Effect of cool vs. warm dialysate on toxin removal: rationale and study design

10.1186/s12882-015-0017-5BMC Nephrology16

Health-related quality of life in patients treated with Continuous Ambulatory Peritoneal Dialysis and Automated Peritoneal Dialysis in Singapore

OBJECTIVE: This study aimed to compare the health-related quality of life (HRQOL) in patients with end-stage renal disease (ESRD) treated with continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD) in Singapore. METHODS: The data used in this study were from two cross-sectional surveys of ESRD patients. HRQOL was assessed using the Kidney Disease Quality of Life (KDQOL) instrument. Socio-demographic characteristics and clinical data were collected. The physical component summary (PCS) and mental component summary (MCS) scores, kidney disease component summary (KDCS) score and its three scales (symptoms, effects, burden), and one health utility score [EuroQol 5-dimension (EQ-5D)] were calculated and compared between CAPD and APD using multivariate linear regression. RESULTS: In total, 266 patients were included, with 145 on CAPD (mean age 60.8 years) and 121 on APD (mean age 57.4 years). After adjustment for all variables collected, APD patients had significant higher scores in PCS and KDQOL symptoms than CAPD patients, suggesting that APD was associated with better physical health and milder dialysis-related symptoms. CONCLUSION: The HRQOL of CAPD and APD patients was largely equivalent in Singapore, but APD patients seemed to experience better physical health and be less bothered by dialysis-related symptoms

Risk assessment of failure during transitioning from in-centre to home haemodialysis

Background: Introducing a de-novo home haemodialysis (HHD) program often raises safety concerns as errors could potentially lead to serious adverse events. Despite the complexity of performing haemodialysis at home without the supervision of healthcare staff, HHD has a good safety record. We aim to pre-emptively identify and reduce the risks to our new HHD program by risk assessment and using failure mode and effects analysis (FMEA) to identify potential defects in the design and planning of HHD. Methods: We performed a general risk assessment of failure during transitioning from in-centre to HHD with a failure mode and effects analysis focused on the highest areas of failure. We collaborated with key team members from a well-established HHD program and one HHD patient. Risk assessment was conducted separately and then through video conference meetings for joint deliberation. We listed all key processes, sub-processes, step and then identified failure mode by scoring based on risk priority numbers. Solutions were then designed to eliminate and mitigate risk. Results: Transitioning to HHD was found to have the highest risk of failure with 3 main processes and 34 steps. We identified a total of 59 areas with potential failures. The median and mean risk priority number (RPN) scores from failure mode effect analysis were 5 and 38, with the highest RPN related to vascular access at 256. As many failure modes with high RPN scores were related to vascular access, we focussed on FMEA by identifying the risk mitigation strategies and possible solutions in all 9 areas in access-related medical emergencies in a bundled- approach. We discussed, the risk reduction areas of setting up HHD and how to address incidents that occurred and those not preventable. Conclusions: We developed a safety framework for a de-novo HHD program by performing FMEA in high-risk areas. The involvement of two teams with different clinical experience for HHD allowed us to successfully pre-emptively identify risks and develop solutions

Anomalous beam transport through gabor (plasma) lens prototype

An electron plasma lens is a cost-effective, compact, strong-focusing element that can ensure efficient capture of low-energy proton and ion beams from laser-driven sources. A Gabor lens prototype was built for high electron density operation at Imperial College London. The parameters of the stable operation regime of the lens and its performance during a beam test with 1.4 MeV protons are reported here. Narrow pencil beams were imaged on a scintillator screen 67 cm downstream of the lens. The lens converted the pencil beams into rings that show position-dependent shape and intensity modulation that are dependent on the settings of the lens. Characterisation of the focusing effect suggests that the plasma column exhibited an off-axis rotation similar to the m=1 diocotron instability. The association of the instability with the cause of the rings was investigated using particle tracking simulations

Pom33, a novel transmembrane nucleoporin required for proper nuclear pore complex distribution

A previously unrecognized pore membrane protein, Pom33, stabilizes the interface between the nuclear envelope and the NPC to facilitate NPC biogenesis and spatial organization

Auxetic Metamaterial Design for Expanding Backpack Straps

Nepalese porters support themselves by carrying heavy loads for travelers, causing shoulder injuries due to the stress from the straps. We investigated auxetic metamaterials to create straps that dynamically respond to load, reducing the stress on the user. Finite element analysis showed a reduction in stress on the shoulder. Testing of straps demonstrated auxetic behavior when loaded in tension and over a curved surface, but did not match all design requirements. Although no prototype achieved all requirements, the extensive work showed auxetic metamaterials are a viable solution to reduce Nepalese porters’ injuries. Further work with material selection may optimize the auxetic metamaterial strap

Segmental bioimpedance in pregnant end stage renal failure patient for dry weight titration and volume management (case report)

Abstract Background Volume assessment, dry weight titration, and blood pressure control in pregnant kidney failure patients are often challenging, with physiological fluid accumulation in the trunk and lower limbs and an increased risk of preeclampsia. We used segmental bioimpedance in the volume management of our kidney failure patient on haemodialysis. Case presentation We report a case of a female patient on maintenance haemodiafiltration with no residual kidney function for whom we used segmental bioimpedance to guide dry weight adjustment. At different gestational periods, we targeted a different extracellular to total body water ratio according to body segments. This allowed us to support her high-risk pregnancy, identify her as probably developing preeclampsia and trigger a plan for closer monitoring and delivery during the third trimester when she had rapid weight gain. Conclusion Segmental bioimpedance is a practical, simple, and non-invasive test that can be performed at the dialysis unit and is useful as an adjunct decision-making tool in the management of pregnant dialysis patients

Telemedicine and Haemodialysis Care during the COVID-19 Pandemic: An Integrative Review of Patient Safety, Healthcare Quality, Ethics and the Legal Considerations in Singapore Practice.

10.3390/ijerph19095445Int J Environ Res Public Health1995445