Who Should Place Peritoneal Dialysis Catheters?

2010 ◽  
Vol 30 (2) ◽  
pp. 142-150 ◽  
Author(s):  
John H. Crabtree
Keyword(s):  
Peritoneal Dialysis ◽  
Training Programs ◽  
The United States ◽  
Fellowship Training ◽  
Catheter Placement ◽  
Medical Society ◽  
Dialysis Access ◽  
Surgical Workforce ◽  
Surgeon Performance

BackgroundNephrologists are often thwarted in their attempts to grow their peritoneal dialysis programs because of suboptimal surgeon performance in placing catheters. A rallying call is heard among nephrologists to step up to the role of dialysis access providers.ObjectiveWhat factors influence the practicability of nephrologists becoming primary dialysis access providers? Why have surgeons failed their task and can anything motivate them to change their performance and improve outcomes?MethodsWhile the issues are universal, this analysis focuses on current practice data from the United States. Evidence reviewed includes dialysis center size and annual new starts, profile of specialties performing catheter placement, nephrology workforce capacity, catheter implantation methodology, resource utilization for peritoneal access, and surgeon performance.ResultsThe current nephrology workforce is running at maximum capacity and fellowship training programs will struggle to meet additional demands. Nephrology training programs are often deficient in providing adequate experience in peritoneal dialysis management. Only 2.3% of peritoneal catheters are placed by nephrologists. The best catheter outcomes are produced by laparoscopic methods used by surgeons. Compared to other catheter placement techniques, laparoscopy enables a larger candidate pool of patients. Nonetheless, suboptimal surgical performances are related to inadequate training, low procedure volume, and poor reimbursement.ConclusionsIt is improbable that nephrologists can expand the scope of their practice to assume the additional role of dialysis access providers. The performance of the existing surgical workforce can be enhanced through medical society-sponsored educational activities, channeling access procedures to designated surgeons, and improved remuneration through outcomes-based incentive programs.

Modification of the percutaneous approach to peritoneal dialysis catheter placement under peritoneoscopic visualization: clinical results in 78 patients.

1992 ◽  
Vol 3 (1) ◽  
pp. 103-107
Author(s):  
N S Nahman ◽  
D F Middendorf ◽  
W H Bay ◽  
R McElligott ◽  
S Powell ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Catheter Placement ◽  
Seldinger Technique ◽  
First Episode ◽  
Dialysis Access ◽  
Peritoneal Dialysis Catheter ◽  
Exit Site ◽  
Exit Site Infection ◽  
Percutaneous Approach ◽  
Tunnel Infection

The placement of percutaneous peritoneal dialysis catheters under direct peritoneoscopic visualization is a relatively new technique for establishing peritoneal dialysis access. In this study, in which a modification of the Seldinger technique was used to facilitate the placement of the peritoneoscope, the experience with 82 consecutive catheterization procedures in 78 patients is reported. In 2 (2.4%) of 82 catheterization procedures, we were unable to enter the peritoneal cavity but experienced no other complications unique to the percutaneous approach. Of the 80 successful catheterization procedures, 76 represented first-time catheter placement and constituted a population subjected to life-table analysis examining catheter survival rates, the time to first cutaneous exit site or s.c. tunnel infection, and the time to first episode of peritonitis. After a follow-up period of 50.1 patient yr, 11 catheters were lost because of catheter dysfunction. Other clinical complications included peritoneal fluid leaks at the cutaneous exit site in 11 instances (0.22/patient yr), cutaneous exit site infection in 7 instances (0.14/patient yr), s.c. tunnel infection in 2 instances (0.04/patient yr), and 34 episodes of peritonitis (0.68/patient yr). The results of this study demonstrate that the suggested modification of the percutaneous placement of peritoneal dialysis catheters, under peritoneoscopic visualization, is a viable method for establishing peritoneal access.

Pediatricians as Child Health Advocates: The Role of Advocacy Education

2020 ◽  
Vol 22 (1) ◽  
pp. 13-17
Author(s):  
Nancy A. Dodson ◽  
Hina J. Talib ◽  
Qi Gao ◽  
Jaeun Choi ◽  
Susan M. Coupey
Keyword(s):  
New York ◽  
Child Health ◽  
Training Programs ◽  
Fellowship Training ◽  
Health Advocacy ◽  
Pediatric Residency ◽  
History Of ◽  
Historical Role ◽  
High Effort

In this article, we discuss the role of formal advocacy education with high-effort advocacy activities among pediatricians. We discuss the historical role of advocacy in the field of pediatrics and the changing role of advocacy education in pediatric training programs. We describe our survey of pediatricians in New York, in which we asked about a history of formal child health advocacy education, current high- and low-effort advocacy activities, perceived barriers to advocacy work, and child health advocacy issues of interest. Our findings demonstrate an association between a history of formal child health advocacy education and recent participation in high-effort advocacy activities on behalf of children’s health. We also found that practicing pediatricians were more likely to participate in high-effort advocacy work than individuals still in pediatric residency training. Our findings imply that education in child health advocacy should be considered an important part of pediatric training. Advocacy education should not only be included in residency and fellowship training programs but also made available as part of continuing medical education for pediatricians. Time for professional advocacy work should be allotted and encouraged.

scholarly journals Impact of the COVID-19 Pandemic on the Education of Plastic Surgery Trainees in the United States (Preprint)

2020 ◽  
Author(s):  
Alireza Hamidian Jahromi ◽  
Alisa Arnautovic ◽  
Petros Konofaos
Keyword(s):  
United States ◽  
Plastic Surgery ◽  
Training Programs ◽  
The United States ◽  
Fellowship Training ◽  
Educational Activities ◽  
Journal Clubs ◽  
Long Time ◽  
Almost All ◽  
The Impact

UNSTRUCTURED The current COVID-19 pandemic has vastly impacted the health care system in the United States, and it is continuing to dictate its unprecedented influence on the education systems, especially the residency and fellowship training programs. The impact of COVID-19 on these training programs has not been uniform across the board, with plastic surgery residency and fellowship programs among the hardest hit specialties. Implementation of social distancing regulations has affected departmental educational activities, including preoperative, morbidity and mortality conferences and journal clubs; operating room educational activities; as well as the overall education of plastic surgery trainees in the United States. Almost all elective and semielective surgeries across the United States were suspended for a few months during the COVID-19 pandemic; this constitutes a significant portion of plastic surgery cases. Considering the current staged reopening policies, it may be a long time, if ever, before restrictions are completely lifted. In this paper, we review the multidimensional impact of the current COVID-19 pandemic on the training programs of plastic surgery residents and fellows in the United States and worldwide, along with some potential solutions on how to address existing challenges.

MO706PATIENTS AND CENTER-RELATED FACTORS IN PERIOTONEAL CHOICE IN INCIDENT PATIENTS: A REGIONAL EXPERIENCE

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Vincenzo Antonio Panuccio ◽  
Giovanna Parlongo ◽  
Rocco Tripepi ◽  
Giovanni Luigi Tripepi ◽  
Paola Cianfrone ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Venous Catheter ◽  
Dialysis Access ◽  
Related Factors ◽  
Early Referral ◽  
Dialysis Treatment ◽  
Outpatient Program ◽  
Dialytic Modality ◽  
Late Referral

Abstract Background and Aims Effective outpatient organization is essential in the management of patients with chronic kidney disease. Although peritoneal dialysis (PD) has many advantages it is still not popular. Method The aim of this study was to evaluate patient and center-related factors that affect the final choice of peritoneal dialysis (PD) versus hemodialysis (HD) in the Calabrian region (Italy). We analyzed 2 annual regional surveys performed by nephrologists (2017 and 2018) in incident dialysis patients. Collected factors included: early and late referral to the dialysis program, pre-dialysis participation in outpatient visits, first dialysis access [peritoneal catheter (PC), central venous catheter (CVC), arteriovenous fistula (AVF)], final dialysis treatment (HD or PD) and the care giver. Results The study sample included 296 incident patients (63% males) aged 66±15 years. Time to referral influenced the type of first dialysis access. Among patients with early referral, 35% initiated dialysis by a PC, 34% by AVF and 31% by CVC, while among those with late referral, only 5% started dialysis by a PC, 15% by AVF, and the majority (80%) by CVC (P<0.001). Time to referral was also associated with pre-dialysis visits (34%, 33% and 34% versus 5%, 22% and 73%, respectively, P<0.001). When evaluating clinical suitability for treatment modality, 54% of early referrals and 45% of late referrals were eligible for PD. The choice of dialytic modality was again related to time to referral: 38% with early referral chose PD compared to 15% of those with late referral (P<0.001). Furthermore, in patients who participated in the pre-dialysis program, 38% started PD versus 11% of patients that did not participate (P<0.001). The role of the caregiver remains uncertain. Conclusion These data confirm that a more attentive and dedicated organization of the pre-dialysis outpatient program would contribute to a greater expansion of the peritoneal dialysis program.

S1349 Is Nutrition Education Adequate in Residency and Fellowship Training Programs? the Role of a Comprehensive Training Program

2010 ◽  
Vol 138 (5) ◽  
pp. S-234
Author(s):  
Bijo K. John ◽  
Maqsood A. Khan ◽  
Kristen Rhoda ◽  
Robert DeChicco ◽  
Cindy Hamilton ◽  
...  
Keyword(s):  
Training Program ◽  
Nutrition Education ◽  
Training Programs ◽  
Fellowship Training

scholarly journals Pediatric Ophthalmology Fellowship Survey: Fellows Selection Criteria for Training Programs

2018 ◽  
Vol 10 (01) ◽  
pp. e140-e142
Author(s):  
Jasleen Singh ◽  
Kimberly Lovelace ◽  
Jennifer Patnaik ◽  
Robert Enzenauer
Keyword(s):  
Training Programs ◽  
The United States ◽  
Fellowship Training ◽  
Strabismus Surgery ◽  
Postal Service ◽  
Pediatric Ophthalmology ◽  
United States Postal Service ◽  
Administration Hospital ◽  
National Reputation ◽  
United States Postal

Purpose This article investigates the characteristics that trainees look for in a pediatric ophthalmology fellowship program. Methods A 14-question anonymous survey was created and sent out via the United States Postal Service to all physicians of American Association of Pediatric Ophthalmology and Strabismus. The survey addressed demographics, the interview process, and the qualities of fellowship training programs that were important factors in ranking fellowship training programs. A Likert scale was used to rate different qualities (1: not important, 9: very important) and summary statistics were reported as overall means and standard deviations. Results In total, 1,061 were mailed out with 413 returned amounting to a 38.9% response rate. The qualities with the highest mean were diversity of surgical procedures, volume of procedures/surgeries, reputation of the fellowship director, advice from mentor, emphasis on type of surgery performed, program association with an academic institution, and national reputation of program. The characteristics that ranked the lowest were presence of a Veteran's Administration hospital and presence of a county hospital. Females rated proximity to family significantly higher than males. Among responders who ranked volume of procedures/surgeries as very important, strabismus surgery was the most important. Conclusion Pediatric ophthalmologists chose fellowship training programs based on the diversity and surgical volume of procedures and the reputation of the program director.

Further speculation about numbers of pediatricians

PEDIATRICS ◽  
1975 ◽  
Vol 56 (4) ◽  
pp. 500-502
Author(s):  
Kenneth D. Rogers
Keyword(s):  
United States ◽  
Training Programs ◽  
The United States ◽  
Birth Rates ◽  
Hospital Beds ◽  
Recommended Action

In their article, "Some Implications Of Declining ng Birth Rates for Pediatricians," Gorwitz and Smith make three predictions and propose responses to these. The predictions are that births in the United States will remain at about three million or less per year for several decades, hospital beds for children will remain excessive, and the number of pediatricians will increase to a point of oversupply. The recommended action includes a moratorium on construction of new hospital beds for children and reevaluation of the role of the pediatrician with appropriate modification of size and content of training programs. These predictions and recommendations ions deserve examination.

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