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Search Results: 1 - 10 of 53057 matches for " David Gilbertson "
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Associations of anemia persistency with medical expenditures in Medicare ESRD patients on dialysis
Jiannong Liu, Haifeng Guo, David Gilbertson, Robert Foley, et al.
Therapeutics and Clinical Risk Management , 2009, DOI: http://dx.doi.org/10.2147/TCRM.S4856
Abstract: ssociations of anemia persistency with medical expenditures in Medicare ESRD patients on dialysis Original Research (3635) Total Article Views Authors: Jiannong Liu, Haifeng Guo, David Gilbertson, Robert Foley, et al. Published Date April 2009 Volume 2009:5 Pages 319 - 330 DOI: http://dx.doi.org/10.2147/TCRM.S4856 Jiannong Liu1, Haifeng Guo1, David Gilbertson1, Robert Foley1,2, Allan Collins1,2 1Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN, USA; 2Department of Medicine, University of Minnesota, Minneapolis, MN, USA Abstract: Most end-stage renal disease (ESRD) patients begin renal replacement therapy with hemoglobin levels below the recommended US National Kidney Foundation Dialysis Outcomes Quality Initiative Guidelines lower level of 110 g/L. Although most patients eventually reach this target, the time required varies substantially. This study aimed to determine whether length of time with below-target hemoglobin levels after dialysis initiation is associated with medical costs, and if so, whether intermediate factors underlie the associations. US patients initiating dialysis in 2002 were studied using the Centers for Medicare and Medicaid Services ESRD database. Anemia persistence (time in months with hemoglobin below 110 g/L) was determined in a six-month entry period, and outcomes were assessed in the subsequent six-month follow-up period. The structural equation modeling technique was used to evaluate associations between persistent anemia and medical costs and to determine intermediate factors for these associations. The study included 28,985 patients. Mean per-patient-per-month medical cost was $6267 (standard deviation $5713) in the six-month follow-up period. Each additional month with hemoglobin below 110 g/L was associated with an 8.9% increment in medical cost. The increased cost was associated with increased erythropoietin use and blood transfusions, and increased rates of hospitalization and vascular access procedures in the follow-up period.
Associations of anemia persistency with medical expenditures in Medicare ESRD patients on dialysis
Jiannong Liu,Haifeng Guo,David Gilbertson,Robert Foley
Therapeutics and Clinical Risk Management , 2009,
Abstract: Jiannong Liu1, Haifeng Guo1, David Gilbertson1, Robert Foley1,2, Allan Collins1,21Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN, USA; 2Department of Medicine, University of Minnesota, Minneapolis, MN, USAAbstract: Most end-stage renal disease (ESRD) patients begin renal replacement therapy with hemoglobin levels below the recommended US National Kidney Foundation Dialysis Outcomes Quality Initiative Guidelines lower level of 110 g/L. Although most patients eventually reach this target, the time required varies substantially. This study aimed to determine whether length of time with below-target hemoglobin levels after dialysis initiation is associated with medical costs, and if so, whether intermediate factors underlie the associations. US patients initiating dialysis in 2002 were studied using the Centers for Medicare and Medicaid Services ESRD database. Anemia persistence (time in months with hemoglobin below 110 g/L) was determined in a six-month entry period, and outcomes were assessed in the subsequent six-month follow-up period. The structural equation modeling technique was used to evaluate associations between persistent anemia and medical costs and to determine intermediate factors for these associations. The study included 28,985 patients. Mean per-patient-per-month medical cost was $6267 (standard deviation $5713) in the six-month follow-up period. Each additional month with hemoglobin below 110 g/L was associated with an 8.9% increment in medical cost. The increased cost was associated with increased erythropoietin use and blood transfusions, and increased rates of hospitalization and vascular access procedures in the follow-up period. Keywords: anemia persistency, end-stage renal disease, medical costs, structural equation modeling
Comparison of methodologies to define hemodialysis patients hyporesponsive to epoetin and impact on counts and characteristics
Gilbertson David T,Peng Yi,Arneson Thomas J,Dunning Stephan
BMC Nephrology , 2013, DOI: 10.1186/1471-2369-14-44
Abstract: Background Some hemodialysis patients require large doses of erythropoiesis-stimulating agents (ESAs) to manage anemia. These patients, termed “ESA hyporesponsive,” have been characterized using various definitions. We applied three definitions of hyporesponsiveness to a large, national cohort of hemodialysis patients to assess the impact of definition on counts and on characteristics associated with hyporesponsiveness. Methods We studied point-prevalent hemodialysis patients on May 1, 2008, with Medicare as primary payer, who survived through December 31, 2008. Included patients received recombinant human erythropoietin (EPO) in each month, August-December. Hyporesponsiveness definitions were: above the ninetieth percentile of total monthly EPO dose; above the ninetieth percentile of total monthly EPO dose divided by weight in kg; above the ninetieth percentile of total monthly EPO dose divided by hemoglobin level. Hyporesponsiveness was further classified as chronic, acute, or other. Comorbid conditions were assessed before and concurrent with the hyporesponsive period. Results Women, African Americans, and patients aged <40 years, with cause of renal failure other than diabetes or hypertension, or longer dialysis duration, were more likely to be hyporesponsive. Antecedent comorbid conditions most predictive of any subsequent hyporesponsiveness were congestive heart failure, peripheral vascular disease, other cardiac disease, gastrointestinal bleeding, and cancer. Concurrent comorbid conditions most strongly associated with any hyporesponsiveness were gastrointestinal bleeding and cancer. All conditions were somewhat more likely when ascertained concurrently. Comorbidity burdens were lowest for non-hyporesponsive patients. Conclusions As associations were similar between patient characteristics and three methods of characterizing EPO hyporesponsiveness, the simplest definition using EPO dose can be used.
So Far-So Close: Remembering Clive Robbins: Invited Editorial
Simon Gilbertson
Voices: A World Forum for Music Therapy , 2012,
Abstract:
The Silent Epidemic of Road Traffic Injury: What Can Music Therapists do About It?
Simon Gilbertson
Voices: A World Forum for Music Therapy , 2008,
Abstract: Can music therapists do anything about road traffic injury and its effects? Road traffic crashes are responsible for up to 1.2 million deaths and up to 50 million injuries globally each year. One quarter of these injuries are traumatic brain injuries. In this paper, the literature related to music therapy and traumatic brain injury is reviewed. By analysing this literature, it becomes apparent that music therapists have provided for those injured almost to the exclusion of those affected by traumatic brain injury, the family, the community and the society. Using literature related to trauma, the author discusses ways in which music therapists may change the scope of music therapy in relation to caring for people affected by road traffic injury and considers the role music therapists may play in the prevention of road traffic injury in the future.
The Silent Epidemic of Road Traffic Injury: What Can Music Therapists do About It?
Simon Gilbertson
Voices: A World Forum for Music Therapy , 2008,
Abstract: Can music therapists do anything about road traffic injury and its effects? Road traffic crashes are responsible for up to 1.2 million deaths and up to 50 million injuries globally each year. One quarter of these injuries are traumatic brain injuries. In this paper, the literature related to music therapy and traumatic brain injury is reviewed. By analysing this literature, it becomes apparent that music therapists have provided for those injured almost to the exclusion of those affected by traumatic brain injury, the family, the community and the society. Using literature related to trauma, the author discusses ways in which music therapists may change the scope of music therapy in relation to caring for people affected by road traffic injury and considers the role music therapists may play in the prevention of road traffic injury in the future.
Comparative mortality of hemodialysis patients at for-profit and not-for-profit dialysis facilities in the United States, 1998 to 2003: A retrospective analysis
Robert N Foley, Qiao Fan, Jiannong Liu, David T Gilbertson, Eric D Weinhandl, Shu-Cheng Chen, Allan J Collins
BMC Nephrology , 2008, DOI: 10.1186/1471-2369-9-6
Abstract: Our primary objective was to compare the mortality hazards of patients initiating hemodialysis at for-profit and not-for-profit centers in the United States between 1998 and 2003. For-profit status of dialysis facilities was determined after subjects received 6 months of dialysis therapy, and mean follow-up was 1.7 years.Of the study population (N = 205,076), 79.9% were dialyzed in for-profit facilities after 6 months of dialysis therapy. Dialysis at for-profit facilities was associated with higher urea reduction ratios, hemoglobin levels (including levels above 12 and 13 g/dL [120 and 130 g/L]), epoetin doses, and use of intravenous iron, and less use of blood transfusions and lower proportions of patients on the transplant waiting-list (P < 0.05). Patients dialyzed at for-profit and at not-for-profit facilities had similar mortality risks (adjusted hazards ratio 1.02, 95% CI 0.99–1.06, P = 0.143).While hemodialysis treatment at for-profit and not-for-profit dialysis facilities is associated with different patterns of clinical benchmark achievement, mortality rates are similar.The incidence rate of treated end-stage renal disease (ESRD) has increased fourfold in the last quarter century [1]. In 2003, the cost to the US Medicare program for a typical dialysis patient was estimated at $67,000 and ESRD accounted for 6.7% of all Medicare expenditures, compared with 4.8% in 1991 [1]. Reimbursement for dialysis services, which has changed little since 1982, is delivered on a per-treatment basis, irrespective of medical, logistical, and infrastructure complexities; cost containment has been a concern since the early days of the Medicare ESRD program [2]. Not surprisingly, for-profit dialysis facilities have become the norm, with freestanding, private, chain-affiliated facilities exhibiting the most prolific growth [1].The concern that treatment at for-profit dialysis facilities may be associated with lower survival rates has been debated for decades [3-12]. Two comparativ
Myelodysplastic Syndrome with t(1;7) Associated with Marked Dysmegakarypoiesis & Severe Thrombocytopenia: A Case Report and Review of the Literature
Michael Gilbertson,Annabel Tuckfield,Surender Juneja
Case Reports in Hematology , 2012, DOI: 10.1155/2012/167653
Abstract: We present the case of a 70-year-old woman who had a bone marrow examination performed to investigate marked thrombocytopenia in the context of a recent history of metastatic glucagonoma. Surprisingly this identified marked dysmegakaryopoiesis and fulfilled diagnostic criteria for refractory cytopenia with multilineage dysplasia, with a relatively uncommon associated cytogenetic lesion t(1;7). We present the case and review the literature of this cytogenetic lesion.
An Unusual Complication of an Infiltrated Intravenous Catheter: Heterotopic Ossification in a Newborn
Lavi Nissim,Dorothy Gilbertson-Dahdal
Journal of Radiology Case Reports , 2008, DOI: 10.3941/jrcr.v2i2.30
Abstract: Heterotopic ossification refers to formation of lamellar bone in soft tissues. The etiology is diverse and includes genetic, post-traumatic, and metabolic causes. Elicitation of bone morphogenic proteins are thought to play a key role in the pathogenic process. Initially, heterotopic ossification presents a clinical and radiographic challenge in that it can be mistaken for other more worrisome entities which present with calcified soft tissue masses. However, a spontaneous clinical resolution, temporal relationship to an inciting agent, and radiographic evolution to a peripherally-calcified lesion are all clues to the diagnosis. Here we present the clinical and radiographic features of heterotopic ossification as a result of an infiltrated peripheral IV.
Myelodysplastic Syndrome with t(1;7) Associated with Marked Dysmegakarypoiesis & Severe Thrombocytopenia: A Case Report and Review of the Literature
Michael Gilbertson,Annabel Tuckfield,Surender Juneja
Case Reports in Hematology , 2012, DOI: 10.1155/2012/167653
Abstract: We present the case of a 70-year-old woman who had a bone marrow examination performed to investigate marked thrombocytopenia in the context of a recent history of metastatic glucagonoma. Surprisingly this identified marked dysmegakaryopoiesis and fulfilled diagnostic criteria for refractory cytopenia with multilineage dysplasia, with a relatively uncommon associated cytogenetic lesion t(1;7). We present the case and review the literature of this cytogenetic lesion. 1. Case Presentation A 70-year-old woman was referred to our institution in June 2010 for further evaluation of moderate to severe pancytopenia. She was clinically relatively well with no recent infective symptoms or bleeding events. Her past history was noteworthy for metastatic glucagonoma diagnosed in June 2009, for which she had undergone surgical resection and radiolabelled octreotide therapy. She had an FDG-PET scan which confirmed metabolic remission in March 2010 and was scheduled to continue octreotide therapy at the time of referral however, the degree of thrombocytopenia limited the patient’s tolerability of further octreotide. She also had insulin requiring type 2 diabetes as a result of the glucagonoma. Her initial full blood parameters (FBE) were Hb 107?g/L, MCV 105 fL, WBC 2.1 × 109/L (Neutrophils 1.6 × 109/L, Lymphocytes 0.3 × 109/L), and Platelets 20 × 109/L. The blood film showed mild red cell anisocytosis with macrocytosis and moderate numbers of tear-drop red cells (Figure 1). Granulocytes showed mild left shift and dysplastic changes (hyposegmented and hypersegmented neutrophils). Platelets were markedly reduced and showed marked anisocytosis with many large forms as well as abnormal granulation. Renal and liver functions were within normal limits. Previous FBEs performed at our institution in September 2008 revealed completely normal full blood parameters. Clinical examination was non-contributory. Figure 1: Mild red cell anisocytosis with macrocytosis and moderate numbers of tear drops. Mild granulocyte left shift and dysplastic changes (hyposegmented and hypersegmented neutrophils). Peripheral blood film. Wrights stain ×200. Bone marrow examination was undertaken to exclude metastatic disease—of which there was none demonstrated on three heamatoxylin and eosin (H&E) levels and relevant neuroendocrine immunohistochemistry (cytokeratin and synaptophysin Figures 5 and 6, resp.). Surprisingly, the bone marrow showed mild increase in megakaryocyte numbers with marked megakaryocyte dysplasia; although they appeared normal in size, the nucleus of most megakaryocytes was
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