bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparative investigation of two rotary nickel–titanium instruments: ProTaper versus RaCe. Part 1. Shaping ability in simulated curved canals
Authors: Schäfer E. , Vlassis M. 
Published: March 2004

AbstractAim  To compare the shaping ability of ProTaper with Reamer with Alternating Cutting Edges (RaCe) instruments. Part 1 of this two‐part report describes the efficacy of these two nickel–titanium instruments in simulated curved root canals.Methodology  Simulated canals with 28° and 35° curves in resin blocks were prepared with ProTaper and RaCe instruments using a crown‐down preparation technique (n = 24 canals in each case). Pre‐ and postinstrumentation images were recorded, and assessment of canal shape was completed with a computer image analysis program. Material removal was measured at 20 measuring points, beginning 1 mm from the apex. Incidence of canal aberrations, preparation time, changes of working length and instrument failures were also recorded. The data were analysed statistically using the Mann–Whitney U‐test or the chi‐square test.Results  On average, canals prepared with RaCe instruments remained better centred compared with those enlarged with ProTaper files. Three RaCe instruments and two ProTaper files fractured during preparation (P > 0.05). Between both the canal types, RaCe was significantly faster (P < 0.001) than ProTaper and maintained working length significantly better (P < 0.05).Conclusion  Both instruments prepared curved canals rapidly and were relatively safe. RaCe respected original canal curvature better than ProTaper, which tended to transport towards the outer aspect of the curve.
A standard for radiopacity of root‐end (retrograde) filling materials is urgently needed
Authors: Tagger M. , Katz A. 
Published: March 2004

AbstractAim  To assess the radiopacity of materials used, or recommended for use, as apical root‐end (retrograde) fillings.Methodology  The radiopacity of 14 materials falling into the category of root‐end filling materials was measured in equivalent millimetres of aluminium (mm Al) using a new computerized method. These included temporary or intermediate sealing materials; composite, compomer and GIC filling materials; EBA‐derived cements; amalgam, etc. Gutta‐percha cone material was added as a control. Samples of 1 mm thickness were radiographed on periapical film alongside an aluminium step wedge calibrated in millimetres, and the opacity of the materials, in greyscale or pseudo‐colour, was compared with the equivalent step.Results  The radiopacity ranged from 1.75 mm Al to >10 mm Al. The lower range appears insufficient for routine clinical detection when it is compared with the minimal requirement for intracanal fillings.Conclusions  Because of the proliferation of root‐end filling materials with a broad range of radiopacity, an international standard stipulating the required minimal radiopacity, as well as other properties, is needed urgently. It should be based on in vitro results and on large‐scale clinical radiographic surveys.
DAILY HEMODIALYSIS—SELECTED TOPICS: The London, Ontario, Daily/Nocturnal Hemodialysis Study
Authors: Lindsay Robert M. ,   the Daily/Nocturnal Dialysis Study Group
Published: March 2004

ABSTRACTThe London Daily/Nocturnal Hemodialysis Study, a prospective, comparative, nonrandomized study, directly compared outcomes of quotidian (daily) hemodialysis patients with conventional thrice‐weekly hemodialysis patients. Patients were assigned to either daily (short‐hours) hemodialysis (n = 11) or nocturnal hemodialysis (n = 12) and followed up for 5–36 months; all data were directly compared with matched control patients receiving conventional hemodialysis (n = 22). Outcomes evaluated were adequacy (urea kinetics), nutrition, anemia management, blood pressure and volume control, calcium/phosphorus control, and patient quality of life. In addition, a detailed economic analysis was undertaken. The study showed that both quotidian hemodialysis regimens are more effective than conventional hemodialysis in improving weekly urea clearance. Significant clinical improvements were seen with quotidian therapy in the areas of nutrition (short‐hours daily), blood pressure (both), volume control (short‐hours daily), calcium/phosphorus control (nocturnal), and quality of life (both). A nonsignificant trend for improvement in anemia management was suggested. The economic analysis showed substantial savings in annualized cost per quality‐adjusted life‐year in changing from conventional hemodialysis (carried out in‐center, in satellite units, or at home) to home quotidian hemodialysis. The substantial clinical benefits of home quotidian hemodialysis, combined with the economic advantage shown by this study, clearly justify its expansion. (The details of this study have recently been published in 11 articles in the American Journal of Kidney Diseases[2003;42(suppl 1)].
DAILY HEMODIALYSIS—SELECTED TOPICS: Short Daily Hemodialysis and Nutritional Status in Patients with Chronic Renal Failure
Authors: Galland Roula , Traeger Jules 
Published: March 2004

ABSTRACTMalnutrition is a frequent complication in hemodialysis patients and is associated with increased mortality and morbidity. Interventions such as oral or intravenous nutritional supplements have often failed to improve nutritional status. We report here the effect that daily dialysis, practiced in our center since 1997, has had on nutritional parameters. Seventeen patients treated with conventional hemodialysis (4–5 hours, three times per week, for 9.6 ± 8.4 years) were converted to short daily hemodialysis (2–2.5 hours, six times per week, for a mean of 39.1 ± 23.5 months). Dietary, anthropometric, and biochemical evaluations were performed during conventional hemodialysis, after 1 year on short daily hemodialysis (sDHDyear), and at the end of follow‐up (sDHDend). Daily protein intake increased from 1.21 ± 0.27 g/kg/day with conventional hemodialysis to 1.51 ± 0.47 g/kg/day at sDHDyear and 1.51 ± 0.37 g/kg/day at sDHDend. Energy intake increased from 33.6 ± 9.5 kcal/kg/day to 38.3 ± 10.9 kcal/kg/day at sDHDyear and 39.4 ± 9.4 kcal/kg/day at sDHDend. The normalized protein equivalent nitrogen appearance (nPNA) increased from 1.19 ± 0.34 g/kg/day with conventional hemodialysis to 1.34 ± 0.43 g/kg/day sDHDyear and 1.37 ± 0.37 g/kg/day sDHDend. Biochemical indicators also increased: serum albumin increased from 40.2 ± 3.3 g/L to 44.5 ± 4.6 g/L and 45.1 ± 4.1 g/L, and prealbumin increased from 0.32 ± 0.06 g/L to 0.38 ± 0.09 g/L and 0.36 ± 0.09 g/L, respectively. These improvements were accompanied by an increase in body weight from 62.0 ± 10.6 kg on conventional hemodialysis to 64.3 ± 10.2 kg at sDHDyear and 65.5 ± 9.7 kg at sDHDend. All the changes between conventional hemodialysis and short daily hemodialysis were statistically significant. Increased frequency is more important than increased dialysis dose. Short daily hemodialysis appears to be a suitable method to improve nutritional status in dialysis patients.
DAILY HEMODIALYSIS—SELECTED TOPICS: Sleep Apnea and Daytime Sleepiness in End‐Stage Renal Disease
Authors: Hanly Patrick 
Published: March 2004

ABSTRACTSleep disorders are common in patients with end‐stage renal disease (ESRD). The prevalence of sleep apnea is 10 times greater in patients with ESRD than in the general population. Although sleep apnea is not improved by conventional modes of dialysis, it is corrected by nocturnal hemodialysis, which provides a new and unique model to study its pathophysiology in this patient population. In addition to causing sleep disruption and impairment of daytime function, sleep apnea may also increase the cardiovascular morbidity and mortality that is commonly found in patients with ESRD. “Pathological” daytime sleepiness is found in 50% of patients with ESRD. Although its pathogenesis has been related both to sleep apnea and periodic limb movements, it has also been attributed to a variety of metabolic factors, including the severity of uremia. Further research is required to evaluate the impact of sleep disorders on the clinical outcome of patients with ESRD.
DAILY HEMODIALYSIS—SELECTED TOPICS: Development of a Nocturnal Home Hemodialysis (NHHD) Program for Children
Authors: Geary Denis F. , Piva Elizabeth , Gajaria Mukesh , Tyrrel Jennifer , Picone Gail , Harvey Elizabeth 
Published: March 2004

ABSTRACTWhereas the success of nocturnal home hemodialysis (NHHD) as a treatment modality for adults has been clearly demonstrated, there is very little experience with NHHD in children. There are genuine concerns related to patient safety, as well as a potentially overwhelming burden on the parents of children, while supervising NHHD. Each of these issues has been considered in the development of the NHHD program for children in Toronto. The steps involved in the development of this program are outlined. The experience of Simonsen (4), that NHHD is feasible and provides excellent dialysis for children, is confirmed.
DAILY HEMODIALYSIS—SELECTED TOPICS: Reducing Hemodialysis Costs: Conventional and Quotidian Home Hemodialysis in Canada
Authors: McFarlane Philip A. 
Published: March 2004

ABSTRACTThe cost of hemodialysis is a concern as the prevalence of end‐stage renal disease (ESRD) increases. While home hemodialysis has been described as less expensive than in‐center hemodialysis, the proportion of patients performing home hemodialysis has been declining. In Canada, there is increasing interest in daily (or quotidian) forms of home hemodialysis, such as nocturnal hemodialysis and short daily hemodialysis. We reviewed the recent Canadian experience with the costs of these modalities and identified four descriptive costing studies: two whole‐program comparisons of home conventional hemodialysis and unmatched in‐center hemodialysis patients, and two comparing quotidian home hemodialysis and matched in‐center hemodialysis patients. All costs are listed as per patient‐year in 2003 U.S. dollars. In the two whole‐program analyses, conventional home hemodialysis was less expensive than in‐center hemodialysis ($36,840 versus $100,198 [p < 0.001] and $34,466 versus $58,959 [p < 0.001]). Reductions in categories such as staffing and overhead are likely due to the modality, while reductions in medications and hospital admissions may be due to differences in the patient mix. The savings for quotidian home hemodialysis are significant, but less striking. In the two matched analyses, nocturnal hemodialysis cost less than in‐center hemodialysis ($48,656 versus $59,476 [p = 0.006]), and costs decreased by $8,046 in those converted to short daily hemodialysis and by $14,341 in those converted to nocturnal hemodialysis, while increasing by $2,521 in those who remained on in‐center hemodialysis. Home conventional hemodialysis is less expensive than in‐center hemodialysis. Much of these savings are lost when dialysis frequency increases; however, quotidian home hemodialysis remains less expensive than in‐center hemodialysis.
DAILY HEMODIALYSIS—SELECTED TOPICS: The Direction of End‐Stage Renal Disease Reimbursement in the United States
Authors: Lockridge Robert S. 
Published: March 2004

ABSTRACTIn the 1960s, care of the end‐stage renal disease (ESRD) patient changed. Either through transplantation or intermittent hemodialysis ESRD patients were able to live longer. The Gottschalk Committee issued the “Report of the Committee on Chronic Kidney Disease” to the Bureau of Budget. This report established that hemodialysis and kidney transplantation were the standard of care for the treatment of ESRD patients. Section 2991 of the Social Security Amendment of 1972 provided that patients with ESRD who qualified for Medicare were entitled to receive dialysis and/or transplantation nationwide. The first Medicare hearing held in 1975 regarding the Medicare ESRD program found that the cost of the program was much greater than had been predicted in 1972. Ever since 1975, accelerating cost has been a concern of the government. Quality of care for ESRD patients has been a major focus of the renal community and the Centers for Medicare and Medicaid Services (CMS) over the past 10 years. Consensus for entitlement has remained, but the staggering cost of the program as a whole has become a major problem that must be addressed. Since 1978, Congress and the CMS have passed laws and developed demonstration projects to improve quality of care and reduce costs in the Medicare ESRD program. Kt/V, urea reduction ratio (URR), and hemoglobin levels have all improved, but hospital admissions have remained unchanged and mortality rates have increased. Do the renal community and CMS need to rethink how they will improve the quality of care for ESRD patients and reduce costs in the Medicare ESRD program?
DAILY HEMODIALYSIS—SELECTED TOPICS: An International Registry to Compare Quotidian Dialysis Regimens with Conventional Thrice‐Weekly Hemodialysis: Why, How, and Potential Pitfalls
Authors: Nesrallah Gihad E. , Moist Louise M. , Awaraji Christian , Lindsay Robert M. 
Published: March 2004

ABSTRACTThrice‐weekly hemodialysis is the most commonly used form of renal replacement therapy, yet it is associated with unacceptably high morbidity and mortality. Attempts to improve outcomes for hemodialysis patients by increasing their per‐session dose of dialysis have recently proven unsatisfactory in the multicentered Hemodialysis (HEMO) study. Interest has thus turned to increasing dialysis frequency. Short daily and long nocturnal dialysis, which are typically performed 6 days per week, are gaining acceptance and are associated with significant improvements in secondary outcomes, including nutrition, left ventricular hypertrophy, hypertension, anemia, and calcium‐phosphorus balance. Studies to date have not been adequately powered to detect the survival benefits that these changes may confer. Large‐scale randomized studies are planned, but will likely not answer the survival question for several years. Until this issue is resolved, funding policies are unlikely to change, confining current dialysis patients to potentially suboptimal therapy. By capturing data from current and future daily dialysis patients using an international registry, a survival benefit might be demonstrated more quickly. Such a project will soon be undertaken by the London Daily/Nocturnal Study Group with endorsement from the International Society for Hemodialysis and the U.S. National Institutes of Health. This database will also provide useful descriptive data that will help develop methodologies in this growing field. Historically the interpretation of dialysis registry data has been plagued with various methodological problems. These are briefly reviewed, and some potential solutions and necessary precautions are discussed.
DAILY HEMODIALYSIS—SELECTED TOPICS: Evidence‐Based Medicine in the Dialysis Unit: A Few Lessons from the USRDS and the NCDS and HEMO Trials
Authors: Briggs Josephine P. 
Published: March 2004

ABSTRACTThis short review argues for the importance of evidence‐based medicine in the evolution of improved dialysis care. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) has supported two major randomized clinical trials in dialysis, the National Cooperative Dialysis Study (NCDS), completed in 1981, and the Hemodialysis (HEMO) study, completed in 2002, and supports a major body of ongoing observational research through the U.S. Renal Data System (USRDS). The main results from the two randomized clinical trials and their implications for clinical practice and subsequent research are discussed here. The importance of observational research in the formulation of hypotheses and improvement of quality of care is examined. A brief historical perspective is provided on the critical examination of dialysis care in the late 1980s that occurred following completion of the NCDS. Finally, the rationale for continued investment in dialysis research and the plans of NIDDK to launch studies of more intensive dialysis regimens are discussed.
DAILY HEMODIALYSIS—SELECTED TOPICS: Rationale and Experience with Short Daily Hemofiltration
Authors: Jaber Bertrand L. , Zimmerman Deborah L. 
Published: March 2004

ABSTRACTPatients with end‐stage renal disease (ESRD) have morbidity and mortality rates that are much higher than those found in the general population. The nonphysiologic nature of thrice‐weekly hemodialysis may be partially responsible for the poor outcomes in this patient population. In response to the problems encountered with conventional hemodialysis schedules, a number of investigators have explored potential solutions to the problem. One such solution is to increase the time and/or frequency of hemodialysis. With this approach, ESRD patients have been observed to have better anemia management and blood pressure control, as well as improvements in quality of life. Hemodialysis is based on diffusion of solutes across a semipermeable membrane such that only small molecules are readily removed. Therefore a second solution has been to utilize hemofiltration instead of hemodialysis. Hemofiltration utilizes convective clearance of molecules, resulting in an improvement in the removal of larger solutes, much like the glomerular basement membrane of the kidney. Despite the accumulated evidence that thrice‐weekly hemofiltration adds to the benefits seen with increasing hemodialysis time and/or frequency, the use of hemofiltration has been limited by the available technology, cost, and low access blood flows. However, current technological advances in equipment and access creation are addressing these problems. With these advances, a number of investigators have also explored the potential benefits of daily hemofiltration as a treatment option for ESRD. The preliminary results suggest that improvements in blood pressure, β2‐microglobulin (β2M) levels, and quality of life are possible.
APPROACHES TO QUOTIDIAN DIALYSIS: The Aksys Personal Hemodialysis System
Authors: Kjellstrand Carl M. , Blagg Christopher R. , Bower John , Twardowski Zbylut J. 
Published: March 2004

ABSTRACTThe Aksys personal hemodialysis system empowers patients to dialyze where, when, and how they want. It allows them to easily do the best dialysis—daily hemodialysis—in the safest place—at home—by simplifying operation (almost anyone can do it), doing the drudgery work of dialysis (the patient is the master, not the slave of the dialysis machine, giving patients their lives back), needing no bulky disposables (patients have their homes back), reducing emergencies during dialysis, and performing immediate fluid resuscitation on demand.
APPROACHES TO QUOTIDIAN DIALYSIS: Baxter Aurora Dialysis System
Authors: Kelly Thomas D. 
Published: March 2004

ABSTRACTWith the recent focus on the benefits of more frequent dialysis, the Baxter Aurora dialysis system provides maximum flexibility for therapy prescription, including short daily treatments, long nocturnal treatments, hemodialysis, hemofiltration, and online hemodiafiltration, all in a compact, reliable, easy to use system. A self‐prompting touch screen user interface mounted on a movable arm provides for comfortable operation, whether sitting and standing. An automatic treatment setup mode facilitates easy treatment setup. Complex menus are eliminated by the use of a hardware key that automatically selects only the prescribed options during power up, eliminating all menus associated with nonprescribed functions and modalities. This prevents the user from becoming confused or accidentally altering the dialysis treatment. Prior to dialysis the instrument goes through an automatic self‐test that confirms the operation of internal systems. The screen will dim when there is no action that the patient needs to attend to on the instrument. After dialysis, press the disinfect button and the instrument disinfects itself and shuts off. For patient safety, the “disinfect” menus are not available during dialysis. The instrument can also be programmed to automatically start and rinse at a set time. For remote treatment monitoring, the instrument connects to the Internet. The Aurora records information about the machine's technical status, providing a record of instrument history for easy servicing. The Aurora is a flexible platform that provides the desired renal therapy with ease of use and proper support for the hemodialysis patient when combined with Baxter's 24‐hour infrastructure and support.
APPROACHES TO QUOTIDIAN DIALYSIS: Bellco Formula Domus Home Care System
Authors: Trewin Elizabeth 
Published: March 2004

ABSTRACTThere are certain characteristics in a dialysis machine that would be desirable for use in home and limited care environments. These features relate to safety, ease of use, consideration of physical space, and reliability. The Bellco Formula Domus Home Care System was designed to meet all these requirements. Bellco's philosophy of patient treatment centers on global biocompatibility. This is evident in the design of the Formula Domus Home Care System. It has the smallest hydraulic fluid pathway of any dialysis machine on the market. Formula is capable of preparing ultrapure dialysate. The ultrafiltration measurement mechanism, the patented Coriolis flow meter, measures the mass of the dialysate, not the volume. For this reason it is the only dialysis machine that detects actual backfiltration, not just the theoretical possibility of it based on transmembrane pressure. The Coriolis flow meter also ensures that dialysate flow is a true single pass. The operator interface is a single window operating control. It is possible to select up to 14 different languages. There is an online help key to assist patients with troubleshooting. Programmable start‐up and shutdown times save time for the patient. Formula is the only dialysis machine to offer a backup battery feature. Formula is capable of communicating with any software available. The focus on global biocompatibility ensures the best quality dialysis treatments for a population of patients who will likely remain on dialysis for a longer period of time than conventional dialysis patients.
APPROACHES TO QUOTIDIAN DIALYSIS: The Fresenius Medical Care Home Hemodialysis System
Authors: Schlaeper Christian , Diaz‐Buxo Jose A. 
Published: March 2004

ABSTRACTThe Fresenius Medical Care home dialysis system consists of a newly designed machine, a central monitoring system, a state‐of‐the‐art reverse osmosis module, ultrapure water, and all the services associated with a successful implementation. The 2008K@home hemodialysis machine has the flexibility to accommodate the changing needs of the home hemodialysis patient and is well suited to deliver short daily or prolonged nocturnal dialysis using a broad range of dialysate flows and concentrates. The intuitive design, large graphic illustrations, and step‐by‐step tutorial make this equipment very user friendly. Patient safety is assured by the use of hydraulic systems with a long history of reliability, smart alarm algorithms, and advanced electronic monitoring. To further patient comfort with their safety at home, the 2008K@home is enabled to communicate with the newly designed iCare remote monitoring system. The Aquaboss Smart reverse osmosis (RO) system is compact, quiet, highly efficient, and offers an improved hygienic design. The RO module reduces water consumption by monitoring the water flow of the dialysis system and adjusting water production accordingly. The Diasafe Plus filter provides ultrapure water, known for its long‐term benefits. This comprehensive approach includes planning, installation, technical and clinical support, and customer service.