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Medical director hemodialysis

Debbie Benner, Mary Burgess, Maria Stasios, Becky Brosch, Ken Wilund, Sa Shen, Brandon Kistler
BACKGROUND AND OBJECTIVES: Eating during hemodialysis treatment remains a controversial topic. It is perceived that more restrictive practices in the United States contribute to poorer nutritional status and elevated mortality compared with some other parts of the world. However, in-center food practices in the United States have not been previously described. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In 2011, we conducted a survey of clinic practices and clinician (dietitian, facility administrator, and medical director) opinions related to in-center food consumption within a large dialysis organization...
May 6, 2016: Clinical Journal of the American Society of Nephrology: CJASN
Monir Nobahar, Mohammad Reza Tamadon
INTRODUCTION: Patients undergoing hemodialysis require direct and continuous care. Identifying the barriers to and factors facilitating hemodialysis care can improve care quality. OBJECTIVES: The aim of this study was to assess the barriers and facilitators of care for hemodialysis patients. PATIENTS AND METHODS: This study was conducted as a qualitative study and it utilized content analysis approach. The study was performed in hemodialysis ward of Kowsar hospital in Semnan, in 2014...
2016: Journal of Renal Injury Prevention
Li Zuo, Mia Wang, Fanfan Hou, Yucheng Yan, Nan Chen, Jiaqi Qian, Mei Wang, Brian Bieber, Ronald L Pisoni, Bruce M Robinson, Shuchi Anand
BACKGROUND: As the utilization of hemodialysis increases in China, it is critical to examine anemia management. METHODS: Using data from the China Dialysis Outcomes and Practice Patterns Study (DOPPS), we describe hemoglobin (Hgb) distribution and anemia-related therapies. RESULTS: Twenty one percent of China's DOPPS patients had Hgb <9 g/dl, compared with ≤10% in Japan and North America. A majority of medical directors targeted Hgb ≥11...
2016: Blood Purification
Toros Kapoian, Klemens B Meyer, Douglas S Johnson
Infections continue to be a major cause of disease and contributor to death in patients on dialysis. Despite our knowledge and acceptance that hemodialysis catheters should be avoided and eliminated, most patients who begin dialysis initiate treatment through a central vein hemodialysis catheter. Dialysis Medical Directors must be the instrument through which our industry changes. We must lead the charge to educate our dialysis staff and our dialysis patients. We must also educate ourselves so that we not only know that our facility policies are consistent with the best evidence available, but we must also know where local and federal regulations differ...
May 7, 2015: Clinical Journal of the American Society of Nephrology: CJASN
Ronald L Pisoni, Lindsay Zepel, Friedrich K Port, Bruce M Robinson
BACKGROUND: Since the bundled end-stage renal disease prospective payment system began in 2011 in the United States, some hemodialysis practices have changed substantially, raising the question of whether vascular access practice also has changed. We describe monthly US vascular access use from August 2010 to August 2013 with international comparisons, and other aspects of US vascular access practice. STUDY DESIGN: Prospective observational cohort study of vascular access...
June 2015: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Elitza S Theel, Christopher D Doern
Invasive fungal infections are a significant cause of morbidity and mortality in patients who receive immunosuppressive therapy, such as solid organ and hematopoietic stem cell transplant (HSCT) recipients. Many of the fungi associated with these infections are angioinvasive and are best diagnosed by visualizing the organism in or culturing the organism from deep tissue. However, obtaining such tissue often requires an invasive procedure. Many HSCT recipients are thrombocytopenic, making such procedure too risky because of potential bleeding complications...
November 2013: Journal of Clinical Microbiology
Eduardo Lacson, Franklin W Maddux
The Medical Director is responsible for all levels of quality patient care in the facility as mandated by the 2008 revision of the Medicare Conditions for Coverage of dialysis facilities. He/she is the leader and primary individual tasked with ensuring that facility processes are in place to meet or exceed key quality goals or adopt new ones and prioritize them appropriately-all to drive improved facility performance, particularly the ultimate outcomes of morbidity and mortality rates. Management of vascular access, dialysis dose, mineral metabolism, acid-base balance, sodium and fluid management, anemia, among other aspects of care, have representative intermediate clinical outcomes that are often called "surrogate" or "process" measures-because they may reflect the quality of care delivery while impacting "primary" outcomes such as death and hospitalization...
May 2012: Seminars in Dialysis
Brennan M R Spiegel
No abstract text is available yet for this article.
May 2012: Seminars in Dialysis
Peter B DeOreo, Raynel Wilson, Jay B Wish
No abstract text is available yet for this article.
May 2012: Seminars in Dialysis
Renee Garrick, Alan Kliger, Beth Stefanchik
Patient safety is the foundation of high-quality health care. More than 350,000 patients receive dialysis in the United States, and the safety of their care is ultimately the responsibility of the facility medical director. The medical director must establish a culture of safety in the dialysis unit and lead the quality assessment and performance improvement process. Several lines of investigation, including surveys of patients and dialysis professionals, have helped to identify important areas of safety risk in dialysis facilities...
April 2012: Clinical Journal of the American Society of Nephrology: CJASN
Wiam A Alashek, Christopher W McIntyre, Maarten W Taal
Dialysis is entirely funded by the public health care sector in Libya. Access to treatment is unrestricted for citizens but there is a lack of local information and no renal registry to gather national data. This cross-sectional study aimed to investigate dialysis provision and practice in Libyan dialysis facilities in 2009. A structured interview regarding dialysis capacity, staffing and methods of assessment of dialysis patients, and infection control measures was conducted with the medical directors of all 40 dialysis centers and 28 centers were visited...
October 2011: Hemodialysis International
Nissim Levy
The 60th anniversary of Israel coincides with the advent of the first hemodialysis in the Middle East. It was performed by Dr. Kurt Steinitz--a Jewish immigrant from Breslau, then in Germany. After spending 9 years at the Istanbul Faculty of Medicine as a clinical biochemist, Steinitz became the director of the chemical laboratory of the Rothschild Hospital in Haifa in 1945. During the spring of 1948, he completed the construction of a hemodialysis machine according to articles published by Kolff (The Netherlands) and mainly by Alwall (Sweden)...
February 2010: Harefuah
Deuzimar Kulawik, Jeffrey J Sands, Kelly Mayo, Mary Fenderson, Janet Hutchinson, Cindy Woodward, Sally Gore, Arif Asif
Tunneled hemodialysis catheters (TDCs) carry the highest mortality risk for chronic hemodialysis patients of any access modality. Recent data have emphasized that mortality risk decreases when these devices are discontinued. Herein, we present the results of a gap-reduction assisted catheter elimination strategy that Network 7 employed as its quality improvement initiative to reduce the use of TDCs. Hemodialysis facilities with high catheter rates (>90 days) were identified. Interventions included focused vascular access education, monthly follow-up and site visits to assist the facility catheter reduction program...
November 2009: Seminars in Dialysis
Dana C Miskulin, Daniel E Weiner, Hocine Tighiouart, Vladimir Ladik, Karen Servilla, Philip G Zager, Alice Martin, H K Johnson, Klemens B Meyer
BACKGROUND: Anemia management in hemodialysis patients poses significant challenges. The present study explored the hypothesis that computerized dosing of intravenous erythropoietin (EPO) would increase the percentage of hemoglobin (Hb) values within the target range and reduce staff time spent on anemia management. STUDY DESIGN: Retrospective cohort. SETTING & PARTICIPANTS: In-center hemodialysis patients who received EPO at Dialysis Clinic Inc dialysis units for at least 3 months between October 1, 2005, and April 30, 2006...
December 2009: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Mark R Rohrscheib, Orrin B Myers, Karen S Servilla, Christopher D Adams, Dana Miskulin, Edward J Bedrick, William C Hunt, Douglas E Lindsey, Darlene Gabaldon, Philip G Zager et al.
BACKGROUND AND OBJECTIVES: Despite the high prevalence of cardiovascular disease among hemodialysis patients, the relationship between age and blood pressure (BP) is not well understood. It was postulated that the relationship of BP to age differs among hemodialysis patients versus the general population and that there is significant variability in dialysis unit BP measurements. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: To explore this hypothesis, the patterns of systolic, diastolic, mean arterial, and pulse pressures in the general population using data from National Health and Nutrition Examination Survey participants (n = 9242) were compared with those in a cohort of hemodialysis patients (n = 9849)...
September 2008: Clinical Journal of the American Society of Nephrology: CJASN
Richard S Goldman
Medical directors are directly or indirectly responsible for everything that occurs in a dialysis facility. The proposed Conditions of Coverage require medical directors to oversee the process resulting in involuntary discharges from the facility. Involuntary discharges result in high costs to the patient, family, facility and payers. Consequently, End Stage Renal Disease (ESRD) Networks oversee individual facility involuntary discharge rates. A large national survey found that involuntary discharges were due to disruptive behaviors, most commonly nonadherence to medical advice...
May 2008: Seminars in Dialysis
Jeffrey S Berns, W Charles O'Neill
BACKGROUND AND OBJECTIVES: Some procedures (e.g., placement of temporary hemodialysis catheters and kidney biopsies) are required in nephrology fellowship training. Others (e.g., placement of tunneled hemodialysis catheters, ultrasonography, and hemodialysis access interventions) are not required but are performed at some centers. To assess the procedures performed by nephrologists and nephrology fellows at U.S. adult nephrology training programs and the number of procedures required for fellow competency, a survey was conducted of all such training programs...
July 2008: Clinical Journal of the American Society of Nephrology: CJASN
Franklin W Maddux, Dugan W Maddux, Raymond M Hakim
The role of the dialysis unit Medical Director has evolved over time to an expanded set of roles from one that used to be strictly "medical" to one that is more "managerial." Physicians providing these Medical Director services are facing increasing demands for a leadership role regarding clinical quality improvement and measurement of performance in core areas of care within the dialysis program. The dialysis Medical Director is asked to lead in group decision-making, in analyzing core process and patient outcomes and in stimulating a team approach to Continuous Quality Improvement (CQI) and patient safety...
January 2008: Seminars in Dialysis
Peter B Deoreo
While Medicare funds neither 100% of the patients, nor 100% of the costs incurred by dialysis patients, Medicare's policies dominate reimbursement. The medical director is well advised to understand these mechanisms and the processes leading to change. Medicare pays for dialysis according to laws and rules enacted by Congress. Congress is re-evaluating the funding of the end-stage renal disease program. The rules are changing. They are changing in a way designed to encourage better outcomes, and increased provider accountability...
January 2008: Seminars in Dialysis
Alan S Kliger
The medical director of dialysis is responsible for leadership in a dialysis facility's quality improvement activities and patient safety initiatives. The Director should have knowledge of, and an ability to utilize, Continuous Quality Improvement techniques, evidence-based guidelines, standardized mortality, hospitalization and transplantation data and other modalities to improve systems of care.
May 2007: Seminars in Dialysis
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