Active Management of Patients with Chronic Renal Insufficiency: The Effect on Hospital Days During the Initial Hemodialysis Period

Introduction: Suboptimal management of patients with chronic renal insufficiency (CRI) is thought to contribute to the high morbidity and early mortality seen after the onset of end-stage renal disease (ESRD), and may therefore impact on healthcare costs associated with patients with ESRD. The objective of this study was to investigate the effects of pre-dialysis patient care on hospital days during the 6 months after hemodialysis initiation. Study Design: Data were obtained from Group Health Cooperative in Seattle, Washington, USA, a staff model health management organization with an established, active, CRI management program, and were analyzed retrospectively. Patients who started long-term hemodialysis between 1 January 1997 and 31 January 2000, and who were referred to the Group Health Cooperative CRI management program, were included in the study. Methods: Demographic and baseline clinical characteristics, details of interventions received by patients prior to dialysis, and hemoglobin (Hb) levels during the 6 months prior to the onset of ESRD were recorded. The numbers of days that each patient spent in hospital during the baseline (1 year to 6 months pre-dialysis), pre-dialysis (180 days pre-dialysis), and post-dialysis initiation (180 days following dialysis initiation) periods were recorded. Hospital days during the post-dialysis initiation period were associated with patient characteristics and pre-dialysis interventions received, and were compared with national data from the US Renal Data System (USRDS). Results: When calculated similarly to data from the USRDS, the mean number of hospital days for patients in this study was lower than that for the national hemodialysis population (9.4 vs 13.9 days). Temporary vascular access and inadequate nephrology visits prior to dialysis were the key factors increasing the risk of a greater number of hospital days. The use of a catheter for initial dialysis significantly increased patients Conclusion: Early, active management of patients with CRI can reduce hospital days and associated costs in the early months after hemodialysis initiation.Disease-management-programmes, Haemodialysis, Hospitalisation, Pharmacoeconomics, Renal-failure

Drought monitoring using high resolution soil moisture throughmulti-sensor satellite data fusion over the Korean peninsula

Droughts, typically caused by the deficiencies of precipitation and soil moisture, affect water resources and agriculture. As soil moisture is of key importance in understanding the interaction between the atmosphere and Earth???s surface, it can be used to monitor droughts. In this study, a High resolution Soil Moisture Drought Index (HSMDI) was proposed and evaluated for meteorological, agricultural, and hydrological droughts. HSMDI was developed using the 1 km downscaled soil moisture data produced from the Advanced Microwave Scanning Radiometer on the Earth Observing System (AMSR-E) from 2003 to 2011 (March to November) over the Korean peninsula. Seven products from the Moderate Resolution Imaging Spectroradiometer (MODIS) and Tropical Rainfall Measuring Mission (TRMM) satellite sensors were used to downscale AMSR-E soil moisture based on random forest machine learning. The downscaled 1 km soil moisture was correlated well with both in situ and AMSR-E soil moisture with the mean coefficient of determination (R2) of 0.29 and 0.59, respectively. The Standardized Precipitation Index (SPI) with time scales from 1 to 12 months, crop yields (for sesame, highland radish, and highland napa cabbage) and streamflow data were used to validate HSMDI for various types of droughts. The results showed that HSMDI depicted meteorological drought well, especially during the dry season, with a similar pattern with the 3-month SPI. However, the performance fluctuated a bit during the wet season possibly due to the limited availability of optical sensor data and heterogeneous land covers around the stations. HSMDI also showed high correlation with crop yield data, in particular the highland radish and napa cabbage cultivated in non-irrigated regions with a mean R2 of 0.77. However, HSMDI did not monitor streamflow well for hydrological drought presenting a various range of correlations with streamflow data (from 0.03 to 0.83).clos