scholarly journals Fewer hospitalizations and prolonged technique survival with Home Hemodialysis– a matched cohort study from the Swedish Renal Registry

2019 ◽  
Author(s):  
Helena Rydell ◽  
Kerstin Ivarsson ◽  
Martin Almquist ◽  
Naomi Clyne ◽  
Mårten Segelmark
Keyword(s):  
Infectious Disease ◽  
Hospital Admissions ◽  
Admission Rate ◽  
European Population ◽  
Matched Cohort ◽  
Home Hemodialysis ◽  
Swedish Population ◽  
Technique Survival ◽  
Start Date ◽  
Dialysis Technique

Abstract Background Patients on home hemodialysis (HHD) exhibit superior survival compared with patients on institutional hemodialysis (IHD) and peritoneal dialysis (PD). There is a sparsity of reports comparing morbidity between HHD and IHD or PD and none in a European population. The aim of this study is to compare morbidity between modalities in a Swedish population. Methods The Swedish Renal Registry was used to retrieve patients starting on HHD, IHD or PD. Patients were matched according to sex, age, comorbidity and start date. The Swedish Inpatient Registry was used to determine comorbidity before starting renal replacement therapy (RRT) and hospital admissions during RRT. Dialysis technique survival was compared between HHD and PD. Results RRT was initiated with HHD for 152 patients; these were matched with 608 patients with IHD and 456 with PD. Patients with HHD had significantly lower annual admission rate and number of days in hospital. (median 1.7 admissions; 12 days) compared with IHD (2.2; 14) and PD (2.8; 20). The annual admission rate was significantly lower for patients with HHD compared with IHD for cardiovascular diagnoses and compared with PD for infectious disease diagnoses. Dialysis technique survival was significantly longer with HHD compared with PD. Conclusions Patients choosing HHD as initial RRT spend less time in hospital compared with patients on IHD and PD and they were more likely than PD patients, to remain on their initial modality. These advantages, in combination with better survival and higher likelihood of renal transplantation, are important incentives for promoting the use of HHD.

scholarly journals Fewer hospitalizations and prolonged technique survival with Home Hemodialysis– a matched cohort study from the Swedish Renal Registry

2019 ◽  
Author(s):  
Helena Rydell ◽  
Kerstin Ivarsson ◽  
Martin Almquist ◽  
Naomi Clyne ◽  
Mårten Segelmark
Keyword(s):  
Infectious Disease ◽  
Hospital Admissions ◽  
Admission Rate ◽  
European Population ◽  
Matched Cohort ◽  
Home Hemodialysis ◽  
Swedish Population ◽  
Technique Survival ◽  
Start Date ◽  
Dialysis Technique

Abstract Background Patients on home hemodialysis (HHD) exhibit superior survival compared with patients on institutional hemodialysis (IHD) and peritoneal dialysis (PD). There is a sparsity of reports comparing morbidity between HHD and IHD or PD and none in a European population. The aim of this study is to compare morbidity between modalities in a Swedish population. Methods The Swedish Renal Registry was used to retrieve patients starting on HHD, IHD or PD. Patients were matched according to sex, age, comorbidity and start date. The Swedish Inpatient Registry was used to determine comorbidity before starting renal replacement therapy (RRT) and hospital admissions during RRT. Dialysis technique survival was compared between HHD and PD. Results RRT was initiated with HHD for 152 patients; these were matched with 608 patients with IHD and 456 with PD. Patients with HHD had significantly lower median annual admission rate and number of days in hospital. (1.7 admissions; 12 days) compared with IHD (2.2; 14) and PD (2.8; 20). The annual admission rate was significantly lower for patients with HHD compared with IHD for cardiovascular diagnoses and compared with PD for infectious disease diagnoses. Dialysis technique survival was significantly longer with HHD compared with PD. Conclusions Patients choosing HHD as initial RRT spend less time in hospital compared with patients on IHD and PD and they were more likely than PD patients, to remain on their initial modality. These advantages, in combination with better survival and higher likelihood of renal transplantation, are important incentives for promoting the use of HHD.

scholarly journals Fewer hospitalizations and prolonged technique survival with home hemodialysis– a matched cohort study from the Swedish Renal Registry

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Helena Rydell ◽  
Kerstin Ivarsson ◽  
Martin Almquist ◽  
Naomi Clyne ◽  
Mårten Segelmark
Keyword(s):  
Infectious Disease ◽  
Hospital Admissions ◽  
Admission Rate ◽  
European Population ◽  
Matched Cohort ◽  
Home Hemodialysis ◽  
Swedish Population ◽  
Technique Survival ◽  
Start Date ◽  
Dialysis Technique

Abstract Background Patients on home hemodialysis (HHD) exhibit superior survival compared with patients on institutional hemodialysis (IHD) and peritoneal dialysis (PD). There is a sparsity of reports comparing morbidity between HHD and IHD or PD and none in a European population. The aim of this study is to compare morbidity between modalities in a Swedish population. Methods The Swedish Renal Registry was used to retrieve patients starting on HHD, IHD or PD. Patients were matched according to sex, age, comorbidity and start date. The Swedish Inpatient Registry was used to determine comorbidity before starting renal replacement therapy (RRT) and hospital admissions during RRT. Dialysis technique survival was compared between HHD and PD. Results RRT was initiated with HHD for 152 patients; these were matched with 608 patients with IHD and 456 with PD. Patients with HHD had significantly lower annual admission rate and number of days in hospital. (median 1.7 admissions; 12 days) compared with IHD (2.2; 14) and PD (2.8; 20). The annual admission rate was significantly lower for patients with HHD compared with IHD for cardiovascular diagnoses and compared with PD for infectious disease diagnoses. Dialysis technique survival was significantly longer with HHD compared with PD. Conclusions Patients choosing HHD as initial RRT spend less time in hospital compared with patients on IHD and PD and they were more likely than PD patients, to remain on their initial modality. These advantages, in combination with better survival and higher likelihood of renal transplantation, are important incentives for promoting the use of HHD.

scholarly journals Fewer hospitalizations and prolonged technique survival with Home Hemodialysis– a matched cohort study from the Swedish Renal Registry

2019 ◽  
Author(s):  
Helena Rydell ◽  
Kerstin Ivarsson ◽  
Martin Almquist ◽  
Naomi Clyne ◽  
Mårten Segelmark
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Hospital Admissions ◽  
Admission Rate ◽  
Care Utilization ◽  
Matched Cohort ◽  
Home Hemodialysis ◽  
Technique Survival ◽  
Start Date ◽  
Dialysis Technique

Abstract Background Patients on home hemodialysis (HHD) exhibit superior survival compared with patients on institutional hemodialysis (IHD) and peritoneal dialysis (PD). However, the effects of treatment modality on morbidity and health care utilization are divergent between studies. The aim of this study is to compare health care utilization between modalities. Methods The Swedish Renal Registry was used to retrieve patients starting on HHD, IHD or PD. Patients were matched according to sex, age, comorbidity and start date. The Swedish Inpatient Registry was used to determine comorbidity before starting renal replacement therapy (RRT) and hospital admissions during RRT. Dialysis technique survival was compared between HHD and PD. Results RRT was initiated with HHD for 152 patients; these were matched with 608 patients with IHD and 456 with PD. Patients with HHD had significantly lower median annual admission rate and number of days in hospital. (1.7 admissions; 12 days) compared with IHD (2.2; 14) and PD (2.8; 20). The annual admission rate was significantly lower for patients with HHD compared with IHD for cardiovascular diagnoses and compared with PD for infectious disease diagnoses. Dialysis technique survival was significantly longer with HHD compared with PD. Conclusions Patients choosing HHD as initial RRT spend less time in hospital compared with patients on IHD and PD and they were more likely than PD patients, to remain on their initial modality. These advantages, in combination with better survival and higher likelihood of renal transplantation, are important incentives for promoting the use of HHD.

81 Integrating A Front Door Frailty Service in the Emergency Department: Results of A Pilot Study

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
L Dunnell ◽  
A Shrestha ◽  
E Li ◽  
Z Khan ◽  
N Hashemi
Keyword(s):  
Emergency Department ◽  
Hospital Admissions ◽  
Admission Rate ◽  
Community Services ◽  
Service Improvement ◽  
Specialist Nurse ◽  
Front Door ◽  
Medication Changes ◽  
Health Service Improvement

Abstract Introduction Increasing old age and frailty is putting pressure on health services with 5–10% of patients attending the emergency department (ED) and 30% of patients in acute medical units classified as older and frail. National Health Service improvement mandates that by 2020 hospital trusts with type one EDs provide at least 70 hours of acute frailty service each week. Methodology A two-week pilot (Monday–Friday 8 am-5 pm) was undertaken, with a “Front Door Frailty Team” comprising a consultant, junior doctor, specialist nurse and pharmacist, with therapy input from the existing ED team. They were based in the ED seeing patients on arrival, referrals from the ED team and patients in the ED observation ward—opposed to the usual pathway of referral from the ED team to medical team. Data was captured using “Cerner” electronic healthcare records. A plan, do, study, act methodology was used throughout with daily debrief and huddle sessions. Results 95 patients were seen over two weeks. In the over 65 s, average time to be seen was 50 minutes quicker than the ED team over the same period, with reduced admission rate (25.7% vs 46.5%). The wait between decision to admit and departure was shortened by 119 minutes. Overall, this led to patients spending on average 133 minutes less in the ED. 64 patients were discharged, of which 44 had community follow-up (including 37.5% of 64 referred to acute elderly clinic and 25% to rapid response). 47 medications were stopped across 25 patients. Conclusion The pilot shows that introduction of an early comprehensive geriatric assessment in the ED can lead to patients being seen sooner, with more timely decisions over their care and reduction in hospital admissions. It allowed for greater provision of acute clinics and community services as well as prompt medication review and real time medication changes.

scholarly journals Invasive Devices and Sensors for Remote Care of Heart Failure Patients

Sensors ◽  
2021 ◽  
Vol 21 (6) ◽  
pp. 2014
Author(s):  
Sumant P. Radhoe ◽  
Jesse F. Veenis ◽  
Jasper J. Brugts
Keyword(s):  
Heart Failure ◽  
Remote Monitoring ◽  
Hospital Admissions ◽  
Acute Decompensated Heart Failure ◽  
Admission Rate ◽  
Decompensated Heart Failure ◽  
Hospital Admission Rate ◽  
Remote Care ◽  
New Sensors ◽  
Near Future

The large and growing burden of chronic heart failure (CHF) on healthcare systems and economies is mainly caused by a high hospital admission rate for acute decompensated heart failure (HF). Several remote monitoring techniques have been developed for early detection of worsening disease, potentially limiting the number of hospitalizations. Over the last years, the scope has been shifting towards the relatively novel invasive sensors capable of measuring intracardiac filling pressures, because it is believed that hemodynamic congestion precedes clinical congestion. Monitoring intracardiac pressures may therefore enable clinicians to intervene and avert hospitalizations in a pre-symptomatic phase. Several techniques have been discussed in this review, and thus far, remote monitoring of pulmonary artery pressures (PAP) by the CardioMEMS (CardioMicroelectromechanical system) HF System is the only technique with proven safety as well as efficacy with regard to the prevention of HF-related hospital admissions. Efforts are currently aimed to further develop existing techniques and new sensors capable of measuring left atrial pressures (LAP). With the growing body of evidence and need for remote care, it is expected that remote monitoring by invasive sensors will play a larger role in HF care in the near future.

Differences in peritoneal dialysis technique survival between patients treated with peritoneal dialysis systems from different companies

2018 ◽  
Vol 34 (6) ◽  
pp. 1035-1044 ◽  
Author(s):  
Neil Boudville ◽  
Shahid Ullah ◽  
Phil Clayton ◽  
Kamal Sud ◽  
Monique Borlace ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Technique Survival ◽  
Dialysis Technique

scholarly journals Smoking Ban: A Long-term Analysis of the Malta Paradox in a Population of over 400,000 Subjects

2015 ◽  
Vol 1 (4) ◽  
pp. 184 ◽  
Author(s):  
Caroline Magri ◽  
Robert Xuereb ◽  
Sandra Distefano ◽  
Neville Calleja ◽  
Victor Grech
Keyword(s):  
Hospital Admissions ◽  
Public Awareness ◽  
Age Groups ◽  
Admission Rate ◽  
Coronary Heart Disease Mortality ◽  
Smoking Ban ◽  
Annual Data ◽  
Public Areas ◽  
Coronary Syndromes ◽  
The Impact

Objectives: The introduction of laws that make indoor public areas and workplaces smoke-free has resulted in a significant<br />reduction in the incidence of acute coronary syndromes (ACS). Malta was the second European country to introduce the<br />smoking ban legislation in April 2004. The purpose of the study was to investigate the impact of the smoking ban in Malta on<br />ACS morbidity and mortality.<br />Methods: The number of ACS hospital admissions and the number of cardiovascular deaths were retrospectively analysed.<br />The annual data for 5 years prior to and following the introduction of the Tobacco Act were obtained according to age-groups<br />for both genders. Poisson regression analyses were performed to assess for decline in ACS admission and cardiovascular<br />death.<br />Results: The ACS admission rate increased throughout the 5 years following the introduction of the smoking ban. There was<br />no change in mortality rate in the 5 years following the legislation, except in 2007 when a small but significant decline was<br />noted.<br />Conclusions: The Malta smoking ban did not have a significant impact on cardiovascular mortality and ACS admissions<br />rates, indicating the need for proper enforcement of the public smoking ban and increase in public awareness regarding the<br />adverse effects of smoking.<br />Key words: Coronary heart disease; Mortality; Prevention; Smoking.

scholarly journals Biphasic pattern in the effect of severe measles infection; the difference between additive and multiplicative scale

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nhat Thanh Hoang Le ◽  
Nhan Thi Ho ◽  
Bryan Grenfell ◽  
Stephen Baker ◽  
Ronald B. Geskus
Keyword(s):  
Infectious Diseases ◽  
Hospital Admission ◽  
Measles Virus ◽  
Hospital Admissions ◽  
Admission Rate ◽  
Second Phase ◽  
Before And After ◽  
The Difference ◽  
Two Phases ◽  
Additive Scale

Abstract Background Infection with measles virus (MeV) causes immunosuppression and increased susceptibility to other infectious diseases. Only few studies reported a duration of immunosuppression, with varying results. We investigated the effect of immunosuppression on the incidence of hospital admissions for infectious diseases in Vietnamese children. Methods We used retrospective data (2005 to 2015; N = 4419) from the two pediatric hospitals in Ho Chi Minh City, Vietnam. We compared the age-specific incidence of hospital admission for infectious diseases before and after hospitalization for measles. We fitted a Poisson regression model that included gender, current age, and time since measles to obtain a multiplicative effect measure. Estimates were transformed to the additive scale. Results We observed two phases in the incidence of hospital admission after measles. The first phase started with a fourfold increased rate of admissions during the first month after measles, dropping to a level quite comparable to children of the same age before measles. In the second phase, lasting until at least 6 years after measles, the admission rate decreased further, with values up to 20 times lower than in children of the same age before measles. However, on the additive scale the effect size in the second phase was much smaller than in the first phase. Conclusion The first phase highlights the public health benefits of measles vaccination by preventing measles and immune amnesia. The beneficial second phase is interesting, but its strength strongly depends on the scale. It suggests a complicated interaction between MeV infection and the host immunity.

Continuous Ambulatory Peritoneal Dialysis (CAPD) in a Developing Country

1985 ◽  
Vol 5 (1) ◽  
pp. 56-58 ◽  
Author(s):  
Jorge Dominguez ◽  
Gladys Gonzalez ◽  
Lenin Figueroa ◽  
Jose Mendez
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Transplantation ◽  
End Stage Renal Disease ◽  
Admission Rate ◽  
Home Hemodialysis ◽  
Hospital Admission Rate ◽  
Economic Problems ◽  
Stage Renal Disease ◽  
End Stage ◽  
Chronic Ambulatory Peritoneal Dialysis

This paper describes our experience during the first 39 months of the CAPD program at the Miguel Perez Carreno Hospital in Caracas, Venezuela. Forty-eight patients were started on CAPD and treated for a total of 767 patient/months. Mean age was 45.8 years. Average time in the program was 15.9 months. At 39 months 87% of patients were alive and 78% were still on CAPD. The peritonitis rate was one episode per 6.39 pt/month with a probability of peritonitis of 0.70 at 25 months. Incidence of sterile peritonitis was high (41 %). Our patients had a low hospital admission rate (0.5 days per patient month) and a high percentage were rehabilitated (81%). Chronic ambulatory peritoneal dialysis (CAPD) is a widely accepted therapy for end-stage renal disease (ESRD): in Venezuela, approximately 160 patients (37%) of all those under treatment for ESRD receive this form of therapy. The Nephrology Section of the Miguel Perez Carreno Hospital in Caracas manages the largest CAPD program in the country. Here 149 patients are receiving treatment for ESRD by different techniques -hospital hemodialysis, home hemodialysis, intermittent peritoneal dialysis, CAPD and renal transplantation, under the care of five nephrologists, four nephrology residents and 30 nurses. Our CAPD program started in January 1980. This paper, which describes our three years of experience, indicates that CAPD is feasible in a country such as ours which, because of economic problems, is limited in its ability to provide other forms of treatment for ESRD.

scholarly journals Place-based social contact and mixing: a typology of generic meeting places of relevance for infectious disease transmission

2017 ◽  
Vol 145 (12) ◽  
pp. 2582-2593 ◽  
Author(s):  
M. STRÖMGREN ◽  
E. HOLM ◽  
Ö. DAHLSTRÖM ◽  
J. EKBERG ◽  
H. ERIKSSON ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Disease Transmission ◽  
Social Contact ◽  
Physical Contact ◽  
Transmission Risk ◽  
Geographical Differences ◽  
Infectious Disease Transmission ◽  
Swedish Population ◽  
The Social ◽  
The Family

SUMMARYThis study aims to develop a typology of generic meeting places based on social contact and mixing of relevance for infectious disease transmission. Data were collected by means of a contact diary survey conducted on a representative sample of the Swedish population. The typology is derived from a cluster analysis accounting for four dimensions associated with transmission risk: visit propensity and its characteristics in terms of duration, number of other persons present and likelihood of physical contact. In the analysis, we also study demographic, socio-economic and geographical differences in the propensity of visiting meeting places. The typology identifies the family venue, the fixed activity site, the family vehicle, the trading plaza and the social network hub as generic meeting places. The meeting place typology represents a spatially explicit account of social contact and mixing relevant to infectious disease modelling, where the social context of the outbreak can be highlighted in light of the actual infectious disease.

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