scholarly journals Adverse Effects of Conventional Thrice-Weekly Hemodialysis: Is It Time to Avoid 3-Day Interdialytic Intervals?

2015 ◽  
Vol 41 (4-5) ◽  
pp. 400-408 ◽  
Author(s):  
Panagiotis I. Georgianos ◽  
Pantelis A. Sarafidis ◽  
Arjun D. Sinha ◽  
Rajiv Agarwal
Keyword(s):  
Adverse Effects ◽  
Large Scale ◽  
Hospital Admissions ◽  
Maintenance Hemodialysis ◽  
Acid Base Status ◽  
Left Ventricle Mechanics ◽  
Background Maintenance ◽  
Day Of The Week ◽  
Simple Logistic ◽  
Improve Patient

Background: Maintenance hemodialysis is typically scheduled thrice weekly due to simple logistic reasons; thus, the vast majority of hemodialysis patients receive renal replacement therapy for two shorter 2-day intervals and a longer 3-day interval. As compared to the 2-day interval, we review the ill effects of the longer 3-day interdialytic interval in this report. Summary: Large-scale observational studies show that both cardiovascular-related hospital admissions and mortality occur more frequently on the day following the long interdialytic interval than on any other day of the week. Although the reasons for excess mortality are obscure, several pathophysiologic mechanisms may be involved, such as a greater magnitude of change during the long interdialytic interval in the following parameters: volume status, electrolyte and acid-base status, arterial wall and left ventricle mechanics. These data raise the need for re-examining the issue of timing and frequency of prescribed dialysis regimens in an attempt to improve patient outcomes. Although enhanced-frequency and/or extended-time dialysis schedules may mitigate the risks of the long interdialytic interval, the benefit of such dialytic modalities on survival is not yet proven. Key Message: This article summarizes currently available epidemiologic and pathophysiologic evidence on the adverse effects related to the long interdialytic interval of thrice-weekly hemodialysis and discusses the need to research further alternative dialysis practices that could mitigate these risks.

scholarly journals How to improve emergency care to adults discharged within 24 hours? Acute Care planning in Emergency departments (The ACE study): a protocol of a participatory design study

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e041743
Author(s):  
Christina Østervang ◽  
Annmarie Touborg Lassen ◽  
Charlotte Myhre Jensen ◽  
Elisabeth Coyne ◽  
Karin Brochstedt Dieperink
Keyword(s):  
Patient Outcomes ◽  
Participatory Design ◽  
Hospital Admissions ◽  
Phase 1 ◽  
Family Needs ◽  
Focus Group Interviews ◽  
Phase 3 ◽  
Ace Study ◽  
Group Interviews ◽  
Improve Patient

IntroductionThe development of acute symptoms or changes in diseases led to feelings of fear and vulnerability and the need for health professional support. Therefore, the care provided in the acute medical and surgical areas of the emergency department (ED) is highly important as it influences the confidence of patients and families in managing everyday life after discharge. There is an increase in short-episode (<24 hours) hospital admissions, related to demographic changes and a focus on outpatient care. Clear discharge information and inclusion in treatment decisions increase the patient’s and family’s ability to understand and manage health needs after discharge, reduces the risk of readmission. This study aims to identify the needs for ED care and develop a solution to improve outcomes of patients discharged within 24 hours of admission.Methods and analysisThe study comprises the three phases of a participatory design (PD). Phase 1 aims to understand and identify patient and family needs when discharged within 24 hours of admission. A qualitative observational study will be conducted in two different EDs, followed by 20 joint interviews with patients and their families. Four focus group interviews with healthcare professionals will provide understanding of the short pathways. Findings from phase 1 will inform phase 2, which aims to develop a solution to improve patient outcomes. Three workshops gathering relevant stakeholders are arranged in the design plus development of a solution with specific outcomes. The solution will be implemented and tested in phase 3. Here we report the study protocol of phase 1 and 2.Ethics and disseminationThe study is registered with the Danish Data Protection Agency (19/22672). Approval of the project has been granted by the Regional Committees on Health Research Ethics for Southern Denmark (S-20192000–111). Findings will be published in suitable international journals and disseminated through conferences.

scholarly journals Collateral impact of COVID-19: why should children continue to suffer?

2021 ◽  
Author(s):  
Prasad Nagakumar ◽  
Ceri-Louise Chadwick ◽  
Andrew Bush ◽  
Atul Gupta
Keyword(s):  
Young People ◽  
Large Scale ◽  
Hospital Admissions ◽  
Severe Disease ◽  
Children And Young People ◽  
Collateral Effects ◽  
Rsv Infection ◽  
Syncytial Virus ◽  
Set Up ◽  
The Uk

AbstractThe COVID-19 pandemic caused by SARS-COV-2 virus fortunately resulted in few children suffering from severe disease. However, the collateral effects on the COVID-19 pandemic appear to have had significant detrimental effects on children affected and young people. There are also some positive impacts in the form of reduced prevalence of viral bronchiolitis. The new strain of SARS-COV-2 identified recently in the UK appears to have increased transmissibility to children. However, there are no large vaccine trials set up in children to evaluate safety and efficacy. In this short communication, we review the collateral effects of COVID-19 pandemic in children and young people. We highlight the need for urgent strategies to mitigate the risks to children due to the COVID-19 pandemic. What is Known:• Children and young people account for <2% of all COVID-19 hospital admissions• The collateral impact of COVID-19 pandemic on children and young people is devastating• Significant reduction in influenza and respiratory syncytial virus (RSV) infection in the southern hemisphere What is New:• The public health measures to reduce COVID-19 infection may have also resulted in near elimination of influenza and RSV infections across the globe• A COVID-19 vaccine has been licensed for adults. However, large scale vaccine studies are yet to be initiated although there is emerging evidence of the new SARS-COV-2 strain spreading more rapidly though young people.• Children and young people continue to bear the collateral effects of COVID-19 pandemic

scholarly journals IMPACT OF A LARGE-SCALE TELEMEDICINE NETWORK ON ALL-CAUSE AND CARDIOVASCULAR EMERGENCY AND HOSPITAL ADMISSIONS DURING THE COVID-19 PANDEMIC IN BRAZIL

2021 ◽  
Vol 77 (18) ◽  
pp. 3109
Author(s):  
Bruno Ramos Nascimento ◽  
Luiz Eduardo V. Fróes ◽  
Ana Cristina T. Castro ◽  
Eduardo T. Fróes ◽  
Cynthia B.M. Araújo ◽  
...  
Keyword(s):  
Large Scale ◽  
Hospital Admissions

scholarly journals Using Participatory Spatial Tools to Unravel Community Perceptions of Land-Use Dynamics in a Mine-Expanding Landscape in Ghana

2021 ◽  
Author(s):  
Jane J. Aggrey ◽  
Mirjam A. F. Ros-Tonen ◽  
Kwabena O. Asubonteng
Keyword(s):  
Land Use ◽  
Adverse Effects ◽  
Large Scale ◽  
Sub Saharan Africa ◽  
Small Scale ◽  
Eastern Region ◽  
Food Crop ◽  
Mosaic Landscape ◽  
Rural Landscapes ◽  
The Future

AbstractArtisanal and small-scale mining (ASM) in sub-Saharan Africa creates considerable dynamics in rural landscapes. Many studies addressed the adverse effects of mining, but few studies use participatory spatial tools to assess the effects on land use. Hence, this paper takes an actor perspective to analyze how communities in a mixed farming-mining area in Ghana’s Eastern Region perceive the spatial dynamics of ASM and its effects on land for farming and food production from past (1986) to present (2018) and toward the future (2035). Participatory maps show how participants visualize the transformation of food-crop areas into small- and large-scale mining, tree crops, and settlement in all the communities between 1986 and 2018 and foresee these trends to continue in the future (2035). Participants also observe how a mosaic landscape shifts toward a segregated landscape, with simultaneous fragmentation of their farming land due to ASM. Further segregation is expected in the future, with attribution to the expansion of settlements being an unexpected outcome. Although participants expect adverse effects on the future availability of food-crop land, no firm conclusions can be drawn about the anticipated effect on food availability. The paper argues that, if responsibly applied and used to reveal community perspectives and concerns about landscape dynamics, participatory mapping can help raise awareness of the need for collective action and contribute to more inclusive landscape governance. These findings contribute to debates on the operationalization of integrated and inclusive landscape approaches and governance, particularly in areas with pervasive impacts of ASM.

scholarly journals Patients’ attitudes toward conventional and herbal treatments for depression and anxiety: A cross-sectional Israeli survey

2021 ◽  
pp. 002076402199238
Author(s):  
Or Burstein ◽  
Alon Shamir ◽  
Nurit Abramovitz ◽  
Ravid Doron
Keyword(s):  
Adverse Effects ◽  
Large Scale ◽  
Prescription Medications ◽  
Depression And Anxiety ◽  
Cultural Backgrounds ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Cultural Aspects ◽  
Final Sample ◽  
Choice Of Treatment

Background: As many patients view conventional antidepressants and anxiolytics negatively, it is not surprising that the willingness to apply these treatments is far from ideal, thus posing a critical barrier in promoting an effective and durable treatment. Aim: The present study aimed to explore patients’ attitudes toward conventional and herbal treatments for depression and anxiety, while considering cultural and demographic factors, to further elucidate the antecedes that putatively determine the treatment’s outcome. Methods: During June 2017, a cross-sectional survey was conducted using stratified sampling from a large-scale Israeli volunteer online panel. The final sample included 591 Jewish Israeli adults that reported they were suffering from depression or anxiety. Results: A heterogeneous range of attitudes toward treatment was found: for example, a large group of patients did not utilize prescription medications (39%), a professional consultation (12.9%), or any form of treatment (17.4%). Interestingly, these patients were significantly more likely to support naturally-derived treatments and were less concerned with scientific proof. Further, adverse effects were demonstrated as a prominent factor in the choice of treatment. A higher incidence of adverse effects was associated with an increased willingness to consider an alternative herbal treatment. Noteworthy attitudes were found in orthodox-Jewish individuals, who showed similar consultation rates, but utilized more psychological, rather than pharmacological treatments. Conclusions: It is proposed that patients’ perspectives and cultural backgrounds are needed to be taken into consideration during the clinical assessment and choice of treatment. The findings imply that a particular emphasis should be placed on patients that discard conventional pharmacological options and on distinct cultural aspects. Several recommendations for revising the current policy are advocated to promote more culturally-informed and patient-oriented care.

Hospitalization Rates Among Dialysis Patients During Hurricane Katrina

2012 ◽  
Vol 27 (4) ◽  
pp. 325-329 ◽  
Author(s):  
David Howard ◽  
Rebecca Zhang ◽  
Yijian Huang ◽  
Nancy Kutner
Keyword(s):  
Hurricane Katrina ◽  
Large Scale ◽  
Service Use ◽  
Hospital Admissions ◽  
Gulf Coast ◽  
The United States ◽  
Time Varying ◽  
Dialysis Patients ◽  
Hospitalization Rates ◽  
The Impact

AbstractIntroductionDialysis centers struggled to maintain continuity of care for dialysis patients during and immediately following Hurricane Katrina's landfall on the US Gulf Coast in August 2005. However, the impact on patient health and service use is unclear.ProblemThe impact of Hurricane Katrina on hospitalization rates among dialysis patients was estimated.MethodsData from the United States Renal Data System were used to identify patients receiving dialysis from January 1, 2001 through August 29, 2005 at clinics that experienced service disruptions during Hurricane Katrina. A repeated events duration model was used with a time-varying Hurricane Katrina indicator to estimate trends in hospitalization rates. Trends were estimated separately by cause: surgical hospitalizations, medical, non-renal-related hospitalizations, and renal-related hospitalizations.ResultsThe rate ratio for all-cause hospitalization associated with the time-varying Hurricane Katrina indicator was 1.16 (95% CI, 1.05-1.29; P = .004). The ratios for cause-specific hospitalization were: surgery, 0.84 (95% CI, 0.68-1.04; P = .11); renal-related admissions, 2.53 (95% CI, 2.09-3.06); P < .001), and medical non-renal related, 1.04 (95% CI, 0.89-1.20; P = .63). The estimated number of excess renal-related hospital admissions attributable to Katrina was 140, representing approximately three percent of dialysis patients at the affected clinics.ConclusionsHospitalization rates among dialysis patients increased in the month following the Hurricane Katrina landfall, suggesting that providers and patients were not adequately prepared for large-scale disasters.Howard D, Zhang R, Huang Y, Kutner N. Hospitalization rates among dialysis patients during Hurricane Katrina. Prehosp Disaster Med. 2012;27(4):1-5.

scholarly journals Breastfeeding Mother and Child Clinical Outcomes After COVID-19 Vaccination

2021 ◽  
pp. 089033442110565
Author(s):  
Jia Ming Low ◽  
Le Ye Lee ◽  
Yvonne Peng Mei Ng ◽  
Youjia Zhong ◽  
Zubair Amin
Keyword(s):  
Adverse Effects ◽  
Study Protocol ◽  
Messenger Rna ◽  
Hospital Admissions ◽  
Vaccine Dose ◽  
Common Side Effect ◽  
Short Term ◽  
Serious Adverse Events ◽  
Axillary Lymphadenopathy ◽  
Breastfed Infants

Background: Pre-approval clinical trials of the Pfizer/BioNTech messenger RNA COVID-19 vaccine, BNT162b2 did not include participants who were breastfeeding. Therefore, there is limited evidence about outcomes of breastfeeding mother–child dyads and effects on breastfeeding after vaccination. Research Aims: To determine: (1) solicited adverse effects (e.g., axillary lymphadenopathy, mastitis, and breast engorgement), which are unique to lactating individuals; and (2) systemic and local adverse effects of COVID-19 mRNA vaccine on mothers and potential effects on their breastfed infants. Method: This was a prospective cohort study of lactating healthcare workers ( N = 88) in Singapore who received two doses of BNT162b2 vaccination (Pfizer/BioNTech). The outcomes of mother–child dyads within 28 days after the second vaccine dose were determined through a participant-completed questionnaire. Results: Minimal effects related to breastfeeding were reported by this cohort; three of 88 (3.4%) participants had mastitis, one (1.1%) participant experienced breast engorgement, five of 88 (5.7%) participants reported cervical or axillary lymphadenopathy. There was no change in human milk supply after vaccination. The most common side effect was pain/redness/swelling at the injection site, which was experienced by 57 (64.8%) participants. There were no serious adverse events of anaphylaxis or hospital admissions. There were no short-term adverse effects reported in the infants of 67 lactating participants who breastfed within 72 hr after BNT162b2 vaccination. Conclusions: BNT162b2 vaccination was well tolerated in lactating participants and was not associated with short-term adverse effects in their breastfed infants. Study Protocol Registration: The study protocol was registered at clinicaltrials.gov (NCT04802278).

scholarly journals Do automatic push notifications improve patient flow in the emergency department? analysis of an ED in a large medical center in Israel

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0258169
Author(s):  
Daniel Trotzky ◽  
Liron Posner ◽  
Jonathan Mosery ◽  
Aya Cohen ◽  
Shiran Avisar ◽  
...  
Keyword(s):  
Large Scale ◽  
Medical Center ◽  
Patient Flow ◽  
Primary Objective ◽  
Control Group ◽  
Minimal Impact ◽  
Notification System ◽  
Patient Morbidity ◽  
Improve Patient

Introduction Congestion in emergency departments [ED] is a significant challenge worldwide. Any delay in the timely and immediate medical care provided in the ED can affect patient morbidity and mortality. Our research analyzed the use of an innovative platform to improve patient navigation in the ED, as well as provide updated information about their care. Our hope is that this can improve ED efficiency and improve overall patient care. Objective The primary objective of our study was to determine whether the use of an automatic push notification system can shorten ‘length of stay’ (LOS) in the ED, improve patient flow, and decrease ED patient load. Methods This was a prospective cohort study utilizing data extrapolated from the electronic medical records of 2972 patients who visited the walk-in ED of a large-scale central hospital in Israel from January 17, 2021 to March 15, 2021. During this period, the automatic push text notification system was activated on a week-on week-off basis. We compared data from our experimental group with the control group. Results The results of this study indicate that the use of an automatic push notification system had a minimal impact on specific parameters of ED patient flow. Apart from a few significant reductions of specific timed-intervals during patients’ ED visit, the majority of results were not statistically significant. Conclusion This study concluded that the anticipated benefits of a push text notification system in the ED do not, at this stage, justify the system’s additional cost. We recommend a follow-up study to further investigate other possible benefits.

Effects of the Blair/Brown NHS Reforms on Socioeconomic Equity in Health Care

2012 ◽  
Vol 17 (1_suppl) ◽  
pp. 55-63 ◽  
Author(s):  
Richard Cookson ◽  
Mauro Laudicella ◽  
Paolo Li Donni ◽  
Mark Dusheiko
Keyword(s):  
Health Care ◽  
Hip Replacement ◽  
Large Scale ◽  
Hospital Admissions ◽  
Public Hospitals ◽  
Patient Choice ◽  
Socioeconomically Disadvantaged ◽  
Equity In Health ◽  
Socioeconomic Equity ◽  
Equity In Health Care

The central objectives of the ‘Blair/Brown’ reforms of the English NHS in the 2000s were to reduce hospital waiting times and improve the quality of care. However, critics raised concerns that the choice and competition elements of reform might undermine socioeconomic equity in health care. By contrast, the architects of reform predicted that accelerated growth in NHS spending combined with increased patient choice of hospital would enhance equity for poorer patients. This paper draws together and discusses the findings of three large-scale national studies designed to shed empirical light on this issue. Study one developed methods for monitoring change in neighbourhood level socioeconomic equity in the utilization of health care, and found no substantial change in equity between 2001-02 and 2008-09 for non-emergency hospital admissions, outpatient admissions (from 2004-05) and a basket of specific hospital procedures (hip replacement, senile cataract, gastroscopy and coronary revascularization). Study two found that increased competition between 2003-04 and 2008-09 had no substantial effect on socioeconomic equity in health care. Study three found that potential incentives for public hospitals to select against socioeconomically-disadvantaged hip replacement patients were small, compared with incentives to select against elderly and co-morbid patients. Taken together, these findings suggest that the Blair/Brown reforms had little effect on socioeconomic equity in health care. This may be because the ‘dose’ of competition was small and most hospital services continued to be provided by public hospitals which did not face strong incentives to select against socioeconomically-disadvantaged patients.

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