Improving Dialysis Adherence for High Risk Patients Using Automated Messaging: Proof of Concept.

Comorbidities and socioeconomic barriers often limit patient adherence and self-management with hemodialysis. Missed sessions, often associated with communication barriers, can result in emergency dialysis and avoidable hospitalizations. This proof of concept study explored using a novel digital-messaging platform, EpxDialysis, to improve patient-to-dialysis center communication via widely available text messaging and telephone technology. A randomized controlled trial was conducted through Washington University-affiliated hemodialysis centers involving ESRD patients with poor attendance, defined as missing 2-6 sessions over the preceding 12 weeks. A cross-over study design evaluated appointment adherence between intervention and control groups. Comparing nonadherence rates eight weeks prior to enrollment, median appointment adherence after using the system increased by 75%, and median number of unintended hospitalization days fell by 31%. A conservative cost-benefit analysis of EpxDialysis demonstrates a 1:36 savings ratio from appointment adherence. EpxDialysis is a low-risk, cost-effective, intervention for increasing hemodialysis adherence in high-risk patients, especially at centers caring for vulnerable and low-income patients.

Pyogranulomatous lesion causing neurological signs localised to the sacral region in a horse.

This case report describes neurological signs associated with a pyogranulomatous lesion within the sacral vertebral canal of a horse. The clinical findings included urinary overflow incontinence and reduced anal, perianal and tail tone. The horse failed to respond to medical management and a guarded prognosis for return to athletic performance initiated the decision for euthanasia.

Electromyography of some respiratory muscles in the horse.

To investigate activity in respiratory muscles, insulated wire electrodes were used to record electromyographic activity in the costal diaphragm and in the intercostal, serratus ventralis, internal abdominal oblique, transversalis and rectus abdominis muscles in conscious horses and in the same animals when anaesthetised. Electromyographic activity was related to respiratory phases as recorded by a stethograph around the chest wall. The costal diaphragm showed tonic and inspiratory activity in both conscious and anaesthetised animals. The principal muscle actively involved in expiration was the transversalis muscle. Intercostal muscle activity, and any increased activity in the second part of either inspiration or expiration recorded in the conscious animal, was absent under anaesthesia. The very marked tonic activity found in the serratus ventralis muscle in standing horses disappeared during anaesthesia. It was concluded that any stabilisation of the chest wall contributed by activity in the serratus ventralis and intercostal muscles in conscious, standing horses is greatly reduced during anaesthesia.