... ESRD patient Bergman et al. 1996 [108] First -degree relatives of patients with hypertensive ... more ... ESRD patient Bergman et al. 1996 [108] First -degree relatives of patients with hypertensive ESRD Relative of ESRD patient Renal abnormality Evidence for CKD was seen in 65% of participating families O'Dea et al. 1998 [53 ...
This study was undertaken to determine whether tailoring the dialysis prescription in Asian child... more This study was undertaken to determine whether tailoring the dialysis prescription in Asian children on nightly intermittent peritoneal dialysis (NIPD), without adding high-dose therapy for cost-savings purposes, was able to achieve dialysis adequacy and improvement in nutrition. Eight children (age range: 5.5-20 years) on NIPD for a mean of 2.1 +/- 0.6 years, were studied at baseline and at 3 months and 9 months after their dialysis dose was tailored. Dialysis adequacy was measured by weekly Kt/Vurea and creatinine clearance (CCr). Fat-free mass (FFM) and percent body fat (%FAT) as measured by bioelectrical impedance, together with anthropometric measurements, serum total protein, and albumin, were used as indicators of nutrition. After the dialysis prescription was tailored, the mean weekly Kt/Vurea increased from 1.89 +/- 0.35 to 2.12 +/- 0.54 at 9 months, and total CCr increased from 36.4 +/- 11.51 L/1.73 m2 to 48.30 +/- 14.30 L/1.73 m2. The increase occurred despite a decline in residual renal function and was attributable to significant improvements in the peritoneal clearances of urea and creatinine (p < 0.05). The mid arm muscle circumference (MAMC) increased significantly (p = 0.006), while FFM increased from 25.68 +/- 7.92 kg to 26.95 +/- 9.83 kg, and %FAT decreased from 21.56% +/- 8.41% to 18.66% +/- 8.16%. The increase in FFM correlated significantly with a decrease in serum creatinine (r = -0.94, p = 0.005). In conclusion, tailoring the dialysis prescription in NIPD, without adding high-dose therapy, resulted in a trend of improvement in dialysis adequacy and some nutritional parameters.
Clinical Journal of The American Society of Nephrology, Mar 1, 2008
In consideration of the epidemiologic basis for screening and surveillance, a comprehensive progr... more In consideration of the epidemiologic basis for screening and surveillance, a comprehensive program for chronic kidney disease prevention was initiated in Singapore by the National Kidney Foundation Singapore (NKF Singapore) in 1997. Reasons for developing this include the rising rate of end-stage renal disease in the country, and the projected escalation because of the increase in chronic diseases that lead to end-stage renal disease (ESRD) such as diabetes mellitus and hypertension. Presented are progress and preliminary findings of this program, as well as that of the parallel initiative of Singapore's Ministry of Health. The NKF Singapore program incorporates primary, secondary and tertiary approaches to the prevention of chronic kidney disease. These include the population-based screening for early chronic kidney disease and chronic diseases that are associated with kidney disease and the implementation of disease management programs that aim to improve the multi-faceted care of patients with chronic diseases that lead to ESRD, including the development of community-based "Prevention Centers." The screening program identified risk factors for proteinuria, including the Malay race, increasing age, family history of kidney disease, and higher levels of systolic and diastolic BP even within the normal ranges. Longitudinal follow-up of both prevention programs are critical to provide evidence for the efficacy of such screening and intervention programs in improving chronic kidney disease outcomes, while reducing the cost of care.
haemodialysis (HD) and peritoneal dialysis (PD) treatments using the same bundled payment system,... more haemodialysis (HD) and peritoneal dialysis (PD) treatments using the same bundled payment system, since 2008. However, this package does not include hospitalizations, physician/emergency room visits, access-related procedures and patient transportation. The aim of our study was to evaluate the annual health care expenses of chronic kidney disease (CKD) patients initiating HD with a catheter (CVC) or an arteriovenous fistula (AVF) and PD, in Portugal. Methods: The study was performed from the Public Administration perspective. One year cost data of 152 CKD patients who consecutively initiated dialysis in our institution in the year 2008 (HD-AVF, n=65; HD-CVC, n=45; PD, n=42) were generated and analyzed, using an intention-to-treat approach. Annual health care expenses were evaluated using a mixed costing method: a) HD and PD treatment expenses were established as the bundled payment of €547.94 per patient-week; b) hospitalizations (inpatient), physician/emergency room visits (outpatient) and transportation data, related or unrelated to kidney failure as defined by the discharge diagnosis [International Classification of Diseases Ninth Revision codes], was captured from the Information Management Division of São João Hospital. Expenditure was determined in accordance with the Ministry of Health and Welfare Ordinance Legislation; c) dialysis access expenses were estimated using a micro-costing approach, using publicly available hospital suppliers' price lists. Multivariate analysis was used to assess the impact of various comorbid factors on the outcome of interest (annual health care expenses). Results are reported in 2010 Euros (€). Results: Dialysis treatment expenses for HD-AVF, HD-CVC and PD modalities were €28,270, €27,332 and €28,062 per patient-year at risk, respectively (p=0.002). Compared with HD-AVF and PD patients, HD-CVC patients were more likely to have outpatient (€2869 vs. €1794 vs. €1315 per patient-year at risk for, HD-CVC, HD-AVF and PD; p<0.001) and inpatient expenses (€10,554.1 vs. €1324.7 vs. €2052.2 per patient-year at risk, for HD-CVC, HD-AVF and PD; p<0.001). Transportation expenditure were significantly lower in PD modality (€852 vs. €2232 vs. €2099 per patient-year at risk, for PD, HD-AVF and HD-CVC; p<0.001).The costs related to dialysis access for PD, HD-AVF and HD-CVC patients were €1172, €1555 and €4208 per patient-year, respectively (p<0.001). Mean annual health care expenses for HD-AVF, HD-CVC and PD patients were €33,621, €42,855 and €32,282 per patient-year at risk, respectively (p<0.001). In multivariate analysis, PD and HD-AVF modalities were associated with approximately €7500 per patient-year cost savings, compared to HD-CVC modality (β-coefficient=-7364, 95%CI [3749 to 10979]; p<0.001). Conclusions: Patients who choose PD or HD with a functioning AVF incur significant lower annual health care expenses compared to those who initiate HD with a catheter, in the new Portuguese bundled payment plan.
Background Underserved ethnic minorities with psychiatric disorders are at an increased risk of C... more Background Underserved ethnic minorities with psychiatric disorders are at an increased risk of COVID-19. This study aims to examine the effectiveness of one-to-one counseling on COVID-19 vaccination and vaccination readiness among underserved African American and Latinx individuals with mental illnesses and adult caregivers of children with mental illness. Methods Through an academic-community partnered collaboration, a multidisciplinary and culturally sensitive training on COVID-19 was co-developed and delivered to 68 therapists from January to March 2021. Mental health clients and their caregivers were recruited to participate in pre-and post-intervention surveys to evaluate the impact of the intervention on their perceptions of COVID-19 public health guidelines, testing, and vaccination. Mental health therapists delivered four lessons of the COVID-19 educational intervention with 254 clients from March to June 2021, when vaccine availability was widely available. Of those clients, we collected 180 baseline and 115 follow-up surveys. The main outcome was the uptake in COVID-19 vaccine. Results There was a positive shift in participant vaccine acceptance and receptivity. Pre-intervention survey shows that only 56% of adult clients and 48% of caregivers had indicated a likelihood of getting the vaccine for themselves at baseline. Postintervention documented that more than 57% of each group had been vaccinated, with another 11-15% of the unvaccinated individuals reporting that they were somewhat or very likely to get the vaccine. Conclusion This study demonstrated that multidisciplinary academic-community and theoretical-based educational intervention delivered by mental health therapists is an effective strategy in increasing COVID-19 vaccine acceptance and reducing the negative impact and disruption that COVID-19 caused in the daily life of mental health patients and caregivers.
Advances in peritoneal dialysis. Conference on Peritoneal Dialysis, 1999
This study was undertaken to determine whether tailoring the dialysis prescription in Asian child... more This study was undertaken to determine whether tailoring the dialysis prescription in Asian children on nightly intermittent peritoneal dialysis (NIPD), without adding high-dose therapy for cost-savings purposes, was able to achieve dialysis adequacy and improvement in nutrition. Eight children (age range: 5.5-20 years) on NIPD for a mean of 2.1 +/- 0.6 years, were studied at baseline and at 3 months and 9 months after their dialysis dose was tailored. Dialysis adequacy was measured by weekly Kt/Vurea and creatinine clearance (CCr). Fat-free mass (FFM) and percent body fat (%FAT) as measured by bioelectrical impedance, together with anthropometric measurements, serum total protein, and albumin, were used as indicators of nutrition. After the dialysis prescription was tailored, the mean weekly Kt/Vurea increased from 1.89 +/- 0.35 to 2.12 +/- 0.54 at 9 months, and total CCr increased from 36.4 +/- 11.51 L/1.73 m2 to 48.30 +/- 14.30 L/1.73 m2. The increase occurred despite a decline i...
Clinical, Cosmetic and Investigational Dermatology
Multiple effects of the COVID-19 pandemic have been described, including an increase in concerns ... more Multiple effects of the COVID-19 pandemic have been described, including an increase in concerns about one's facial appearance resulting in greater interest in cosmetic procedures. However, additional research is required to examine the impact of the pandemic on patients' overall stress levels and whether this reported stress is associated with an interest in facial aesthetic procedures. We aimed to describe perceived stress and to identify factors associated with increased stress among patients seeking aesthetic treatments during the pandemic. Patients and Methods: Patients coming to a Singapore-based clinic and who completed a questionnaire over a one-month period were included. Stress was evaluated using the Perceived Stress Scale (PSS); additional questions sought to understand factors associated with perceived stress and future interest in aesthetic procedures. Results: Two hundred and thirteen respondents participated in the study. Separation from family and inability to travel for leisure were major stressors in 54% and 55%; getting COVID-19 was less frequently a stressor (11%). Patients reported greater concern with appearance (increased worry in 32%, comparison to others in 41%). Ninety-one percent of patients continued aesthetic procedures despite the pandemic and 75% reported interest in proceeding with treatments not previously tried before. PSS scores were higher than published norms. Factors associated with increased scores included residency status, job insecurity and markers of increased concern about appearance. Finally, higher stress scores were observed in patients with greater likelihood of receiving future aesthetic treatments, although this was not statistically significant after applying the Bonferroni correction for multiple comparisons. Conclusion: Significantly higher stress scores were seen in patients seeking aesthetic treatments. We identified factors associated with increased stress with a suggested association between increased likelihood of proceeding with any aesthetic procedure and higher levels of stress. These highlight the importance of caution in treating patients given their increased stress levels and potential vulnerability.
Clinical, Cosmetic and Investigational Dermatology, 2021
Purpose Identifying predictors for patients’ readiness to receive non-surgical facial aesthetic t... more Purpose Identifying predictors for patients’ readiness to receive non-surgical facial aesthetic treatments facilitates the physician’s understanding of the patient’s goals and expectations. This paper aims to identify clinical and demographic characteristics of patients who proceed with non-surgical facial aesthetic procedures in Singapore. Patients and Methods Using data from electronic patient health records, authors examined clinical and demographic characteristics of 624 Asian and Caucasian patients who sought treatment in a 12-month period and who had minimum follow-up of 1 year. Variables examined included age, race/ethnicity, gender, prior treatment, and attitudes and motivation for seeking treatment. Univariate and multivariate analyses of factors associated with proceeding with the treatment plan were evaluated using chi-square and logistic regression analyses. Results Approximately 88% of patients who sought consultation proceeded with treatment. The majority were older th...
Cumulative evidence indicates it may be worthwhile revisiting the twice-weekly hemodialysis (HD) ... more Cumulative evidence indicates it may be worthwhile revisiting the twice-weekly hemodialysis (HD) regimen as a valid option for individualized or incremental treatments for selected patients with end-stage renal disease. In this article, we will review the current evidences on the potential pros and cons of twice-weekly HD compared to thrice-weekly HD including China's experience in the practice of twice-weekly HD. A prudent patient selection and close dialysis adequacy monitoring might be necessary for this medical treatment choice. More randomized prospective controlled studies for the critical evaluation of twice-weekly dialysis are encouraged.
The function encoded by the Ke 6 gene has been recently determined to be 17beta-hydroxysteroid de... more The function encoded by the Ke 6 gene has been recently determined to be 17beta-hydroxysteroid dehydrogenase. Previously, the abnormal expression of the Ke 6 gene has been intimately associated with development of recessive polycystic kidney disease. The Ke 6 gene is normally expressed at very high levels in the kidney and liver and is severely down regulated in all recessive murine models of polycystic kidney disease that have been examined to date. Here, we report a detailed examination of the promoter region of the Ke 6 gene in normal mouse kidney cells (CTA) and in cells derived from mouse kidneys homozygous for the cpk (congenital polycystic kidney) mutation, using transfection analysis and DNA-protein gel shift assays. The minimal promoter region, P1 (+1 to -96), and a putative enhancer site, P3 (-165 to -256), within the Ke 6 gene 5&#39; flanking sequence have been identified. We have also identified another region, P2 (-97 to -165), that may be responsible for the lower promoter activity of the Ke 6 gene in cpk cells. Furthermore, absence of binding of a 38 kDa nuclear protein to a 16 bp sequence element (P1A) within the minimal promoter of the Ke 6 gene suggests that the P1A element could be responsible for the overall reduction in promoter function in cpk cells.
Background: A comprehensive analysis of sex-specific differences in the characteristics, treatmen... more Background: A comprehensive analysis of sex-specific differences in the characteristics, treatment, and outcomes of individuals with end-stage renal disease undergoing dialysis might reveal treatment inequalities and targets to improve sexspecific patient care. Here we describe hemodialysis prevalence and patient characteristics by sex, compare the adult maleto-female mortality rate with data from the general population, and evaluate sex interactions with mortality. Methods and Findings: We assessed the Human Mortality Database and 206,374 patients receiving hemodialysis from 12 countries (Australia,
Given the prohibitive costs of end-stage renal disease (ESRD) care for certain countries and the ... more Given the prohibitive costs of end-stage renal disease (ESRD) care for certain countries and the increasing incidence of ESRD worldwide, alternative methods of funding dialysis care are increasingly necessary. We describe the paradigm of the National Kidney Foundation of Singapore (NKF-S), the provider of subsidized dialysis care and comprehensive rehabilitative services to approximately 60% of all ESRD patients in the country, whose activities are funded entirely by charitable public donations. Unique to the NKF-S model are the considerations of the donor as an &amp;amp;amp;amp;quot;investor&amp;amp;amp;amp;quot; in the health care of NKF-S dialysis patients, the personal responsibility of the dialysis patient as a recipient of this &amp;amp;amp;amp;quot;investment&amp;amp;amp;amp;quot; to play an active role in achieving good clinical and rehabilitative outcomes, and the fostering of community-based support systems to facilitate patient rehabilitation such as partnerships with employers willing to employ dialysis patients. The success of the system is shown by its clinical outcomes, which approximate those observed in the United States. We believe that several aspects of the NKF-S model for ESRD care may be implemented in other communities, particularly in countries that have yet to develop financially and clinically mature dialysis programs.
The importance of tight glycemic control in all forms of diabetes has been well documented. 3-6 A... more The importance of tight glycemic control in all forms of diabetes has been well documented. 3-6 As early as 1967, the International Diabetes Center demonstrated that tight glycemic control was a critical component in the management of type 1 diabetes and that a multidisciplinary approach would be necessary to meet this goal. As a participant in the Diabetes Control and Complications Trial (DCCT), the IDC was able to demonstrate that an evidence-based multidisciplinary approach could achieve near normal glycemia in individuals with type 1 diabetes. During the course of this landmark study it became clear that an evidence-based systematic approach to clinical decision-making PRINCIPLES AND DEVELOPMENT OF SDM Chairperson: Richard Bergenstal (USA), Donnell Etzwiler (USA), Roger Mazze (USA), Boniface J Lin (Taiwan) INTRODUCTION Continued As SDM moves into the 21st century, its mission has expanded to encompass the principles of primary and secondary prevention. With the recent identification of an increasing number of novel disease susceptibility genes for type 2 diabetes, the substantial evidence related to the contribution of diet and lifestyle to the onset of disease, and a more complete understanding of the natural history and pathophysiology of all types of diabetes, the possibility of identifying with greater sensitivity and specificity individuals at high risk for diabetes may soon be realized. More important is the introduction of non-hypoglycaemic insulin sensitizing agents and the renewed emphasis on lifestyle changes as viable therapeutic interventions for the prevention of type 2 diabetes and perhaps gestational diabetes. These developments will not dampen the current emphasis on identifying those with undiagnosed disease. Rather, the goal is to accomplish this more systematically and at an earlier point in the natural history of diabetes, in order to prevent or slow the progression of complications. Nor does this portend a reduction in the utilization of resources devoted to the treatment of complications. With an increased understanding of the pathophysiology of cardiovascular, renal, neurological and retinal complications, there is a need to translate what we know into practical clinical processes that will assure the person with diabetes an opportunity to enjoy the highest possible quality of life. Thus, the goal of SDM is to continue to develop and implement new approaches to the continuum of diabetes care. This takes into account an integrated strategy for the prevention, early detection and improved treatment of all forms of diabetes and associated complications. To achieve this goal, the results of research on complex interrelated genetic and environmental risk factors may one day be integrated into the SDM protocols. Simultaneously, efforts to slow the progression of complications have to continue. On 11-12 November 2000, 70 delegates who have worked with SDM,
... ESRD patient Bergman et al. 1996 [108] First -degree relatives of patients with hypertensive ... more ... ESRD patient Bergman et al. 1996 [108] First -degree relatives of patients with hypertensive ESRD Relative of ESRD patient Renal abnormality Evidence for CKD was seen in 65% of participating families O'Dea et al. 1998 [53 ...
This study was undertaken to determine whether tailoring the dialysis prescription in Asian child... more This study was undertaken to determine whether tailoring the dialysis prescription in Asian children on nightly intermittent peritoneal dialysis (NIPD), without adding high-dose therapy for cost-savings purposes, was able to achieve dialysis adequacy and improvement in nutrition. Eight children (age range: 5.5-20 years) on NIPD for a mean of 2.1 +/- 0.6 years, were studied at baseline and at 3 months and 9 months after their dialysis dose was tailored. Dialysis adequacy was measured by weekly Kt/Vurea and creatinine clearance (CCr). Fat-free mass (FFM) and percent body fat (%FAT) as measured by bioelectrical impedance, together with anthropometric measurements, serum total protein, and albumin, were used as indicators of nutrition. After the dialysis prescription was tailored, the mean weekly Kt/Vurea increased from 1.89 +/- 0.35 to 2.12 +/- 0.54 at 9 months, and total CCr increased from 36.4 +/- 11.51 L/1.73 m2 to 48.30 +/- 14.30 L/1.73 m2. The increase occurred despite a decline in residual renal function and was attributable to significant improvements in the peritoneal clearances of urea and creatinine (p < 0.05). The mid arm muscle circumference (MAMC) increased significantly (p = 0.006), while FFM increased from 25.68 +/- 7.92 kg to 26.95 +/- 9.83 kg, and %FAT decreased from 21.56% +/- 8.41% to 18.66% +/- 8.16%. The increase in FFM correlated significantly with a decrease in serum creatinine (r = -0.94, p = 0.005). In conclusion, tailoring the dialysis prescription in NIPD, without adding high-dose therapy, resulted in a trend of improvement in dialysis adequacy and some nutritional parameters.
Clinical Journal of The American Society of Nephrology, Mar 1, 2008
In consideration of the epidemiologic basis for screening and surveillance, a comprehensive progr... more In consideration of the epidemiologic basis for screening and surveillance, a comprehensive program for chronic kidney disease prevention was initiated in Singapore by the National Kidney Foundation Singapore (NKF Singapore) in 1997. Reasons for developing this include the rising rate of end-stage renal disease in the country, and the projected escalation because of the increase in chronic diseases that lead to end-stage renal disease (ESRD) such as diabetes mellitus and hypertension. Presented are progress and preliminary findings of this program, as well as that of the parallel initiative of Singapore's Ministry of Health. The NKF Singapore program incorporates primary, secondary and tertiary approaches to the prevention of chronic kidney disease. These include the population-based screening for early chronic kidney disease and chronic diseases that are associated with kidney disease and the implementation of disease management programs that aim to improve the multi-faceted care of patients with chronic diseases that lead to ESRD, including the development of community-based "Prevention Centers." The screening program identified risk factors for proteinuria, including the Malay race, increasing age, family history of kidney disease, and higher levels of systolic and diastolic BP even within the normal ranges. Longitudinal follow-up of both prevention programs are critical to provide evidence for the efficacy of such screening and intervention programs in improving chronic kidney disease outcomes, while reducing the cost of care.
haemodialysis (HD) and peritoneal dialysis (PD) treatments using the same bundled payment system,... more haemodialysis (HD) and peritoneal dialysis (PD) treatments using the same bundled payment system, since 2008. However, this package does not include hospitalizations, physician/emergency room visits, access-related procedures and patient transportation. The aim of our study was to evaluate the annual health care expenses of chronic kidney disease (CKD) patients initiating HD with a catheter (CVC) or an arteriovenous fistula (AVF) and PD, in Portugal. Methods: The study was performed from the Public Administration perspective. One year cost data of 152 CKD patients who consecutively initiated dialysis in our institution in the year 2008 (HD-AVF, n=65; HD-CVC, n=45; PD, n=42) were generated and analyzed, using an intention-to-treat approach. Annual health care expenses were evaluated using a mixed costing method: a) HD and PD treatment expenses were established as the bundled payment of €547.94 per patient-week; b) hospitalizations (inpatient), physician/emergency room visits (outpatient) and transportation data, related or unrelated to kidney failure as defined by the discharge diagnosis [International Classification of Diseases Ninth Revision codes], was captured from the Information Management Division of São João Hospital. Expenditure was determined in accordance with the Ministry of Health and Welfare Ordinance Legislation; c) dialysis access expenses were estimated using a micro-costing approach, using publicly available hospital suppliers' price lists. Multivariate analysis was used to assess the impact of various comorbid factors on the outcome of interest (annual health care expenses). Results are reported in 2010 Euros (€). Results: Dialysis treatment expenses for HD-AVF, HD-CVC and PD modalities were €28,270, €27,332 and €28,062 per patient-year at risk, respectively (p=0.002). Compared with HD-AVF and PD patients, HD-CVC patients were more likely to have outpatient (€2869 vs. €1794 vs. €1315 per patient-year at risk for, HD-CVC, HD-AVF and PD; p<0.001) and inpatient expenses (€10,554.1 vs. €1324.7 vs. €2052.2 per patient-year at risk, for HD-CVC, HD-AVF and PD; p<0.001). Transportation expenditure were significantly lower in PD modality (€852 vs. €2232 vs. €2099 per patient-year at risk, for PD, HD-AVF and HD-CVC; p<0.001).The costs related to dialysis access for PD, HD-AVF and HD-CVC patients were €1172, €1555 and €4208 per patient-year, respectively (p<0.001). Mean annual health care expenses for HD-AVF, HD-CVC and PD patients were €33,621, €42,855 and €32,282 per patient-year at risk, respectively (p<0.001). In multivariate analysis, PD and HD-AVF modalities were associated with approximately €7500 per patient-year cost savings, compared to HD-CVC modality (β-coefficient=-7364, 95%CI [3749 to 10979]; p<0.001). Conclusions: Patients who choose PD or HD with a functioning AVF incur significant lower annual health care expenses compared to those who initiate HD with a catheter, in the new Portuguese bundled payment plan.
Background Underserved ethnic minorities with psychiatric disorders are at an increased risk of C... more Background Underserved ethnic minorities with psychiatric disorders are at an increased risk of COVID-19. This study aims to examine the effectiveness of one-to-one counseling on COVID-19 vaccination and vaccination readiness among underserved African American and Latinx individuals with mental illnesses and adult caregivers of children with mental illness. Methods Through an academic-community partnered collaboration, a multidisciplinary and culturally sensitive training on COVID-19 was co-developed and delivered to 68 therapists from January to March 2021. Mental health clients and their caregivers were recruited to participate in pre-and post-intervention surveys to evaluate the impact of the intervention on their perceptions of COVID-19 public health guidelines, testing, and vaccination. Mental health therapists delivered four lessons of the COVID-19 educational intervention with 254 clients from March to June 2021, when vaccine availability was widely available. Of those clients, we collected 180 baseline and 115 follow-up surveys. The main outcome was the uptake in COVID-19 vaccine. Results There was a positive shift in participant vaccine acceptance and receptivity. Pre-intervention survey shows that only 56% of adult clients and 48% of caregivers had indicated a likelihood of getting the vaccine for themselves at baseline. Postintervention documented that more than 57% of each group had been vaccinated, with another 11-15% of the unvaccinated individuals reporting that they were somewhat or very likely to get the vaccine. Conclusion This study demonstrated that multidisciplinary academic-community and theoretical-based educational intervention delivered by mental health therapists is an effective strategy in increasing COVID-19 vaccine acceptance and reducing the negative impact and disruption that COVID-19 caused in the daily life of mental health patients and caregivers.
Advances in peritoneal dialysis. Conference on Peritoneal Dialysis, 1999
This study was undertaken to determine whether tailoring the dialysis prescription in Asian child... more This study was undertaken to determine whether tailoring the dialysis prescription in Asian children on nightly intermittent peritoneal dialysis (NIPD), without adding high-dose therapy for cost-savings purposes, was able to achieve dialysis adequacy and improvement in nutrition. Eight children (age range: 5.5-20 years) on NIPD for a mean of 2.1 +/- 0.6 years, were studied at baseline and at 3 months and 9 months after their dialysis dose was tailored. Dialysis adequacy was measured by weekly Kt/Vurea and creatinine clearance (CCr). Fat-free mass (FFM) and percent body fat (%FAT) as measured by bioelectrical impedance, together with anthropometric measurements, serum total protein, and albumin, were used as indicators of nutrition. After the dialysis prescription was tailored, the mean weekly Kt/Vurea increased from 1.89 +/- 0.35 to 2.12 +/- 0.54 at 9 months, and total CCr increased from 36.4 +/- 11.51 L/1.73 m2 to 48.30 +/- 14.30 L/1.73 m2. The increase occurred despite a decline i...
Clinical, Cosmetic and Investigational Dermatology
Multiple effects of the COVID-19 pandemic have been described, including an increase in concerns ... more Multiple effects of the COVID-19 pandemic have been described, including an increase in concerns about one's facial appearance resulting in greater interest in cosmetic procedures. However, additional research is required to examine the impact of the pandemic on patients' overall stress levels and whether this reported stress is associated with an interest in facial aesthetic procedures. We aimed to describe perceived stress and to identify factors associated with increased stress among patients seeking aesthetic treatments during the pandemic. Patients and Methods: Patients coming to a Singapore-based clinic and who completed a questionnaire over a one-month period were included. Stress was evaluated using the Perceived Stress Scale (PSS); additional questions sought to understand factors associated with perceived stress and future interest in aesthetic procedures. Results: Two hundred and thirteen respondents participated in the study. Separation from family and inability to travel for leisure were major stressors in 54% and 55%; getting COVID-19 was less frequently a stressor (11%). Patients reported greater concern with appearance (increased worry in 32%, comparison to others in 41%). Ninety-one percent of patients continued aesthetic procedures despite the pandemic and 75% reported interest in proceeding with treatments not previously tried before. PSS scores were higher than published norms. Factors associated with increased scores included residency status, job insecurity and markers of increased concern about appearance. Finally, higher stress scores were observed in patients with greater likelihood of receiving future aesthetic treatments, although this was not statistically significant after applying the Bonferroni correction for multiple comparisons. Conclusion: Significantly higher stress scores were seen in patients seeking aesthetic treatments. We identified factors associated with increased stress with a suggested association between increased likelihood of proceeding with any aesthetic procedure and higher levels of stress. These highlight the importance of caution in treating patients given their increased stress levels and potential vulnerability.
Clinical, Cosmetic and Investigational Dermatology, 2021
Purpose Identifying predictors for patients’ readiness to receive non-surgical facial aesthetic t... more Purpose Identifying predictors for patients’ readiness to receive non-surgical facial aesthetic treatments facilitates the physician’s understanding of the patient’s goals and expectations. This paper aims to identify clinical and demographic characteristics of patients who proceed with non-surgical facial aesthetic procedures in Singapore. Patients and Methods Using data from electronic patient health records, authors examined clinical and demographic characteristics of 624 Asian and Caucasian patients who sought treatment in a 12-month period and who had minimum follow-up of 1 year. Variables examined included age, race/ethnicity, gender, prior treatment, and attitudes and motivation for seeking treatment. Univariate and multivariate analyses of factors associated with proceeding with the treatment plan were evaluated using chi-square and logistic regression analyses. Results Approximately 88% of patients who sought consultation proceeded with treatment. The majority were older th...
Cumulative evidence indicates it may be worthwhile revisiting the twice-weekly hemodialysis (HD) ... more Cumulative evidence indicates it may be worthwhile revisiting the twice-weekly hemodialysis (HD) regimen as a valid option for individualized or incremental treatments for selected patients with end-stage renal disease. In this article, we will review the current evidences on the potential pros and cons of twice-weekly HD compared to thrice-weekly HD including China's experience in the practice of twice-weekly HD. A prudent patient selection and close dialysis adequacy monitoring might be necessary for this medical treatment choice. More randomized prospective controlled studies for the critical evaluation of twice-weekly dialysis are encouraged.
The function encoded by the Ke 6 gene has been recently determined to be 17beta-hydroxysteroid de... more The function encoded by the Ke 6 gene has been recently determined to be 17beta-hydroxysteroid dehydrogenase. Previously, the abnormal expression of the Ke 6 gene has been intimately associated with development of recessive polycystic kidney disease. The Ke 6 gene is normally expressed at very high levels in the kidney and liver and is severely down regulated in all recessive murine models of polycystic kidney disease that have been examined to date. Here, we report a detailed examination of the promoter region of the Ke 6 gene in normal mouse kidney cells (CTA) and in cells derived from mouse kidneys homozygous for the cpk (congenital polycystic kidney) mutation, using transfection analysis and DNA-protein gel shift assays. The minimal promoter region, P1 (+1 to -96), and a putative enhancer site, P3 (-165 to -256), within the Ke 6 gene 5&#39; flanking sequence have been identified. We have also identified another region, P2 (-97 to -165), that may be responsible for the lower promoter activity of the Ke 6 gene in cpk cells. Furthermore, absence of binding of a 38 kDa nuclear protein to a 16 bp sequence element (P1A) within the minimal promoter of the Ke 6 gene suggests that the P1A element could be responsible for the overall reduction in promoter function in cpk cells.
Background: A comprehensive analysis of sex-specific differences in the characteristics, treatmen... more Background: A comprehensive analysis of sex-specific differences in the characteristics, treatment, and outcomes of individuals with end-stage renal disease undergoing dialysis might reveal treatment inequalities and targets to improve sexspecific patient care. Here we describe hemodialysis prevalence and patient characteristics by sex, compare the adult maleto-female mortality rate with data from the general population, and evaluate sex interactions with mortality. Methods and Findings: We assessed the Human Mortality Database and 206,374 patients receiving hemodialysis from 12 countries (Australia,
Given the prohibitive costs of end-stage renal disease (ESRD) care for certain countries and the ... more Given the prohibitive costs of end-stage renal disease (ESRD) care for certain countries and the increasing incidence of ESRD worldwide, alternative methods of funding dialysis care are increasingly necessary. We describe the paradigm of the National Kidney Foundation of Singapore (NKF-S), the provider of subsidized dialysis care and comprehensive rehabilitative services to approximately 60% of all ESRD patients in the country, whose activities are funded entirely by charitable public donations. Unique to the NKF-S model are the considerations of the donor as an &amp;amp;amp;amp;quot;investor&amp;amp;amp;amp;quot; in the health care of NKF-S dialysis patients, the personal responsibility of the dialysis patient as a recipient of this &amp;amp;amp;amp;quot;investment&amp;amp;amp;amp;quot; to play an active role in achieving good clinical and rehabilitative outcomes, and the fostering of community-based support systems to facilitate patient rehabilitation such as partnerships with employers willing to employ dialysis patients. The success of the system is shown by its clinical outcomes, which approximate those observed in the United States. We believe that several aspects of the NKF-S model for ESRD care may be implemented in other communities, particularly in countries that have yet to develop financially and clinically mature dialysis programs.
The importance of tight glycemic control in all forms of diabetes has been well documented. 3-6 A... more The importance of tight glycemic control in all forms of diabetes has been well documented. 3-6 As early as 1967, the International Diabetes Center demonstrated that tight glycemic control was a critical component in the management of type 1 diabetes and that a multidisciplinary approach would be necessary to meet this goal. As a participant in the Diabetes Control and Complications Trial (DCCT), the IDC was able to demonstrate that an evidence-based multidisciplinary approach could achieve near normal glycemia in individuals with type 1 diabetes. During the course of this landmark study it became clear that an evidence-based systematic approach to clinical decision-making PRINCIPLES AND DEVELOPMENT OF SDM Chairperson: Richard Bergenstal (USA), Donnell Etzwiler (USA), Roger Mazze (USA), Boniface J Lin (Taiwan) INTRODUCTION Continued As SDM moves into the 21st century, its mission has expanded to encompass the principles of primary and secondary prevention. With the recent identification of an increasing number of novel disease susceptibility genes for type 2 diabetes, the substantial evidence related to the contribution of diet and lifestyle to the onset of disease, and a more complete understanding of the natural history and pathophysiology of all types of diabetes, the possibility of identifying with greater sensitivity and specificity individuals at high risk for diabetes may soon be realized. More important is the introduction of non-hypoglycaemic insulin sensitizing agents and the renewed emphasis on lifestyle changes as viable therapeutic interventions for the prevention of type 2 diabetes and perhaps gestational diabetes. These developments will not dampen the current emphasis on identifying those with undiagnosed disease. Rather, the goal is to accomplish this more systematically and at an earlier point in the natural history of diabetes, in order to prevent or slow the progression of complications. Nor does this portend a reduction in the utilization of resources devoted to the treatment of complications. With an increased understanding of the pathophysiology of cardiovascular, renal, neurological and retinal complications, there is a need to translate what we know into practical clinical processes that will assure the person with diabetes an opportunity to enjoy the highest possible quality of life. Thus, the goal of SDM is to continue to develop and implement new approaches to the continuum of diabetes care. This takes into account an integrated strategy for the prevention, early detection and improved treatment of all forms of diabetes and associated complications. To achieve this goal, the results of research on complex interrelated genetic and environmental risk factors may one day be integrated into the SDM protocols. Simultaneously, efforts to slow the progression of complications have to continue. On 11-12 November 2000, 70 delegates who have worked with SDM,
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Papers by Sylvia Ramirez