scholarly journals Nocturnal hemodialysis: three-year experience.

1998 ◽  
Vol 9 (5) ◽  
pp. 859-868 ◽  
Author(s):  
A Pierratos ◽  
M Ouwendyk ◽  
R Francoeur ◽  
S Vas ◽  
D S Raj ◽  
...  

There is evidence that high frequency, as well as long duration, hemodialysis provides better clinical outcomes. We developed nocturnal hemodialysis, a new innovative form of renal replacement therapy, which is performed six to seven nights per week for 8 to 10 h during sleep at home. Blood flow was set at 300 ml/min and dialysate flow at 100 ml/min. An internal jugular catheter was used as the vascular access. Special precautions were taken to prevent accidental disconnection during sleep, as well as air embolization. Dialysis functions from the patient's home were monitored continuously via a modem at the nocturnal hemodialysis center. Twelve patients have completed training and have been successfully performing nocturnal hemodialysis for up to 34 mo. This study represents 170 patient months of experience accumulated over 3 yr. There was hemodynamic stability and significant subjective improvement in patient well being. Nightly Kt/V was 0.99. Weekly removal of phosphate was twice as high and beta2 microglobulin 4 times as high as conventional hemodialysis. All patients have discontinued their phosphate binders and have increased dietary phosphate and protein intake. BP control was achieved with fewer medications. Dialyzer reuse has decreased the operating costs to the level of the other form of home dialysis. Complications were infrequent and were related primarily to the dialysis access. Nocturnal hemodialysis represents the most efficient form of dialysis at low cost and should be considered as an option for patients who can be trained for home hemodialysis.

2019 ◽  
pp. 2-3

Impaired phosphate excretion by the kidney leads to Hyperphosphatemia. It is an independent predictor of cardiovascular disease and mortality in patients with advanced chronic kidney disease (stage 4 and 5) particularly in case of dialysis. Phosphate retention develops early in chronic kidney disease (CKD) due to the reduction in the filtered phosphate load. Overt hyperphosphatemia develops when the estimated glomerular filtration rate (eGFR) falls below 25 to 40 mL/min/1.73 m2. Hyperphosphatemia is typically managed with oral phosphate binders in conjunction with dietary phosphate restriction. These drugs aim to decrease serum phosphate by binding ingested phosphorus in the gastrointestinal tract and its transformation to non-absorbable complexes [1].


2019 ◽  
Author(s):  
Nikki Theofanopoulou ◽  
Katherine Isbister ◽  
Julian Edbrooke-Childs ◽  
Petr Slovák

BACKGROUND A common challenge within psychiatry and prevention science more broadly is the lack of effective, engaging, and scale-able mechanisms to deliver psycho-social interventions for children, especially beyond in-person therapeutic or school-based contexts. Although digital technology has the potential to address these issues, existing research on technology-enabled interventions for families remains limited. OBJECTIVE The aim of this pilot study was to examine the feasibility of in-situ deployments of a low-cost, bespoke prototype, which has been designed to support children’s in-the-moment emotion regulation efforts. This prototype instantiates a novel intervention model that aims to address the existing limitations by delivering the intervention through an interactive object (a ‘smart toy’) sent home with the child, without any prior training necessary for either the child or their carer. This pilot study examined (i) engagement and acceptability of the device in the homes during 1 week deployments; and (ii) qualitative indicators of emotion regulation effects, as reported by parents and children. METHODS In this qualitative study, ten families (altogether 11 children aged 6-10 years) were recruited from three under-privileged communities in the UK. The RA visited participants in their homes to give children the ‘smart toy’ and conduct a semi-structured interview with at least one parent from each family. Children were given the prototype, a discovery book, and a simple digital camera to keep at home for 7-8 days, after which we interviewed each child and their parent about their experience. Thematic analysis guided the identification and organisation of common themes and patterns across the dataset. In addition, the prototypes automatically logged every interaction with the toy throughout the week-long deployments. RESULTS Across all 10 families, parents and children reported that the ‘smart toy’ was incorporated into children’s emotion regulation practices and engaged with naturally in moments children wanted to relax or calm down. Data suggests that children interacted with the toy throughout the duration of the deployment, found the experience enjoyable, and all requested to keep the toy longer. Child emotional connection to the toy—caring for its ‘well-being’—appears to have driven this strong engagement. Parents reported satisfaction with and acceptability of the toy. CONCLUSIONS This is the first known study investigation of the use of object-enabled intervention delivery to support emotion regulation in-situ. The strong engagement and qualitative indications of effects are promising – children were able to use the prototype without any training and incorporated it into their emotion regulation practices during daily challenges. Future work is needed to extend this indicative data with efficacy studies examining the psychological efficacy of the proposed intervention. More broadly, our findings suggest the potential of a technology-enabled shift in how prevention interventions are designed and delivered: empowering children and parents through ‘child-led, situated interventions’, where participants learn through actionable support directly within family life, as opposed to didactic in-person workshops and a subsequent skills application.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Arthur Holtzclaw ◽  
Jack Ellis ◽  
Christopher Colombo

Abstract Background Almost half of trainees experience burnout during their career. Despite the Accreditation Council on Graduate Medical Education (ACGME) recommendation that training programs enact well-being curricula, there is no proven method of addressing this difficult topic. Methods We created a curriculum addressing physician resiliency and well-being, designed for an Internal Medicine Residency Program. This curriculum utilized episodes from a medical television series, Scrubs, to facilitate a monthly, 1-h faculty guided discussion group. We collected informal feedback and abbreviated Maslach Burnout Inventories (aMBI) monthly and conducted a formal focus group after 6 months to gauge its effectiveness. Results The curriculum was successfully conducted for 12 months with each session averaging 18–20 residents. Residents reported high satisfaction, stating it was more enjoyable and helpful than traditional resiliency training. 19 of 24 residents (79 %) completed a baseline aMBI, and 17 of 20 residents (85 %) who attended the most recent session completed the 6-month follow-up, showing a non-significant 1-point improvement in all subsets of the aMBI. Conclusions This novel, low-cost, easily implemented curriculum addressed resiliency and burn-out in an Internal Medicine Residency. It was extremely well received and can easily be expanded to other training programs or to providers outside of training.


Author(s):  
Thais Pousada García ◽  
Jessica Garabal-Barbeira ◽  
Patricia Porto Trillo ◽  
Olalla Vilar Figueira ◽  
Cristina Novo Díaz ◽  
...  

Background: Assistive Technology (AT) refers to “assistive products and related systems and services developed for people to maintain or improve functioning and thereby to promote well-being”. Improving the process of design and creation of assistive products is an important step towards strengthening AT provision. Purpose: (1) to present a framework for designing and creating Low-Cost AT; (2) to display the preliminary results and evidence derived from applying the framework. Methodology: First, an evidence-based process was applied to develop and conceptualize the framework. Then, a pilot project to validate the framework was carried out. The sample was formed by 11 people with disabilities. The measure instruments were specific questionnaire, several forms of the Matching Person-Technology model, the Psychosocial Impact of Assistive Device Scale, and a tool to assess the usability and universal design of AT. Results: The framework integrates three phases: Identification (Design), Creation (Making the prototype), and Implementation (Outcome Measures), based on the principles of Design Thinking, and with a user-centered perspective. The preliminary results showed the coherence of the entire process and its applicability. The matching between person and device was high, representing the importance of involving the user in the design and selection of AT. Conclusions: The framework is a guide for professionals and users to apply a Low-Cost and Do-It-Yourself perspective to the provision of AT. It highlights the importance of monitoring the entire procedure and measuring the effects, by applying the outcome measures.


2016 ◽  
Vol 49 (6) ◽  
pp. 685-716 ◽  
Author(s):  
Jamie Anderson ◽  
Kai Ruggeri ◽  
Koen Steemers ◽  
Felicia Huppert

Empirical urban design research emphasizes the support in vitality of public space use. We examine the extent to which a public space intervention promoted liveliness and three key behaviors that enhance well-being (“connect,” “be active,” and “take notice”). The exploratory study combined directly observed behaviors with self-reported, before and after community-led physical improvements to a public space in central Manchester (the United Kingdom). Observation data ( n = 22,956) and surveys (subsample = 212) were collected over two 3-week periods. The intervention brought significant and substantial increases in liveliness of the space and well-being activities. None of these activities showed increases in a control space during the same periods. The findings demonstrate the feasibility of the research methods, and the impact of improved quality of outdoor neighborhood space on liveliness and well-being activities. The local community also played a key role in conceiving of and delivering an effective and affordable intervention. The findings have implications for researchers, policy makers, and communities alike.


2000 ◽  
Vol 6 (1_suppl) ◽  
pp. 80-83 ◽  
Author(s):  
Karl A Stroetmann ◽  
Peter Gruetzmacher ◽  
Veli N Stroetmann

Home dialysis can improve the care and quality of life for patients with renal failure. We have explored the possibility of extending home care to more patients needing continuous ambulatory peritoneal dialysis (CAPD) using telemedicine. We tested videoconferencing support for five CAPD patients using low-cost ISDN equipment (128 kbit/s). Initial results indicated that it was possible to integrate video-communication into the daily routine of the clinic and the response from patients was surprisingly positive. Selection of appropriate, affordable technology and the ISDN service support by the telecommunications provider proved to be considerably more difficult than anticipated. The first indications also suggest medical advantages for home teledialysis.


Author(s):  
G. E. Servetnik ◽  
E. V. Pishchenko

Feeding is one of the main methods of intensification of agricultural fish farming. Based on FAO reports, the share of aquaculture products grown with feed is gradually increasing. In pond farms with medium and high degree of intensification, up to 80% of fish products are produced due to feeding. Moreover, in the structure of the cost of fish production, compound feeds account for up to half of the total costs, and in industrial aquaculture up to 65–70%. It is shown that it is Known that feeding and growing technology account for about 55% of the success rate of increasing fish productivity, while the genetic potential is only about 25%, and the share of veterinary and sanitary well-being of fish accounts for about 20%. In Russia and many other countries, cereals are used to reduce the cost of carp farming products, as a relatively cheap and affordable source of energy compared to granulated feed. The availability and low cost of such feed is of paramount importance in pond aquaculture and currently all cereal species are used for artificial feeding. Information about feeding carp with grain crops, as well as requirements for the quality and safety of feed is provided. It is indicated that feeding carp with whole grains is advisable if the natural food base is well developed. Traditional fish farming experience shows that feeding carp with whole wheat grain is advisable when the planting density of two-year-olds is up to 3.5 thousand / ha and mainly in August-September. Before eating fish, the grain must necessarily swell in water, otherwise it injures the intestines and is excreted from the digestive tract poorly digested.


2015 ◽  
Author(s):  
Satchel B. Douglas ◽  
Nolan R. Conway ◽  
Matthew B. Weklar

The use of autonomous vehicles is growing in all industries. However, there are no open-source autonomous surface vehicles available in the marine industry. This paper details the design decisions made, construction methods used, and testing performed on a low-cost, open-source vessel. The vessel was designed to cross the Atlantic Ocean as a means of proving its ability to survive the harsh marine environment. A trimaran hull form and free rotating wing sail were used because the combination provided good righting characteristics, durability and low power consumption. The vessel has been shown to navigate autonomously. Total costs were less than $4000 dollars, excluding labor. Vessels of this type could be used for long duration missions recording data in the open ocean at extremely low cost.


1993 ◽  
Vol 13 (2_suppl) ◽  
pp. 544-549 ◽  
Author(s):  
Elias V. Balaskas ◽  
I. Rogers Melamed ◽  
Amit Gupta ◽  
Joanne Bargman ◽  
Dimitrios G. Oreopoulos

Seventeen patients -10 females, 7 males -mean age 52 years (range: 21–77 years), on CAPD for an average of 35 months (range 10–160 months) were studied. Mean initial dose of EPO was 114±45 U/kg/week subcutaneously (range: 59–209). The dose was adjusted to achieve and maintain a target Hb of 100 g/L and Hct 30%. Fifteen of the patients (88.2%) achieved this target within 6 months [baseline to month 6 changes: Hb 72±10 g/L to 107±12 g/L (p=0.0001); Hct 22±3% to 33±4% (p=0.0001)]. Serum total protein also increased significantly over the time of EPO use (p=0.0133); changes from baseline were significant by the fourth month [68±9 g/L to 72±9 g/L (p=0.0115)]. Serum albumin also increased significantly over time (p=0.0157). The change from the baseline result (37±4 g/L) was statistically significant by month 2 (p=0.0060) and was maintained over the following 4 months [month 6 result: 40±3 g/L (p=0.0180)]. The increase was greater for 8 patients with initial serum albumin <35 g/L (mean change 5.75 g/L) than for the 9 subjects with levels >35 g/L (mean change 0.11 g/L). In a comparison group of 17 patients (matched for age, sex, duration of CAPD, underlying disease and antihypertensive treatment), who did not receive EPO treatment, albumin and protein did not appear to increase over time. Mean body weight increased from 60.9± 14.0 kg at the start to 62.1± 13.9 kg at month 6 (p=0.281) and the absolute lymphocyte count from 1.6±0.8 x 109/L to 1.8±1.0 x 109/L (p=0.0472). Serum potassium, urea, creatinine, phosphorus, cholesterol, tri. glycerides, WBC and platelets did not show significant changes over time. Serum phosphorus increased at the end of the second and third months (from 1.6±0.5 mmol/L to 1.9±0.4 and 1.8±0.4 mmol/L and then decreased at the sixth month (1.7±0.5 mmol/L); this is probably due to an increase in phosphate binders in 9 of 17 patients. An improvement in appetite, sleep and well-being, by patients’ self-assessment, was noted during the treatment. We conclude that the treatment with EPO is associated with improvement of the nutritional status of patients on CAPD.


2005 ◽  
Vol 10 (3) ◽  
pp. 133-144 ◽  
Author(s):  
Mary E Lynch

Methadone, although having been available for approximately half a century, is now receiving increasing attention in the management of chronic pain. This is due to recent research showing that methadone exhibits at least three different mechanisms of action including potent opioid agonism, N-methyl-D-aspartate antagonism and monoaminergic effects. This, along with methadone's excellent oral and rectal absorption, high bioavailability, long duration of action and low cost, make it a very attractive option for the treatment of chronic pain. The disadvantages of significant interindividual variation in pharmacokinetics, graduated dose equivalency ratios based on prerotation opioid dose when switching from another opioid, and the requirement for special exemption for prescribing methadone make it more complicated to use. The present review is intended to educate physicians interested in adding methadone to their armamentarium for assisting patients with moderate to severe pain.


Sign in / Sign up

Export Citation Format

Share Document