Christian Sayings For 2010

Mobile Phone. New application makes possible an outpatient dialysis program.

"What is that all patients have at hand? " was what was asked a doctor to try to find a solution to the resource constraints that shared their hospital and uninsured patients with advanced renal failure, so they could perform an outpatient treatment essential to compensate for 85% or more of the role that had already lost their kidneys. The answer came immediately: a cell phone.

"The lack of adequate staff, the great dispersion of the patients in the suburbs and insecurity prevented us from making home visits necessary to assess whether housing of patients who are very poor, they met the basic conditions to get dialysis at home and leave his post at the hospital to another in a more serious condition, "said Dr. Carlos Cangado Pousa of Nephrology Department Hospital Presidente Perón, Avellaneda (Buenos Aires, Argentina).

It struck him that these home visits could be replaced with photographs taken with the phone. That would be corrected, if necessary, features housing to meet safely each step of peritoneal dialysis, which together with hemodialysis are two renal replacement therapies for people with less than 15% of renal function.

- Haemodialysis or filtering the blood, is performed three times per week for four hours in a hospital or a specialized center,
- peritoneal dialysis: is outpatient and the patient needs to repeat several times a day. It is less invasive than hemodialysis because no needles are used, but a catheter into the abdominal cavity, placing a surgeon. To filter impurities can no longer dispose of the kidneys, this therapy uses the body membrane, the peritoneum, as natural filter. Still, it is underutilized in our country: 94% of the 25,000 patients with renal replacement therapy in undergoing hemodialysis. "peritoneal dialysis prolongs residual renal function, whereas hemodialysis is lost faster -added Cangado Pousa. It is therefore very useful for kids and very good as initial therapy"

- A unique program
After teaching patients how to perform peritoneal dialysis, doctors "Public Program of Peritoneal Dialysis hospital Peron asked them to take pictures with their cell phones to the pool where levaban hands to manipulate the elements of treatment, the site where they stored the kits to receive free treatment through INCUCAI and the place they used for dialysis .
also answered a questionnaire about the services they had in the house, such as electricity and water, the level of income if they work and educational attainment. With this information, organized an electronic file for have a complete idea of \u200b\u200bthe situation of each patient.

"At first, were ashamed to show photos of their homes, "recalled Cangado Pousa. Over time, and after learning " mirror " to wash their hands as a surgeon before operating and keep out germs the body , to use surfaces that can be easily cleaned (without tablecloths, for example) and find a place without humidity or too much heat to store treatment kits, they strove to follow the advice of doctors to improve their housing conditions .
That included from up the spout kitchen sink to wash their hands, to learn to adapt a tap to a 20 liter loaded with water once a day at the spigot or garden hose in the neighborhood, or given a coat of paint to floor to prevent dust from cement.

But how could they know whether the program was working? The doctors decided to implement the quality criteria used by the International Society of Nephrology: the number of peritonitis, and infections at the catheter exit site with patients and mortality.
In a study of 26 patients in the program, the team found that on average patients had peritonitis ("Achilles heel method, "according Cangado Pousa) and an exit infection every 25 months.

The average income was 546 pesos, only six had their own home, while 15 of shared and three lived in very precarious. Regarding health services, five had no running water and four did not have a faucet in the house.

"We found that the survival of these patients is similar to that of those with adequate housing "said Cangado Pousa. With this we proved that the housing characteristics are not a limitation for peritoneal dialysis ambulatory. We also learned that the concept of health is primary, and that patients accept all suggestions and try to implement them, because they feel better. It's something that has nothing to do with poverty and destitution. "

For more information about the program Perón Hospital, for which he spent more than 100 patients, is available at: nefro.peron @ gmail.com.