Ownership of dialysis facilities and patients' survival.
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Ambulatory Care Facilities↗
Biomedical subjects
S J Bander
Publications and source records attributed to S J Bander.
How a multidisciplinary vascular access care program enables implementation of the DOQI guidelines. Part I.
This comprehensive, proactive, multidisciplinary team approach to access management has enabled the achievement of center-specific best-demonstrated clinical practiCes for vascular access care. It has also resulted in significant cost savings to the health care delivery process. It has not been an easy task; if it were, access care outcomes would be better nationally than they are today. The VACP approach to vascular access care improvement employs four key implementation principles that ensure the success of Gambro's program and form the infrastructure supporting any successful team approach to care. These core processes, known as the four "C's, include: 1. Commitment, 2. Continuous Quality Improvement, 3. Core Competency, and 4. Communication.
Arteriovenous Shunt, Surgical↗
The current and future state of the ESRD program: a provider roundtable.
The decade of the 1990s have seen substantial consolidation of services in the dialysis industry in the United States. A small number of horizontally and/or vertically integrated companies oversee the care of over two-thirds of dialysis patients. There are many questions regarding this trends as well as the vision of these large organizations regarding the future of the ESRD program. The senior physicians in the four largest such organizations agreed to participate in a provider roundtable to share their thoughts on the following issues: What are the advantages and disadvantages of industry consolidation?; What steps has your organization taken to succeed?; What are the key issues facing this industry in the next decade?; What policy changes by the Federal Government do you anticipate?; What policy changes would you like to see? Although significant differences in specifics are clear in the responses, a recurrent theme relates to how value will be maintained in the program-the balance between high-quality outcomes and the costs of achieving these outcomes. This is clearly the challenge in the years ahead.
Health Personnel↗
Lessons learned. Implementing a vascular access quality improvement program. Part II.
Implementing a CQI program for vascular access can seem an overwhelming task. It encompasses many areas that are not in the nephrologists' or dialysis facilities' control. However, involving the right multidisciplinary team members in the process and aligning the goals and objectives creates an environment conducive to success. Ongoing communication is critical. Everyone needs to be a part of the change process.
Catheters, Indwelling↗
The for-profit providers.
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Ambulatory Care Facilities↗
Hemodialysis morbidity and mortality: links to patient non-compliance.
Patient non-compliance with the dialysis treatment prescription has often been overlooked as an important variable that contributes to outcomes in end-stage renal disease. This review discusses evidence from a limited number of researchers that such behavior may be as important as the traditional medical indicators that predict patient survival.
Adult↗
Heparin-flush associated thrombocytopenia--induced hemorrhage: a case report.
Thrombocytopenia is a well known complication of heparin. It occurs when heparin is used in full therapeutic dose or in subcutaneous mini-doses for prophylaxis. This has also been reported with minuscule dose of heparin used in heparin-flushes to keep vascular access catheters patient. We are reporting for the first time, a case of severe hemorrhage due to thrombocytopenia associated with heparin flushes.
Aged↗
Depressed central respiratory drive causing weaning failure. Its reversal with doxapram.
A patient failed to wean from mechanical ventilation. Her problem was unique in that she had a depressed central drive to breathe manifested by hypopnea when removed from the ventilator. After excluding the known problems that impair successful weaning, we empirically administered three separate infusions of doxapram, a respiratory stimulant. These infusions produced a dramatic improvement in spontaneous ventilation and led to successful weaning and hospital discharge.
Doxapram↗
Renal infection in autosomal dominant polycystic kidney disease.
Upper urinary tract (renal) infections have been reported to be frequent and difficult to treat in patients with autosomal dominant polycystic kidney disease. This study examined renal infections and responses to therapy in this patient population. Fifteen cyst infections and 11 parenchymal infections occurred during the study. Eighty-seven percent of the cyst and 91 percent of the parenchymal infections occurred in women. Gram-negative enterics were the causative organisms in 92 percent of the cyst and 100 percent of the parenchymal infections. All of the parenchymal but only one of the cyst infections responded to therapy with ampicillin and an aminoglycoside despite favorable sensitivities. Eighty-three percent of the cyst infections were eradicated with use of lipid-soluble antibiotics. It is concluded that Cyst infections are refractory to therapy with the antibiotics commonly used to treat urinary infections; Female preference and enteric organism predominance suggest that these renal infections are acquired retrograde from the urinary bladder.
Adult↗
Reversible renal failure and nephrotic syndrome without interstitial nephritis from zomepirac.
This report describes two patients with the clinical syndrome of reversible renal failure and nephrotic syndrome caused by the nonsteroidal anti-inflammatory agent, zomepirac sodium. What is unique about this report are the pathologic findings on renal biopsy which showed fusion of foot processes consistent with minimal change disease without evidence of an interstitial infiltrate. A cause-and-effect relationship of the disease to zomepirac administration is strongly suggested by the resolution of the renal dysfunction when the drug was stopped and by more than eighteen months of follow-up without evidence of any impairment in renal function.
Acute Kidney Injury↗
Long-term effects of 24-hr unilateral ureteral obstruction on renal function in the rat.
To characterize the pattern of recovery following release of unilateral ureteral obstruction of 24-hr duration, rats were studied with whole kidney clearance techniques, 3 hrs, 8, 14, and 60 days after release. The single nephron glomerular filtration rate (SNGFR) of superficial and juxtamedullary nephrons was estimated with a modification of Hanssen's technique in rats studied 8 and 60 days after ureteral release. The whole kidney glomerular filtration rates (GFR) were decreased markedly 3 hrs after relief of obstruction, but gradually increased and by 14 days, the GFR of the postobstructed kidney (POK) and the contralateral kidney (CK) were comparable. This recovery of GFR was not a consequence of a homogeneous improvement in SNGFR. At 8 days, more than 15% of superficial and juxtamedullary nephrons were not filtering in the POK. This decrease in the percent of filtering nephrons persisted to 60 days post release, indicating a permanent loss of nephron units. The SNGFR of the residual nephrons of the POK was significantly greater than that of the CK at 8 and 60 days following ureteral release. Thus, acute unilateral ureteral obstruction results in a permanent loss of filtering nephrons, which is offset by hyperfiltration of those remaining. Abnormalities in renal tubule function persisted beyond the time (14 days) when whole kidney GFR had returned to normal. These abnormalities were in distal tubule function. Urine osmolality was consistently lower at all time intervals post release, as was net acid excretion. The results of the present study suggest that these abnormalities are a consequence of the reduction in the number of filtering juxtamedullary nephrons and/or to abnormalities in collecting duct function.
Animals↗