Assessing key cost drivers associated with caring for chronic kidney disease patients.

Background: To examine key factors influencing chronic kidney disease (CKD) patients' total expenditure and offer recommendations on how to reduce total cost of CKD care without compromising quality.

Methods: Using the 2002-2011 Medical Expenditure Panel Survey (MEPS) data, our cross-sectional study analyzed 197 patient records-79 patients with one record and 59 with two entries per patient (138 unique patients). We used three patient groups, based on international statistical classification of diseases version 9 code for condition (ICD9CODX) classification, to focus inference from the analysis: (a) non-dialysis dependent CKD, (b) dialysis and (c) transplant.

Esophageal strictures and diverticula.

Esophageal disease and dysfunction of the lower esophageal sphincter (LES) manifesting as gastroesophageal reflux disease (GERD) particularly, is the most common of all gastrointestinal conditions impacting patients on a day-to-day basis. LES dysfunction can lead to anatomic changes to the distal esophagus, with GERD-mediated changes being benign stricture or progression of GERD to Barrett's esophagus and even esophageal cancer, and LES hypertension impairing esophageal emptying with subsequent development of pulsion esophageal diverticulum. This article details the causes, clinical presentation, workup, and treatment of esophageal stricture and epiphrenic esophageal diverticulum.

Using carbohydrate counting in diabetes clinical practice.

Carbohydrate counting is a meal planning approach used with clients who have diabetes that focuses on carbohydrate as the primary nutrient affecting postprandial glycemic response. The concept of carbohydrate counting has been around since the 1920s, but it received renewed interest after being used as 1 of 4 meal planning approaches in the Diabetes Control and Complications Trial. In the trial, carbohydrate counting was found to be effective in meeting outcome goals and allowed flexibility in food choices.