × 2 factorial design, such that 5 sites will receive a multimodal provider education intervention, 5 sites will receive a patient activation intervention, 5 sites will receive both interventions, and 5 sites will receive none of the 2 interventions. The multimodal provider education intervention involved theory-informed team training and the use of a digital, tablet-based checklist to heighten attention to patient clinical factors associated with increased IDH risk. The patient activation intervention involves tablet-based, theory-informed patient education and peer mentoring. Patient outcomes will be monitored during a 12-week baseline period, followed by a 24-week intervention period and a 12-week postintervention follow-up period. The primary outcome of the study is the proportion of treatments with IDH, which will be aggregated at the facility level. Secondary outcomes include patient symptoms, fluid adherence, hemodialysis adherence, quality of life, hospitalizations, and mortality. RESULTS This study is funded by the Patient-Centered Outcomes Research Institute and approved by the University of Michigan Medical School’s institutional review board. The study began enrolling patients in January 2023. Initial feasibility data will be available in May 2023. Data collection will conclude in November 2024. CONCLUSIONS The effects of provider and patient education on reducing the proportion of sessions with IDH and improving other patient-centered clinical outcomes will be evaluated, and the findings will be used to inform further improvements in patient care. Improving the stability of hemodialysis sessions is a critical concern for clinicians and patients with ESKD; the interventions targeted to providers and patients are predicted to lead to improvements in patient health and quality of life. CLINICALTRIAL ClinicalTrials.gov NCT03171545; https://clinicaltrials.gov/ct2/show/NCT03171545 INTERNATIONAL REGISTERED REPORT PRR1-10.2196/46187
The Journals of Gerontology: Series A, 2021
Background In older adults, vision impairment (VI) is associated with worse cognitive function. H... more Background In older adults, vision impairment (VI) is associated with worse cognitive function. However, the relationship between midlife vision and future cognitive function remains unknown. Methods The Study of Women’s Health Across the Nation, Michigan site, is a longitudinal cohort of midlife women aged 42–52 years at baseline. Presenting Titmus visual acuity (VA) in the better-seeing eye was assessed at baseline and categorized as no or mild VI (VA ≥20/60), or moderate or worse VI (VA <20/60). Cognitive function was measured 8 times over 15 years using the East Boston Memory Test immediate (EBMTi) and delayed (EBMTd) recall and the Digit Span Backwards (DSB) test. Linear mixed models with a random intercept and slope for age were constructed to detect associations between VI at baseline and future repeated measures of cognitive function, adjusting for age, race, education, financial strain, alcohol use, and tobacco use. Results About 394 women aged 42–52 at baseline with a m...
Ophthalmology, 2020
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Investigative Ophthalmology & Visual Science, May 1, 2006
Investigative Ophthalmology & Visual Science, May 1, 2006
Investigative Ophthalmology & Visual Science, May 1, 2006
Investigative Ophthalmology & Visual Science, Jul 13, 2018
Journal of Glaucoma, Feb 1, 1999
Investigative Ophthalmology & Visual Science, Apr 17, 2010
Investigative Ophthalmology & Visual Science, Apr 28, 2009
Innovation in Aging, 2021
Based on the 2018 American Academy of Neurology guideline, the prevalence of mild cognitive impai... more Based on the 2018 American Academy of Neurology guideline, the prevalence of mild cognitive impairment (CI) increases from 6.7% at 60-64 years to 25.2% at 80-84 years. There is interest to identify potential biomarkers in the retina for CI and dementia. The aims of this analysis was to test whether hypertensive retinopathy (HR) was associated with cognitive function using data from the Study of Women’s Health Across the Nation (SWAN), Michigan cohort. SWAN, launched in 1996/97, is a longitudinal study of women traversing midlife and into late adulthood. Starting in 2000, cognitive function tests were administered: East Boston Memory Test immediate (EBMTi) and 10-minute delay (EBMTd) for verbal episodic memory; digit span backwards (DSB) for working memory; and symbol digits modalities test (SDMT) for perception speed, motor speed, and visual scanning. Z-scores were calculated for EBMTi, EBMTd, DSB and SDMT and averaged at follow-up visit 15 (2015/16). Eye exams were performed on 255...
Investigative Ophthalmology & Visual Science, 2007
Investigative Ophthalmology & Visual Science, 2005
Translational Vision Science & Technology, 2021
Purpose To investigate differences across the visual field (VF) in the rate of glaucomatous progr... more Purpose To investigate differences across the visual field (VF) in the rate of glaucomatous progression, the likelihood of defect in four disease severity cross-sections, and comparisons of subgroups in each of between 12 demographic, comorbid, and clinical variables. Methods Two long-term glaucoma clinical trials used Humphrey Field Analyzer 24-2 VFs to calculate pointwise deviations from age-matched normal controls. Slopes of glaucomatous progression over time were calculated per participant using linear mixed models. Pointwise differences between subgroups in slopes and cross-sectional categories were tested, adjusting for multiple comparisons using false discovery rate (FDR) and Q values. Results Pointwise data were available for 1118 patients who had 15,073 VFs. On average, defects were seen at all VF points. Of the 12 variables, six had average pointwise slopes where Subgroup 1 had significantly faster progression than Subgroup 2 at all or many of the 52 VF points: participants who were older (≥65 vs. younger), 52/52; were male, 13/52; had diabetes, 29/52; had hypertension, 46/52; had a larger cup-to-disc ratio (≥0.7), 36/52; or had larger differences in absolute mean deviation (MD) between eyes (>3 dB), 52/52. Cross-sectional patterns at MD severity of −12 to −6.1 dB showed strong midline effects for gender and other patterns for hypertension, cup-to-disc ratio, absolute difference in MD between eyes, and disc notching. Conclusions The approach used provides new longitudinal and cross-sectional insights into variation across the VF associated with demographic, comorbid, and clinical variables. Translational Relevance This exploration and characterization of variable effects in the setting of pointwise VF testing may enable clinicians to anticipate patterns of VF loss based on demographic, comorbid, and clinical associations.
Innovation in Aging, 2020
In this analysis of data from the Study of Women Across the Nation (SWAN), a longitudinal cohort ... more In this analysis of data from the Study of Women Across the Nation (SWAN), a longitudinal cohort study of mid-life women, we sought to describe the relationship between vision impairment (VI) during mid-life and future CF during the mid- to later-life transition period. Presenting visual acuity was assessed at baseline, between 1996-2000, using a Titmus occupational screener. “Mild” and “moderate to severe” VI were respectively categorized as visual acuity <20/40 and <20/60 in the better seeing eye. CF was measured at near-annual visits from 2003-2015 using the East Boston Memory Test immediate (EBMTi) and delayed (EBMTd) recall and Digit Span Backwards (DSB). Linear mixed models with a random intercept and slope for age were constructed to detect associations between vision and CF, adjusting for race, education, financial strain, alcohol use, and tobacco use. The sample included 341 women aged 42-53 years (mean: 46.6) at baseline with up to 16 years of follow-up. The prevalen...
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Papers by Brenda Gillespie