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Perez-Moran D, Perez-Cuevas R, Doubova SV. Challenges for Peritoneal Dialysis Centers Before and During the COVID-19 Pandemic in Mexico. Arch Med Res 2022; 53:431-440. [PMID: 35527074 PMCID: PMC9050655 DOI: 10.1016/j.arcmed.2022.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/31/2022] [Accepted: 04/21/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Diana Perez-Moran
- Unidad de Investigación en Epidemiología y Servicios de Salud Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Ricardo Perez-Cuevas
- Division of Social Protection and Health, Interamerican Development Bank, Jamaica Country Office, Jamaica
| | - Svetlana V Doubova
- Unidad de Investigación en Epidemiología y Servicios de Salud Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México.
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Piccoli GB, Breuer C, Cabiddu G, Testa A, Jadeau C, Brunori G. Where Are You Going, Nephrology? Considerations on Models of Care in an Evolving Discipline. J Clin Med 2018; 7:jcm7080199. [PMID: 30081442 PMCID: PMC6111293 DOI: 10.3390/jcm7080199] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 07/21/2018] [Accepted: 08/01/2018] [Indexed: 12/18/2022] Open
Abstract
Nephrology is a complex discipline, including care of kidney disease, dialysis, and transplantation. While in Europe, about 1:10 individuals is affected by chronic kidney disease (CKD), 1:1000 lives thanks to dialysis or transplantation, whose costs are as high as 2% of all the health care budget. Nephrology has important links with surgery, bioethics, cardiovascular and internal medicine, and is, not surprisingly, in a delicate balance between specialization and comprehensiveness, development and consolidation, cost constraints, and competition with internal medicine and other specialties. This paper proposes an interpretation of the different systems of nephrology care summarising the present choices into three not mutually exclusive main models (“scientific”, “pragmatic”, “holistic”, or “comprehensive”), and hypothesizing an “ideal-utopic” prevention-based fourth one. The so-called scientific model is built around kidney transplantation and care of glomerulonephritis and immunologic diseases, which probably pose the most important challenges in our discipline, but do not mirror the most common clinical problems. Conversely, the pragmatic one is built around dialysis (the most expensive and frequent mode of renal replacement therapy) and pre-dialysis treatment, focusing attention on the most common diseases, the holistic, or comprehensive, model comprehends both, and is integrated by several subspecialties, such as interventional nephrology, obstetric nephrology, and the ideal-utopic one is based upon prevention, and early care of common diseases. Each model has strength and weakness, which are commented to enhance discussion on the crucial issue of the philosophy of care behind its practical organization. Increased reflection and research on models of nephrology care is urgently needed if we wish to rise to the challenge of providing earlier and better care for older and more complex kidney patients with acute and chronic kidney diseases, with reduced budgets.
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Affiliation(s)
- Giorgina Barbara Piccoli
- Department of Clinical and Biological Sciences, University of Torino Italy, 10100 Torino, Italy.
- Nephrologie, Centre Hospitalier Le Mans, 72000 Le Mans, France.
| | - Conrad Breuer
- Direction, Centre Hospitalier Le Mans, 72000 Le Mans, France.
| | | | | | - Christelle Jadeau
- Centre de Recherche Clinique, Centre Hospitalier Le Mans, 72000 Le Mans, France.
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Shiff B, Pierrato A, Oliver MJ, Jain AK, McCormick B, Kandasamy G, Perl J. Knowledge, attitudes, and practices with regard to PD access: a report from the Peritoneal Dialysis Access Subcommittee of the Ontario Renal Network Committee on Independent Dialysis. Perit Dial Int 2015; 34:791-5. [PMID: 25520483 DOI: 10.3747/pdi.2013.00240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Benjamin Shiff
- Division of Nephrology St. Michael's Hospital, University of Toronto Toronto, Ontario, Canada Division of Nephrology University of Toronto, Department of Medicine, Humber River Regional Hospital Toronto, Ontario, Canada Ontario Renal Network Toronto, Ontario, Canada Division of Nephrology London Health Sciences Centre, University of Western Ontario London, Ontario, Canada Division of Nephrology Sunnybrook Health Sciences Centre, University of Toronto Toronto, Ontario, Canada Division of Nephrology University of Ottawa Ottawa, Ontario, Canada
| | - Andreas Pierrato
- Division of Nephrology St. Michael's Hospital, University of Toronto Toronto, Ontario, Canada Division of Nephrology University of Toronto, Department of Medicine, Humber River Regional Hospital Toronto, Ontario, Canada Ontario Renal Network Toronto, Ontario, Canada Division of Nephrology London Health Sciences Centre, University of Western Ontario London, Ontario, Canada Division of Nephrology Sunnybrook Health Sciences Centre, University of Toronto Toronto, Ontario, Canada Division of Nephrology University of Ottawa Ottawa, Ontario, Canada Division of Nephrology St. Michael's Hospital, University of Toronto Toronto, Ontario, Canada Division of Nephrology University of Toronto, Department of Medicine, Humber River Regional Hospital Toronto, Ontario, Canada Ontario Renal Network Toronto, Ontario, Canada Division of Nephrology London Health Sciences Centre, University of Western Ontario London, Ontario, Canada Division of Nephrology Sunnybrook Health Sciences Centre, University of Toronto Toronto, Ontario, Canada Division of Nephrology University of Ottawa Ottawa, Ontario, Canada
| | - Matthew J Oliver
- Division of Nephrology St. Michael's Hospital, University of Toronto Toronto, Ontario, Canada Division of Nephrology University of Toronto, Department of Medicine, Humber River Regional Hospital Toronto, Ontario, Canada Ontario Renal Network Toronto, Ontario, Canada Division of Nephrology London Health Sciences Centre, University of Western Ontario London, Ontario, Canada Division of Nephrology Sunnybrook Health Sciences Centre, University of Toronto Toronto, Ontario, Canada Division of Nephrology University of Ottawa Ottawa, Ontario, Canada
| | - Arsh K Jain
- Division of Nephrology St. Michael's Hospital, University of Toronto Toronto, Ontario, Canada Division of Nephrology University of Toronto, Department of Medicine, Humber River Regional Hospital Toronto, Ontario, Canada Ontario Renal Network Toronto, Ontario, Canada Division of Nephrology London Health Sciences Centre, University of Western Ontario London, Ontario, Canada Division of Nephrology Sunnybrook Health Sciences Centre, University of Toronto Toronto, Ontario, Canada Division of Nephrology University of Ottawa Ottawa, Ontario, Canada
| | - Brendan McCormick
- Division of Nephrology St. Michael's Hospital, University of Toronto Toronto, Ontario, Canada Division of Nephrology University of Toronto, Department of Medicine, Humber River Regional Hospital Toronto, Ontario, Canada Ontario Renal Network Toronto, Ontario, Canada Division of Nephrology London Health Sciences Centre, University of Western Ontario London, Ontario, Canada Division of Nephrology Sunnybrook Health Sciences Centre, University of Toronto Toronto, Ontario, Canada Division of Nephrology University of Ottawa Ottawa, Ontario, Canada
| | - Gokulan Kandasamy
- Division of Nephrology St. Michael's Hospital, University of Toronto Toronto, Ontario, Canada Division of Nephrology University of Toronto, Department of Medicine, Humber River Regional Hospital Toronto, Ontario, Canada Ontario Renal Network Toronto, Ontario, Canada Division of Nephrology London Health Sciences Centre, University of Western Ontario London, Ontario, Canada Division of Nephrology Sunnybrook Health Sciences Centre, University of Toronto Toronto, Ontario, Canada Division of Nephrology University of Ottawa Ottawa, Ontario, Canada
| | - Jeffrey Perl
- Division of Nephrology St. Michael's Hospital, University of Toronto Toronto, Ontario, Canada Division of Nephrology University of Toronto, Department of Medicine, Humber River Regional Hospital Toronto, Ontario, Canada Ontario Renal Network Toronto, Ontario, Canada Division of Nephrology London Health Sciences Centre, University of Western Ontario London, Ontario, Canada Division of Nephrology Sunnybrook Health Sciences Centre, University of Toronto Toronto, Ontario, Canada Division of Nephrology University of Ottawa Ottawa, Ontario, Canada
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Perl J, Davies SJ, Lambie M, Pisoni RL, McCullough K, Johnson DW, Sloand JA, Prichard S, Kawanishi H, Tentori F, Robinson BM. The Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS): Unifying Efforts to Inform Practice and Improve Global Outcomes in Peritoneal Dialysis. Perit Dial Int 2015; 36:297-307. [PMID: 26526049 DOI: 10.3747/pdi.2014.00288] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 03/22/2015] [Indexed: 12/23/2022] Open
Abstract
UNLABELLED ♦ BACKGROUND Extending technique survival on peritoneal dialysis (PD) remains a major challenge in optimizing outcomes for PD patients while increasing PD utilization. The primary objective of the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) is to identify modifiable practices associated with improvements in PD technique and patient survival. In collaboration with the International Society for Peritoneal Dialysis (ISPD), PDOPPS seeks to standardize PD-related data definitions and provide a forum for effective international collaborative clinical research in PD. ♦ METHODS The PDOPPS is an international prospective cohort study in Australia, Canada, Japan, the United Kingdom (UK), and the United States (US). Each country is enrolling a random sample of incident and prevalent patients from national samples of 20 to 80 sites with at least 20 patients on PD. Enrolled patients will be followed over an initial 3-year study period. Demographic, comorbidity, and treatment-related variables, and patient-reported data, will be collected over the study course. The primary outcome will be all-cause PD technique failure or death; other outcomes will include cause-specific technique failure, hospitalizations, and patient-reported outcomes. ♦ RESULTS A high proportion of the targeted number of study sites has been recruited to date in each country. Several ancillary studies have been funded with high momentum toward expansion to new countries and additional participation. ♦ CONCLUSION The PDOPPS is the first large, international study to follow PD patients longitudinally to capture clinical practice. With data collected, the study will serve as an invaluable resource and research platform for the international PD community, and provide a means to understand variation in PD practices and outcomes, to identify optimal practices, and to ultimately improve outcomes for PD patients.
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Affiliation(s)
- Jeffrey Perl
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA Division of Nephrology, The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Simon J Davies
- Health Services Research Unit, Institute of Science and Technology in Medicine, Keele University and University Hospitals of North Midlands,Stoke-on-Trent, United Kingdom
| | - Mark Lambie
- Health Services Research Unit, Institute of Science and Technology in Medicine, Keele University and University Hospitals of North Midlands,Stoke-on-Trent, United Kingdom
| | - Ronald L Pisoni
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | - Keith McCullough
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | - David W Johnson
- Australasian Kidney Trials Network, School of Medicine, University of Queensland, Brisbane, Australia Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | | | | | - Hideki Kawanishi
- Akane Foundation, Tsuchiya General Hospital, Nakaku, Hiroshima, Japan
| | - Francesca Tentori
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Bruce M Robinson
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Sood MM, Tangri N, Hiebert B, Kappel J, Dart A, Levin A, Manns B, Molzahn A, Naimark D, Nessim SJ, Rigatto C, Soroka SD, Zappitelli M, Komenda P. Geographic and facility-level variation in the use of peritoneal dialysis in Canada: a cohort study. CMAJ Open 2014; 2:E36-44. [PMID: 25077124 PMCID: PMC3985977 DOI: 10.9778/cmajo.20130050] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Peritoneal dialysis is associated with similar survival and similar improvement in quality of life and is less costly compared with in-centre hemodialysis. We examined facility and geographic variation in the use of peritoneal dialysis in Canada. METHODS We analyzed data from the Canadian Organ Replacement Register for the period January 2001 to December 2010. We identified patients for whom peritoneal dialysis was the primary modality at 90 days after initiation of dialysis. We used multilevel models to evaluate variation in use of peritoneal dialysis by facility and geographic region. RESULTS We analyzed data for 31 778 incident dialysis patients at 56 facilities in 13 geographic regions across Canada. Use of peritoneal dialysis at 90 days varied considerably across geographic regions (range 19.8%-36.1%) and declined over time, from 28.8% in 2001 to 22.5% in 2010. After adjustment for case mix and facility-level quality indicators, 9.3% and 3.4% of the variability was attributable to facility and geographic factors, respectively. In adjusted models, there was a substantial difference between geographic regions with the lowest and highest peritoneal dialysis use (odds ratio for high use 1.51, 95% confidence interval [CI] 1.33-1.73 v. odds ratio for low use 0.69, 95% CI 0.60-0.79). INTERPRETATION In Canada, substantial variability in the use of peritoneal dialysis attributable to facility and geographic region was not explained by differences in patient case mix. An opportunity exists to optimize use of this cost-effective therapy through changes in policy and standardization of criteria for initiation of peritoneal dialysis.
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Affiliation(s)
- Manish M Sood
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont
| | - Navdeep Tangri
- Seven Oaks Hospital, University of Manitoba, Winnipeg, Man
| | - Brett Hiebert
- Cardiac Sciences Program, St Boniface Hospital, Winnipeg, Man
| | - Joanne Kappel
- Saskatoon Health Region, University of Saskatchewan, Saskatoon, Sask
| | - Allison Dart
- Health Sciences Centre, University of Manitoba, Winnipeg, Man
| | - Adeera Levin
- St Paul's Hospital, University of British Columbia, Vancouver, BC
| | - Braden Manns
- Foothills Hospital, University of Calgary, Calgary, Alta
| | - Anita Molzahn
- Faculty of Nursing, University of Alberta, Edmonton, Alta
| | - David Naimark
- Sunnybrook Hospital, University of Toronto, Toronto, Ont
| | | | | | | | | | - Paul Komenda
- Seven Oaks Hospital, University of Manitoba, Winnipeg, Man
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Wente SJK, Kleiber C. An exploration of context and the use of evidence-based nonpharmacological practices in emergency departments. Worldviews Evid Based Nurs 2013; 10:187-97. [PMID: 23809687 DOI: 10.1111/wvn.12010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND The uptake of evidence in practice remains a challenge for healthcare professionals including nurses and providers. Increased use of evidence-based practices (EBPs) in healthcare settings may improve patient conditions such as pain and decrease the cost of health care. The relationship between context in the practice environment and uptake of EBP remains an understudied area. AIMS This study explored the relationships of context including the elements of individual, unit, and hospital and the use of evidence-based nonpharmacological pediatric pain management practices (EBNPPs) using an existing data set of RNs and providers, defined as doctors of medicine and osteopathy, nurse practitioners, and physician assistants caring for children in the emergency department. METHODS A secondary data analysis was conducted using correlation and regression. RESULTS Initial analysis identified several significant positive correlations with individual, unit, and hospital context elements and EBNPP. A significant correlation was not found between evaluation and EBNPP and magnet status and EBNPP for RNs or providers. RN regression analyses found that knowledge and continuing education were significant predictors of EBNPP. Overall context was a significant predictor of EBNPP for both the RN and provider models. A pooled regression analysis with RNs and providers found that RNs had a significant increased use of EBNPP when compared to providers. CONCLUSIONS Regression analyses found that overall context significantly predicted the use of EBPPM for RNs and providers although no one element-individual, unit, or hospital-was identified as more important. The effect of context on EBNPP did not differ by profession in this sample. Future research should focus on the overall influence of context on EBP and consider other factors that may play a role in the uptake of EBP.
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International practice patterns and factors associated with non-conventional hemodialysis utilization. BMC Nephrol 2011; 12:66. [PMID: 22142369 PMCID: PMC3241205 DOI: 10.1186/1471-2369-12-66] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Accepted: 12/05/2011] [Indexed: 11/23/2022] Open
Abstract
Background The purpose of our study was to determine characteristics that influence the utilization of non-conventional hemodialysis (NCHD) therapies and its subtypes (nocturnal (NHD), short daily (SDHD), long conventional (LCHD) and conventional hemodialysis (CHD) as well as provider attitudes regarding the evidence for NCHD use. Methods An international cohort of subscribers of a nephrology education website http://www.nephrologynow.com was invited to participate in an online survey. Non-conventional hemodialysis was defined as any forms of hemodialysis delivered > 3 treatments per week and/or > 4 hours per session. NHD and SDHD included both home and in-centre. Respondents were categorized as CHD if their centre only offered conventional thrice weekly hemodialysis. Variables associated with NCHD and its subtypes were determined using multivariate logistic regression analysis. The survey assessed multiple domains regarding NCHD including reasons for initiating and discontinuing, for not offering and attitudes regarding evidence. Results 544 surveys were completed leading to a 15.6% response rate. The final cohort was limited to 311 physicians. Dialysis modalities utilized among the respondents were as follows: NCHD194 (62.4%), NHD 83 (26.7%), SDHD 107 (34.4%), LCHD 81 (26%) and CHD 117 (37.6%). The geographic regions of participants were as follows: 11.9% Canada, 26.7% USA, 21.5% Europe, 6.1% Australia/New Zealand, 10% Africa/Middle East, 10.9% Asia and 12.9% South America. Variables associated with NCHD utilization included NCHD training (OR 2.47 CI 1.25-4.16), government physician reimbursement (OR 2.66, CI 1.11-6.40), practicing at an academic centre (OR 2.28 CI 1.25-4.16), higher national health care expenditure and number of ESRD patients per centre. Hemodialysis providers with patients on NCHD were significantly more likely to agree with the statements that NCHD improves quality of life, improves nutritional status, reduces EPO requirements and is cost effective. The most common reasons to initiate NCHD were driven by patient preference and the desire to improve volume control and global health outcomes. Conclusion Physician attitudes toward the evidence for NCHD differ significantly between NCHD providers and conventional HD providers. Interventions and health policy targeting these areas along with increased physician education and training in NCHD modalities may be effective in increasing its utilization.
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