Hemodialysis Units, Hospital
Renal Dialysis
Kidneys, Artificial
Gloves, Protective
Staphylococcus hominis
Universal Precautions
Kidney Failure, Chronic
Hepatitis C
Hepatitis C Antibodies
Hepacivirus
Prospective Studies
Disease Outbreaks
Hepatitis B
Hemodialysis Solutions
Arteriovenous Shunt, Surgical
Hospitals, Teaching
Hospitals, University
Hospitals, General
Hospital Costs
Catheters, Indwelling
Uremia
Intensive Care Units
Hospital Units
Retrospective Studies
Practice patterns, case mix, Medicare payment policy, and dialysis facility costs. (1/107)
OBJECTIVE: To evaluate the effects of case mix, practice patterns, features of the payment system, and facility characteristics on the cost of dialysis. DATA SOURCES/STUDY SETTING: The nationally representative sample of dialysis units in the 1991 U.S. Renal Data System's Case Mix Adequacy (CMA) Study. The CMA data were merged with data from Medicare Cost Reports, HCFA facility surveys, and HCFA's end-stage renal disease patient registry. STUDY DESIGN: We estimated a statistical cost function to examine the determinants of costs at the dialysis unit level. PRINCIPAL FINDINGS: The relationship between case mix and costs was generally weak. However, dialysis practices (type of dialysis membrane, membrane reuse policy, and treatment duration) did have a significant effect on costs. Further, facilities whose payment was constrained by HCFA's ceiling on the adjustment for area wage rates incurred higher costs than unconstrained facilities. The costs of hospital-based units were considerably higher than those of freestanding units. Among chain units, only members of one of the largest national chains exhibited significant cost savings relative to independent facilities. CONCLUSIONS: Little evidence showed that adjusting dialysis payment to account for differences in case mix across facilities would be necessary to ensure access to care for high-cost patients or to reimburse facilities equitably for their costs. However, current efforts to increase dose of dialysis may require higher payments. Longer treatments appear to be the most economical method of increasing the dose of dialysis. Switching to more expensive types of dialysis membranes was a more costly means of increasing dose and hence must be justified by benefits beyond those of higher dose. Reusing membranes saved money, but the savings were insufficient to offset the costs associated with using more expensive membranes. Most, but not all, of the higher costs observed in hospital-based units appear to reflect overhead cost allocation rather than a difference in real resources devoted to treatment. The economies experienced by the largest chains may provide an explanation for their recent growth in market share. The heterogeneity of results by chain size implies that characterizing units using a simple chain status indicator variable is inadequate. Cost differences by facility type and the effects of the ongoing growth of large chains are worthy of continued monitoring to inform both payment policy and antitrust enforcement. (+info)A large outbreak of hemolytic uremic syndrome caused by an unusual sorbitol-fermenting strain of Escherichia coli O157:H-. (2/107)
Escherichia coli O157:H7 does not ferment sorbitol, a factor used to differentiate it from other E. coli. From December 1995 to March 1996, 28 children with hemolytic uremic syndrome in Bavaria, Germany, were identified; many had a sorbitol-fermenting (sf) E. coli O157:H- cultured. A case-control study showed a dose-response relationship between sausage consumption and illness. A second case-control study showed a relationship between mortadella and teewurst consumption and illness, particularly during December (mortadella odds ratio [OR], 10.5, P=.004; teewurst OR, 6.2, P=.02). Twelve sf O157:H- were characterized to determine clonality and virulence traits. The strains possessed the Stx2, eae, and EHEC-hlyA genes but were nonhemolytic on blood agar plates. The O157:H- isolates belonged to phage type 88 and had identical pulsed-field gel electrophoresis patterns. This outbreak was caused by sf E. coli O157:H-, which is not detectable by culture on sorbitol MacConkey's agar. Consumption of two sausages, including a raw beef-containing sausage, was statistically related to illness. (+info)Molecular epidemiology of a hepatitis C virus outbreak in a haemodialysis unit. Multicentre Haemodialysis Cohort Study on Viral Hepatitis. (3/107)
BACKGROUND: Haemodialysis patients are at high risk of infection by hepatitis C virus. The aim of this study was to investigate a hepatitis C virus outbreak which occurred in a haemodialysis unit, using epidemiological and molecular methods. METHODS: Five seroconversions to hepatitis C virus antibody (anti-HCV) were observed over a 6 month period and these were added to the four previously recorded anti-HCV-positive patients. All nine patients involved in the outbreak were tested for HCV RNA by reverse transcription-polymerase chain reaction and hepatitis C genotype determination was accomplished by a reverse hybridization assay. Furthermore, part of the NS5 region of hepatitis C genome (nucleotide positions 7904-8304) was amplified and sequenced in all HCV RNA-positive patients. Then, phylogenetic analysis of the nucleotide sequences obtained was carried out in order to investigate any possible epidemiological linkage among patients. Detailed epidemiological records were also available for all haemodialysis patients. RESULTS: Samples from all five incident cases and three out of four prevalent HCV infections were found positive for HCV RNA. HCV genotyping studies revealed that all incident cases were classified as 4c/d, whereas one and two prevalent cases were 1a and 4c/d respectively. Sequence comparisons and phylogenetic tree analysis revealed that six of the patients harboured very similar strains and clustered together, including all incident and one prevalent case, which was implicated as index case. Further epidemiological analysis was consistent with patient to patient transmission. CONCLUSIONS: Molecular and epidemiological analysis suggested that horizontal nosocomial patient to patient transmission was the most likely explanation for the virus spread within the haemodialysis unit under study. (+info)Prevalence, predictors, and consequences of late nephrology referral at a tertiary care center. (4/107)
Despite improvements in dialysis care, mortality of patients with end-stage renal disease (ESRD) remains high. One factor that has thus far received little attention, but might contribute to morbidity and mortality, is the timing of referral to the nephrologist. This study examines the hypothesis that late referral of patients to the nephrologist might lead to suboptimal pre-ESRD care. Clinical and laboratory data were obtained from the patient records and electronic databases of New England Medical Center, its affiliated dialysis unit (Dialysis Clinics, Inc., Boston), and the office records of the outpatient nephrology clinic. Early (ER) and late (LR) referral were defined by the time of first nephrology encounter greater than or less than 4 mo, respectively, before initiation of dialysis. Multivariate models were built to explore factors associated with LR, and whether LR is associated with hypoalbuminemia or late initiation of dialysis. Of the 135 patients, 30 (22%) were referred late. There were no differences in age, gender, race, and cause of ESRD between ER and LR patients. However, there were significant differences in insurance coverage between these two groups. In the multivariate analysis, patients covered by health maintenance organizations were more likely to be referred late (odds ratio = 4.5) than patients covered by Medicare. Compared to ER, LR patients were more likely to have hypoalbuminemia (56% versus 80%), hematocrit <28% (33% versus 55%), and predicted GFR <5 ml/min per 1.73 m2 (17% versus 40%) at the start of dialysis, and less likely to have received erythropoietin (40% versus 17%) or have a functioning permanent vascular access for the first hemodialysis (40% versus 4%). It is concluded that late referral to the nephrologist is common in the United States and is associated with poor pre-ESRD care. Pre-ESRD care of patients treated by nephrologists was also less than ideal. The patient-, physician-, and system-related factors behind this observation are unclear. Meanwhile, pre-ESRD educational efforts need to target patients, generalists, and nephrologists. (+info)Twenty-five years of experience with out-center hemodialysis. (5/107)
Twenty-five years of experience with out-center hemodialysis. BACKGROUND: Out-center hemodialysis (HD) offers patients a better quality of life, a greater independence, and a better rehabilitation opportunity. A lower mortality than with other modalities of dialysis has been reported. In addition, in France the charges paid depend on the modality of dialysis, out-center HD being the less expensive, and savings are also accomplished through fewer patient transports, which are additionally reimbursed. We present a 25-year experience of out-center HD. METHODS: We retrospectively studied the clinical records of 471 patients treated between 1974 and 1997 in a single nonprofit organization operating regional home HD (H-HD) and facilities for self-care HD (SC-HD). Survival results were analyzed according to: (a) causes of end-stage renal disease, (b) age at the start of HD, (c) period of start of HD, (d) modality of HD (H-HD, SC-HD), and (e) a subgroup of 174 patients defined at risk because they were contraindicated for transplantation. RESULTS: The mean age at the start of HD increased from 31.2 +/- 9.7 (mean +/- SD) years in 1974 to 52.6 +/- 13.5 years in 1997. Causes of the end of treatment were: (a) transplantation (63%), (b) transfer (20%), and (c) death (17%). The overall survival was 90% at 5 years, 77% at 10 years, 62% at 15 years, and 45% at 20 years, and, for the group at risk, 78%, 62%, 46%, and 31%, respectively. Cox proportional hazard analyses showed that risk factors were older age, diabetes, and renal vascular diseases. CONCLUSION: If adequate choice is given, out-center HD offers a reliable and safe modality of dialysis with better survival results than survival in full-care in-center HD. In addition, out-center HD ensures a striking financial benefit as compared with the higher costs if the same patients were treated with full-care in-center HD. These modalities should be encouraged for all HD patients who are able to be treated by out-center modalities. (+info)Epidemic transmission of human immunodeficiency virus in renal dialysis centers in Egypt. (6/107)
In 1993 an epidemic of human immunodeficiency virus (HIV) infection occurred among 39 patients at 2 renal dialysis centers in Egypt. The centers, private center A (PCA) and university center A (UCA) were visited, HIV-infected patients were interviewed, seroconversion rates at UCA were calculated, and relatedness of HIV strains was determined by sequence analysis; 34 (62%) of 55 patients from UCA and 5 (42%) of 12 patients from PCA were HIV-infected. The HIV seroconversion risk at UCA varied significantly with day and shift of dialysis session. Practices that resulted in sharing of syringes among patients were observed at both centers. The analyzed V3 loop sequences of the HIV strain of 12 outbreak patients were >96% related to each other. V3 loop sequences from each of 8 HIV-infected Egyptians unrelated to the 1993 epidemic were only 76%-89% related to those from outbreak strains. Dialysis patients may be at risk for HIV infection if infection control guidelines are not followed. (+info)Polymicrobial outbreak of intermittent peritoneal dialysis peritonitis during external wall renovation at a dialysis center. (7/107)
OBJECTIVE: To investigate an outbreak of peritonitis in intermittent peritoneal dialysis (IPD) patients. DESIGN: An outbreak investigation was performed to identify the etiology of the polymicrobial outbreak, and a retrospective case-control study was conducted to assess the risk factors for development of peritonitis. SETTING: Renal dialysis center. PATIENTS: Ten episodes of peritonitis occurred in 8 of 61 patients over a 6-month period in which 669 IPD procedures were analyzed. INTERVENTIONS: Field visit to renal dialysis center to examine the entire IPD procedure, inspect the hospital environment, and perform air bacterial count. MAIN OUTCOME MEASURES: The environmental factors and risk factors contributing to the polymicrobial peritonitis outbreak in IPD patients. The incidence of IPD peritonitis was determined before and after interventions. RESULTS: The causative organisms included Acinetobacter baumanii (6), Stenotrophomonas maltophilia (2), Pseudomonas aeruginosa (1), Candida albicans (1), C. tropicalis (1), Enterococcus (3), and Enterobacteriaceae (2). Four episodes of peritonitis involved infection by more than one organism. Air sampling of the environment detected a median of 110 colony forming units of bacteria per cubic meter of air, 10% of which were found to be Acinetobacter baumanii. The source of this polymicrobial outbreak was attributed to the bamboo scaffolding structure covering the external wall of the hospital during renovation. A retrospective case-control study indicated that the absence of the flush-before-fill step was a risk factor for development of peritonitis. CONCLUSION: In addition to invasive aspergillosis in transplant or oncology patients, Acinetobacter peritonitis in dialysis patients should be considered another microbial cause of outbreak associated with hospital renovation. (+info)Relationship between patients' perceptions of disadvantage and discrimination and listing for kidney transplantation. (8/107)
OBJECTIVES: This study explored wait-listing decisions among African American and White men and women eligible for kidney transplants, focusing on lifetime experiences of race and sex discrimination as a possible influence. METHODS: Patient records from 3 Baltimore-area hemodialysis units were reviewed, and semistructured face-to-face interviews were conducted with transplant-eligible patients and with unit staff members. RESULTS: African American patients reported more racial discrimination, and women reported more sex discrimination. Women and older patients were less likely to be placed on the waiting list, as were patients with previous experiences of racial discrimination. Discrimination measures predicted list access more strongly than patient race. CONCLUSIONS: Lifetime experience of and response to discrimination may contribute to race and sex differences in access to care and should be included in research on health care disparities. (+info)Hemodialysis units in a hospital setting are specialized departments or facilities that provide hemodialysis treatment to patients with kidney failure. Hemodialysis is a process of purifying the blood of waste products and excess fluids using a machine (hemodialysis machine) and a semi-permeable membrane (dialyzer). The procedure typically involves accessing the patient's bloodstream through a surgically created vascular access, such as a fistula or graft, and passing the blood through the dialyzer to remove waste products and excess fluids.
Hospital hemodialysis units are staffed by trained healthcare professionals, including nephrologists (kidney specialists), nurses, technicians, and support personnel. These units provide inpatient and outpatient services for patients who require hemodialysis due to acute or chronic kidney failure, as well as those who need dialysis while hospitalized for other medical conditions.
Hospital hemodialysis units may offer various types of hemodialysis treatments, including conventional hemodialysis, high-flux hemodialysis, hemofiltration, and hemodiafiltration. They also provide education and support to patients and their families regarding dialysis treatment options, lifestyle modifications, and long-term management of kidney disease.
Renal dialysis is a medical procedure that is used to artificially remove waste products, toxins, and excess fluids from the blood when the kidneys are no longer able to perform these functions effectively. This process is also known as hemodialysis.
During renal dialysis, the patient's blood is circulated through a special machine called a dialyzer or an artificial kidney, which contains a semi-permeable membrane that filters out waste products and excess fluids from the blood. The cleaned blood is then returned to the patient's body.
Renal dialysis is typically recommended for patients with advanced kidney disease or kidney failure, such as those with end-stage renal disease (ESRD). It is a life-sustaining treatment that helps to maintain the balance of fluids and electrolytes in the body, prevent the buildup of waste products and toxins, and control blood pressure.
There are two main types of renal dialysis: hemodialysis and peritoneal dialysis. Hemodialysis is the most common type and involves using a dialyzer to filter the blood outside the body. Peritoneal dialysis, on the other hand, involves placing a catheter in the abdomen and using the lining of the abdomen (peritoneum) as a natural filter to remove waste products and excess fluids from the body.
Overall, renal dialysis is an essential treatment option for patients with kidney failure, helping them to maintain their quality of life and prolong their survival.
Artificial kidney, also known as a renal replacement therapy or dialysis, is a device that performs the essential functions of the human kidney when the natural kidneys are unable to do so. The main function of an artificial kidney is to filter and remove waste, excess water, and toxic substances from the blood, helping to maintain the body's chemical balance and regulate blood pressure.
There are two primary types of artificial kidney treatments: hemodialysis and peritoneal dialysis. Hemodialysis involves circulating the patient's blood through an external filter (dialyzer) that contains a semi-permeable membrane, which separates waste products and excess fluids from the blood. The cleaned blood is then returned to the body. This process typically takes place in a clinical setting, such as a hospital or dialysis center, for about 3-5 hours, several times a week.
Peritoneal dialysis, on the other hand, uses the patient's own peritoneum (a membrane lining the abdominal cavity) as a natural filter. A special solution called dialysate is introduced into the peritoneal cavity via a catheter, and waste products and excess fluids pass from the blood vessels in the peritoneum into the dialysate. After a dwell time of several hours, the used dialysate is drained out and replaced with fresh solution. This process can be performed manually (continuous ambulatory peritoneal dialysis) or using a machine (automated peritoneal dialysis), typically at home and during sleep.
Artificial kidneys are life-saving treatments for patients with end-stage renal disease, helping them maintain their quality of life and extend their lifespan until a kidney transplant becomes available.
Protective gloves are a type of personal protective equipment (PPE) used to shield the hands from potential harm or contamination. They can be made from various materials such as latex, nitrile rubber, vinyl, or polyethylene and are designed to provide a barrier against chemicals, biological agents, radiation, or mechanical injuries. Protective gloves come in different types, including examination gloves, surgical gloves, chemical-resistant gloves, and heavy-duty work gloves, depending on the intended use and level of protection required.
"Staphylococcus hominis" is a species of grampositive, facultatively anaerobic bacteria that belongs to the genus Staphylococcus. It is commonly found on the skin and mucous membranes of humans, particularly in the nostrils and groin area. While it is generally considered to be a commensal organism, meaning that it can exist harmlessly on the body without causing disease, S. hominis has been associated with some types of infections, such as bloodstream infections (bacteremia) and device-related infections (such as catheter-associated infections). However, these infections are relatively rare compared to those caused by other Staphylococcus species like S. aureus.
It's worth noting that while S. hominis is a normal part of the human microbiome, it can sometimes cause infections if it enters the body through a break in the skin or if it colonizes medical devices such as catheters. In these cases, it may be necessary to treat the infection with antibiotics. However, because S. hominis is resistant to many commonly used antibiotics, identifying the specific species of bacteria causing an infection can help guide appropriate treatment decisions.
Universal Precautions are a set of guidelines and procedures used in the medical field to prevent the transmission of bloodborne pathogens and other potentially infectious materials, regardless of whether a patient is known to be infected or not. These precautions were introduced by the Centers for Disease Control and Prevention (CDC) in 1987, in response to the HIV/AIDS epidemic.
The key components of Universal Precautions include:
1. Hand hygiene: Washing hands with soap and water or using an alcohol-based hand sanitizer before and after patient contact, as well as after removing gloves.
2. Use of personal protective equipment (PPE): This includes wearing gloves, gowns, masks, face shields, or eye protection when there is potential for exposure to blood or other bodily fluids.
3. Safe injection practices: Using sterile needles and syringes for each patient, never reusing or recapping used needles, and safely disposing of sharps in designated containers.
4. Mouthpieces or resuscitation bags should be used during resuscitation instead of mouth-to-mouth breathing.
5. Proper handling and disposal of contaminated equipment and waste: Using appropriate methods to clean and disinfect reusable equipment, as well as safely disposing of single-use items.
6. Implementing engineering controls: Utilizing devices such as needleless systems, safety catheters, and self-sheathing needles to minimize the risk of accidental injuries from sharp objects.
7. Regularly updating policies and procedures related to Universal Precautions and providing ongoing training for healthcare personnel.
By following these guidelines, healthcare professionals can significantly reduce the risk of exposure to bloodborne pathogens such as HIV, Hepatitis B, and Hepatitis C while caring for patients.
Chronic kidney failure, also known as chronic kidney disease (CKD) stage 5 or end-stage renal disease (ESRD), is a permanent loss of kidney function that occurs gradually over a period of months to years. It is defined as a glomerular filtration rate (GFR) of less than 15 ml/min, which means the kidneys are filtering waste and excess fluids at less than 15% of their normal capacity.
CKD can be caused by various underlying conditions such as diabetes, hypertension, glomerulonephritis, polycystic kidney disease, and recurrent kidney infections. Over time, the damage to the kidneys can lead to a buildup of waste products and fluids in the body, which can cause a range of symptoms including fatigue, weakness, shortness of breath, nausea, vomiting, and confusion.
Treatment for chronic kidney failure typically involves managing the underlying condition, making lifestyle changes such as following a healthy diet, and receiving supportive care such as dialysis or a kidney transplant to replace lost kidney function.
Hepatitis C is a liver infection caused by the hepatitis C virus (HCV). It's primarily spread through contact with contaminated blood, often through sharing needles or other equipment to inject drugs. For some people, hepatitis C is a short-term illness but for most — about 75-85% — it becomes a long-term, chronic infection that can lead to serious health problems like liver damage, liver failure, and even liver cancer. The virus can infect and inflame the liver, causing symptoms like jaundice (yellowing of the skin and eyes), abdominal pain, fatigue, and dark urine. Many people with hepatitis C don't have any symptoms, so they might not know they have the infection until they experience complications. There are effective treatments available for hepatitis C, including antiviral medications that can cure the infection in most people. Regular testing is important to diagnose and treat hepatitis C early, before it causes serious health problems.
Hepatitis C antibodies are proteins produced by the immune system in response to an infection with the hepatitis C virus (HCV). Detection of these antibodies in the blood indicates a past or present HCV infection. However, it does not necessarily mean that the person is currently infected, as antibodies can persist for years even after the virus has been cleared from the body. Additional tests are usually needed to confirm whether the infection is still active and to guide treatment decisions.
Cross infection, also known as cross-contamination, is the transmission of infectious agents or diseases between patients in a healthcare setting. This can occur through various means such as contaminated equipment, surfaces, hands of healthcare workers, or the air. It is an important concern in medical settings and measures are taken to prevent its occurrence, including proper hand hygiene, use of personal protective equipment (PPE), environmental cleaning and disinfection, and safe injection practices.
Home hemodialysis is a type of renal replacement therapy that can be performed at the patient's residence. It involves the use of a home hemodialysis machine, which pumps the patient's blood through a dialyzer to remove waste products and excess fluids. The cleaned blood is then returned back to the patient's body.
In home hemodialysis, patients or their caregivers are trained to perform the procedure themselves, typically with the help of a healthcare professional who visits their home. This allows for greater flexibility in scheduling treatments, which can be done more frequently (e.g., five to six times per week) and for longer durations than traditional in-center hemodialysis.
Home hemodialysis has been shown to have several potential benefits over in-center hemodialysis, including improved blood pressure control, better phosphate management, reduced need for medication, and potentially slower progression of kidney disease. However, it also requires a significant commitment from the patient or caregiver, as well as investment in home modifications and equipment.
Hepacivirus is a genus of viruses in the family Flaviviridae. The most well-known member of this genus is Hepatitis C virus (HCV), which is a major cause of liver disease worldwide. HCV infection can lead to chronic hepatitis, cirrhosis, and liver cancer.
Hepaciviruses are enveloped viruses with a single-stranded, positive-sense RNA genome. They have a small icosahedral capsid and infect a variety of hosts, including humans, non-human primates, horses, and birds. The virus enters the host cell by binding to specific receptors on the cell surface and is then internalized through endocytosis.
HCV has a high degree of genetic diversity and is classified into seven major genotypes and numerous subtypes based on differences in its RNA sequence. This genetic variability can affect the virus's ability to evade the host immune response, making treatment more challenging.
In addition to HCV, other hepaciviruses have been identified in various animal species, including equine hepacivirus (EHCV), rodent hepacivirus (RHV), and bat hepacivirus (BtHepCV). These viruses are being studied to better understand the biology of hepaciviruses and their potential impact on human health.
Prospective studies, also known as longitudinal studies, are a type of cohort study in which data is collected forward in time, following a group of individuals who share a common characteristic or exposure over a period of time. The researchers clearly define the study population and exposure of interest at the beginning of the study and follow up with the participants to determine the outcomes that develop over time. This type of study design allows for the investigation of causal relationships between exposures and outcomes, as well as the identification of risk factors and the estimation of disease incidence rates. Prospective studies are particularly useful in epidemiology and medical research when studying diseases with long latency periods or rare outcomes.
A disease outbreak is defined as the occurrence of cases of a disease in excess of what would normally be expected in a given time and place. It may affect a small and localized group or a large number of people spread over a wide area, even internationally. An outbreak may be caused by a new agent, a change in the agent's virulence or host susceptibility, or an increase in the size or density of the host population.
Outbreaks can have significant public health and economic impacts, and require prompt investigation and control measures to prevent further spread of the disease. The investigation typically involves identifying the source of the outbreak, determining the mode of transmission, and implementing measures to interrupt the chain of infection. This may include vaccination, isolation or quarantine, and education of the public about the risks and prevention strategies.
Examples of disease outbreaks include foodborne illnesses linked to contaminated food or water, respiratory infections spread through coughing and sneezing, and mosquito-borne diseases such as Zika virus and West Nile virus. Outbreaks can also occur in healthcare settings, such as hospitals and nursing homes, where vulnerable populations may be at increased risk of infection.
Hepatitis B is a viral infection that attacks the liver and can cause both acute and chronic disease. The virus is transmitted through contact with infected blood, semen, and other bodily fluids. It can also be passed from an infected mother to her baby at birth.
Acute hepatitis B infection lasts for a few weeks to several months and often causes no symptoms. However, some people may experience mild to severe flu-like symptoms, yellowing of the skin and eyes (jaundice), dark urine, and fatigue. Most adults with acute hepatitis B recover completely and develop lifelong immunity to the virus.
Chronic hepatitis B infection can lead to serious liver damage, including cirrhosis and liver cancer. People with chronic hepatitis B may experience long-term symptoms such as fatigue, joint pain, and depression. They are also at risk for developing liver failure and liver cancer.
Prevention measures include vaccination, safe sex practices, avoiding sharing needles or other drug injection equipment, and covering wounds and skin rashes. There is no specific treatment for acute hepatitis B, but chronic hepatitis B can be treated with antiviral medications to slow the progression of liver damage.
Hemodialysis solutions are sterile, pyrogen-free fluids used in the process of hemodialysis, a renal replacement therapy for patients with kidney failure. These solutions are formulated to remove waste products and excess fluid from the blood by means of diffusion and osmosis across a semipermeable membrane.
The primary components of hemodialysis solutions include:
1. Electrolytes: Sodium, potassium, chloride, calcium, and magnesium ions are present in concentrations that aim to restore normal levels in the body or to correct for abnormalities in patients' serum electrolyte levels.
2. Buffer: Bicarbonate or acetate is added as a buffer to maintain the pH of the dialysate and prevent acidification of the blood during hemodialysis.
3. Glucose: A small amount of glucose may be included in the solution to provide energy for the patient.
4. Water: Ultrapure water is used to prepare the solution, free from microbial contaminants and endotoxins.
Hemodialysis solutions are available in different concentrations and formulations to address individual patient needs and specific clinical situations. The composition of these solutions must be carefully controlled to ensure their effectiveness and safety during hemodialysis treatments.
An arteriovenous shunt is a surgically created connection between an artery and a vein. This procedure is typically performed to reroute blood flow or to provide vascular access for various medical treatments. In a surgical setting, the creation of an arteriovenous shunt involves connecting an artery directly to a vein, bypassing the capillary network in between.
There are different types of arteriovenous shunts used for specific medical purposes:
1. Arteriovenous Fistula (AVF): This is a surgical connection created between an artery and a vein, usually in the arm or leg. The procedure involves dissecting both the artery and vein, then suturing them directly together. Over time, the increased blood flow to the vein causes it to dilate and thicken, making it suitable for repeated needle punctures during hemodialysis treatments for patients with kidney failure.
2. Arteriovenous Graft (AVG): An arteriovenous graft is a synthetic tube used to connect an artery and a vein when a direct AVF cannot be created due to insufficient vessel size or poor quality. The graft can be made of various materials, such as polytetrafluoroethylene (PTFE) or Dacron. Grafts are more prone to infection and clotting compared to native AVFs but remain an essential option for patients requiring hemodialysis access.
3. Central Venous Catheter (CVC): A central venous catheter is a flexible tube inserted into a large vein, often in the neck or groin, and advanced towards the heart. CVCs can be used as temporary arteriovenous shunts for patients who require immediate hemodialysis access but do not have time to wait for an AVF or AVG to mature. However, they are associated with higher risks of infection and thrombosis compared to native AVFs and AVGs.
In summary, a surgical arteriovenous shunt is a connection between an artery and a vein established through a medical procedure. The primary purpose of these shunts is to provide vascular access for hemodialysis in patients with end-stage renal disease or to serve as temporary access when native AVFs or AVGs are not feasible.
A "Teaching Hospital" is a healthcare institution that provides medical education and training to future healthcare professionals, such as medical students, residents, and fellows. These hospitals are often affiliated with medical schools or universities and have a strong focus on research and innovation in addition to patient care. They typically have a larger staff of specialized doctors and medical professionals who can provide comprehensive care for complex and rare medical conditions. Teaching hospitals also serve as important resources for their communities, providing access to advanced medical treatments and contributing to the development of new healthcare technologies and practices.
A viral RNA (ribonucleic acid) is the genetic material found in certain types of viruses, as opposed to viruses that contain DNA (deoxyribonucleic acid). These viruses are known as RNA viruses. The RNA can be single-stranded or double-stranded and can exist as several different forms, such as positive-sense, negative-sense, or ambisense RNA. Upon infecting a host cell, the viral RNA uses the host's cellular machinery to translate the genetic information into proteins, leading to the production of new virus particles and the continuation of the viral life cycle. Examples of human diseases caused by RNA viruses include influenza, COVID-19 (SARS-CoV-2), hepatitis C, and polio.
A "University Hospital" is a type of hospital that is often affiliated with a medical school or university. These hospitals serve as major teaching institutions where medical students, residents, and fellows receive their training and education. They are equipped with advanced medical technology and resources to provide specialized and tertiary care services. University hospitals also conduct research and clinical trials to advance medical knowledge and practices. Additionally, they often treat complex and rare cases and provide a wide range of medical services to the community.
A "General Hospital" is a type of hospital that provides a broad range of medical and surgical services to a diverse patient population. It typically offers general medical care, emergency services, intensive care, diagnostic services (such as laboratory testing and imaging), and inpatient and outpatient surgical services. General hospitals may also have specialized departments or units for specific medical conditions or populations, such as pediatrics, obstetrics and gynecology, geriatrics, oncology, and mental health. They are usually staffed by a variety of healthcare professionals, including physicians, nurses, pharmacists, therapists, and support personnel. General hospitals can be found in both urban and rural areas and may be operated by governmental, non-profit, or for-profit organizations.
Phylogeny is the evolutionary history and relationship among biological entities, such as species or genes, based on their shared characteristics. In other words, it refers to the branching pattern of evolution that shows how various organisms have descended from a common ancestor over time. Phylogenetic analysis involves constructing a tree-like diagram called a phylogenetic tree, which depicts the inferred evolutionary relationships among organisms or genes based on molecular sequence data or other types of characters. This information is crucial for understanding the diversity and distribution of life on Earth, as well as for studying the emergence and spread of diseases.
Hospital costs are the total amount of money that is expended by a hospital to provide medical and healthcare services to patients. These costs can include expenses related to:
* Hospital staff salaries and benefits
* Supplies, such as medications, medical devices, and surgical equipment
* Utilities, such as electricity, water, and heating
* Facility maintenance and renovation
* Equipment maintenance and purchase
* Administrative costs, such as billing and insurance processing
Hospital costs can also be classified into fixed and variable costs. Fixed costs are those that do not change with the volume of services provided, such as rent or depreciation of equipment. Variable costs are those that change with the volume of services provided, such as supplies and medications.
It's important to note that hospital costs can vary widely depending on factors such as the complexity of care provided, the geographic location of the hospital, and the patient population served. Additionally, hospital costs may not always align with charges or payments for healthcare services, which can be influenced by factors such as negotiated rates with insurance companies and government reimbursement policies.
Indwelling catheters, also known as Foley catheters, are medical devices that are inserted into the bladder to drain urine. They have a small balloon at the tip that is inflated with water once the catheter is in the correct position in the bladder, allowing it to remain in place and continuously drain urine. Indwelling catheters are typically used for patients who are unable to empty their bladders on their own, such as those who are bedridden or have nerve damage that affects bladder function. They are also used during and after certain surgical procedures. Prolonged use of indwelling catheters can increase the risk of urinary tract infections and other complications.
Uremia is not a disease itself, but rather it's a condition that results from the buildup of waste products in the blood due to kidney failure. The term "uremia" comes from the word "urea," which is one of the waste products that accumulate when the kidneys are not functioning properly.
In uremia, the kidneys are unable to effectively filter waste and excess fluids from the blood, leading to a variety of symptoms such as nausea, vomiting, fatigue, itching, mental confusion, and ultimately, if left untreated, can lead to coma and death. It is a serious condition that requires immediate medical attention, often involving dialysis or a kidney transplant to manage the underlying kidney dysfunction.
An Intensive Care Unit (ICU) is a specialized hospital department that provides continuous monitoring and advanced life support for critically ill patients. The ICU is equipped with sophisticated technology and staffed by highly trained healthcare professionals, including intensivists, nurses, respiratory therapists, and other specialists.
Patients in the ICU may require mechanical ventilation, invasive monitoring, vasoactive medications, and other advanced interventions due to conditions such as severe infections, trauma, cardiac arrest, respiratory failure, or post-surgical complications. The goal of the ICU is to stabilize patients' condition, prevent further complications, and support organ function while the underlying illness is treated.
ICUs may be organized into different units based on the type of care provided, such as medical, surgical, cardiac, neurological, or pediatric ICUs. The length of stay in the ICU can vary widely depending on the patient's condition and response to treatment.
'Hospital Nursing Staff' refers to the group of healthcare professionals who are licensed and trained to provide nursing care to patients in a hospital setting. They work under the direction of a nurse manager or director and collaborate with an interdisciplinary team of healthcare providers, including physicians, therapists, social workers, and other support staff.
Hospital nursing staff can include registered nurses (RNs), licensed practical nurses (LPNs) or vocational nurses (LVNs), and unlicensed assistive personnel (UAPs) such as nursing assistants, orderlies, and patient care technicians. Their responsibilities may vary depending on their role and the needs of the patients, but they typically include:
* Administering medications and treatments prescribed by physicians
* Monitoring patients' vital signs and overall condition
* Providing emotional support and education to patients and their families
* Assisting with activities of daily living such as bathing, dressing, and grooming
* Documenting patient care and progress in medical records
* Collaborating with other healthcare professionals to develop and implement individualized care plans.
Hospital nursing staff play a critical role in ensuring the safety, comfort, and well-being of hospitalized patients, and they are essential members of the healthcare team.
In the field of medicine, "time factors" refer to the duration of symptoms or time elapsed since the onset of a medical condition, which can have significant implications for diagnosis and treatment. Understanding time factors is crucial in determining the progression of a disease, evaluating the effectiveness of treatments, and making critical decisions regarding patient care.
For example, in stroke management, "time is brain," meaning that rapid intervention within a specific time frame (usually within 4.5 hours) is essential to administering tissue plasminogen activator (tPA), a clot-busting drug that can minimize brain damage and improve patient outcomes. Similarly, in trauma care, the "golden hour" concept emphasizes the importance of providing definitive care within the first 60 minutes after injury to increase survival rates and reduce morbidity.
Time factors also play a role in monitoring the progression of chronic conditions like diabetes or heart disease, where regular follow-ups and assessments help determine appropriate treatment adjustments and prevent complications. In infectious diseases, time factors are crucial for initiating antibiotic therapy and identifying potential outbreaks to control their spread.
Overall, "time factors" encompass the significance of recognizing and acting promptly in various medical scenarios to optimize patient outcomes and provide effective care.
"Urban hospitals" is not a medical term per se, but rather a term that describes the location and setting of healthcare facilities. In this context, "urban" refers to densely populated cities or built-up areas, as opposed to rural or suburban regions. Therefore, urban hospitals are medical institutions located in or near urban centers, serving large populations and typically providing a wide range of specialized services.
These hospitals often have more resources, advanced technology, and subspecialties compared to their rural counterparts due to the higher patient volume and financial support they receive. They also tend to be teaching hospitals affiliated with medical schools and research institutions, contributing significantly to medical education, innovation, and clinical trials.
However, it is important to note that urban hospitals may face unique challenges in providing care, such as serving diverse populations with varying socioeconomic backgrounds, addressing health disparities, managing high patient volumes, and dealing with issues related to overcrowding and resource allocation.
A hospital unit, also known as a patient care unit or inpatient unit, is a designated area within a hospital where patients with similar medical conditions or needs are grouped together to receive specialized nursing and medical care. These units can include intensive care units (ICUs), telemetry units, medical-surgical units, pediatric units, maternity units, oncology units, and rehabilitation units, among others. Each unit has its own team of healthcare professionals who work together to provide comprehensive care for the patients in their charge. The specific layout, equipment, and staffing of a hospital unit will depend on the type of care provided and the needs of the patient population.
Retrospective studies, also known as retrospective research or looking back studies, are a type of observational study that examines data from the past to draw conclusions about possible causal relationships between risk factors and outcomes. In these studies, researchers analyze existing records, medical charts, or previously collected data to test a hypothesis or answer a specific research question.
Retrospective studies can be useful for generating hypotheses and identifying trends, but they have limitations compared to prospective studies, which follow participants forward in time from exposure to outcome. Retrospective studies are subject to biases such as recall bias, selection bias, and information bias, which can affect the validity of the results. Therefore, retrospective studies should be interpreted with caution and used primarily to generate hypotheses for further testing in prospective studies.
Hospital economics refers to the study and application of economic principles and concepts in the management and operation of hospitals and healthcare organizations. This field examines issues such as cost containment, resource allocation, financial management, reimbursement systems, and strategic planning. The goal of hospital economics is to improve the efficiency and effectiveness of hospital operations while maintaining high-quality patient care. It involves understanding and analyzing various economic factors that affect hospitals, including government regulations, market forces, technological advancements, and societal values. Hospital economists may work in a variety of settings, including hospitals, consulting firms, academic institutions, and government agencies.
A pediatric hospital is a specialized medical facility that provides comprehensive healthcare services for infants, children, adolescents, and young adults up to the age of 21. These hospitals employ medical professionals with expertise in treating various childhood illnesses, injuries, and developmental disorders. The facilities are designed to cater to the unique needs of children, including child-friendly environments, specialized equipment, and age-appropriate care.
Pediatric hospitals offer a wide range of services such as inpatient and outpatient care, emergency services, surgical procedures, diagnostic testing, rehabilitation, and mental health services. They also focus on preventive healthcare, family-centered care, and education to support the overall well-being of their young patients. Some pediatric hospitals may specialize further, focusing on specific areas such as cancer treatment, cardiology, neurology, or orthopedics.
Hospital bed capacity, in a medical context, refers to the maximum number of hospital beds that are available and equipped to admit and care for patients in a healthcare facility. This capacity is determined by factors such as the physical layout and size of the hospital, the number of nursing and support staff, and the availability of medical equipment and supplies. Hospital bed capacity can be categorized into different types, including:
1. Usual Bed Capacity: The total number of beds that are regularly available for patient care in a hospital.
2. Adjusted Bed Capacity: The total number of beds that can be made available for patient care after accounting for temporary closures or conversions of beds for special purposes, such as during an outbreak or emergency situation.
3. Surge Bed Capacity: The additional number of beds that can be made available beyond the adjusted bed capacity to accommodate a sudden influx of patients due to a disaster, pandemic, or other mass casualty event.
It is important to note that hospital bed capacity does not necessarily reflect the actual number of patients that can be safely and effectively cared for at any given time, as factors such as staffing levels, equipment availability, and patient acuity must also be taken into consideration.