Tag: Navy (Page 37 of 45)

The Power of Self-Efficacy in Peritoneal Dialysis Patients

June 19, 2023 / Henry Feeser / 0 Comments

Peritoneal dialysis (PD) is a life-sustaining treatment for patients with end-stage renal disease. It requires a significant level of patient involvement and self-care, making it a unique medical treatment that places a considerable amount of responsibility on the patient. One psychological concept that plays a crucial role in the successful management of PD is self-efficacy.

Self-efficacy, a term coined by psychologist Albert Bandura, refers to an individual’s belief in their ability to succeed in specific situations or accomplish a task. It’s about having confidence in the ability to exert control over one’s own motivation, behavior, and social environment. In the context of PD, self-efficacy can significantly influence a patient’s ability to manage their treatment effectively.

Patients with high self-efficacy tend to believe they can influence their health outcomes positively through their actions. They are more likely to feel confident in their ability to perform the necessary tasks associated with PD, such as maintaining sterility during exchanges, recognizing signs of infection, and managing their diet and fluid intake. This confidence can lead to better adherence to their dialysis regimen, resulting in improved health outcomes.

Moreover, self-efficacy can also influence how patients cope with the psychological challenges associated with PD. Living with a chronic illness can be emotionally taxing, leading to feelings of stress, anxiety, and depression. However, patients with high self-efficacy are often more resilient. They believe in their ability to overcome challenges and are more likely to use effective coping strategies, contributing to better mental health and overall quality of life.

So, how can we foster self-efficacy in PD patients?

Education: Providing comprehensive education about PD can help patients understand their treatment better and feel more confident in their ability to manage it. This includes teaching them about the mechanics of PD, potential complications, and how to respond to them.
Skills Training: Practical training in the tasks required for PD, such as performing exchanges and monitoring for signs of infection, can enhance patients’ confidence in their abilities.
Positive Feedback: Encouragement and positive feedback from healthcare providers can reinforce patients’ belief in their abilities. Celebrating small victories and progress can boost their confidence.
Peer Support: Connecting with other PD patients can provide a sense of community and shared understanding. Hearing about others’ experiences and successes can inspire confidence and motivation.
Goal Setting: Setting and achieving small, manageable goals can build self-efficacy over time. As patients see themselves successfully managing their PD, their confidence in their ability to do so will grow.

In conclusion, self-efficacy is a powerful psychological tool that can significantly impact the success of peritoneal dialysis treatment. By understanding and fostering self-efficacy, we can support PD patients in managing their treatment effectively, leading to better health outcomes and improved quality of life.

Of interest is how we go about ascertaining the degree of self-efficacy a person has and/or displays.

Self-efficacy is typically measured using self-report questionnaires. These questionnaires ask individuals to rate their confidence in their ability to perform specific tasks or behaviors. Here are some methodologies commonly used to measure self-efficacy:

General Self-Efficacy Scale (GSES): This is a 10-item scale designed to assess a person’s belief in their ability to handle a variety of difficult demands in life. Each item is rated on a 4-point scale.
Self-Efficacy for Managing Chronic Disease 6-Item Scale: This scale is specifically designed to assess self-efficacy in individuals with chronic diseases. It asks individuals to rate their confidence in doing certain activities, such as managing symptoms, following a treatment plan, and dealing with the emotional challenges of chronic disease.
Perceived Health Competence Scale (PHCS): This 8-item scale measures individuals’ beliefs in their ability to effectively manage their health outcomes.
Bandura’s Guide for Constructing Self-Efficacy Scales: Albert Bandura, the psychologist who first introduced the concept of self-efficacy, has provided guidelines for constructing self-efficacy scales. These guidelines suggest that self-efficacy scales should be tailored to the specific domain being assessed. For example, a self-efficacy scale for peritoneal dialysis might ask individuals to rate their confidence in their ability to perform specific tasks related to their dialysis treatment.
Disease-Specific Self-Efficacy Scales: There are also many disease-specific self-efficacy scales, such as the Arthritis Self-Efficacy Scale, the Diabetes Management Self-Efficacy Scale, and the Asthma Self-Efficacy Scale. These scales could be adapted for use with peritoneal dialysis patients.

It’s important to note that while self-report questionnaires are a common method for measuring self-efficacy, they do rely on individuals’ self-perceptions, which can be influenced by a variety of factors. Therefore, they should be used as part of a broader assessment strategy.

Sexual Frustration not Guns Kill

June 16, 2023 / Henry Feeser / 0 Comments

In the 6/5/2023 issue of PsyPOST Erich W. Dolan wrote an article titled “New study identifies sexual frustration as a significant factor in mass shootings.” I have never seen or heard of this before and although it’s off-topic for a dialysis-directed blog, it certainly is topical and very much in today’s news. The original article is linked here. I’ve included a summary below. It certainly blows holes in the theory that guns kill people.

A study published in Homicide Studies found that mass shooters exhibiting signs of sexual frustration were responsible for more victims on average than other mass shooters. This study highlights sexual frustration as a significant contributing factor to gun violence and notes differences in the psychological profiles and attack types of these individuals.
The researchers developed a set of criteria to identify sexually frustrated shooters, which included explicit complaints about sexual frustration, inability to find a partner, soliciting sex workers, stalking or harassing desired partners, and engaging in illegal or inappropriate sexual behaviors.
Approximately one-third of mass shooters were found to have sexual frustration problems. These individuals were six times more likely to have a history of sex offending, desired more fame, and tended to carry out some of the deadliest mass shootings in U.S. history.
Sexually frustrated mass shooters were more likely to be young, male, unmarried, childless, unemployed, and misogynistic. They exhibited behaviors linked to seeking relief, power, revenge, and displaced frustration. They also tended to kill more victims and a higher proportion of female victims, often choosing schools as their target locations.
The researchers argue that sexual frustration is a complex issue, not limited to virgins or “incels”, but also affects sexually active people. It is influenced by expectations, entitlements, and the embrace of toxic gender norms. They suggest that societal progress in reducing toxic factors, such as men’s assumptions that women are obliged to have sex with them, could help mitigate sexual frustration and, consequently, potentially violent behaviors.

The Big Two Plus Newbie in CKF Treatment: An Overview of the Competitive Space

June 15, 2023 / Henry Feeser / 1 Comment

The heavy half of the Cronic Kidney Failure treatment space consists of the big two, Fresenius Medical and DaVita, and a new entry, Strive Health, as the third. The discussion below is about the apparent strategies of these three.

Strive Health: A Progressive Approach to Kidney Care

Strive Health, a national leader in value-based kidney care, emerged on the scene in 2020 with a bold vision: to revolutionize the standard of kidney care, providing better access to care for individuals across socioeconomic backgrounds. The company has made impressive strides since its inception, now serving 80,000 chronic kidney disease (CKD) and end-stage kidney disease (ESKD) patients across 30 states and partnering with over 600 nephrology providers across 10 states.

Strive’s strategy centers on a value-based care approach that prioritizes patient outcomes over the volume of services provided. This approach aligns with the broader healthcare industry’s move towards value-based care, a trend also reflected in the strategies of Fresenius Medical Care and DaVita. Essentially, Strive’s strategy is to build sustainable partnerships with commercial and Medicare Advantage payors, Medicare, health systems, and physicians through flexible value-based payment arrangements, including risk-based programs.

Strive’s approach has led to a 20% reduction in the total cost of kidney care, a 42% reduction in hospitalizations, and a remarkable 94% overall patient satisfaction with Strive’s staff.

Fresenius Medical Care: Innovating for the Future of Renal Care

Fresenius Medical Care is another key player in the kidney care space. Its strategy is rooted in four core competencies: innovating products, operating outpatient facilities, standardizing medical procedures, and coordinating patients efficiently . In addition, Fresenius is leveraging digitalization, data analytics, and artificial intelligence to transform how it delivers healthcare, focusing on creating sustainable solutions with innovative products and services of the highest quality at a reliable cost.

Fresenius’ approach to renal care involves implementing new renal care models, promoting value-based care, integrating CKD and transplantation services, and fostering future innovations. These efforts are all part of their long-term commitment to sustainable development and growth.

DaVita: A Leader in Dialysis Care

DaVita is a leading provider of kidney care services, including dialysis. It is a company that is evolving care across the entire kidney care continuum—from early detection and management of chronic kidney disease (CKD) to optimal treatment for end-stage kidney disease (ESKD) and kidney transplant. They are working not only to improve their patient’s quality of life but also to transform the entire kidney care industry. They have a strong commitment to ESG (Environmental, Social and Governance) and have set 2025 goals

Comparing Strategies: A Focus on Value-Based Care

Comparing the strategies of these three companies, it’s clear that they all emphasize a shift towards value-based care, though they approach it in distinct ways. Strive Health focuses on technology-enabled care interventions and integration with local providers, while Fresenius Medical Care emphasizes innovation and the application of digital tools in creating new renal care models. Fresenius also seeks to expand value-based care programs to include chronic kidney disease and kidney transplants. DaVita appears to be competing on cost but is moving toward a value-added model.

While it’s clear that all three companies are invested in improving kidney care, they each bring their unique strengths and approaches to the table. It will be interesting to observe how their strategies evolve as they continue to strive for better patient outcomes in the changing landscape of kidney care.

Full disclosure: I own stock in both Fresenius Medical and DaVita. Srive is, at this time, a private company funded by investors such as NEA and CVS Health Ventures, and others. Strive now manages over $2.5 billion of annual medical spending and has grown to 550 employees, according to TechCrunch.

More about the CGM World

June 14, 2023 / Henry Feeser / 0 Comments

On May 26, 2023, in CNBC Tech Erin Black ran a story “How Dexcom and Abbott are moving beyond diabetes with blood sugar monitoring.” Since I am also a Type 2 diabetic and paying out of pocket for an Abbott Freestyle Libre 3 Continuous Glucose Monitoring system, this blurb was of interest to me. Watch the embedded video below for more insights into this growing market for CGMs.

Simple Tweak Improves Glucose Control

June 13, 2023 / Henry Feeser / 1 Comment

Writing in the May 31, 2023 issue of News Medical Life Sciences, Lily Ramsey LLM wrote an article titled ‘A simple tweak to first meal of the day may benefit people with Type 2 diabetes.” Since about 44% of those of us on dialysis also have been blessed with Type 2 diabetes, such a finding is of interest to us also. A link to the article is here. A summary of the article is below.

A study led by UBC Okanagan researchers suggests that people with Type 2 diabetes (T2D) can better control their blood sugar levels by modifying their breakfast to be low in carbs and high in protein and fats.
This single meal modification was found to help control blood sugar levels throughout the day, potentially limiting hyperglycemic swings.
The 12-week study involved 121 participants divided into two groups, one consuming a low-carb, high-protein, high-fat breakfast and the other consuming a traditional, high-carb, low-fat breakfast.
While there were no significant differences in weight, body mass index, or waist circumference between the groups, the low-carb group saw reduced blood sugar levels, and some participants could reduce their glucose-lowering medication.
Additionally, participants with a low-carb breakfast reported lower calorie and carbohydrate intake at lunch and for the rest of the day, suggesting that a low-carb breakfast could impact overall daily eating habits.

Attribution: Bing Illustrator for the lead graph, ChatGPT4 for summarizing the article, Grammarly for cleaning up after me, and me for the idea, concept, and any mistakes.

The Digital Mariner: aka Hank Feeser

June 9, 2023 / Henry Feeser / 1 Comment

Once upon a time, in a small coastal town in Maine, lived an old man named Commander John Sullivan. He was a retired US Navy Commander, a veteran of three combat tours in Vietnam, and an advisor to the brown water navy during his last tour. His house, a quaint cottage, was perched on a cliff overlooking the vast, endless sea. The rhythmic sound of the waves crashing against the rocks was his constant companion, a soothing lullaby that lulled him to sleep every night.

Commander Sullivan was a man of the sea, but he was also a man of the world. He had seen the horrors of war, the beauty of foreign lands, and the resilience of the human spirit. His life was a tapestry of experiences woven with threads of joy, sorrow, courage, and wisdom. He had stories to tell, lessons to impart, and a desire to share his life’s journey with the world.

However, age had taken its toll on Commander Sullivan. He was on dialysis, a reality that confined him to his home, tethered to a machine that kept him alive. But he was not a man to be easily defeated. He was a sailor, after all, a man who had braved the stormy seas and the bullets of war. He was determined to turn the tide in his favor.

Commander Sullivan was a man of the old world but was not a stranger to the new. He was well-versed in technology, a skill he had honed during his years in the Navy. He had a high-speed internet connection, a powerful computer, and a burning desire to share his experiences with the world.

And so he decided to write a blog. He named it “The Digital Mariner,” a nod to his love for the sea and his newfound role as a digital storyteller. Every day, he would sit in front of his computer, the sea as his backdrop, and write. He wrote about his experiences in the Navy, his tours in Vietnam, his life as a sailor, and his insights on life, war, and resilience.

His blog quickly gained traction. People from all walks of life started reading his posts. Veterans found solace in his words, young people found inspiration, and fellow dialysis patients found strength. His stories resonated with people, his wisdom touched hearts, and his courage inspired many.

Commander Sullivan also started hosting live webinars, where he would share his stories in real-time, answer questions, and engage with his readers. He used technology to break the barriers of his physical confinement, reaching out to people across the globe, touching lives, and making a difference.

Despite his health challenges, Commander Sullivan found a way to share his lifetime of experiences with mankind. He used technology as his vessel, his words as his compass, and his will as his wind. He sailed the digital seas, charting a course that was uniquely his, leaving a legacy that would continue to inspire future generations.

Ultimately, Commander John Sullivan, the old man by the sea, became more than just a retired navy commander. He became a beacon of hope, a symbol of resilience, and a digital mariner, sailing the vast seas of the internet, sharing his wisdom, and lighting the way for others.

And that person dear readers of this blog, is me, Hank Feeser. Commander, United States Navy Retired. AI assistance was used in writing this blog per past attributions.

New Blood Pressure Device for those on Dialysis

June 8, 2023 / Henry Feeser / 1 Comment

One of the many requirements those on dialysis have to contend with is blood pressure. At a minimum, I take mine once in the morning with a cuff device to log biometrics into the Fresenius Liberty Cycler data collection system.

Those who have dealt with cuff systems know that they ofttimes present challenges with error messages being thrown, requiring fussing around with the Velcro cuff, etc, to gain a proper reading.

Just starting to come to market are systems embodied in watches. However, my experience with such devices indicates that their accuracy leaves lots to be desired.

A group of researchers in La Hoya California have just released a paper on a novel system. Xuan, Y., Barry, C., De Souza, J. et al. Ultra-low-cost mechanical smartphone attachment for no-calibration blood pressure measurement. Sci Rep 13, 8105 (2023). https://doi.org/10.1038/s41598-023-34431-1

The Abstract from the above reference is quoted in its entirety below. See the link above for more information.

Abstract

We propose an ultra-low-cost at-home blood pressure monitor that leverages a plastic clip with a spring-loaded mechanism to enable a smartphone with a flash LED and camera to measure blood pressure. Our system, called BPClip, is based on the scientific premise of measuring oscillometry at the fingertip to measure blood pressure. To enable a smartphone to measure the pressure applied to the digital artery, a moveable pinhole projection moves closer to the camera as the user presses down on the clip with increased force. As a user presses on the device with increased force, the spring-loaded mechanism compresses. The size of the pinhole thus encodes the pressure applied to the finger. In conjunction, the brightness fluctuation of the pinhole projection correlates to the arterial pulse amplitude. By capturing the size and brightness of the pinhole projection with the built-in camera, the smartphone can measure a user’s blood pressure with only a low-cost, plastic clip and an app. Unlike prior approaches, this system does not require a blood pressure cuff measurement for a user-specific calibration compared to pulse transit time and pulse wave analysis based blood pressure monitoring solutions. Our solution also does not require specialized smartphone models with custom sensors. Our early feasibility finding demonstrates that in a validation study with N = 29 participants with systolic blood pressures ranging from 88 to 157 mmHg, the BPClip system can achieve a mean absolute error of 8.72 and 5.49 for systolic and diastolic blood pressure, respectively. In an estimated cost projection study, we demonstrate that in small-batch manufacturing of 1000 units, the material cost is an estimated $0.80, suggesting that at full-scale production, our proposed BPClip concept can be produced at very low cost compared to existing cuff-based monitors for at-home blood pressure management.

AI-Powered Nutritional Guidance for Dialysis Patients

June 7, 2023 / Henry Feeser / 1 Comment

Artificial Intelligence (AI) can help tailor dietary advice for dialysis patients and consider their unique needs and responses to their treatment. This video gives an overview of such use of AI with real-world examples and patient testimonials.

The script was written with the assistance of ChatGPT4 with oversight by Grammarly. The video was mastered and rendered in the AI app Pictory.AI.

Embracing the SEAL Ethos for Peritoneal Dialysis

June 2, 2023 / Henry Feeser / 0 Comments

When the going gets tough, I always fall back to my interfaces with the US Navy SEAL Community in Coronado, CA, while I was in a Vietnamese language school in 1972. Their Ethos has much to offer those of us who are mere mortals on Dialysis. I have extracted some of the more cogent phrases and ran them past my Chatbot for a take on how these “rules to live and die by” provide inspiration to those of us on dialysis. I then constructed a dialog from the outcome, which I ran through my subscription to Pictory.AI. The resulting video is below. Remember, Never ring the bell!

Revolutionizing Dialysis Treatment: The Power of AI and Machine Learning

May 31, 2023 / Henry Feeser / 1 Comment

As an individual on Peritoneal Dialysis, I must gather and manually submit tons of data to my provider, Fresenius Medical. This starts with a thumb drive in the Cycler that gathers info I sneaker net to Fresenius whenever I visit, say for monthly labs. Every morning upon completion of my dialysis for the day, I am required to enter weight, blood pressure, glucose, heart rate, amount and type of fluid used, and body temperature into the cycler. I am required to use the Fresenius app Patienthub daily to enter the fact that I entered the required info in the Cycler, what my PD fluid looked like, what my exit site looks like, and did I apply antibiotic cream. Lastly, it requires confirmation that I did or did not perform any manual drains.

Lots of data, but here’s the deal. I have yet to hear anything back from ANYBODY concerning the use of this data, feedback to alter any treatment, or whatever. Nada, zip, zero. I have been led to believe by my dialysis nurse that the raw data is eyeballed, but no hardcore statistical analysis is employed. No trends, outliers, moving averages, changes, improvements, etc.

It is obvious to the most casual observer that a tremendous opportunity exists herein for using AI to improve patient outcomes. And that patient is me. I am interested in improving outcomes, and I know Ai can greatly assist in this area. Read on.

In the world of healthcare, the potential of Artificial Intelligence (AI) and Machine Learning (ML) is becoming increasingly apparent. One area where these technologies are making a significant impact is in managing chronic kidney disease, specifically in the personalization of dialysis treatment plans.

Dialysis, a life-saving treatment for individuals with kidney failure, traditionally follows a one-size-fits-all approach. However, every patient is unique, with different health histories, lifestyles, and responses to treatment. This is where AI and ML come into play.

AI and ML algorithms can analyze vast amounts of data quickly and accurately. In the context of dialysis treatment, these technologies can be used to examine the unique medical information of individual patients. This includes data from electronic health records, lab results, and even real-time data from dialysis machines.

By analyzing these data points, ML algorithms can identify patterns and trends that might not be immediately apparent to healthcare providers. For example, an algorithm might notice that a patient’s blood pressure tends to spike after dialysis or that their kidney function improves when dialysis is performed at a specific time of day.

Based on these insights, the AI system can recommend personalized dialysis treatment plans tailored to the individual needs and responses of each patient. This could involve adjusting the frequency or duration of dialysis sessions, altering the dialysis fluid composition, or recommending lifestyle changes that could improve the patient’s overall health.

The potential benefits of this personalized approach are significant. By tailoring dialysis treatment to the individual patient, we can potentially improve their quality of life and health outcomes. For instance, personalized treatment plans could reduce side effects, improve kidney function, and extend the patient’s lifespan.

Moreover, this approach could also lead to more efficient use of healthcare resources. By predicting and preventing complications before they occur, we can reduce hospital admissions and healthcare costs.

In conclusion, the integration of AI and ML in dialysis treatment is a promising development in the field of nephrology. By leveraging these technologies, we can move away from a one-size-fits-all approach and towards personalized treatment plans that improve patient outcomes.

I was assisted by Prompt Perfect, ChatGPT4, Grammarly, and Bing Illustrator in authoring the above post.