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Moody's affirms U.S. Renal's B2 CFR; outlook changed to stable from negative - Moodys.com (press release) (subscription) PDF Print
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MJKK and MSFJ also maintain policies and procedures to address Japanese regulatory requirements.

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Thompson selected as new WCHCS dialysis director - Centerville Daily Iowegian PDF Print
Thompson selected as new WCHCS dialysis director

Thompson selected as new WCHCS dialysis director

Submitted photoAngie Thompson, RN

Posted: Wednesday, June 24, 2015 3:12 pm

CORYDON — Wayne County Hospital and Clinic System is pleased to announce Angie Thompson, RN has been chosen as the new director of the Susie B. Tuttle Dialysis Unit. Thompson succeeds former director Maggie Lindsey, RN who moved into the position of WCHCS Specialty Clinic director.

“We are very pleased have someone with Angie’s qualifications and capability assume this position. She has tremendous experience and understands the intricacies of managing a dialysis unit,” commented Sheila Mattly, CNO.

Originally, from Nebraska, Angie has worked as a dialysis nurse for eight years. She started as a staff nurse in Council Bluffs, Iowa for three years, moving into a charge nurse position in Harlan, Iowa which she also held for three years. She then accepted a temporary position as the clinical nurse manager for the Omaha Tribe of Nebraska until a Native American was found to fill the position. Angie comes experienced in all facets of dialysis patient care and staff management. Her most recent position was as a traveling dialysis nurse in the state of Florida. She is pleased to now be working close to home.

Angie’s husband also works in dialysis, on the biomed side, and was recently transferred to the Centerville and Ottumwa units prompting their relocation from Onawa, Iowa to Centerville, Iowa. They have seven grown children and are empty nesters. They are enjoying five grandchildren with more expected to follow. Angie’s personal talents include singing and playing guitar.

Angie received her Associates of Arts and Sciences degree in nursing from Northeast Community College, Norfolk, Nebraska. She is a member of Phi Beta Kappa National Honor Society.

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Days After Refusing 'Dog Dialysis', Chief of Kolkata's Premier Hospital ... - NDTV PDF Print
Kolkata:  The director of West Bengal's top government-run post graduate medical college and hospital, SSKM, has applied for voluntary retirement after being summarily transferred from the post.

Dr Pradip Mitra says he has been humiliated and insulted. He doesn't know for what, but does not rule out the possibility of being punished for stopping the dialysis of a dog at the premier hospital on June 10.

The dog was allegedly sent for treatment at the hospital by Trinamool Congress leader Dr Nirmal Majhi, who heads the state medical council. There is no facility for veterinary dialysis in Kolkata.

When the matter was first reported, Trinamool's Nirmal Majhi was quoted saying, "It was a cute dog. It was suffering. So why not treat it?" But on Wednesday, when contacted over phone, Dr Majhi said, "I have nothing to do with any dog. The report is planted to defame me."

The dog was almost admitted, on the orders of the head of the nephrology department, Dr Rajen Pandey who was out of town on that day but apparently telephoned orders to his juniors to conduct the procedure.

Dr Pandey also texted Dr Mitra that "VIP dog dialysis required. Vet of govt hospital has approached me."

"Soon after, I was contacted by a senior nephrologist, Dr Aprita Roy Chowdury, who said a 'dog dialysis' is going to be held at the hospital. I was surprised," said Dr Mitra. "Immediately, I ordered that it should be stopped. I asked who ordered it, and was told that the head of the department ordered some persons and it has been registered in the log book."

Hospital sources confirm that the dialysis unit's log book has an entry, number 13, for "unknown dog" on June 10.

Thirteen days later, on June 23, Dr Mitra was summarily transferred, given his release papers and replaced.

Health officials insist it is a routine transfer. But Dr Mitra, who has been in the state health service for 33 years, says such summary transfer is highly unusual.

"This happens only if there is some mischief and complaint against a person. In such cases it is done. It is not routine, even though they are saying it is a routine transfer. This has not been done before," he said. Mr Mitra had served as the director of SSKM for over seven years.

Dr Mitra asked the government to probe the "dog dialysis" incident. But it is yet to be done.

Now posted to a fledgling medical college, he has applied for voluntary retirement. Asked why he didn't appeal to the Chief Minister, he said, his transfer could not have happened without her consent. Mamata Banerjee also holds the health portfolio.

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More than 1 in 10 Lupus Patients Have Pulmonary Hypertension - Renal and Urology News PDF Print
June 24, 2015 More than 1 in 10 Lupus Patients Have Pulmonary Hypertension - Renal and Urology News
Patients have few cardiopulmonary symptoms; serum uric acid can predict presence of pumonary hypertension.

(HealthDay News) -- About 8% of patients with systemic lupus erythematosus (SLE) have pulmonary hypertension (PH), and serum uric acid (UA) has reasonable accuracy for predicting PH, according to a study published in the International Journal of Rheumatic Diseases.

Ki-Jo Kim, M.D., from the Catholic University of Korea in Seoul, and colleagues conducted a prospective cross-sectional study of 114 patients with SLE to examine the point prevalence of PH and associated risk factors. Pulmonary arterial pressures were estimated with transthoracic echocardiography.

The researchers identified PH in 7.9% of patients who had few cardiopulmonary symptoms. SLE disease activity score was higher in patients with PH. Serum UA was significantly higher in patients with versus those without PH. UA remained significant for the presence of PH in multivariate analysis. There was a correlation for serum UA with plasma N-terminal-pro-B-type natriuretic peptide level and systolic pulmonary artery pressure. Serum UA had reasonable accuracy for predicting the presence of PH at the cutoff level of 6.5 mg/dL (sensitivity of 66.7% and specificity of 96.2%).

"A significant number of SLE patients in rheumatology practice have undiagnosed PH with few discernible symptoms," the authors write. "Serum UA level may be useful as a surrogate marker for screening of PH in patients with SLE."

Source

  1. Kim, K, et al. International Journal of Rheumatic Diseases, volume 18, issue 5, pages 524–532, June 2015; doi: 10.1111/1756-185X.12262.

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Dialysis patients get substandard care despite guidelines - ModernHealthcare.com PDF Print
Many kidney failure patients continue to receive critical dialysis treatments through catheters, a vein access method that is widely known to increase the risk of serious infections, blood clots, poor outcomes and even death.

The best method (an arteriovenous fistula) is not always the first resort, despite more than 20 years of evidence and national best-practice campaigns encouraging its use. It's a problem some associate with poor access to care, misaligned reimbursement incentives and geographic disparities.

It's a “massive failure,” said Dr. Mahmoud Malas, associate professor of surgery at the Johns Hopkins School of Medicine. He coauthored a study released Wednesday identifying geographic disparities in meeting target rates for AV fistula use.

“It's both surprising and disappointing,” Malas said. “We know fistula use is associated with the best outcomes—but we're still not doing a good job. It makes me think there's something wrong with the system."

To live, patients whose kidneys stop working require dialysis—a process to filter toxins from their body—three times a week for several hours at a time. The toxins are filtered through a vein, which can be accessed using a graft, catheter or an AV fistula. The fistula, created in the patient's arm by surgically stitching an artery to a vein, is recognized as the highest standard of care.

However, of the 400,000 hemodialysis patients in the U.S., approximately 25% are dialyzing with catheters, according to estimates. Each hospitalization for catheter-related infections costs an average of $23,000. Reducing catheter use by half could yield $1 billion a year in Medicare savings, according to 2011 article in the Journal of the American Society of Nephrology.

The CMS began publicly rating dialysis providers on quality with a five-star system rolled out earlier this year as part of ongoing efforts to boost transparency for consumers. AV fistula and catheter use are among 11 quality measures that are now publically reported through the CMS's Dialysis Facility Compare site and contribute to the ratings.

About 98% of facilities receiving five-stars had at least half their patients on a fistula, compared with 57% of the one-star locations, a Modern Healthcare analysis of the federal data finds. Only about a third of five-star facilities achieved eight of 10 patients on a fistula. No one-star facility reached that rate.

A national campaign called “Fistula First, Catheter Last,” encourages facilities to reach the target rate of 68% of patients on fistulas. That's still low compared with other countries, where as many as 9 out of 10 patients use them, according to the CMS.

But, “it seems the goal is within reach,” an agency spokesperson said in response to the Modern Healthcare analysis. “There is substantial room for improvement.”

Kidney care providers, surgeons, nephrologists and others interviewed by Modern Healthcare, however, cite several barriers.

One is that low-income patients with limited access to primary care are less likely to have warning signs of kidney disease detected early. As a result, they “crash into dialysis,” meaning the window between learning they have kidney failure and the need to start dialysis is only a few days.

That's problematic because it takes six to eight weeks after surgery for a fistula to be ready to use. It only takes one day for a catheter. “Catheter is the last resort. But that's all people have sometimes—a last resort,” said Dr. Mark Leischner, medical director of the 16-station Fresenius Northcenter Dialysis Facility in Chicago, which received four stars on the CMS' rating system.

Once a patient has crashed in with a catheter, the quality goal is to switch them to a fistula within 90 days. But many said that process can be laborious. It can take more than the allotted time to get insurance approved and schedule appointments with surgeons whose rosters may be packed. Patients may also be resistant to undergoing another surgery and want to stick to the method they already have.

“It's a major challenge; 90 days is not enough,” said Dr. Kam Kalantar-Zadeh, chief of the division of nephrology and hypertension at the University of California School of Medicine. He is also medical director of the university's dialysis facility, which got three-stars on the recent CMS rating. “A center that has an 80% fistula rate really deserves a five-star rating,” he said.

Researchers have attempted to identify what factors determine which dialysis patients get the best care and which do not, and they emphasize that providers should learn from the places getting it right.

The JAMA surgery study this week co-authored by Malas found some geographic regions are doing better than others. The study looked at 464,547 patients who began hemodialysis between January 2006 and December 2010.

Regional differences in the use of fistulas first ranged from 11% to 22%, the study found. Of the 18 end-stage renal disease networks, fistula rates were highest in New England (Network 1) and the Pacific Northwest (Network 16). Their rates were double the amount of those in Florida (Network 7) and Texas (Network 14).

Not surprisingly there were similar differences among networks in terms of the distribution of quality performance on the CMS star ratings, a Modern Healthcare analysis shows. For example of 342 dialysis facilities in Florida, 174 (19%) received four- and five- stars while of 214 facilities in the Northern California network, 97(45%) achieved those high marks. Modern Healthcare also previously noted marked differences among the nation's two largest dialysis providers.

Such differences are troubling to Malas, who says opportunities to reduce catheter overuse are being overlooked. His current research focuses on patient education, specifically using peer-to-peer methods. “One of the biggest problems is trust,” he said. In surveys of dialysis patients, he has found patients tend to trust other patients more than they trust the physician.

DaVita leaders in May told providers who scored low on the CMS's controversial rating system to “stop being sour grapes” and work on known methods to improve outcomes.

That sentiment was shared by Dr. Wootaek Chang, chief of the division of nephrology at the Brooklyn Hospital Center in New York. One of the first things he noticed when he joined the staff more than 27 years ago was that at least 70% of the patients receiving treatments had catheters.

“This was no good,” said Chang, who recalls being surprised by the high rates. 'We made a concerted effort,” he said, by working with vascular surgeons to evaluate all new patients and ensure every patient whose veins were good enough would have a fistula created.

Those efforts seem to have paid off. One of the hospital's dialysis facilities had five-stars and the other four, and both had fistula use rates above 80%, despite high poverty rates in the community.

Chang has some concerns with Medicare's ratings methodology but is optimistic it will at least renew focus on catheter use.

“There's no doubt it will give motivation for facilities to do something,” he said. “The goal should be to do what is right for the patient.”

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