Assisted Peritoneal Dialysis

The number of patients depending on dialysis therapies increases worldwide. The home-based dialysis modalities offer some advantages especially for elderly patients. In the case of peritoneal dialysis (PD), the life quality is superior compared to in-center hemodialysis (HD), and other advantages are existent. Due to the effect that a lot of elderly PD patients are frail, a concept covering the different modalities of PD must include the assistance at home or the living environment (assisted PD) for the bag exchanges that often cannot be performed reliably by elderly and frail patients by themselves. Nowadays, we have enough data to safely offer assisted peritoneal dialysis (aPD) in a cost-saving manner. Putting all these aspects together, aPD is a safe and in some countries widely used modality. The issue of reimbursement and education of home nurse staff must be solved. However, for elderly and frail patients, aPD offers a change to use the advantages of PD for these population, and on a local level, the provider should seek ways to establish aPD programs

The Practice of Medicine in the Age of Information Technology

Regarding the practice of medicine, we have to face the chances and challenges of all aspects of e-Health; however, the term “digitalization” is broader and spanning all aspects. However, the digitalization of medicine offers solutions for pressing problem. We know the factors that lead to excellence in medicine. Without the right amount of experiences based on a solid ground of knowledge, no excellence is achievable. The problem, nowadays, is that due to restriction of working hours, to the goals of life (“life-work-balance”) and the restrictions of Generation Y, almost no education in medicine is spanning the needed 10,000 h experiences in practical medicine for excellence. Therefore, we will see the fading of medical excellence, if we could not establish other systems. A solution can be searched in decision-support systems. However, a requirement before is the need of a digitalization of all health data. We surely do not have enough evidences for all aspects of the practice of medicine, the intuition is fading away and therefore, we have to look around for other solutions. Big data generated by the digitalization of all health data could be the problem solver. In combination, IT will help to improve the quality of care

Durchlaufzeiten in der Zentralen Notaufnahme – eine Prinzipal-Agenten-Analyse

Fast die Hälfte (42%) aller Patienten eines Krankenhauses durchläuft die Notaufnahme [31]. Die Reduktion langer Wartezeiten, verursacht u.a. durch Prozessineffizienzen [26], verspricht daher gerade in der Zentralen Notaufnahme (ZNA) besonders hohe Optimierungspotenziale. In der Literatur werden verschiedene Ineffizienzen genannt, z.B. „Verschwinden“ der Patienten in der Radiologie [5] oder social loafing [22]. Der vorliegende Beitrag vermutet Informationsasymmetrien zwischen den beteiligten Akteuren als Ursache. Vorgestellt wird eine Analyse der ZNA mittels der Prinzipal-Agenten-Theorie und das Design einer empirischen Untersuchung zum Nachweis der Reduktion von Informationsasymmetrien und der Durchlaufzeiten durch ein Monitoring System

Underutilization of information and knowledge in everyday medical practice: Evaluation of a computer-based solution

<p>Abstract</p> <p>Background</p> <p>The medical history is acknowledged as the <it>sine qua non </it>for quality medical care because recognizing problems is pre-requisite for managing them. Medical histories typically are incomplete and inaccurate, however. We show here that computers are a solution to this issue of information gathering about patients. Computers can be programmed to acquire more complete medical histories with greater detail across a range of acute and chronic issues than physician histories.</p> <p>Methods</p> <p>Histories were acquired by physicians in the usual way and by a computer program interacting directly with patients. Decision-making of what medical issues were queried by computer were made internally by the software, including determination of the chief complaint. The selection of patients was from admissions to the Robert-Bosch-Hospital, Stuttgart, Germany by convenience sampling. Physician-acquired and computer-acquired histories were compared on a patient-by-patient basis for 45 patients.</p> <p>Results</p> <p>The computer histories reported 160 problems not recorded in physician histories or slightly more than 3.5 problems per patient. However, physicians but not the computer reported 13 problems. The data show that computer histories reported problems across a range of organ systems, that the problems detected by computer but not physician histories were both acute and chronic and that the computer histories detected a significant number of issues important for preventing further morbidity.</p> <p>Conclusion</p> <p>A combination of physician and computer-acquired histories, in non-emergent situations, with the latter available to the physician at the time he or she sees the patient, is a far superior method for collecting historical data than the physician interview alone.</p

Histological and clinical findings in patients with post-transplantation and classical encapsulating peritoneal sclerosis: A European multicenter study

Background: Encapsulating peritoneal sclerosis (EPS) commonly presents after peritoneal dialysis has been stopped, either post-transplantation (PT-EPS) or after switching to hemodialysis (classical EPS, cEPS). The aim of the present study was to investigate whether PT-EPS and cEPS differ in morphology and clinical course. Methods: In this European multicenter study we included fifty-six EPS patients, retrospectively paired-matched for peritoneal dialysis (PD) duration. Twenty-eight patients developed EPS after renal transplantation, whereas the other twenty-eight patients were classical EPS patients. Demographic data, PD details, and course of disease were documented. Peritoneal biopsies of all patients were investigated using histological criteria. Results: Eighteen patients from the Netherlands and thirty-eight patients from Germany were included. Time on PD was 78(64-95) in the PT-EPS and 72(50-89) months in the cEPS group (p>0.05). There were no significant differences between the morphological findings of cEPS and PT-EPS. Podoplanin positive cells were a prominent feature in both groups, but with a similar distribution of the podoplanin patterns. Time between cessation of PD to the clinical diagnosis of EPS was significantly shorter in the PT-EPS group as compared to cEPS (4(2-9) months versus 23(7-24) months, p<0.001). Peritonitis rate was significantly higher in cEPS. Conclusions: In peritoneal biopsies PT-EPS and cEPS are not distinguishable by histomorphology and immunohistochemistry, which argues against different entities. The critical phase for PT-EPS is during the first year after transplantation and therefore earlier after PD cessation then in cEPS