A5084114336- Palliative Care and End-of-Life Issues
- Dialysis and Renal Disease Management
- Organ Donation and Transplantation
- Patient Dignity and Privacy
- Poverty, Education, and Child Welfare
- Chronic Kidney Disease and Diabetes
- Health Systems, Economic Evaluations, Quality of Life
- Healthcare cost, quality, practices
- Global Maternal and Child Health
- Patient-Provider Communication in Healthcare
- Education Systems and Policy
- Healthcare Policy and Management
- Microfinance and Financial Inclusion
- Ethics in medical practice
- Community Development and Social Impact
- COVID-19 and healthcare impacts
- Urban and Rural Development Challenges
- Ethics and Legal Issues in Pediatric Healthcare
- Intimate Partner and Family Violence
- Fiscal Policy and Economic Growth
- Syphilis Diagnosis and Treatment
- Taxation and Compliance Studies
- Grief, Bereavement, and Mental Health
- Parental Involvement in Education
- Local Governance and Development
Monash University Malaysia
2025
University of Washington
2015-2024
VA Puget Sound Health Care System
2016-2024
Optical Air Data Systems (United States)
2023
Health Services Research & Development
2019-2022
University of Puget Sound
2021
Denver Health Medical Center
2020
University of Colorado Denver
2020
Center for Innovation
2020
World Bank
2012-2014
acteristics and risk taking (P=.32), stress from uncertainty (P=.30), malpractice fear (P=.26) were not predictive of head CT use.Even after controlling for the patient factors, physician identity was still strongly associated with use (PϽ.001), suggesting that significant variation in exists among physicians.Comment.We found ED trauma patients explained by factors tolerance or fear.Variation physicians has been demonstrated previously, 8,9 but specifically patients.Because well-validated...
<h3>Importance</h3> Little is known about how US clinicians have responded to resource limitation during the coronavirus disease 2019 (COVID-19) pandemic. <h3>Objective</h3> To describe perspectives and experiences of involved in institutional planning for and/or patient care <h3>Design, Setting, Participants</h3> This qualitative study used inductive thematic analysis semistructured interviews conducted April May 2020 with a national group (eg, intensivists, nephrologists, nurses) clinical...
We report an experiment in 3,000 villages that tested whether incentives improve aid efficacy. Villages received block grants for maternal and child health education incorporated relative performance incentives. Subdistricts were randomized into incentives, otherwise identical program without or control. Incentives initially improved preventative indicators, particularly underdeveloped areas, spending efficiency increased. While school enrollments overall, had no differential impact on...
<h3>Importance</h3> Although maintenance dialysis is a treatment choice with potential benefits and harms, little known about care practices for patients advanced chronic kidney disease who forgo this treatment. <h3>Objective</h3> To describe how decisions not to start unfold in the clinical setting. <h3>Design, Setting, Participants</h3> A qualitative study was performed of documentation electronic medical records 851 adults receiving from US Veterans Health Administration between January...
Little is known about the circumstances under which older adults initiate chronic dialysis and subsequent outcomes. Using national registry data, we conducted a retrospective analysis of 416,657 Medicare beneficiaries aged ≥67 years who initiated between January 1995 December 2008. Our goal was to define relationship health care intensity around time initiation survival patterns hospitalization, use intensive procedures (mechanical ventilation, feeding tube placement, cardiopulmonary...
There is often considerable uncertainty about the optimal time to initiate maintenance dialysis in individual patients and little medical evidence guide this decision.To gain a better understanding of factors influencing timing initiation clinical practice.A qualitative analysis was conducted using electronic records from Department Veterans Affairs (VA) national random sample 1691 for whom decision occurred VA between January 1, 2000, December 31, 2009. Data took place June 1 November 30,...
It is not known what proportion of United States patients with advanced CKD go on to receive RRT. In other developed countries, receipt RRT highly age dependent and the exception rather than rule at older ages.We conducted a retrospective study national cohort 28,568 adults who were receiving care within US Department Veteran Affairs had sustained eGFR <15 ml/min per 1.73 m2 between January 1, 2000 December 31, 2009. We used linked administrative data from Renal Data System, Affairs,...
For older adults with kidney failure who are not referred for transplant, medical management is an alternative to dialysis.
Using the technique of genomic footprinting, we demonstrate cadmium-inducible protection from dimethyl sulfate (DMS) modification guanine residues in vivo five metal-responsive elements (MREs) promoter rat metallothionein 1 (MT-1) gene. We also identify a site extreme DMS hyperreactivity which, like MRE protection, occurs only after metal ion induction. With this hyperreactive as an indicator, can measure kinetics induction and deinduction. Changes intracellular concentrations are reflected...
Understanding cardiopulmonary resuscitation (CPR) practices and outcomes can help to support advance care planning in patients receiving maintenance dialysis.To characterize patterns of in-hospital CPR US adults dialysis.This national retrospective cohort study studied 663,734 Medicare beneficiaries 18 years or older from a comprehensive registry for end-stage renal disease who initiated dialysis January 1, 2000, through December 31, 2010.Receipt 91 days after initiation the time death,...
Rationale & ObjectiveIt is relatively unusual for US patients with advanced chronic kidney disease (CKD) to forgo initiation of maintenance dialysis. Our objective was describe practice approaches nephrologists who have provided conservative care members this population.Study DesignQualitative study using semi-structured interviews.Setting ParticipantsA national sample 21 experienced in caring CKD decided not start dialysis.Analytical ApproachGrounded theory methods identify dominant themes...
Objective The COVID-19 pandemic has transformed healthcare delivery in the USA, but there been little empirical work describing impact of these changes on clinicians. We conducted a study to address following question: how impacted US clinicians’ professional roles and relationships? Design Inductive thematic analysis semi-structured interviews. Setting Clinical settings across USA April May 2020. Participants Clinicians with leadership and/or clinical during pandemic. Measures Emergent...
Available decision aids for patients about treatment of advanced chronic kidney disease (CKD) often lack information on conservative management (CKM). We assessed the feasibility and acceptability a aid CKM among with CKD their family members.Randomized pilot trial.Patients aged≥75 years stage 4 or 5 members at medical centers in greater Seattle area between August 2020 December 2021.Usual care without CKM.Acceptability was by attrition rates initial study visit (T1) 3-month follow-up...
Whether secular trends in eGFR at dialysis initiation reflect changes clinical presentation over time is unknown. We reviewed the medical records of a random sample patients who initiated maintenance Department Veterans Affairs (VA) fiscal years 2000-2009 (n=1691) to characterize relation initiation. Between 2000-2004 and 2005-2009, mean increased from 9.8±5.8 11.0±5.5 ml/min per 1.73 m(2) (P<0.001), percentage with an 10-15 23.4% 29.9% (P=0.002), eGFR>15 12.1% 16.3% (P=0.01). The proportion...