Chronic kidney disease in older adults: challenges and opportunities for the primary care provider.

Kidney disease and its comorbidities disproportionately affect older persons. Kidney disease modifying therapy is underutilized in older adults, as guidelines lack consensus on approaching diagnosis and treatment in older adults. This review aims to highlight the challenges presented by, and opportunities for, identifying and treating CKD in older adults.

Patient-Reported Experiences with Dialysis Care and Provider Visit Frequency.

Background And Objectives: New payment models resulting from the Advancing American Kidney Health initiative may create incentives for nephrologists to focus less on face-to-face in-center hemodialysis visits. This study aimed to understand whether more frequent nephrology practitioner dialysis visits improved patient experience and could help inform future policy.

Design, Setting, Participants, & Measurements: In a cross-sectional study of patients receiving dialysis from April 1, 2015 through January 31, 2016, we linked patient records from a national kidney failure registry to patient experience data from the In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems survey.

Revealing Novel IDEAS: A Fiduciary Framework for Team-Based Prescribing.

The importance of safe, effective, and cost-effective prescribing habits can hardly be overstated in the current pay-for-value environment. The prescribing process taught in most medical curricula focuses primarily on accurate medical indications. While this may be of utmost importance from the clinician's perspective, it falls short of addressing the other key elements of highly effective prescribing.

Exploring Care Attributes of Nephrologists Ranking Favorably on Measures of Value.

Background: Despite growth in value-based payment, attributes of nephrology care associated with payer-defined value remains unexplored.

Methods: Using national health insurance claims data from private preferred provider organization plans, we ranked nephrology practices using total cost of care and a composite of common quality metrics. Blinded to practice rankings, we conducted site visits at four highly ranked and three average ranked practices to identify care attributes more frequently present in highly ranked practices.

Patient-Reported Experiences of Dialysis Care Within a National Pay-for-Performance System.

Importance: Medicare's End-Stage Renal Disease Quality Incentive Program incorporates measures of perceived value into reimbursement calculations. In 2016, patient experience became a clinical measure in the Quality Incentive Program scoring system. Dialysis facility performance in patient experience measures has not been studied at the national level to date.

A multicenter phase IIb study of a novel combination of intramuscular androgen (testosterone decanoate) and oral progestogen (etonogestrel) for male hormonal contraception.

The effect of a novel combination of oral etonogestrel (ENG) and im testosterone decanoate (TD) on suppression of gonadotropins and spermatogenesis as a potential lead for male contraception was investigated. Healthy male volunteers were randomized into two groups receiving 300 microg ENG daily and 400 mg TD every 4 (n = 55) or 6 (n = 57) wk for 48 wk. At wk 48, all men except one in the 6-wk group suppressed sperm concentration to less than 1 million/ml.

Advances in male contraception.

Advances in contraception have been almost exclusively female-directed despite the widespread use of male methods worldwide and increasing calls for the burden of contraception to be more evenly shared. Of the several potential approaches to novel male methods, the hormonal approach is the nearest to fruition. The use of testosterone as a reversible contraceptive agent in men has been demonstrated in studies undertaken by the WHO over the last decade.