There are little aggregate data that examine attributes of peritoneal dialysis (PD) training programs for children. We determined characteristics of pediatric home PD training programs in a sample of 54 centers in the NAPRTCS PD registry by telephone interview. Sixty-seven percent of the programs trained pediatric patients only (P-only); 33% were combined pediatric/adult (P/A) programs; 33 programs had dedicated training rooms. Most programs trained 5 to 8 patients/year; only 2 trained more than 12 patients/year. Forty-eight of 54 programs (89%) taught both automated and manual PD techniques; the preferred type of PD varied. All units preferred to train 2 people. The patient was often one of the trainees, but the minimal eligible age varied greatly. The patients were trained as inpatients (IP) in 38 units (70%) and as outpatients (OP) in 16 units (30%). P-only programs were less likely to train as OP (20%) than P/A programs (50%) (p < 0.01). There was no difference in the mean training time for P-only versus P/A programs. However, training that took more than 6 days occurred more often when done as an IP (79%) than as an OP (56%) (p = 0.057). Furthermore, only 25% of IP units that took more than 6 days to train offered training on the weekend; none of the IP units that took more than 10 days offered weekend training. In conclusion, the structure of PD training programs for children in the United States varies tremendously. OP training is usually shorter in duration and potentially more cost-effective.(ABSTRACT TRUNCATED AT 250 WORDS)
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Pain
January 2025
Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States.
Rapid declines in opioid analgesics dispensed in American communities since 2011 raise concerns about inadequate access to effective pain management among patients for whom opioid therapies are appropriate, especially for those living in racial/ethnic minority and socioeconomically deprived communities. Using 2011 to 2021 national data from the Automated Reports and Consolidated Ordering System and generalized linear models, this study examined quarterly per capita distribution of oxycodone, hydrocodone, and morphine (in oral morphine milligram equivalents [MMEs]) by communities' racial/ethnic and socioeconomic profiles. Communities (defined by 3-digit-zip codes areas) were classified as "majority White" (≥50% self-reported non-Hispanic White population) vs "majority non-White.
View Article and Find Full Text PDFJAMA Health Forum
January 2025
School of Nursing, Duke University, Durham, North Carolina.
JAMA Netw Open
January 2025
Center of Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil.
Importance: Congenital Zika syndrome (CZS) can lead to a range of developmental and neurological issues, which increases the risk of early death. However, the all-cause and cause-specific mortality in children with CZS in the first 5 years of life remain unknown.
Objective: To compare the hazard of all-cause and cause-specific mortality before age 5 years among children with and without CZS in Brazil.
Proc Natl Acad Sci U S A
January 2025
The Harris School of Public Policy, University of Chicago, Chicago, IL 60637.
Americans collectively hold over $1.6 trillion in student loan debt, and over the last decade millions of borrowers have defaulted on loans, with serious consequences for their financial health. In a 13-million-person field experiment with the U.
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