Search PubMed⌕ Search

Biomedical subjects

S S Prichard

Publications and source records attributed to S S Prichard.

12 recordsLinked to original sources
PubMed1997

The costs of dialysis in Canada.

In summary, Canada enjoys a publicly funded healthcare system which is the second most costly in the world. The treatment rate for renal replacement therapy is comparable with countries in Europe but falls short of that in the United States and Japan. With respect to costs, peritoneal dialysis is a cheaper option than haemodialysis. The major costs in peritoneal dialysis are supply related and the major costs in haemodialysis are labour and supplies. A treatment modality change includes a set of costs which makes the most cost-effective therapy in almost cases a therapy that can be successfully maintained.

Canada↗
PubMed1997

Peritoneal dialysis and haemodialysis: are they comparable?

It is difficult to make adequate comparisons between peritoneal and haemodialysis. Survival studies show somewhat different results from country to country. In Canada, peritoneal dialysis appears to have some advantage over haemodialysis using the Cox regressional analysis. Intention-to-treat survival curves show no difference. With respect to the quality of life, it is difficult to demonstrate significant differences. Cost differences are country dependent. For any given patient, where medical considerations heavily favour one modality over another, one can safely presume that either haemodialysis or peritoneal dialysis can be successfully employed in managing the patient.

Humans↗
PubMed1996

Socioeconomic and health-care policies and peritoneal dialysis.

1. All ESRD treatments is expensive and a modality change adds considerably to that expense. 2. Ideally, the cost of ESRD therapy should be reported as the cost incurred for all aspects of the treatment to the health-care system. 3. Most studies show peritoneal dialysis to be less expensive than hemodialysis, but this can vary depending on the local costs of supplies and labor. 4. Strategic decisions with regard to new innovations should be made after a full analysis of all of the involved costs and savings that the innovation might introduce. 5. Economic factors and reimbursement rates appear to have an important impact on modality selection.

Canada↗
PubMed1991

ESRD treatment modality selection: which factors are important in the decision?

UNLABELLED: The purpose of this study was to determine which factors are most important in choosing between ESRD treatments and to assess if patients, R.N.'s and M.D.'s agree or differ as to the level of importance of different factors. METHODS: 22 patients, 11 R.N.'s and 10 M.D.'s were interviewed to determine which factors should be considered. Forty-three factors were identified relevant to CAPD and hemodialysis. Then 14 patients, 8 R.N.'s and M.D.'s were asked to rate each of these factors on a scale of 1-10 (10 being most important) and the average score for each was computed. The factors were then ranked in order of importance (1 being most important). The results revealed that peritonitis ranked as overall the most important factor in determining treatment modality choice. In general, life style considerations ranked higher than medical consequences of a specific therapy. There was concordance amongst the three groups in some areas but there were also differences between patients, R.N.'s and M.D.'s. This raises important issues with regards to the adequacy of patient counselling.

Attitude of Health Personnel↗
PubMed1989

Impact of left ventricular hypertrophy on survival in end-stage renal disease.

We examined the prognostic significance of left ventricular hypertrophy determined by echocardiography in a cohort beginning renal replacement therapy. No patient had hemodynamically significant valvular disease or echocardiographic signs of obstructive cardiomyopathy. Using the Cox proportional hazards model, left ventricular hypertrophy was significantly associated with survival. The relative risk, based on comparison of upper and lower quintiles of left ventricular mass index, was 3.7 (95% confidence intervals, 1.6 to 8.3) for all-cause mortality and 3.7 (95% confidence intervals, 1.2 to 11.1) for cardiac mortality. The independent risk, adjusted for age, known coronary artery disease, diabetes, level of systolic blood pressure, and treatment (dialysis or transplantation), was 2.9 (95% confidence intervals, 1.3 to 6.9) for all-cause mortality and 2.7 (95% confidence intervals, 0.9 to 8.2) for cardiac mortality. Therefore, left ventricular hypertrophy appears to be an important, independent, determinant of survival in patients receiving therapy for end-stage renal failure.

Cardiomegaly↗
PubMedDate not supplied

Treatment modality selection in 150 consecutive patients starting ESRD therapy.

OBJECTIVE: The purpose of this study was to assess the reasons for treatment modality selection between hemodialysis (HD) and peritoneal dialysis (PD) in 150 consecutive patients in a single center. DESIGN: This study is a retrospective study using chart review as the data collection method. SETTING: A single tertiary care university teaching hospital. PATIENTS: One hundred and fifty consecutive patients starting end-stage renal disease (ESRD) therapy at the Royal Victoria Hospital in Montreal were assessed. Their treatment modality at 6 weeks after starting dialysis was recorded as their treatment modality. Patients transplanted or who died prior to that 6-week period were excluded. MAIN OUTCOME MEASURES: The treatment modality, that is, either HD or PD, at 6 weeks after the initiation of ESRD was the modality assigned to the patient. RESULTS: One hundred and fifty patients started ESRD therapy of whom 83 went to HD and 67 to PD. Thirty-one patients were directed to HD, including 20 for social reasons, 3 with ostomies, and 6 with unsuitable abdomens. Fourteen patients were directed to PD, including 10 with severe cardiovascular disease, 3 with no vascular access, and one for geographical reasons. Of 31 diabetics who were encouraged to do PD, 17 went to PD and 14 to HD (10 for social reasons, 3 refused PD, and one with an inappropriate abdomen). Seventy-four patients were initially eligible for either PD or HD. Fifty percent (37) went to PD and 50% to HD. Of those going to HD, 15 went to self-care HD, of whom 7 had prior exposure to HD. Eleven were not informed regarding PD. There was no gender preference for PD versus HD. CONCLUSION: We conclude that among informed patients, if given a choice of treatment modality, the majority will choose self-care dialysis including continuous ambulatory peritoneal dialysis (CAPD) or self-care HD.

Adolescent↗