Clinical outcomes, quality of life, and costs evaluation of peritoneal dialysis management models in Shanghai Songjiang District: a multi-center and prospective cohort study

Background: The new Family-Community-Hospital (FCH) three-level comprehensive management aimed to improve the efficiency and scale of peritoneal dialysis (PD) to meet the increased population of end-stage renal disease (ESRD). Our study focused on the clinical outcomes, quality of life, and costs evaluation of this model in a multi-center and prospective cohort study.

Methods: A total of 190 ESRD patients who commenced PD at Shanghai Songjiang District were enrolled. According to different PD management models, patients were divided into the Family-Community-Hospital three-level management model (n = 90) and the conventional all-course central hospital management model (n = 100). The primary outcome was clinical outcomes of PD. The secondary outcomes were health-related quality of life (HRQOL) and medical costs evaluation.

Results: Compared to conventional management, community-based FCH management achieved a similar dialysis therapeutic effect, including dropout rate (p = 0.366), peritonitis rate (p = 0.965), patient survival (p = 0.441), and technique survival (p = 0.589). Follow-up data showed that similar levels of the renal and peritoneal functions, serum albumin, cholesterol and triglyceride, PTH, serum calcium, and phosphorus between the two groups (all p > 0.05). HRQOL survey showed that the FCH management model helped to improve the psychological status of PD patients, including social functioning (p = 0.006), role-emotional (p = 0.032), and mental health (p = 0.036). FCH management also reduced the hospitalization (p = 0.009) and outpatient visits (p = 0.001) and saved annual hospitalization costs (p = 0.005), outpatient costs (p = 0.026), and transport costs (p = 0.006).

Conclusions: Compared with conventional management, community-based FCH management achieved similar outcomes, improved psychological health, reduced medical budgets, and thus had a good social prospect.

Modified management mode for colorectal cancer during COVID-19 outbreak - a single-center experience

During the epidemic of COVID-19, the management model of colorectal cancer has to be changed at our center due to relatively limited medical resources. Outpatient visits are reduced under well protected after appointment, and rigorous investigation of epidemiological history and clinical symptoms are needed. We prefer a simple and convenient treatment regimen, which may also be postponed appropriately. Minimally invasive CRC surgery combined with a perioperative program of enhanced recovery after surgery should be recommended. We also focus on mental health treatments and healthy lifestyle education. In addition, routine follow-up can be moderately delayed. In total, adequate doctor-patient communication is also recommended throughout the treatment.

Effectiveness of a clinic-based randomized controlled intervention for type 2 diabetes management: an innovative model of intensified diabetes management in Mainland China (C-IDM study)

OBJECTIVES

Highly efficient diabetes management programs are needed for tackling diabetes in China. This study aimed to assess the effectiveness of a clinic-based intensified diabetes management model (C-IDM) in Mainland China.

RESEARCH DESIGN AND METHODS

A 2-year clinic-based randomized controlled trial was conducted among patients with type 2 diabetes in Nanjing, China. The C-IDM intervention components comprised four domains (disease targeting management, express referral channel, expert visit, patients' self-management) and an integrated running system (disease control centers, general hospitals and local clinics). Control group participants received their usual care, while intervention participants received both the C-IDM package and the usual services. The primary outcome variable was change of hemoglobin A1c (HbA1c). Mixed-effects models were used to compute effect estimates and 95% CI with consideration of both individual and cluster-level confounders.

RESULTS

Overall, 1095 of 1143 participants were assessed at study completion. The mean change in HbA1c was significantly greater in the intervention group than in the control group (mean difference (MD)=-0.57, 95% CI -0.79 to -0.36). Similar results were observed for change in body mass index (MD=-0.29, 95% CI -0.49 to -0.10). Participants in the intervention group were more likely to achieve normal HbA1c and body weight compared with their counterparts in control group after adjusting for potentially confounding variables (adjusted OR=1.94, 95% CI 1.35 to 2.81 and 1.79, 95% CI 1.13 to 2.85, respectively).

CONCLUSIONS

The C-IDM model is feasible and effective in large-scale management of patients with type 2 diabetes in China. It has public health implications for tackling the burden of diabetes in China.

TRIAL REGISTRATION NUMBER

ChiCTR-IOR-15006019.

[Discussion on Management Model of Medical Devices for Clinical Trials]

By analyzing the main problems existing in the current management of medical devices for clinical trials, this study proposes a feasible management model and specific requirements for acceptance, distribution, storage and recovery combining with the characteristics of medical consumable equipment and diagnostic reagent, which provides a favorable guarantee for the authenticity and reliability of clinical trials.

Building a Sustainable Portfolio of Core Facilities: a Case Study

Core facilities are an integral component of modern research institutions. Here, we describe our efforts over the past decade to build a sustainable portfolio of core facilities at Northwestern University. Through careful strategic planning, coordination, investment, and oversight, we have developed a model for managing core facilities that addresses researchers' needs within 3 schools across 2 campuses. Our management model is a partnership between core directors and central administrators that maintains operational control of each facility at the local level to ensure that the needs of researchers are being addressed. Central administrative oversight ensures that facilities are compliant with federal regulations, are financially sound, and align with institutional priorities. This hybrid management model is comprised of 4 pillars that are essential and necessary to ensure the long-term viability and success of facilities: core personnel, core space, institutional investment, and institutional evaluation. With these pillars in place, our facilities are well positioned to fulfill their key value propositions, to demonstrate a robust return on the university's investment, and to ensure that facilities remain vibrant, sustainable components of the research ecosystem for the foreseeable future.