Anxiety and depression linked to physical impairments in dialysis patients

With the rate of chronic kidney disease on the rise among older Americans, researchers seeking to improve patients’ quality of life studied a group of adults undergoing hemodialysis and found their higher rates of depression andanxiety could be associated with their impaired physical exercise capability and reduced daily physical activity, according a new study published online by the Journal of Renal Nutrition.

The researchers studied 72 relatively healthy maintenance hemodialysis patients and compared them to 39 healthy adults who were not on dialysis. They found significantly higher rates of anxiety and depression among the dialysis patients, than among the adults who were not on dialysis. They also found the dialysis patients suffering from depression and anxiety had the greatest impairments in physical exercise performance and daily physical activity.

“Adults undergoing dialysis often have less daily physical activities than other adults, but little was known about what, if any, effect this reduced activity had on their mental state,” said Joel D. Kopple, MD, Los Angeles Biomedical Research Institute (LA BioMed) lead researcher. “Our study found an association between reduced daily physical activities and depression and anxiety. Also, the capacity to perform physical exercise was diminished in these patients. These findings provide a strong rationale for studying whether increased daily physical activity can reduce depression and anxiety among adults undergoing dialysis.”

Each person enrolled in the study took walks, climbed stairs and engaged in other physical activities so that researchers could determine their physical abilities. The researchers gauged their depression and anxiety using standardized tests and found 43% of the dialysis patients had anxiety and 33% suffered from depression. In comparison, only 2.5% of the adults who were not on dialysis had anxiety and only 5% of them suffered from depression.

Approximately one in 10 Americans has some form of chronic kidney disease, and the incidence of chronic kidney disease among people ages 65 and older more than doubled between 2000 and 2008, according to the Centers for Disease Control and Prevention.

Hemodialysis is a life-preserving treatment for hundreds of thousands of Americans with kidney failure. It is a medical procedure to remove fluid and waste products from the blood and to correct electrolyte imbalances. This is accomplished using a machine and a dialyzer, which is sometimes described as an “artificial kidney.”

“Research is important to improve the quality of life of patients undergoing dialysis,” said Dr. Kopple. “With the growing population of people undergoing dialysis, this research is growing in importance.”

http://www.medicalnewstoday.com/releases/277460.php

Picture courtesy of www.rncentral.com

 

More physician visits could help prevent re-hospitalization of dialysis patients

 

More frequent face-to-face physician visits in the month following hospital discharge may help reduce a kidney failure patient’s chances of needing to be sent back to the hospital, according to a study appearing in an upcoming issue of theJournal of the American Society of Nephrology (JASN). The study also found that closer outpatient monitoring of kidney failure patients following hospital discharge could cut health care costs significantly.

Kevin Erickson, MD, from Stanford University, and his colleagues looked to see if more outpatient physician visits to patients might cut down on readmissions among kidney failure patients.

Highlights of the study

• In 26,613 patients who were on dialysis between 2004 and 2009, one additional provider visit in the month following hospital discharge was estimated to reduce the probability of 30-day hospital readmission by 3.5%.
• The reduction in 30-day hospital readmission ranged from 0.5% to 4.9% in an additional four groups of patients tested, depending on population density around facilities, facility profit status, and patient Medicaid eligibility.
• At current Medicare reimbursement rates, the effort to see patients one additional time in the month following hospital discharge could lead to 31,370 fewer hospitalizations per year, and $240 million per year saved.

“This research is important by highlighting the role that outpatient nephrology providers have in preventing hospital readmissions for patients receiving hemodialysis,” said. Erickson.

 

In an accompanying editorial, Raymond Hakim, MD, from Vanderbilt University, and Allan Collins, MD, FACP, from the University of Minnesota, Minneapolis, noted that the study’s findings should be considered in any plan to reduce rehospitalizations in the dialysis population. They also noted several other interventions and services by the health care team that can lead to reduced rehospitalization. “Reducing the high rates of rehospitalization in [kidney failure] patients is clearly in the best interests of patients and in the financial interests of dialysis facilities providing maintenance dialysis services, as well as the hospitals to which patients are occasionally admitted to receive acute services,” they wrote.

Study co-authors include Jay Bhattacharya, MD, PhD, Wolfgang Winkelmayer, MD, ScD, and Glenn Chertow, MD, MPH.

The article, entitled “Physician Visits and 30-Day Hospital Readmissions in Patients Receiving Hemodialysis,” appears online at http://jasn.asnjournals.org/

http://www.nephrologynews.com/articles/110222-more-physician-visits-could-help-prevent-re-hospitalization-of-dialysis-patients

 

Picture courtesy to http://jasn.asnjournals.org/

 

 

 

Muscle mass of dialysis patients linked with physical function and quality of life

Dialysis patients with more muscle mass had better scores on a 6-minute walking test as well as better scores on physical and mental health questionnaires in a study appearing in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN). The findings suggest that physical activity that builds muscle mass may help improve the health and quality of life of dialysis patients.

Physical functional ability is often significantly impaired in patients on maintenance hemodialysis. Srinivasan Beddhu, MD (University of Utah), Macy Martinson, MD (University of Utah), T. Alp Ikizler (Vanderbilt University), and their colleagues wondered whether modifiable factors such as body size and body composition could influence dialysis patients’ physical function and quality of life.

To investigate, the researchers assessed 105 maintenance dialysis patients’ body mass index (BMI), waist circumference, and measurements of mid-thigh muscle area and intra-abdominal fat area. They also tested how far patients could walk in 6 minutes, and they examined other measures of physical and mental health through questionnaires. Assessments were made at the start of the study, after 6 months, and after 12 months.

The investigators found that higher BMI levels at the start of the study were linked with shorter 6-minute walking distances measured at both at the start of the study and at later time points. Results were similar for waist circumference and intra-abdominal fat. On the other hand, higher levels of mid-thigh muscle – which indicates higher muscle mass – were linked with longer 6-minute walking distances. After adjusting for BMI, increases in mid-thigh muscle were also strongly linked with higher physical and mental health scores at the start of the study, but only weakly so at later time points.

“Because this study shows that higher muscle mass is associated with better physical function and quality of life in dialysis patients, interventions such as increased physical activity that decrease fat mass and increase muscle mass are likely to improve physical function, quality of life, and survival in dialysis patients,” said Dr. Beddhu. “Such interventions need to be tested in clinical trials.”

The findings may help explain the “obesity paradox” associated with dialysis patients, which relates to the prolonged survival sometimes seen in obese patients compared with normal-weight patients. “The obesity paradox has been interpreted in earlier studies as fat is good. Some have even argued that weight loss should be discouraged in dialysis patients,” said Dr. Beddhu. “But the situation is more nuanced. This study provides a better understanding of the role of body composition in dialysis patients.”

http://www.medicalnewstoday.com/releases/275960.php

Picture courtesy of medicineworld.org

 

 

 

Quick, simple blood test for solid cancers looks feasible

The idea of a general, quick and simple blood test for a diverse range of cancers just came closer to reality with news of a new study published in Nature Medicine.

Researchers from Stanford University School of Medicine have devised an ultra-sensitive method for finding DNA from cancer tumors in the bloodstream.

Previous research has already shown circulating tumor DNA holds promise as a biomarker for cancer, but existing methods for detecting it are not sufficiently sensitive and do not cover a diverse range of cancers.

Ways to increase the sensitivity and coverage of such tests exist, but these are cumbersome and time-consuming, and need lots of steps to customize for individual patients, so they are not feasible for use in clinics.

The new approach promises to change that. It is highly sensitive and specific and should be broadly applicable to a range of cancers, say the researchers.

Their new test identified around half of patients with stage 1 lung cancer and all patients with stage 2 or higher disease. They also showed the circulation tumor DNA was highly correlated with tumor volume estimated using CT and PET scans.

This suggests an approach based on CAPP-Seq could monitor tumors at a fraction of the cost of present methods that rely on imaging studies.

Team faced two major hurdles

In developing the test, they faced two major hurdles, as Maximilian Diehn, co-senior author and assistant professor of radiation oncology, explains:

“First, the technique needs to be very sensitive to detect the very small amounts of tumor DNA present in the blood. Second, to be clinically useful it’s necessary to have a test that works off the shelf for the majority of patients with a given cancer.”

Co-senior author, Ash Alizadeh, assistant professor of medicine, explains why they are interested in developing a general way to detect and measure disease burden in solid cancers, and how they are approaching it:

“Blood cancers like leukemias can be easier to monitor than solid tumors through ease of access to the blood. By developing a general method for monitoring circulating tumor DNA, we’re in effect trying to transform solid tumors into liquid tumors that can be detected and tracked more easily.”

Cancer cells divide and die, even without treatment. When a cancer cell dies, the DNA in its nucleus escapes into the bloodstream. This is present in small concentrations; something like 1 in 1,000 or 10,000 bits of DNA in the blood can be from a dead cancer cell in a person with cancer.

Even in patients with advanced cancer, the vast majority of DNA circulating in their blood is from healthy, normal cells.

So a test that can quickly and non-invasively monitor the tiny concentrations of cancer cell DNA would be really useful to clinicians who need to estimate the size of the tumor, how it changes over time, and monitor a patient’s response to treatment.

New test boosts existing methods for analyzing DNA

The team found a way to do this by boosting existing methods for extracting, processing and analyzing the DNA. They called their approach CAPP-Seq (which is short for Cancer Personalized Profiling by deep Sequencing).

CAPP-Seq is sensitive enough to detect one molecule of tumor DNA among 10,000 DNA molecules from healthy cells in the blood.

In their study, they tested blood from patients with non-small-cell lung cancer (this includes most lung cancers, like adenocarcinomas, squamous cell carcinoma and large cell carcinoma). But they say the approach should also work with solid cancers that occur in other parts of the body.

And while they see the test one day being used to follow the progress of tumors in patients already diagnosed with cancer, the researchers say it also has potential as a cancer screening tool for healthy and at-risk populations.

Although the test is described as a general test for cancer, it by no means just looks for one pattern of DNA. Each cancer is genetically different in different patients, but there are certain sets of DNA mutations that are the same across patients with the same cancer.

So the challenge was to find which DNA sequences were the ones most likely to indicate the presence of a given cancer across a diverse range of patients.

Test looks for as many of the known mutations for a given cancer as possible

This is why the team decided to take a population-based approach. They looked in national databases that contain DNA sequences of tumors from thousands of patients, and identified the points on the cancer DNA that are different from normal DNA.

From this information, they were able to compile a fingerprint for each cancer type made up of all the DNA mutations recorded – these include insertions or deletions of short pieces of genetic material, plus where sequences of DNA have been shuffled around or even flipped over.

But while no patient will have all these mutations, nearly all of them will have at least one of them. This makes it possible to compile a test that looks for as many of the known mutations for a given cancer as possible. But it only has to find one of them to strike a positive.

The next stage of the study was to examine the genome of the 407 patients with non-small-cell lung cancer recruited for the study.

Prof. Alizadeh explains how, using an approach called bioinformatics, they looked for regions in the genome enriched for cancer-associated mutations:

“We looked for which genes are most commonly altered, and used computational approaches to identify what we call the genetic architecture of the cancer. That allowed us to identify the part of the genome that would be best to identify and track the disease.”

They identified 139 genes that only represent 0.004% of the human genome but are recurrently mutated in non-small-cell lung cancer.

“By sequencing only those regions of the genome that are highly enriched for cancer mutations, we’re able to keep costs down and identify multiple mutations per patient,” Prof. Diehn says.

Other approaches tend to look for single, well-known mutations that occur frequently, but not necessarily in every patient, with a particular cancer. Because it looks for more than one mutation, the CAPP-Seq approach is more sensitive and gives researchers more flexibility in how to track the cancer over time.

Prof. Diehn explains that there are currently no reliable biomarkers for lung cancer, a cancer that claims the most lives. He says they are “very excited” about the study results because “a personalized, clinically useful biomarker could revolutionize how we detect and manage this devastating disease.”

The team is now working on ways to quickly home in on patient-specific mutations and methods to suppress background noise in a sample so they can identify even very tiny amounts of cancer DNA that might be in it.

CAPP-Seq may also have possibilities as a prognostic tool

The researchers say CAPP-Seq may also have potential as a prognostic tool. When they tested one patient thought to have been successfully treated for lung cancer, they found low levels of circulating tumor DNA. The cancer came back in that patient, and they died.

Conversely, scans of another patient who was treated for early stage disease showed a mass that was thought to indicate disease was still present. But CAPP-Seq found no circulating tumor DNA in that patient’s blood, and they remained disease-free for the rest of the study period.

And in a third patient, CAPP-Seq found a mutation that makes non-small-cell lung cancer resistant to the drug that is commonly used to treat it.

Prof. Diehn says this suggests another use for the approach – to monitor how the tumor progresses and look out for the emergence of treatment resistance early on, giving enough time to switch therapy to target the resistant cells.

“It’s also possible we could use CAPP-Seq to identify subsets of early stage patients who could benefit most from additional treatment after surgery or radiation, such as chemotherapy or immunotherapy,” he adds.

Funds from a number of sources helped finance the study, including the Department of Defense and the National Institutes of Health.

Meanwhile, Medical News Today recently learned how another US study led by The Scripps Research Institute (TSRI) found a new biomarker for head and neck cancer and non-small-cell lung cancer. That study focused on CCTα – an antigen that prompts the immune system to make specific antibodies – and concluded it was a better predictor of patient outcomes than expression of ERCC1, which is involved in DNA repair.

Written by Catharine Paddock PhD

http://www.medicalnewstoday.com/articles/275146.php

 

To motivate patients on peritoneal dialysis, first motivate staff

Asking patients to perform their own dialysis can be a tall order, even when you provide the needed training. It may take some motivation on the part of the patient—and sometimes on the part of your staff.

(Defining key elements in promoting peritoneal dialysis to patients)

In their poster, “Thriving on PD,” presented at the Annual Dialysis Conference this past week, Mary Jo Miller-Grandfield, RN, BSN, and her dialysis team at Renal Venture Management’s Fort Dodge/Storm Lake, Iowa clinic, set out to spread the word about the value of home dialysis in their mainly rural community. They focused on peritoneal dialysis as the modality choice, saying in the abstract, “There are many misconceptions related to PD therapies and outcomes, both with existing dialysis patients and the medical community.” So the team, with the help of Baxter Health Care, developed a campaign to highlight the positive quality of life improvements for patients going on PD.

The group developed the “We don’t just survive, we thrive,” campaign. That effort include several components, as detailed by Miller-Grandfield:

• “Removal of the word ‘no’ from our vocabulary: all needs, wishes, goals … even prescription changes…are met with an open mind and the patient’s quality of life as a priority.”

• The dialysis team accommodated patient schedules. “…We became very flexible. We arranged our schedule to accommodate the needs of the patients.” The staff trained working patients in the evening and opened early evening lab draws to accommodate work schedules. They became the only program in the area to train nursing home staff on peritoneal dialysis.

• Get patients to talk about the outcomes.  The dialysis team empowered patients “to not only focus on their quality of life but to document that quality via testimonials, pictures and postcards.”

(The benefits of offering extended-hour dialysis shifts)

The results of this positive thinking? After 2.5 years, the Fort Dodge/Storm Lake facility grew their peritoneal dialysis program from five patients to 37, divided between two clinics. “Our goal is to continue to promote PD (and the quality of life benefits) to surrounding physicians and the medical community,” wrote Miller-Grandfield.

http://www.nephrologynews.com/articles/110039-to-motivate-patients-on-peritoneal-dialysis-first-motivate-staff

 

Picture courtesy of www.renalresource.com

 

Two studies: Preimplant kidney biopsy doesn’t predict organ viability

 

Preimplant biopsy of donor kidneys doesn’t accurately predict the organs’ viability and leads to many acceptable kidneys being discarded, according to two separate reports published online in the Clinical Journal of the American Society of Nephrology.

Biopsies are obtained routinely from donor kidneys in the United States, and unfavorable biopsy findings are the most frequently cited reason for discarding donor kidneys as unacceptable. Ideally, such samples would be obtained by core needle biopsy, would not be frozen, would be thoroughly examined by a pathologist with special training in reading kidney biopsies, and would be assessed meticulously for chronic tubular atrophy, arteriolar hyalinosis, interstitial inflammation, interstitial fibrosis, and the presence and severity of acute tubular necrosis.

In actual practice, however, these samples are almost always obtained by wedge biopsy, are frozen, and are rushed through a perfunctory examination by whatever pathologist is available so that the organ can be transplanted as quickly as possible if it is found to be acceptable. So many clinicians have questioned whether the results of such biopsies actually assess the organs’ viability and predict graft failure, both groups of researchers noted.

In what they described as the largest cohort study to date on this issue, one team analyzed data regarding 651 consecutive kidney transplants performed during a 2-year period, for which four organ procurement organizations obtained the kidneys from 369 deceased donors. The four organizations performed wedge biopsies immediately after procurement, and different pathology services evaluated frozen sections from these organs and reported their findings to potential transplant centers.

Patient outcomes were tracked using information in the United Network for Organ Sharing (UNOS) database, said Dr. Isaac E. Hall of the section of nephrology and the program of applied translational research, Yale University, New Haven, Conn., and his associates.

They assessed whether a biopsy finding of acute tubular necrosis correlated with the graft’s performance after transplantation. Acute tubular necrosis was reported in 110 biopsies (17%) overall. The four procurement organizations varied widely in their reported rates of the abnormality, from a low of zero cases to a high of 25% of cases. This variation suggests that the process of obtaining and interpreting these biopsies is, at best, not uniform among procurement groups, according to the investigators.

During a median follow-up of 1 year, the primary outcome of interest – delayed graft function – occurred in 45% of kidneys that were reported to have tubular necrosis and in 39% of those reportedly free of such necrosis. This is a nonsignificant difference. There also was no significant difference in the secondary outcome of graft failure between recipients of organs with acute tubular necrosis, compared with recipients of organs without it.

In summary, there was no significant association between biopsy reports of acute tubular necrosis and graft viability. “It is reasonable to question whether acute tubular necrosis, or acute kidney injury in general for that matter, truly causes important allograft outcomes,” Dr. Hall and his colleagues wrote (Clin. J. Am. Soc. Nephrol. 2014 [doi:10.2215/CJN.08270813]).

In the second study, Dr. Bertram L. Kasiske of the Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, and his associates assessed the records for 83 kidneys that were discarded because of unfavorable biopsy findings (cases) and 83 contralateral kidneys from the same donors that were transplanted (contralateral controls). They compared these findings with those for 151 transplanted kidneys from 83 deceased donors who were matched for the index cases’ donor profiles.

“Ours is the first controlled study to compare biopsy findings between discarded kidneys and matched transplanted kidneys,” Dr. Kasiske and his colleagues noted.

They found that most of the biopsy reports were of low quality, and very few indicated the amounts of tubular atrophy, interstitial inflammation, arteriolar hyalinosis, or acute tubular necrosis. The percentage of glomerulosclerosis was often the only finding upon which to base the decision of whether to use or discard the allograft.

But the percentage of glomerulosclerosis overlapped substantially between cases (discarded kidneys) and controls (transplanted kidneys). This suggests that “information obtained from procurement biopsies is of low quality and may lead to unnecessary discard of transplantable kidneys,” Dr. Kasiske and his associates wrote (Clin. J. Am. Soc. Nephrol. 2014 [doi:10.2215/CJN.07610713]).

“A reasonable conclusion from this and other studies is that the widespread practice of routinely obtaining procurement biopsies should be abandoned, as has been successfully done in Europe,” they noted.

Dr. Hall’s study was supported by the American Heart Association, the Roche Organ Transplantation Research Foundation, the National Institute of Diabetes and Digestive and Kidney Diseases, and the U.S. Health Resources and Services Administration. Dr. Kasiske’s study was supported by the Minneapolis Medical Research Foundation, the Organ Procurement and Transplantation Network, the Scientific Registry of Transplant Recipients, and the United Network for Organ Sharing. Both research groups reported no potential financial conflicts of interest.

http://www.familypracticenews.com/single-view/two-studies-preimplant-kidney-biopsy-doesnt-predict-organ-viability/2727dfa0edc481365ad740d8734e3f5b.html?tx_ttnews%5BsViewPointer%5D=1

 

 

Study finds intensive dialysis in pregnant women with kidney failure benefits mother and baby

Intensive dialysis treatments in pregnant women with kidney failure lead to a higher proportion of live births than standard dialysis care, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology. The findings suggest that more frequent and longer dialysis sessions should be considered for dialysis patients of childbearing age who want to become pregnant or who are already pregnant.

(Study shows stopping transplant drugs before conception benefits fetus)

When young women develop advanced kidney disease, pregnancy becomes dangerous and often impossible because their fertility declines as their kidney disease progresses, according to the study. Also, in the few women with kidney failure who conceive while on dialysis, pregnancy is typically complicated and can be dangerous for both the mother and baby. In Toronto, young kidney failure patients are offered more intensive dialysis to help improve their quality of life. Physicians have found that such intensive dialysis also helps restore fertility and allow some young women to conceive.

Michelle Hladunewich, MD from Sunnybrook Health Sciences Centre, in Toronto, and her colleagues assessed the effects of such intensive dialysis on pregnancy outcomes by comparing patients from Toronto with that from the United States. In Toronto, young women undergo on average 43 hours of dialysis per week compared with only 17 hours per week in the United States. The researchers’ analysis included 22 pregnancies in the Toronto Pregnancy and Kidney Disease Clinic and Registry (2000-2013) with 70 pregnancies in the American Registry for Pregnancy in Dialysis Patients (1990-2011). In Toronto, 18 of the pregnancies occurred after the start of dialysis, whereas dialysis was initiated during pregnancy in four women. In America, 57 pregnancies occurred in women already on dialysis and 13 occurred in women approaching the need for dialysis.

(Task force recommends screening all pregnant women for gestational diabetes)

Among the major findings:

• In patients with established kidney failure at conception, the live birth rate in the group from Toronto was 83%, compared with only 53% in the American group.

• The median duration of pregnancy in the more intensively dialyzed group of women from Toronto was 36 weeks compared with 27 weeks in American women.

• A dose response between dialysis intensity and pregnancy outcomes occurred. For women dialyzed for more than 36 hours per week, the live birth rate was 85%, while it was only 48% in women dialyzed for 20 hours or less per week. Infants were a healthier weight at birth when women were dialyzed for more than 20 hours per week than when women were dialyzed for 20 hours or less per week.

• Complications were few and manageable in women who received intensive dialysis.

“More intensive dialysis has improved pregnancy rates and dramatically improved pregnancy outcomes,” said Dr. Hladunewich. “This study provides hope to young women on dialysis who might want to consider having a family.”

Study co-authors include Susan Hou, MD, Ayodele Odutayo, MD, Tom Cornelis, MD, Andreas Pierratos, MD, Marc Goldstein, MD, Karthik Tennankore, MD, Johannes Keunen, MD, PhD, Dini Hui, MD, and Christopher Chan, MD.

The article, entitled “Intensive Hemodialysis Associates with Improved Pregnancy Outcomes: A Canadian and United States Cohort Comparison,” appears online at http://jasn.asnjournals.org/.

http://www.nephrologynews.com/articles/110043-study-finds-intensive-dialysis-in-pregnant-women-with-kidney-failure-benefits-mother-and-baby

 

Picture courtesy of www.vascularweb.com.

 

 

Study finds that paying people to become kidney donors could be cost-effective

A strategy where living kidney donors are paid $10,000, with the assumption that this strategy would increase the number of transplants performed by 5% or more, would be less costly and more effective than the current organ donation system, according to a study appearing in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN). The findings demonstrate that a paid living donor strategy is attractive from a cost-effectiveness perspective, even under conservative estimates of its effectiveness.

Lianne Barnieh, PhD, Braden Manns, MD, from the University of Calgary, in Canada, and their colleagues studied whether a government or third party administered program of paying living donors $10,000 would be cost-effective. W2ould it save money and, by increasing the number of transplants, improve patient outcomes?

According to their model, a strategy to increase the number of kidneys for transplantation by 5% (a very conservative estimate) by paying living donors $10,000 could result in an incremental cost savings of $340 and a gain of 0.11 quality-adjusted life years over a patient’s lifetime compared with the current organ donation system. Increasing the number of kidneys for transplantation by 10% and 20% would translate into an incremental cost savings of $1,640 and $4,030 and a quality-adjusted life year gains of 0.21 and 0.39, respectively.

“Such a program could be cost saving because of the extra number of kidney transplants and, consequently, lower dialysis costs. Further, by increasing the number of people receiving a kidney transplant, this program could improve net health by increasing the quality and quantity of life for patients with end-stage renal disease,” said Barnieh.

In an accompanying editorial, Matthew Allen, BA, and Peter Reese, MD, MSCE, from the University of Pennsylvania have proposed a research agenda and necessary elements for a limited trial of incentives. “Current trends regarding the use of financial incentives in medicine suggest that the time is ripe for new consideration of payments for living kidney donation,” they wrote. “Reassurance about the ethical concerns, however, can come only through empirical evidence from actual experience.”

http://www.nephrologynews.com/articles/109821-study-finds-that-paying-people-to-become-kidney-donors-could-be-cost-effective

Picture courtesy of www.timeoutchicago.com

Legacy Good Samaritan Hospital

Established in 1875, Legacy Good Samaritan Medical Center is situated in the heart of Northwest Portland, Oregon. Employing cutting edge technology and best-in class physicians, the hospital is now nationally recognized in the diagnosis and treatment of eye disease, cancer, heart and vascular care, weight management, rehabilitation, and kidney transplantation. A dedicated community partner, Legacy Good Samaritan Medical Center works through well established partnerships with schools and faith-based organizations, as well as numerous wellness programs and health screenings offered throughout the year.

The Joint Commission awarded Legacy Good Samaritan its prestigious Gold Seal of Approval for 12 programs, placing the Northwest Portland-based hospital fourth in the nation to be awarded a total of 12 disease-specific awards, and the first in the nation to receive six gold seals for heart care.

Legacy Heart Services, and orthopedic and stroke programs were recognized for patient satisfaction and education, quality outcomes, patient and community education, and physician involvement.

For more information about Legacy Good Samaritan Medical Center, please visit www.legacyhealth.org.

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