The Association of Functional Status with Mortality and Dialysis Modality Change: Results from the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS)

2019 ◽  
Vol 39 (2) ◽  
pp. 103-111 ◽  
Author(s):  
Karthik Tennankore ◽  
Junhui Zhao ◽  
Angelo Karaboyas ◽  
Brian A. Bieber ◽  
Bruce M. Robinson ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Functional Status ◽  
Functional Impairment ◽  
Practice Patterns ◽  
Cox Regression ◽  
The United States ◽  
The United Kingdom ◽  
The Us ◽  
Self Reports ◽  
Dialysis Outcomes

Background Little is known about the prevalence of functional impairment in peritoneal dialysis (PD) patients, its variation by country, and its association with mortality or transfer to hemodialysis. Methods A prospective cohort study was conducted in PD patients from 7 countries in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) (2014 – 2017). Functional status (FS) was assessed by combining self-reports of 8 instrumental and 5 basic activities of daily living, using the Lawton-Brody and the Katz questionnaires. Summary FS scores, ranging from 1.25 (most dependent) to 13 (independent), were based on the patient's ability to perform each activity with or without assistance. Logistic regression was used to estimate the odds ratio (OR; 95% confidence interval [CI]) of a FS score < 11 comparing each country with the United States (US). Cox regression was used to estimate the hazard ratio (HR; 95% CI) for the effect of a low FS score on mortality and transfer to hemodialysis, adjusting for case mix. Results Of 2,593 patients with complete data on FS, 48% were fully independent (FS = 13), 32% had a FS score 11 to < 13, 14% had a FS score 8 to < 11, and 6% had a FS score < 8. Relative to the US, low FS scores (< 11; more dependent) were more frequent in Thailand (OR = 10.48, 5.90 – 18.60) and the United Kingdom (UK) (OR = 3.29, 1.77 – 6.08), but similar in other PDOPPS countries. The FS score was inversely and monotonically associated with mortality but not with transfer to hemodialysis; the HR, comparing a FS score < 8 vs 13, was 4.01 (2.44 – 6.61) for mortality and 0.91 (0.58 – 1.43) for transfer to hemodialysis. Conclusion Regional differences in FS scores observed across PDOPPS countries may have been partly due to differences in regional patient selection for PD. Functional impairment was associated with mortality but not with permanent transfer to hemodialysis.

scholarly journals The Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS): Unifying Efforts to Inform Practice and Improve Global Outcomes in Peritoneal Dialysis

2016 ◽  
Vol 36 (3) ◽  
pp. 297-307 ◽  
Author(s):  
Jeffrey Perl ◽  
Simon J. Davies ◽  
Mark Lambie ◽  
Ronald L. Pisoni ◽  
Keith McCullough ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Practice Patterns ◽  
International Study ◽  
The United States ◽  
Primary Objective ◽  
Technique Survival ◽  
Related Data ◽  
Patient Reported ◽  
Dialysis Outcomes ◽  
Technique Failure

Background Extending technique survival on peritoneal dialysis (PD) remains a major challenge in optimizing outcomes for PD patients while increasing PD utilization. The primary objective of the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) is to identify modifiable practices associated with improvements in PD technique and patient survival. In collaboration with the International Society for Peritoneal Dialysis (ISPD), PDOPPS seeks to standardize PD-related data definitions and provide a forum for effective international collaborative clinical research in PD. Methods The PDOPPS is an international prospective cohort study in Australia, Canada, Japan, the United Kingdom (UK), and the United States (US). Each country is enrolling a random sample of incident and prevalent patients from national samples of 20 to 80 sites with at least 20 patients on PD. Enrolled patients will be followed over an initial 3-year study period. Demographic, comorbidity, and treatment-related variables, and patient-reported data, will be collected over the study course. The primary outcome will be all-cause PD technique failure or death; other outcomes will include cause-specific technique failure, hospitalizations, and patient-reported outcomes. Results A high proportion of the targeted number of study sites has been recruited to date in each country. Several ancillary studies have been funded with high momentum toward expansion to new countries and additional participation. Conclusion The PDOPPS is the first large, international study to follow PD patients longitudinally to capture clinical practice. With data collected, the study will serve as an invaluable resource and research platform for the international PD community, and provide a means to understand variation in PD practices and outcomes, to identify optimal practices, and to ultimately improve outcomes for PD patients.

International comparison of peritoneal dialysis prescriptions from the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS)

2020 ◽  
Vol 40 (3) ◽  
pp. 310-319
Author(s):  
Angela Yee-Moon Wang ◽  
Junhui Zhao ◽  
Brian Bieber ◽  
Talerngsak Kanjanabuch ◽  
Martin Wilkie ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Practice Patterns ◽  
Urine Volume ◽  
Japanese Patients ◽  
Urea Clearance ◽  
Patient Reported ◽  
The Us ◽  
Dialysis Outcomes ◽  
The Uk

Background: We describe peritoneal dialysis (PD) prescription variations among Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) participants on continuous ambulatory PD (CAPD) and automated PD (APD; n = 4657) from Australia/New Zealand (A/NZ), Canada, Japan, Thailand, United Kingdom (UK), and United States (US). Results: CAPD was more commonly used in Thailand and Japan, while APD predominated over CAPD in A/NZ, Canada, the US, and the UK. Total prescribed PD volume normalized to the surface area was the highest in Thailand and the lowest in Japan (for both APD and CAPD) and the UK (for CAPD). PD patients from Thailand had the lowest residual urine volume and residual renal urea clearance, yet achieved the highest dialysis urea clearance. Japanese patients had the lowest dialysis urea clearances for both APD and CAPD. Despite having similar urine volumes to patients in A/NZ, Canada, Japan, and the UK, US CAPD and APD patients used 2.5% and 3.86% glucose PD solutions more frequently, whereas fewer than 25% of these patients used icodextrin. Over half of the patients in A/NZ, Canada, the UK, and Japan used icodextrin, whereas it was hardly used in Thailand. Japan and Thailand were more likely to use 1.5% glucose solutions for their PD prescription. Conclusions: There are considerable international variations in PD modality use and prescription patterns that translate into important differences in achieved dialysis clearances. Ongoing recruitment of additional PDOPPS participants and accrual of follow-up time will allow us to test the associations between specific PD prescription regimens and clinical and patient-reported outcomes.

International Anemia Prevalence and Management in Peritoneal Dialysis Patients

2019 ◽  
Vol 39 (6) ◽  
pp. 539-546 ◽  
Author(s):  
Rachel L. Perlman ◽  
Junhui Zhao ◽  
Douglas S. Fuller ◽  
Brian Bieber ◽  
Yun Li ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Ferritin Level ◽  
Transferrin Saturation ◽  
The United States ◽  
Clinical Practices ◽  
Dialysis Patients ◽  
The Us ◽  
Anemia Management ◽  
Iv Iron ◽  
Dialysis Outcomes

Background The optimal treatment for managing anemia in peritoneal dialysis (PD) patients and best clinical practices are not completely understood. We sought to characterize international variations in anemia measures and management among PD patients. Methods The Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) enrolled adult PD patients from 6 countries from 2014 to 2017. Hemoglobin (Hb), ferritin levels, and transferrin saturation (TSAT), as well as erythropoiesis stimulating agents (ESAs) and iron use were compared cross-sectionally at study enrollment in Australia and New Zealand (A/NZ), Canada, Japan, the United Kingdom (UK), and the United States (US). Results Among 3,603 PD patients from 193 facilities, mean Hb ranged from 11.0 – 11.3 g/dL across countries. The majority of patients (range 53% – 59%) had Hb 10 – 11.9 g/dL, with 4% – 12% patients ≥ 13 g/dL and 16% – 23% < 10 g/dL. Use of ESAs was higher in Japan (94% of patients) than elsewhere (66% – 79% of patients). In the US, 63% of patients had a ferritin level > 500 ng/mL, compared with 5% – 38% in other countries. In the US and Japan, 87% – 89% of PD patients had TSAT ≥ 20%, compared with 73% – 76% in other countries. Intravenous (IV) iron use within 4 months of enrollment was higher in the US (55% of patients) than elsewhere (6% – 17% patients). Conclusions In this largest international observational study of anemia and anemia management in patients receiving PD, comparable Hb levels across countries were observed but with notable differences in ESA and iron use. Peritoneal dialysis patients in the US have higher ferritin levels and higher IV iron use than other countries.

scholarly journals SP532THE ASSOCIATION OF FUNCTIONAL STATUS WITH MORTALITY AND DIALYSIS MODALITY CHANGE: RESULTS FROM THE PERITONEAL DIALYSIS OUTCOMES AND PRACTICE PATTERNS STUDY (PDOPPS)

2018 ◽  
Vol 33 (suppl_1) ◽  
pp. i527-i527
Author(s):  
Karthik Tennankore ◽  
Junhui Zhao ◽  
Angelo Karaboyas ◽  
Brian Bieber ◽  
Bruce Robinson ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Functional Status ◽  
Practice Patterns ◽  
Dialysis Modality ◽  
Dialysis Outcomes

Surgery for Parkinson disease in the United States, 1996 to 2000: practice patterns, short-term outcomes, and hospital charges in a nationwide sample

2003 ◽  
Vol 99 (5) ◽  
pp. 863-871 ◽  
Author(s):  
Emad N. Eskandar ◽  
Alice Flaherty ◽  
G. Rees Cosgrove ◽  
Leslie A. Shinobu ◽  
Fred G. Barker
Keyword(s):  
Surgical Treatment ◽  
Parkinson Disease ◽  
Practice Patterns ◽  
The United States ◽  
Hospital Charges ◽  
Short Term ◽  
Content Type ◽  
The Us ◽  
Fine Print ◽  
Deep Brain

Object. The surgical treatment of Parkinson disease (PD) has undergone a dramatic shift, from stereotactic ablative procedures toward deep brain stimulaion (DBS). The authors studied this process by investigating practice patterns, mortality and morbidity rates, and hospital charges as reflected in the records of a representative sample of US hospitals between 1996 and 2000. Methods. The authors conducted a retrospective cohort study by using the Nationwide Inpatient Sample database; 1761 operations at 71 hospitals were studied. Projected to the US population, there were 1650 inpatient procedures performed for PD per year (pallidotomies, thalamotomies, and DBS), with no significant change in the annual number of procedures during the study period. The in-hospital mortality rate was 0.2%, discharge other than to home was 8.1%, and the rate of neurological complications was 1.8%, with no significant differences between procedures. In multivariate analyses, hospitals with larger annual caseloads had lower mortality rates (p = 0.002) and better outcomes at hospital discharge (p = 0.007). Placement of deep brain stimulators comprised 0% of operations in 1996 and 88% in 2000. Factors predicting placement of these devices in analyses adjusted for year of surgery included younger age, Caucasian race, private insurance, residence in higher-income areas, hospital teaching status, and smaller annual hospital caseload. In multivariate analysis, total hospital charges were 2.2 times higher for DBS (median $36,000 compared with $12,000, p < 0.001), whereas charges were lower at higher-volume hospitals (p < 0.001). Conclusions. Surgical treatment of PD in the US changed significantly between 1996 and 2000. Larger-volume hospitals had superior short-term outcomes and lower charges. Future studies should address long-term functional end points, cost/benefit comparisons, and inequities in access to care.

scholarly journals From Dreams to Reality: The Evolution of Anglo-Canadian Trade During the Diefenbaker Era

2006 ◽  
Vol 9 (1) ◽  
pp. 243-266 ◽  
Author(s):  
Bruce Muirhead
Keyword(s):  
United States ◽  
Economic Policy ◽  
United Kingdom ◽  
Trade Policy ◽  
Normal Development ◽  
The United States ◽  
Foreign Economic Policy ◽  
Conservative Government ◽  
The United Kingdom ◽  
The Us

Abstract The articulated foreign economic policy of the Conservative government of John Diefenbaker following its election in June 1957 was to redirect trade away from the United States and toward the United Kingdom. This policy reflected Diefenbaker's almost religious attachment to the Commonwealth and to Britain, as well as his abiding suspicion of continentalism. However, from these brave beginnings, Conservative trade policy ended up pretty much where the Liberals had been before their 1957 defeat-increasingly reliant on the US market for Canada's domestic prosperity. This was a result partly of the normal development of trade between the two North American countries, but it also reflected Diefenbaker's growing realisation of the market differences between Canada and the United Kingdom, and the impossibility of enhancing the flow of Canadian exports to Britain.

Unwitting Architect

2021 ◽  
Author(s):  
Julian Germann
Keyword(s):  
The United States ◽  
Export Markets ◽  
Neoliberal Reforms ◽  
The United Kingdom ◽  
The Us ◽  
Pragmatic Reasoning ◽  
Anglo American ◽  
Crisis Managers ◽  
Policy Elites ◽  
Interest Rate Shock

The global rise of neoliberalism since the 1970s is widely seen as a dynamic originating in the United States and the United Kingdom, and only belatedly and partially repeated by Germany. From this Anglocentric perspective, Germany's emergence at the forefront of neoliberal reforms in the eurozone is perplexing, and tends to be attributed to the same forces conventionally associated with the Anglo-American pioneers. This book challenges this ruling narrative. It recasts the genesis of neoliberalism as a process driven by a plenitude of actors, ideas, and interests. And it lays bare the pragmatic reasoning and counterintuitive choices of German crisis managers obscured by this master story. This book argues that German officials did not intentionally set out to promote neoliberal change. Instead they were more intent on preserving Germany's export markets and competitiveness in order to stabilize the domestic compact between capital and labor. Nevertheless, the series of measures German policy elites took to manage the end of golden-age capitalism promoted neoliberal transformation in crucial respects: it destabilized the Bretton Woods system; it undermined socialist and social democratic responses to the crisis in Europe; it frustrated an internationally coordinated Keynesian reflation of the world economy; and ultimately it helped push the US into the Volcker interest-rate shock that inaugurated the attack on welfare and labor under Reagan and Thatcher. From this vantage point, the book illuminates the very different rationale behind the painful reforms German state managers have demanded of their indebted eurozone partners.

Antitrust Regulation of IT Giants` Activities: Main Trends of Foreign and Russian Legislation

2021 ◽  
Author(s):  
D.V. Shram ◽  
Keyword(s):  
House Of Representatives ◽  
Network Effects ◽  
The United States ◽  
The European Union ◽  
The United Kingdom ◽  
The Us ◽  
The Usa ◽  
Economic Concentration ◽  
The Uk ◽  
Antitrust Regulation

The article is devoted to the antimonopoly regulation of IT giants` activities. The author presents an overview of the main trends in foreign and Russian legislation in this area. The problems the antimonopoly regulation of digital markets faces are the following: the complexity of determining the criteria for the dominant position of economic entities in the digital economy and the criteria for assessing the economic concentration in the commodity digital markets; the identification and suppression of cartels; the relationship between competition law and intellectual property rights in the digital age. Some aspects of these problems are considered through the prism of the main trends in the antimonopoly policy in the United States, the European Union, the United Kingdom and Russia. The investigation findings of the USA House of Representatives Antitrust Subcommittee against Apple, Google, Amazon and Facebook are presented. The author justifies the need to separate them, which requires the adoption of appropriate amendments to the antimonopoly legislation. The article analyzes the draft law of the European Commission on the regulation of digital markets – Digital Markets Act, reveals the criteria for classifying IT companies as «gatekeepers», and notes the specific approaches to antimonopoly regulation in the UK and the US. The article describes the concepts «digital platform» and «network effects», presented in the «fifth antimonopoly package of amendments», developed in 2018 by the Federal Antimonopoly Service of the Russian Federation, and gives an overview of the comments of the Ministry of Economic Development regarding these concepts wording in the text of the draft law, which formed the basis for the negative conclusion of the regulator. It is concluded that in the context of the digital markets’ globalization, there is a need for the international legal nature antitrust norms formation, since regional legislation obviously cannot cope with the monopolistic activities of IT giants.

Abstract 134: Implementation of Home-Based Cardiac Rehabilitation in the VA

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
David W Schopfer ◽  
Nirupama Krishnamurthi ◽  
Hui Shen ◽  
Mary A Whooley
Keyword(s):  
Cardiac Rehabilitation ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
The United States ◽  
Medical Centers ◽  
The United Kingdom ◽  
Home Based ◽  
Percutaneous Coronary ◽  
The Us ◽  
Va Hospitals

Objective: Referral to cardiac rehabilitation (CR) is one of nine performance measures for patients with ischemic heart disease (IHD), but fewer than 20% of eligible patients participate in the United States. Home-based CR programs (available in the United Kingdom, Australia, and Canada) have similar effects on morbidity and mortality as traditional (facility-based) CR, but they are not currently available or reimbursed in the US. We sought to determine whether implementing home-based programs could increase CR participation among patients with IHD. Methods: Using electronic health records from 134 VA medical centers, we identified 106,277 veterans hospitalized for acute myocardial infarction, percutaneous coronary intervention or coronary artery bypass grafting between 2010 and 2015. We compared the proportion of eligible patients who participated in CR at 13 VA hospitals that offered referral to either home-based CR or facility-based CR vs. 121 VA hospitals that offered referral to only facility-based CR (usual care). Results: The number of VA medical centers offering home-based CR increased from 2 in 2010 to 13 in 2015. Among the 20,949 eligible patients hospitalized at VA medical centers that implemented home-based CR between 2010 and 2015, CR participation increased from 11% to 26% (Figure). Among the 85,328 eligible patients hospitalized at VA medical centers that did not offer home-based CR, CR participation increased from only 8% to 11%. Conclusion: Among eligible patients with IHD, participation in CR more than doubled at VA medical centers that implemented home-based CR programs between 2010 and 2015, whereas participation increased by only 3% at VA medical centers that did not implement home-based CR programs. Home-based CR is an effective way of engaging patients who may otherwise decline to participate in CR.

John Harold Plumb, 1911–2001

2005 ◽  
Author(s):  
David Cannadine
Keyword(s):  
United States ◽  
United Kingdom ◽  
The United States ◽  
The United Kingdom ◽  
The Us ◽  
Race Horse

Sir John Plumb was a commanding figure, both within academe and also far beyond. He was as much read in the United States as in the United Kingdom; he was a great enabler, patron, fixer and entrepreneur; he belonged to the smart social set both in Mayfair and Manhattan; a race horse was named after him in England and the stars and the stripes were once flown above the US Capitol in his honour; and he appeared, thinly disguised but inadequately depicted, in the fiction of Angus Wilson, William Cooper and C. P. Snow. Yet one important aspect of Plumb's career has been repeatedly ignored and overlooked: for while his life was an unusually long one, his productive period as a significant historian was surprisingly, almost indecently, brief.

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