Using billing codes for all healthcare encounters within 30 days of each patient's first dialysis-related claim ("index encounter"), we attempted to designate each study subject as either a "PD patient" or "HD patient." Using alternative windows of ± 30 days, ± 90 days, and ± 180 days around the index encounter, we reviewed patients' medical records to determine the dialysis modality actually received. The study population consisted of all persons aged 18 - 63 years in a large US integrated health plan with ESRD and dialysis-related billing codes (i.e., diagnosis, procedures) on healthcare encounters between January 1, 2005, and December 31, 2008.
While health insurance claims data are often used to estimate the costs of renal replacement therapy in patients with end-stage renal disease (ESRD), the accuracy of methods used to identify patients receiving dialysis - especially peritoneal dialysis (PD) and hemodialysis (HD) - in these data is unknown.
Taneja, Charu Berger, Ariel Inglese, Gary W Lamerato, Lois Sloand, James A Wolff, Greg G Sheehan, Michael Oster, Gerry Collaboration between a GP and a practice based community nurse represents a potential solution to identifying (and responding to) unmet physical and psychosocial needs to improve quality of life in community dwelling older adults.Ĭan dialysis patients be accurately identified using healthcare claims data? The importance of such assessments is underscored by strong associations between various domains and perceived general health. Health assessments were effective in identifying significant physical and psychosocial problems in older adults. Mobility, ADL, visual impairment, bowel problems, use of sleep medications and psychological wellbeing were strongly associated to self reported health. There were age and gender differences in activities of daily living (ADL). Women reported more psychological distress. Incontinence affected one-third of patients, mainly women. Men rated their health more poorly than women. Over 90% of participants reported one or more health problems, with musculoskeletal issues being most common. Fifty percent of the women and 25% of the men lived alone. Data were collected by GP-nurse teams on physical and psychosocial variables using a combination of physical examination, self reporting, and rating scales. Five hundred and forty-six consecutive, eligible patients were recruited. Community dwelling patients of a large suburban general practice aged 75 years and over were invited to participate. This study aimed to identify unmet needs in community dwelling general practice patients aged 75 years and over through annual health assessments performed by a general practitioner-nurse team. The Enhanced Primary Care program seeks to reduce this burden by promoting preventive and coordinated care. Williams, Ian D O'Doherty, Lorna J Mitchell, Geoffrey K Williams, Karen EĪustralia's rapidly aging population has a high prevalence of chronic disease and disability, leading to an increased social and economic burden. Identifying unmet needs in older patients-nurse-GP collaboration in general practice. Overall, our results suggest Hp1bp3 may serve as a potential target against cognitive aging and demonstrate the utility of genetically diverse animal models for the study of complex human disease. Deletion of functional Hp1bp3 in mice recapitulates memory deficits characteristic of aged impaired mice and humans, further supporting the idea that Hp1bp3 and associated molecular networks are modulators of cognitive aging. Here, we identify Hp1bp3 as a novel modulator of cognitive aging using a genetically diverse population of mice and confirm that HP1BP3 protein levels are significantly reduced in the hippocampi of cognitively impaired elderly humans relative to cognitively intact controls. Challenges to identifying these specific genes in human studies include complex genetics, difficulty in controlling environmental factors, and limited access to human brain tissue. Identifying the specific genes that contribute to cognitive aging may aid in early diagnosis of at-risk patients, as well as identify novel therapeutics targets to treat or prevent development of symptoms.
Neuner, Sarah M Garfinkel, Benjamin P Wilmott, Lynda A Ignatowska-Jankowska, Bogna M Citri, Ami Orly, Joseph Lu, Lu Overall, Rupert W Mulligan, Megan K Kempermann, Gerd Williams, Robert W O'Connell, Kristen M S Kaczorowski, Catherine CĪn individual's genetic makeup plays an important role in determining susceptibility to cognitive aging. Systems genetics identifies Hp1bp3 as a novel modulator of cognitive aging.
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