Times of India

Ahmedabad's Renal transplant varsity to research on new techniques Times of India AHMEDABAD: The world's first kidney transplant university in Ahmedabad, being built by Institute of Kidney Diseases and Research Centre (IKDRC) at the cost of Rs 50 crore, will prepare documentary-based science evidence on transplants and new-age ...

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Talks are underway to reopen Suffolk County's John J. Foley nursing home by having Brookhaven Memorial Hospital move its downtown Patchogue dialysis operation to the Yaphank complex, which the county already has an informal agreement to sell.

The discussions, which began last fall, have involved Suffolk and Patchogue officials, the hospital and Tritec, the Setauket company whose 291 apartments and retail complex has helped spur a Main Street rejuvenation.

"I think there's a decent shot of it happening," said Mayor Paul Pontieri. But he said the deal is "far more complicated" than envisioned because of the number of parties involved.

"I don't know if chances are 60-40 or 40-60, but from where we sit, I hope we can make all the dominoes fall," Pontieri said.

County Executive Steve Bellone is "very open . . . to see if we can put through a deal" because of the potential benefits to the hospital and the village, said Bellone's deputy, Jon Schneider.

Schneider added, "It's in everyone's interest to resolve this thing sooner rather than later," because the unused Foley building costs $1.2 million a year in upkeep and $11.5 million has already been budgeted this year as revenue from a sale.

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Under the proposal, the hospital would sell its Main Street Patchogue annex to a developer, giving the hospital at least part of the cash to buy the nursing home. Those familiar with the talks say the village and Tritec are interested in a deal because the hospital's Main Street location, which has 36 dialysis beds and some home nursing services, does not generate much foot traffic for the recently redeveloped west end of the village.

The hospital's downtown building is about 23,000 square feet, which could be used for shops or a hotel. Its 160 parking spaces also are valuable in a village where new restaurants and music venues have opened.

"If the property became available, if the hospital wanted to sell the property we'd always be interested," said Rob Loscalzo, Tritec chief operating officer. "If it's something we could put together, it would be a win-win for everyone."

Officials also say a deal is important to Brookhaven Memorial because the nursing home once was a steady source of patients and revenue when Foley residents needed acute care. Before Foley closed, Browning estimated the hospital made about $2 million caring for nursing home patients.

For more than a year, the county has had an $11.7 million informal agreement to sell the former county nursing home to Kenneth Gaul, who now operates a 143-bed Woodhaven Nursing Home and an adjoining assisted living facility in Port Jefferson Station. He said Dennis Cohen, a chief deputy county executive, asked him to "stand down" temporarily because there were not enough votes in the county legislature to approve the sale.

Gaul said he would move his residents from Woodhaven, built in 1971, to Foley, which was finished in 1995. He said he is open to a "joint venture" with the hospital or leasing them space.

"I'm trying to be delicate, but I'd like an answer so we can move forward," Gaul said this week.

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Heather St. Pierre had been feeling pretty rundown — but she never suspected her body had gone into renal failure.

“It was completely not on my radar when I was diagnosed,” recalled St. Pierre. “I was healthy. I was a high school teacher, I coached, I was very active … I was living a very normal life.”

Dialysis patient Heather St. Pierre talks about being diagnosed with chronic kidney disease at Windsor Regional Hospital on Mar. 12, 2015. (Tyler Brownbridge / The Windsor Star)

St. Pierre’s condition was detected two years ago only because she underwent tests associated with her pregnancy at the time. She had no pre-existing conditions, and no family history of chronic kidney disease.

As a result of the diagnosis, St. Pierre was immediately subjected to intensive dialysis treatment: For seven months, she spent six hours a day, six days a week hooked up to a machine that filtered her blood. She also underwent three blood transfusions.

“In retrospect, there were symptoms,” St. Pierre said. “I was a little bit more fatigued than normal … I was cold, I was tired.”

“But at the time, I had a busy job. I was probably stressed out. I didn’t realize these were symptoms of kidney failure. I just thought these were symptoms of being an active young woman.”

St. Pierre recounted her experiences to media on Thursday as part of Windsor Regional Hospital‘s recognition of World Kidney Day.

Although the disease took St. Pierre by surprise, her story had a positive outcome: With the help of WRH, she gave birth to a healthy baby boy.

Now St. Pierre’s on the kidney transplant list, and has learned how to administer peritoneal dialysis to herself at home. “I think I’ve learned you have to listen to your body,” she said.

Dino Villalta, director of renal, stroke and allied health at Windsor Regional Hospital, on Mar. 12, 2015. (Tyler Brownbridge / The Windsor Star)

WRH’s data shows St. Pierre is far from alone. According to Dino Villalta, director of renal, stroke and allied health, demand for the hospital’s dialysis program has increased 45 per cent over the past five years.

Villalta said the hospital now administers more than 40,000 dialysis treatments per year, and the need continues to grow at a rate that’s higher than the provincial average.

Dr. Amit Bagga, nephrologist with the Windsor Kidney Function Clinic, only half-jokingly calls the kidney “the most important organ in the body.”

According to Bagga, the kidney is more than just a simple filter — It’s a complex, “magic” filter that simultaneously moderates your fluid levels and regulate hormones while removing toxins.

That said, Bagga also described the kidney as “behind-the-scenes” and “relatively silent.”

“You never really know what it’s doing, even when it’s working well. And when it’s not working well, and it can kill you — you also don’t know.”

Dr. Amit Bagga, nephrologist, at Windsor Regional Hospital on Mar. 12, 2015. (Tyler Brownbridge / The Windsor Star)

Along with raising awareness and promoting kidney-friendly lifestyles, WRH has plans to expand its renal health resources. The hospital intends to develop space in the nearby Bell building for dialysis treatment, hopefully to be ready for patients in 18 months.

But the long-term goal is to give those with kidney conditions the ability to administer dialysis to themselves at home. The second stage of a strategic plan by the Ontario Renal Network (ORP2) will make this a priority.

“It’s going to be a push for us and for the rest of the province to really focus on giving people some autonomy,” said WRH spokesman Steve Erwin.

St. Pierre said learning how to undergo dialysis without a hospital visit was game-changing for her.

“There are still lots of challenges with being on dialysis,” she said. “But the home treatment has really helped improved my life.”

To join the organ donor list via Internet, go to beadonor.ca. For more information about kidney health, go to www.kidney.ca.

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Nurse Madeline Power shows how a dialysis machine works at Windsor Regional Hospital on Mar. 12, 2015. (Tyler Brownbridge / The Windsor Star)

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Google “curse” or “expletive” and you'll find variably vulgar words. From 4-letter profanities to 12+ letter obscenities, these terms assert strongly negative or even hostile emotions. What won't appear on such lists are words like “guidelines,” “standards,” or “checklists,” even though they can be equally dispiriting to many well-intentioned, hard-working clinicians who equate such terms with excessive oversight or “cookbook medicine.”

Physicians recognize the need for standards and process improvement in medicine. Yet the complexities of individual patient care seem far removed from manufacturing and other industries necessitating rigorously controlled standards. Indeed, standardization implies loss of control. Most providers understand that the benefits of variations in care are best measured only after appropriate and rational standards are put in place, particularly for the treatment of common ailments.

Outpatient treatment of uncomplicated urinary tract infections (UTIs) is common. They account for more than 8 million visits to doctors' offices, emergency departments, and urgent care facilities annually. Practicing physicians recognize that evaluation, antibiotic choice, duration of therapy, and follow-up of UTIs vary significantly. 

In a recently published review of 27 randomized controlled trials, 6 systematic reviews, and 11 observational studies involving more than 250,000 patients, Grigoryan and colleagues outline common sense processes and standards for management for uncomplicated UTIs.

Strong data support that women with at least 2 symptoms of UTI (dysuria, urgency, or frequency) and no vaginal discharge have a 90% or greater chance of having a bacterial UTI. Given the high pre-test probability, additional testing (urine dipstick and culture) appear to provide no additional benefit. Thus, an office visit without culture, telephone management, or patient-initiated therapy is acceptable for uncomplicated UTIs in women. Treatment with single dose fosfomycin (3 g), nitrofurantoin (100 mg po bid × 5 days) or trimethoprim-sulfamethoxazole (1 DS bid × 3 days) is equivalent to alternative and overused therapies (e.g., ciprofloxacin 250 mg bid × 3 d) and better than a beta-lactam antibiotic (e.g., amoxicillin-clavulanate).

Algorithmic care can be easily and broadly applied to most practices. Health system, data-driven, community-centric, physician-led standardized approaches to common ailments represent the lowest-hanging fruit toward delivering better care. Standardizing when it's easy allows you to standardize when it's hard. Building a provider culture around simple standards is anything but profane.

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