Sodium Dialysate Prescription in a New Dialysis Facility

As the Medical Director of this new dialysis facility, I recommend a fixed sodium dialysate (Nadial) concentration at 138 mEq/L. This relates to my former experience in the Tassin unit in France and the fear of sodium as a powerful uremic toxin. I realize that, according to the Na+ set-point theory, a fixed value of the Nadial may create a plasma–dialysate (P–D) gradient and may favor intradialytic plasma Na+ changes. In cases where this is associated with signs of negative Na+ balance (bad session tolerance/quality of life) or positive Na+ balance (high interdialytic weight gain or high blood pressure), individualization of the Nadial to reduce the P–D gradient and change in plasma Na+ concentration may be useful, even though evidence remains scarce. I look forward to the possibility of using new dialysis machines that allow for the evaluation of sodium balance and tailoring of the sodium diffusion process.

Dialysate Sodium—One Size Unlikely to Fit All

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.

Regionalization of EMS Medical Direction for Naval Medical Forces Pacific

ABSTRACT Introduction Medical direction has been the cornerstone to safe and effective prehospital and enroute care since the establishment of emergency medical services (EMS). Medical oversight by a physician has been shown to improve clinical outcomes in both settings. When the Navy Regional Office of the EMS Medical Director was established in 2016, it brought additional resources, including the addition of a paramedic and nurse EMS analyst and recruitment of additional local medical directors (LMDs). This, combined with the engagement of military leadership, allowed for expansion and improvement of medical direction in our prehospital and enroute care system and the establishment of a continuous quality improvement (CQI) program. Materials and Methods In 2017, a database was created to collect total run volume, acuity of calls, number of certain time-sensitive conditions, and CQI performance. A retrospective review of this database was conducted. This project was deemed institutional review board exempt. Results LMD reports that submission went from 17% for 2017 to 64% for 2018, 91% for 2019, and 79% for 2020. In 2019, 67% of the sites had verifiable CQI programs and, in 2020, this improved to 80% of sites. The review also revealed insight into levels of acuity seen by prehospital and enroute care providers. Conclusion Our results demonstrate that improvement in medical oversight in a large regional prehospital system can be achieved through persistence and engagement of nonmedical leadership.

HEALTH ECONOMICS IN THE FIELD OF PROSTHETICS AND ORTHOTICS: A GLOBAL PERSPECTIVE

The rapid advancement of prosthetic and orthotic (P&O) technology raises the question how the industry can ensure that patients have access to the benefits and providers get paid properly and fairly by healthcare payers. This is a challenge that not only P&O but all areas of health technology face. In many areas of medicine and health products, such as drugs and medical devices, health-technology assessments (HTA) have become a standard procedure in the coverage and reimbursement process. In most countries, P&O is lagging behind that development, although some countries have already formalized HTA for prosthetic and orthotic products and may even use cost-effectiveness analyses to determine pricing and payment amounts. This article gives an overview on the coverage and reimbursement processes in the United States, Canada, Germany, France, Sweden, the United Kingdom, Poland, Japan, and China. This selection reflects the variety and diversity of coverage and reimbursement processes that the P&O industry faces globally. The paper continues with an overview on the necessary research and investment efforts that manufacturers will have to make in the future, and contemplates the likely consequences for the manufacturer community in the market place. Health economics may help support the transition from price-based to value-based coverage and reimbursement but will come at considerable costs to the industry. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/35298/28317 How To Cite: Kannenberg A, Seidinger S. Health economics in the field of prosthetics and orthotics: A global perspective. Canadian Prosthetics & Orthotics Journal. 2021; Volume 4, Issue 2, No.6. https://doi.org/10.33137/cpoj.v4i2.35298 Corresponding Author: Andreas Kannenberg, MD (GER), PhDExecutive Medical Director North America, Otto Bock Healthcare LP, 11501 Alterra Parkway, Suite 600, Austin, Texas, USA.E-Mail: [email protected] ID: https://orcid.org/0000-0001-7983-1744

Evolution of the deployed medical director role in an era of contingency operations: reflections from a United Nations operation

This paper examines the development and evolution of the deployed medical director (DMD) role and argues for the re-establishment of a formal selection process and training pathway. Recent deployments into new areas of operations, deployment of smaller medical treatment facilities (MTFs), the reduced numbers of deployments for clinicians, working with various multinational partners and both military and civilian organisations all pose specific problems for DMDs. The initial and then continued deployment of a secondary care role 2 MTF as part of the United Nations Mission in South Sudan illustrated some of these challenges. Although a novel operation, the broad categories of these new challenges were similar to the historical challenges facing the first DMDs in Afghanistan. Corporate memory loss may be unavoidable to some degree due to rapid turnover in appointments, particularly in single service and joint headquarters. However, individual memory and experience remains extant within the military medical deployable workforce. After the cessation of UK military deployed hospital care involvement in Afghanistan, the UK DMD formal training pathway ended. This paper argues for the re-establishment of a more formal DMD selection process and training pathway to ensure that organisational learning is optimised.