Home Before Hospital: A Whole of System Re-Design Project to Improve Rates of Home–Based Dialysis Therapy: Experience and Outcomes Over 8 Years

2021 ◽  
Author(s):  
Omar Tombocon ◽  
Peter Tregaskis ◽  
Catherine Reid ◽  
Daniella Chiappetta ◽  
Kethly Fallon ◽  
...  
Keyword(s):  
Decision Making ◽  
Peritoneal Dialysis ◽  
Change Management ◽  
Working Group ◽  
Multidisciplinary Care ◽  
Cost Effective ◽  
Successful Implementation ◽  
Dialysis Therapy ◽  
Outreach Service ◽  
Home Based

Abstract Background Despite evidence that clinical outcomes for patients treated with peritoneal dialysis or home haemodialysis are better than for patients treated with conventional satellite or hospital-based haemodialysis, rates of home-based dialysis therapies world-wide remain low. Home-based dialysis care is also cost effective and indeed the favoured dialysis option for many patients. Methods Using a lean-thinking framework and established change management methodology, a project embracing a system-wide approach at making a change where a Home before Hospital philosophy underpinned all approaches to dialysis care was undertaken. Three multidisciplinary working groups (Pathway, Outreach and Hybrid) were established for re-design and implementation. The primary aim was to improve home-based dialysis therapy prevalence rates from a baseline of 14.8% % by ≥2.5 %/year to meet a target of 35%, whilst not only maintaining but improving the quality of care provided to patients requiring maintenance dialysis. A future state pathway was developed after review of the current state (Pathway Working Group) and formed the basis on which a nurse-led Outreach service (Outreach Working Group) was established. With the support of the multidisciplinary team, the Outreach Service model focussed on early, consistent, and frequent education, patient support in decision making, and clinician engagement. Results A target prevalence of >30 % for home-based therapies (mainly achieved with peritoneal dialysis) was achieved within 2 years. This prevalence rate reached 35% within 3 years and was maintained at 8 years. In addition, selected patients already on maintenance satellite-based haemodialysis (Hybrid Working Group) were educated to achieve high levels of proficiencies in self-care. Conclusion Having the system-wide approach to a Quality Improvement Process and using established principles and change management processes, the successful implementation of a new sustainable model of care focused on home-based dialysis therapy was achieved. A key feature of the model (through Outreach) was early nurse-led education and support of patients in decision making and ongoing support through multidisciplinary care.

scholarly journals Peritoneal Dialysis Guidelines 2019 Part 2: Main Text (Position paper of the Japanese Society for Dialysis Therapy)

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Munekazu Ryuzaki ◽  
Yasuhiko Ito ◽  
Hidetomo Nakamoto ◽  
Yuichi Ishikawa ◽  
Noritomo Itami ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Working Group ◽  
Japanese Society ◽  
Angiotensin Receptor Blockers ◽  
Intraperitoneal Administration ◽  
Diabetic Patients ◽  
Dialysis Therapy ◽  
Converting Enzyme Inhibitors ◽  
Grade Approach ◽  
Ras Inhibitors

Abstract Background This article is a duplicated publication from the Japanese version of “2019 JSDT Guidelines for Peritoneal Dialysis” with permission from the Japanese Society for Dialysis Therapy (JSDT). This clinical practice guideline (CPG) was developed primarily by the Working Group on Revision of Peritoneal Dialysis (PD) Guidelines of the Japanese Society for Dialysis Therapy. Recently, the definition and creation process for CPGs have become far more rigorous; traditional methods and formats no longer adhere to current standards. To improve the reliability of international transmission of our findings, CPGs are created in compliance with the methodologies developed by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) working group. Part 2 of this PD guideline is the first CPG developed by our society that conforms to the GRADE approach. Methods Detailed processes were created in accordance with the Cochrane handbook and the GRADE approach developed by the GRADE working group. Results Clinical question (CQ)1: Is the use of renin-angiotensin system inhibitors (RAS inhibitors), such as angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB), effective in PD patients? Recommendation: We suggest the usage of RAS inhibitors (ACEI and ARB) in PD patients (GRADE 2C). CQ2: Icodextrin or glucose solution: which is more useful as a dialysate among patients with PD? Recommendation: We suggest using icodextrin when managing body fluids in PD patients (GRADE 2C). CQ3: Is it better to apply or not apply mupirocin/gentamicin ointment to the exit site? Recommendation: We suggest not applying mupirocin/gentamicin ointment to the exit sites of PD patients (GRADE 2C). CQ4: Which surgical approach is more desirable when a PD catheter is placed, open surgery or laparoscopic surgery? No recommendation. CQ5: Which administration route of antibiotics is better in PD patients with peritonitis, intravenous or intraperitoneal? Recommendation: We suggest intraperitoneal administration of antibiotics in PD patients with peritonitis (GRADE 2C). Note: The National Insurance does not currently cover intraperitoneal administration. CQ6: Is peritoneal dialysis or hemodialysis better as the first renal replacement therapy in diabetic patients? No recommendation. Conclusions In the future, we suggest that society members construct their own evidence to answer CQs not brought up in this guideline, and thereby show the achievements of Japan worldwide.

Setting up a Continuous Ambulatory Peritoneal Dialysis Training Program

2003 ◽  
Vol 23 (2_suppl) ◽  
pp. 178-182 ◽  
Author(s):  
Irene L.L. Kong ◽  
Irene L.P. Yip ◽  
Grace W.S. Mok ◽  
Soso Y.M. Chan ◽  
Candic M.K. Tang ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Training Program ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Training Programs ◽  
Cost Effective ◽  
Essential Elements ◽  
Unplanned Readmission ◽  
Successful Implementation ◽  
Team Approach ◽  
Exit Site Infection

Continuous ambulatory peritoneal dialysis (CAPD) training programs have become fundamental patient education programs in renal centers providing peritoneal dialysis (PD) services. Several key topics must be addressed in setting up a CAPD training program: • Health care and organizational issues • Multidisciplinary team approach • Evidence-based practice • Pre-training patient assessment • Patient training • Program evaluation The PD nurses should identify key learning objectives for patient training. The essential elements of CAPD training are the training content and schedule, training assessment, and teaching methods. Program set-up also includes establishing a back-up system and follow-up protocols, which are essential for continuity of care in renal patients. Outcomes such as rates of peritonitis and exit-site infection, unplanned readmission, and patient satisfaction are all important indicators when the results of CAPD training programs are reviewed. The development and successful implementation of a cost-effective CAPD training program has a significant impact on patient outcomes in the renal specialty.

A CONSULTATION GUIDE FOR ASSESSING THE APPLICABILITY OF HEALTH TECHNOLOGIES:A CASE STUDY

2017 ◽  
Vol 33 (5) ◽  
pp. 577-585 ◽  
Author(s):  
Stephanie Polus ◽  
Lisa Pfadenhauer ◽  
Louise Brereton ◽  
Wojciech Leppert ◽  
Philip Wahlster ◽  
...  
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Panel Discussion ◽  
Complex Interventions ◽  
Health Technology ◽  
Successful Implementation ◽  
Specific Information ◽  
Health Technologies ◽  
Home Based

Objectives:The translation of research findings into policy and practice is crucially dependent on the applicability of such findings in a given decision-making context. We explored in a case study whether a generic consultation guide to assess the applicability of a health technology could be rapidly deployed and deliver useful insights.Methods:A consultation guide based on the context and implementation for complex interventions (CICI) framework was developed and piloted to assess the applicability of reinforced home-based palliative care in three European countries. Individual consultations in England and Germany and a panel discussion in Poland were completed.Results:Various barriers may hinder successful implementation of reinforced home-based palliative care in the three countries. Whilst the experts across all countries emphasized the lack of funding along with organization and structure as major barriers, information varied by country for many of the other identified barriers and facilitators. Participants in the pilot study provided positive feedback in terms of understanding the topic and purpose of the consultation, and both individual and panel consultations could be easily implemented.Conclusions:In this case study, the consultation guide presented a pragmatic, ready-to-use tool to assess the applicability of a health technology. As shown here, it can be used in a generic manner without discrete empirical information on the technology in question or, ideally, makes use of specific information collected as part of a HTA. Further studies are needed to validate this guide and apply it to other types of health technologies and more diverse decision-making contexts.

scholarly journals Strategies for Management of Peritoneal Dialysis Patients in Singapore during COVID-19 Pandemic

2020 ◽  
Vol 49 (12) ◽  
pp. 1025-1028
Author(s):  
Htay Htay ◽  
Penelope Maxine PK Wong ◽  
Rui-En Ryan Choo ◽  
Ubaidullah S Dawood ◽  
Marjorie Wai Yin Marjorie Wai Yin Foo ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Kidney Failure ◽  
Fluid Overload ◽  
Kidney Injury ◽  
Outbreak Response ◽  
Dialysis Therapy ◽  
Response System ◽  
Home Based ◽  
Kidney Replacement Therapy ◽  
Inpatient Management

Abstract Peritoneal dialysis (PD) is the only well-established home-based dialysis therapy in Singapore. As it is a home-based modality, PD should be considered as a preferred mode of kidney replacement therapy (KRT) for patients with kidney failure during this COVID-19 pandemic as it avoids frequent visits to hospitals and/or satellite dialysis centres. The highly infectious nature of this virus has led to the implementation of the Disease Outbreak Response System Condition orange status in Singapore since early February 2020. This paper summarises the strategies for management of several aspects of PD in Singapore during this COVID-19 pandemic, including PD catheter insertion, PD training, home visit and assisted PD, outpatient PD clinic, inpatient management of PD patients with or without COVID-19 infection, PD as KRT for COVID-19 patients with acute kidney injury, management of common complications in PD (peritonitis and fluid overload), and management of PD inventory. Keywords: Home-based dialysis, kidney failure, practice, SARS-CoV-2

scholarly journals Delayed bowel perforation after instilling over warmed peritoneal dialysate

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Xueli Lai ◽  
Mingming Nie ◽  
Xiaodong Xu ◽  
Yuanjie Chen ◽  
Zhiyong Guo
Keyword(s):  
Peritoneal Dialysis ◽  
Bowel Perforation ◽  
Exploratory Laparotomy ◽  
Peritoneal Dialysis Patient ◽  
Case Presentation ◽  
Abdominal Organs ◽  
Home Based ◽  
Dialysis Solution ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background Peritoneal dialysis (PD) is a safe and home-based treatment for end-stage renal disease (ESRD) patients. The direct thermal damage of abdominal organs is very rare. Case presentation We report a peritoneal dialysis patient presented abdominal pain and feculent effluent 3 weeks after he instilled hot dialysis solution. In spite of emergency exploratory laparotomy and active treatment, the patient died of septic shock. Biopsy revealed necrosis and perforation of the intestines. Conclusions Delayed bowel perforation by hot fluid is very rare. Standardized performance is of the first importance for peritoneal dialysis patients.

scholarly journals Bayesian maintenance decision optimisation based on computing the information value from condition inspections

2021 ◽  
pp. 1748006X2097812
Author(s):  
Guang Zou ◽  
Kian Banisoleiman ◽  
Arturo González
Keyword(s):  
Decision Making ◽  
Structural Integrity ◽  
Fatigue Cracking ◽  
Cost Effective ◽  
Offshore Structures ◽  
Information Value ◽  
Bayesian Decision ◽  
Maintenance Strategies ◽  
Optimal Maintenance ◽  
Maintenance Decision

A challenge in marine and offshore engineering is structural integrity management (SIM) of assets such as ships, offshore structures, mooring systems, etc. Due to harsh marine environments, fatigue cracking and corrosion present persistent threats to structural integrity. SIM for such assets is complicated because of a very large number of rewelded plates and joints, for which condition inspections and maintenance are difficult and expensive tasks. Marine SIM needs to take into account uncertainty in material properties, loading characteristics, fatigue models, detection capacities of inspection methods, etc. Optimising inspection and maintenance strategies under uncertainty is therefore vital for effective SIM and cost reductions. This paper proposes a value of information (VoI) computation and Bayesian decision optimisation (BDO) approach to optimal maintenance planning of typical fatigue-prone structural systems under uncertainty. It is shown that the approach can yield optimal maintenance strategies reliably in various maintenance decision making problems or contexts, which are characterized by different cost ratios. It is also shown that there are decision making contexts where inspection information doesn’t add value, and condition based maintenance (CBM) is not cost-effective. The CBM strategy is optimal only in the decision making contexts where VoI > 0. The proposed approach overcomes the limitation of CBM strategy and highlights the importance of VoI computation (to confirm VoI > 0) before adopting inspections and CBM.

scholarly journals Efficient Design of Energy Disaggregation Model with BERT-NILM Trained by AdaX Optimization Method for Smart Grid

Energies ◽  
2021 ◽  
Vol 14 (15) ◽  
pp. 4649
Author(s):  
İsmail Hakkı ÇAVDAR ◽  
Vahit FERYAD
Keyword(s):  
Smart Grids ◽  
Energy Demand ◽  
Optimization Technique ◽  
Cost Effective ◽  
Optimization Method ◽  
Long Term Memory ◽  
Successful Implementation ◽  
Efficient Design ◽  
Energy Disaggregation ◽  
Load Monitoring

One of the basic conditions for the successful implementation of energy demand-side management (EDM) in smart grids is the monitoring of different loads with an electrical load monitoring system. Energy and sustainability concerns present a multitude of issues that can be addressed using approaches of data mining and machine learning. However, resolving such problems due to the lack of publicly available datasets is cumbersome. In this study, we first designed an efficient energy disaggregation (ED) model and evaluated it on the basis of publicly available benchmark data from the Residential Energy Disaggregation Dataset (REDD), and then we aimed to advance ED research in smart grids using the Turkey Electrical Appliances Dataset (TEAD) containing household electricity usage data. In addition, the TEAD was evaluated using the proposed ED model tested with benchmark REDD data. The Internet of things (IoT) architecture with sensors and Node-Red software installations were established to collect data in the research. In the context of smart metering, a nonintrusive load monitoring (NILM) model was designed to classify household appliances according to TEAD data. A highly accurate supervised ED is introduced, which was designed to raise awareness to customers and generate feedback by demand without the need for smart sensors. It is also cost-effective, maintainable, and easy to install, it does not require much space, and it can be trained to monitor multiple devices. We propose an efficient BERT-NILM tuned by new adaptive gradient descent with exponential long-term memory (Adax), using a deep learning (DL) architecture based on bidirectional encoder representations from transformers (BERT). In this paper, an improved training function was designed specifically for tuning of NILM neural networks. We adapted the Adax optimization technique to the ED field and learned the sequence-to-sequence patterns. With the updated training function, BERT-NILM outperformed state-of-the-art adaptive moment estimation (Adam) optimization across various metrics on REDD datasets; lastly, we evaluated the TEAD dataset using BERT-NILM training.

scholarly journals Public Officials’ Knowledge of Advances and Gaps for Implementing the Ecosystem Approach to Fisheries in Chile

2021 ◽  
Vol 13 (5) ◽  
pp. 2703
Author(s):  
Rodrigo A. Estévez ◽  
Stefan Gelcich
Keyword(s):  
Decision Making ◽  
Fisheries Management ◽  
Cost Effective ◽  
Ecosystem Approach ◽  
Social Dimensions ◽  
Public Officials ◽  
Government Officials ◽  
Effective Implementation ◽  
Mandatory Requirement ◽  
Support Decision Making

The United Nations calls on the international community to implement an ecosystem approach to fisheries (EAF) that considers the complex interrelationships between fisheries and marine and coastal ecosystems, including social and economic dimensions. However, countries experience significant national challenges for the application of the EAF. In this article, we used public officials’ knowledge to understand advances, gaps, and priorities for the implementation of the EAF in Chile. For this, we relied on the valuable information held by fisheries managers and government officials to support decision-making. In Chile, the EAF was established as a mandatory requirement for fisheries management in 2013. Key positive aspects include the promotion of fishers’ participation in inter-sectorial Management Committees to administrate fisheries and the regulation of bycatch and trawling on seamounts. Likewise, Scientific Committees formal roles in management allow the participation of scientists by setting catch limits for each fishery. However, important gaps were also identified. Officials highlighted serious difficulties to integrate social dimensions in fisheries management, and low effective coordination among the institutions to implement the EAF. We concluded that establishing clear protocols to systematize and generate formal instances to build upon government officials’ knowledge seems a clear and cost effective way to advance in the effective implementation of the EAF.

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