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Introduction: End-stage kidney disease (ESKD) patients who need renal replacement therapy need to face a dialysis modality decision: the choice between hemodialysis (HD) and peritoneal dialysis (PD). Although the global differences in HD/PD penetration are affected by health-care policies, these two modalities may exert different effects on survival in patients with ESKD. Although Taiwan did not implicate PD as first policy, we still need to compare patients' outcomes using two modalities in a nation-wise database to determine future patients' care and health policies. Methods: We used the nationwide Taiwan Renal Registry Data System (TWRDS) database from 2005 to 2012 and included 52,900 patients (48,371 on HD and 4529 on PD) to determine all-cause and cardiovascular mortality among ESKD patients. Results: Age-matched survival probability from all-cause mortality was significantly lower in patients on PD than in those on HD (p < 0.05). The adjusted hazard ratios of 3-year and 5-year all-cause and cardiovascular mortality were significantly higher in PD compared with HD. The presence of comorbid conditions including myocardial infarction, coronary artery disease (CAD), diabetes mellitus (DM), hypoalbuminemia, hyperferritinemia and hypophosphatemia was related with significantly higher all-cause and CV mortality in PD patients. No significant difference was noted among younger patients <45 years of age regardless of DM and/or comorbid conditions. Conclusion: Although PD did not have the survival advantage compared to HD in all dialysis populations, PD was related with superior survival in younger non-DM patients, regardless of the presence of comorbidities. Similarly, for younger ESKD patients without the risk of CV disease, both PD and HD would be suitable dialysis modalities.
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Although erythropoietin-stimulating agents are effective in treating anemia in patients with end-stage kidney disease (ESKD) undergoing hemodialysis, some ESKD patients, especially those with inflammation, continue to suffer from anemia. Statin, an inhibitor of hydroxymethylglutaryl-CoA (HMG-CoA) reductase with lipid-lowering effects, may have a pleiotropic effect in reducing inflammation, and thus increase hemoglobin (Hb) level. We searched the PubMed, Embase, and Cochrane databases for relevant studies. The population of interest comprised advanced chronic kidney disease (CKD) patients and ESKD patients receiving hemodialysis with statin treatment. The included study designs were randomized control trial/cohort study/pre-post observational study, and outcomes of interest were Hb, erythropoietin resistance index (ERI) and ferritin. PRISMA 2020 guidelines were followed, and risk of bias (RoB) was assessed using the RoB 2.0 tool in randomized controlled trials, and the Newcastle-Ottawa scale (NOS) in cohort studies. We eventually included ten studies (5258 participants), comprising three randomized controlled trials and seven cohort studies. Overall, Hb increased by 0.84 g/dL (95% confidence interval [CI]: -0.02 to 1.70) in all groups using statins, including single-arm cohorts, and by 0.72 g/dL (95% CI: -0.02 to 1.46) in studies with placebo control. Hb levels were higher in the study group than in the control group, with a mean difference of 0.18 g/dL (95% CI: 0.04-0.32) at baseline and 1.0 g/dL (95% CI: 0.13-1.87) at the endpoint. Ferritin increased by 9.97 ng/mL (95% CI: -5.36 to 25.29) in the study group and decreased by 34.01 ng/mL (95% CI: -148.16 to 80.14) in the control group; ferritin fluctuation was higher in the control group. In conclusion, statin may improve renal anemia in ESKD patients receiving hemodialysis and regular erythropoietin-stimulating agents. Future studies with more rigorous methodology and larger sample size study should be performed to confirm this beneficial effect.
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Flipped teaching is one of the most popular innovative teaching methods which has attracted a lot of attention and lead to amount of discussion in recent years. Many educators have generally encountered same doubt when implementing flipped education: Is this kind of teaching mode only applicable to students with high learning achievements? In addition, collaborative learning is often applied in flip teaching and it is also an issue worth to explore. In this study, both quantitative and qualitative studies were conducted to examine the potential factors in affecting the learners' satisfaction in flipped education. The survey results from 171 participants showed that collaborative learning and need for cognition are significant predictors of learning satisfaction. In addition, a deeper look at the collaborative learning process was further examined by conducting deep interview. A total of 12 students from 6 different flipped-teaching courses participated the interview. The findings suggested that arranging some activities to encourage students to know each other before class that helps students find corresponding group and facilitates their expertise for collaborative learning. The mechanism significantly influenced team members' engagement, discussion atmosphere, and efficiency. In addition, when learning tasks diversity, it will also enhance students' innovative ability, empathy, and even promote mutual learning.
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Some patients are uncomfortable with being wired to a device to have their heart activity measured. Accordingly, this study adopts a noncontact electrocardiogram (ECG) measurement system using coupled capacitance in a conductive textile. The textiles can be placed on a chair and are able to record some of the patient's heart data. Height and distance between the conductive textile electrodes were influential when trying to obtain an optimal ECG signal. A soft and highly conductive textile was used as the electrode, and clothing was regarded as capacitance insulation. The conductive textile and body were treated as the two electrode plates. This study found that placing the two conductive textiles at the same height provided better data than different heights. The system also enabled identifying the P, Q, R, S, and T waves of the ECG signal and eliminated unnecessary noise successfully.
