|Commenced in January 2007||Frequency: Monthly||Edition: International||Paper Count: 12|
The increasing costs of healthcare on one hand, and the rise in aging population and associated chronic disease, on the other hand, are putting increasing burden on the current health care system in many Western countries. For instance, chronic kidney disease (CKD) is a common disease and in Europe, the cost of renal replacement therapy (RRT) is very significant to the total health care cost. However, the recent advancement in healthcare technology, provide the opportunity to treat patients at home in their own comfort. It is evident that home healthcare offers numerous advantages apparently, low costs and high patients’ quality of life. Despite these advantages, the intake of home hemodialysis (HHD) therapy is still low in particular in Germany. Many factors are accounted for the low number of HHD intake. However, this paper is focusing on patients’ safety-related factors of current HHD practices in Germany. The aim of this paper is to analyze the current HHD practices in Germany and to identify risks related factors if any exist. A case study has been conducted in a dialysis center which consists of four dialysis centers in the south of Germany. In total, these dialysis centers have 350 chronic dialysis patients, of which, four patients are on HHD. The centers have 126 staff which includes six nephrologists and 120 other staff i.e. nurses and administration. The results of the study revealed several risk-related factors. Most importantly, these centers do not offer allied health services at the pre-dialysis stage, the HHD training did not have an established curriculum; however, they have just recently developed the first version. Only a soft copy of the machine manual is offered to patients. Surprisingly, the management was not aware of any standard available for home assessment and installation. The home assessment is done by a third party (i.e. the machines and equipment provider) and they may not consider the hygienic quality of the patient’s home. The type of machine provided to patients at home is similar to the one in the center. The model may not be suitable at home because of its size and complexity. Even though portable hemodialysis machines, which are specially designed for home use, are available in the market such as the NxStage series. Besides the type of machine, no assistance is offered for space management at home in particular for placing the machine. Moreover, the centers do not offer remote assistance to patients and their carer at home. However, telephonic assistance is available. Furthermore, no alternative is offered if a carer is not available. In addition, the centers are lacking medical staff including nephrologists and renal nurses.
In addition to kidney transplant, renal replacement therapy involves hemodialysis and peritoneal dialysis (PD). PD possesses advantages such as maintaining stable physiological blood status and blood pressure, alleviating anemia, and improving mobility, which make it an ideal method for at-home dialysis treatment. However, potential danger still exists despite the numerous advantages of PD, particularly when patients require dialysis exchange four to five times a day, during which improper operation can easily lead to peritonitis. The process of draining and filling is called an exchange and takes about 30 to 40 minutes. Connecting the transfer set requires sterile technique. Transfer set may require a new cap each time that it disconnects from the bag after an exchange. There are many chances to get infection due to unsafe behavior (ex: hand tremor, poor eyesight and weakness, cap fall-down). The proposed semi-automatic connection mechanism used in the PD can greatly reduce infection chances. This light-weight connection device is portable. The device also does not require using throughout the entire process. It is capable of significantly improving quality of life. Therefore, it is very promising to adopt in home care application.
Neuropsychological problems are more common in hemodialysis (HD) patients than in healthy individuals. The aim of this study was to investigate the effect of long term HD on memory types of HD patients. To assess the different type of memory, we used memory parts of the Persian Papers and Pencil Cognitive assessment package (PCAP) and Addenbrooke's Cognitive Examination (ACE-R). Our study included 80 HD patients of whom 39 had less than six months of HD and 41 patients and another group which had a history of HD more than six months. The population had a mean age of 51.60 years old and 27.5% of them were female. The scores of patients who have been hemodialyzed for a long time (median time of HD was up to 4 years) had lower score in anterograde, explicit, visual, recall and recognition memory (5.44±1.07, 9.49±3.472, 22.805±6.6913, 5.59±10.435, 11.02±3.190 score) than the HD patients who underwent HD for a shorter term, where the median time was 3 to 5 months (P<0.01). The regression result shows that, by increasing the HD duration, all memory types are reduced (R2=0.600, P<0.01). The present study demonstrated that HD patients who were under HD for a long time had significantly lower scores in the different types of memory. However, additional researches are needed in this area.
Chronic Kidney Disease is considered a serious public health problem. The exploitation of resilience has been guided by studies conducted in various contexts, especially in hemodialysis, since the impact of diagnosis and restrictions produced during the treatment process because, despite advances in treatment, remains the stigma of the disease and the feeling of pain, hopelessness, low self-esteem and disability. The objective was to evaluate the level of resilience of patients in chronic renal dialysis. This is a descriptive, correlational, cross and quantitative research. The sample consisted of 100 patients from a Renal Replacement Therapy Unit in the countryside of São Paulo. For data collection were used the characterization instrument of Participants and the Resilience Scale. There was a predominance of males (70.0%) were Caucasian (45.0%) and had completed elementary education (34.0%). The average score obtained through the Resilience Scale was 131.3 (± 20.06) points. The resiliency level submitted may be considered satisfactory. It is expected that this study will assist in the preparation of programs and actions in order to avoid possible situations of crises faced by chronic renal patients.
Most thermal power plants use steam as working fluid in their power cycle. Therefore, in addition to fuel, water is the other main input for thermal plants. Water and steam must be highly pure in order to protect the systems from corrosion, scaling and biofouling. Pure process water is produced in water treatment plants having many several treatment methods. Treatment plant design is selected depending on raw water source and required water quality. Although working principle of fossil-fuel fired thermal power plants are same, there is no standard design and equipment arrangement valid for all thermal power plant utility systems. Besides that, there are many other technology evaluation and selection criteria for designing the most optimal water systems meeting the requirements such as local conditions, environmental restrictions, electricity and other consumables availability and transport, process water sources and scarcity, land use constraints etc. Aim of this study is explaining the adopted methodology for technology selection for process water preparation and industrial waste water treatment plant in a thermal power plant project located in Tufanbeyli, Adana Province in Turkey. Thermal power plant is fired with indigenous lignite coal extracted from adjacent lignite reserves. This paper addresses all above-mentioned factors affecting the thermal power plant water treatment facilities (demineralization + waste water treatment) design and describes the ultimate design of Tufanbeyli Thermal Power Plant Water Treatment Plant.
Ammonium nitrate (AN) is produced by the reaction of ammonia and nitric acid, and a waste condensate is obtained. The condensate contains pure AN in concentration up to 10g/L. The salt content in the condensate is too high to discharge immediately into the river thus it must be treated. This study is concerned with the treatment of condensates from an industrial AN production by combination of electrodialysis (ED) and electrodeionization (EDI). The condensate concentration was in range 1.9–2.5g/L of AN. A pilot ED module with 25 membrane pairs following by a laboratory EDI module with 10 membrane pairs operated continuously during 800 hours. Results confirmed that the combination of ED and EDI is suitable for the condensate treatment.
Many inherited diseases and non-hereditary disorders are common in the development of renal cystic diseases. Polycystic kidney disease (PKD) is a disorder developed within the kidneys in which grouping of cysts filled with water like fluid. PKD is responsible for 5-10% of end-stage renal failure treated by dialysis or transplantation. New experimental models, application of molecular biology techniques have provided new insights into the pathogenesis of PKD. Researchers are showing keen interest for developing an automated system by applying computer aided techniques for the diagnosis of diseases. In this paper a multilayered feed forward neural network with one hidden layer is constructed, trained and tested by applying back propagation learning rule for the diagnosis of PKD based on physical symptoms and test results of urinalysis collected from the individual patients. The data collected from 50 patients are used to train and test the network. Among these samples, 75% of the data used for training and remaining 25% of the data are used for testing purpose. Further, this trained network is used to implement for new samples. The output results in normality and abnormality of the patient.
Haemodialysis (HD) is a procedure saving patient lives around the world, unfortunately it brings numerous complications. Oxidative stress is one of the major factors which lead to erythrocytes destruction during extracorporeal circulation. Repeated HD procedures destroy blood elements and the organism is not able to keep up with their production. 30 HD procedures on healthy sheep were performed to evaluate effects of such treatment. Oxidative stress study was performed together with an analysis of basic blood parameters and empirical assessment of dialyzer condition after the procedure. A reversible decline in absolute leukocyte count, during first 30 min of HD, was observed. Blood clots were formed in the area of the blood inlet and outlet of the dialyzer. Our results are consistent with outcomes presented throughout the literature specifically with respect to the effects observed in humans and will provide a basis to evaluate methods for blood protection during haemodialysis.