scholarly journals Ambulatory Hemodialysis-Technology Landscape and Potential for Patient-Centered Treatment

2019 ◽  
Vol 15 (1) ◽  
pp. 152-159 ◽  
Author(s):  
Nina Hojs ◽  
William H. Fissell ◽  
Shuvo Roy
Keyword(s):  
The United States ◽  
Implantable Devices ◽  
Recent Experience ◽  
Patient Centered ◽  
Number Of Patients ◽  
Key Technologies ◽  
Kidney Replacement Therapy ◽  
Intensive Hemodialysis ◽  
Wearable Unit

CKD is a worldwide health problem and the number of patients requiring kidney replacement therapy is rising. In the United States, most patients with ESKD rely on in-center hemodialysis, which is burdensome and does not provide the same long-term benefits as kidney transplantation. Intensive hemodialysis treatments have demonstrated improved clinical outcomes, but its wider adoption is limited by equipment complexity and patient apprehension. Ambulatory devices for hemodialysis offer the potential for self-care treatment outside the clinical setting as well as frequent and prolonged sessions. This article explains the motivation for ambulatory hemodialysis and provides an overview of the necessary features of key technologies that will be the basis for new wearable and implantable devices. Early work by pioneers of hemodialysis is described followed by recent experience using a wearable unit on patients. Finally, ongoing efforts to develop an implantable device for kidney replacement and its potential for implantable hemodialysis are presented.

scholarly journals Providing care to long-term mechanically ventilated patients in Germany – Current situation and needs for action from the perspective of health professionals / Die Versorgung langzeitbeatmeter Patienten in Deutschland – Aktuelle Situation und Handlungsbedarfe aus der Sicht von Gesundheitsberufsangehörigen

2020 ◽  
Vol 7 (1) ◽  
pp. 53-65
Author(s):  
Yvonne Lehmann ◽  
Susanne Stark ◽  
Michael Ewers
Keyword(s):  
Health Professionals ◽  
Invasive Mechanical Ventilation ◽  
Life Quality ◽  
Control Mechanisms ◽  
Health Providers ◽  
Patient Centered ◽  
Patient Pathways ◽  
Number Of Patients

AbstractBackgroundThe number of patients depending on long-term invasive mechanical ventilation (IMV) has been increasing for several years. Anecdotal reports indicate heterogeneous health structures, opaque patient pathways, nontransparent and sometimes questionable practices in individual areas of care, inadequate quality standards and control mechanisms in Germany. However, there is hardly any empirical data on this topic.AimTo report findings from a qualitative study conducted as part of a complex research project to assess the appropriateness of care provided to IMV patients in Germany.MethodsThirteen semi-structured expert interviews were conducted with 22 health professionals providing care for IMV patients. The data analysis was conducted with MAXQDA according to the framework by Meuser and Nagel.ResultsInterviewees emphasized similar healthcare deficits. They considered health providers to be nontransparent and influenced by secondary interests. Quality of care is reported to be jeopardized by shortage of trained staff. Warranty of self-determination and participatory decision-making is not a matter of fact. Clarifying issues of sustaining life, quality of life and shaping the end of life is often ignored. The professionals are familiar with the patient pathways, allocation processes and responsibilities described in existing guidelines, but criticize the fact that they are not sufficiently binding. Accordingly, patient pathways are frequently individual results of experience-based, informal networking, and often left to chance.ConclusionsThe results point to a considerable need for action to reach an appropriate, integrated, patient-centered level of care for long-term IMV patients and ensure its quality.

Predictive value of the conditions for the optimal dialysis initiation (Meta-analysis of observational studies)

2021 ◽  
Vol 25 (4) ◽  
pp. 42-47
Author(s):  
V. A. Dobronravov ◽  
A. V. Karunnaya
Keyword(s):  
Observational Studies ◽  
Meta Analysis ◽  
Fatal Outcome ◽  
Systematic Search ◽  
Dialysis Initiation ◽  
Patient Centered ◽  
Number Of Patients ◽  
Initiation Of Dialysis ◽  
Publica Tions

BACKGROUND. The survival of dialysis patients remains unsatisfactory. A number of observational studies have shown that the conditions of initiation of dialysis can influence long-term outcomes, including mortality.THE AIM. To compare the mortality of patients under predefined conditions of optimal (planned) and suboptimal (unplanned) dialysis initiation.METHODS. Using the MEDLINE and EMBASE databases from inception to June 2020, we conducted a systematic search for studies that examined the overall mortality of patients who met or did not meet the predefined conditions for an “optimal” start of renal replacement therapy (RRT): planned vs. unplanned onset; initiation of substitution therapy on permanent access vs. temporary; with priorobservation of the nephrologist vs. without it. As a result of a systematic search, subsequent analysis and selection of publica tions, 8 studies were included in the meta-analysis (total number of incident patients was 22755; 13680 patients met the conditions of the optimal dialysis start).RESULTS. All-cause mortality among patients with the conditions of suboptimal dialysis start was higher than in those with the optimal start (34.4 % vs. 46.6 %, p<0,001) with the increase in the relative risk (RR) of fatal outcome by 35.1 % (95 % confidence interval (CI) 30.8 %-39.4 %, p<0.0001). Estimated number of patients needed to start dialysis in the optimal conditions to prevent 1 death was 8 (95 % CI 7-9).CONCLUSION. The meta-analysis demonstrated the relationship between the urgent initiation of RRT, the use of temporary access for dialysis, and the lack of timely prior follow-up by a nephrologist with an increase in mortality. Prevention of dialysis initiation in these suboptimal conditions in real-world clinical practice can be an effective tool for improving patient-centered outcomes.

Bibliometric Analysis of Integrative Medicine Studies from 2000 to 2019

2021 ◽  
pp. 1-13
Author(s):  
Bo-Young Youn ◽  
Hyun Jong Song ◽  
Keeyoung Yang ◽  
Chunhoo Cheon ◽  
Youme Ko ◽  
...  
Keyword(s):  
Patient Care ◽  
Integrative Medicine ◽  
Healthcare Providers ◽  
Well Being ◽  
The United States ◽  
Patient Centered ◽  
Medicine Research ◽  
Number Of Patients ◽  
Centered Care ◽  
Complementary And Alternative

Integrative medicine has become a vital component of patient care. It provides patient-centered care that is focused on prevention and overall well-being. As there has been a growing number of patients favoring a blend of conventional, complementary and alternative approaches, integrative medicine has exceeded beyond the evaluation of complementary therapies. However, it is noteworthy that there has been a dilemma of providing substantial evidence supporting the efficacy of some complementary and alternative therapies. This study’s goals were to analyze publication trends, most productive journals, most productive funding agencies, most productive authors, most relevant keywords, and countries in the field of integrative medicine research. Additionally, science mapping included country collaboration analysis and thematic evolution analysis. The findings from this study showed a constant rise in annual growth of publications from 2000 to 2019; the United States was dominant in various analysis categories. In conclusion, a comprehensive review of the evolution of research of integrative medicine will help healthcare providers understand an overview of the present status while encouraging more evidence-based research for the betterment of integrative patient care.

scholarly journals Insights into Effects/Risks of Chronic Hypergastrinemia and Lifelong PPI Treatment in Man Based on Studies of Patients with Zollinger–Ellison Syndrome

2019 ◽  
Vol 20 (20) ◽  
pp. 5128 ◽  
Author(s):  
Lingaku Lee ◽  
Irene Ramos-Alvarez ◽  
Tetsuhide Ito ◽  
Robert T. Jensen
Keyword(s):  
Side Effects ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
The United States ◽  
Long Term Effects ◽  
Ulcer Disease ◽  
Zollinger Ellison Syndrome ◽  
Number Of Patients

The use of proton pump inhibitors (PPIs) over the last 30 years has rapidly increased both in the United States and worldwide. PPIs are not only very widely used both for approved indications (peptic ulcer disease, gastroesophageal reflux disease (GERD), Helicobacter pylori eradication regimens, stress ulcer prevention), but are also one of the most frequently off-label used drugs (25–70% of total). An increasing number of patients with moderate to advanced gastroesophageal reflux disease are remaining on PPI indefinitely. Whereas numerous studies show PPIs remain effective and safe, most of these studies are <5 years of duration and little data exist for >10 years of treatment. Recently, based primarily on observational/epidemiological studies, there have been an increasing number of reports raising issues about safety and side-effects with very long-term chronic treatment. Some of these safety issues are related to the possible long-term effects of chronic hypergastrinemia, which occurs in all patients taking chronic PPIs, others are related to the hypo-/achlorhydria that frequently occurs with chronic PPI treatment, and in others the mechanisms are unclear. These issues have raised considerable controversy in large part because of lack of long-term PPI treatment data (>10–20 years). Zollinger–Ellison syndrome (ZES) is caused by ectopic secretion of gastrin from a neuroendocrine tumor resulting in severe acid hypersecretion requiring life-long antisecretory treatment with PPIs, which are the drugs of choice. Because in <30% of patients with ZES, a long-term cure is not possible, these patients have life-long hypergastrinemia and require life-long treatment with PPIs. Therefore, ZES patients have been proposed as a good model of the long-term effects of hypergastrinemia in man as well as the effects/side-effects of very long-term PPI treatment. In this article, the insights from studies on ZES into these controversial issues with pertinence to chronic PPI use in non-ZES patients is reviewed, primarily concentrating on data from the prospective long-term studies of ZES patients at NIH.

scholarly journals State Budget Deficit Dynamics and the California Debacle

2004 ◽  
Vol 18 (2) ◽  
pp. 205-226 ◽  
Author(s):  
Steven M Sheffrin
Keyword(s):  
The United States ◽  
Capital Gains ◽  
Recent Experience ◽  
Budget Deficits ◽  
State Budget ◽  
Revenue Sources ◽  
Depth Analysis ◽  
The Face ◽  
Budgetary Decisions

This paper analyzes the recent experience with state budget deficits in the United States, with an in-depth analysis of the California experience. Compared to prior recessions, states were slower to make adjustments in taxes and spending this time. The paper explores a variety of reasons for this difference including changes in the legal, political, and institutional environments, the unusual increase in capital gains revenue during the boom preceding the recession, and the inherent difficulties in forecasting revenues, particularly those derived from capital income. As the case study from California illustrates, states made long term commitments from temporary revenue sources and were required to make budgetary decisions in the face of very incomplete information about current and projected tax receipts.

From Concierge Medicine to Patient-Centered Medical Homes: International Lessons & the Search for a Better Way to Deliver Primary Health Care in the U.S.

2009 ◽  
Vol 35 (4) ◽  
pp. 585-619 ◽  
Author(s):  
Gwendolyn Roberts Majette
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Business Models ◽  
Quality Care ◽  
Chronically Ill ◽  
The United States ◽  
Direct Access ◽  
Patient Centered ◽  
Number Of Patients ◽  
Efficient Resource

Primary care is crucial to the United States health care system. It is essential to the provision of high quality care; including the ability to reach health outcomes, ensure patient satisfaction, and facilitate efficient resource use. Primary care also places strong “emphasis on health promotion, disease prevention, and care of the chronically ill.”Physicians have introduced two business models in their attempts to improve the delivery of primary care: Concierge Medicine (“CM”) and the Patient Centered Medical Home (“PCMH”). Both models provide personalized, comprehensive preventive care services.CM is a private medical practice in which the physician charges patients an annual fee to be a patient in the practice. In exchange, the physician limits the number of patients in order to offer more personalized services and amenities such as: direct access through email or cell phone, same day or next day appointments, longer, more personalized appointments, house calls, and physician accompaniment to a specialist.

scholarly journals Milan Criteria and UCSF Criteria: A Preliminary Comparative Study of Liver Transplantation Outcomes in the United States

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Supriya S. Patel ◽  
Amanda K. Arrington ◽  
Shaun McKenzie ◽  
Brian Mailey ◽  
Michelle Ding ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Overall Survival ◽  
Survival Rates ◽  
Hepatocellular Cancer ◽  
The United States ◽  
Milan Criteria ◽  
Ucsf Criteria ◽  
Number Of Patients ◽  
Transplantation Outcomes

The application of orthotopic liver transplantation (OLT) for patients with hepatocellular cancer (HCC) necessitates highly selective criteria to maximize survival and to optimize allocation of a scarce resource. The objective of this study was to compare the outcomes of OLT for HCC in patients transplanted under Milan and UCSF criteria. The United Network of Organ Sharing (UNOS) database was queried for patients who had undergone OLT for HCC from 2002 to 2007, and 1,972 patients (Milan criteria,n=1,913; UCSF criteria,n=59) were identified. Patients were stratified by pretransplant criteria (Milan versus UCSF), and clinical and pathologic factors and overall survival were compared. There were no differences in age, gender, diabetes mellitus, body mass index, and hepatitis B, or C status between the two groups. Overall survival was similar between the Milan and UCSF cohorts (1-, 2-, 3-, and 4-year survival rates: 88%, 81%, 76%, and 72% versus 91%, 80%, 68% and 51%, respectively,P=0.21). Although the number of patients within UCSF criteria was small, our results nevertheless suggest that patients with HCC may have equivalent survival when transplanted under Milan and UCSF criteria. Long-term followup may better determine whether UCSF criteria should be widely adopted.

Abstract 4629: Long-Term Open Label Extension of the Prevention of Embolic and Thrombotic Events on Dabigatran in Atrial Fibrillation (PETRO- Ex study)

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Rangadham Nagarakanti ◽  
Michael D Ezekowitz ◽  
Kambiz Parcham-Azad ◽  
Paul A Reilly ◽  
Gerhard Nehmiz ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Major Bleeding ◽  
Anticoagulation Therapy ◽  
The United States ◽  
Thrombin Inhibitor ◽  
Bleeding Events ◽  
Open Label ◽  
Onset Of Action ◽  
Number Of Patients

Dabigatran is an oral direct thrombin inhibitor (DTI), which has a rapid onset of action and can be given twice daily (b-i-d) without anticoagulation monitoring. To determine the long term safety and efficacy of dabigatran in patients with atrial fibrillation (AF). AF patients (n=502) from 53 centers in Denmark, the Netherlands, Sweden and the United States were enrolled in the PETRO study, a 12 week comparison between dabigatran (50, 150, and 300 mg b-i-d) and warfarin (INR 2–3). 361 dabigatran patients were rolled over into a long term extension trial (PETRO-Ex). The warfarin patient arm (n=70) was discontinued. All patients were initially maintained on the same dabigatran doses as in PETRO except the 50 mg b-i-d dose group who were switched to 150 mg once daily (qd). At entry, patients were 70 years old (mean age), 19% female, median AF duration of 4.2 years, and had a median of 3 stroke risk factors. Maximum and mean follow-up times were 51 and 29 months respectively. Due to higher frequency of major bleeding events in 300 mg b-i-d group and thromboembolic events in 150 mg qd group, they were switched to dabigatran 300 mg qd or 150 mg b-i-d groups. PETRO and PETRO-Ex results: Events reported as absolute number of patients (per 100 patient-years) Thromboembolic event rates were lowest in the dabigatran 150 and 300 mg b-i-d groups. Major bleeding was most frequent in the 300 mg b-i-d group. No significant liver function abnormalities were noted in any of the dabigatran groups. The balance between stroke and bleeding risk supported dabigatran doses between 100 and 150 mg b-i-d for the ongoing phase 3 Randomized Evaluation of Longterm anticoagulation therapY (RELY) trial.

Speech-Language Pathology in the Peace Corps: Necessity and Sustainability

2012 ◽  
Vol 2 (1) ◽  
pp. 11-18
Author(s):  
Melissa A. Pierce
Keyword(s):  
United States ◽  
Special Education ◽  
Peace Corps ◽  
People With Disabilities ◽  
Communication Disorders ◽  
The United States ◽  
Speech Language Pathology ◽  
Speech Language Pathologists ◽  
Language Pathology

In countries other than the United States, the study and practice of speech-language pathology is little known or nonexistent. Recognition of professionals in the field is minimal. Speech-language pathologists in countries where speech-language pathology is a widely recognized and respected profession often seek to share their expertise in places where little support is available for individuals with communication disorders. The Peace Corps offers a unique, long-term volunteer opportunity to people with a variety of backgrounds, including speech-language pathologists. Though Peace Corps programs do not specifically focus on speech-language pathology, many are easily adapted to the profession because they support populations of people with disabilities. This article describes how the needs of local children with communication disorders are readily addressed by a Special Education Peace Corps volunteer.

Multidisciplinary Evidence to Treat Bilingual Individuals with Aphasia

2008 ◽  
Vol 15 (3) ◽  
pp. 66-72 ◽  
Author(s):  
José G. Centeno
Keyword(s):  
Stroke Rehabilitation ◽  
Culturally Diverse ◽  
Treatment Strategies ◽  
The United States ◽  
Intervention Strategies ◽  
Steady Increase ◽  
Clinical Procedures ◽  
Bilingual Speakers ◽  
Aphasic Clients

Abstract The steady increase in linguistic and cultural diversity in the country, including the number of bilingual speakers, has been predicted to continue. Minorities are expected to be the majority by 2042. Strokes, the third leading cause of death and the leading cause of long-term disability in the U.S., are quite prevalent in racial and ethnic minorities, so population estimates underscore the imperative need to develop valid clinical procedures to serve the predicted increase in linguistically and culturally diverse bilingual adults with aphasia in post-stroke rehabilitation. Bilingualism is a complex phenomenon that interconnects culture, cognition, and language; thus, as aphasia is a social phenomenon, treatment of bilingual aphasic persons would benefit from conceptual frameworks that exploit the culture-cognition-language interaction in ways that maximize both linguistic and communicative improvement leading to social re-adaptation. This paper discusses a multidisciplinary evidence-based approach to develop ecologically-valid treatment strategies for bilingual aphasic individuals. Content aims to spark practitioners' interest to explore conceptually broad intervention strategies beyond strictly linguistic domains that would facilitate linguistic gains, communicative interactions, and social functioning. This paper largely emphasizes Spanish-English individuals in the United States. Practitioners, however, are advised to adapt the proposed principles to the unique backgrounds of other bilingual aphasic clients.

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