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Transitioning the Nutritional Support Patient to Homecare
Published in Michael M. Rothkopf, Jennifer C. Johnson, Optimizing Metabolic Status for the Hospitalized Patient, 2023
Michael M. Rothkopf, Jennifer C. Johnson
A few interesting exceptions to the hospital model existed. The polio epidemic of the early 20th century had left some patients dependent on negative pressure ventilators. Many of these patients were treated in respiratory care facilities. But some did transition to a homecare environment. Similarly, the early use of hemodialysis included home hemodialysis machines for patients that could not find a suitable, nearby dialysis unit. In contrast, peritoneal dialysis was typically done at home, utilizing an overnight cycle of infusions.
Renal diseases in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Prolonged or intensive dialysis during pregnancy results in longer gestational periods, higher fetal birth weights, and greater fetal survivability (76,77,80). Home hemodialysis and nocturnal hemodialysis are emerging modes of intensive HD that have shown to offer multiple clinical advantages in terms of HTN, volume status, and mineral metabolism. A retrospective study from Canada prescribing nocturnal HD (>36 hr dialysis) for women in childbearing age group showed not only improved fertility rates (15%) but also more successful live births and fewer maternal–fetal complications (85).
Assessing need and planning health services: the case of renal services
Published in Ian Rees Jones, Professional Power and the Need for Health Care, 2018
To address the imbalance in UK services there appeared to be a need for an expansion in haemodialysis facilities in decentralised units. Such a policy would inevitably place great strains on existing facilities particularly those based in teaching hospitals with large capital costs and overheads. An expansion in home haemodialysis seemed to be unlikely as the increase in demand would come from older and more vulnerable patients who needed more support than home haemodialysis could provide. Contracting out of dialysis had been pioneered in Wales. Such private ventures were considered a commercial success and were welcomed by the Renal Association. Nevertheless, there was a general awareness of the dangers in commercialisation of renal services linked to the drawbacks associated with monopoly suppliers and the restraints on clinical advancement.
Effectiveness of psychosocial interventions on the burden and quality of life of informal caregivers of hemodialysis patients: a systematic review
Published in Disability and Rehabilitation, 2022
Ana Bártolo, Helena Sousa, Oscar Ribeiro, Daniela Figueiredo
Continuing to develop intervention programs for informal carers of patients receiving in-center hemodialysis treatment should be a high priority in future research. The need for these interventions is even more urgent in the face of the new coronavirus challenges. Previous studies have shown that these family caregivers' fears and concerns have been exacerbated by the current pandemic [50], which may further contribute to the burden. There is also an opportunity to invest in intervention types that adjust to the challenges of this new situation including the development of internet-based interventions for these caregivers. In addition, it is important to highlight that caregiver burden is transversal to all those providing care across the ESRD spectrum. Future studies should consider the development of interventions for caregivers of peritoneal dialysis patients and caregivers of patients receiving home hemodialysis.
Chronic kidney disease in Spain: analysis of patient characteristics, incidence and direct medical costs (2011–2017)
Published in Journal of Medical Economics, 2020
Previous studies indicate a prevalence of CKD in Spain of around 15%, and a mortality rate that could be increasing, as measured in the global burden of disease studies7,8. In the present study however, in-hospital mortality remained stable over the study period, which could be indicative of shifts in clinical practice rather than variations in disease mortality. The number of admissions linked to CKD in primary care settings increased over the study period, whereas hospital incidence, in specialized healthcare centers, decreased. An increasing tendency to treat milder symptoms of the disease in primary care must be considered when interpreting these data. Global meta-analyses indicate a higher prevalence of CKD stage 3, whilst most of the patients attended in hospital care were in stage 51. Indeed, the KDIGO guidelines recommend referral to specialist kidney care services when GFR is under 30 mL/min, namely stages 4 and 59. Another factor to be considered is the introduction of home hemodialysis as an alternative to the recurrent admissions required for in-hospital dialysis. This practice has increased progressively in many countries, yet, no records are available for Spain and its inclusion in standard practice appears distant19. In this study, renal dialysis and transplants in hospital settings corresponded principally to patients in CKD stage 5. A small number of patients in early CKD stages registered renal replacement therapy, these cases corresponded to patients that changed CKD stage after an intervention or to other particular situations that could not be evaluated.
Haemodialysis at home: review of current dialysis machines
Published in Expert Review of Medical Devices, 2018
Sabrina Haroon, Andrew Davenport
Reports of patients with chronic kidney disease treated by home hemodialysis (HHD) have consistently observed superior clinical outcomes and improved quality of life for patients [1-4]. As HHD is by far the most complex medical treatment undertaken by patients at home, it is not surprising that despite adequate information and education provided, most patients still find the management and responsibility of the HHD machine too complex and challenging, preferentially choosing in-center hemodialysis (ICHD), where trained healthcare professionals operate the dialysis machine and supervise the dialysis session, dealing with any alarms and emergency situations [5–8].