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Statistical Approaches in the Development of Digital Therapeutics
Published in Oleksandr Sverdlov, Joris van Dam, Digital Therapeutics, 2023
Oleksandr Sverdlov, Yevgen Ryeznik, Sergei Leonov, Valerii Fedorov
As another example, consider success stories of the development of various artificial organs, such as an artificial kidney. Hemodialysis as a means of replacing renal function started and developed in the 20th century (Twardowski, 2008). Hemodialyzers evolved from capillary dialyzers and sorbent systems in the 1960s to wearable artificial kidney systems. A recent US FDA 510(k) clearance of the Artificial Kidney (AK) 98 dialysis machine1 highlights a significant milestone in bringing new, improved quality of care for many patients who are on hemodialysis. The AK 98 is a portable and easy-to-use system with encrypted, two-way connectivity that enables the system to pull prescriptions directly from the patient's electronic medical record.1
Renal disorders
Published in Rachel U Sidwell, Mike A Thomson, Concise Paediatrics, 2020
Rachel U Sidwell, Mike A Thomson
This is technically more difficult. Access is obtained using an indwelling main venous catheter (most common in children) or by creating an A-V fistula. Blood is directed through the dialysis machine where the semi-permeable membrane is located. Performed on average three times per week for 3–4 h per session. Complications: line infections and sepsis.
Uncertainty and decision making
Published in Anna-leila Williams, Integrating Health Humanities, Social Science, and Clinical Care, 2018
Secondly, a good decision must be practical to implement. This means it must be affordable, efficacious, geographically accessible, and integrate the patient’s social support system. To get a better sense of the practical component of a good decision, let’s look at a clinical case. An 80-year-old man lives alone and is adamant that he wants to remain at home. He has progressive chronic renal failure that now requires dialysis three times per week. He also has severe arthritis of the hands that effectively precludes fine motor control. He has one daughter who lives two hours away and visits every weekend. Her work and family responsibilities do not allow her to visit during the week. The daughter cleans her dad’s home, does his laundry, prepares meals for the week, and tends to his finances. He socializes with a few friends in town, all of whom are dealing with age-related disabilities. The patient and daughter read online about home peritoneal dialysis and decide that it is the best course of action to support his renal failure. Unfortunately, the arthritis in his hands prohibits the patient from safely operating the dialysis machine at home by himself. The daughter’s other responsibilities make it impossible for her to manage her dad’s dialysis three times per week. Unless they can identify someone who the patient feels comfortable having in his home three times per week to help with dialysis and who is physically and cognitively capable of the tasks, then peritoneal dialysis at home does not meet the practical to implement criterion for a good decision.
A step towards the application of an artificial intelligence model in the prediction of intradialytic complications
Published in Alexandria Journal of Medicine, 2022
Ahmed Mustafa Elbasha, Yasmine Salah Naga, Mai Othman, Nancy Diaa Moussa, Hala Sadik Elwakil
Artificial intelligence has also been used to predict long-term outcome in HD patients. Titapiccolo J et al. [38]trained a Lasso logistic regression model and a random forest model and used it for predicting the cardiovascular outcome of incident hemodialysis (HD) patients. Data relating to the dialysis machine properties and the vital signs of 4246 incident hemodialysis patients were collected during the first 18 months of HD and then used to predict the occurrence of cardiovascular events within a 6-month time interval. Random forest showed higher performance with AUC of the ROC curve and sensitivity higher than 70%. The most important variables in the model were blood test variables such as the total protein content, percentage value of albumin, total protein content, creatinine, C reactive protein, age of patients and weight loss in the first six months. Although the studied outcome is different from our study, some variables like serum albumin level, patient age, and ultrafiltration rate were also predictive in our study, indicating that they play a role in short-term as well as long-term outcomes in HD patients.
“Harmful” Choices and Subjectivity: Against an Externalist Approach to Capacity Assessments
Published in The American Journal of Bioethics, 2022
Harleen Kaur Johal, Aoife M. Finnerty, Jordan A. Parsons
While Pickering and colleagues may identify inconsistencies in the reasoning behind these judgments, these cases clearly emphasize the protection and promotion of self-determination in English law. This is perhaps owing to an appreciation of the harm that imposing certain values and “demanding conformity” can cause. For instance, if a capacitous person’s refusal of dialysis—based on their own beliefs and values—was rejected, and they were forced to undergo treatment despite their clear objections, this could introduce logistical issues, physical harm, and moral distress (Parsons et al. 2021). Transporting a person to a dialysis unit three times a week and requiring them to stay connected to the dialysis machine for several hours could require anything from verbal coercion to physical and chemical restraint. This would not only be burdensome to the person receiving dialysis against their wishes, but it could conceivably cause considerable moral distress for the health and care professionals involved in providing the treatment.
Prevalence of musculoskeletal complaints among haemodialysis nurses – a comparison between Danish and Swedish samples
Published in International Journal of Occupational Safety and Ergonomics, 2021
Eva Westergren, Mette Spliid Ludvigsen, Magnus Lindberg
Haemodialysis is a life-sustaining treatment that replaces kidney functions for patients with kidney failure. The haemodialysis system consists of a dialysis machine, a disposable dialyser, a disposable blood tubing set and a dialysate solution used within the machine and the dialyser. The blood tubing set and the dialyser make up a closed extracorporeal circuit through which the patient’s blood circulates, while waste products and excessive fluid are removed from the human body [11]. Before the extracorporeal circuit can be utilized in dialysis treatment, both the blood tubing and the dialyser have to be primed by the dialysis nurse. The priming process, which occurs before the patient is connected, involves a number of manipulations and twisting forces using both hands to put up the extracorporeal circuit as well as manual clamping and sometimes turning to remove all air from the tube and dialyser. The entire priming process takes approximately 15 min to complete per treatment, but the expenditure of time varies depending on the equipment used. Proper priming is extremely important, because remaining air bubbles in the extracorporeal circuit could cause severe complications for the patient or have deadly outcomes [11,12]. Directly after cleaning, the priming process for the next treatment begins.