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Allan J Collins - One of the best experts on this subject based on the ideXlab platform.
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united states renal data system assessment of the impact of the national kidney foundation dialysis outcomes quality initiative guidelines
American Journal of Kidney Diseases, 2002Co-Authors: Allan J Collins, Jim Ebben, Tricia Roberts, Wendy L St Peter, Shu Cheng Chen, Edward ConstantiniAbstract:Abstract Since 1989, significant efforts have focused on improving the care of dialysis patients in the United States. Numerous organizations have developed clinical practice guidelines; however, few guidelines have received the broad support given to the National Kidney Foundation-Dialysis Outcomes Quality Initiative (DOQI). These guidelines, independently developed from an extensive review of the literature, include sections on dialysis adequacy, anemia treatment, and vascular access. To assess the impact of these guidelines on clinical practice, we evaluated data on Hematocrits, recombinant human erythropoietin dosing, hemodialysis adequacy, and simple fistula and dialysis catheter utilization using Medicare dialysis provider claims and Medicare Part B physician services. Hematocrits have increased steadily, with the exception of the period when the Hematocrit Measurement Audit was in effect. After cancellation of the policy, Hematocrits increased to the midpoint of the DOQI target range (34.4%). Although the level of dialysis therapy has stabilized, with the average urea reduction rate of 68% to 69.9% in 1997 to 1999 being slightly greater than the DOQI target of 65% or greater, geographic variability is apparent. Simple fistula placement rates increased by 45% during the pre-DOQI and post-DOQI period from 1994 to 1999. The use of temporary catheters decreased, whereas placement of permanent catheters has increased, which may reflect recommended practice guidelines. Although it appears that clinical practice guidelines have improved the clinical care of dialysis patients, considerable regional variations in care across the country should be given significant attention. © 2002 by the National Kidney Foundation, Inc.
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death hospitalization and economic associations among incident hemodialysis patients with Hematocrit values of 36 to 39
Journal of The American Society of Nephrology, 2001Co-Authors: Allan J Collins, Jennie Z, Jim Ebben, Tricia Roberts, Wendy L St Peter, Willard G ManningAbstract:Abstract . Anemia treatment with epoetin has led to dramatic increases in Hematocrit levels since 1989. Studies have demonstrated that morbidity and mortality rates are lower when Hematocrit values are within the Disease Outcomes Quality Initiative (DOQI) target range (33 to 36%). Recently, clinical studies demonstrated that patients without cardiovascular disease exhibited lower morbidity rates and improved cognitive function with Hematocrit values of >36%. One prospective trial, in contrast, demonstrated that normal Hematocrit values among patients with cardiac disease were associated with higher mortality rates. These conflicting results have led to concerns regarding the risks and benefits associated with Hematocrit values between 36 and 42%. To address these concerns, a recent cohort of 1996 to 1998 incident hemodialysis patients was studied, with assessments of the risks of death and hospitalization and the medical costs associated with Hematocrit values of >36%. Patients survived at least 9 mo after dialysis initiation, and comorbidity, disease severity, and Hematocrit levels were determined for months 4 to 9. Patients were grouped on the basis of Hematocrit values, i.e. ,
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Hematocrit levels and hospitalization risks in hemodialysis patients
Journal of The American Society of Nephrology, 1999Co-Authors: Hong Xia, Jennie Z, Jim Ebben, Allan J CollinsAbstract:Abstract . The association between Hematocrit level and future hospitalization risks in hemodialysis patients has not been fully investigated on a national level. A total of 71,717 prevalent Medicare hemodialysis patients who survived a 6-mo entry period from July 1 through December 31, 1993 were studied, and their risk of hospitalizations was evaluated the next year. Five Hematocrit groups were defined from Medicare recombinant human erythropoietin-treated patients: p = 0.0001) and a 7 to 18% increased risk with disease severity adjustment ( p = 0.0001). Patients in the 33 to p = 0.0001), with and without adjustment for disease severity. It is concluded that patients with Hematocrits of
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Hematocrit level and associated mortality in hemodialysis patients
Journal of The American Society of Nephrology, 1999Co-Authors: Jennie Z, Jim Ebben, Hong Xia, Allan J CollinsAbstract:Although a number of clinical studies have shown that increased Hematocrits are associated with improved outcomes in terms of cognitive function, reduced left ventricular hypertrophy, increased exercise tolerance, and improved quality of life, the optimal Hematocrit level associated with survival has yet to be determined. The association between Hematocrit levels and patient mortality was retrospectively studied in a prevalent Medicare hemodialysis cohort on a national scale. All patients survived a 6-mo entry period during which their Hematocrit levels were assessed, from July 1 through December 31, 1993, with follow-up from January 1 through December 31, 1994. Patient comorbid conditions relative to clinical events and severity of disease were determined from Medicare claims data and correlated with the entry period Hematocrit level. After adjusting for medical diseases, our results showed that patients with Hematocrit levels less than 30% had significantly higher risk of all-cause (12 to 33%) and cause-specific death, compared to patients with Hematocrits in the 30% to less than 33% range. Without severity of disease adjustment, patients with Hematocrit levels of 33% to less than 36% appear to have the lowest risk for all-cause and cardiac mortality. After adjusting for severity of disease, the impact of Hematocrit levels of 33% to less than 36% is vulnerable to the patient sample size but also demonstrates a further 4% reduced risk of death. Overall, these findings suggest that sustained increases in Hematocrit levels are associated with improved patient survival.
Jim Ebben - One of the best experts on this subject based on the ideXlab platform.
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united states renal data system assessment of the impact of the national kidney foundation dialysis outcomes quality initiative guidelines
American Journal of Kidney Diseases, 2002Co-Authors: Allan J Collins, Jim Ebben, Tricia Roberts, Wendy L St Peter, Shu Cheng Chen, Edward ConstantiniAbstract:Abstract Since 1989, significant efforts have focused on improving the care of dialysis patients in the United States. Numerous organizations have developed clinical practice guidelines; however, few guidelines have received the broad support given to the National Kidney Foundation-Dialysis Outcomes Quality Initiative (DOQI). These guidelines, independently developed from an extensive review of the literature, include sections on dialysis adequacy, anemia treatment, and vascular access. To assess the impact of these guidelines on clinical practice, we evaluated data on Hematocrits, recombinant human erythropoietin dosing, hemodialysis adequacy, and simple fistula and dialysis catheter utilization using Medicare dialysis provider claims and Medicare Part B physician services. Hematocrits have increased steadily, with the exception of the period when the Hematocrit Measurement Audit was in effect. After cancellation of the policy, Hematocrits increased to the midpoint of the DOQI target range (34.4%). Although the level of dialysis therapy has stabilized, with the average urea reduction rate of 68% to 69.9% in 1997 to 1999 being slightly greater than the DOQI target of 65% or greater, geographic variability is apparent. Simple fistula placement rates increased by 45% during the pre-DOQI and post-DOQI period from 1994 to 1999. The use of temporary catheters decreased, whereas placement of permanent catheters has increased, which may reflect recommended practice guidelines. Although it appears that clinical practice guidelines have improved the clinical care of dialysis patients, considerable regional variations in care across the country should be given significant attention. © 2002 by the National Kidney Foundation, Inc.
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death hospitalization and economic associations among incident hemodialysis patients with Hematocrit values of 36 to 39
Journal of The American Society of Nephrology, 2001Co-Authors: Allan J Collins, Jennie Z, Jim Ebben, Tricia Roberts, Wendy L St Peter, Willard G ManningAbstract:Abstract . Anemia treatment with epoetin has led to dramatic increases in Hematocrit levels since 1989. Studies have demonstrated that morbidity and mortality rates are lower when Hematocrit values are within the Disease Outcomes Quality Initiative (DOQI) target range (33 to 36%). Recently, clinical studies demonstrated that patients without cardiovascular disease exhibited lower morbidity rates and improved cognitive function with Hematocrit values of >36%. One prospective trial, in contrast, demonstrated that normal Hematocrit values among patients with cardiac disease were associated with higher mortality rates. These conflicting results have led to concerns regarding the risks and benefits associated with Hematocrit values between 36 and 42%. To address these concerns, a recent cohort of 1996 to 1998 incident hemodialysis patients was studied, with assessments of the risks of death and hospitalization and the medical costs associated with Hematocrit values of >36%. Patients survived at least 9 mo after dialysis initiation, and comorbidity, disease severity, and Hematocrit levels were determined for months 4 to 9. Patients were grouped on the basis of Hematocrit values, i.e. ,
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Hematocrit levels and hospitalization risks in hemodialysis patients
Journal of The American Society of Nephrology, 1999Co-Authors: Hong Xia, Jennie Z, Jim Ebben, Allan J CollinsAbstract:Abstract . The association between Hematocrit level and future hospitalization risks in hemodialysis patients has not been fully investigated on a national level. A total of 71,717 prevalent Medicare hemodialysis patients who survived a 6-mo entry period from July 1 through December 31, 1993 were studied, and their risk of hospitalizations was evaluated the next year. Five Hematocrit groups were defined from Medicare recombinant human erythropoietin-treated patients: p = 0.0001) and a 7 to 18% increased risk with disease severity adjustment ( p = 0.0001). Patients in the 33 to p = 0.0001), with and without adjustment for disease severity. It is concluded that patients with Hematocrits of
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Hematocrit level and associated mortality in hemodialysis patients
Journal of The American Society of Nephrology, 1999Co-Authors: Jennie Z, Jim Ebben, Hong Xia, Allan J CollinsAbstract:Although a number of clinical studies have shown that increased Hematocrits are associated with improved outcomes in terms of cognitive function, reduced left ventricular hypertrophy, increased exercise tolerance, and improved quality of life, the optimal Hematocrit level associated with survival has yet to be determined. The association between Hematocrit levels and patient mortality was retrospectively studied in a prevalent Medicare hemodialysis cohort on a national scale. All patients survived a 6-mo entry period during which their Hematocrit levels were assessed, from July 1 through December 31, 1993, with follow-up from January 1 through December 31, 1994. Patient comorbid conditions relative to clinical events and severity of disease were determined from Medicare claims data and correlated with the entry period Hematocrit level. After adjusting for medical diseases, our results showed that patients with Hematocrit levels less than 30% had significantly higher risk of all-cause (12 to 33%) and cause-specific death, compared to patients with Hematocrits in the 30% to less than 33% range. Without severity of disease adjustment, patients with Hematocrit levels of 33% to less than 36% appear to have the lowest risk for all-cause and cardiac mortality. After adjusting for severity of disease, the impact of Hematocrit levels of 33% to less than 36% is vulnerable to the patient sample size but also demonstrates a further 4% reduced risk of death. Overall, these findings suggest that sustained increases in Hematocrit levels are associated with improved patient survival.
Lijun Peng - One of the best experts on this subject based on the ideXlab platform.
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Evaluation of factors influencing accuracy in the analysis of succinylacetone in dried blood spots.
Clinica Chimica Acta, 2012Co-Authors: Minzhi Peng, Li Liu, Lijun PengAbstract:Abstract Background Dried blood spots offer specific advantages over conventional blood collection methods, but with certain limitations. This article aims to evaluate factors which affect succinylacetone test in dried blood spots. Methods Whole blood with defined Hematocrit and blood volume spiked with succinylacetone was spotted on filter paper, and analyzed by liquid chromatography − tandem mass spectrometry (LC-MS/MS). Four Hematocrit levels (30%, 40%, 50%, and 60%) and five blood volume levels (10, 30, 50, 70, and 100 μl) were tested. Results Succinylacetone concentration increased with increasing Hematocrit, large bias from added concentration was found to be - 45% when Hematocrit was 30%, as the difference of Hematocrit level between the calibrator and QC sample increased, the bias from nominal value was increased. Blood volume also has effect on succinylacetone concentration level, but the accuracy was 20% as the blood volume went to ≥ 70 μl. Conclusions Both Hematocrit and blood volume have effect on analysis of succinylacetone in dried blood spots, the effect of Hematocrit is more significant, due to Hematocrit level of majority Type I tyrosinemia patients is low, diagnoses may be missed by using dried blood spots to analysis.
Jennie Z - One of the best experts on this subject based on the ideXlab platform.
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death hospitalization and economic associations among incident hemodialysis patients with Hematocrit values of 36 to 39
Journal of The American Society of Nephrology, 2001Co-Authors: Allan J Collins, Jennie Z, Jim Ebben, Tricia Roberts, Wendy L St Peter, Willard G ManningAbstract:Abstract . Anemia treatment with epoetin has led to dramatic increases in Hematocrit levels since 1989. Studies have demonstrated that morbidity and mortality rates are lower when Hematocrit values are within the Disease Outcomes Quality Initiative (DOQI) target range (33 to 36%). Recently, clinical studies demonstrated that patients without cardiovascular disease exhibited lower morbidity rates and improved cognitive function with Hematocrit values of >36%. One prospective trial, in contrast, demonstrated that normal Hematocrit values among patients with cardiac disease were associated with higher mortality rates. These conflicting results have led to concerns regarding the risks and benefits associated with Hematocrit values between 36 and 42%. To address these concerns, a recent cohort of 1996 to 1998 incident hemodialysis patients was studied, with assessments of the risks of death and hospitalization and the medical costs associated with Hematocrit values of >36%. Patients survived at least 9 mo after dialysis initiation, and comorbidity, disease severity, and Hematocrit levels were determined for months 4 to 9. Patients were grouped on the basis of Hematocrit values, i.e. ,
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Hematocrit levels and hospitalization risks in hemodialysis patients
Journal of The American Society of Nephrology, 1999Co-Authors: Hong Xia, Jennie Z, Jim Ebben, Allan J CollinsAbstract:Abstract . The association between Hematocrit level and future hospitalization risks in hemodialysis patients has not been fully investigated on a national level. A total of 71,717 prevalent Medicare hemodialysis patients who survived a 6-mo entry period from July 1 through December 31, 1993 were studied, and their risk of hospitalizations was evaluated the next year. Five Hematocrit groups were defined from Medicare recombinant human erythropoietin-treated patients: p = 0.0001) and a 7 to 18% increased risk with disease severity adjustment ( p = 0.0001). Patients in the 33 to p = 0.0001), with and without adjustment for disease severity. It is concluded that patients with Hematocrits of
-
Hematocrit level and associated mortality in hemodialysis patients
Journal of The American Society of Nephrology, 1999Co-Authors: Jennie Z, Jim Ebben, Hong Xia, Allan J CollinsAbstract:Although a number of clinical studies have shown that increased Hematocrits are associated with improved outcomes in terms of cognitive function, reduced left ventricular hypertrophy, increased exercise tolerance, and improved quality of life, the optimal Hematocrit level associated with survival has yet to be determined. The association between Hematocrit levels and patient mortality was retrospectively studied in a prevalent Medicare hemodialysis cohort on a national scale. All patients survived a 6-mo entry period during which their Hematocrit levels were assessed, from July 1 through December 31, 1993, with follow-up from January 1 through December 31, 1994. Patient comorbid conditions relative to clinical events and severity of disease were determined from Medicare claims data and correlated with the entry period Hematocrit level. After adjusting for medical diseases, our results showed that patients with Hematocrit levels less than 30% had significantly higher risk of all-cause (12 to 33%) and cause-specific death, compared to patients with Hematocrits in the 30% to less than 33% range. Without severity of disease adjustment, patients with Hematocrit levels of 33% to less than 36% appear to have the lowest risk for all-cause and cardiac mortality. After adjusting for severity of disease, the impact of Hematocrit levels of 33% to less than 36% is vulnerable to the patient sample size but also demonstrates a further 4% reduced risk of death. Overall, these findings suggest that sustained increases in Hematocrit levels are associated with improved patient survival.
John E Mayer - One of the best experts on this subject based on the ideXlab platform.
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the effect of Hematocrit during hypothermic cardiopulmonary bypass in infant heart surgery results from the combined boston Hematocrit trials
The Journal of Thoracic and Cardiovascular Surgery, 2008Co-Authors: David Wypij, Richard A Jonas, David C Bellinger, Pedro J Del Nido, John E MayerAbstract:Objective Two randomized trials of Hematocrit strategy during hypothermic cardiopulmonary bypass in infant heart surgery have been performed. The first suggested worse outcomes were concentrated in patients with lower Hematocrit levels (approximately 20%), whereas the second suggested there was little benefit to increasing the Hematocrit level above 25%. The form of the relationship between continuous Hematocrit levels and outcomes requires further study. Methods In the two trials, 271 infants who underwent biventricular repair not involving the aortic arch were enrolled. Analysis was undertaken of the effects of Hematocrit level, as a continuous variable, at the onset of low-flow cardiopulmonary bypass. Results Psychomotor Development Index scores at age 1 year varied nonlinearly with Hematocrit levels, with increasing scores up to 23.5% Hematocrit (P Conclusions A Hematocrit level at the onset of low-flow cardiopulmonary bypass of approximately 24% or higher is associated with higher Psychomotor Development Index scores and reduced lactate levels. Because the effects of hemodilution may vary according to diagnosis, age at operation, bypass variables such as pH strategy and flow rate, and other perioperative factors, this study cannot ascertain a universally "safe" hemodilution level.
