scholarly journals Dialysate Sodium—One Size Unlikely to Fit All

2021 ◽  
Vol 1 (2) ◽  
pp. 135-137
Author(s):  
Finnian R. Mc Causland
Keyword(s):  
Clinical Care ◽  
Well Being ◽  
Evidence Base ◽  
Medical Director ◽  
Hemodialysis Unit ◽  
The Many ◽  
Fiscal Considerations ◽  
Dialysate Sodium ◽  
Improve Patient

The role of medical director of a hemodialysis unit has become increasingly complex. Among the many roles it encompasses, the delivery of safe and effective dialysis treatments requires constant review, synthesis, and interpretation of the medical literature. Despite decades of experience with hemodialysis, the evidence base for dialysate prescription is relatively limited, with the choice of dialysate sodium being a prime example. The ask of this exercise was to imagine ourselves as the medical director of a new hemodialysis unit and to consider factors influencing the choice of dialysate sodium. While fiscal considerations are indeed important, one hopes that these align with the delivery of clinical care to improve patient well-being. Therefore, my approach was to focus on exploring the clinical responsibilities of a medical director in the choice of dialysate sodium. As such, after reviewing the evidence to date, my ‘default’ dialysate sodium prescription would be 140 mmol/L, but I would retain the option of individualizing treatment for certain patients until further evidence becomes available.

scholarly journals Great debate: how clinicians make their views heard in health reform

2009 ◽  
Vol 33 (1) ◽  
pp. 5
Author(s):  
Scott Blackwell ◽  
Kim Gibson ◽  
Shane Combs ◽  
Rowan Davidson ◽  
Carolyn Drummond ◽  
...  
Keyword(s):  
Health Reform ◽  
Best Practice ◽  
Clinical Care ◽  
Best Interests ◽  
Reform Process ◽  
Reform Agenda ◽  
Great Debate ◽  
System 2 ◽  
The Many

PUBLIC HEALTH SYSTEMS in Australia and internationally are faced with the need to implement significant reforms. These reforms are driven by the need to balance the delivery of best practice clinical care with rapidly spiralling cost pressures. With much of the agenda for reform driven by managerial, administrative and even political priorities, clinicians have often felt sidelined from the reform process. Indeed, there is some evidence that clinicians have had decreased enthusiasm for their work in recent years, coinciding with a greater role of nonmedical managers and more restrictions on resources.1 There is a wealth of experience and intelligence within the clinical workforce that can contribute to finding solutions to the many complex issues facing the health system.2 This experience and intelligence is expressed in advice on the clinician?s specific areas of expertise and often within their own environment. This may work against the clinician having an effective impact on the reform agenda at the macro level. In that context, the establishment of a Clinical Senate in Western Australia to inform the health reform process by debating major issues that impact across the system is innovative. The Clinical Senate requires that Senators adopt a broad view, set aside their particular clinical allegiances and debate the issues in the best interests of the community. The Clinical Senate is a forum that allows clinicians to influence statewide-level processes through formally recognised channels. This article examines the rationale, processes and operation of the Clinical Senate in WA as a mechanism for effective clinician input into health reform.

The Role of Non-Pharmacologic Approaches in the Management of Fibromyalgia

CNS Spectrums ◽  
2009 ◽  
Vol 14 (S16) ◽  
pp. 10-12
Author(s):  
David A. Williams
Keyword(s):  
Patient Education ◽  
Behavioral Therapy ◽  
Well Being ◽  
Evidence Base ◽  
Tender Point ◽  
Clinical Criteria ◽  
The Impact ◽  
Term Benefit

The optimal management of fibromyalgia (FM) is comprised of both pharmacologic and nonpharmacologic approaches. This multidimensional approach is preferred given that FM is not only a pain condition, but involves a number of other symptoms as is reflected in the new clinical criteria being developed by Wolfe and colleagues. Proper management of FM should be informed through multidimensional assessment of the clinically relevant domains described previously in this supplement. Pharmacologic and nonpharmacologic approaches work together to provide the broadest possible coverage of these domains, minimize the impact of each domain on functioning and well-being, and facilitate long-term adaptations to one's lifestyle.The use of nonpharmacologic strategies in the management of FM has varying levels of evidence. The strongest evidence currently exists for aerobic exercise, cognitive-behavioral therapy (CBT), and for patient education or self-management. Moderate evidence exists for strength training, acupuncture, hypnotherapy, and biofeedback modalities. Weaker evidence exists for manual massage therapy. Currently, there is no evidence of long-term benefit for tender point injections or flexibility exercise modalities, although these options may be beneficial in the short term. This article will focus on the three areas that have the strongest evidence base: patient education, exercise, and CBT.Educational programs are typically offered in the context of primary care or in specialty practices. In their simplest form, these programs try to dispel myths about FM and provide patients with the most up-to-date knowledge about the condition.

scholarly journals Evidence ν. rights-based decision making for nutrition

2003 ◽  
Vol 62 (2) ◽  
pp. 553-562 ◽  
Author(s):  
Roger Shrimpton
Keyword(s):  
Human Rights ◽  
Large Body ◽  
Well Being ◽  
Evidence Base ◽  
Wide Distribution ◽  
Role Of The State ◽  
Food And Nutrition ◽  
The Uk ◽  
The Right

The need for an evidence base for human nutrition action is analysed in the context of human rights. Over the last 50 years the twin tracks of development, economical needs based and normative rights based, have come progressively closer in terms of goals and objectives, even if they do maintain different orientations and origins. The international human rights machinery is described, together with those parts that are of relevance to the right to food and nutrition. The role of the State in respecting, protecting and facilitating these rights is further described. The evidence base for the benefit of nutrition interventions during the fetal and infant period to the health and well-being of populations throughout life's course is briefly reviewed, and reasons why such a large body of evidence has not been acted upon are discussed. The power of nutrition is in prevention more than cure, and the prevention of nutritional deficiency is best suited to radical population-wide strategies rather than high-risk strategies targeted at individuals. The population-wide distribution of benefits of nutrition is in congruence with universality of human rights. In the UK much remains to be done to ensure that food and nutrition rights are realised, especially during the critical period of fetal and infant growth. What role the Nutrition Society might play in the realisation of these rights, including the creation of a robust evidence base for nutrition action, is further discussed.

The role of environmental law

2018 ◽  
pp. 298-303
Author(s):  
Cinnamon P. Carlarne ◽  
Jeffrey M. Bielicki
Keyword(s):  
Hydraulic Fracturing ◽  
National Parks ◽  
Environmental Law ◽  
Well Being ◽  
Complex Relationship ◽  
The Many ◽  
Us National Parks

Analysing and developing environmental law requires a broad analysis of the interplay of many factors. This chapter explores some of the many ways in which environmental law influences the connections between nature and people. The chapter does not explore these connections in minute detail, but instead: (i) examines what is meant by ‘environmental law’; (ii) pushes for a broader understanding of the interactions between law, nature, and human well-being; and (iii) provides two examples of the complex relationship between environmental law and human well-being. It provides an overview of environmental law and its origins. It also presents the motivations for environmental law. Finally, hydraulic fracturing and US national parks are used as examples of environmental law and human well-being contexts. These examples highlight some of complicated ways in which environmental law affects human well-being, and demonstrates the need for an expansive view of what well-being entails.

The role of osteopathy in clinical care: Broadening the evidence-base

2017 ◽  
Vol 24 ◽  
pp. 32-36 ◽  
Author(s):  
Amie Steel ◽  
Raymond Blaich ◽  
Tobias Sundberg ◽  
Jon Adams
Keyword(s):  
Clinical Care ◽  
Evidence Base

scholarly journals The Role of Universal Basic Income in Preventing and Ending Homelessness

2021 ◽  
Vol 1 (1) ◽  
pp. 3-13
Author(s):  
Nick Kerman
Keyword(s):  
Well Being ◽  
Evidence Base ◽  
The Political ◽  
Basic Income ◽  
Structural Intervention ◽  
Cash Payment ◽  
Policy Shift ◽  
Phase Out ◽  
Health And Well Being

There are growing calls for Universal Basic Income (UBI) as a means of reducing poverty and addressing the changing nature of work. UBI involves the provision of a cash payment to all adult citizens, which is sufficient to live on and either does not phase out as earnings increase or does so slowly for higher incomes. Despite many theorized benefits and beneficiaries of UBI, its implications for preventing and ending homelessness have not been explored. Accordingly, this article provides an overview on UBI and its evidence base, and then discusses how UBI could help to structurally prevent and end homelessness by reducing values-based exclusion in the provision of income supports, promoting choice in housing, facilitating workforce returns and buffering against automation job losses, and improving health and well-being. Like any transformative policy shift, there are also risks associated with UBI, which largely lie in the details of how it is designed and the political context in which it is implemented. Nevertheless, given its potential, now is the time to properly trial UBI as a structural intervention for preventing and ending homelessness.

Remote Physiologic Monitoring

2021 ◽  
pp. 234-246
Author(s):  
Ksenya K. Badashova ◽  
Tenagne Haile-Mariam ◽  
Robert Jarrin
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Clinical Care ◽  
Clinical Information ◽  
Physiologic Monitoring ◽  
Medical Systems ◽  
Health Care Settings ◽  
Patients At Risk ◽  
Improve Patient

Remote physiologic monitoring (RPM) allows for the collection and transmission of clinical information from a patient to a clinician for evaluation (and potentially intervention) in a synchronous or asynchronous manner. The initiation and judicious utilization of RPM is fundamental to distance-based medical care and provides opportunities to improve clinical outcomes and decrease utilization of resources. COVID-19’s stress on medical systems has encouraged innovations, including those that incorporate RPM. Emergency Department (ED) RPM programs have shown that COVID-19 patients at risk for clinical decompensation can successfully be monitored and treated at home. RPM can capitalize on emergency medicine’s (EM’s) role as the interface between in-patient and out-patient care to implement increasingly complex medical services to patients in nontraditional health care settings. Despite their promise, the development and implementation of RPM programs is a challenging task that requires investment in human and other resources. The role of RPM in expanding EM and ED-based clinical care to improve patient outcomes and decrease costs will require continued investigations and innovations.

scholarly journals Environmental Change and Human Mobility: Trends, Law and Policy

2017 ◽  
Vol 42 ◽  
Author(s):  
Susan F. Martin
Keyword(s):  
Environmental Change ◽  
Human Mobility ◽  
Well Being ◽  
Evidence Base ◽  
Population Movements ◽  
Law And Policy ◽  
Policy Frameworks ◽  
The Many ◽  
The Impact ◽  
The Relationship

Enhancing the protection of persons displaced by natural disasters and the impacts of climate change will require sustained attention. This article identifies practical solutions, many of which are currently under consideration by governments and international organizations, to improve the lives of millions of people affected by environmental crises. It begins with a brief overview of why people move, the nature of those movements, and the relationship between human mobility and adaptation to environmental change by highlighting three types of mobility – migration, displacement and planned relocation. Next, the international and regional level will be discussed, with particular focus on legislative and policy frameworks for addressing human mobility in the context of environmental change. The article identifies gaps in existing frameworks as well as recent efforts to address them, particularly through mini-multilateral initiatives aimed at identifying principles and practices that should guide governmental action. The article concludes that efforts to improve responses require a better evidence base than currently exists on issues such as the environmental determinants of migration, displacement and planned relocation; the multi-faceted ways in which environmental factors relate to the many other causes of population movements in the cases of human mobility; and the impact of such movements on the well-being of migrants, communities of origin, and communities of destination.

Human Security

2018 ◽  
Author(s):  
Kenneth A. Reinert
Keyword(s):  
Human Security ◽  
Well Being ◽  
Security Services ◽  
Arms Trade ◽  
Humanitarian Space ◽  
Negative Impacts ◽  
United Nations System ◽  
The Many ◽  
The Right

This chapter introduces the concept of human security and relates the concept to the basic goods approach. It considers the widespread nature of human security deprivation and the consequent negative impacts for well-being and safety. The chapter examines the right to human security and the central role of this right within the United Nations system of human rights. It considers the related concepts of the right to protect and humanitarian space, the many causes of human insecurity, the contribution of the drug and arms trade to human insecurity, and the various kinds of costs and impacts of human insecurity. It concludes with a brief consideration of various means to better provide human security services.

scholarly journals A Missing Link: Nutritional Healing in Recovery

2018 ◽  
Vol 1 (2) ◽  
pp. 8
Author(s):  
Emmy L Henley
Keyword(s):  
Physical State ◽  
Spiritual Healing ◽  
Well Being ◽  
Nutritional Deficiencies ◽  
Early Recovery ◽  
Missing Link ◽  
Recovery Programs ◽  
The Many ◽  
Recovery Program

The journey of students in a Collegiate Recovery Program (CRP) begins with early recovery and continues towards a well-developed mental, spiritual, emotional, and physical state. Much emphasis is placed on mental, emotional, and spiritual healing through traditional recovery programs. Though all of these aspects are vital to flourishing in recovery, nourishing the physical state is often overlooked. The “missing link” within CRPs, the role of nutrition, can significantly impact physical well-being in recovery and a student’s reconnection with their body. Delivering information to CRP staff and students on the many aspects impacted from nutritional deficiencies and imbalances (neurobiological, gastrointestinal, emotional, mental), particularly in early recovery, will provide a means to evaluate  inclusion of nutritional and physical health emphasis at their CRP.  Appropriate implementation, not only knowledge, of resources to support this “missing link” is also crucial  in a student’s journey to flourishing in recovery.

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