Column: AKI and the mess we're in
|
|
- Cecil Farmer
- 5 years ago
- Views:
Transcription
1 This is a GREAT article. From: Masucci, Kara Sent: Friday, June 17, :31 AM To: Epstein, Jeffrey; Amspacher, Donna It s confusing to all best we can do is educate and go w/ the flow here s another really good article Column: AKI and the mess we're in September 16, 2010 Why AKI was demoted to CC status by CMS By Robert S. Gold, MD In March 2008, the National Kidney Foundation sent a letter to the National Centers for Health Statistics and asked that the term acute kidney injury (AKI) be an optional phrase for assigning ICD-9-CM code (i.e., that it was the current terminology for what used to be called acute renal failure. ) The request was granted. CDI specialists and coders looked at the definitions published through the Acute Kidney Injury Network and noted the criteria of stages 1, 2 and 3 of AKI. They began to ask physicians to document AKI whenever a patient s labs or urine output met those criteria. But in so doing we hurt ourselves and we hurt acute renal failure. And it s a shame. Now, with CMS resulting reduction of acute renal failure to CC, it now has no more severity attached to it than a simple urinary tract infection. Let s see where we went wrong and where we have to go to get it right. What AKI was Long ago, in a galaxy far, far away, we had the terms acute renal insufficiency and acute renal failure, and we had advice as to when each was appropriate terminology to use in order to assign the codes that were designed for those conditions. These codes included for renal insufficiency and for acute renal failure (notice I didn t use the term acute in the description of it was a nonessential modifier then). In the medical textbooks and within the medical community there was confusion in the terminology. For example, one medical textbook called the disease renal insufficiency and talked about progressive renal failure, and another textbook had a chapter entitled renal failure and spoke of anemia of renal insufficiency. AHA s Coding Clinic for ICD-9-CM, First Quarter 1993, p. 17, gave us the following definitions as guidance: Renal insufficiency It is generally accepted that renal insufficiency (code 593.9, Unspecified disorder of the kidney and ureter) refers to the early stages of renal impairment, determined by mildly abnormal elevated values of serum creatinine or BUN or diminished creatinine clearance. Clinical symptoms or other abnormal laboratory parameters may or may not be present but are usually minimal. The treatment of renal insufficiency depends to a very large extent on the underlying cause, with much attention given to the possibility of preventing progression to renal failure.
2 And on p. 18, Coding Clinic states: Renal failure Renal failure (code 584, Acute renal failure, code 585, Chronic renal failure, code 586, Renal failure, unspecified) is a progression of renal insufficiency where renal function is further impaired and overt clinical consequences, such as anemia, have developed. In essence, renal insufficiency is more of an abnormal laboratory assessment, while renal failure incorporates both abnormal laboratory and clinical findings. Back then, we looked for more than dehydration. We looked at more than a minor bump in creatinine. We looked for a sick patient. Sure, there may have been obstruction due to prostate cancer associated with a high creatinine level which returned to normal soon after suprapubic tube insertion. Yes, there may have been a patient found down for three days at home who came in with depressed mental status and rhabdomyolysis and responded to a couple of liters of IV fluids in a couple of days. And these patients came back, at least measurably, to normal. But they were sick and they had acute renal failure. And if a patient had two days of diarrhea altered mental status and responded to a glass of water to return the creatinine level to normal, we were happy with dehydration or prerenal azotemia or acute renal insufficiency because that s what is was. During this time, the renal world recognized the problems with lack of consistency and did some studies of acute decrease in renal function. It came up with mortality rates, rates of need for Renal Replacement Therapy (RRT or dialysis) and identified three pretty distinct levels of change in creatinine, change in Glomerular Filtration Rate (GFR) and change in urine production. It also identified two levels of long-term outcome: Return of measurable function, or no return of measurable function. They published their results and findings and called the system RIFLE. And all rejoiced. But there were two issues of massive importance that somehow didn t get into the subsequent evolution of acute damage to the kidneys. First, all of the studies were done in critical care units on critically ill patients. Certainly there was mortality but it was not clear whether the mortality came either from the renal damage or from the other conditions that the patients had at the time of death. It was merely an observation of mortality, regardless of the cause, in patients with measurable changes in renal function. Secondly, and they were very specific about this RIFLE only applied to intrarenal damage and did NOT apply to prerenal causes or postrenal causes. Basically, they said that the patients who actually had what they believed was acute tubular necrosis or hemorrhage of the kidney or infectious or immune destruction of renal parenchyma counted, and that the patients with elevations of creatinine due to dehydration without ATN or elevations of creatinine due to obstructing bladder cancer did not count. Several iterations of acute kidney injury studies followed to validate the results and recommendations above and the Acute Kidney Injury Network was formed. Again, all of the studies were done on critically ill patients on critical care units. But this group changed some of the rules. They eliminated GFR change as a valid measure and that was reasonable, especially if one didn t know what the patient s creatinine was before the insult and didn t know if the end result was a decrease in function or not. And other less important issues could impact GFR than the renal destructive condition. And then they said that their new staging of AKI was applicable to prerenal and postrenal causes because, in critically ill patient in critical care units, many had intrarenal damage because of prerenal and postrenal causes. The problem is that all of their patients again were critically ill and on critical care units. They did not look at creatinine change or urine output change in patients who didn t make it to the ICU. I think that this overlooked the 80+% of patients who have changes in creatinine or urine output that falls within their established criteria particularly of Stage 1.
3 As an aside, let s take a quick look at the term injury as it has pertained to other organs. There was a time that the pulmonology groups spoke of acute lung injury and there were a ton of publications talking about acute lung injury. What these investigators recognized is that the myriad of diseases that fall into the category of acute lung injury included the range of the most mild to the most severe and that the identification of the particular disease was more important than the vague term of injury. Thank goodness for that. Acute lung injury due to viral pneumonia is a totally different animal than acute lung injury from ARDS due to amniotic fluid embolism. And they now continue to clarify acute respiratory failure and distinguish it by pathologic change rather than dwelling on a new term that has no specificity for risk. Should the renal world follow this lead? It s not for me to say. What AKI is So we are left with a term, acute kidney injury, that has a myriad of levels of severity, and entering a reimbursement world where classification of failure of an organ the kidney is not an MCC at all. It s the only failure of an organ that is not a major condition. Why? I believe it s because the proper homework wasn t done. Because of the approved definition of to include AKI, all levels of AKI were included in the statistics generated through coding and CDI initiatives. And patients with a creatinine bump of 0.3 mg % due to dehydration who were treated with a glass of water were reported with and they went home in six hours when they cleared up mentally. We have met the enemy and they is us (with fond memories to the critters of the Okeefenokee swamp). Certainly, patients with stages 2 and 3 AKI are pretty darned sick and I would guess that a significant portion of patients with stage 1 are sick, as well. But it may not be from the renal disease specifically. They do have other organs! What AKI should be I see a couple of options to fix the problem and I ve worked with some of the authorities in renal disease medicine on this. The first is to create individual codes for the three stages of AKI (if we re going to stay with AKI). And with these levels, we could perform some analysis on all patients with the identified stages, not only on patients on ICUs. We could run statistics from ICU patients only, non-icu patients only, and all patients, just to see if there is an identifiable difference in mortality or in long term damage of renal function between the groups. By examining mortality, the rate of RRT, and cost, we would have a viable way to identify which patients are sick who has a major disease and who isn t. The second option is to follow the lead of the pulmonologists and dump AKI. From a coding, resource utilization, and CMS perspective, that s a great option. From the perspective of statistical analysis of risk of mortality, we need the breakdown of acute renal failure or acute kidney injury to be studied, analyzed, and classified appropriately. This cannot be accomplished by repeating the flawed studies of the past. Let s open it up to all comers. If the definition of the disease applies to all comers, the studies have to be done on all comers. In the meantime, CDI specialists and coders who are dealing with the rules as they exist must look at how sick the patient was and how the patient was treated. If the cause of a bump in creatinine is dehydration and the patient s treatment consists of a bolus of 500 cc of crystalloid in the ED and then regular diet, or consists of IV fluids at a normal rate of cc/hour with no efforts at real resuscitation of vital signs and perfusion, and if the patient responds rapidly to these treatments, the patient should be considered to have the old acute renal insufficiency and not coded to because it was not failure and it did not entail kidney injury. If we re going to use AKI, we have to be able to validate injury, reversible or not. There has to be some consequence.
4 In fact, Mehta and his group of international nephrologists unanimously agreed that the that application of the diagnostic criteria would be used only after an optimal state of hydration had been achieved. (Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury, Critical Care, volume 11, issue 2) Some consultants are now advising their clients to tell the docs to document acute tubular necrosis rather than AKI across the board. That s a very questionable practice and can do nothing but get you into trouble. If the case is one in which the patient probably has measurable injury of the kidneys, after fluid resuscitation, with acute tubular necrosis due to salicylate poisoning or sepsis or shock, sure call it acute tubular necrosis, because that s what it likely is. Even severe dehydration with significant hypovolemia can cause ATN but it should be significant. Got it? From: Epstein, Jeffrey Sent: Friday, June 17, :24 AM To: Masucci, Kara; Amspacher, Donna Sounds good. Once I fully understand this renal stuff, I will modify or add a slide to the pocket guide and maybe this will help (if we can make it very simple, maybe they will be open to learning). Just from a glance at the info you sent, it looks like acute renal failure and acute renal injury are the same and used interchangeably. Of course, clinically, they are different, so this is important to know. Later it says that acute renal insufficiency can be acute renal injury or acute renal failure, so I am confused again. I will read more If I am confused, you can bet the surgeons and the orthopedic docs are confused (at least I hope so ) From: Masucci, Kara Sent: Friday, June 17, :10 AM To: Epstein, Jeffrey; Amspacher, Donna HI Dr. Epstein, We agree so, we tailored their query by type education snapshot specifically for them. The coding minute is one hot topic for the month for everyone so that we can educate AKI is seen post-op in ortho, so it s worth at least sending it out to them (if they read it, they read it hopefully they do but, more importantly they have the reference to refer to if they need it). When we met with Dr. Dowling, he was interested in their top numbers on their query by type you ll see 2 education bubbles to try to teach those points specifically tailored to them -Kara From: Epstein, Jeffrey Sent: Friday, June 17, :07 AM To: Amspacher, Donna; Masucci, Kara Subject: FW: ortho.june2011.pptx Same comment.
5 I don t think these guys care about renal function coding. Maybe we should hammer home the acute blood loss anemia and other simpler concepts (ask Dowling what they may be open to learning) From: Amspacher, Donna Sent: Wednesday, June 15, :02 PM To: Dowling, William Cc: Epstein, Jeffrey; D'Auria, Joseph Subject: FW: ortho.june2011.pptx Attached please find the May report for the clinical documentation program. Let me know if you have any questions. We still strive for 100%. Donna
Acute Kidney Injury for the General Surgeon
Acute Kidney Injury for the General Surgeon UCSF Postgraduate Course in General Surgery Maui, HI March 20, 2011 Epidemiology & Definition Pathophysiology Clinical Studies Management Summary Hobart W. Harris,
More informationTreating Lung Cancer: Past, Present, & Future Dr. Ramiswamy Govindan Washington University November, 2009
Treating Lung Cancer: Past, Present, & Future Dr. Ramiswamy Govindan Washington University November, 2009 GRACE, the Global Resource for Advancing Cancer Education, is pleased to provide the following
More informationSepsis 911 Leader Script
Sepsis 911 Leader Script SLIDE 1 Sepsis 911 Welcome to Sepsis 9-1-1. My name is. I m speaking to you today about sepsis, something that you may not have heard of before you joined us today. You re not
More informationLondon Strategic Clinical Networks. My AKI. Guidance for patients with, or recovering from, acute kidney injury
London Strategic Clinical Networks My AKI Guidance for patients with, or recovering from, acute kidney injury Supporting the delivery of equitable, high quality AKI care through collaboration www.londonaki.net
More informationUnderstanding Acute Kidney Injury and Its Impact
Understanding Acute Kidney Injury and Its Impact Recorded on: March 7, 2013 Chi-Yuan Hsu, M.D., M.S. Chief of the Division of Nephrology, UCSF Department of Medicine UCSF Medical Center Raymond Hsu, M.D.
More informationChapter 1. Dysfunctional Behavioral Cycles
Chapter 1. Dysfunctional Behavioral Cycles For most people, the things they do their behavior are predictable. We can pretty much guess what someone is going to do in a similar situation in the future
More informationGROUP ONE: Dr. Langerhans Melodrama-cue Nurse Beta Type 1 Patient. GROUP TWO: Dr. Langerhans Melodrama-cue. GROUP THREE: Dr.
A Two Play with Melodrama Characters Listed by Groups (All characters may be played by either male or female student) 1 2 3 GROUP ONE: Type 1 Patient GROUP TWO: Type 1 Patient GROUP THREE: Type 2 patient
More informationMaking Connections: Early Detection Hearing and Intervention through the Medical Home Model Podcast Series
Making Connections: Early Detection Hearing and Intervention through the Medical Home Model Podcast Series Podcast 2 Utilization of the Teach-Back Methodology in Early Hearing Detection and Intervention
More informationCHIROPRACTIC ADJUSTMENTS TRIGGER STROKE
CHIROPRACTIC I m sending this out for your information!!!! I can see his points on a lot of the issues. I was taught by an AWESOME Chiropractor that an adjustment bruises tissue and that it usually took
More informationThe Current Research on Stretching and Flexibility is Flawed!
Transcript from: https://www.youtube.com/watch?v=qz0ot7tbbg0 Original Article: http://stretchcoach.com/articles/proper-stretching/ The Current Research on Stretching and Flexibility is Flawed! Hi. I'm
More informationThe symptom recognition and help- seeking experiences of men in Australia with testicular cancer: A qualitative study
The symptom recognition and help- seeking experiences of men in Australia with testicular cancer: A qualitative study Stephen Carbone,, Susan Burney, Fiona Newton & Gordon A. Walker Monash University gordon.walker@med.monash.edu.au
More informationTake new look emotions we see as negative may be our best friends (opposite to the script!)
Tony Robbins - emotions Take new look emotions we see as negative may be our best friends (opposite to the script!) How do people deal? 1. They avoid them try not to feel them. a. Rejection 2. I ll endure
More informationSpring Survey 2014 Report - ADULTS
RESPONDANTS Spring Survey 2014 Report - ADULTS Responses from the ADULTS section of our Spring Survey 2014 came from 108 (out of 668) participants who said they were born with a cleft and were over 18.
More informationAdvanced Concept of Nursing- II UNIT-VI Advance Nursing Management of Genitourinary (GU) Diseases.
In The Name of God (A PROJECT OF NEW LIFE COLLEGE OF NURSING KARACHI) Advanced Concept of Nursing- II UNIT-VI Advance Nursing Management of Genitourinary (GU) Diseases. Shahzad Bashir RN, BScN, DCHN,MScN
More informationWelcome to Progress in Community Health Partnerships latest episode of our Beyond the Manuscript podcast. In
Beyond the Manuscript 45 Podcast Interview Transcript Larkin Strong, Zeno Franco, Mark Flower Welcome to Progress in Community Health Partnerships latest episode of our Beyond the Manuscript podcast. In
More informationDr.Nahid Osman Ahmed 1
1 ILOS By the end of the lecture you should be able to Identify : Functions of the kidney and nephrons Signs and symptoms of AKI Risk factors to AKI Treatment alternatives 2 Acute kidney injury (AKI),
More informationI don t want to be here anymore. I m really worried about Clare. She s been acting different and something s not right
I just can t take what s happening at home anymore Clare 23 mins Instagram When your friend is thinking about suicide I don t want to be here anymore... I m really worried about Clare. She s been acting
More informationLetter to the teachers
Letter to the teachers Hello my name is Sasha Jacombs I m 12 years old and I have had Type 1 Diabetes since I was four years old. Some of the people reading this may not know what that is, so I had better
More informationUnraveling Recent Cervical Cancer Screening Updates and the Impact on Your Practice
Transcript Details This is a transcript of a continuing medical education (CME) activity accessible on the ReachMD network. Additional media formats for the activity and full activity details (including
More informationHow to Work with the Patterns That Sustain Depression
How to Work with the Patterns That Sustain Depression Module 5.2 - Transcript - pg. 1 How to Work with the Patterns That Sustain Depression How the Grieving Mind Fights Depression with Marsha Linehan,
More informationSection 4 Decision-making
Decision-making : Decision-making Summary Conversations about treatments Participants were asked to describe the conversation that they had with the clinician about treatment at diagnosis. The most common
More informationKeeping your kidneys young
Keeping your kidneys young Ramy M. Hanna MD FASN FACP Clinical Instructor David Geffen School of Medicine UCLA Health Department of Medicine Division of Nephrology June 25, 2018 The kidneys gets a lot
More informationMy Review of John Barban s Venus Factor (2015 Update and Bonus)
My Review of John Barban s Venus Factor (2015 Update and Bonus) December 26, 2013 by Erin B. White 202 Comments (Edit) This article was originally posted at EBWEIGHTLOSS.com Venus Factor is a diet program
More informationProf. Michael Joannidis Medical Intensive Care and Emergency Unit Department of Internal Medicine Medical University Innsbruck Innsbruck, Austria
1 di 27 Prevention of AKI: experimental promises and clinical realities Michael Joannidis, Innsbruck, Austria Chairs:Norbert Lameire, Ghent, Belgium Gert Mayer, Innsbruck, Austria Prof. Michael Joannidis
More informationQUESTIONS ANSWERED BY
Module 16 QUESTIONS ANSWERED BY BERNIE SIEGEL, MD 2 Q How do our thoughts and beliefs affect the health of our bodies? A You can t separate thoughts and beliefs from your body. What you think and what
More informationSam: Annette, can we just start out with a brief simple explanation of what neuro-immune diseases are, including ME and CFS?
Sam: Annette, can we just start out with a brief simple explanation of what neuro-immune diseases are, including ME and CFS? Annette: They are systemic diseases that impact the nervous system and immune
More informationLesson 8 STD & Responsible Actions
Lesson 8 STD & Responsible Actions Overview This lesson reinforces taking care of sexual health by teaching responsible actions around STD prevention. After discussing the responsibilities of a person
More informationElevated Serum Creatinine, a simplified approach
Elevated Serum Creatinine, a simplified approach Primary Care Update Creighton University School of Medicine. April 27 th, 2018 Disclosure Slide I have no disclosures and have no conflicts with this presentation.
More informationKIDNEY FAILURE. What causes kidney failure People who are most at risk for kidney failure usually have one or more of the following causes:
KIDNEY FAILURE Your kidneys are a pair of organs located toward your lower back. One kidney is on each side of your spine. They filter your blood and remove toxins from your body. Your kidneys send toxins
More informationWhat IPF Really Means: Discussions with Caregivers, Patients, & Healthcare Providers
Transcript Details This is a transcript of an educational program accessible on the ReachMD network. Details about the program and additional media formats for the program are accessible by visiting: https://reachmd.com/programs/conference-coverage/what-ipf-really-means-discussions-withcaregivers-patients-healthcare-providers/9926/
More informationCuriosity Vs. Judgment
Curiosity Vs. Judgment USING NEUROSCIENCE TO BUILD AND POWER OUR PEOPLE by Frank Keck Curiosity Vs. Judgment Copyright 2015 By Frank Keck of Excellerant, Inc. i Preface For more details on any of these
More informationWho's Driving the DRG Bus: Selecting the Appropriate Principal Diagnosis
7th Annual Association for Clinical Documentation Improvement Specialists Conference Who's Driving the DRG Bus: Selecting the Appropriate Principal Diagnosis MedPartners CDI: Karen Newhouser, RN, BSN,
More informationRini Purwanti Sekretaris PD IPDI Jatim
Kidney Emergency Rini Purwanti Sekretaris PD IPDI Jatim overview The kidneys are a pair of small ( about the size of your fist-sized ), bean shaped organs that lie on either side of your spine, located
More informationAcute kidney injury definition, causes and pathophysiology. Financial Disclosure. Some History Trivia. Key Points. What is AKI
Acute kidney injury definition, causes and pathophysiology Financial Disclosure Current support: Center for Sepsis and Critical Illness Award P50 GM-111152 from the National Institute of General Medical
More informationDefinition : Stages : ( RIFLE vs. AKIN ) Causes and classification : Pre-renal Renal Post- renal Clinical manifestations and Complication Management
AKI Definition : Stages : ( RIFLE vs. AKIN ) Causes and classification : Pre-renal Renal Post- renal Clinical manifestations and Complication Management and indications for RRT Etiology prerenal causes
More informationManaging Your Emotions
Managing Your Emotions I love to ask What s your story? (pause) You immediately had an answer to that question, right? HOW you responded in your mind is very telling. What I want to talk about in this
More informationACUTE KIDNEY INJURY FOCUS ON OBSTETRICS DONNA HIGGINS, CLINICAL NURSE EDUCATOR, NORTHERN LINCOLNSHIRE HOSPITALS NHS FOUNDATION TRUST
ACUTE KIDNEY INJURY FOCUS ON OBSTETRICS DONNA HIGGINS, CLINICAL NURSE EDUCATOR, NORTHERN LINCOLNSHIRE HOSPITALS NHS FOUNDATION TRUST AIMS & OBJECTIVES Review the functions of the kidney Identify renal
More informationNoshima: Any suggestions for making the HIV update better?
Realizing some members on the call were not able to attend the last CAB meeting, Noshima started things off by introducing herself and the other UNC members who will now be assisting with the CAB. After
More informationWhy Is Mommy Like She Is?
Why Is Mommy Like She Is? A Book For Kids About PTSD Deployment Edition Patience H. C. Mason Patience Press High Springs, Florida PP Patience Press 2010 by Patience Mason All rights reserved. No part of
More informationAKI: definitions, detection & pitfalls. Jon Murray
AKI: definitions, detection & pitfalls Jon Murray Previous conventional definition Acute renal failure (ARF) An abrupt and sustained decline in renal excretory function due to a reduction in glomerular
More informationGSB of EDA Meeting Minutes
Hello Everyone! We held a General Service Board meeting on July 8, 2015. Starting July 15, 2015, there is a new number for the General Service Board meeting. To join the GSB meeting after July 15, 2015,
More informationTrending Issues in Inpatient Coding HEALTHCON 2017, Las Vegas, NV May 8, 2017 Peggy Turner, BS, RHIT, CDIP, CCS, CCS-P
Trending Issues in Inpatient Coding HEALTHCON 2017, Las Vegas, NV May 8, 2017 Peggy Turner, BS, RHIT, CDIP, CCS, CCS-P Trending Issues in Inpatient Coding The intent of this presentation is to discuss
More informationNon-protein nitrogenous substances (NPN)
Non-protein nitrogenous substances (NPN) A simple, inexpensive screening test a routine urinalysis is often the first test conducted if kidney problems are suspected. A small, randomly collected urine
More informationH2O to Go! Hydration. It s easier than you think to get dehydrated. No water, no go...
H2O to Go! Hydration You ve probably heard those narrators on the National Geographic specials say things like, Water gives life, or, Without water there could be no life. They may be overly dramatic,
More informationDr Rodney Itaki Lecturer Anatomical Pathology Discipline. University of Papua New Guinea School of Medicine & Health Sciences Division of Pathology
Acute Renal Failure & Malaria Dr Rodney Itaki Lecturer Anatomical Pathology Discipline University of Papua New Guinea School of Medicine & Health Sciences Division of Pathology Definitions Inability of
More informationDigestion Assessment Guide
K I C K I T N A T U R A L L Y. C O M Digestion Assessment Guide Digestion Episodes The secret to improving Digestive Issues is Understanding the underlying cause for YOUR digestive issues. Most digestive
More informationBladder Cancer Knowing the Risks and Warning Signs. Part II: Warning Signs
Bladder Cancer Knowing the Risks and Warning Signs Part II: Warning Signs May 8, 2018 Presented by: is the Director of Urologic Oncology at MedStar Washington Hospital Center and an Assistant Professor
More informationDOCTOR: The last time I saw you and your 6-year old son Julio was about 2 months ago?
DOCTOR: The last time I saw you and your 6-year old son Julio was about 2 months ago? MOTHER: Um, ya, I think that was our first time here. DOCTOR: Do you remember if you got an Asthma Action Plan? MOTHER:
More informationPresented by Jodie M. Dewey, Doctoral Candidate Loyola University 2010 CPATH Conference April 30 th, 2010
Presented by Jodie M. Dewey, Doctoral Candidate Loyola University 2010 CPATH Conference April 30 th, 2010 SAMPLE: 21 WPATH Members TYPE OF PROFESSIONAL NUMBER INTERVIEWED LICENSED SOCIAL WORKERS 2 CLINICAL
More information4 INSTRUCTOR GUIDELINES
STAGE: Recent Quitter You are a clinician working on the vascular surgery service and are about to discharge Mr. McCray, a 58-year-old patient who recently underwent a femoral artery bypass graft for peripheral
More informationUniversity of Groningen. Acute kidney injury after cardiac surgery Loef, Berthus Gerard
University of Groningen Acute kidney injury after cardiac surgery Loef, Berthus Gerard IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it.
More informationHospital Inpatient Quality Reporting (IQR) Program
SEP-1 Early Management Bundle, Severe Sepsis/Septic Shock: v5.5a Measure FAQs Presentation Transcript Noel Albritton, MSN, RN Lead Solutions Specialist, Hospital Inpatient and Outpatient Process and Structural
More informationDisorders of the kidney. Urine analysis. Nephrotic and nephritic syndrome.
Disorders of the kidney. Urine analysis. Nephrotic and nephritic syndrome. Azotemia and Urinary Abnormalities Disturbances in urine volume oliguria, anuria, polyuria Abnormalities of urine sediment red
More informationWhat You Need to Know about a Kidney Transplant
Page 1 of 5 What You Need to Know about a Kidney Transplant This information will help you understand the risks, benefits and possible complications involved in a kidney transplant. Please read it carefully.
More informationFlu Vaccines: Questions and Answers
Flu Vaccines: Questions and s Question 1 Does the flu shot give me the flu? Does the flu shot give me the flu? I heard people get sick after the shot. Well, I m really glad you asked that question about
More informationCohen: Well, hi to my listeners, this is Dr. Marc Cohen, and I am happy again to discuss with you advances in the efficacy and safety of TNF
Cohen: Well, hi to my listeners, this is Dr. Marc Cohen, and I am happy again to discuss with you advances in the efficacy and safety of TNF inhibitors. This is a subject of great interest to me and I
More informationNews from ASH: Updates on Lymphoma and Other Blood Cancers ASH Conference Coverage December 8, 2008 Andrew Evens, D.O.
News from ASH: Updates on Lymphoma and Other Blood Cancers ASH Conference Coverage December 8, 2008 Andrew Evens, D.O. Please remember the opinions expressed on Patient Power are not necessarily the views
More informationRCP : Regional Update in Medicine Acute Kidney Injury : A Renal Problem?
RCP : Regional Update in Medicine Acute Kidney Injury : A Renal Problem? Lui G Forni : Consultant Intensivist & Nephrologist Faculty of Health Sciences : University of Surrey Disclosures Research Funding
More informationScouter Support Training Participant Workbook
Scouter Support Training Participant Workbook Version 2.1 June 15, 2011 Minor changes November 5, 2012 For use with the Scouter Support Playbook Scouter Support Training: Trainer s Manual 2 Participant
More informationAlterations of Renal and Urinary Tract Function
Alterations of Renal and Urinary Tract Function Chapter 29 Urinary Tract Obstruction Urinary tract obstruction is an interference with the flow of urine at any site along the urinary tract The obstruction
More informationBeattie Learning Disabilities Continued Part 2 - Transcript
Beattie Learning Disabilities Continued Part 2 - Transcript In class Tuesday we introduced learning disabilities and looked at a couple of different activities that are consistent and representative of
More informationAcute Kidney Injury in the ED
+ Acute Kidney Injury in the ED + Dr Eric Clark, MD FRCPC University of Ottawa Canada Canadian Association of Emergency Physicians + Outline 1. Diagnostic challenges 2. ED treatment 3. Contrast induced
More informationBlood pressure and kidney disease
Blood pressure and High blood pressure is the second most common cause of. Your heart pumps your blood through tubes (blood vessels) called arteries and veins. When your blood moves through the blood vessels,
More informationWEEK. MPharm Programme. Acute Kidney Injury. Alan M. Green MPHM13: Acute Kidney Injury. Slide 1 of 47
MPharm Programme Acute Kidney Injury Alan M. Green 2017 Slide 1 of 47 Overview Renal Function What is it? Why does it matter? What causes it? Who is at risk? What can we (Pharmacists) do? How do you recognise
More informationANAEMIA MANAGEMENT: THE KDIGO RECOMMENDATIONS Patrick S. Parfrey, St. John s, Canada
ANAEMIA MANAGEMENT: THE KDIGO RECOMMENDATIONS Patrick S. Parfrey, St. John s, Canada Chair: Kai- Uwe Eckardt, Erlangen, Germany Pierre- Yves Martin, Geneva, Switzerland Prof. Patrick S. Parfrey Division
More informationScript: Placebo Effect Matt Biggers, Amelia Hulbert, Kathryn Valchar
Script: Placebo Effect Matt Biggers, Amelia Hulbert, Kathryn Valchar Cast of Characters Scene 1 Doctor Ruth Cannon Patient 1 Mark Bridges Patient 2 Stella Brody Doctor Doris Bradley Open on a doctor s
More informationChoosing Life: empowerment, Action, Results! CLEAR Menu Sessions. Adherence 1: Understanding My Medications and Adherence
Choosing Life: empowerment, Action, Results! CLEAR Menu Sessions Adherence 1: Understanding My Medications and Adherence This page intentionally left blank. Understanding My Medications and Adherence Session
More informationIt is very common to get symptoms like cough, sore throat, runny nose and watery eyes. Usually when you
A Publication of the National Center for Farmworker Health Let s Learn about Respiratory Infections It is very common to get symptoms like cough, sore throat, runny nose and watery eyes. Usually when you
More informationUpper Tract Urothelial Carcinomas (UTUCs)
Upper Tract Urothelial Carcinomas (UTUCs) Part II: UTUC Treatment Options November 14, 2017 Moderated by: Presented by: Gary D. Steinberg, MD University of Chicago Medical Center Ahmad Shabsigh, MD Ohio
More informationLet me introduce you to her. That s Barbara Scribner who joins us from Kent, Washington. Barbara, thank you so much for joining us.
Lung Cancer: Detection and Early Intervention Webcast November 30, 2009 Douglas E. Wood, M.D. Jason Chien, M.D., M.S. Barbara Scribner Please remember the opinions expressed on Patient Power are not necessarily
More informationWhy Is It That Men Can t Say What They Mean, Or Do What They Say? - An In Depth Explanation
Why Is It That Men Can t Say What They Mean, Or Do What They Say? - An In Depth Explanation It s that moment where you feel as though a man sounds downright hypocritical, dishonest, inconsiderate, deceptive,
More informationEp #89: Diets. Full Episode Transcript. Brooke Castillo. With Your Host. The Life Coach School Podcast with Brooke Castillo
Ep #89: Diets Full Episode Transcript With Your Host Brooke Castillo Welcome to the Life Coach School Podcast Welcome to The Life Coach School Podcast, where it s all about real clients, real problems,
More informationLet s get clear about what a Diarrhea Flare is
Before we begin, we need to go through a couple of disclaimers. 1) We re clearly not Doctors and don t claim to be. In fact, we don t want to be although we used to be very sick and now we re not, that
More informationHelping Kidney Stones Pass: Use of Alpha Antagonists Frankly Speaking EP7
Helping Kidney Stones Pass: Use of Alpha Antagonists Frankly Speaking EP7 Transcript Details This is a transcript of an episode from the podcast series Frankly Speaking accessible at Pri- Med.com. Additional
More informationMotivational Strategies for Challenging Situations
Motivational Strategies for Challenging Situations Mandy Fauble, PhD, LCSW Executive Director, Safe Harbor Behavioral Health of UPMC Hamot James, Wyler, MA, CPRP Scenario When I talked to her about my
More informationHere are a few ideas to help you cope and get through this learning period:
Coping with Diabetes When you have diabetes you may feel unwell and have to deal with the fact that you have a life long disease. You also have to learn about taking care of yourself. You play an active
More informationThe role of the Nephrologist in Acute Kidney Injury. Rebecca Brown Consultant Nephrologist Royal Liverpool University Hospital
The role of the Nephrologist in Acute Kidney Injury Rebecca Brown Consultant Nephrologist Royal Liverpool University Hospital Overview Impact of AKI Need for change Who needs a Nephrologist Are we making
More informationHigher Risk, Lowered Age: New Colorectal Cancer Screening Guidelines
Transcript Details This is a transcript of an educational program accessible on the ReachMD network. Details about the program and additional media formats for the program are accessible by visiting: https://reachmd.com/programs/clinicians-roundtable/higher-risk-lowered-age-new-colorectal-cancerscreening-guidelines/10309/
More informationDON'T WORK AND WHAT YOU CAN DO ABOUT IT. BY DR. RHONA EPSTEIN
5 REASONS WHY DIETS DON'T WORK...... AND WHAT YOU CAN DO ABOUT IT. BY DR. RHONA EPSTEIN Note: This is an excerpt from Food Triggers: End Your Cravings, Eat Well, and Live Better. The book is written for
More informationStaying Fit With Kidney Disease
Staying Fit With Kidney Disease Many people with chronic kidney disease (CKD) are enjoying the improved health and increased physical strength that come from a regular exercise routine. You may want to
More informationYes, I just said, HOGWASH. I would have stronger words if not for the family audience.
Welcome Welcome and thank you for for purchasing the Fat Loss Forever Program. This plan is a special THANK YOU for being an action taker and purchasing FLF. We are obviously biased when we say that this
More informationDraft 0-25 special educational needs (SEN) Code of Practice: young disabled people s views
Draft 0-25 special educational needs (SEN) Code of Practice: young disabled people s views Young people s consultation When I used to on have the my reviews at school they never used to tell me what was
More informationDefinitions. You & Your New Transplant ` 38
Definitions Acute Short, relatively severe Analgesic Pain medicine Anemia A low number of red blood cells Anesthetic Medication that dulls sensation in order to reduce pain Acute Tubular Necrosis (ATN)
More informationDisclosures. Acute Kidney Injury. Outline. Do electronic alerts improve the care of patients with AKI? 5/9/2015
Disclosures Acute Kidney Injury Kathleen D. Liu, MD, PhD May 2015 Consultant: Achaogen, Chemocentryx, Durect, Z Pharma Clinical trials adjudication: Astute Funding: NIH Stockholder: Amgen Outline patients
More informationCASE NO. 07-XXXXXXXXX10A
IN THE COUNTY COURT OF THE TH JUDICIL CIRCUIT, IN ND FOR BROWRD COUNTY, FLORID CSE NO. 0-XXXXXXXXX0 0 STTE OF FLORID, Plaintiff, VS. KK, Defendant. Fort Lauderdale, Florida ugust, 0 DEPOSITION OF DR. IYUN
More informationEnglish for living in the UK. The Cervical Smear
English for living in the UK The Cervical Smear At a glance... Objective This class is aimed at teaching new arrivals to the UK about the need for cervical screening and to reduce the anxiety a smear test
More information5 MISTAKES MIGRAINEURS MAKE
5 MISTAKES MIGRAINEURS MAKE Discover the most common mistakes, traps and pitfalls that even the smart and savvy migraineurs can fall into if not forewarned. A brief & practical guide for the modern migraine
More informationInterviewer: Tell us about the workshops you taught on Self-Determination.
INTERVIEW WITH JAMIE POPE This is an edited translation of an interview by Jelica Nuccio on August 26, 2011. Jelica began by explaining the project (a curriculum for SSPs, and for Deaf-Blind people regarding
More informationAbout Your Dialysis Treatment
PATIENT & CAREGIVER EDUCATION About Your Dialysis Treatment This information explains dialysis at Memorial Sloan Kettering (MSK). Your Kidneys and Their Functions Your kidneys are 2 bean-shaped organs
More informationTHE RETURN OF GERRY THE GERM:
THE RETURN OF GERRY THE GERM: Bigger, Better, and Booger By David I. Levine & Echo Yupan Lu Illustrations by Charlotte Passot Hi! My name is Gerry the Germ. I love to get people sick. There is just ONE
More informationAcute Kidney Injury (AKI) Undergraduate nurse education
Acute Kidney Injury (AKI) Undergraduate nurse education Year One Developed Summer 2017 Overview Basic A & P of: Urinary system Kidneys Followed by: Introduction to Acute Kidney Injury Urinary System The
More information18 INSTRUCTOR GUIDELINES
STAGE: Ready to Quit You are a community pharmacist and have been approached by a 16-year-old girl, Nicole Green, who would like your advice on how she can quit smoking. She says, I never thought it would
More informationHospital Inpatient Quality Reporting (IQR) Program
SEP-1 Early Management Bundle, Severe Sepsis/Septic Shock: v5.4 Measure Updates Presentation Transcript Speakers Noel Albritton, RN, BS Lead Solutions Specialist Hospital Inpatient and Outpatient Process
More informationBilateral Wilms Tumor: New Protocols and Procedures by Dawn Wolf
www.complexchild.com Bilateral Wilms Tumor: New Protocols and Procedures by Dawn Wolf Masses...tumors...oncologist...straight to the ER... Those were the words the doctor was using as he talked about our
More informationLiving With Lung Cancer. Patient Education Guide
Living With Lung Cancer Patient Education Guide A M E R I C A N C O L L E G E O F C H E S T P H Y S I C I A N S Your doctor has just told you that you have lung cancer. Even if you thought that you might
More informationIngredients of Difficult Conversations
Ingredients of Difficult Conversations Differing Perceptions In most difficult conversations, there are different perceptions of the same reality. I think I'm right and the person with whom I disagree
More informationTSM Protocol for Physicians
1 TSM Protocol for Physicians Dear, fellow physicians: I am a medical physician much like you, probably. I have volunteered to concisely detail how I use The Sinclair Method (TSM), a refined version of
More informationChoosing Life: Empowerment, Action, Results! CLEAR Menu Sessions. Substance Use Risk 2: What Are My External Drug and Alcohol Triggers?
Choosing Life: Empowerment, Action, Results! CLEAR Menu Sessions Substance Use Risk 2: What Are My External Drug and Alcohol Triggers? This page intentionally left blank. What Are My External Drug and
More informationAcute Kidney Injury. Elaine Go, RN, MSN, CNN-NP. Clinical Educator, St. Joseph Hospital Renal Center Nurse Practitioner NSMG Orange, Ca
Acute Kidney Injury Elaine Go, RN, MSN, CNN-NP Clinical Educator, St. Joseph Hospital Renal Center Nurse Practitioner NSMG Orange, Ca Objectives Causes and etiologies of Acute Kidney Injury (AKI) Care
More informationThanks. You Might Also Like. I look forward helping you focus your instruction and save time prepping.
Thanks Connect Thank you for downloading my product. I truly appreciate your support and look forward to hearing your feedback. You can connect with me and find many free activities and strategies over
More information