How and who manage hemodialysis inpatients at national university hospitals in Japan? Based on questionnaire survey

Abstract Background More than three hundred thousand hemodialysis (HD) patients exist in Japan. The average of vintage of Japanese hemodialysis patients was longer than Western country. Longer and older hemodialysis patients tend to have various complications to be hospitalized and treated by various departments. However, the clinical management practices for HD inpatients are not well-known. In this study, we investigated the clinical management practices for HD inpatients in national university hospitals in Japan. Methods The questionnaire-based survey was conducted among HD management specialists of 42 national university hospitals in Japan via online correspondence or letters. This survey investigated their clinical management practices for HD inpatients of other departments. The responses were obtained from 173 (69%) of 249 HD management specialists among 37 (90%) of the 42 facilities. Results The majority (87%) of HD management specialists were aware of the importance of medical intervention by HD specialists for the management of HD inpatients. However, only approximately 20% of HD management specialists regularly ordered blood examination and chest X-ray for the management of HD inpatients of other departments. Dialysis physicians with less experience faced more difficulty in managing HD inpatients of other departments, than experienced HD management specialists. The main reason for this difficulty was poor communication with the attending physicians, lack of management rules, and short duration of hospital stay of HD inpatients. Conclusions This study indicated that the clinical management practices for HD inpatients in other department were different for each HD management specialists and were affected by their clinical experience. Good communication and established inter-departmental HD management rules would be necessary.

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P1553QUESTIONNARIE-BASED SURVEY ON PRACTICE PATTERNS OF INPATIENTS WITH HEMODIALYSIS AT ALL 42 NATIONAL HOSPITALS IN JAPAN

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1553 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Takeshi Nakata ◽

Yuji Kamijo ◽

Tsuneo Konta

Keyword(s):

Clinical Practice ◽

Practice Patterns ◽

Management Policy ◽

University Hospitals ◽

Actual Clinical Practice ◽

Clinical Practice Patterns ◽

X Ray ◽

National University ◽

Chest X Ray ◽

Inpatient Management

Abstract Background and Aims General physicians reportedly play an essential role in improving inpatient care. Hemodialysis (HD) management physicians are expected to become “hospitalists” for managing HD inpatients. However, the actual clinical practice patterns of HD inpatients management are not well known. Method To clarify the actual clinical practice patterns of inpatients with HD, we conducted a questionnaire-based survey among HD management physicians who worked at the HD centers of 42 national university hospitals in Japan. These universities are members of the “Council of Blood Purification Division in Japanese National University Hospitals.” This survey investigated the affiliations of each HD management physician and their clinical management of inpatients under the care of other departments, via online correspondence or letters. We asked questions about (1) the department managing the HD center; (2) physicians’ experience (by 5 years); (3)working style (full time or part-time); (4) management policy of each facility; (5) how to communicate with other department doctors; (6) how often are laboratory data checked; (7) how often are chest X-ray data checked; (8) how often do they advise doctors from other departments regarding fluid, medication, and nutrition; (9)what do they think about the importance of physicians’ involvement in HD management; and (10)do they find it difficult to manage HD inpatients under the care of other departments. We analyzed whether these aspects were influenced by physicians' experience or department or working style via statistical analysis. We used the linear regression model, Fisher’s exact probability test, or Chi-square test as appropriate. The ethics committee of Oita University approved this survey. Results Thirty-seven of 42 facilities(90%) and 173 of 249 HD management physicians (69%) answered this survey. Furthermore, 31 HD centers (84%) were managed by the physicians from a single department (Nephrology = 24, Urology = 6, Emergency = 1), whereas 6 HD centers (16%) were managed by the physicians from two departments (Nephrology and Urology = 5, Nephrology and Emergency = 1). Besides, 87% of HD management physicians were aware of the importance of medical intervention by HD specialists on HD inpatient management. However, only approximately 10% of HD management physicians regularly performed blood examination and chest X-ray for managing the HD inpatients under the care of other departments, whereas 70% of physicians only performed the tests when necessary. Even in the same hospital, the management policy differed among individual physicians. Only 28% of facilities had a shared management policy among physicians. The physicians with little experience faced more difficulty in managing HD inpatients than experienced physicians ( with five years of experience; |r| = 0.75, p < 0.05). The main reason for this difficulty was poor communication with attending physicians, lack of management rules, and short duration of hospital stay. Conclusion The clinical practice patterns of HD inpatient management who were under the care of other departments were different for each HD management physician. The physician’s clinical experiences might affect the outcomes of HD management. In addition, good communication and established HD management rules between departments appear to be important.

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Patients perspectives on drug shortages in six European hospital settings – a cross sectional study

BMC Health Services Research ◽

10.1186/s12913-021-06721-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Darija Kuruc Poje ◽

Domagoj Kifer ◽

Isabelle Huys ◽

Joao Miranda ◽

Helena Jenzer ◽

...

Keyword(s):

Management Practices ◽

Healthcare Professionals ◽

Demographic Data ◽

General Information ◽

Basic Knowledge ◽

Drug Shortage ◽

Cross Sectional ◽

Drug Shortages ◽

Good Communication ◽

Information Preferences

Abstract Background It is known that drug shortages represent a major challenge for all stakeholders involved in the process, but there is little evidence regarding insights into patients′ awareness and perspectives. This study aimed to investigate the patients-perceived drug shortages experience and their view on outcomes in different European hospital settings. Furthermore, we wanted to explore information preferences on drug shortages. Methods A retrospective, cross sectional, a mixed method study was conducted in six European hospital settings. One hospital (H) from each of this country agreed to participate: Bosnia and Herzegovina (H-BiH), Croatia (H-CR), Germany (H-GE), Greece (H-GR), Serbia (H-SE) and Poland (H-PO). Recruitment and data collection was conducted over 27 months from November 2017 until January 2020. Overall, we surveyed 607 patients which completed paper-based questionnaire. Questions related to: general information (demographic data), basic knowledge on drug shortages, drug shortages experienced during hospitalization and information preferences on drug shortage. Differences between hospital settings were analyzed using Chi-squared test or Fisher’s exact test. For more complex contingency tables, Monte Carlo simulations (N = 2000) were applied for Fisher’s test. Post-hoc hospital-wise analyses were performed using Fisher’s exact tests. False discovery rate was controlled using the Bonferroni method. Analyses were performed using R: a language and environment for statistical computing (v 3.6.3). Results 6 % of patients reported experiences with drug shortages while hospitalized which led to a deterioration of their health. The majority of affected patients were hospitalized at hematology and/or oncology wards in H-BiH, H-PO and H-GE. H-BiH had the highest number of affected patients (18.1 %, N = 19/105, p < 0.001) while the fewest patients were in H-SE (1 %, N = 1/100, p = 0.001). In addition, 82.5 %, (N = 501/607) of respondents wanted to be informed of alternative treatment options if there was a drug shortage without a generic substitute available. Majority of these patients (66.4 %, N = 386/501) prefer to be informed by a healthcare professional. Conclusions Although drug shortages led to serious medical consequences, our findings show that most of the patients did not perceive shortages as a problem. One possible interpretation is that good hospital management practices by healthcare professionals helped to mitigate the perceived impact of shortages. Our study highlights the importance of a good communication especially between patients and healthcare professionals in whom our patients have the greatest trust.

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Clinical outcomes and healthcare costs of inpatients with tetanus in Korea, 2011–2019

BMC Infectious Diseases ◽

10.1186/s12879-021-05935-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sohyun Bae ◽

Minsik Go ◽

Yoonjung Kim ◽

Soyoon Hwang ◽

Shin-Woo Kim ◽

...

Keyword(s):

South Korea ◽

Clinical Outcomes ◽

Medical Costs ◽

Common Symptom ◽

University Hospitals ◽

South Korean ◽

National University ◽

Hospital Stays ◽

Serious Disease ◽

Vaccination Completion

Abstract Background Tetanus is a rare, vaccine-preventable but extremely serious disease. We investigated the recent trend of the clinical outcomes and medical costs for inpatients with tetanus in South Korea over 10 years. Methods We conducted a retrospective review to determine the clinical factors and medical costs associated with tetanus at two national university hospitals in South Korea between January 2011 and October 2019. Results Forty-nine patients were admitted for tetanus (mean age, 67.0 years [range, 53.0–80.0 years]; 32 women [57.1%]). All the patients had generalized tetanus, and 5 (10.2%) died during hospitalization. The median duration from symptom onset to hospital admission was 4 days. Trismus (85.7%) was the most common symptom, and the median hospital stay was 39 days. Thirty-two patients (65.3%) required mechanical ventilation, and 20 (40.8%) developed aspiration pneumonia. The median total healthcare cost per patient was US $18,011. After discharge, 35 patients (71.4%) recovered sufficiently to walk without disability. Conclusions Tetanus requires long hospital stays and high medical expenditures in South Korea; however, the vaccination completion rate is low. Medical staff should therefore promote medical advice and policies on the management of tetanus to the general South Korean population.

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Comparative Mortality Risk of Anemia Management Practices in Incident Hemodialysis Patients

Yearbook of Medicine ◽

10.1016/s0084-3873(10)79638-3 ◽

2010 ◽

Vol 2010 ◽

pp. 249-250

Author(s):

R. Garrick

Keyword(s):

Mortality Risk ◽

Management Practices ◽

Hemodialysis Patients ◽

Anemia Management

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Effect of hyperparathyroidism on vascular stiffness in hemodialysis patients

QJM ◽

10.1093/qjmed/hcab100.026 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Magdy Mohamed Saeed El-Sharkawy ◽

Ahmed Hassan Mohamed El Thakaby ◽

Ahmed Abdelmoniem Emara ◽

Ahmed Mohamed Abdelkhalek

Keyword(s):

Arterial Stiffness ◽

Pulse Wave ◽

Cross Sectional Study ◽

Hemodialysis Patients ◽

Mean Value ◽

University Hospitals ◽

Cross Sectional ◽

Risk Of Death ◽

Group B ◽

Stage Renal Disease

Abstract Background Cardiovascular disease (CVD) is present in > 50% of patients undergoing dialysis and the relative risk of death due to CVD events in HD patients is reported to be 20 times higher than in the general population. In fact, in patients on renal replacement therapy (RRT) the prevalence of coronary heart disease and ventricular hypertrophy has been described to be 40% and 70% respectively, other CVD events include hypertention, arrhythmias, valvular calcification and arterial stiffness. Objective To detect the prevalence of arterial stiffness among end stage renal disease patients on prevalent hemodialysis with hyperparathyroidism. Patients and Methods This observational cross sectional study was conducted on 60 prevalent hemodialysis patients attending at hemodialysis unit of Ain Shams University hospitals, with convenient sampling method. The included patients are clinically stable on thrice weekly hemodialysis sessions for 4 hours per session. Results The Dual Pulse Wave Doppler (DPWD) method we proposed in this study may be considered as a useful and convenient option for clinical local Pulse Wave Velocity (PWV) measurement, this clinical practical and reproducible method had the capability to detect an increased local PWV of LCCA (which reflect arterial stiffness) in the patients with PTH > 300 more than the patients with PTH < 300 as it showed that in Group B (PTH>300), the measured carotid artery local PWV values ranged from 6.22 m/s to 8.84 m/s and the mean value was 7.81 ± 0.72 m/s, which was higher than 6.72 ± 1.06 m/s (ranging from 4.48 m/s to 8.44 m/s) of Group A (PTH<300). Conclusion Our study showed that there is a high prevalence of arterial stiffness in prevalent hemodialysis patients.

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CONSIDERATIONS OF TALENT MANAGEMENT IN RETENTION OF ACADEMICS IN THE NATIONAL UNIVERSITY OF LESOTHO

Education and New Developments 2021 ◽

10.36315/2021end127 ◽

2021 ◽

Author(s):

Theressa Madzingesu Zengeya ◽

◽

Gregory Alexander ◽

Desiree Pearl Larey ◽

◽

...

Keyword(s):

Social Theory ◽

Qualitative Methodology ◽

Management Practices ◽

Talent Management ◽

Symbolic Capital ◽

Management Program ◽

Structured Interviews ◽

Design And Implementation ◽

National University ◽

The University

The aim of the study was to examine the contribution of talent management practices at the National University of Lesotho in the retention of talented academics. The university has immense competition within the local, regional and international labour market. It isthreatened by high mobility and low retention of highly qualified staff, which has affected the quality of learning, especially postgraduate programmes. The study employed Bourdieu’s social theory and Adam’s theory of equity as a theoretical lens to understand talent management practices to retain talented academics. Bourdieu’s theory was used to offer insight on the various forms of capital, and how the capitals could be instrumental in the design and implementation of talent management practices in order to increase retention of talent in universities. In this study ‘talent’ is used to refer to holders of doctorates, associate professors and professors or researchers of new information and theories and inventors of new technology with great potential to make a significant impact on the university’s productivity. A literature review was undertaken to examine how the social theory of Bourdieu, particularly the conversion of different kinds of capital (symbolic capital) are used by the university to recognise the value of talented academics in order to retain these academics. Following a qualitative methodology and purposive sampling, data was generated through semi-structured interviews and document analysis to advance a critical and interpretive understanding of the perspectives of talent management from both management and talented academics in the university. Thematic analysis was used to synthesise the data. The data from fourteen (14) participants composed of management and academics revealed that, though the university is implementing talent management practices, it does not have an official and structured talent management program, which is imperative in retaining academics. This study concludes by advocating the design and implementation of a formal, contextual and structured talent management framework, in consultation with all key stakeholders, in order to increase retention of talent academics in the National University of Lesotho.

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(F)utility of computed tomography of the chest in the presence of pleural effusion

Pleura and Peritoneum ◽

10.1515/pp-2017-0019 ◽

2017 ◽

Vol 2 (4) ◽

pp. 181-186 ◽

Cited By ~ 1

Author(s):

Tilak Pathak ◽

Malvinder S. Parmar

Keyword(s):

Computed Tomography ◽

Pleural Effusion ◽

Ct Scan ◽

Clinical Management ◽

Chest Ct ◽

X Ray ◽

Contrast Enhanced ◽

Plain Chest ◽

Chest X Ray ◽

Chest Ct Scan

AbstractBackgroundPleural effusion is common and can cause significant morbidity. The chest X-ray is often the initial radiological test, but additional tests may be required to reduce uncertainty and to provide additional diagnostic information. However, additional exposure and unnecessary costs should be prevented. The objective of the study was to assess the clinical benefit of an additional chest computed tomography (CT) scan over plain chest X-ray alone in the management of patients with pleural effusion.MethodsRetrospective analysis in 94 consecutive patients with pleural effusion who underwent chest X-ray and CT scan over an 18-month period in a single institution. All chest X-ray and CT scan reports were compared and correlated with clinical parameters in order to assess their utility in the clinical management. No blinding was applied.ResultsIn 75 chest CT scan reports (80 %), information provided by the radiologist did not change clinical management when compared to plain chest X-ray alone and did not provide any additional information over chest X-ray. Only 2/49 (4 %) of the native chest CT scan reports provided clinically relevant information as compared to 17/45 (38 %) contrast-enhanced chest CT scan reports (p<0.001).ConclusionsIn this retrospective cohort of patients with pleural effusion, an additional chest CT scan was not useful in the majority of patients. However, if a chest CT scan is required, then a contrast-enhanced study after pleural aspiration should be performed. Further prospective studies are required to confirm these findings.

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