Searching for synergy from a combination of heterogeneous business models: measurement and assessment from the polish software industry.

The authors propose a universal methodology for measuring and assessing the synergy potential when combining companies into a group, using the business model perspective. Based on interviews with company representatives, as well as consultations with Polish software industry experts, we have found 40 key variables which are characteristic for business models of resellers and integrators. The combination of business model concepts, of Balanced Scorecard and multi-criteria decision analysis, as proposed in the paper, allows the opportunities and threats (for strategic objectives to be reached within company group) in terms of business model variables, to be indicated more precisely.

A need for a paradigm shift in focus: From Kt/V to appropriate removal of sodium (the ignored uremic toxin).

Hemodialysis for chronic renal failure was introduced and developed in Seattle, WA, in the 1960s. Using Kiil dialyzers, weekly dialysis time and frequency were established to be about 30 hours on 3 time weekly dialysis. This dialysis time and frequency was associated with 10% yearly mortality in the United States in 1970s.

Update on cannulation techniques.

There are two methods of fistula cannulation for hemodialysis. The first, different site or rope-ladder cannulation method, established by originators of the arteriovenous fistula as a blood access for hemodialysis in 1966, relies on changing the puncture sites for each dialysis. The second, constant site or buttonhole method, developed several years later, recommends using the same puncture sites for consecutive dialyses.

Con: Randomized controlled trials (RCT) have failed in the study of dialysis methods.

All progress in dialysis methods was made in research presented in case reports, case-control studies and other observational studies. On the contrary, randomized controlled trials (RCTs) did not bring any valuable results. Comparison of the value of peritoneal dialysis and hemodialysis (HD) in RCTs was not completed because of recruitment problems.

Peritoneal dialysis survival in relation to patient body size and peritoneal transport characteristics.

This study compares patient and technique survival on continuous ambulatory peritoneal dialysis (CAPD) and other peritoneal dialysis (PD) modalities in relation to body size indicators, race, sex, and peritoneal transport characteristics. Data were abstracted from a PD adequacy database, with 354 patients subjected to analysis. Transfers between PD modalities were almost exclusively from CAPD to various offshoots of PD, mostly due to inadequate dialysis or inadequate ultrafiltration.

Long-term follow-up of body size indices, residual renal function, and peritoneal transport characteristics in continuous ambulatory peritoneal dialysis.

Technique survival in continuous ambulatory peritoneal dialysis (CAPD) depends mostly on clearances in relation to body size and residual renal function (RRF). Our clinical impression has been that when RRF fails, larger patients leave CAPD sooner than smaller patients do. Peritoneal equilibration tests (PETs) and 24-hour adequacy evaluations performed in 277 patients in a single center from 1986 through 2009 were abstracted from the existing peritoneal dialysis adequacy database.

Sodium, hypertension, and an explanation of the "lag phenomenon" in hemodialysis patients.

Sodium balance is precisely regulated by intake and output. The kidneys are responsible for adjusting sodium excretion to maintain balance at varying intakes. Our distant ancestors were herbivores.

History of hemodialyzers' designs.

Accumulation of knowledge requisite for development of hemodialysis started in antiquity and continued through Middle Ages until the 20th century. Firstly, it was determined that the kidneys produce urine containing toxic substances that accumulate in the body if the kidneys fail to function properly; secondly, it was necessary to discover the process of diffusion and dialysis; thirdly, it was necessary to develop a safe method to prevent clotting in the extracorporeal circulation; and fourthly, it was necessary to develop biocompatible dialyzing membranes. Most of the essential knowledge was acquired by the end of the 19th century.

Measuring central venous structures in humans: implications for central-vein catheter dimensions.

The tip of a central vein catheter for hemodialysis should be located in the upper right atrium for the best performance. Hemodialysis catheters do have internal diameter unadjusted to the catheter length; however, the longer the catheter the slower the flow at the same pressure difference. On the other hand, the catheter diameter cannot be so large as to fill the vein too tightly as it predisposes to the damage of the vein wall, thrombosis and stenosis.

Treatment time and ultrafiltration rate are more important in dialysis prescription than small molecule clearance.

Chronic hemodialysis sessions, as developed in Seattle in the 1960s, were long procedures with minimal intra- and interdialytic symptoms. Over the next three decades, dialysis duration was shorten to 4, 3, even 2 h in thrice weekly schedules. This method spread rapidly, particularly in the United States, after the National Cooperative Dialysis Study suggested that the time of dialysis is of minor importance as long as urea clearance multiplied by dialysis time and scaled to total body water (Kt/V(urea)) equals 0.

Daily dialyses decrease plasma levels of brain natriuretic peptide (BNP), a biomarker of left ventricular dysfunction.

Brain natriuretic peptide or B-type natriuretic peptide (BNP) is a sensitive marker of heart disease. Plasma levels of BNP increase in left ventricular failure and determination of plasma BNP has become a useful tool in the diagnosis of heart failure. Hemodialysis (HD) patients may have elevated plasma levels of BNP, particularly predialysis, that correlate with echocardiographic signs of left ventricular dysfunction.

Current trends in the use of peritoneal dialysis catheters.

The Tenckhoff catheter was developed in 1968 and has been widely used since for chronic peritoneal dialysis (PD) patients. Variations of the Tenckhoff catheter have been designed over the years in a search for the ideal PD catheter--an access that can provide reliable dialysate flow rates with few complications. Currently, data derived from randomized, controlled, multicenter trials dedicated to testing how catheter design and placement technique influence long-term catheter survival and function are scarce.

Peritoneal access: the past, present, and the future.

In the early years of peritoneal dialysis, there was no specific device for peritoneal dialysis; rather the devices used in general surgery and urology were taken advantage of for peritoneal access. These early devices, used for short-term peritoneal dialysis, were plagued with multiple complications, such as pressure on intestines of rigid tubes, plugging of openings, leakage of fluid around the access, and difficulties in fixation of the tube on the abdominal wall. In the late 1940s, after World War II, multiple peritoneal dialysis solution compositions and multiple peritoneal accesses were tried, and first accesses specifically for peritoneal dialysis were designed.