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BACKGROUND: Hemodialysis is a procedure that requires efficient removal and return of blood to a patient's body. Despite being a life-sustaining process, hemodialysis is associated with morbidity, mortality, and high societal costs. A significant part of the financial costs to patients and society at large can be attributed to vascular access dysfunction. The cornerstone to efficient hemodialysis is a well-functioning vascular access that simultaneously allows efficient blood flow for dialysis and easy cannulation. It is hypothesized that the poor health outcomes associated with vascular access dysfunction can be improved by paying closer attention to patient-specific factors in clinical guidelines for hemodialysis vascular access. This may require a shift to a more patient-centered approach to vascular access management. OBJECTIVE: To assess the presence of patient-specific treatment recommendations in the current clinical practice guidelines for hemodialysis vascular access. METHODS: We conducted a systematic search of PubMed and professional nephrology organization websites for full-text clinical practice guidelines with treatment recommendations regarding hemodialysis vascular access. We developed a coding sheet to document the number of patient-specific treatment recommendations and other quality attributes found in the extracted clinical practice guidelines. RESULTS: Our search resulted in the extraction of 5 clinical practice guidelines for final review. Only 1 of the 5 extracted guidelines was found to contain patient-specific treatment recommendations, but the treatment recommendations were limited to juvenile patients. Of the 5 clinical practice guidelines, 4 were published within the past decade (ie, after 2006). CONCLUSION: Our findings show that current clinical practice guidelines for hemodialysis vascular access lack patient-specific recommendations. Future clinical guidelines must consider patient-specific treatment recommendations with the goal of improving hemodialysis vascular access outcomes for patients, a goal that is supported in the recommendations of the National Kidney Foundation. [ABSTRACT FROM AUTHOR]

BACKGROUND: End-stage renal disease (ESRD) imposes significant economic and social burdens on patients and healthcare systems. In the United States alone, more than 600,000 Americans have ESRD, with an estimated annual cost of treatment of more than $30 billion. Peritoneal dialysis and hemodialysis are competing renal replacement therapies in ESRD; however, data comparing quality-of-life outcomes between these 2 modalities are limited. OBJECTIVES: To compare the effectiveness of peritoneal dialysis with the more common treatment modality of hemodialysis on the health-related quality of life (HRQoL) of patients with ESRD in the general, physical, and psychological domains; and to determine whether the time of publication and the origin of each study influenced its findings regarding the effectiveness of the 2 modalities. METHODS: This meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta- Analyses guidelines to collect the data. PubMed, MEDLINE, and PsycINFO were the primary databases searched. Only articles published in English were included in this meta-analysis. The measure of effect size was Cohen's standardized mean difference. A random-effects model was used to test the hypothesis of equality in the mean HRQoL. RESULTS: A total of 15 studies with a combined sample size of 4318 patients met the study criteria and were included in the analysis. The pooled effect sizes based on the random-effects model were 0.24 (95% confidence interval [CI], -0.17-0.66) in the general domain; 0.10 (95% CI, -0.09-0.29) in the physical-functioning domain; and 0.29 (95% CI, -0.13-0.71) in the psychological-functioning domain. None of the summary effect sizes was statistically significant. Subgroup analyses favored peritoneal dialysis regarding the time and country of publication. CONCLUSION: The majority of the studies included in this analysis favored peritoneal dialysis over hemodialysis in all 3 domains. However, the pooled effect sizes were not significant, resulting in the inability to conclude that peritoneal dialysis is the more effective of these 2 treatment modalities. [ABSTRACT FROM AUTHOR]

The article discusses the due diligence obligations of international organizations under international law as of 2018, and it mentions global human rights law, the International Finance Corporation (IFC), and the monetary management-related Bretton Woods Institutions. The United Nations International Law Commission's (ILC's) Draft Articles on the Responsibility of International Organizations (DARIO) and the ILC's Articles on State Responsibility (ASR) are assessed.

African American (AA) men face disproportionately higher rates of prostate cancer (PCa) in comparison to other races. In addition, higher mortality rates from PCa amongst AA men signifies PCa as a formidable health disparity. Inconsistent PCa screening guidelines among medical organizations, further clouds one's decision on receiving a PCa screening. Examining various relations among factors which influence PCa screening may provide insight into their decision whether or not to receive a PCa screening. The purpose of the study was to examine the presence of associations among PCa knowledge, psychosocial factors, and PCa screening over a six month time frame. There were 76 participants at baseline, intervention group (n = 37) and control group (n = 35) and 54 participants, intervention group (n = 26) and control group (n = 28) remained at the 6 month follow up. At the six month follow up, the control group was more likely to have not received a PCa screening and the intervention group was more likely to have received a PCa screening, p < 0.01. PCa knowledge scores rose from 49% to 71%, intervention group, and 52% to 58%, control group. Significant associations were found among the following covariates, age and religion (rs = 0.499, p < 0.01), income and education (rs = 0.535, p < 0.01), income and healthcare coverage (rs = 0.528, p < 0.01), income and PCa knowledge at 6 months (rs = 0.424, p < 0.01), PCa screening and religion (rs = 0.353, p < 0.01), healthcare empowerment and preparation for decision making (rs = 0.421, p < 0.01), decisional self-efficacy and active surveillance knowledge (rs = 0.377, p < 0.01), and active surveillance knowledge and PCa knowledge (rs = 0.497, p < 0.01). The study revealed associations among PCa knowledge and psychosocial factors regarding a decision for PCa screening among the PCa high risk group, AA men. [ABSTRACT FROM AUTHOR]

Background: The selection of the most appropriate treatment combinations requires the balancing of benefits and harms of these treatment options as well as the patients' preferences for the resulting outcomes.Objective: This research aimed at estimating and comparing the utility weights between elderly women with early stage hormone receptor positive (HR+) breast cancer receiving a combination of radiotherapy and hormonal therapy after breast conserving surgery (BCS) and those receiving a combination of BCS and hormonal therapy.Methods: The Surveillance, Epidemiology, and End Results (SEER) linked with Medicare Health Outcomes Survey (MHOS) was used as the data source. Health utility weights were derived from the VR-12 health-related quality of life instrument using a mapping algorithm. Descriptive statistics of the sample were provided. Two sample t-tests were performed to determine potential differences in mean health utility weights between the two groups after propensity score matching.Results: The average age at diagnosis was 72 vs. 76 years for the treated and the untreated groups, respectively. The results showed an inverse relationship between the receipt of radiotherapy and age. Patients who received radiotherapy had, on average, a higher health utility weight (0.70; SD = 0.123) compared with those who did not receive radiotherapy (0.676; SD = 0.130). Only treated patients who had more than two comorbid conditions had significantly higher health utility weights compared with patients who were not treated.Conclusions: The mean health utility weights estimated for the radiotherapy and no radiotherapy groups can be used to inform a comparative cost-effectiveness analysis of the treatment options. However, the results of this study may not be generalizable to those who are outside a managed care plan because MHOS data is collected on managed care beneficiaries. [ABSTRACT FROM AUTHOR]

Biological dinitrogen (N2) fixation and the distribution of diazotrophic phylotypes were investigated during two cruises in the Coral Sea and the Solomon Sea (southwestern Pacific) during austral winter conditions. N2 fixation rates weremeasurable at every station, but integrated (0-150m) rates were an order of magnitude higher in the Solomon Sea (30 to 5449 μmol Nm-2 d-1) compared to those measured in the Coral Sea (2 to 109 μmol Nm-2 d-1). Rates measured in the Solomon Sea were in the upper range (100-1000 μmol Nm-2 d-1) or higher than rates compiled in the global MARine Ecosystem biomass DATa database, indicating that this region has some of the highest N2 fixation rates reported in the global ocean. While unicellular diazotrophic cyanobacteria from group A (UCYN-A1 and UCYN-A2) and the proteobacteria γ-24774A11 dominated in the Coral Sea and were correlated with N2 fixation rates (p<0.05), Trichodesmium and UCYN-B dominated in the Solomon Sea and were correlated (p<0.05) with N2 fixation rates. UCYN-A were totally absent in the Solomon Sea. The biogeographical distribution of diazotrophs is discussed within the context of patterns in measured environmental parameters. [ABSTRACT FROM AUTHOR]

Discusses the cost of unnecessary hospitalizations associated with dehydration in elderly patients in the United States. Average age of the patients; Hospitalization for dehydration; Average per diem charge.