Podcasts about esrd

During this episode a panel of experts discuss the patient journey through the interpretation and application of safety and efficacy data to establish and maintain protocols designed to address optimal VTE treatment pathways. Claim CE and MOC Credit at bit.ly/VTEPJ6 

In this episode, we explore how data analytics and clinical expertise can transform kidney health management for health plans. Joining the conversation is Joe Vattamattam, Founder and President of Healthmap Solutions, who shares insights on why tackling chronic kidney disease (CKD) and end-stage renal disease (ESRD) is crucial. Tune in to learn how Healthmap leverages technology, clinical support, and innovative strategies to improve outcomes for patients and providers.This episode is sponsored by Healthmap Solutions.

In this episode, a panel of experts discuss existing and emerging VTE (venous thromboembolism) treatment options for the complex patient, such as a patient who has been diagnosed with cancer, end stage renal disease (ESRD), chronic kidney disease (CKD), or is obese.  Claim CE and MOC Credit at https://bit.ly/VTEHBCPX

Tune in to The Heart of Innovation this week as we share an incredible story of a young woman who helped save her grandfather's life and now is trying to save others through organ donation advocacy. Since it's National Kidney Month, Emmy Award-winning journalist Kym McNicholas and Dr. John Phillips interview Danica Almazan, RN and Miss Marin County 2025, whose family's courageous fight against kidney disease sparked a powerful mission of hope. You might wonder why we are talking about kidney disease on a show about cardiovascular and vascular health. Kidney disease, especially in advanced stages can lead to peripheral artery disease, which is poor circulation in mainly the legs, and lead to amputation. Many of the peripheral artery disease (PAD) patients both Kym and Dr. John support have CKD and ESRD, some of which are also in need of a kidney transplant. They want to get the word out there on the importance of kidney health as well as raise awareness that all kidney disease patients should be checked for peripheral artery disease and to find a doctor who specializes in opening the small vessels below the knee and into the foot, which is where kidney disease patients are typically stricken with PAD. Whether you're impacted by peripheral artery disease, kidney health challenges, or simply want to understand the power of family support, this episode is a must-watch! #KidneyHealth #OrganDonation #TheHeartOfInnovation #NationalKidneyMonth #MissMarin2025 #peripheralarterydisease #padsupport #CLI #criticallimbischemia

High phosphorus (hyperphosphatemia) is a common complication caused by chronic kidney disease. Join us for this NKF Live to learn more about why this happens and how to successfully manage high phosphorus in CKD. During this program, you will hear a kidney doctor, a clinical pharmacist, and a person living with high phosphorus discuss important information to know about when managing high phosphorus.   Dr. Jay Wish is Professor of Clinical Medicine at Indiana University School of Medicine in Indianapolis and Chief Medical Officer for Outpatient Dialysis at Indiana University Health.  He is past president of the National Forum of ESRD Networks, served on the Board of Directors of the Renal Physicians Association and the American Association of Kidney Patients and was the recipient of the latter's Visionary Award in 2005. He has over 150 articles, reviews, and book chapters published, particularly in the areas of ESRD quality oversight/improvement, accountability, anemia management and vascular access. Dr. Katie Cardone is an associate professor at Albany College of Pharmacy and Health Sciences in Albany, NY. She is a clinical pharmacist with a clinical practice and research program focused on improving care in patients with kidney disease in outpatient nephrology and dialysis. She co-led the publication of pharmacy practice standards for pharmacists caring for people with kidney disease. She is a member of the Board of Pharmacy Specialties Ambulatory Care Pharmacy Council and is a fellow of the National Kidney Foundation, the American Society of Nephrology, and the American College of Clinical Pharmacy. Quenton Turner Gee has been on in-center hemodialysis for about 2 years. He was diagnosed with Stage 4 CKD in 2020. After a battle with COVID-19, it quickly progressed to end-stage kidney disease. Since starting on dialysis, he's been advocating for mental health and policies improving access to transplants and kidney innovations.   Additional Resources: Phosphate Lowering Agents High Phosphorus Information NKF Peers   Do you have comments, questions, or suggestions? Email us at NKFpodcast@kidney.org. Also, make sure to rate and review us wherever you listen to podcasts.

Send us a message!Ellen McCloy has been working exclusively with pediatric nephrology patients since 2014. She began her pediatric career in Detroit and has spent the last 8 years working at Children's Hospital Los Angeles which has the largest pediatric dialysis center in the US. Her clinical areas of interest include malnutrition and nutrition support in pediatric nephrology patients across the spectrum from CKD to ESRD. In addition to her clinical work, she is the Dietetic Internship Director at CHLA, one of only 9 pediatric dietetic internships in the country. She is passionate about fostering a positive and encouraging learning environment for both interns and preceptors.Find her on Instagram at @NoursihwithEllen  Join the Children's Hospital Los Angeles On November 1st at 10:45a PST. Register here.

In this episode we're diving into an important topic that offers hope and new possibilities for those with end-stage renal disease (ESRD): "Life After Dialysis: Exploring Kidney Transplantation and Other Treatment Options." Over the next 15 minutes, we'll explore the benefits and challenges of kidney transplantation, alternative treatments, and how to make informed decisions for a healthier future. - The Kidney Zone Podcast with Dr. Mo Welcome to the Kidney Zone, where we will dive deep into the fascinating world of our body's remarkable filters. Get ready to unlock the secrets of the kidneys and transplantation as we travel through their pathways, uncovering vital tips, insightful knowledge, and practical advice to keep our kidneys healthy. Whether you're a patient with kidney disease, a medical professional, or simply curious about the kidneys, this is the place for you. _ Follow Along on Social Media: Facebook: https://www.facebook.com/Dr.Mo.Page Instagram: https://www.instagram.com/dr.mo.ibrahim/ Twitter: https://twitter.com/drmoibrahim TikTok: https://www.tiktok.com/@dr.mo.ibrahim _ Dr. Mo Ibrahim is an assistant professor of kidney transplantation at the University of Maryland, Baltimore. He completed his clinical transplant nephrology fellowship at Washington University in 2022. Originally from Cairo, he pursued a physician/scientist career, conducting research at Duke University from 2012 to 2019. He has authored 70+ journal articles, given a TEDx talk, and holds 5 patents. Currently finishing his PhD at Erasmus University, he drives international collaborations to advance medical technology and improve medical monitoring. _ DISCLAIMER The content of this episode is intended for informational purposes only and is not to be considered medical advice. The information presented here is not meant to diagnose, treat, cure, or prevent any disease or medical condition. Always consult with a qualified healthcare professional or your doctor before making any healthcare decisions or starting any treatment regimen. Individual medical situations can vary, and only a licensed healthcare provider can offer personalized advice tailored to your specific needs. The creators of this episode are not responsible for any actions taken based on the information provided herein. Any reliance on the content of this episode is at your own risk. If you have any medical concerns or questions, please seek guidance from a medical professional promptly. Remember that medical knowledge and practices can evolve over time, and new information may become available after the creation of this episode. Therefore, it is essential to stay up-to-date with the latest medical research and consult with your healthcare provider to ensure the best possible care for your health.

For people with kidney failure, hemodialysis is a life saving treatment. On average, people can live for 5 to 10 years on dialysis, but many have lived 20 to 30 years. Hemodialysis also comes with some distressing symptoms like muscle cramps, itching, and fatigue. Doctor Jennifer Flythe and Precious McCowan, a dialysis patient and kidney advocate, are here to talk about a new study that aims to better monitor and help manage the symptoms of hemodialysis. Dr. Jenny Flythe, MD -is a nephrologist and clinical investigator at the University of North Carolina (UNC) Kidney Center, Associate Professor and Vice Chief of Nephrology and Hypertension at the UNC School of Medicine, and Director of Dialysis Services at UNC Hospitals in Chapel Hill, NC. She conducts patient-oriented qualitative, epidemiologic, and prospective research aimed at improving outcomes and experiences among individuals with kidney disease. Precious McCowan, BS, MS, ESRD- At the age of nine, I was diagnosed with type 1 diabetes; living with this condition for over 25 years progress my kidney failure.  By the age of twenty-seven, I was placed on in-center hemodialysis. In 2010 I received both a kidney and pancreas transplant; unfortunately, I had to return to dialysis and insulin shortly after transplantation.  In 2019 I received my second kidney transplant. Before my second kidney transplantation, I did dialysis for nine years. I have served as a Facility Patient Representative (FPR) for my dialysis facility throughout this challenging yet rewarding journey. I heartily work to advance patient health engagement and renal education to better care while on dialysis. Acquiring the passion for assisting those affected by End-Stage Renal Disease (ESRD) promoted my affiliation with the ESRD Medical Review Board (MRB) and the ESRD Patient Advisory Council (PAC) of Texas. Also, I am a member of the Kidney Patient Advisory Council; as an advocate partnering with ESRD caregivers and medical professionals to effectively meet the needs of those living with kidney disease.   Do you have comments, questions, or suggestions? Email us at NKFpodcast@kidney.org. Also, make sure to rate and review us wherever you listen to podcasts.

Take Home Points Always obtain an EKG in patients with ESRD upon presentation Always obtain an EKG in patients with hyperkalemia as pseudohyperkalemia is the number one cause If the patient with hyperkalemia is unstable or has significant EKG changes (wide QRS, sine wave) rapidly administer calcium salts In patients who are anuric, early mobilization ... Read more The post REBEL Core Cast 125.0 – Hyperkalemia appeared first on REBEL EM - Emergency Medicine Blog.

Also, a medical expert expresses his opinion on the value of colorectal screening for older people. ESRD: end stage renal disease, finally accepted by MA plans although Medicare has a bunch of special rules surrounding the transplant process. Benefit changes, acquisitions and divestitures; do we see turmoil coming in the near future for Advantage plans. We wrap up with tales of shooting wild game in the Orange County jungles of Disneyland before Walt's legacy turned into a bunch of woke snowflakes crybabies.                                Contact me at: DBJ@MLMMailbag.com (Most severe critic: A+)    Inspired by: "MEDICARE FOR THE LAZY MAN 2024; Simplest & Easiest Guide Ever!" on Amazon.com. Return to leave a short customer review & help future readers. Official website: https://www.MedicareForTheLazyMan.com.

Nachhaltigkeit ist für Unternehmen kein Nischenthema mehr, sondern wichtiger Bestandteil ihrer Strategien und Pflichten. CSRD oder ESRD schreiben nachhaltiges Handeln und Berichten vor. Wie also damit umgehen?

Ever heard Medicare myths that made you think twice? This episode cuts through the confusion, debunking the most common Medicare myths to help you avoid costly mistakes. From the real costs of Medicare to eligibility misconceptions, we're covering essential truths:- Medicare Isn't Free: Unpack the real costs behind Part A, Part B, and why Medicare Advantage or Medigap might cost you extra.- Not Everyone Needs Medicare at 65: Discover when you can delay enrollment without penalties, depending on your current health coverage.- Medicare Before 65: Learn how disabilities, ALS, or ESRD can qualify you for Medicare earlier than you thought.- No Family Coverage: Medicare coverage is individual—what this means for you and your loved ones.- Enrollment Isn't Automatic: Find out when you need to sign up for Medicare yourself to avoid being left without coverage.- Medicare Advantage vs. Supplements: Clearing up the confusion between these two very different options.- Changing Plans Can Be Simple: Demystifying the process of switching your Medicare or Medigap plans.Tune in for a straightforward breakdown, designed to guide you through the Medicare maze with ease. Subscribe for more insights, and don't hesitate to reach out for personalized assistance. Do you have questions or experiences to share? Drop us a comment below!Please register for our FREE Online Course here: https://www.gmedcourse.com/Giardini Medicare is an independent insurance agency specializing in helping Medicare beneficiaries enroll in the Medigap or Medicare Advantage plan that fits their needs during their transition to Medicare. We are licensed and work virtually in the following states:  AZ, CA, FL,  IL, IN, KY, MI, MD, NC, OH, PA, SC, TX. If we do NOT work in your state, we can refer to agents that we know, like & trust across the country.Check out our website at  https://gmedicareteam.com/ Also, see our additional educational content on our YouTube Channel.You can also connect with and learn more on TikTok and our private Facebook Group, and while you're at it, check out our Google Reviews!  And please get added to our mailing list so we can remain in touch with you.Sources:Medicare Savings Program QualificationsSSA Full Retirement AgeMedicare Card with Medicare Advantage2024 Medicare CostsMedicare Guide for Turning 65Medicare Eligibility Under Age 65

Listen as Lori tells us her experience as a hemodialysis nurse.

David White is joined by Health Policy Scholar in Residence Dr. Suzanne Watnick and Zach Kribs to discuss the Kidney PATIENT Act of 2023- a bill that would delay the inclusion oral only drugs in the ESRD PPS.

David White is joined by Health Policy Scholar in Residence Dr. Suzanne Watnick and Zach Kribs to discuss the Kidney PATIENT Act of 2023- a bill that would delay the inclusion oral only drugs in the ESRD PPS.

JAMA 2001;285:1711-18.Background Statin therapy had been shown to improve blood cholesterol and improve long-term outcomes in patients with stable coronary artery disease with significant effects evident after 2 years of treatment. These early trials excluded patients with recent acute coronary syndromes and thus, the possibility of early benefit from statin therapy in this patient population was untested. But, patients with ACS are the most vulnerable to experiencing recurrent events in the early period following an initial event and certain physiologic effects of statins were theorized to be beneficial during this period. These effects included improvement in endothelial function, decreased platelet aggregation and thrombus deposition, and reduced vascular inflammation. The Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) study sought to test the hypothesis that early treatment with high dose atorvastatin in patients with unstable angina or non-Q-wave AMI would reduce early ischemic events and death.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.Patients Eligible patients were ≥18 years of age of experienced unstable angina or non-Q-wave AMI within the 24-hour period before hospitalization. The definition of unstable angina was strictly applied and in contemporary practice, all would meet criteria for NSTEMI. Patients were excluded for the following reasons: serum cholesterol >270 mg/dl but there was no lower limit; if coronary revascularization was planned or anticipated at the time of screening; evidence of Q-wave AMI within preceding 4 weeks; CABG surgery within the preceding 3 months; PCI within the preceding 6 months; left bundle branch block or paced rhythm; severe CHF; concurrent treatment with other lipid-lowering agents, vitamin E, drugs associated with rhabdomyolysis in combination with statins; severe anemia; renal failure requiring dialysis; hepatic dysfunction (ALT >2 ULN); insulin-dependent diabetes; pregnancy or lactation.Baseline characteristics The average age of patients was 65 years and two-thirds were men; 86% were white. Approximately one quarter of patients had a prior MI, 23% had non-insulin-dependent diabetes and 55% had hypertension. The average time to randomization from hospital admission was about 2.5 days. The inclusion event was unstable angina in 46% and non-Q-wave AMI in the remainder. Non-cholesterol lowering cardiac medicines were similar prior to, during and following the hospitalization index event.Procedures Between 24 and 96 hours after hospital admission, patients received either atorvastatin 80 mg per day or matching placebo for 16 weeks. Treating physicians were instructed not measure serum lipid levels in the local hospital laboratory during the study period. All patients received instruction and counseling on a low cholesterol diet. Patients were seen in follow-up 2, 6, and 16 weeks after initiation of therapy. Laboratory testing was performed centrally at baseline and at 6 and 16 weeks.Endpoints The primary endpoint was a composite of all-cause death, nonfatal MI, cardiac arrest with resuscitation, or recurrent symptomatic myocardial ischemia with objective evidence requiring emergency hospitalization. The recurrent ischemia endpoint required both exacerbation of the patient's usual symptoms and new objective evidence of ischemia with definite change from a comparison study performed after the index ischemic event. Secondary endpoints were occurrence of each component of the primary composite endpoint as well as nonfatal stroke; new or worsening heart failure requiring hospitalization, worsening angina requiring hospitalization but without objective evidence of ischemia, coronary revascularization, time to first occurrence of any primary or secondary endpoint, and percentage changes in blood lipid levels from baseline to 16 weeks.An initial sample size requirement of 2,100 was based on an assumption of a 20% primary composite event rate in the control group and 14% rate in the atorvastatin-treated group (17% overall rate), with an alpha of 0.05 and 95% power. The sample size was then increased to 3,000 upon the recommendation of the steering committee. This, after a blinded analysis of pooled data from the first 1,260 patients indicated the event rate was lower than anticipated (13% overall). A sample size of 3,000 would confer 95% power to detect a 30% relative treatment effect and 80% power to detect a 25% relative effect at an alpha of 0.05.Results 3,086 patients were included in the final analysis; 1,548 in the placebo group and 1,538 in the atorvastatin group. All patients were followed for 16 weeks. Compared to placebo, atorvastatin significantly reduced the risk of the primary composite endpoint (RR 0.84; 14.8% vs 17.4%%; 95% CI 0.70-1.00; p=0.048). For the individual components, there were no significant differences in death (4.2% vs 4.4%), nonfatal MI (6.6% vs 7.3%), or resuscitated cardiac arrest (0.5% vs 0.6%), but there was a statistically significant reduction in the endpoint of emergency rehospitalization for recurrent symptomatic ischemia (RR 0.74; 6.2% vs 8.4%; 95% CI 0.57-0.95).For the secondary endpoints, there were significant reductions in stroke in the atorvastatin group but this was based on a small number of events. Perhaps unexpectedly, there was a numerical increase in coronary revascularization procedures in the atorvastatin group despite there being a statistically significant reduction in emergency hospitalizations for recurrent ischemia as mentioned above.Data on subgroups was not presented.Compliance with prescribed study treatment was 86% in the atorvastatin group and 88% in the placebo group. Treatment was discontinued prematurely in 11.2% of the atorvastatin group compared to 10.3% in the placebo group. No serious adverse events occurred with a frequency of more than 1% in either group. An increase in LFTs (>3x ULN) occurred in 2.5% in the atorvastatin group and 0.6% of patients in the placebo group; 3 of these patients in the atorvastatin group were hospitalized with hepatitis and each case resolved following discontinuation of the drug. There were no documented cases of myositis.After 16 weeks, LDL cholesterol had increased by an adjusted mean of 12% to 135 mg/dl in the placebo group and decreased by an adjusted mean of 40% to 72 mg/dl in the atorvastatin group. Total cholesterol and triglycerides also decreased significantly in the atorvastatin group compared to placebo and there were no significant changes in HDL cholesterol.Conclusions In patients admitted to the hospital with non-Q-wave acute coronary syndromes, high dose atorvastatin significantly reduced a composite primary endpoint of cardiovascular events over the first 16 weeks of treatment with an NNT of 38; however, this was driven by a reduction in emergency hospitalizations for recurrent ischemia. There is no evidence from this trial that high dose statin therapy reduces the individual endpoints of death or nonfatal MI over this period; nor did it reduce coronary revascularization, which is counterintuitive given the significant increase in emergency hospitalizations for recurrent ischemia. Coronary revascularization events were twice as likely to occur as emergency hospitalizations.The external validity of the trial is limited by the restricted nature of the study population. Patients were excluded if revascularization was planned during initial admission, which in many places is the standard of care for ACS up to the present day. Furthermore, higher risk ACS subgroups were excluded, including patients with insulin-dependent diabetes, advanced heart failure and ESRD. The relatively unimpressive clinical benefit observed in MIRACL should not be assumed to extend to such patients. It would not be unreasonable to conclude that the results from MIRACL do not apply to the average patient with ACS in contemporary practice.Thank you for reading Cardiology Trial's Substack. This post is public so feel free to share it. Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe

Herb and Eric sit down in the Flywheel Studio to read and talk about H. E. Sargent's journal entries from every birthday he had, every 10 years, starting in 1943. Herb shares that the goal of having discussions inspired by H. E. Sargent's birthday is to help everyone in the company, especially those joining recently, to know what it means to be stewards of the Sargent legacy. Don't miss this special episode celebrating Sargent's Founder, Herbert E. Sargent!Don't forget about the FEDlogic webinars the last Wednesday of every month!FEDlogic is the Sargent employee-owner's independent resource to help navigate and maximize federal and state benefits.The seminars are educational and completely free to Sargent employee-owners and their households.The next one is coming up on February 28th at 2pm.They will be covering Social Security 101 and Disability/Unable to Work & Major Illness (such as cancer, ALS, & ESRD).Sargent employee-owners can sign up using this link:https://us02web.zoom.us/webinar/register/WN_fJHjCxK0Sjy6xJyCtYkq9g#/registration The Ramsey Smart Dollar Giveaway is underway!Earn points by working toward your money goals on the Ramsey website for a chance to win a cash prize!During the entire month of February, every day that you log-into SmartDollar or EveryDollar, it counts as one entry.SmartDollar is giving away CASH: $500 each week, $1,000 budget bonus, and a grand prize winner of $5,000! If you sign up for SmartDollar, and log in each day of February, you'll be eligible to win cash prizes all month long!Company Keyword: sargent6536  Link:https://www.ramseysolutions.com/corporate-wellness/smartdollar/sign-up?utm_source=client-distributed&utm_medium=start_redirect&utm_content=direct_entry_start&utm_term=financial_wellness_bu&utm_campaign=start PLUS Sargent is doing its own Ramsey SmartDollar GiveawayEvery week in February, anyone who earns 1,000 points working towards their money goals on Ramsey SmartDollar, will be entered into our own drawing for a chance to win a $250 boot voucher and a $250 Sargent store voucher! $500 total! There will be one winner per week!Resources:If you're an Employee-Owner at Sargent, and haven't joined the Sargent Employee Facebook page, please send a request and it will be approved ASAP.https://www.facebook.com/groups/654722688058070/permalink/2072270649636593/If you liked this week's episode and are interested in becoming an Employee-Owner at Sargent, please visit our careers page on the Sargent website.https://sargent.us/apply/  If you have an episode suggestion, please send your idea to: sbennage@sargent.usResources: If you're an Employee-Owner at Sargent, and haven't joined the Sargent Employee Facebook page, please send a request and it will be approved ASAP. https://www.facebook.com/groups/654722688058070/permalink/2072270649636593/ If you liked this week's episode and are interested in becoming an Employee-Owner at Sargent, please visit our careers page on the Sargent website. https://sargent.us/apply/If you have an episode suggestion, please send your idea to:sbennage@sargent.us

Tim Powell from the Workforce Advancement Team is joined by Foremen-in-Training Jacob Lancaster and Brandon Powell in the Flywheel Studio to discuss why Workforce Advancement is crucial to grow our current and future employee-owners. Tim, Jacob, and Brandon share a lot of wisdom in this episode, so you won't want to miss out! Many important announcements are shared and, as always, don't skip this week's solid shout-outs. Don't forget about the FEDlogic webinars the last Wednesday of every month!FEDlogic is our employee-owners' independent resource to help navigate and maximize your federal and state benefits.The seminars are educational and completely free to you and your household members!The next one is coming up on February 28th at 2pm.They will be covering Social Security 101 and Disability/Unable to Work & Major Illness (such as cancer, ALS, & ESRD).Sargent employee-owners can sign up using this link:https://us02web.zoom.us/webinar/register/WN_fJHjCxK0Sjy6xJyCtYkq9g#/registration  New Scholarship Program for Children of Employee OwnersSargent is a member of the Employee ownership Foundation and they have announced the establishment of a new annual scholarship program that employee-owners and their children are eligible to receive for their college or vocational education. The Trustee Scholars program will provide scholarship funds for college and vocational school education for employees or the dependent children of employees who are corporate members of The ESOP Association.Application Open: December 15, 2023 - February 15, 2024Each year, the Foundation will award two $5,000 per year scholarships for college or trade school, renewable for up to four years each. Up to $20,000 for a four-year degree.The Foundation will start awarding scholarships for students beginning school in the fall of 2024. Link: https://www.employeeownershipfoundation.org/grants-funding/trustee-scholars?_zs=ULwxd&_zl=uvCt3  The Ramsey Smart Dollar Giveaway has begun!Earn points by working toward your money goals on the Ramsey website for a chance to win a cash prize!During the entire month of February, every day that you log-into SmartDollar or EveryDollar, it counts as one entry.SmartDollar is giving away CASH: $500 each week, $1,000 budget bonus, and a grand prize winner of $5,000! If you sign up for SmartDollar, and log in each day of February, you'll be eligible to win cash prizes all month long!  Link:https://www.ramseysolutions.com/corporate-wellness/smartdollar/sign-up?utm_source=client-distributed&utm_medium=start_redirect&utm_content=direct_entry_start&utm_term=financial_wellness_bu&utm_campaign=start PLUS Sargent is doing its own Ramsey SmartDollar GiveawayEvery week in February, anyone who earns 1,000 points working towards their money goals on Ramsey SmartDollar, will be entered into our own drawing for a chance to win a $250 boot voucher and a $250 Sargent store voucher! $500 total! There will be one winner per week! Resources: If you're an Employee-Owner at Sargent, and haven't joined the Sargent Employee Facebook page, please send a request and it will be approved ASAP. https://www.facebook.com/groups/654722688058070/permalink/2072270649636593/ If you liked this week's episode and are interested in becoming an Employee-Owner at Sargent, please visit our careers page on the Sargent website. https://sargent.us/apply/If you have an episode suggestion, please send your idea to:sbennage@sargent.us

In this episode, host Dr. Chris Beck interviews Dr. Jason Wagner about his experience with using the Hemodialysis Reliable Outflow (HeRO) graft and the Surfacer system for treating patients with end stage renal disease (ESRD) and limited vascular access options. Dr. Wagner is a practicing vascular surgeon in Sarasota, Florida. Dr. Wagner explains the steps to implant a HeRO endovascular graft, how it provides a durable and reliable outflow for hemodialysis patients, and how it can be used and revised based on the patient's needs. He also discusses the Surfacer system in obtaining central venous access, its advantages, and the necessity of preoperative imaging. Dr. Wagner emphasizes the critical role of continued learning in utilizing and optimizing these advanced dialysis solutions. The suggestions and other information, which may include Merit products, are for the practitioner's convenience and for general information purposes only. This information does not constitute medical or legal advice. Before using, refer to the Instructions for Use (IFU) for indications, contraindications, warnings, precautions, and directions for use. --- CHECK OUT OUR SPONSOR Merit HeRO Graft https://www.merit.com/product/merit-hero-graft/ --- SHOW NOTES 00:00 - Introduction 02:25 - Dr. Wagner's Experience in Vascular Surgery 05:49 - Understanding End-Stage Vascular Access 08:52 - Introduction to the HeRO Graft 16:15 - Implantation of the HeRO Graft 28:38 - The Surfacer: A Game Changer in Vascular Access 31:49 - Potential Risks and Precautions with the Surfacer 33:38 - Using Both HeRO Graft and Surfacer 36:31 - Final Thoughts and Resources on Both Devices --- RESOURCES Think Dialysis Access Course from Merit: https://www.merit.com/education/courses/thinkaccess/ HeRO Graft: Indications, Technique, Outcomes, and Secondary Intervention: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8856774/ KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update: https://pubmed.ncbi.nlm.nih.gov/32778223/ The Surfacer: https://bluegrassvascular.com/surfacer-2/

If you had 5 reproductive age women, all late on their menstrual cycle, who were having unprotected sex, and all have a positive pregnancy test… What would be your diagnosis? The most likely diagnosis would be that there are five pregnancies! Right?! But what if 1 of those patients had end stage renal disease (ESRD), on hemodialysis. Is there anything else to consider? While ruling out pregnancy is priority #1, it is possible that this HCG is a phantom result. This is a slippery slope discussion and one that could easily lead down the rabbit hole. In this podcast, we will highlight this clinical conundrum, based on a real case from our practice, and summarize some fascinating reports from the literature.

Dialysis facilities in the US are financially rewarded for higher rates of home dialysis and kidney transplant, but facilities that serve patients with high social risk might have a harder time meeting these goals. JAMA Associate Editor Karen E. Joynt Maddox, MD, MPH, speaks with Amal N. Trivedi, MD, MPH, of Brown University, about how this plays out under the ESRD Treatment Choices Model. Related Content: Social Risk and Dialysis Facility Performance in the First Year of the ESRD Treatment Choices Model

Download for FREE today -  special Mnemonics Cheatsheet - so you can be SURE that you have that Must Know information down:  bit.ly/nursing-memory   Outline AEIOU A-Acid-Base Problems E-Electrolyte Problems I-Intoxications O-Overload of fluids U-Uremic Symptoms Description As a patient progresses from chronic kidney disease to end stage renal disease the need for dialysis becomes more imminent. When the kidneys are no longer able to filter the blood alone you will see problematic metabolic acidosis since they kidneys can't excrete excess acids that are in the blood. During kidney failure, excess potassium isn't excreted and levels will start to rise. The kidneys help remove certain medications from the body, and when they aren't working, toxicity can occur even with normal doses. Patients with ESRD become fluid overloaded due to inadequate urine production. Uremia will occur as the body can't excrete enough urea.

CardioNerds co-founder Dr. Amit Goyal, series co-chair Dr. Colin Blumenthal, and episode lead Dr. Anushka Tandon to discuss pharmacologic anticoagulation options in atrial fibrillation with Drs. Ashley Lochman and Chris Domenico. The case-based review helps clarify some key concepts, such as when warfarin is preferred for anticoagulation, who may be a good DOAC (direct-acting oral anticoagulant) candidate, how to choose an appropriate DOAC agent, and how to manage anticoagulation therapy in patients already on antiplatelet therapies. Notes were drafted by Dr. Anushka Tandon. The episode audio was edited by student Dr. Shivani Reddy. This CardioNerds Atrial Fibrillation series is a multi-institutional collaboration made possible by contributions of stellar fellow leads and expert faculty from several programs, led by series co-chairs, Dr. Kelly Arps and Dr. Colin Blumenthal. This episode was planned and recorded prior to the release of the 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation. Please refer to this guideline document for the most updated recommendations. We have collaborated with VCU Health to provide CME. Claim free CME here! CardioNerds Atrial Fibrillation PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls and Quotes - Anticoagulation Pharmacology Avoid potentially fatal errors with this terminology tip for correctly referencing non-warfarin oral anticoagulant agents: it's DOAC (like, please DO use AntiCoagulation), not NOAC (imagine someone interpreting that as “NO AntiCoagulation for this patient” at discharge – yikes)! Sometimes, an oldie really is a goodie – warfarin is recommended over DOACs for patients with mechanical heart valves, moderate-to-severe mitral stenosis, anti-phospholipid antibody syndrome (APLS), left ventricular (LV) thrombus, higher INR goals, or DOAC failure. Patient preference and medication costs should also be considered – at the end of the day, “the best drug is the drug that a patient is willing to take!” Standard-dose rivaroxaban or apixaban may be considered for use in patients weighing >120kg or with BMI >40; use of other DOACs should be limited to pts weighing =/< 120kg or with BMI =/< 40. The pharmacists involved in this podcast promise they don't have stock in apixaban! It just often happens to be the preferred DOAC option in certain scenarios – think patients with severe renal impairment (including ESRD) or with an increased risk for bleeding events (including older adults, those with a history of GI bleed, etc). In general, dual therapy (DOAC or warfarin + P2Y12 inhibitor) is non-inferior to triple therapy (oral anticoagulant + P2Y12 inhibitor + aspirin) at preventing thrombotic events but is associated with a lower risk of bleeding events. Most patients can be transitioned to dual therapy after 7-30 days on triple therapy post-percutaneous coronary intervention. What's that on the horizon? Factor XI inhibitors may become the breakout stars of anticoagulation – multiple investigational agents are being studied for their potential to reduce thrombotic risk without significantly increasing bleeding risk in patients with indications for anticoagulation therapy…at least that's the theorize hope. Watch this space! Notes - Anticoagulation Pharmacology In which cases is warfarin preferred over DOACs in patients with atrial fibrillation? Long-term anticoagulation with warfarin is indicated in patients with atrial fibrillation and either a mechanical valve or moderate-to-severe mitral stenosis (i.e., valvular atrial fibrillation as defined in the 2019 AHA/ACC/HRS guidelines on atrial fibrillation [1]). The REALIGN trial [2] showed increased rates of thromboembolic and bleeding complications with dabigatran vs.

Today, we're excited to speak with Arvind Rajan, Co-founder and CEO/Executive Chairman of Cricket Health.  Arvind led Cricket Health which is a technology-enabled specialty care provider for patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). In August 2022, Cricket Health merged with Interwell and Fresenius Health Partners to form the new Interwell Health, a leader in value-based kidney care. Before co-founding Cricket Health, Arvind served as Managing Director and Vice President of New Markets at LinkedIn, where he was responsible for the company's growth and operations in Asia Pacific and Japan.   Arvind has spent most of his career building companies across a wide range of industries. Although the industries have been different, every one of these companies was trying to create transformative change that would have a positive impact on the world. In this insightful discussion, Arvind opens up about his career path, the challenges and successes in building Cricket Health from scratch, practical advice for fundraising, and valuable insights for aspiring startup founders such as strategies and tips for conducting productive board meetings.

Joining us on Well Said is Ms. Candice Halinski, a nurse practitioner who specializes in the care of patients with chronic and end-stage kidney disease, Deputy Chief Nursing Officer for Northwell Health Ambulatory Care and an Assistant Professor at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell. She will be talking about how traditionally, the only choices that patients with ESRD have been offered are a kidney transplant or chronic dialysis – however today there are different approaches to be considered.

We revisit the topic of Hyperkelamia to update our prior episode from 2015 (pre-Lokelma) Hosts: Brian Gilberti, MD Jonathan Kobles, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/Hyperkalemia.mp3 Download 2 Comments Tags: Renal Colic Show Notes Introduction Background Physiology: Normal range and the significance of deviations (>5.5 mEq/L) Epidemiology: Prevalence of hyperkalemia in the ER ESRD missed HD → ECG, monitor Causes / Risk Factors Causes Kidney Dysfunction, Medications,  Cellular Destruction,  Endocrine Causes, Pseudohyperkalemia High-Risk Medications: Antibiotics: Bactrim, antifungals Calcineurin inhibitors

In this healthcare podcast, I am talking with Dan Serrano; and we're talking about payer/provider collaboration—blocking and tackling, I'm gonna say—from primarily a financial and revenue point of view. I'd classify this as, say, a 201-level discussion (ie, not entry level, but it's also not super deep in the weeds). We mainly cover the ins and outs of why a provider organization should probably be looking to get paid to better take care of patients with chronic disease and drive better patient outcomes at lower downstream costs and, to some degree, also why payers should be helping provider organizations in their local communities to do so by providing some help and shelter on the journey from here to a capitated payment. The focus today is really, I'd have to say, on the messy middle, where a provider organization does not have capitated contracts nor access to any premium dollars, which, by all accounts, is the holy grail here. The premium is where it's at, and provider organizations might want to be aiming to get a piece of that action. The why for this “get the premium dollar” prime directive is pretty self-evident when you look at the big bucks rolling around in the coffers of those who are collecting said premium dollars. So, this “get the premium” endgame is, for sure, a big piece of the why—why, if I am a provider organization, I might want to take the time and energy and spend the money to embark on a path that might lead me to be able to get compensated for the stuff that patients really want and need to do better, which includes all of the things that I spoke about with Eric Gallagher in episode 405. Also, Vivek Garg, MD, MBA, in episode 407 and Amy Scanlan, MD, in episode 402. Spoiler alert: It's not easy. Now, I asked Dan Serrano, as aforementioned my guest today, to offer up his advice here in the context of CKD (chronic kidney disease) patients. Why did I ask Dan to use the CKD case study, as a touchstone? Well, first of all, talking about this topic in totally theoretical terms is not ideal. We need an actual example for a lot of this to kind of make sense, combined with the first step for most outcomes improvement programs, which is to study your data and pick a patient population to focus on where the data suggests that you can have a big impact. And speaking of impact, did you know that an underlying reason why heart failure patients get hospitalized and rehospitalized is because of underlying CKD? So, impact in the short term and longer term, which I'll get to in a sec. Another reason is—and I'm quoting John Rodis, MD, MBA, here, who is the independent medical director of QC-Health®—Dr. Rodis said the other day, “I sure as heck hope I don't get CKD, because if I do, chances are I'm not going to be diagnosed. And even if I am diagnosed, I won't be treated properly.” So, there's that. And I can see why he's saying that. Two out of five patients with ESRD (end-stage renal disease) don't even know they have kidney disease at all. And the number of patients with progressing CKD on any kind of evidence-based treatment plan is stunningly low. But also, here's another reason I asked Dan Serrano to talk about CKD patient populations specifically as his example: I and Dr. Rodis and the team at QC-Health are not the only ones who have figured out that CKD patients are notoriously expensive and way underdiagnosed. You know who else has figured this out? Payers. Also, private equity. In fact, I was in a meeting with a payer recently, and they stated they had to get CKD patients into point solutions. This payer—and I've heard of others, too—none of these entities are waiting around. And I guess, fair enough, if you look at some of the population health data, that I'm sure these payers and others are looking at. But if you work for a payer and you're listening right now, what I would say, “Okay, with the point solutions, one that you have carefully vetted, of course, because we have patients suffering right now and dollars being frittered away right now.” But I also would submit that those point solutions will perform a whole lot better if we are all gunning for synergies. PCPs (primary care physicians) and traditional FFS (fee-for-service) models in this country need your help. The payment models and admin burden are decimating. Payers certainly are a group with some culpability here. (Sorry to be saying the quiet part out loud.) Instead of forgoing them, please help PCPs. Am I saying be altruistic? Actually, no. Listen to episode 409 with Larry Bauer or episode 391 with Scott Conard, MD, or an upcoming show with Jodilyn Owen and what you will hear is the amazing ability for clinicians rooted in the community to actually drive change in their local markets. In fact, I'd hypothesize that these community-rooted organizations probably have a better track record for actually moving the needle on patient outcomes than any snazzy tech that I have seen, although I am sure that there are one or two very effective snazzy techs out there—the exception proves the rule and all that. Bottom line: As I do so often, I am advocating for payers and provider organizations within communities to collaborate, regardless of whether there's a third party also in the mix. I am reporting all of this in the spirit of being helpful but also with some degree of urgency for any care delivery organization because, I mean, really, forget about the holy grail of trying to capture a percentage of the premium if the money is already going elsewhere to too many point solutions who are already capturing a portion of the premium. IRL, this is what's already going on out there. But where there's a challenge, there is also opportunity. As I have said pretty repeatedly for the past four minutes, because the bar is so low and because CKD patient outcomes are bad news, in general, from a lot of angles, CKD is actually a great place for providers to work hard to improve care and quality. From a financial standpoint, I think there's also a great business case for payers to help provider organizations do so. Doing better than the local standard of care is not hard, sadly. And what that means is that there's so much money that's possible to save due to the expense of this condition. And if you're a payer, even a payer with a third-party CKD solution, if you can help local PCPs and others level up their care, then either you don't have to pay for the third-party point solution for patients who can be managed successfully locally and/or there's a more frictionless path for those patients to be identified and get into the point solutions that are available to them. Let's all keep in mind that patients at rising risk are falling through a lot of cracks. You can have the best point solution in the world, but if patients aren't making it there, then, yeah, no outcomes will improve. No costs will be reduced. Everything I just went through are also all of the reasons why we picked CKD as our focus for a national Groundswell Movement™ that the benefit corp I am co-president of is kicking off to improve CKD patient outcomes. If you are also thinking about improving CKD patient outcomes, for sure, hit me up. On to a few thank yous. Thank you so much to Carl Hansen, MD, a direct primary care physician, for a really generous tip in our tip jar. Also, thanks so much to Keith Passwater, who is CEO of Havarti Risk Services and Pasco Advisers, for a really nice donation to the cause over here. It was such an honor and a pleasure to moderate a panel at the Society of Actuaries' latest meeting at Keith's invitation also. Additionally, may I extend thanks to Dffdgg, RKC2023, and Healthy economist for super nice iTunes reviews. The shout-outs are amazing, especially when public like this. Also much appreciated how you have shared Relentless Health Value with your colleagues. Back on track, let's hear from Dan Serrano, who is a consultant with COPE Health Solutions, where he works to help clients figure out the best way to make investments that drive better outcomes in a more cost-efficient way.   You can learn more at the COPE Health Solutions Web site or by emailing Dan at dserrano@copehealthsolutions.com.   Dan Serrano joined COPE Health Solutions in September 2022 as principal and senior vice president. He supports Analytics for Risk Contracting (ARC) finance build and cost models in terms of drive and delivery with Great Lakes Integrated Network (GLIN). He is a seasoned healthcare/finance professional with 20+ years' experience and has held a number of roles across the industry and has primarily served as a senior finance leader with proven ability to drive strategy development and execution across multiple business lines for complex organizations in various stages of maturity. Prior to COPE Health Solutions, Dan served as senior vice president of finance at CareAbout, a private equity–backed start-up focused on driving performance for primary care physicians. He also was the vice president of value- and risk-based contracting at Mount Sinai Health System, where he worked to align contracting, operational performance, and network strategy for employed and voluntary physician groups. Prior to his role at Mount Sinai, Dan served as vice president of commercial products at Healthfirst, market chief financial officer at ChenMed, and Mid-Atlantic Region chief financial officer at Aetna, where he focused on driving strategic financial decisions by analyzing the value drivers for each of the stakeholders across the industry. Dan holds a bachelor's degree in finance from the Peter J. Tobin College of Business at St. John's University.   09:08 What is the importance of payer/provider partnerships in reducing costs with chronic condition care? 10:52 Josh Berlin, JD, of rule of three; look out for his episode in a few weeks. 11:19 What's the endgame here with this payer/provider collaboration? 11:43 What advice does Dan have for providers who want to do better by patients with chronic conditions? 15:11 Who's driving costs in the system? 15:50 Why is lowering the average cost of chronic condition care important? 17:03 Why is there a meaningful delta between well-controlled CKD patients and those who aren't well managed or identified? 21:57 What does a realistic time horizon look like for addressing chronic condition care? 22:38 Why is it important to start in a shared savings place? 25:25 William Shrank, MD, of Andreessen Horowitz; look out for his episode in the fall. 26:35 Financially, what is the goal and how are we achieving a sustainable goal? 29:06 What is the balance between progress and risk here?   You can learn more at the COPE Health Solutions Web site or by emailing Dan at dserrano@copehealthsolutions.com.   Dan Serrano of @COPEHS discusses #chronicconditions and #payer #provider #collaboration on our #healthcarepodcast. #healthcare #podcast   Recent past interviews: Click a guest's name for their latest RHV episode! Larry Bauer, Dr Vivek Garg (Summer Shorts 3), Dr Scott Conard (Summer Shorts 2), Brennan Bilberry (Summer Shorts 1), Stacey Richter (INBW38), Scott Haas, Chris Deacon, Dr Vivek Garg, Lauren Vela, Dale Folwell (Encore! EP249)  

Thanks for joining me as we kick off the summer season. Here's what we're gonna talk about today in our 10-ish-minute conversation. Keeping it short and sweet. First up, we got three super interesting voice messages left by your fellow members of the Relentless Tribe that I wanted to share with you. Next up, I will cover plans for the summer, because this summer, we have plans. And then after that, just wanted to chat a little bit about what I am up to right now. Agenda item #1: Episodes 399 and 400 of Relentless Health Value were me sharing my manifesto as it were. At the end of the show, I said that if you have a manifesto of your own, to share it by going to relentlesshealthvalue.com and hitting the orange leave a voice mail button. Doug Pohl, CEO of HealthTech Content, did so; and here is what he had to say: “My name is Doug Pohl. I'm the founder and CEO of HealthTech Content, and I'm pretty frustrated by the lack of progress toward making the improvements we need for healthcare. So, I put this out there to sort of be a bat signal for anyone else who feels the same way I do but to also hold myself accountable to be congruent outwardly with how I feel inwardly. No longer will I accept healthcare's prioritization of the bottom line. No more will I ignore the flagrant victimization of our society. I won't sit silently while shortsighted greed ruins families. I don't accept a profit-first model that kills people daily. I can't let complacency keep me from taking action. I won't let my voice wither away in fear. I can't—and I won't—remain quiet. I believe in the potential of regular people. I know how powerful we can be working together. Every one of us is affected by healthcare eventually, and it will take all of us to create the healthcare we deserve. The first step is rejecting the status quo. I'm tossing it out the window. How about you?” And now let me share two more voice mail messages, and here's why they both are meaningful. We know that this journey to transform the healthcare industry in this country can be long and slow and, at times, lonely. But together we are stronger and more able to help patients receive the care that they need and deserve at a price that we all can afford. So, thank you for being part of our community, and here's two perspectives on why you being here matters. Here's a voice mail from Justina Lehman from the Infinite Health Collaborative (iHealth): “When you are in the work of creating change in healthcare and really working to align with value for the patient, value for the physician, the clinician so they have an environment that they can thrive in, the work can feel hard. And it can feel lonely, and you can feel on an island. And Relentless Health Value podcast is your people. We often say this in our team of … when you look to that podcast, you're reminded of all the amazing people across this country doing incredibly meaningful work. And linking up with one another can create that strength and help you with your resiliency, especially on those days where you're feeling down and that the work is hard and that you're doing it alone. And sometimes you may even question: Is this work of value? Will it be valued of others? The Relentless Health Value podcast, Stacey, all of her guests have really been those people for us. Not uncommon for us to share podcasts amongst each other during the work of reminding each other of the people out there doing great things. So, so incredibly grateful for what Stacey's built and for all the guests that have been on her show and the value it's adding and the support it's giving to those of us who are out in the trenches trying to make this happen. So, thank you, Stacey.” And here's a message from Amy Scanlan, MD, who was also a guest on episode 402: “Hi, Stacey. It's Amy Scanlan. Wanted to say thank you for your latest episode. It's so helpful to be reminded that, even though we're making little steps, we are making progress and we're part of a greater movement. Thanks so much for the inspiration and for always doing the good work. Bottom line, here's my point and call to action: Share this show, especially with colleagues, with anybody trying to find a path forward who may be helped by a little companionship along the way. I just got a note, in fact, from Rajiv Patel, MD, MBA, FACP, from Bluestone Physician Services, and he wrote, “I am only a six-month listener and pretty upset to have not found this podcast earlier.” So, help spread the word and there are some people out there—not everybody, but some people—who you would be doing, frankly, a great service to. It sucks to feel alone. Agenda item #2: Let's talk about our summer plans here at Relentless Health Value. These plans are made possible because I am a collector. I grew up in Pennsylvania Dutch country. What can I say? We don't throw things away. We get a recycled jar and start throwing, I don't know, old keys into it until—it's like a magic trick, really—suddenly we have a collection of old keys. You know you're a collector when you have to buy a Brother P-Touch label maker because you have so many collections you require fancy labels to keep track of them all. Here's why this is relevant to you: Over the past year or so, I started collecting the sound bites that we had to cut from our episodes. I'm not talking about bloopers. I'm talking about really good insights and information but on a topic that maybe was slightly off-topic from the main thrust of the episode or sometimes just a little too long. I try to keep our shows around the 32-ish-minute mark because … yeah, you people are busy. At a certain point, though, I realized I had maybe half a dozen of these 5- to 10-minute clips. So, that's what we're doing this summer. We're going to play a drawer of, I'll call them, “Summer Shorts.” Get it? Summer shorts? These shorts are all with previous guests, and each short shares one or two very concise insights. I have about seven shorts in this drawer, so this will take us through most of the summer. There will be an episode or two sprinkled in. We have one on deck from Larry Bauer, who goes through some really heartwarming bright spots in the delivery of healthcare, and another one from Dan Serrano talking about CKD (chronic kidney disease) from a financial modeling standpoint. We'll see how it goes. Feedback is welcome. Speaking of bloopers, though, after 400 or whatever shows, I have to say I'm very blasé about bloopers as you will discover if you ask me about them, which many people do. I've heard them all what feels like a thousand times each: the ambulances, the helicopters, the lawn guys, the kids screaming about not wanting to give their germs to the dog (come to think of it, I should have saved that one), squirrels in the mini blinds, dogs barking, obviously the cat on the keyboard, the ice machine, the doorbells, things beeping, an occasional rooster. I always just delete them because guests get embarrassed. But yeah, I probably have enough audio to put together a game show entitled Where Is the Guest Working From— Home, Hospital, Office? Answer correctly and win prizes. That was a detour. Back on track now. One of the other reasons for doing summer shorts is because … wow, I am really busy. QC-Health®, the benefit corp that I'm co-president of, is working really hard in the CKD space. Right now, we are collaborating with several provider organizations—amazing ones, if you ask me—trying to co-design with PCPs in a very helpful way (ie, a way that is intrinsically motivating) to diagnose CKD earlier, slow disease progression, and help their colleagues do so, too. Considering that 50% (five-oh percent!) of patients who go into dialysis crash into dialysis in the ER (ie, they go to the emergency room for something or other and, while there, they are told that the root cause of their problem is “Oh yeah, you have end-stage renal disease [ESRD] and need to be on dialysis,” which costs, what, a quarter million dollars a year [according to a study in JAMA Network Open]). Oh, and also, two out of five of those patients who crash into dialysis—this is sad—had no idea they even had CKD, meaning they had no chance to slow their disease progression even if they wanted to. So, lots of work to be done there. This said, if you are working on anything that has to do with CKD, hit me up. There may be some alignments that we could explore. The process that we are using here to address and try to level up CKD outcomes is the same process that we used in the chronic liver disease (CLD) space, in which we improved the use of clinical guidelines for end-stage liver disease by 23% in about six months nationwide. Yeah, I know. I actually have a day job and do real work. Now, I will say that if you have a drug in the CKD space or a device or you are an ESRD value-based provider … yeah, call me kinda quick. It's humbling and nice validation the number of folks who are interested in working with us, but we don't want to bite off more than we can chew. Moving on, here's some more news about me. Thanks so much to the Validation Institute for awarding me Healthcare Influencer of the Year. That was a really cool surprise, and I am looking forward to picking up the award in DC at thINc360. So, that happened. I'm also looking forward to giving the keynote at the Pittsburgh Business Group on Health Symposium in September. Please come and see me there. I would love to meet you.   For more information, go to aventriahealth.com.   Each week on Relentless Health Value, Stacey uses her voice and thought leadership to provide insights for healthcare industry decision makers trying to do the right thing. Each show features expert guests who break down the twists and tricks in the medical field to help improve outcomes and lower costs across the care continuum. Relentless Health Value is a top 100 podcast on iTunes in the medicine category and reaches tens of thousands of engaged listeners across the healthcare industry. In addition to hosting Relentless Health Value, Stacey is co-president of QC-Health, a benefit corporation finding cost-effective ways to improve the health of Americans. She is also co-president of Aventria Health Group, a consultancy working with clients who endeavor to form collaborations with payers, providers, Pharma, employer organizations, or patient advocacy groups.   01:14 Doug Pohl's manifesto. 02:43 Justina Lehman's thoughts on why our podcast listeners are important. 04:05 Dr. Amy Scanlan's voice mail. 04:39 Note from Rajiv Patel, MD, MBA, FACP. 05:01 Relentless Health Value's plans for the summer. 09:18 Stacey's plans for the summer.   For more information, go to aventriahealth.com.   Our host, Stacey, discusses our #healthcarepodcast plans for the summer. #healthcare #podcast   Recent past interviews: Click a guest's name for their latest RHV episode! Scott Haas, Chris Deacon, Dr Vivek Garg, Lauren Vela, Dale Folwell (Encore! EP249), Eric Gallagher, Dr Suhas Gondi, Dr Rachel Reid, Dr Amy Scanlan, Peter J. Neumann  

Welcome to the Paint The Medical Picture Podcast, created and hosted by Sonal Patel, CPMA, CPC, CMC, ICD-10-CM. Thanks to all of you for making this a Top 15 Podcast for 2 Years: https://blog.feedspot.com/medical_billing_and_coding_podcasts/ I'd love your continued support of this content-rich, value-add podcast to help you succeed in the business of medicine: https://podcasters.spotify.com/pod/show/sonal-patel5/support Sonal's 9th Season starts up and Episode 5 features her Newsworthy updates for the month's fraud, waste, and abuse cases. Trusty Tip features Sonal's compliance recommendations for the fifth CBR of 2023 - the CBR report issued on End Stage Renal Disease and Related Services. Spark inspires us all to reflect on success based on the inspirational words of Winston Churchill. Thanks to Advanced Coding Services, LLC: Website: https://advancedcodingservices.com/ Paint The Medical Picture Podcast now on: Spotify for Podcasters: https://podcasters.spotify.com/pod/show/sonal-patel5 Spotify: https://open.spotify.com/show/6hcJAHHrqNLo9UmKtqRP3X Apple Podcasts: https://podcasts.apple.com/us/podcast/paint-the-medical-picture-podcast/id1530442177 Google Podcasts: https://podcasts.google.com/feed/aHR0cHM6Ly9hbmNob3IuZm0vcy8zMGYyMmZiYy9wb2RjYXN0L3Jzcw== Amazon Music: https://music.amazon.com/podcasts/bc6146d7-3d30-4b73-ae7f-d77d6046fe6a/paint-the-medical-picture-podcast Breaker: https://www.breaker.audio/paint-the-medical-picture-podcast Pocket Casts: https://pca.st/tcwfkshx Radio Public: https://radiopublic.com/paint-the-medical-picture-podcast-WRZvAw Find Paint The Medical Picture Podcast on YouTube: https://www.youtube.com/channel/UCzNUxmYdIU_U8I5hP91Kk7A Find Sonal on LinkedIn: https://www.linkedin.com/in/sonapate/ And checkout the website: https://paintthemedicalpicturepodcast.com/ If you'd like to be a sponsor of the Paint The Medical Picture Podcast series, please contact Sonal directly for pricing: PaintTheMedicalPicturePodcast@gmail.com --- Send in a voice message: https://podcasters.spotify.com/pod/show/sonal-patel5/message Support this podcast: https://podcasters.spotify.com/pod/show/sonal-patel5/support

In this episode, Patrick W. G. Mallon, MB, BCh, PhD, FRACP, FRCPI, discusses new data on COVID-19 presented at ECCMID 2023, including:Treatment in special populationsREDPINE: remdesivir in people with renal impairment hospitalized for COVID-19 pneumoniaRemdesivir and readmission for COVID-19 in immunocompromised patientsMolnupiravir vs nirmatrelvir plus ritonavir for COVID-19 with hematologic malignancyManagement of patients with severe diseaseRECOVERY: higher-dose vs standard-dose corticosteroids for hospitalized patients with COVID-19Real-world study of tocilizumab vs baricitinib for severe COVID-19Novel antiviralsEnsitrelvirBemnifosbuvir Novel vaccinesNB2155AZD2816/AZD1222qNIV/CoV2373GRT-R910NVX-CoV2373 in people with HIVFaculty:  Patrick W. G. Mallon, MB, BCh, PhD, FRACP, FRCPIProfessor of Microbial DiseasesCentre for Experimental Pathogen Host ResearchUniversity College DublinDublin, IrelandContent based on an online CME/CE program supported by independent educational grants from Gilead Sciences, Inc. and Novavax.  Link to full program: bit.ly/3niXGJ6Link to downloadable slides: bit.ly/3LUFejG

Visit: https://nursing.com/140meds to request your free copy of "140 Must Know Meds" Generic Name calcium acetate Trade Name PhosLo Indication treatment of hypocalcemia, prevention of post-menopausal osteoporosis, treatment of hyperkalemia and hypermagnesaemia, adjunct in cardiac arrest, control of hyperphosphatemia with ESRD. Binds to phosphate in food and prevents absorption. Action calcium is essential for nervous muscular and skeletal systems, helps maintain cell membranes, aids in transmission of nerve impulses and muscle contraction, aids in blood formation and coagulation Therapeutic Class mineral and electrolyte replacements/supplements Pharmacologic Class antacids Nursing Considerations • may cause cardiac arrest and arrhythmias • phlebitis at site of insertion • monitor hemodynamics • may cause hypotension, bradycardia, and arrhythmias • hypercalcemia can increase risk for digoxin toxicity • administer slowly • instruct pt on foods that contain Vitamin D and encourage adequate intake. • monitor parathyroid hormone

Welcome back to our weekend Cabral HouseCall shows! This is where we answer our community's wellness, weight loss, and anti-aging questions to help people get back on track! Check out today's questions:    Ryan: Hi Dr Cabral, I love your podcast , and your equilife products too! My question is for father . He has ESRD because of untreated hypertension. His BP was 284/165 his last trip to ER. He gets dialysis. He eat relatively good for a 65 year old. He eats lots of fruit and veggies. He likes beef , chicken an pork. He's not overweight, small belly. Sorry just wanted you to have as much info to make possible suggestions. Every since he started dialysis and years before , his uncontrolled BP in return gave him ckd, an now ESRD . He feels so wiped-out afterwards and gets cramps in back legs and feet. Maybe something revitalizing a little and replenishing him? And maybe electrolyte products or shakes of your line. Love the podcast . So incredibly grateful to have stumbled upon your podcast !   Kenzie: My boyfriend is getting his deviated septum fixed. They want him on antibiotics because it's a surgery. Any tips for supporting the gut during? Any thoughts on this surgery?   Shannon: Hi Dr. Cabral, my 12-year-old son has been suffering from post-concussive syndrome since May 2022. He has had daily pounding headaches, accompanied sometimes by nausea, dizziness, difficulty concentrating etc. I had to withdraw him from school and his mood is very low and he cries a lot which is not normal for him. My heart is breaking as I don't know how to help him. We've seen the chiropractor, Osteopath, function Medicine practitioner, naturopath had acupuncture, cranial sacral therapy, massage and tried so many different things such as essential oils, food eliminations, high dose Omega 3, magnesium, homeopathic remedies. His sleep is poor and he is not himself in so many ways. I feel like this nightmare will never end. What am I missing? Please give me hope that this will get better.   Leora: My 22 month old son has been diagnosed with Severe Congenital Neutropenia with a mutation of the ELANE gene. We are currently investigating whether it is cyclic or not. Is there anything natural I can do to boost his neutrophils level? Moreover, he has chronic ear infections. Every time he has a virus he gets an ear infection. Of course the doctors always want him on antibiotics but I have found that onion juice works well to clear up the ear infection. However, is there anything I can do to prevent the ear infection occuring in the first place? His doctor believes it is caused by a fluid buildup that doesn't release due to the architecture of his ear.   Kenzie: Hello! Any tips for cutting down emf when living in apartment? I can't shut off my wifi. And obviously I live next to above and under other apartments.   Thank you for tuning into today's Cabral HouseCall and be sure to check back tomorrow where we answer more of our community's questions!    - - - Show Notes and Resources: StephenCabral.com/2598 - - - Get a FREE Copy of Dr. Cabral's Book: The Rain Barrel Effect - - - Join the Community & Get Your Questions Answered: CabralSupportGroup.com - - - Dr. Cabral's Most Popular At-Home Lab Tests: > Complete Minerals & Metals Test (Test for mineral imbalances & heavy metal toxicity) - - - > Complete Candida, Metabolic & Vitamins Test (Test for 75 biomarkers including yeast & bacterial gut overgrowth, as well as vitamin levels) - - - > Complete Stress, Mood & Metabolism Test (Discover your complete thyroid, adrenal, hormone, vitamin D & insulin levels) - - - > Complete Food Sensitivity Test (Find out your hidden food sensitivities) - - - > Complete Omega-3 & Inflammation Test (Discover your levels of inflammation related to your omega-6 to omega-3 levels) - - - Get Your Question Answered On An Upcoming HouseCall: StephenCabral.com/askcabral - - - Would You Take 30 Seconds To Rate & Review The Cabral Concept? The best way to help me spread our mission of true natural health is to pass on the good word, and I read and appreciate every review!  

Dr. Staci Leisman, Associate Professor of Medicine and Medical Education at the Icahn School of Medicine at Mount Sinai, joins us to discuss renal replacement therapies. With host Dr. Emily Gutowski, she works through several cases that highlight the different types of RRT, advantages and disadvantages of each, as well as clinical pearls to consider when treating patients with end stage renal disease (ESRD). Run the List podcast on AccessMedicine: https://accessmedicine.mhmedical.com/multimedia.aspx#1460

Efficacy and Safety of Intensive Versus Nonintensive Supplemental Insulin With a Basal-Bolus Insulin Regimen in Hospitalized Patients With Type 2 Diabetes: A Randomized Clinical Study | Diabetes Care | American Diabetes Association (diabetesjournals.org)   randomized noninferiority study from Emory University, 224 hospitalized patients with longstanding type 2 diabetes  Both groups received basal/bolus insulin; both the starting dose and subsequent changes were specified by the study protocol. Additional premeal SSI was added to scheduled premeal bolus doses.randomized to either intensive SSI (at BG >140 mg/dL) or nonintensive SSI (at BG >260 mg/dL) before meals and at bedtime.  Mean baseline glycosylated hemoglobin (HbA1c) was 9%, and 60% of patients were using insulin at home. Patients with a presenting glucose level of >400 mg/dL or diabetic ketoacidosis were excluded.  Outcome---Mean daily BG level, hypoglycemia, severe hyperglycemia, percent of BGs in the target range (70–180 mg/dL), and the amount of total, basal, or prandial insulin used did not differ between groups. However, significantly fewer patients in the nonintensive group than in the intensive group received SSI (34% vs. 91%).   COMMENTAlthough this is a single-center study, its results are persuasive and suggest that a less-intense SSI regimen can achieve similar glucose outcomes in hospitalized patients with type 2 diabetes who are receiving basal/bolus insulin. It also could decrease nursing treatment burden. As we move slowly toward more continuous glucose monitoring in hospitals, reducing use of SSI is another opportunity to achieve similar results with less staff burden and more patient comfort.  Comparative Effectiveness and Safety Between Apixaban, Dabigatran, Edoxaban, and Rivaroxaban Among Patients With Atrial Fibrillation: A Multinational Population-Based Cohort Study: Annals of Internal Medicine: Vol 175, No 11 (acpjournals.org) In a retrospective study, investigators accessed five electronic health databases from Europe and the U.S. to compare >500,000 new DOAC users with newly diagnosed atrial fibrillation. Follow up varied from 1.5 to 4.5 years.   In propensity score–adjusted analyses, patients who received apixaban had significantly less gastrointestinal (GI) bleeding did those who received any of the other three drugs (hazard ratios, 0.7–0.8). This result was consistent among older patients and those with chronic kidney disease (CKD). Risk for stroke or other systemic embolism, intracranial hemorrhage, and all-cause mortality did not differ significantly among DOACs.    COMMENTThis is the largest comparison of individual DOACs, and it demonstrates similar efficacy among all agents. Although apixaban was associated with less GI bleeding, absolute percentages of GI bleeds ranged from ≈2% to ≈3.5% for all DOACs; therefore, apixaban's statistically significant safety benefit might amount to marginal clinical benefit for any individual patient. I might turn to apixaban for patients at high risk for GI bleeding (and those with CKD), but all DOACs remain reasonable options for preventing thromboembolism in most patients with atrial fibrillation. Ellenbogen MI et al. Safety and effectiveness of apixaban versus warfarin for acute venous thromboembolism in patients with end-stage kidney disease: A national cohort study. J Hosp Med 2022 Oct; 17:809. (https://doi.org/10.1002/jhm.12926. opens in new tab)  . In an industry-funded retrospective study, investigators used a national database (years, 2014–2018) and propensity score–adjusted analysis to compare outcomes among >11,500 patients with ESRD and newly diagnosed VTE who received either apixaban or warfarin.Only 2% of patients received apixaban in 2014, but 47% received apixaban in 2018.during the 6 months following initiation of therapy, apixaban — compared with warfarin  associated with significantly lower incidence of major bleeding (10% vs. 14%), including intracranial bleeding (1.8% vs. 2.5%) and gastrointestinal bleeding (8.6% vs. 10.4%). Recurrent VTE and all-cause mortality were similar in the two groups.   VTE and creatine clearence less than 30 then I think apixaban is the drug of choice—I would like to see this study don't with afib and done with exclusively

From ASTMH2022 in Seattle, Aisha joins the TWiP team to talk about her training and her career, including delivering a baby on an airplane, and they solve the Case of the Heartsick Guatemalan Septuagenarian. Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula Guest: Aisha Khatib Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Links for this episode Aisha delivers baby on airplane (The Varsity) Helminth infections during pregnancy (J Travel Med) SARS-CoV-2 transmission during air travel (Curr Op Inf Dis) Letters read on TWiP 210 Become a patron of TWiP Case Study for TWiP 210 We are consulted about a rash.  A male in his mid 60s originally from Hong Kong with PMH of T2DM, Hypertension, BPH, Hepatitis B infection, COPD (not on home o2), current smoker, ESRD  with right chest cath on dialysis (MWF) presented to the ED  c/o progressive SOB and DOE for 1 week. 2 weeks prior the patient missed 1 session of hemodialysis. Progressively worsening SOB, DOE, orthopnea began to develop starting one week ago with an associated productive cough with white sputum. Last dialysis was session was 3 days PTA. Pt also began developing nausea and vomiting for 3 days x12 times last week. Pt also started developing diarrhea. Pt has states to have a notable generalized pruritic rash for 3 months that has been worsening. He reports he has been seen by dermatology and was told that the rash is due to certain allergies from food and has been using an unknown cream for 1 month that does not relieve his symptoms. Pt recently admitted for management of bleeding permacath and acute hypoxic respiratory failure likely 2/2 COPD requiring intubation and vent support. Denies recent travel, recent antibiotic use, or sick contacts…but his nephrologist reaches out and is concerned about a certain diagnosis as he says three other patients that come for dialysis have recently been diagnosed with a certain diagnosis. On exam ee has a diffuse symmetrical rash and is scratching the while time. On careful examination there are small linear scabbed areas between his fingers.          9.3   8.97  )———–( 210                28.4  Absolute eosinophil count is >1000 134  |  97  |  51 —————————-