PubMed Health⌕ Search

Biomedical subjects

Myra A Kleinpeter

Publications and source records attributed to Myra A Kleinpeter.

11 recordsLinked to original sources
PubMed2007

End-stage renal disease use in hurricane-prone areas: should nephrologists increase the utilization of peritoneal dialysis?

Hurricane Katrina resulted in massive destruction of the gulf coast of the United States in 2005. In the immediate aftermath, displaced dialysis patients required urgent hemodialysis or additional peritoneal dialysis (PD) supplies. Massive damage to the health care infrastructure in these communities disrupted dialysis services for several months. As a result of this event and subsequent storms during the 2005 Atlantic hurricane season, many decisions regarding future services to dialysis patients in hurricane prone communities (HPCs) need to occur. Nephrologists, dialysis nurses, dialysis providers, and patients need to discuss the ramifications of and types of continued dialysis services in HPC. Nephrologists should encourage PD, and efforts to educate on other renal replacement therapies including PD and transplant should occur. With the potential for interruption of electrical, sewerage, and water services, more patients should consider PD. Recovery from future events begins with appropriate disaster planning. Many questions are considered and need answering in planning for dialysis services in HPC and other communities subject to natural disasters. This summary provides the basis to begin discussions when planning for dialysis services in communities prone to natural disasters.

Community Networks↗
PubMed2006

Management of hypertension and dyslipidemia.

Cardiovascular disease, the leading cause of death in the United States and other developed societies, can be managed with intensive risk factor modification, including treatment of hypertension and dyslipidemia. Evidence for reduction of cardiovascular morbidity and mortality is summarized in evidence-based guidelines, primarily for hypertension in the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure and for dyslipidemia in the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Many medications exist for treatment of hypertension and a limited number for dyslipidemia; the cornerstone of therapy for both remains lifestyle modification, including dietary interventions. Despite guidelines, control rates of concomitant hypertension and dyslipidemia remain low. Patient adherence may affect achievement of recommended goals of therapy for dyslipidemia and hypertension. Effective education and communication may improve overall achievement of treatment goals.

Adrenergic beta-Antagonists↗
PubMed2006

Dialysis services in the hurricane-affected areas in 2005: lessons learned.

BACKGROUND: Hurricane Katrina resulted in partial or complete devastation of dialysis services throughout the Gulf Coast, including the New Orleans metropolitan area. In the immediate aftermath, dialysis had to be provided to patients by surrounding communities in Louisiana, and ultimately by dialysis programs throughout the nation. Peritoneal dialysis patients, though typically more independent, also endured challenges in continuing dialysis following Hurricane Katrina. Hurricane Rita caused similar damage to the western Gulf Coast at Lake Charles, Louisiana and Beaumont, Texas and further delayed recovery of dialysis services in the New Orleans metropolitan area. SETTING: A review of the problems created by the disaster provided many opportunities to improve healthcare delivery and to prepare for recovery from the event. Understanding what happened to the delivery of dialysis and chronic kidney disease services allows the opportunity to develop better systems to support this particularly vulnerable population of patients. CONCLUSION: Many lessons can be learned from these events to minimize future interruption of dialysis services in the face of natural disasters such as hurricanes.

Community Health Services↗
PubMed2006

Perioperative management of peritoneal dialysis patients: review of abdominal surgery.

On abdominal computed tomography scan for evaluation of hematuria, the index patient, a 23-year-old male, was found to have multiple renal cysts bilaterally. He had been on peritoneal dialysis for 6 years, complicated by intermittent episodes of exit-site infection and peritonitis. Over time, he developed recurrent urinary tract infection and nephrolithiasis with intermittent hematuria. His maintenance dose of recombinant erythropoietin was discontinued, and he maintained a normal hemoglobin level. Annual surveillance of the bilateral renal cysts with magnetic resonance imaging revealed development of a complex cystic mass that warranted further investigation. Following a urology consultation, laparoscopic nephrectomy was performed without complications and with minimal interruption of PD. Pathology evaluation revealed renal cell carcinoma within the renal parenchyma and multiple cystic structures consistent with acquired cystic kidney disease. No clear recommendations exist in the literature regarding continuation or interruption of PD in the perioperative period for planned nephrectomy, tumor resection, or other uncomplicated abdominal or retroperitoneal procedures. A perioperative management strategy for PD patients requiring abdominal or retroperitoneal surgery is outlined here. If these recommendations are followed, patients may continue PD with minimal interruption, preservation of the peritoneal membrane, and few complications.

Abdomen↗
PubMed2006

Disaster planning for peritoneal dialysis programs.

Because of increased intensity of hurricanes in the Gulf Coast region of the United States, peritoneal dialysis (PD) programs have been disrupted and patients relocated temporarily following these catastrophic events. We describe the disaster planning, implementation, and follow-up that occurred in one such PD program in New Orleans following Hurricane Katrina. Each year at the beginning of the North American hurricane season, the PD program's disaster plan is reviewed by clinic staff and copies are distributed to patients. Patients are instructed to assemble a disaster kit and are provided with contact numbers for dialysis suppliers and for a PD program in their planned evacuation city. In July 2005, this disaster plan was tested when an early tropical storm and hurricane entered the Gulf and several patients briefly relocated or evacuated because of power loss and then returned without incident. However, when Hurricane Katrina, a category 5 storm, was predicted to strike the metropolitan area, patients were notified by telephone to evacuate, and contact information, including their evacuation city and telephone and cellular phone numbers, was obtained. Patients were also reminded to take all medications, bottled water, antibacterial soap, hand sanitizer, and 4-5 days of PD supplies. Following the storm, telephone and cellular phone services were severely disrupted. However, text messaging was available to contact patients to confirm safety and to provide further instructions. Arrangements with the major dialysis suppliers to ship emergency supplies to new locations were made by the PD nurse and the patients. Only 2 of 22 patients required hospitalization because of complications resulting from evacuation failure, contamination, and inability to perform dialysis for a prolonged period of time. Both of these patients were quickly released and have continued PD. Following the event, all patients remained on PD, and most have planned to return to their home PD program. Thorough preparation, planning, practice, and implementation and effective communication are necessary to prevent complications in PD patients who are affected by disasters. With advdnce preparation, maintenance of communication with health care providers, and planning for alternative sites of care, patients can be safely maintained on PD without complications following catastrophic natural disasters.

Communication↗
PubMed2006

The Massachusetts health insurance law: providing health insurance to all.

There have been increasing rates of uninsured patients in the United States over the past few decades. Despite this growing problem, little progress has been made to decrease the rate of growth of uninsured patients or to provide affordable insurance coverage to those who are unable to maintain insurance coverage throughout the year. The legislature in the Commonwealth of Massachusetts has enacted legislation that requires health insurance for all in the same manner that automobile insurance is required in many states. This bold comprehensive legislation augments current Medicaid and state child health insurance program coverage and expands coverage options for part-time workers, those employed by small companies or those employed at lower-income jobs.

Health Behavior↗
PubMed2004

Successful treatment of Candida infections in peritoneal dialysis patients: case reports and review of the literature.

Infections with Candida species have been associated with significant morbidity and mortality in peritoneal dialysis (PD) patients. Such infections include peritonitis and exit-site infections attributable to Candida species, disseminated candidiasis in immunocompromised patients, and Candida esophagitis. In peritonitis and exit-site infections, both success and failure have been reported with commercially available medications. In disseminated candidiasis and Candida esophagitis, successful treatment and patient recovery depend on the overall nutritional and immune state of the patient. One case each of peritonitis and exit-site infection with non Candida albicans species were successfully treated with oral voriconazole. No literature currently exists on the use of this new product in dialysis patients. Presented here is a treatment strategy that resulted in maintenance of PD in the home setting and catheter survival following completion of treatment. A review of the English-language literature shows mixed outcomes associated with continuation of PD during treatment for Candida infection in PD patients. In conclusion, a commercially available product can be used to successfully treat PD patients who have Candida infections and to maintain the PD catheter for PD.

Aged↗
PubMed2003

Health literacy affects peritoneal dialysis performance and outcomes.

Health literacy (HL) is the ability to perform the basic reading, writing, and numerical skills required to function in a health care setting. Patients with adequate HL are able to read, interpret, and respond to health care information provided by health care providers and health plans. Several means of assessing HL are available for English- and Spanish-speaking patients. A review of the English-language literature on HL indicated that no prior studies included a subset of peritoneal dialysis (PD) patients. I administered the Rapid Estimate of Adult Literacy in Medicine (REALM) assessment tool to PD patients. I also asked patients for information about their highest education level completed. Following completion of the REALM, patients were classified as having adequate, marginal, or inadequate HL. As other studies have shown, patients with lower levels of education have inadequate HL. Patients with some college education or higher have adequate HL. However, at the average education level of patients, most patients have marginal HL. Relative lack of HL affects a patient's ability to make decisions regarding care as part of a home self-management program for end-stage renal disease (ESRD) and other chronic illnesses. Consequently, relative HL level affects the method of instruction and the time required for instruction during training of PD patients.

Adult↗
PubMed2002

Review of health information Web sites for peritoneal dialysis information for patients.

We performed a review of United States-based, English-language Web sites to evaluate the information on peritoneal dialysis (PD) available to patients via the Internet. The "hits" obtained after using the search term "peritoneal dialysis" on a series of health care Web sites were listed and reviewed. Information was classified as limited, brief summary, detailed, or extensive, in order of increasing information. Professional organizations dedicated to kidney disease provided extensive information on PD, but Web sites for consumers generally provided little information. Information regarding PD is available to patients on the Internet, but for the most detailed and accurate information, patients should be directed to sites provided by professional organizations that specialize in kidney disease.

Humans↗