Using repeated-prevalence data in multi-state modeling of renal replacement therapy

Multi-state models help predict future numbers of patients requiring specific treatments but these models require exhaustive incidence data. Deriving reliable predictions from repeated-prevalence data would be helpful. A new method to model the number of patients that switch between therapeutic modalities using repeated-prevalence data is presented and illustrated. The parameters and goodness of fit obtained with the new method and repeated-prevalence data were compared to those obtained with the classical method and incidence data. The multi-state model parameters’ confidence intervals obtained with annually collected repeated-prevalence data were wider than those obtained with incidence data and six out of nine pairs of confidence intervals did not overlap. However, most parameters were of the same order of magnitude and the predicted patient distributions among various renal replacement therapies were similar regardless of the type of data used. In the absence of incidence data, a multi-state model can still be successfully built with annually collected repeated-prevalence data to predict the numbers of patients requiring specific treatments. This modeling technique can be extended to other chronic diseases.     

对思想政治教育现代困境的深层次透析

传统思想政治教育与现代教育社会化趋势不相适应,在自身教育理念、教育内容与教育方式方面存在诸多问题,受教育者对其普遍逆反,被边缘化倾向严重。思想政治教育的现代困境消解了思想政治教育的功能。造成思想政治教育现代困境的因素很多,但主要集中在三个方面：一是思想政治教育泛政治化导致对生活世界的遮蔽;二是社会价值观念一元要求与个人多样化价值取向的矛盾致使思想教育缺乏社会向心力;三是科技文化对思想政治教育文化的挤压使其存在成为问题。     

乙醇透析发酵耦合过程研究（Ⅰ）

设计了乙醇发酵与膜透析耦合系统并进行了试验研究．结果表明，该过程可减少产物乙醇对发酵的抑制作用，膜透析系统的乙醇总量比对照组提高２０％～８０％，基质转化率提高３０％～８０％．     

中美透析灾难应急工作研究进展与比较分析

文章通过文献分析,了解我国及美国部分地区透析患者对透析突发事件的了解程度及灾难应急方面的研究进展?美国透析灾难应急研究围绕经验总结?透析机构及患者调查等多方面开展,研究成果对透析灾难应急预案起到不断完善的作用,而国内目前对透析灾难应急研究较少?提示我们应借鉴美国透析灾难应急研究取得的成果,重视国内透析应急工作的开展?     

腹膜透析液配送上门服务推广中的利益相关分析

目的:对腹膜透析液配送上门服务中利益相关方进行界定和分析?方法:采用米切尔评分法确定利益相关者类型,利用专家咨询评分分析各方利益影响水平及立场? 结果:腹膜透析液配送上门服务推广涉及医疗机构?医保部门?卫生部门及药监部门四类确定型利益相关者,患者及专业协会组织两类预期型利益相关者,以及相关医务人员?药品生产企业?药品流通企业及社会媒体四类潜在型利益相关者;各利益相关方在腹膜透析液配送上门服务中表现出不同的利益诉求及立场等?结论:腹膜透析液配送上门服务的推广需发挥各利益相关方的作用,充分挖掘本土化循证依据,不断加强流通与监管机制建设?     

Chronic kidney disease (CKD) in the elderly – a geriatrician's perspective

Chronic kidney disease (CKD) is becoming increasingly prevalent among many different populations all over the world, including the US and Europe. Its multitude of complications with devastating outcomes leads to a significantly higher risk for cardio-vascular and all-cause mortality in an individual. However, it is clear now that early detection of CKD might not only delay some of the complications but also prevent them. Therefore, various important public health organizations all over the world have turned their focus and attention to CKD and its risk factors, early detection and early intervention. Nevertheless, the general goals in preventing the increase in CKD and its complications are far from being completely achieved. Why is this so? What is the magnitude and complexity of the problem? How is it affecting the population – are there differences in its affection by age, gender or frail elderly versus the robust? Are we modifying the risk factors appropriately and aggressively? Are there subtle differences in managing the risk factors in those on dialysis versus the non-dialysis CKD patients? Is it important to treat anaemia of CKD aggressively, will it make a difference in the disease progression, its complications or to quality of life? What do these unfortunate individuals commonly succumb to? What do we advise patients who refuse dialysis or those who desire dialysis or transplant? Are there useful non-dialytic treatment recommendations for those who refuse dialysis? What is the role of the physicians caring for the elderly with CKD? When should the primary care givers refer a CKD patient to a nephrologist? The key to eventually controlling incident and prevalent CKD and improve quality of life of affected individuals, lies in not only knowing these and many other vital aspects, but also in applying such knowledge compulsively in day-to-day practice by each and every one us. As CKD is increasingly a disease of the elderly with men being affected more, this review details fairly comprehensively the vital aspects of CKD, especially from a primary care geriatrician's practical standpoint.     

Free testosterone by direct and calculated measurement versus equilibrium dialysis in a clinical population

Abstract

Introduction: The value of clinically available free testosterone (FT) assays remains controversial. Here, we evaluate the agreement between the radioimmunoassay (RIA) and calculated FT (cFT) versus equilibrium dialysis (EqD), considered the gold standard.

Methods: Fifty-six consecutive men (aged 26–77) had blood samples assessed for FT, including men with treated and untreated testosterone deficiency (TD) and men without TD. Samples were split and tested by the two methodologies at a Quest Diagnostics national reference laboratory. cFT was calculated by the Vermeulen method.

Results: A robust correlation was noted for RIA and EqD (r?=?0.966) and for cFT and EqD (r?=?0.986). Strong correlations were observed for men receiving testosterone therapy and for men in the lowest and highest quartiles for total and FT. The correlation of total testosterone with FT was similar for cFT (r?=?0.843), RIA (r?=?0.806), and EqD (r?=?0.809). Sex-hormone binding globulin (SHBG) was not correlated with any measure of FT. Bland–Altman analysis demonstrated similar bias for both cFT and RIA, although cFT consistently overestimated FT. Numerical values for RIA were approximately one seventh of EqD values.

Conclusions: These results support the clinical use of both RIA and cFT as measures of FT. Due to numerical differences, each test requires its own set of reference values.     

离子色谱法测定人工肾透析液中阳离子和阴离子

目的:建立一种快速测定人工肾透析液中的阳离子Na~+、K~+、Ca~(2+)、Mg~(2+),和阴离子Ac~-、Cl~-的新方法。方法:分别采用单柱阳离子色谱法和双柱阴离子色谱法测定人工肾透析液中的阳离子和阴离子。结果Na~+、K~+、Ca~(2+)、Mg~(2+)、Ac~-和Cl~-的线性范围分别是0.01～10,0.1～10,0.05～10,0.05～10,0.09～20,0.03～10ug·mL~(-1),相关系数r分别为0.999 8,0.9996,0.007 8,0.996 4,0.9995,0.999 6(n=5),每种离子测定结果的RSD均小于4％。结论:此方法简便快速,灵敏准确,优于其它方法。     

Social Support: An Important Factor for Treatment Adherence and Health-related Quality of Life of Patients with End-stage Renal Disease

ABSTRACT

End-stage Renal Disease (ESRD) or chronic kidney disease constitutes a serious public health problem in the United States. The purpose of this study is to examine the causal relationship of perceived social support with treatment adherence and health-related quality of life (HRQOL) of ESRD patients. The study utilized a non-experimental research design and Structural Equation Modeling (SEM) to analyze the data collected from a sample of 413 ESRD patients. The findings of the study supported a statistically significant relationship between perceived social support and HRQOL as well as between perceived social support and treatment adherence. Formulating appropriately targeted interventions to improve social support may help in enhancing the HRQOL and treatment adherence, where both those factors were empirically supported to be related to mortality and hospitalizations in ESRD patients. This study helps to enhance the body of knowledge relating to HRQOL of ESRD patients, and provided foundation for interventions in improving treatment adherence and the HRQOL. Future research may focus on the complexities associated with the HRQOL and treatment adherence in ESRD patients, with emphasis on demographic characteristics and its relationship with social support.     

我国基层医疗服务体系完善的新途径——基于“基层连锁血透中心”的视角

经过多年发展,我国基本建成了布局合理、功能较完善的基层医疗卫生服务体系。基层医疗服务体系承担着基本公共卫生服务和基本医疗服务的任务,但是受限于有限的医疗投入,血液透析治疗服务并未渗透到我国的基层服务机构。鉴于此,本文以＂基层连锁血透中心＂为视角,探索完善我国基层医疗服务体系的新途径,并提出相关的政策建议。