Biomedical subjects
D Tilton
Publications and source records attributed to D Tilton.
Effects of acetate and bicarbonate dialysate in stable chronic dialysis patients.
The effects of acetate and bicarbonate dialysate on the biochemical and clinical parameters of 16 stable chronic hemodialysis patients were investigated in a double-blind crossover study. A central delivery system was used for both types of dialysates with identical sodium concentrations (138 mEq/liter) and osmolality in a single-pass dialysate flow. The results indicate that dialysis with bicarbonate leads to significantly less hypoxemia (P less than or equal to 0.001) and hypotensive episodes (P less than or equal to 0.002) than with acetate. Pre- to post-dialysis blood pressure changes were also more marked during acetate dialysis. Older patients with recurrent hypotension on acetate benefit most from bicarbonate dialysate. This group of patients appears to metabolize acetate more slowly and has a significantly lower post-dialysis bicarbonate concentration (P less than or equal to 0.005) than asymptomatic patients during dialysis with acetate dialysate.
Strategies for developing a cost-effective pulmonary rehabilitation program.
A cost-effective pulmonary rehabilitation program can be created by using strategic planning, a thorough budgetary process, and then promotion of the program. Strategic planning assesses the need for such a program, develops its overall direction, establishes priorities, assesses economic factors and the presence or absence of similar services already in existence, and identifies the proposed scope of the program. The budgetary process identifies the specific services to be offered and estimates the volume of services, their costs, and revenues. Promotion of the program serves to acquaint potential referring physicians and patients with the services to be offered. If preliminary investigation indicates that a pulmonary rehabilitation program is needed in the community, then strategic planning, careful budgeting, and creative promotion can help assure that the program is financially viable.