Journal articles on the topic 'Chronic renal failure Patients Home care'
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SIMON, Pierre. "The Telemedicine applied to the follow up of patients with End Stage Renal Failure." Bulletin de la Dialyse à Domicile 1, no. 2 (September 25, 2018): 51–58. http://dx.doi.org/10.25796/bdd.v1i2.44.
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In the 21st century, renal failure is a chronic disease that affects several millions people in France and around 600 millions worldwide. Its prevalence in the general population increases with the lengthening of the life expectancy that characterizes the developed countries and which begins to appear in the developing countries. Chronic hemodialysis is a treatment that saved many children and young adults in the 20th century whose kidneys were destroyed by several infectious and toxic agents and by untreated malignant hypertension. These causes have been controlled by hygiene measures, anti-infective agents or protective pharmacological agents of the cardiovascular system. Today the causes of end stage renal failure are dominated by degenerative diseases due to aging, such as diabetes and chronic vascular disease. The prevention of the worsening of chronic renal failure is now possible due to better control of high blood pressure and diabetes which are the two main causes of kidney destruction. Hemodialysis treatment cannot always be relayed by renal transplantation. Many patients remain on chronic hemodialysis until they die. It is important to adapt the conditions of treatment to the social life of patients affected by this chronic disease so that these are the best possible. This is the goal of telemedicine that allows to remotely monitor the main clinical and biological factors associated with the worsening of the disease. Teledialysis (hemodialysis and peritoneal dialysis) allows to perform dialysis sessions at home or at the nearest in home substitutes (nursing home) or in satellite units of hemodialysis. Similarly, when the patient is transplanted, it makes possible to either lighten or intensify the surveillance according to the risk or not of graft rejection through home teleconsultation.The tools of the digital era such as telemedicine, health connected with connected objects and mobile apps for medical purposes, the performance of which is increasing with the algorithms of artificial intelligence (machine learning, deep learning), can improve the relationship between the patient and his doctor. An ethical reflection must be associated with all these innovations. New exercise of the medicine will be greatly enriched due to medical time more devoted to the relationship with the patient. The new care organizations made possible by digital technologies must be taught to the new generations of nephrologists.
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Freitas, Larissa Rodrigues de, Viviane Peixoto dos Santos Pennafort, Ana Elza Oliveira de Mendonça, Francisco José Maia Pinto, Letícia Lima Aguiar, and Rita Mônica Borges Studart. "Guidebook for renal dialysis patients: care of central venous catheters and arteriovenous fistula." Revista Brasileira de Enfermagem 72, no. 4 (August 2019): 896–902. http://dx.doi.org/10.1590/0034-7167-2018-0131.
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ABSTRACT Objective: To design and validate the content and format of a guidebook for chronic renal failure patients about the care with venous access for hemodialysis at home. Method: Methodological study, in which the steps for the guidebook design were: project planning, literature search, material content, and qualification selection. Results: After analysis of the articles, the content to be included in the guidebook was selected. The first draft of the guidebook was submitted for content and format validation, with the participation of 12 specialists. The necessary adjustments for the design of the final version were made with the help of an illustrator. Conclusion: The designed guidebook, “Hemodialysis: Care of Venous Accesses and Intercurrences at Home,” consists of educational material to help hemodialysis patients with daily care with central venous catheter and arteriovenous fistula practices in case of intercurrences.
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Guzman Melgar, I., L. M. Osorio Guerra, and H. Mendizabal. "PM243 Bacterial Endocarditis in Patients With Chronic Renal Failure Hemodialysis Catheter Users." Global Heart 11, no. 2 (June 2016): e111. http://dx.doi.org/10.1016/j.gheart.2016.03.389.
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Sadala, Maria Lúcia Araújo, Gabriela Azevedo de Souza Bruzos, Estela Regina Pereira, and Edwa Maria Bucuvic. "Patients' experiences of peritoneal dialysis at home: a phenomenological approach." Revista Latino-Americana de Enfermagem 20, no. 1 (February 2012): 68–75. http://dx.doi.org/10.1590/s0104-11692012000100010.
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The aim of this study was to highlight the meaning of home dialysis as experienced by patients with chronic renal failure. The research design was influenced by Ricoeur´s phenomenology. Nineteen patients from a Brazilian public hospital were interviewed, from May to September 2009. Interviews were guided by the question: "Tell me about your experiences lived undergoing PD". Findings unveiled the patients' perception of the drastic changes in their existence, consequent to disease and treatment; and the perception of themselves in that process. The feeling of anguish, physical pain and deprivations were part of living that condition. They foresee an uncertain future, depending on the expertise of health care providers and the demands on support of significant others. Findings suggest that individual aspects of patients' experiences must be considered if health care providers are to facilitate positive health outcomes.
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Shimizu, Hideyuki, Naritaka Kimura, Misato Kobayashi, Ryo Suzuki, Hirofumi Kasahara, Tatsuo Takahashi, Osamu Ishida, Kentaro Yamabe, Hiroyuki Kawajiri, and Ryohei Yozu. "P-140 Thoracic/Thoracoabdominal Aortic Repair in Patients with Chronic Renal Failure on Hemodialysis." CVD Prevention and Control 4 (May 2009): S91. http://dx.doi.org/10.1016/s1875-4570(09)60332-6.
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Mueller, Stephanie, Jie Zheng, Endel John Orav, and Jeffrey L. Schnipper. "Inter-hospital transfer and patient outcomes: a retrospective cohort study." BMJ Quality & Safety 28, no. 11 (September 26, 2018): e1-e1. http://dx.doi.org/10.1136/bmjqs-2018-008087.
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BackgroundInter-hospital transfer (IHT, the transfer of patients between hospitals) occurs regularly and exposes patients to risks of discontinuity of care, though outcomes of transferred patients remains largely understudied.ObjectiveTo evaluate the association between IHT and healthcare utilisation and clinical outcomes.DesignRetrospective cohort.SettingCMS 2013 100 % Master Beneficiary Summary and Inpatient claims files merged with 2013 American Hospital Association data.ParticipantsBeneficiaries≥age 65 enrolled in Medicare A and B, with an acute care hospitalisation claim in 2013 and 1 of 15 top disease categories.Main outcome measuresCost of hospitalisation, length of stay (LOS) (of entire hospitalisation), discharge home, 3 -day and 30- day mortality, in transferred vs non-transferred patients.ResultsThe final cohort consisted of 53 420 transferred patients and 53 420 propensity-score matched non-transferred patients. Across all 15 disease categories, IHT was associated with significantly higher costs, longer LOS and lower odds of discharge home. Additionally, IHT was associated with lower propensity-matched odds of 3-day and/or 30- day mortality for some disease categories (acute myocardial infarction, stroke, sepsis, respiratory disease) and higher propensity-matched odds of mortality for other disease categories (oesophageal/gastrointestinal disease, renal failure, congestive heart failure, pneumonia, renal failure, chronic obstructivepulmonary disease, hip fracture/dislocation, urinary tract infection and metabolic disease).ConclusionsIn this nationally representative study of Medicare beneficiaries, IHT was associated with higher costs, longer LOS and lower odds of discharge home, but was differentially associated with odds of early death and 30 -day mortality depending on patients’ disease category. These findings demonstrate heterogeneity among transferred patients depending on the diagnosis, presenting a nuanced assessment of this complex care transition.
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Hardianti, Anggia Fajar, Ika Yuni Widyawati, and Herdina Mariyanti. "Family Behavior in Maintenance Status Hb Chronic Renal Failure Patients through Family Centered Care Approach of Diet Fe Management." Jurnal Ners 8, no. 1 (April 2, 2017): 118–25. http://dx.doi.org/10.20473/jn.v8i1.3887.
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Introduction: Erythropoietic agent as standard practice for anemia treatment, which has a function to increase the value of hemoglobin (Hb) to 12 g/dl in patients with chronic renal failure (CRF), who receiving dialysis treatment. The use of erythropoietin has to keep of the iron/Fe amount in the body. Family who have a duty of care should have knowledge, attitude, and behavior to maintain patient’s Hb by giving support to the patient to obey the Fe diet. The aimed of this study was to investigate the effect of family centered care approach in management Fe diet toward family’s behaviour in maintenance Hb level of CRF patients in hemodialysis ward, Gambiran Hospital, Kediri.Method: This study was used a pre experimental design. Total sample were 10 respondents, who met to inclusion criteria. The independent variables were knowledge, attitude, and psychomotor of family in maintenance of Hb level in CRF’s patients. The dependent variable was Fe diet management with family centered care approach. Data was collected by using a structured questionnaire and home visit observation.Result: Data was analyzed by using Wilcoxon Sign Rank Test with significance level α≤0.05. Results showed that Fe diet management with family centered care approach took effect to family’s knowledge (p=0.011), family’s attitude (p=0.005) and family’s psychomotor (p=0.005) in maintenance Hb level of CRF patients.Conclusion: Family’s knowledge, attitude, and psychomotor were effected by experiences during the care of a patient, not affordable to access information and patient’s own decision. The strengths and weaknesses in the family to got a better plan of care can be made by discuss and sharing among researcher, patient and his family. It can be concluded that Fe diet management with family centered care approach took effect to family’s behaviour. Further studies should involve larger respondents and better measurement tools to obtain more accurate results.
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Kawahara, Chiho, Takayoshi Tsutamoto, Masayuki Yamaji, Keizo Nishiyama, Takashi Yamamoto, Masanori Fujii, and Minoru Horie. "P-65 Relationship Between Renal Function and Serum Cardiac Troponin T in Patients with Chronic Heart Failure." CVD Prevention and Control 4 (May 2009): S70. http://dx.doi.org/10.1016/s1875-4570(09)60257-6.
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Moore, Mikaela D., Andrew Schamess, Nita Williams, Ying Huang, Gifty Menka, and Payal C. Desai. "Home Based Primary Care for Patients with Sickle Cell Disease." Blood 132, Supplement 1 (November 29, 2018): 4721. http://dx.doi.org/10.1182/blood-2018-99-120040.
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Abstract Background: Sickle cell disease (SCD) is characterized by sickled red blood cells that can cause severely painful vaso-occlusive crises. These crises can cause damage to multiple organs and bring about additional chronic disease, such as avascular necrosis, leg ulcers, pulmonary hypertension, and renal failure. While there are options for disease modification, these are not effective if patients (pts) cannot attend regular doctor visits for their condition to be monitored and for medications to be adjusted. Obstacles to obtaining outpatient primary care include physical disability, environmental factors, transportation, and psychosocial factors. Impaired access to primary care leads to poor clinical outcomes in chronic diseases, such as SCD. This study was conducted to help pts with SCD who had the most barriers to obtaining outpatient primary care. Home based primary care has proven beneficial for pts with chronic illnesses in the past. Utilizing this method, a physician meets with pts in their homes to manage both acute and chronic illnesses. This eliminates many potential barriers for pts with difficulty attending office visits and would provide continuity of care. It also allows physicians to observe other potential factors that could undermine the treatment plans for these pts, and get the correct member of the team to intervene more efficiently. Methods: Outcomes were measured for patient quality of care and health service utilization, both one year prior to and one year after the home visits began. Data was collected from a chart review and included the number of primary care visits, day hospital referrals, and emergency department visits. SCD specific immunizations and the number of prescription refills were also noted. McNemar's test and Wilcoxon signed rank test were used to compare binary and continuous outcomes, respectively, during the years prior to and after home based primary care began. Results: There were 23 SCD pts enrolled in this study, with 13 pts (69% female, 31% male) having completed one full year of home visits. These pts ranged from 26 to 66 years old. Comorbidities include one patient with a history of a myocardial infarction (MI) and two with diabetes mellitus. Other medical history noted were: acute chest syndrome (62%), thrombosis (62%), avascular necrosis (46%), retinopathy (46%), depression (38%), kidney disease (31%), hypertension (31%), pulmonary hypertension (23%), stroke (23%), and iron overload (15%). Most pts had received transfusions (92%), and 77% had taken hydroxyurea. Pts received a median number of 11 home visits (range 7-15) during the 1-year program in which they received home based primary care. The median number of new long term prescriptions increased significantly (p = 0.04) from 1 to 3. Five pts not previously receiving PVC-13 vaccine started to receive it after the initiation of the home visit program (p = 0.06). The total number of immunizations (p = 0.09), months with prescription refills (p = 0.08) both increased slightly. There was no change in the number of new short term prescriptions, breast or colon cancer screening rates, nor influenza, PVC-23, or MenAWCY immunization rates. The median number of reported vaso-occlusive crises per patient decreased from 8 per year to 5 (p = 0.69), and the median number of emergency department visits per patient decreased from 6 visits per year to 3 visits per year (p = 0.80). Conclusion: Overall, home based primary care seems to be a promising alternative for pts with SCD. It had a significant impact on patient quality of care and may improve prescription adherence, but more data are needed to determine if it has an effect on healthcare utilization for pts with SCD. Disclosures Moore: Ohio State University College of Medicine: Research Funding. Desai:FDA: Research Funding; Pfizer: Research Funding; University of Pittsburgh: Research Funding; Selexy/Novartis: Research Funding; NIH: Research Funding; Ironwood: Other: Adjudication Committee.
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Saad, M., SMS Iqbal, FA Pereira, SA Hussain, A. Muhammad, HMU Khan, and Z. Hussain. "Frequency of musculoskeletal disorder of upper limb in Type 2 Diabetes patients." Balneo and PRM Research Journal, Vol.13, no.1 (March 19, 2022): 488. http://dx.doi.org/10.12680/balneo.2022.488.
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Diabetes is a frequently occurring chronic metabolic disease that is characterized by a high blood glucose levels. If left unchecked, it can lead to severe functional impairments such as blindness, renal failure, and coronary artery disease. Approximately 463 million adults (20-79 years) are living with diabetes; by 2045 this will rise to 700 million. Material and method: A cross-sectional survey was conducted in National Institute of Diabetes and Endocrinology, Dow University Hospital, Ojha campus. Patients who had T2DM, and were above 35 years of age were included in the study. Anthropometric measurements were recorded, and the remaining data was collected via a self-reporting questionnaire. Results and discussions: In this study n=55(36.2%) participants were male and n=97(63.8%) were female, with the average age of 52.9 years, and an average BMI of 29.5kg/m2. The mean HBA1C of those diabetic patients was 8.8, and average duration of diabetes of our sample was 6.7 years. Prevalence of MSK disorders was 55.3%. Conclusions: There is a high prevalence of musculoskeletal disorders among diabetic pa-tients. There was poor knowledge that upper limb musculoskeletal problems could occur due to diabetes, and a small percentage of patients sought physical therapy treatment for these disor-ders. Keywords: diabetes mellitus, musuculoskeletal diseases, upper extremity
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Hu, Qi, Xue Yang, Wei Wang, and Man Meng. "Analysis of the Effectiveness of the Nurse-Led “Outpatient-Ward-Home” Management Model in Chronic Kidney Patients." Evidence-Based Complementary and Alternative Medicine 2022 (September 30, 2022): 1–11. http://dx.doi.org/10.1155/2022/4229436.
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Objective. To investigate the application and effect of the nurse-led “outpatient-ward-home” management model in the care of patients with chronic kidney disease (CKD). Methods. 120 patients with CKD admitted to our hospital between April 2020 and April 2021 were selected as trial subjects. All patients were divided into experimental and control groups according to the random number table method, with 60 cases in each group. The patients in the experimental group implemented the nurse-led “outpatient-ward-home” management model; the patients in the control group were given routine care and telephone follow-up. The self-rating anxiety scale (SAS), self-rating depression scale (SDS), Pittsburgh Sleep Quality Index (PSQI) score, self-management scores, nutritional status, renal function indicators, and chronic renal failure quality of life scale (QLICD-CRF2.0) were compared between the two groups before and 6 months after the intervention. Results. Before the intervention, there were no statistically significant differences between the control and experimental groups in SAS, SDS, PSQI scores, self-management scores, QLICD-CRF2.0 scores, body mass index (BMI), prealbumin (PAb), albumin (ALB), serum creatinine (Scr), blood urea nitrogen (BUN), and glomerular filtration rate (GFR) levels ( P > 0.05 ). After 6 months of intervention, SAS, SDS, PSQI scores, Scr, BUN, and GFR levels were lower in the experimental group than in the control group; self-management scores, QLICD-CRF2.0 scores, BMI, PAb, and ALB levels were higher in the experimental group than in the control group ( P < 0.05 ). Conclusion. The nurse-led “outpatient-ward-family” intervention model can improve the negative emotions and sleep disorders of CKD patients, enhance patients’ self-management ability, and to a certain extent, slow down the disease process and improve the quality of life.
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Işik, Kevser, and Behice Erci. "The effect of home care based on the Neuman systems model on symptomatic relief and quality of life in patients undergoing hemodialysis." African Health Sciences 20, no. 4 (December 16, 2020): 1809–16. http://dx.doi.org/10.4314/ahs.v20i4.35.
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Background: Chronic renal failure (CRF) is an important common health problem with high morbidity and mortality rate in the world and in Turkey.
Objectives: This study was conducted to determine the effect of home care based on the Neuman Systems Model on relief of physical and psychological symptoms and quality of life in patients undergoing hemodialysis.
Methods: This study was conducted as a pretest-posttest randomized controlled trial. The sample of the study was com- posed of 160 hemodialysis patients. The patients were randomly and sequentially assigned to experimental and control groups as 80 hemodialysis patients.
Results: After the intervention, it was determined that the symptoms levels of the patients in the experimental group re- duced and their quality of life increased.
Conclusion: The care provided based on the Neuman Systems Model reduced the symptoms of the patients having hemo- dialysis treatment and enhanced their quality of life. Care given using a model is important in improving the quality of life of hemodialysis patients.
Keywords: Hemodialysis; dialysis symptom; quality of life.
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Maia, Sayonnara Ferreira, Daniely Matias Facundes, and Amanda Lorena Lima Carneiro. "Patient self-care with double catheter lumen for hemodialization: validation of instructional folder." Acta Scientiarum. Health Sciences 41 (September 11, 2019): e47558. http://dx.doi.org/10.4025/actascihealthsci.v41i1.47558.
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The use of venous catheters for hemodialysis is associated with high rates of morbidity and mortality in patients with chronic renal failure. The implant of the dual lumen catheter (DLC) assists the patient in a worsening situation but commonly the patient remains with the DLC back home and this requires a series of important measures. The use of printed educational materials becomes an important tool to assist this type of care. Thus, the objective was to create and validate an instructive folder for the self-care of the patient using a catheter for hemodialysis. It is a methodological study of creation and evaluation of technology, in three stages. For validation of the content and style the material was submitted to the evaluation by experts in the area. 92.3% of the participants stated that the folder demonstrates clarity in their language, 53.8% of the participants suggested change and addition of information, and the same percentage also states that the instrument is attractive. The main suggestions were to change some term/word used in the folder, suggest changes to the images used, and include some information in the content. It is presumed then that the use of educational materials results in benefits to the patients who will receive the guidelines for self-care. Thus, the importance of nurses to use these resources for chronic renal patient care is emphasized.
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Svetanoff, Wendy Jo, Benjamin Zendejas, Farokh R. Demehri, Alex Cuenca, Bharath Nath, and C. Jason Smithers. "Giant Gastroschisis with Complete Liver Herniation: A Case Report of Two Patients." Case Reports in Surgery 2019 (January 15, 2019): 1–8. http://dx.doi.org/10.1155/2019/4136214.
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Introduction. There are no reported survivors of gastroschisis with complete liver herniation. We describe a case report of two patients, one of whom survived. Case #1. The patient was born with gastroschisis and herniation of the entire liver. Along with silo placement, the abdominal fascia was attached to an external traction system for growth. Complete closure was achieved at 5 months. Due to pulmonary hypoplasia, high-frequency ventilation was required. The patient is doing well, on a home ventilator wean, at 20 months. Case #2. The patient was born prematurely with gastroschisis, total liver herniation, and a defect extending to the pericardium. A silo was attached to the fascia to provide growth of the abdominal cavity. The patient developed respiratory failure, diffuse anasarca, and renal failure. She died at 38 days of life. Discussion. We report the first survivor of gastroschisis with complete liver herniation, contrasting it with a death of a similar case. The associated pulmonary hypoplasia may require long-term ventilation, the inflammatory response can lead to anasarca, and renal injury can occur from acute-on-chronic compartment syndrome. Conclusion. External fascial traction systems can help induce growth of the abdominal wall, allowing closure of the challenging abdomen. While critical care management is complex, survival is possible.
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Wuerth, Diane B., Susan H. Finkelstein, Olena Schwetz, Hugh Carey, Alan S. Kliger, and Fredric O. Finkelstein. "Patients’ Descriptions of Specific Factors Leading to Modality Selection of Chronic Peritoneal Dialysis Or Hemodialysis." Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis 22, no. 2 (March 2002): 184–90. http://dx.doi.org/10.1177/089686080202200204.
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♦ Objectives There has been increasing interest in understanding how patients with chronic renal failure choose between chronic peritoneal dialysis (CPD) and hemodialysis (HD) for renal replacement therapy. The purpose of the present study was to examine the influences and specific factors that patients identify as significant in choosing a specific dialysis modality for treatment of their end-stage renal disease (ESRD). ♦ Patients and Design 40 patients (20 CPD, 20 HD) who had started dialysis within the preceding 6 months were randomly selected to participate in the study. A structured interview was conducted with the patients, discussing and exploring what factors patients thought were important in helping them decide their treatment modality. The format of the interview was open-ended. Based on patients’ comments, a taxonomy of the specific factors that influenced the patients’ decisions was developed. ♦ Setting The study was conducted in a freestanding CPD unit and two freestanding HD units. ♦ Results All 20 CPD patients reported choosing their treatment modality; only 8 of the 20 HD patients reported having a choice of treatment modality. 18 of the 22 patients who participated in predialysis educational programs opted for CPD. 83% of the patients reported that their physician was important in influencing their treatment choice; however, the CPD patients relied more on written material and the opinions of their spouse/significant other or other family members in making their decisions. Issues of autonomy and control were important for 95% of patients choosing CPD. Both CPD and HD patients cited a variety of treatment-specific factors. The three most frequently cited reasons for choosing CPD were ( 1 ) flexibility of schedule (19 patients), ( 2 ) convenience of performing CPD in their own home (19 patients), and ( 3 ) the option of doing dialysis at night while sleeping (8 patients). The 8 HD patients who selected their treatment modality cited the desirability of having a planned schedule (7 patients) and letting nurses or other take care of them (5 patients). ♦ Conclusions The present study explored factors perceived by patients as being important in determining their choice of renal replacement therapy. A taxonomy of patient influences and concerns has been developed to provide caregivers with a framework to structure their educational strategies and assist patients with progressive renal failure in making an informed choice of therapeutic modality for their ESRD treatment.
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Chimada, Carina Akemi, Edilaine Martins da Silva, Joice Karina Otênio, Mariana Moraes Pinc, Renan Almeida de Jesus, Débora Gafuri Teixeira, Juliana Cogo, Odair Alberton, Emerson Luiz Botelho Lourenço, and Giuliana Zardeto-Sabec. "The importance of pharmacotherapeutic follow-up in patients with heart failure." Research, Society and Development 9, no. 10 (September 23, 2020): e1949108538. http://dx.doi.org/10.33448/rsd-v9i10.8538.
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Heart failure is a chronic disease that compromises the patient's quality of life, due to its symptoms, such as: tiredness/fatigue, exercise intolerance, orthopnea, paroxysmal nocturnal dyspnea. The aim of the present study was to intervene and assist in the treatment of Heart Failure patient with pharmacological and non-pharmacological approaches in order to improve the quality of life and patient compliance regarding the existing disease. Pharmaceutical consultations were carried out over a seven-month period with a patient that suffers from Heart Failure, resident of Umuarama-PR, treated at home. The SOAP method was adopted for the registration of consultations for later analysis, and the measurement of blood pressure was performed by the patient, using the HBPM method. For the analysis of interactions, the Micromedex database and the patient’s package leaflet were used.The patient had a significant decrease in his BP with the follow-up; however, he showed resistance to going to the doctor. After some guidance, the patient agreed to go to the consultation and he was diagnosed with Renal Failure and Prostatic Hyperplasia. It is concluded that pharmaceutical care can be an effective alternative in obtaining better clinical results and helps to improve the patient's quality of life, since it can provide awareness of their health status and the need for the correct use of medications, making the most effective and safe treatment.
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Dua, Anahita, Sapan S. Desai, Harvey J. Woehlck, and Cheong J. Lee. "The Impact of Warfarin on Patients with End Stage Renal Disease." Advances in Vascular Medicine 2014 (September 8, 2014): 1–4. http://dx.doi.org/10.1155/2014/542034.
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Introduction. A deficiency in vitamin K through the utilization of warfarin may result in increased vascular calcification and complications. This study aimed to determine the impact of warfarin administration on patients with end stage renal disease (ESRD) in a large, national sample. Methods. A retrospective analysis using the 2005–2010 National Inpatient Sample (NIS), a part of the Health Care Utilization Project (HCUP), was completed using ICD-9 diagnosis codes to capture patients with ESRD prescribed and not prescribed warfarin. Statistical analysis was through ANOVA and chi-squared testing. Results. From 2005–2010, 927,814 patients with ESRD were identified nationally. 3.5% (32,737) were prescribed warfarin. Patients prescribed warfarin had an average age of 64 years and 51% were male. For every comorbid condition (amputation, congestive heart failure, chronic obstructive pulmonary disorder, cerebrovascular accident, diabetes, hypertension, myocardial infarction, peripheral vascular diasese, and valvular disease) patients prescribed Warfarin had significantly higher rates of disease as compared to their nonwarfarin ESRD counterparts. ESRD patients prescribed warfarin had significantly shorter length of stay but increased hospital charges. They were more likely to be discharged to home and had significantly decreased in-hospital mortality. Conclusion. Patients with ESRD taking warfarin are more likely to have comorbidities and/or complications but have a decreased LOS and in-hospital mortality compared to their ESRD counterparts not administered warfarin.
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Hapipa, H. Ummul, and S. Bhuvaneswari. "Effectiveness of self-Instructional module on knowledge regarding post dialysis home care among care givers of chronic renal failure patients undergoing Haemodialysis in Karthik Hospital at Sivagangai." International Journal of Advances in Nursing Management 8, no. 3 (2020): 191. http://dx.doi.org/10.5958/2454-2652.2020.00045.1.
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Barbieri, Ana Rita, Crhistinne Cavalheiro Maymone Gonçalves, Maria de Fátima Meinberg Cheade, Cristina Souza, Daniel Henrique Tsuha, Kássio Costa Ferreira, Lucas Rasi, and Antonio Conceição Paranhos Filho. "Hemodialysis services: are public policies turned to guaranteeing the access?" Cadernos de Saúde Pública 31, no. 7 (July 2015): 1505–16. http://dx.doi.org/10.1590/0102-311x00073514.
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The increasing incidence of chronic renal failure in Brazil and the consequential expansion of hemodialysis as a choice for treatment in final stage have to be taken into account to guarantee access to those in need. The ecological study conducted in Mato Grosso do Sul State, Brazil, in 2012, using data from the Brazilian Health Informatics Department (DATASUS) and from the analysis of medical records in 12 clinics, identified and mapped patients on hemodialysis, the distance they travelled and the estimated number of patients. The prevalence of hemodialysis patients in Mato Grosso do Sul State, about 55 per 100,000 inhabitants, is similar to the national average. The analyses indicated concentration of patients in counties with clinics and also geographical gaps that generate displacement of over 100km for more than 16% of patients. The results point to the necessity of strengthening public policies that consider, for decision-making, the decentralization of service, the expansion of home care and the follow-up education for professionals.
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Habibi, Anoosha, Stephanie Ngo, Keyvan Razazi, Vincent Audard, Gonzalo De Luna, Marc Michel, France Pirenne, et al. "Causes and Circumstances of Death: Analysis in 266 Sickle Cell Adult Patients." Blood 138, Supplement 1 (November 5, 2021): 974. http://dx.doi.org/10.1182/blood-2021-149761.
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Abstract Introduction Sickle cell disease is a genetic disease with acute and chronic complications. Pediatric mortality has decreased in recent decades with the introduction of systematic antibiotic therapy, preventive management of cerebral vasculopathy and therapeutic education of families. However, in the absence of cohort follow-up at birth, life expectancy, which is a different concept from age at death, cannot be assessed. In this retrospective, monocentric study, we describe causes and circumstances of death, acute chronic complications, long-term treatments and baseline biology of these patients. It seems important to analyze the risks of morbidity and mortality in order to decide on the necessary preventive measures. Material and method: Records of patients deceased between 2000 and 2020, from the national referral center (Henri Mondor Hospital), were retrospectively reviewed. The referral center follows 3500 patients. All deaths reported to the hospital, by families, other hospitals and health professionals were retrieved from computerized records. Deaths published by the INSEE (National Institute of Statistical and Economical study) from 2000 to December 2020 were accessible and compared with our databases to identify all our deceased patients. All patients with a medical record in our center were included for the study. Patients who had never visited our center were excluded. Results: During this period 226 patients including 128 women and 138 men are recorded. Genotypes for these patients were 204(76%) SS, 41 (15%) SC, 14(5%) Sβ°thalassemia and 7 (2%) Sβ+thalassemia. The median age at death was 41 years with an IQR [32-51]. 186 (70%) patients were hospitalized, 129 (70%) of whom were admitted to intensive care. 36 (13%) patients died at home, including 15 with opioid addiction and 5 patients with psychiatric pathology, and 4 patients on dialysis. This information was not available for 44 (16%) patients. The causes of death were vaso-occlusive complications with multivisceral failure in 44 cases, 42 sepsis, among which there were 11 renal failures, 9 of which were dialyzed. 5 patients died of COVID 19. Cerebral hemorrhage and neurological accident occurred in 22 cases, 4 of which were known to have macrovasculopathy. 25 patients died of a direct complication of renal failure, of which 17 were dialysed, 8 pre-dialysed and 3 transplanted. Acute liver failure in 16 cases, 10 precapillary pulmonary hypertension, 14 DHTR, 10 end-stage heart failure were noted. Two road accidents, 2 suicides, 1 dementia are repoted. For 51 cases, there was no information on the cause or circumstance of death. The causes of death according to genotype is on Table 1. Concerning the chronic complications, 94/266 (35%) patients had significant chronic organ damage. Sixteen patients had required renal or liver transplantation in their history. End-stage organ damage was frequent, 42 had end-stage renal failure, 21 had major liver failure, of which five were transplanted and 16 were awaiting transplantation. Twenty-one patients had known heart failure, 10 of which were associated with end-stage renal disease. Ten patients were followed for significant precapillary pulmonary hypertension. Transfusion difficulties due to a history of DHTR were found for 33 patients. Fourteen patients had an opioid addiction. Nine patients were pregnant and nine had received corticosteroids. Discussion: Causes of death have changed and chronic organ failure is the leading cause of death, especially in patients with kidney, liver and heart disease. This study does not calculate life expectancy, but there was an increase in age at death of about 1/4 of the patients who were between 51 and 81 years old.The management of sickle cell disease has progressed in recent years and new therapies are being proposed. Prevention of the development of these complications is one of the new challenges, especially for renal disease, which is associated with premature mortality. DHTR and cerebral hemorrhage, Covid-19 are new entities and DHTR was probably underdiagnosed in previous publications. Pregnancy remains a period at risk, for which surveillance should be reinforced. The analysis is ongoing and correlations are currently being investigated between different parameters to find risk factors for mortality. Figure 1 Figure 1. Disclosures Habibi: Novartis: Consultancy, Honoraria; bluebird bio: Consultancy, Honoraria, Research Funding. Audard: Addmedica: Consultancy. Michel: Novartis: Consultancy; Amgen: Consultancy; Rigel: Honoraria; Alexion: Honoraria; UCB: Honoraria; Argenx: Honoraria. Galactéros: Addmedica: Membership on an entity's Board of Directors or advisory committees. Bartolucci: INNOVHEM: Other: Co-founder; Bluebird: Consultancy, Research Funding; F. Hoffmann-La Roche Ltd: Consultancy; GBT: Consultancy; Jazz Pharma: Other: Lecture fees; AGIOS: Consultancy; Hemanext: Consultancy; Emmaus: Consultancy; Fabre Foundation: Research Funding; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Lecture fees, Steering committee, Research Funding; Addmedica: Consultancy, Other: Lecture fees, Research Funding.
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Akkaya, Mehmet, and Mustafa Yilmaz. "P-269 The Effect of Acute Preload Reduction by Haemodialysis on Systolic Function of the Right Ventricle in Patients with Chronic Renal Failure." CVD Prevention and Control 4 (May 2009): S128. http://dx.doi.org/10.1016/s1875-4570(09)60461-7.
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Milnes, Sharyn, Neil R. Orford, Laura Berkeley, Nigel Lambert, Nicholas Simpson, Tania Elderkin, Charlie Corke, and Michael Bailey. "A prospective observational study of prevalence and outcomes of patients with Gold Standard Framework criteria in a tertiary regional Australian Hospital." BMJ Supportive & Palliative Care 9, no. 1 (September 21, 2015): 92–99. http://dx.doi.org/10.1136/bmjspcare-2015-000864.
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ObjectivesReport the use of an objective tool, UK Gold Standards Framework (GSF) criteria, to describe the prevalence, recognition and outcomes of patients with palliative care needs in an Australian acute health setting. The rationale for this is to enable hospital doctors to identify patients who should have a patient-centred discussion about goals of care in hospital.DesignProspective, observational, cohort study.ParticipantsAdult in-patients during two separate 24 h periods.Main outcome measuresPrevalence of in-patients with GSF criteria, documentation of treatment limitations, hospital and 1 year survival, admission and discharge destination and multivariate regression analysis of factors associated with the presence of hospital treatment limitations and 1 year survival.ResultsOf 626 in-patients reviewed, 171 (27.3%) had at least one GSF criterion, with documentation of a treatment limitation discussion in 60 (30.5%) of those patients who had GSF criteria. Hospital mortality was 9.9%, 1 year mortality 50.3% and 3-year mortality 70.2% in patients with GSF criteria. One-year mortality was highest in patients with GSF cancer (73%), renal failure (67%) and heart failure (60%) criteria. Multivariate analysis revealed age, hospital length of stay and presence of the GSF chronic obstructive pulmonary disease criteria were independently associated with the likelihood of an in-hospital treatment limitation. Non-survivors at 3 years were more likely to have a GSF cancer (25% vs 6%, p=0.004), neurological (10% vs 3%, p=0.04), or frailty (45% vs 3%, p=0.04) criteria. After multivariate logistic regression GSF cancer criteria, renal failure criteria and the presence of two or more GSF clinical criteria were independently associated with increased risk of death at 3 years. Patients returning home to live reduced from 69% (preadmission) to 27% after discharge.ConclusionsThe use of an objective clinical tool identifies a high prevalence of patients with palliative care needs in the acute tertiary Australian hospital setting, with a high 1 year mortality and poor return to independence in this population. The low rate of documentation of discussions about treatment limitations in this population suggests palliative care needs are not recognised and discussed in the majority of patients.Trial registration number11/121.
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Li, Juan, Huizhen Wang, Hongzhen Xie, Guiping Mei, Wenzhi Cai, Junsheng Ye, Jianlin Zhang, Guirong Ye, and Huimin Zhai. "Effects of Post-Discharge Nurse-Led Telephone Supportive Care for Patients with Chronic Kidney Disease Undergoing Peritoneal Dialysis in China: A Randomized Controlled Trial." Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis 34, no. 3 (May 2014): 278–88. http://dx.doi.org/10.3747/pdi.2012.00268.
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BackgroundPatients with end-stage renal failure (ESRF) need integrated health care to maintain a desirable quality of life. Studies suggest that post-discharge nurse-led telephone support has a positive effect for patients suffering from chronic diseases. But the post-discharge care is under-developed in mainland China and the effects of post-discharge care on patients with peritoneal dialysis have not been conclusive.AimThe purpose of this study is to test the effectiveness of postdischarge nurse-led telephone support on patients with peritoneal dialysis in mainland China.MethodsA randomized controlled trial was conducted in the medical department of a regional hospital in Guangzhou. 135 patients were recruited, 69 in the study group and 66 in the control group. The control group received routine hospital discharge care. The study group received post-discharge nurse-led telephone support. The quality of life (Kidney Disease Quality of Life Short Form, KDQOL-SF), blood chemistry, complication control, readmission and clinic visit rates were observed at three time intervals: baseline before discharge (T1), 6 (T2) and 12 (T3) weeks after discharge.ResultsStatistically significant effects were found for symptom/problem, work status, staff encouragement, patient satisfaction and energy/fatigue in KDQOL-SF and 84-day (12-week) clinic visit rates between the two groups. The study group had more significant improvement than the control group for sleep, staff encouragement at both T2 and T3, and pain at T2 and patient satisfaction at T3. No significant differences were observed between the two groups for the baseline measures, other dimensions in KDQOL-SF, blood chemistry, complication control, readmission rates at all time intervals and clinic visit rates at the first two time intervals.ConclusionsPost-discharge nurse-led telephone support for patients undergoing peritoneal dialysis is effective to enhance patients’ well-being in the transition from hospital to home in mainland China.
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Nyman, Mark A., Thulasee Jose, Ivana T. Croghan, Mark A. Parkulo, Charles D. Burger, Darrell R. Schroeder, Ryan T. Hurt, and John C. O’Horo. "Utilization of an Electronic Health Record Integrated Risk Score to Predict Hospitalization Among COVID-19 Patients." Journal of Primary Care & Community Health 13 (January 2022): 215013192110697. http://dx.doi.org/10.1177/21501319211069748.
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Objective: To evaluate the performance of an Electronic Health Record (EHR) integrated risk score for COVID-19 positive outpatients to predict 30-day risk of hospitalization. Patients and Methods: A retrospective observational study of 67 470 patients with COVID-19 confirmed by polymerase chain reaction (PCR) test between March 12, 2020 and February 8, 2021. Risk scores were calculated based on data in the chart at the time of the incident infection. Results: The Mayo Clinic COVID-19 risk score consisted of 13 components included age, sex, chronic lung disease, congenital heart disease, congestive heart failure, coronary artery disease, diabetes mellitus, end stage liver disease, end stage renal disease, hypertension, immune compromised, nursing home resident, and pregnant. Univariate analysis showed all components, except pregnancy, have significant ( P < .001) association with admission. The Mayo Clinic COVID-19 risk score showed a Receiver Operating Characteristic Area Under Curve (AUC) of 0.837 for the prediction of admission for this large cohort of COVID-19 positive patients. Conclusion: The Mayo Clinic COVID-19 risk score is a simple score that is easily integrated into the EHR with excellent predictive performance for severe COVID-19. It can be leveraged to stratify risk for severe COVID-19 at initial contact, when considering therapeutics or in the allocation of vaccine supply.
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Gonzalez-Vega, Lizeth Adriana, and Gloria Mabel Carrillo-Gonzalez. "Intervención telefónica y competencia para cuidar de personas con enfermedad crónica." Revista Ciencia y Cuidado 15, no. 1 (January 1, 2018): 98. http://dx.doi.org/10.22463/17949831.1225.
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Objetivo: Determinar el efecto de una intervención telefónica en personas con enfermedad crónica para mejorar su competencia de cuidado en el hogar. Materiales y Métodos: Estudio descriptivo y exploratorio; se vincularon 37 personas con enfermedad crónica, definidas como casos, que ingresaron a una institución de salud de la ciudad de Bogotá. Se aplicó la intervención telefónica durante 1 mes después del egreso hospitalario, se realizó medición antes y después de la competencia para el cuidado en el hogar y se registraron cada uno de los seguimientos telefónicos para determinar la percepción de los usuarios frente a los mismos. Resultados: La mayoría de pacientes son de sexo masculino, con diagnósticos de hipertensión arterial, diabetes mellitus tipo II, enfermedad pulmonar obstructiva crónica- EPOC, enfermedad renal e insuficiencia cardíaca, una edad promedio de 66 años y ocupación hogar. El 100 % de la muestra tiene más de una enfermedad crónica y bajos niveles de dependencia. La competencia para cuidar reportó niveles medios previo al inicio de la intervención, al finalizar aumentó, con cambios estadísticamente significativos. En cuanto a la percepción, se reconoce esta intervención como una continuidad de la atención, surgen temas de interés sobre la regulación del consumo de agua, la administración de medicamentos y la dieta y se demanda el abordaje de los componentes emocionales, sociales y económicos. Conclusiones: La intervención telefónica es una herramienta eficaz para aumentar la competencia de cuidar en el hogar de las personas con enfermedad crónica, genera percepción de seguridad, continuidad y vínculo con el equipo de salud. Palabras clave: pacientes, alta del paciente, enfermedad crónica Telephone intervention and profi ciency to take care of people with a chronic diseaseAbstractObjective: To determine the effect of a telephone intervention in people with chronic disease to improve their skills in home care. Method: Descriptive and exploratory study, including 37 patients with chronic disease, defined as cases; they were admitted to a health institution in the city of Bogotá. The telephone intervention was applied for 1 month after the hospital discharge, before and after the skills for home care were evaluated and each telephone follow-up was recorded to determine the users' perception of them. Results: The majority of patients are male, with diagnoses of hypertension, diabetes mellitus type II, COPD, renal disease and heart failure, an average age of 66 years; and the occupation of the participants was home. 100% of the sample has more than one chronic disease and low levels of dependency. The competency to care reported medium levels prior to the beginning of the intervention, at the end it increased, with statistically significant changes. In terms of perception, this intervention is acknowledged as a continuity of care, issues of interest arise on the regulation of water consumption, medication administration and diet; and it demands the approach of the emotional, social and economic components. Conclusions: Telephone intervention is an effective tool to increase the competence of care for people with chronic illness at home, generates perception of safety, continuity and link with the health team.Key words: patients, patient discharge, chronic disease. Intervenção telefônica e habilidade para cuidar de pessoas com doença crônicaResumoObjetivo: Determinar o efeito de uma intervenção telefônica em pessoas com doença crônica para melhorar sua habilidade de cuidado no lar. Materiais e Métodos: Estudo descritivo e exploratório; se vincularam 37 pessoas com doença crônica, definidas como casos, que ingressaram a uma instituição de saúde da cidade de Bogotá. Aplicou-se a intervenção telefônica durante 1 mês depois da saída hospitalar, se realizou medição antes e depois da habilidade para o cuidado no lar e se registraram cada um dos seguimentos telefônicos para determinar a percepção dos usuários frente aos mesmos. Resultados: A maioria de pacientes são de sexo masculino, com diagnósticos de hipertensão arterial, diabetes mellitus tipo II, doença pulmonar obstrutiva crônica- EPOC, doença renal e insuficiência cardíaca, uma idade média de 66 anos e ocupação no lar. O 100 % da amostra tem mais de uma doença crônica e baixos níveis de dependência. A habilidade para cuidar reportou níveis médios prévio ao início da intervenção, ao finalizar aumentou, com câmbios estatisticamente significativos. Enquanto à percepção, se reconhece esta intervenção como uma continuidade do atendimento, surgem temas de interesse sobre a regulação do consumo de água, a administração de medicamentos e a dieta e se demanda a abordagem dos componentes emocionais, sociais e econômicos. Conclusões: A intervenção telefônica é uma ferramenta eficaz para aumentar a habilidade de cuidar no lar das pessoas com doença crônica, gera percepção de segurança, continuidade e vínculo com a equipe de saúde.Palavras-chave: Alta do paciente, doença crônica, pacientes
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Puri, Akshjot, Michael Chesser, and Thomas Lidner. "Invasive fungal infections: A diagnostic challenge." Case Reports in Clinical Pathology 4, no. 2 (April 24, 2017): 15. http://dx.doi.org/10.5430/crcp.v4n2p15.
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Introduction: Overall incidence of invasive fungal infections in solid organ transplant recipients is low with the more common infections being invasive candidiasis, aspergillosis and cryptococosis. Zygomycosis comprises of only 0.2%-1.2% of infections in renal transplant recipients with current recommendations advising against routine prophylaxis.Case: The patient was a 60-year-old male with a history of renal transplant 25 years ago on immunosuppressants, chronic transplant glomerulopathy, squamous cell carcinoma post penectomy and bilateral orchiectomy 2 years ago, controlled diabetes and hypertension who presented with pain in the perineal region for 4 days. On exam he was discovered to be afebrile and had a scrotal skin fold with urethral opening from his previous surgery and 2.5 cm induration and tenderness in the left gluteal fold. He was treated with 5 days of Unasyn. A biopsy was taken to rule out recurrence of squamous cell carcinoma and he was discharged home. The patient returned with worsening perineal pain within 3 days. On exam he had progressive induration with erythema, swelling and tenderness in the perineum. An initial white blood cell count of 15.8 increased to 25.8 and blood cultures remained negative. The computed tomography scan showed diffuse edema in the perineum without any evidence of abscesses. Immunosuppression was held and broad spectrum antibiotics were started. His renal failure progressively worsened eventually requiring continuous renal replacement therapy, intensive care transfer and vasopressor support. The biopsy revealed intermingled fibrous tissue with focal necrosis and no evidence of malignant cells. A repeat incision and debridement (I&D) culture showed growth consistent with mucor. He was started on liposomal amphotericin B and taken to the OR for multiple debridements. Unfortunately he progressed to multisystem organ failure and died after transitioning to comfort care.Conclusions: Invasive fungal infections remain one of the life threatening differentials for cellulitis like skin lesions, especially for patients not responding to antibiotics and those who are immunocompromised. Early cultures and histopathology of lesions should be done for diagnosis and to avoid delays in treatment.
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Brito-Zerón, P., B. Gracia-Tello, A. Robles, A. Alguacil, M. Bonet, B. De-Escalante, A. Noblejas-Mosso, et al. "Characterization and Outcomes of SARS-CoV-2 Infection in Patients with Sarcoidosis." Viruses 13, no. 6 (May 27, 2021): 1000. http://dx.doi.org/10.3390/v13061000.
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To analyze the clinical characteristics and outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with sarcoidosis from a large multicenter cohort from Southern Europe and to identify the risk factors associated with a more complicated infection. We searched for patients with sarcoidosis presenting with SARS-CoV-2 infection (defined according to the European Centre for Disease Prevention and Control guidelines) among those included in the SarcoGEAS Registry, a nationwide, multicenter registry of patients fulfilling the American Thoracic Society/European Respiratory Society/World Association of Sarcoidosis and Other Granulomatous Disorders 1999 classification criteria for sarcoidosis. A 2:1 age-sex-matched subset of patients with sarcoidosis without SARS-CoV-2 infection was selected as control population. Forty-five patients with SARS-CoV-2 infection were identified (28 women, mean age 55 years). Thirty-six patients presented a symptomatic SARS-CoV-2 infection and 14 were hospitalized (12 required supplemental oxygen, 2 intensive care unit admission and 1 mechanical ventilation). Four patients died due to progressive respiratory failure. Patients who required hospital admission had an older mean age (64.9 vs. 51.0 years, p = 0.006), a higher frequency of baseline comorbidities including cardiovascular disease (64% vs. 23%, p = 0.016), diabetes mellitus (43% vs. 13%, p = 0.049) and chronic liver/kidney diseases (36% vs. 0%, p = 0.002) and presented more frequently fever (79% vs. 35%, p = 0.011) and dyspnea (50% vs. 3%, p = 0.001) in comparison with patients managed at home. Age- and sex-adjusted multivariate analysis identified the age at diagnosis of SARS-Cov-2 infection as the only independent variable associated with hospitalization (adjusted odds ratio 1.18, 95% conficence interval 1.04–1.35). A baseline moderate/severe pulmonary impairment in function tests was associated with a higher rate of hospitalization but the difference was not statistically significant (50% vs. 23%, p = 0.219). A close monitoring of SARS-CoV-2 infection in elderly patients with sarcoidosis, especially in those with baseline cardiopulmonary diseases and chronic liver or renal failure, is recommended. The low frequency of severe pulmonary involvement in patients with sarcoidosis from Southern Europe may explain the weak prognostic role of baseline lung impairment in our study, in contrast to studies from other geographical areas.
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Arnold, Louise M., Jill Stephenson, Richard Kelly, David Buchanan, Gareth Jones, and Peter Hillmen. "Home Infusion of Eculizumab: A Unique and Innovative Model of Drug Delivery to Reduce Treatment-Associated Burden and Enhance Quality of Life for Patients with PNH." Blood 112, no. 11 (November 16, 2008): 4671. http://dx.doi.org/10.1182/blood.v112.11.4671.4671.
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Abstract Paroxysmal Nocturnal Hemoglobinuria (PNH) is an acquired clonal stem cell disease, characterised by intravascular hemolysis, bone marrow failure and lifethreatening thromboses. The median survival is 10–15 years, with the average age of presentation being in the 30’s. Symptoms include hemoglobinuria, fatigue, anemia, venous and arterial thromboses, recurrent pain, renal impairment, erectile dysfunction and pulmonary hypertension. The care of a patient with PNH is complex and challenging, as many experience chronic symptoms with periods of acute exacerbations. Historically the management of PNH included bone marrow transplant, blood transfusion and administration of additional supportive therapies, all necessitating regular visits to the hospital. Eculizumab, a monoclonal antibody that binds to the C5 complement component inhibiting the activity of terminal complement and thus preventing the destruction of red blood cells has dramatically altered the management of hemolytic PNH. Clinical trials of eculizumab demonstrated the resolution of the majority of symptoms and complications of PNH and resulted in its approval in the UK in June 2007. Eculizumab is administered as a 30 minute intravenous infusion every 14 days, and under the terms of its current EU licence, must be administered by a healthcare professional. In view of the rarity of PNH there are relatively few specialist Centres for the disease resulting in, patients travelling long distances for review and treatment. In view of the dramatic improvement in symptoms on eculizumab many patients are able to return to a near normal lifestyle. In the UK, Leeds Teaching Hospitals with Healthcare at Home have developed a home infusion programme that ensures safe administration of eculizumab in the patient’s home at a time convenient to them, leading to enhanced treatment-associated convenience for patients and their families. Patients then only attend the PNH Centre every 3 months to ensure appropriate monitoring and patient education. A recent survey of patients reports a reduction in treatment-associated burden for PNH patients and their families when receiving infusions at home. 46 patients responded to the survey with just over half receiving eculizumab. Of the 21 patients at the time receiving home infusions 19 found this more convenient than the hospital. Home treatment allows flexibility and for some, the return to full-time employment, with the associated financial benefits and improvement in psychological well-being. Of the 21 patients on home care 7 stated there ability to work was transformed with a further 10 having great improvement. Whilst the purpose of the survey was not to address financial burden, the home infusion programme has anecdotally reduced the financial burden on the patient and their family by eliminating the need for time off work, allowing return to full-time employment, and eliminating the cost of travel to and from the hospital for treatments. No patients reporting negative impact, including effect on social life and family relationships, whilst 15 experienced improvement or complete transformation in both areas. The patients reported confidence in the homecare programme, knowing that a very close working relationship existed between the expert hospital and homecare teams. This innovative programme of medication delivery by a dedicated home nursing team allows patients who have previously struggled to cope with their illness to lead a near normal life with an associated enhancement in quality of life. Patients are able to carry on with activities of daily life, including work, recreational activities and holidays, whilst at the same time ensuring compliance with treatment and therefore allowing maximum therapeutic benefit.
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Farhan, Shatha Y., and Ileana Lopez_Plaza. "Erythrocytapheresis in Sickle Cell Disease and Multi-Organ Failure in the Intensive Care Unit." Blood 114, no. 22 (November 20, 2009): 4627. http://dx.doi.org/10.1182/blood.v114.22.4627.4627.
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Abstract Abstract 4627 Introduction Patients with sickle cell disease (SCD), including those with homozygosity for hemoglobin (Hb) S (SCD-SS) or compound heterzygosity for sickle and Hb C (SCD-SC), suffer from chronic variable intravascular hemolysis, microvascular ischemia and organ damage. Vaso-occlusion results from a dynamic combination of abnormalities in hemoglobin S structure and function, red blood cell membrane integrity, erythrocyte density, endothelial activation, microvascular tone, inflammatory mediators, and coagulation. HbC enhances, by dehydrating the SC red cell, the pathogenic properties of HbS, resulting in a clinically significant disorder, but somewhat milder sickle cell anemia. The management of SCD continues to be supportive and includes hydration, pain relief, blood transfusion and psychosocial support. However, transfused red cells will significantly increase blood viscosity, potentially reducing blood flow, if the Hb level rises above 10 g/dL. Therefore, if the goal is an acute reduction in the proportion of sickled red cells in addition to an increase in oxygen-carrying capacity, exchange transfusion is the therapy of choice. We report 3 cases of (SCD-SS) and (SCD-SC) disease with multi-organ failure syndrome who were admitted to our intensive care unit (ICU) between January and July 09 where Erythrocyatperesis was effective but somewhat delayed. Report The first patient is a 46-year old male with SCD-SC disease who presented with severe leg, back, and chest pain. He was treated with intravenous fluid and nasal oxygen supplementation. Chest pain was sustained with severe hypoxemia, elevated troponins and somnolence developed third day of hospitalization. Fourth day he became more lethargic, breathing at 35/ min. His labs showed acute liver and kidney injury. The patient was transferred to ICU. In spite of respiratory and medical support, his medical status worsened, so hematology team was consulted and red cell exchange transfusion was made with subsequent improvement in mental status. The second patient was a 45 year old patient with SCD-SC disease who was found at home confused, complaining of back, chest and extremities pain, with unsteady gait and labored breathing. In Emergency Department (ED) he was hypotensive with abdominal tenderness and hypoactive bowel movements. His labs showed acute hepatic and renal injury with severe metabolic acidosis. Patient was resuscitated with IV fluids and intubated. CT scan of the abdomen showed diffuse bowel inflammation. On the third day of admission, hematology team was consulted and Erythrocytapheresis was started. His mental status improved slowly but he continued to have a seizure disorder and had to be on hemodialysis. The third patient is a 46 year old with SCD-SS disease and chronic lower extremity ulcers who had recurrent admissions for hyperpigmented gallstones and endoscopic retrograde cholangiopancreatography with stent placements. He presented to ED with nausea, vomiting, diarrhea and fever for 3 days. He was found hypotensive, tachycardic, with respiratory distress and acute liver and kidney abnormalities on labs. He was intubated and started on fluids and antibiotics. Thirty hours post admission he underwent erythrocytapheresis. Conclusion Red cell exchange transfusions remain an effective but possibly underutilized and delayed therapy in acute sickle cell complications, especially acute chest and the multi-organ failure syndromes. It can provide needed oxygen carrying capacity while reducing the overall viscosity of the blood. Although the need for a central line and the requirement for sickle- negative, as-fresh-as-possible blood, matched for minor antigens are major reasons for delay, it seems that it is mostly delayed for clinical reasons, trying to rule out other disorders or contributing factors and when the apheresis starts the patients are in the hospital/ICU for days already. We conclude that in patients with sickle cell disorder (SS or SC) being hypoxic and with chest or multi-organ failure syndrome, red cell exchange transfusion is effective treatment modality and should be initiated as soon as possible. Disclosures: No relevant conflicts of interest to declare.
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Murphy, Deborah, Bob Sanders, Loretta Gulley, Ami Knoefler, Alden Smith, Minyoung Park, Susana Tsao, Sanchita Mourya, and Mishaela Rubin. "Disease Burden of Patients Living With Hypoparathyroidism: Results From the Voices of Hypopara Survey." Journal of the Endocrine Society 5, Supplement_1 (May 1, 2021): A260—A261. http://dx.doi.org/10.1210/jendso/bvab048.529.
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Abstract Background: Hypoparathyroidism (HP) is a rare disease that is characterized by insufficient levels of parathyroid hormone, resulting in hypocalcemia, hyperphosphatemia and hypercalciuria. Standard of care (SoC) consists of calcium and active vitamin D supplementation. Some patients may suffer from “calcium crashes”, sudden hypocalcemia symptoms that can be severe enough to require a visit to the emergency room (ER) or urgent care. Conversely, chronic use of SoC supplements can also increase risk of hypercalciuria and renal failure. The HypoPARAthyroidism Association (HPA), a nonprofit organization dedicated to improving the lives of hypoparathyroid patients, developed the “Voices of Hypopara” survey to capture the journey of patients with HP in the US. Methods: The online survey was distributed to all HPA members (approximately 1,000) in May 2020. Questions focused on evaluating patients’ experiences including diagnosis, treatment, quality of care, and impact on daily living. Results: The survey was completed by 146 HPA members (89% female; mean age 51). Most participants reported they are currently taking SoC (calcium 91%; active vitamin D 77%). However, over half felt that this did not optimally address their disease and 29% were extremely concerned about hypocalcemia despite supplementation. Many (69%) felt that taking SoC was moderately to extremely burdensome. More than two-thirds (69%) of respondents reported a “calcium crash” in the past year; of these, 43% reported calcium crashes monthly or weekly. Almost half (42%) of all participants required a visit to an ER/urgent care in the last year as a result of HP symptoms; of these, 56% believed that the staff was inexperienced with management of a calcium crash. More than 60% of participants checked serum calcium levels at least every couple of months at a physician’s office or lab in the past year, with 36% checking monthly or more frequently; the majority of respondents (70%) said the reason was due to symptoms of hypocalcemia. Participants viewed an at-home device for measuring serum calcium, phosphate, and magnesium levels as one key approach to manage their HP symptoms (47% ranked as “most preferred”), followed by more effective medications as the second most preferred option (23%). Almost all (99%) responded that they would use an at-home monitoring device and would test frequently. Conclusions: Results from this survey underscore the high disease burden of patients with HP, highlighting sudden hypocalcemic episodes as a key morbidity despite treatment with calcium and active vitamin D supplementation, and sub-optimal management by clinicians as an impediment to optimal treatment. These findings reinforce the need for more frequent, easily accessible, and real-time serum calcium level monitoring device, more efficacious therapies, and greater disease understanding among health care workers to best manage patients with HP.
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Arnold, Louise M., Gemma L. Brooksbank, Richard J. Kelly, Anita Hill, Stephen John Richards, Rachel Senior, Tracy Downing, et al. "Continued Benefit From Prolonged Treatment with Eculizumab in 130 Patients with PNH in the UK: Home Delivery of Eculizumab Is Safe, Convenient and Associated with Very High Levels of Patient Satisfaction." Blood 118, no. 21 (November 18, 2011): 4368. http://dx.doi.org/10.1182/blood.v118.21.4368.4368.
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Abstract Abstract 4368 Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, acquired bone marrow disorder characterised by intravascular hemolysis with resultant anemia often leading to transfusion dependence, severe disabling symptoms and, frequently, life threatening thrombosis. Historically the management of PNH was largely supportive, relatively ineffective and resulted in frequent visits to hospital, admissions, an inability to function normally including loss of employment or other daily activities. PNH is a chronic condition and in most patients persists for the remainder of the patient’s life. Eculizumab was first used for PNH in 2002 and has been licensed since 2007. Eculizumab has been reported to improve all symptoms due to hemolysis in PNH as well as preventing the common complications, such as thrombosis and renal failure and normalising survival. However eculizumab has to be given as an intravenous infusion every 2 weeks indefinitely. In the UK PNH is managed in a shared care model between local hematologists and the National PNH Service from two Centres based in St James’s University Hospital, Leeds and Kings College Hospital, London. Here we report the management of patients treated with eculizumab within the PNH National Service. A total of 130 patients have been treated with eculizumab since May 2002 with 120 currently receiving therapy. 5 patients have died and none were directly related to PNH or eculizumab. 99 patients requiring transfusions prior to eculizumab have been on treatment for at least a year and 65 (66%) of these have not required transfusions for at least the last 12 months. The rarity of PNH means that patients frequently have to travel long distances for review and treatment. This leads to major issues both in terms of time commitment and expense. In order to allow patients to lead as normal lives as possible we have developed a service model in which Specialist PNH Clinics are performed regionally by the PNH Centre and in which patients receive eculizumab every 2 weeks in their homes delivered by a homecare nursing team. In the UK, the PNH Service and Healthcare at Home Ltd (www.hah.co.uk) have been working in partnership for over 7 years during the clinical trials of eculizumab and since its license in 2007. The PNH Service manages the prescription and delivery of eculizumab including an education program for the homecare nurses. This innovative home infusion programme ensures the safe administration of eculizumab outside of the hospital environment, leading to enhanced treatment-associated convenience for patients and their families. Each year the home infusion program has grown, now over 3000 infusions are given annually including whilst patients are on holiday, visiting family, at University or in the workplace. A recent patient survey has been conducted from the 2 PNH Centres to assess the patients’ experience of their PNH diagnosis and treatment. 122 patients responded with 70 of these patients receiving treatment with eculizumab and all currently on the home infusion programme. 63 of 68 patients reported the homecare service as excellent or very good compared to 1 reporting it as poor and 66 of the 68 patients preferred to have their treatment at home compared to hospital. The patients main concerns before starting treatment were reduced life expectancy and the requirement for blood transfusions along with fatigue. With eculizumab treatment and the convenience of homecare 30 patients reported being able to return to work. The homecare service is supported by contact between the clinic appointments, 56 of 67 patients having contact with their PNH Specialist Centre by phone or email in addition to the care of the patient’s local hematology team that over 90% of the patients continue to see. The impact of PNH on patients lives before eculizumab treatment was rated and improved from a median of 3 out of 10 (0 = no quality of life; 10 = normal) prior to eculizumab to a median of 8 out of 10 on treatment. In summary, a novel model of provision of care in PNH with Outreach Specialist Clinics, a 24 hour on call service and homecare delivery of eculizumab permits the normalisation of patients’ lives and overcomes most of the hurdles associated with prolonged regular intravenous therapy. This allows patients to benefit fully from eculizumab including reduction in transfusions, the prevention of serious complications, normalisation of quality of life and where appropriate a return to work. Disclosures: Arnold: Alexion Pharmaceuticals: Honoraria. Kelly:Alexion Pharmaceuticals: Honoraria, Membership on an entity’s Board of Directors or advisory committees, Speakers Bureau. Hill:Alexion Pharmaceuticals: Honoraria, Membership on an entity’s Board of Directors or advisory committees, Speakers Bureau. Richards:Alexion Pharmaceuticals: Honoraria, Speakers Bureau. Elebute:Alexion Pharmaceuticals: Honoraria, Membership on an entity’s Board of Directors or advisory committees. Hillmen:Alexion Pharmaceuticals: Honoraria, Membership on an entity’s Board of Directors or advisory committees, Research Funding, Speakers Bureau.
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Patel, Keyur, Kathan Dilipbhai Mehta, Smit Patel, Smith Giri, Hong Wang, Roy E. Smith, and Rahul Atul Parikh. "30 Day Readmissions in Patients with Deep Vein Thrombosis in United States." Blood 128, no. 22 (December 2, 2016): 4727. http://dx.doi.org/10.1182/blood.v128.22.4727.4727.
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Abstract Introduction: Deep vein thrombosis (DVT) is an important cause of the morbidity and mortality in the United States (US). National estimates of 30-day readmissions in DVT patients in the US are unknown. The objective of our study was to estimate readmission rates and identify causes, predictors and cost of readmissions in DVT patients. Methods: We used National Readmission Dataset (NRD - the year 2013), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality which represents one of the largest random sample of discharges from all hospitals, excluding rehabilitation and long-term acute care hospitals. NRD is designed to generate national estimates of readmission analysis.NRD contains approximately unweighted 14 million discharges and weighted 36 million discharges for the year 2013. Discharge weights were utilized to generate the national estimates. The patients with DVT were identified by primary discharge diagnosis with ICD9-CM code 451-453. All cause unplanned 30-day readmission rates were calculated for patients admitted between January and November 2013 by excluding elective readmissions. Deyo's modification of Charlson comorbidity index was used to define the severity of co-morbid conditions. Using SAS version 9.3, survey procedures were implemented to adjust for stratified cluster design of NRD with DOMAIN, STRATA, CLUSTER and WEIGHT statement. A p-value of less than 0.05 was considered significant. The independent predictors of unplanned 30-day readmissions were identified by logistic regression. The cost of readmission was calculated by multiplying total charges with the cost to charge ratio provided by HCUP. Results: The NRD contained 60,556 unique DVT patients with 126,362 admissions (weighted N = 288,553) in 2013. After excluding elective readmissions, all cause30-day readmission rate was 13.8%. The top causes of unplanned readmissions were phlebitis (15.9%), septicemia (6.6%), pulmonary heart disease (4.2%), skin and subcutaneous tissue infections (4.0%), gastrointestinal hemorrhage (3.8%), complication of implant or graft (2.9%), nonhypertensive congestive heart failure (2.7%), pneumonia (2.7%), acute, unspecified renal failure (2.4%), and urinary tract infections (2.4%). The multivariate predictors for higher 30 day unplanned readmissions were Charlson comorbidity index (OR 1.13, p<0.0001), large bedside hospitals (OR 1.19, p=0.0008), metropolitan teaching hospitals (OR 1.08, p<0.0001), weekend admissions (OR 1.08, p=0.03), Medicaid payer (OR 1.25, p<0.0001), discharge against medical advice (OR 2.7, p<0.0001), discharge to facility (OR 1.54, p<0.0001), discharge to home health care (OR 1.38, p<0.0001), any bleeding complications (OR 1.13, p=0.017), congestive heart failure (OR 1.44, p<0.0001), chronic pulmonary disease (OR 1.28, p<0.0001), cancer (OR 1.60, p<0.0001), major operative procedures (OR 1.36, p<0.0001), mechanical ventilation (OR 1.79, p=0.016).The multivariate predictors for lower 30 day unplanned readmissions were higher age (OR 0.99, p<0.0001), non-metropolitan hospitals (OR 0.81, p<0.0001), elective admission (OR 0.73, p<0.0001), self-pay, no charge or other pay (OR 0.82, p=0.002), private payer including HMO (health maintenance organization) (OR 0.75, p<0.0001). The estimated total cost of unplanned 30-day readmissions in DVT patients was $ 0.88 billion for 2013. Conclusions: The unplanned 30-day readmission rates and the cost are high in DVT patients in the US. Phlebitis is the most common cause of unplanned 30-day readmission, which is potentially avoidable. Further research is needed to identify preventable readmissions, strategies to cut down the readmissions and eventually reduce the cost of readmissions in patients admitted with DVT. Disclosures No relevant conflicts of interest to declare.
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Benbrahim, Omar, Bernard Grosbois, Jean-François Viallard, Sylvain Choquet, Bruno Royer, Brigitte Dreyfus, Emmanuel Fleck, et al. "Use of Human Immunoglobulins in Secondary Immunodeficiencies Associated with Hematological Malignancy in Real-Life Practice: Which Patients, Which Treatment?" Blood 124, no. 21 (December 6, 2014): 4972. http://dx.doi.org/10.1182/blood.v124.21.4972.4972.
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Abstract Introduction Patients with hematologic malignancies suffer of frequent, severe, and potentially life-threatening infections. Secondary immune deficiency (SID) could be due to the disease and/or to its treatment (immunosuppressants, immunomodulators, monoclonal anti-CD20 antibodies, corticosteroids for auto-immune cytopenia). Polyvalent immunoglobulins (Ig) prevent infections by restoring serum Ig level. Ig may be administered intravenously (IVIG) or subcutaneously (SCIG), in hospital setting or at home with same clinical benefit but various constraints. According to the recommendations, it is legitimate to propose Ig replacement therapy for these patients if the residual Ig rate is less than 5 g/L and/or several infectious accidents occurred. These recommendations are old and based on scarce data (1980’s and 1990’s studies), meantime, new therapies and clinical protocols have been developed to treat hematologic malignancies. Recent data regarding the clinical profile of patients receiving substitutive Ig in France are still scarce. Objective The EPICURE study aims to describe the clinical profile of patients with hematologic malignancies and SID who start a substitutive treatment with Ig. Secondary objectives are to describe the modalities of treatment with Ig (route, place for administration and dosing) and physicians expectation to this treatment. Patients and methods Starting in 2011, EPICURE is an observational, prospective, longitudinal study involving 40 French centers. All adult SID patients with hematologic malignancies, receiving substitutive Ig may enter the study. To date, 240 patients have been included. We report the baseline data of the first 130 patients monitored. Results The analysis focused on 130 patients (88 men, 42 women), aged 67 ± 12 years, with myeloma (N=27), chronic lymphocytic leukemia (N=47), non-Hodgkin B lymphoma either aggressive (N=19) or indolent (N=21) or other hematologic malignancies (N=21). Ten patients (7.7%) presented also autoimmune cytopenia (AIC). 50 patients (38.5%) were receiving antineoplastic chemotherapy (N=47) and/or immunosuppressants (N=8). 34 patients (26.2 %) have received a bone marrow transplant. Serum IgG level was < 5g/L in 67.4% of patients who had no monoclonal peak. Auto-immune disease (apart from AIC) (N=4), renal failure (N=6) and diabetes (N=13) potentially increased the risk of infection. 119 patients (91.5%) had a history of infection within the last 12 months for a total of 236 infectious episodes. 66 (28.0%) of these episodes have been severe (OMS grading ≥ 3), 77 (32.6%) have led to hospitalization for a total number of 972 days, 136 (57.6%) have required oral antibiotics and 59 (25.0%) have required intravenous antibiotics. Replacement therapy with Ig was started as IVIG in 62 patients (47.7%) and as SCIG in 68 patients (52.3%). Treatment with Ig was started in hospital setting for almost all patients (IVIG 100%, SCIG 95.6%) and was planned to be pursued at home for 1.6% of patients with IVIG but 98.5% of patients with SCIG. Physicians were expecting to avoid further infections, to improve quality of life and to decrease hospitalization rate. Mean dosing was 436±257 mg/kg/month in line with current recommendations. Conclusion Patients with SID associated with hematologic malignancies who start a replacement therapy with Ig were at high risk of severe infections and most of them had a low serum level of Ig. Ig replacement therapy was started subcutaneously in half of patients for a further planned administration at home. The other half of patients received IVIG for a further planned administration in hospital setting. Longitudinal monitoring will describe physician’s satisfaction regarding replacement therapy, evaluate infection incidence rate over the treatment period and define therapeutic profiles for a better care of these patients. Disclosures No relevant conflicts of interest to declare.
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Makoto, Hiramatsu. "How to Improve Survival in Geriatric Peritoneal Dialysis Patients." Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis 27, no. 2_suppl (June 2007): 185–89. http://dx.doi.org/10.1177/089686080702702s32.
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♦ Background Recently, more elderly patients who are independent or able to live at home with the support of family are opting for continuous ambulatory peritoneal dialysis (CAPD). At the end of 2005, the annual statistical survey conducted by the Japanese Society for Dialysis Therapy indicated that the mean age of patients at initiation of dialysis treatment is 66.2 years. Only 3.6% of the overall end-stage renal disease population were treated with CAPD, and this small number of elderly patients was treated with CAPD despite the many merits of peritoneal dialysis (PD) for the elderly. In the present study, we reviewed our experience with patients 65 years of age and older at the start of PD and the results from two multicenter studies on PD treatment in elderly patients in Japan. ♦ Patients and Methods Study 1: Of 313 PD patients at Okayama Saiseikai General Hospital between January 1991 and June 2006, 166 patients 65 years of age and older were studied. The characteristics of these elderly PD patients were reviewed to determine which elderly patients can continue PD for more than 5 years, and what the causes of death and the effects of icodextrin were in elderly PD patients. Study 2: A multicenter study of 421 patients introduced to PD from April 2000 to December 2004 in Japan was carried out by the Japanese Society for Elderly Patients on Peritoneal Dialysis to retrospectively analyze patient survival and technique survival and to find factors that have the potential to influence prognosis in these patients. Study 3: A review of the PD management and nursing-care insurance system (long-term care insurance) targeted patients 65 years of age and older who were initiated onto PD from January 2000 to June 2002 at 82 centers in Japan. The review found 765 patients under the age of 65 years (62.6%), and 458 patients 65 years of age and over (37.4%). Data on 409 elderly PD patients from 73 centers were analyzed. ♦ Results Study 1: In 166 elderly patients, 27 (16.3%; 18 women, 9 men) continued PD for more than 5 years at our hospital. The original disease was chronic glomerulonephritis in 21 patients, diabetic nephropathy in 2 patients, nephrosclerosis in 2 patients, and polycystic kidney disease in 2 patients. The causes of death in the elderly PD patients at our hospital were heart failure (20.3%), cerebrovascular disease (17.7%), myocardial infarction (15.2%), debilitation (12.7%), peritonitis (7.6%), and pneumonia (3.8%). We observed significant differences in ultrafiltration, body weight, sodium, chloride, red blood cells, and hematocrit after using icodextrin in 14 elderly PD patients. Also, use of icodextrin in the daytime helps the family supporting an elderly member on PD by reducing the number of exchanges. Study 2: The average age of 421 patients in 37 hospitals throughout Japan was 76.4 years. Women accounted for 41% of all patients. The average modified (exclusive of factors of aging) Charlson comorbidity index (CCI) was 3.7. The modified CCI was an important factor not only in patient survival but also in technique survival. Patient survival was significantly different for the three modified CCI groups (CCI < 3, 3 ≤ CCI < 5, 5 ≤ CCI). Factors that influenced patient survival included patient choice of modality, modified CCI, exchanges performed by family members, and age at the start of PD. Factors that influenced technique survival included patient choice of modality, modified CCI, and exchanges performed by family members. Age at the start of PD was not a significant factor influencing technique survival. Study 3: Most elderly PD patients were living with family; 7% were living alone. At the start of PD, 24% of elderly PD patients were covered by nursing-care insurance, including 11% of young elderly patients (65 – 74 years of age), 35% of old elderly patients (75 – 84 years of age), and 29% of very old elderly patients (85 years of age or older). Patients 75 years of age or older were covered by nursing-care insurance more frequently than were patients under 75 years of age. Nevertheless, at the start of dialysis, fewer than 10% of elderly patients were using nursing-care insurance for PD. ♦ Conclusions In elderly patients, PD has good outcomes, especially in nondiabetic patients, in patients with few comorbidities, and in patients managing PD by themselves. In introducing dialysis in elderly patients, PD should be the treatment of choice. A more secure support system should be established to allow the elderly to choose PD treatment.
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Němeček, K., V. Bártová, M. Jáchymová, and K. Horký. "Endothelin in Patients with Chronic Renal Failure." Renal Failure 17, no. 5 (January 1, 1995): 559–63. http://dx.doi.org/10.1080/0886022x.1995.12098267.
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Nemecek, K., V. Bártová, M. Jáchymová, and K. Horký. "Endothelin in Patients with Chronic Renal Failure." Renal Failure 17, no. 5 (September 1, 1995): 559–63. http://dx.doi.org/10.3109/08860229509037620.
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McCollom, Joseph William, Stephanie A. Dublis, James Hoogeboom, Abigail Doyle, and Jacob Templin. "Catastrophic Multi-Organ Failure with Bone Marrow Necrosis in a Sickle Cell Beta Plus Thalassemia Patient." Blood 124, no. 21 (December 6, 2014): 4942. http://dx.doi.org/10.1182/blood.v124.21.4942.4942.
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Abstract The variant sickle cell hemoglobinopathies have a variety of phenotypic presentations. Sickle cell beta plus thalassemia is an uncommon variant with an incidence that is 1/10th of sickle cell trait. This phenotype usually is associated with a milder clinical course, however often the first clinical presentation of such patients can be fatal vaso-occlusive crisis. Our case involves a 47 year old African American male with a reported history of sickle cell trait presenting with acute on chronic lower back pain for which an organic cause could not be identified with plain Xrays. He was treated with benzodiazepines and narcotics and later admitted to the ICU after being found unresponsive at home. He required intubation for airway protection. He was started on a Narcan drip for presumed narcotic overdose, without improvement. Noncontrast CT imaging of the head was negative. Laboratory findings were significant for anemia, thrombocytopenia, leukocytosis, acute kidney injury and elevated liver enzymes. Hemolysis was suspected with a markedly elevated LDH. Peripheral smear showed mild microangiopathic changes with 0-1 schisctocytes per hpf without evidence of sickle cells. Hematology was consulted and the patient was started on plasma exchange for a presumed diagnosis of TTP, however it was discontinued when his ADAMTS13 returned at a low-normal 67%, and TTP was felt less likely. MRI of the brain showed multiple focal and patchy areas infarcts throughout white matter of both cerebral hemispheres. MRI of the lumbar and thoracic spine showed a heterogeneous appearance of the bone marrow, concerning for a marrow infiltrative process. Work up for infectious or vasculitic causes were unremarkable. Hemoglobin electrophoresis showed Hb A1 20.2 (L), A2 5.8 (H), Hb F 2.2 (H), Hb S 71.8 (H), identifying doubly heterozygous sickle cell beta plus thalassemia. Bone marrow biopsy was hyperplastic with areas of geographic necrosis with sickle cells causing sludging and congested sinusoidal spaces suggesting ischemic necrosis due to vaso-occlusion. He was treated with exchange transfusion, with repeat hemoglobin electrophoresis showing A1 73.2 (L), A2 3.5 (H), HbS 23.3 (H). His lupus anticoagulant was positive raising concern for APLAS contributing to his catastrophic clinical course and severe neurologic disease,so he was started on anticoagulation with Lovenox and high dose steroids at a dose of 1 mg/kg daily. When the anticardiolipin and beta2 glycoprotein antibodies returned negative, the steroids were tapered and eventually discontinued. The clinical significance of the lupus inhibitor remains unclear. Shortly after initiation of plasma exchange and simple transfusion, the patient did stabilize hematologically. Platelets returned to the normal range and there was no evidence to suggest ongoing hemolysis. Renal and liver function improved. However he made no neurological recovery. He continued to require ventilator support and underwent a tracheostomy. A repeat MRI head showed progressive infarcts of both cerebral hemispheres, with new cerebellar infarcts. He was declared brain dead after 23 days and care was withdrawn. This case demonstrates that sickle cell beta plus thalassemia can present with acute hemolysis and bone marrow necrosis in otherwise healthy adults. The literature supports bone marrow necrosis and subsequent fat emboli as the likely pathophysiologic nidus responsible for multiorgan system failure including the catastrophic neurologic insult in this patient. Prompt recognition of this uncommon and challenging disease presentation and timely treatment with exchange transfusion may lead to improved clinical outcomes. Illustration 1: Bone marrow necrosis with ghosted cells Illustration 2: T2 weighted MRI with diffuse white matter ischemia Disclosures No relevant conflicts of interest to declare.
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Jayasena, Rajiv, Hang Ding, Alison Dowling, Gk Shridhar, Dean Richardson, Andrew Maiorana, and Iain Edwards. "Chronic Heart Failure Care Model for home Monitoring of Patients." International Journal of Integrated Care 17, no. 3 (July 11, 2017): 141. http://dx.doi.org/10.5334/ijic.3253.
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Kato, Akihiko, Akira Hishida, Hiromichi Kumagai, Ryuichi Furuya, Toshiaki Nakajima, and Nishio Honda. "Erythropoietin Production in Patients with Chronic Renal Failure." Renal Failure 16, no. 5 (January 1994): 645–51. http://dx.doi.org/10.3109/08860229409044892.
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Haris, Á., and K. Polner. "Care for chronic renal patients – Role of multidisciplinary education." Physiology International 105, no. 4 (December 2018): 347–57. http://dx.doi.org/10.1556/2060.105.2018.4.26.
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The aim of this study is to summarize the beneficial effects of the holistic approach to patients living with chronic renal failure, including multidisciplinary education and psychosocial care. By education, we enable our patients to reach self-management, appropriate compliance, and coping, which may decrease progression of renal failure, avoid urgent need for starting dialysis and may facilitate better modality selection, access planning, renal transplantation activity, and rehabilitation. Psychosocial care reduces anxiety and fear, modifies perception of illness’ burden, and increases quality of life. Yet, both patients and nephrologists feel that transmission of information is often insufficient. Different methods can effectively be utilized as educational interventions, meetings with staff, and also with expert patients, group education sessions, written or online materials, or multimedia presentations. Patient care of such a high complexity can be provided only by multidisciplinary teams. A special Hungarian example of holistic care is presented, and the favorable results of the education and lifestyle camps for patients accompanied by their relatives are discussed. Accordingly, complex care of patients living with chronic renal failure on the long run is cost saving.
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Amin, Mona, Ashraf Fawzy, Magdy Abdel Hamid, and Abdou Elhendy. "Pulmonary Hypertension in Patients With Chronic Renal Failure." Chest 124, no. 6 (December 2003): 2093–97. http://dx.doi.org/10.1378/chest.124.6.2093.
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ALVESTRAND, A. "Amino acid metabolism in patients with chronic renal failure." Clinical Nutrition 4 (1985): 14–23. http://dx.doi.org/10.1016/s0261-5614(85)80004-2.
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Woodrow, G., B. Oldroyd, J. H. Turney, and M. A. Smith. "Segmental bioelectrical impedance in patients with chronic renal failure." Clinical Nutrition 15, no. 5 (October 1996): 275–79. http://dx.doi.org/10.1016/s0261-5614(96)80283-4.
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Ackerman, Nicola. "Renal patients: IRIS scores, nursing care plans and care bundles." Veterinary Nurse 11, no. 10 (December 2, 2020): 440–46. http://dx.doi.org/10.12968/vetn.2020.11.10.440.
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The role of a consulting nurse in chronic medical cases is very important in helping with compliance, client education and ultimately welfare and quality of life. In patients with chronic renal failure the use of the International Renal Interest Society (IRIS) score enables all veterinary professionals to be able to implement any guidelines or protocols (care bundles) in order to benefit the health of the animal and to have these incorporated into long-term care plans.
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Arslanian-Engoren, Cynthia. "Balancing Calcium and Phosphorus Levels in Chronic Renal Failure Patients." Dimensions of Critical Care Nursing 16, no. 6 (November 1997): 282–91. http://dx.doi.org/10.1097/00003465-199711000-00001.
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ÖZKAN TUNCAY, Fatma, and Tülay KARS FERTELLİ. "Care Dependency and Related Factors in Patients with Chronic Renal Failure." Kocaeli Medical Journal 9, no. 1 (2020): 32–40. http://dx.doi.org/10.5505/ktd.2020.78557.
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Kessing, D. E. F., J. Denollet, J. Widdershoven, and N. Kupper. "Self-care and renal dysfunction in patients with chronic heart failure." European Heart Journal 34, suppl 1 (August 2, 2013): P648. http://dx.doi.org/10.1093/eurheartj/eht307.p648.
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Morton, Gillian M. "'Captive and free?' : pastoral care of patients with chronic renal failure." Palliative Medicine 2, no. 2 (June 1988): 122–30. http://dx.doi.org/10.1177/026921638800200206.
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Robles, Niclás Roberto, J. Ocon, C. F. Gomez, M. Manjon, L. Pastor, J. Herrera, J. Villatoro, et al. "Lercanidipine in Patients with Chronic Renal Failure: The ZAFRA Study." Renal Failure 27, no. 1 (January 2005): 73–80. http://dx.doi.org/10.1081/jdi-42801.
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Arifatul Diktina, Amalia, and Fitri Arofiati. "Electronic Application of Bartocar In Chronic Renal Failure Patients: A Literature Review." Journal of World Science 1, no. 7 (July 22, 2022): 522–32. http://dx.doi.org/10.36418/jws.v1i7.62.
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Chronic Renal Failure (CRF) is a slow, progressive and irreversible decline in renal function can lead to the inability of the kidneys to dispose of residual waste products and unable to maintain fluid and electrolyte balance. Hemodialysis treatment measures performed on CRF patients in order to survive. Fluid monitoring in CRF patients using telemonitoring (remote monitoring equipment), the application contains fluid control and diet to facilitate patients at home. To find out the nutritional monitoring of Chronic Renal Failure patients using the electronic application of bartocar (nutritional fluid monitoring sheet). In this literature review were use 3 data bases namely proquest, pubmed and google scholar, he last 5 years from 2016-2020. Inclusion criteria: Quantitative, qualitative and mix method research design, have communication tools such as mobile phones/computers, Based via online (smartphones and websites), Chronic renal failure undergoing hemodialysis, Free, the last 5 years 2016-2020. Exclusion criteria: Paid journals, Patients undergoing hemodialysis. From the results of the journal search obtained 35,944 English journals discussed only 10 journals discussed different topics. Electronic bartocar (fluid monitoring sheet) in patients very helpful to facilitate diet, restriction of incoming and outgoing fluids and nutrients. This mHealth app is designed to help with early diagnosis of CRF and self-monitoring. This app can be accessed via online, android 4.0/ios mobile web application and website app. Bartocar serves to help monitoring fluids and nutrients in chronic renal failure patients at home.