Renal Association Clinical Practice Guideline on Haemodialysis

Abstract This guideline is written primarily for doctors and nurses working in dialysis units and related areas of medicine in the UK, and is an update of a previous version written in 2009. It aims to provide guidance on how to look after patients and how to run dialysis units, and provides standards which units should in general aim to achieve. We would not advise patients to interpret the guideline as a rulebook, but perhaps to answer the question: “what does good quality haemodialysis look like?” The guideline is split into sections: each begins with a few statements which are graded by strength (1 is a firm recommendation, 2 is more like a sensible suggestion), and the type of research available to back up the statement, ranging from A (good quality trials so we are pretty sure this is right) to D (more like the opinion of experts than known for sure). After the statements there is a short summary explaining why we think this, often including a discussion of some of the most helpful research. There is then a list of the most important medical articles so that you can read further if you want to – most of this is freely available online, at least in summary form. A few notes on the individual sections: This section is about how much dialysis a patient should have. The effectiveness of dialysis varies between patients because of differences in body size and age etc., so different people need different amounts, and this section gives guidance on what defines “enough” dialysis and how to make sure each person is getting that. Quite a bit of this section is very technical, for example, the term “eKt/V” is often used: this is a calculation based on blood tests before and after dialysis, which measures the effectiveness of a single dialysis session in a particular patient. This section deals with “non-standard” dialysis, which basically means anything other than 3 times per week. For example, a few people need 4 or more sessions per week to keep healthy, and some people are fine with only 2 sessions per week – this is usually people who are older, or those who have only just started dialysis. Special considerations for children and pregnant patients are also covered here. This section deals with membranes (the type of “filter” used in the dialysis machine) and “HDF” (haemodiafiltration) which is a more complex kind of dialysis which some doctors think is better. Studies are still being done, but at the moment we think it’s as good as but not better than regular dialysis. This section deals with fluid removal during dialysis sessions: how to remove enough fluid without causing cramps and low blood pressure. Amongst other recommendations we advise close collaboration with patients over this. This section deals with dialysate, which is the fluid used to “pull” toxins out of the blood (it is sometimes called the “bath”). The level of things like potassium in the dialysate is important, otherwise too much or too little may be removed. There is a section on dialysate buffer (bicarbonate) and also a section on phosphate, which occasionally needs to be added into the dialysate. This section is about anticoagulation (blood thinning) which is needed to stop the circuit from clotting, but sometimes causes side effects. This section is about certain safety aspects of dialysis, not seeking to replace well-established local protocols, but focussing on just a few where we thought some national-level guidance would be useful. This section draws together a few aspects of dialysis which don’t easily fit elsewhere, and which impact on how dialysis feels to patients, rather than the medical outcome, though of course these are linked. This is where home haemodialysis and exercise are covered. There is an appendix at the end which covers a few aspects in more detail, especially the mathematical ideas. Several aspects of dialysis are not included in this guideline since they are covered elsewhere, often because they are aspects which affect non-dialysis patients too. This includes: anaemia, calcium and bone health, high blood pressure, nutrition, infection control, vascular access, transplant planning, and when dialysis should be started.

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Radionuclide Assessment of the Natural Heart Ejection Fraction before and after LVAD Implantation

The International Journal of Artificial Organs ◽

10.1177/039139888901200107 ◽

1989 ◽

Vol 12 (1) ◽

pp. 41-46 ◽

Cited By ~ 1

Author(s):

A. Moritz ◽

C. A. Napoli ◽

D. Feiglin ◽

N. Uchida ◽

H. Harasaki ◽

...

Keyword(s):

Blood Pressure ◽

Ejection Fraction ◽

Cleveland Clinic ◽

Blood Pool ◽

Left Ventricular ◽

Before And After ◽

Movement Artifacts ◽

Holstein Calves ◽

Left Ventricular Output ◽

The Individual

Complete pressure unloading of the ventricles can preserve ischemically damaged myocardium. Most clinical left heart assist device (LVAD) systems used after ischemic injury of the heart apply atrial cannulation which does not ensure pressure unloading. In order to assess the effect of the implantation of an intracorporeal LVAD on the function of the natural heart, we determined the ejection fraction (EF) in four male Holstein calves (90–105 kg) before and after insertion of a Cleveland Clinic pneumatic LVAD. A gated blood pool scan was obtained with a gamma camera after injection of 40 mCi Tc-labelled albumin. The animals were restrained in a sling to avoid movement artifacts. All animals showed a drop of 65 ± 12% to 42 ± 14% EF in the first postoperative (p.o.) week. Left ventricular output did not maintain sufficient blood pressure as assessed by pump-off tests. Systolic blood pressure dropped from 122 ±6.5 mm Hg to 81 ± 6 mm Hg without pump support on the morning of the first p.o. day. Apical coring and possible restrained heart movement by the implanted LVAD may lead to impaired myocardial function that renders the individual LVAD dependent until adaptative corrections take place.

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Change in vaccine willingness in Australia: August 2020 to January 2021

10.1101/2021.02.17.21251957 ◽

2021 ◽

Author(s):

Nicholas Biddle ◽

Ben Edwards ◽

Matthew Gray ◽

Kate Sollis

Keyword(s):

Public Health ◽

National Level ◽

Indigenous Australians ◽

List Type ◽

Public Health Campaign ◽

Australian Population ◽

Individual Level ◽

Factors Associated ◽

The Individual ◽

Large Decline

AbstractThe ANU Centre for Social Research and Methods ANU COVID-19 Impact Monitoring Survey Program asked the same group of respondents about their vaccine intentions in August 2020 and January 2021. The paper provides data on the vaccine willingness in Australia as of January 2021 and how this changed since August 2020 both at the national level and for particular individuals. The paper provides estimates of how vaccine willingness has changed for different population sub-groups and the individual level characteristics which are associated with changes in vaccine willingness. We find an overall decrease in vaccine willingness, with the biggest decline being those who would definitely get a vaccine as of August 2020 but said they would only probably get a vaccine as of January 2021. We also look at the factors associated with vaccine willingness, as well as the factors associated with change through time.Executive summaryThe paper provides data on the vaccine willingness in Australia as of January 2021 and how this changed since August 2020 both at the national level and for particular individuals.There has been a substantial increase in vaccine resistance and hesitancy and a large decline in vaccine likeliness between August 2020 and January 2021Combined, 21.7 per cent of Australians said they probably or definitely would not get a safe and effective COVID-19 vaccine in January 2021, a significant and substantial increase from the 12.7 per cent of Australians who gave the same responses in August 2020.At the individual level, 31.9 per cent of Australians became less willing to get the vaccine between August 2020 and January 2021 in that they moved from a more to a less willing category.There were still some Australians who became more willing over the period to get vaccinated (9.9 per cent).The largest single flow across willingness categories was the 18.7 per cent of Australians who went from being definitely willing to get a COVID-19 vaccination to only probably willing to get one. There was a large decline in vaccine certainty, alongside increases in vaccine resistance.We found three attitudinal factors that were particularly important in explaining the decline in willingness. Those Australians who think too much is being made of COVID-19, those who have low confidence in hospitals and the health care system, and those who are not optimistic about the next 12 months had all decreased in terms of their willingness to get vaccinated once a vaccine is available.In addition to campaigns targeting vaccination directly, those programs that improve confidence, remind people of the dangers of COVID-19, but importantly highlight the potential for a much better 2022 all have the potential to improve vaccination rates.Females, Indigenous Australians, those who speak a language other than English at home and those who have not completed Year 12 have all became less willing to get a vaccine since August 2020 compared to the rest of the Australian population.These population groups are arguably the most urgent focus of any public health campaigns to improve willingness, both because they have low willingness to start with, but also because there is the potential opportunity to bring their willingness back to what it was in August 2020 when there was a smaller gap with the rest of the Australian population.There is a real need to consider a significantly enhanced public health campaign in languages other than EnglishThere is a need to convey information to the general public in a way that is informative, reassuring and salient for those without a degree

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Influence of blood pressure on pneumonia risk: Epidemiological association and Mendelian randomisation in the UK Biobank

10.1101/2020.04.19.20071936 ◽

2020 ◽

Author(s):

Seyedeh M. Zekavat ◽

Michael Honigberg ◽

James Pirruccello ◽

Puja Kohli ◽

Elizabeth W. Karlson ◽

...

Keyword(s):

Blood Pressure ◽

Observational Studies ◽

Mendelian Randomisation ◽

List Type ◽

Uk Biobank ◽

Increased Risk ◽

Reduce Risk ◽

Novel Coronavirus ◽

The Uk

AbstractObjectivesTo determine whether elevated blood pressure influences risk for respiratory infection.DesignProspective, population-based epidemiological and Mendelian randomisation studies.SettingUK Biobank.Participants377,143 self-identified British descent (54% women; median age 58 years) participants in the UK Biobank.Main outcome measuresFirst incident pneumonia over an average of 8 follow-up years.Results107,310 (30%) participants had hypertension at UK Biobank enrolment, and 9,969 (3%) developed a pneumonia during follow-up. Prevalent hypertension at baseline was significantly associated with increased risk for incident respiratory disease including pneumonia (hazard ratio 1.36 (95% confidence interval 1.29 to 1.43), P<0.001), acute respiratory distress syndrome or respiratory failure (1.43 (1.29 to 1.59), P<0.001), and chronic lower respiratory disease (1.30 (1.25 to 1.36), P<0.001), independent of age, age2, sex, smoking status, BMI, prevalent diabetes mellitus, prevalent coronary artery disease, and principal components of ancestry. Mendelian randomisation analyses indicated that genetic predisposition to a 5 mmHg increase in blood pressure was associated with increased risk of incident pneumonia for SBP (1.08, (1.04 to 1.13), P<0.001) and DBP (1.11 (1.03 to 1.20), P=0.005). Additionally, consistent with epidemiologic associations, increase in blood pressure genetic risk was significantly associated with reduced forced expiratory volume in the first second, forced vital capacity, and the ratio of the two (P<0.001 for all).ConclusionsThese results strongly suggest that elevated blood pressure independently increases risk for pneumonia and reduces pulmonary function. Maintaining adequate blood pressure control, in addition to other measures, may reduce risk for pneumonia. Whether the present findings are generalizable to novel coronavirus disease 2019 (COVID-19) require further study.Summary BoxSection 1: What is already known on this topicHypertension has been associated with pneumonia in small observational studies.Based on early epidemiologic analyses, hypertension is described as a risk factor for SARS-CoV-2 infection and associated novel coronavirus disease 2019 (COVID-19).The influence of hypertension on pneumonia risk is difficult to assess in traditional observational studies.Section 2: What this study addsOur pre-COVID-19 analyses are consistent with a causal relationship between increased blood pressure and increased risk for incident respiratory infections, as well as between increased blood pressure and reduced pulmonary function.These results support hypertension as a pneumonia risk factor; efforts to optimize blood pressure may reduce risk for pneumonia.

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The respiration muscles recovery tangent after the breath holding: The study of affirmation of methods of knowledge

Fizicka kultura ◽

10.5937/fizkul2001030o ◽

2020 ◽

Vol 74 (1) ◽

pp. 30-38

Author(s):

Mirko Ostojić ◽

Đorđe Stefanović

Keyword(s):

Recovery Time ◽

Average Power ◽

Respiratory Muscles ◽

Original Method ◽

Breath Holding ◽

Stressful Situation ◽

Before And After ◽

The Subject ◽

The Moment ◽

The Individual

The subject of this research is the individual respiration constant calculated based on the respiratory musculature breathing equation. This non-experimental observation conducted on a sample of students from the Faculty of Sports and Physical Education in Belgrade (N=30). The measurement aimed at the acquisition and analysis of the average power of the surface electromyography signal (sEMG) in the protocols before and after prolonged respiratory retention. The results of the research showed that the individual coefficient of control break (Cp) represents a unique characteristic of the respiratory muscles of the subjects. In a relatively trained sample of young people of both sexes, it determined that after holding their breath, until the moment of the so-called "stroke" (progression of respiration to adapt to a stressful situation), recovery time has a linear course and is directly related to the engagement of the monitored respiratory muscles of the subjects, i.e., indirectly the capacity of the individual to assimilate O2 from the inhaled air. In the practical meaning of this research, we emphasize that individual results can be correlated with the equation of respiration of respiratory muscles, to find out and approach the original method for the presented personal respirational constant.

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People Financing Entrepreneurs within and outside the Family: Pandemic Decline and Resilience in Cultures around the World

Journal of Risk and Financial Management ◽

10.3390/jrfm14120610 ◽

2021 ◽

Vol 14 (12) ◽

pp. 610

Author(s):

Ahmed Tolba ◽

Ayman Ismail ◽

Thomas Schøtt

Keyword(s):

Hierarchical Linear Modeling ◽

National Level ◽

Family Businesses ◽

Linear Modeling ◽

Individual Level ◽

Level Data ◽

The Family ◽

Before And After ◽

Business Angel ◽

The Individual

People may finance entrepreneurs, often family members. Here, the question is: how has the COVID-19 pandemic affected people’s funding of family-related entrepreneurs and non-family-related entrepreneurs? The pandemic predictably reduced the funding of family-related entrepreneurs and especially the financing of non-family-related entrepreneurs. However, a culture supportive of family businesses may alleviate the declining funding of family-related entrepreneurs, predictably, while a secular–rational culture supportive of non-family businesses may alleviate the declining financing of non-family-related entrepreneurs. Similar to a field experiment, a globally representative survey was conducted before and after the disruption in 42 countries, interviewing 266,983 adults either before or after the disruption. The individual-level data are combined with national-level data on culture, amenable to hierarchical linear modeling. People’s financing of family-related entrepreneurs and especially of non-family-related entrepreneurs are found to have declined with the COVID-19 pandemic. However, culture provides resilience, in that the declining funding of family-related entrepreneurs was alleviated where the culture supports family businesses, and the declining funding of non-family-related entrepreneurs was alleviated in societies with a secular–rational culture. The findings contribute to contextualizing business angel financing temporally, as embedded in time before and after the COVID-19 pandemic disruption, and societally, as embedded in culture providing resilience.

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INFLUENCE OF BIOFEEDBACK-PULSE-TRAINING ON HYPOXIC STABILITY

Ulyanovsk Medico-biological Journal ◽

10.34014/2227-1848-2019-3-63-71 ◽

2019 ◽

pp. 63-71

Author(s):

G.N. Anufriev ◽

M.I. Zinchenko ◽

V.V. Gul'tyaeva ◽

D.Yu. Uryumtsev ◽

S.G. Krivoshchekov

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Stress Test ◽

Individual Characteristics ◽

Biofeedback Training ◽

Hypoxic Stress ◽

Initial State ◽

Before And After ◽

The Individual ◽

Twofold Decrease

The effects of biofeedback trainings (BFT) are sufficiently detailed in scientific literature. However, the mechanism of their formation and individual characteristics of the reactions are not fully disclosed. The purpose of the paper is to study the indirect effect of biofeedback trainings aimed at managing arterial pulse on hypoxic stability and ANS state in healthy people, taking into account the individual characteristics of the response. Materials and Methods. The study involved 28 young women and 26 young men (19–23 years old), who underwent a 15-day biofeedback training. The authors measured the trial subjects’ heart rate (HR), duration of RR-intervals, blood pressure before and after the training. A hypoxic stress test was also carried out. Results. According to the results of the biofeedback trainings, all the volunteers were retrospectively divided into two groups: “reducing heart rate” (R) and “non-reducing heart-rate” (N). All females and N males demonstrated an almost twofold decrease in the number of low-resistant-to-hypoxia persons with their transition into a group of medium- and high- resistant ones. N-girls, if compared with R-girls, showed a greater increase in the number of highly resistant persons (p=0.06). Resistance comparison between male groups also showed a significant increase in highly resistant persons in N-males, if compared to R-males (p=0.01). Biofeedback-training in all groups led to a steady blood pressure decrease (both systolic (p<0.001) and diastolic (p<0.03)). Conclusion. The results obtained indicate an adaptive decrease in sympathetic activation at rest and in response to physiological (hypoxic) stress. Moreover, training effect intensity depends on the individual characteristics of the ANS initial state. Keywords: biofeedback, heart rate, hypoxic stress test, blood pressure, autonomic nervous system. Эффекты влияния тренингов с биологической обратной связью (БОС) достаточно подробно освещены в научной литературе, однако механизм их формирования и индивидуальные особенности возникающих реакций не до конца раскрыты. Цель. Изучение косвенного влияния цикла БОС-тренингов по управлению артериальным пульсом на гипоксическую устойчивость и состояние ВНС у здоровых людей с учетом индивидуальных особенностей реагирования. Материалы и методы. В исследовании приняли участие 28 девушек и 26 юношей от 19 до 23 лет, которые прошли 15-дневный БОС-тренинг. До и после тренинга проводилось измерение частоты сердечных сокращений (ЧСС), длительности RR-интервалов, артериального давления, а также гипоксический стресс-тест. Результаты. По показателям успешности БОС-тренингов добровольцы ретроспективно были подразделены на группы «снижающих ЧСС» (С) и «неснижающих» (Н). У всех девушек и Н-юношей было выявлено практически двукратное снижение количества низкорезистентных к гипоксии лиц с переходом их в группу средне- и высокорезистентных. У Н-девушек по сравнению с С-девушками количество высокорезистентных выросло сильнее (р=0,06). Сравнение резистентности между группами юношей показало также существенный прирост высокорезистентных в группе Н-юношей по сравнению с С-группой (р=0,01). БОС-тренинг у всей группы привел к устойчивому снижению АД, как систолического (p<0,001), так и диастолического (p<0,03). Выводы. Приведённые результаты свидетельствуют об адаптивном снижении симпатической активации в покое и в ответ на физиологический (гипоксический) стресс. При этом выраженность тренировочного эффекта зависит от индивидуальных особенностей исходного состояния вегетативной нервной системы. Ключевые слова: биологическая обратная связь, частота сердечных сокращений, гипоксический стресс-тест, артериальное давление, вегетативная нервная система.

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Electroconvulsive therapy (ECT) and schizophrenia

BJPsych Open ◽

10.1192/bjo.2021.872 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S332-S332

Author(s):

Rhys Masin ◽

George Kirov

Keyword(s):

Hospital Stay ◽

Rating Scales ◽

Average Length ◽

Length Of Hospital Stay ◽

Retrospective Chart Review ◽

Future Research ◽

List Type ◽

Before And After ◽

Clinically Significant ◽

The Uk

AimsAn evaluation of the benefits of ECT in patients with schizophrenia who received ECT in Cardiff & Vale UHB, in order to: ⋅Investigate the effectiveness of ECT as a treatment for schizophrenia⋅Inform future clinical practice⋅Identify clear outcome measures for use in future researchBackgroundSchizophrenia is a severe and debilitating mental illness, for which pharmacological treatment is often ineffective. ECT is seldom used for schizophrenia, despite encouraging evidence for its efficacy. Current guidance in the UK is inconsistent, as RCPsych contemplates the use of ECT in schizophrenia in certain cases, while NICE does not. This confusion warrants the need for further evaluation of ECT as a treatment for schizophrenia.MethodEight suitable patients were identified, and a retrospective chart review was conducted in relation to the following outcomes: •What was the main indication for ECT, and was the issue resolved•Change in clinical rating scales•Concordance with medication before and after treatment•Length of hospital stay before and after treatment, over one year•Mental Health Act status after treatment for those treated on section•Was the level of observation reduced following treatmentResultInitial indication for treatment was completely resolved in seven out of eight cases. All patients improved in overall symptomatic score (mean improvement = 59.5%). Five patients (62.5%) improved above the threshold of clinically significant response. At the commencement of treatment, three (37.5%) patients were refusing all medication, three (37.5%) had poor concordance and two (25%) were fully concordant. At treatment endpoint, all were fully concordant. Average length of hospital stay remained unchanged: 30 weeks during the year before ECT, and 33 weeks during the year after ECT. Of six patients treated under Section 3, four (66.7%) had their section lifted within six months. Observation level was reduced in all cases that had been placed under continuous observation.ConclusionECT improved all outcomes except admission duration. These results provide support for the consideration of ECT as a meaningful treatment option for schizophrenia.

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CHANGES IN PATTERN OF SECOND HOME DEVELOPMENT IN COUNTRIES ARISING FROM SOCIALIST FEDERAL REPUBLIC OF YUGOSLAVIA

JOURNAL OF TOURSIM AND HOSPITALITY MANAGEMENT ◽

10.35666/25662880.2015.1.484 ◽

2015 ◽

pp. 484-494

Keyword(s):

Federal Republic ◽

Census Data ◽

National Level ◽

Second Homes ◽

Stage Of Development ◽

Second Home ◽

Wide Range ◽

Before And After ◽

High Inflation ◽

The Moment

Intense construction of second homes in Socialist Federal Republic of Yugoslavia (hereafter referred as ex-Yugoslavia) started in 1960‘s. Acquisition of second homes was affordable for wide range of ex-Yugoslav citizen population due to low prices of land and real estate, as well as favourable loan conditions from state owned banks. Motivation for ownership was different – spending family holidays, which was more affordable in comparison to hotel accommodation, and investment in real estates in period of unstable ex-Yugoslav economy, represented by high inflation rates and variable currency. Predominant type of second home units was family vacation house, usually built in self-managed construction. In the moment of disintegration of common state in (and after) the year 1991, countries were at considerably different stage of development. Wars that followed even deepened the national and regional differences, which can be observed also in different second home development in new independent states. Due to private building entrepreneurship, most popular second home areas were faced with a new type of secondary residences – multi-apartment recreational buildings, often used as commercialized accommodation capacities. In the same time, prices of second homes have increased; therefore they became a privilege only for higher class. We can conclude that second home development pattern in exYugoslav countries in the last 50 years has changed from affordable to exclusive phenomenon. From the mentioned context, the main goal of the paper arises: to compare the pattern of second home development in ex-Yugoslavia countries before and after the fall of common state. Apart from literature overview, interpretation of official available census data (1971-2011) on the national level will be given. Special emphasis on changing socio-economical context of the second home development in Croatia and Slovenia will be presented.

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COVID-19 incidence and R decreased on the Isle of Wight after the launch of the Test, Trace, Isolate programme

10.1101/2020.07.12.20151753 ◽

2020 ◽

Cited By ~ 3

Author(s):

Michelle Kendall ◽

Luke Milsom ◽

Lucie Abeler-Dorner ◽

Chris Wymant ◽

Luca Ferretti ◽

...

Keyword(s):

Control Method ◽

Reproduction Number ◽

National Level ◽

Causal Link ◽

Contact Tracing ◽

Synthetic Control ◽

Local Authorities ◽

Isle Of Wight ◽

Before And After ◽

The Uk

In May 2020 the UK introduced a Test, Trace, Isolate programme in response to the COVID-19 pandemic. The programme was first rolled out on the Isle of Wight and included Version 1 of the NHS contact tracing app. We used COVID-19 daily case data to infer incidence of new infections and estimate the reproduction number R for each of 150 Upper Tier Local Authorities in England, and at the National level, before and after the launch of the programme on the Isle of Wight. We used Bayesian and Maximum-Likelihood methods to estimate R, and compared the Isle of Wight to other areas using a synthetic control method. We observed significant decreases in incidence and R on the Isle of Wight immediately after the launch. These results are robust across each of our approaches. Our results show that the sub-epidemic on the Isle of Wight was controlled significantly more effectively than the sub-epidemics of most other Upper Tier Local Authorities, changing from having the third highest reproduction number R (of 150) before the intervention to the tenth lowest afterwards. The data is not yet available to establish a causal link. However, the findings highlight the need for further research to determine the causes of this reduction, as these might translate into local and national non-pharmaceutical intervention strategies in the period before a treatment or vaccination becomes available.

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Policy discontinuity and duration outcomes

Quantitative Economics ◽

10.3982/qe639 ◽

2020 ◽

Vol 11 (3) ◽

pp. 871-916

Author(s):

Gerard J. Berg ◽

Antoine Bozio ◽

Mónica Costa Dias

Keyword(s):

Policy Change ◽

Unobserved Heterogeneity ◽

Outcome Variable ◽

Hazard Rates ◽

Model Structure ◽

Program Participation ◽

Before And After ◽

The Moment ◽

The Uk ◽

Anticipation Effects

Causal effects of a policy change on hazard rates of a duration outcome variable are not identified from a comparison of spells before and after the policy change if there is unobserved heterogeneity in the effects and no model structure is imposed. We develop a discontinuity approach that overcomes this by considering spells that include the moment of the policy change and by exploiting variation in the moment at which different cohorts are exposed to the policy change. We prove identification of average treatment effects on hazard rates without model structure. We estimate these effects by kernel hazard regression. We use the introduction of the NDYP program for young unemployed individuals in the UK to estimate average program participation effects on the exit rate to work as well as anticipation effects.

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