Dialysis costs for a health system participating in value-based care.

Objectives: Unplanned "crash" dialysis starts are associated with worse outcomes and higher costs, a challenging problem for health systems participating in value-based care (VBC). We examined expenditures and utilization associated with these events in a large health system.

Study Design: Retrospective, single-center study at Cleveland Clinic, a large, integrated health system participating in VBC contracts, including a Medicare accountable care organization.

Moving from Evidence to Implementation of Breakthrough Therapies for Diabetic Kidney Disease.

Diabetic kidney disease is the most frequent cause of kidney failure, accounting for half of all cases worldwide. Moreover, deaths from diabetic kidney disease increased 106% between 1990 and 2013, with most attributed to cardiovascular disease. Recommended screening and monitoring for diabetic kidney disease are conducted in less than half of patients with diabetes.

Detection of Defects in Geomembranes Using Quasi-Active Infrared Thermography.

High-density polyethylene geomembranes are employed as covers for the sewage treatment lagoons at Melbourne Water Corporation's Western Treatment Plant, to harvest the biogas produced during anaerobic degradation, which is then used to generate electricity. Due to its size, inspecting the cover for defects, particularly subsurface defects, can be challenging, as well as the potential for the underside of the membrane to come into contact with different substrates, viz. liquid sewage, scum (consolidated solid matter), and biogas.

Buttonhole Cannulation of Arteriovenous Fistulas in the United States.

The cannulation technique of a hemodialysis vascular access has remained controversial with differing viewpoints. The quality of dialysis, overall patient safety, and individual dialysis experience often dictate the type of cannulation technique used in clinical practice. The three commonly used techniques to access a hemodialysis vascular access are the rope ladder, area, and buttonhole.

Achieving dialysis safety: The critical role of higher-functioning teams.

The potential for harm from errors and adverse events in dialysis is significant. Achieving a culture of safety in dialysis to reduce the potential harm to patients has been challenging. Recently, improving dialysis safety has been highlighted by Nephrologists Transforming Dialysis Safety (NTDS), a national initiative to eliminate dialysis infections.

Leak Detection in Water Pipes Using Submersible Optical Optic-Based Pressure Sensor.

Leakage is undesirable in water distribution networks, as leaky pipes are financially costly both to water utilities and consumers. The ability to detect, locate, and quantify leaks can significantly improve the service delivered. Optical fibre sensors (OFS) have previously demonstrated their capabilities in performing real-time and continuous monitoring of pipe strength leak detection.

Systems Thinking and Leadership: How Nephrologists Can Transform Dialysis Safety to Prevent Infections.

Infections are the second leading cause of death for patients with ESKD. Despite multiple efforts, nephrologists have been unable to prevent infections in dialysis facilities. The American Society of Nephrology and the Centers for Disease Control and Prevention have partnered to create Nephrologists Transforming Dialysis Safety to promote nephrologist leadership and engagement in efforts to "Target Zero" preventable dialysis infections.

Remote Monitoring of Automated Peritoneal Dialysis Patients: Assessing Clinical and Economic Value.

Background: For chronic kidney disease patients who progress to end-stage renal disease, survival is dependent on renal replacement therapy in the form of kidney transplantation or chronic dialysis. Peritoneal dialysis (PD), which can be performed at home, is both more convenient and less costly than hemodialysis that requires three 4-h visits per week to the dialysis facility and complicated equipment. Remote therapy management (RTM), technologies that collect medical information and transmit it to healthcare providers for patient management, has the potential to improve the outcomes of patients receiving automated peritoneal dialysis (APD) at home.

Uremic pericarditis, pericardial effusion, and constrictive pericarditis in end-stage renal disease: Insights and pathophysiology.

A rising prevalence of end-stage renal disease (ESRD) has led to a rise in ESRD-related pericardial syndromes, calling for a better understanding of its pathophysiology, diagnoses, and management. Uremic pericarditis, the most common manifestation of uremic pericardial disease, is a contemporary problem that calls for intensive hemodialysis, anti-inflammatories, and often, drainage of large inflammatory pericardial effusions. Likewise, asymptomatic pericardial effusions can become large and impact the hemodynamics of patients on chronic hemodialysis.

The Use of a Multidimensional Measure of Dialysis Adequacy-Moving beyond Small Solute Kinetics.

Urea removal has become a key measure of the intensity of dialysis treatment for kidney failure. Small solute removal, exemplified by Kt/V has been broadly applied as a means to quantify the dose of thrice weekly hemodialysis. Yet, the reliance on small solute clearances alone as a measure of dialysis adequacy fails fully to quantify the intended clinical effects of dialysis therapy.

Fatigue Damage Monitoring of a Composite Step Lap Joint Using Distributed Optical Fibre Sensors.

Over the past few decades, there has been a considerable interest in the use of distributed optical fibre sensors (DOFS) for structural health monitoring of composite structures. In aerospace-related work, health monitoring of the adhesive joints of composites has become more significant, as they can suffer from cracking and delamination, which can have a significant impact on the integrity of the joint. In this paper, a swept-wavelength interferometry (SWI) based DOFS technique is used to monitor the fatigue in a flush step lap joint composite structure.

Consistency of color representation in smart phones.

One of the barriers to the construction of consistent computer-based color vision tests has been the variety of monitors and computers. Consistency of color on a variety of screens has necessitated calibration of each setup individually. Color vision examination with a carefully controlled display has, as a consequence, been a laboratory rather than a clinical activity.

Managing hospitalized hemodialysis patients: A guide for the non-nephrologist.

In-hospital care of end-stage renal disease (ESRD) patients, on hemodialysis, is different from the general population in various aspects. Non-nephrologists do not typically receive specialized training to take care of these patients. However, in most circumstances, they serve as the primary attending for these patients in the hospital setting.

Post-surgical surveillance of locally advanced ileal carcinoids found by routine ileal intubation during screening colonoscopy: a case series.

Introduction: Carcinoid tumors are the most common type of small bowel tumor, and the incidence is rising. The majority of small bowel carcinoid tumors arise within 60 cm of the ileocecal valve. The addition of ileoscopy to screening colonoscopy can detect asymptomatic small bowel carcinoid tumors and improve long-term prognosis through early surgical resection.

Endovascular management of thrombosed axillary artery to right atrium hemodialysis graft.

Purpose: To describe the salvage of a left axillary artery to right atrium hemodialysis graft using endovascular techniques.

Case Report: A 54-year-old man with multiple arteriovenous graft failures presented with a thrombosed left axillary artery to right atrium Gore-tex hemodialysis graft. The graft was salvaged using rheolytic catheter thrombectomy, mechanical thrombectomy, balloon angioplasty, and stenting.

Urgent-start peritoneal dialysis: a chance for a new beginning.

Peritoneal dialysis (PD) remains greatly underutilized in the United States despite the widespread preference of home modalities among nephrologists and patients. A hemodialysis-centric model of end-stage renal disease care has perpetuated for decades due to a complex set of factors, including late end-stage renal disease referrals and patients who present to the hospital requiring urgent renal replacement therapy. In such situations, PD rarely is a consideration and patients are dialyzed through a central venous catheter, a practice associated with high infection and mortality rates.

Patient education and care for peritoneal dialysis catheter placement: a quality improvement study.

Background And Objectives: Peritoneal dialysis catheter (PDC) complications are an important barrier to peritoneal dialysis (PD) utilization. Practice guidelines for PDC placement exist, but it is unknown if these recommendations are followed. We performed a quality improvement study to investigate this issue.

Training of surgeons in peritoneal dialysis catheter placement in the United States: a national survey.

Background And Objectives: Peritoneal dialysis (PD) depends on timely and skilled placement of a PD catheter (PDC). Most PDCs are placed surgically, but little is known about the residency training of surgeons in this procedure. Inadequate residency training could limit surgical expertise in PDCs, resulting in high complication rates that discourage PD use.