Hot Weather Health

The Oregon Health Authority has announced a #SummerBummer collection of strategies for Preventing and Responding to common hot-weather risks, including drowning, poor air quality, mosquito-borne and tick-borne illnesses, algal blooms, fecal beach bacteria, food poisoning, and extreme heat.  Find their recommendations at https://www.oregon.gov/oha/ERD/Pages/StaySafeHealthyWithSafetyTipsFromOHAAsSummerKicksOffJune21.aspx.

CDC has a comparable program that sends out a weekly email on Five Minutes or Less for Health Weekly Tip, which also covers skin cancer, hydration, and communicable diseases.  Review their Tips or sign up at https://www.cdc.gov/family/minutes/tips/summersavvy/index.htm.

Homeland Security’s “Ready.gov” website has a thorough discussion of how to stay cool and safe in extreme heat, at https://www.ready.gov/heat, and one to help you Prepare Your Home for Wildfire Season at https://www.ready.gov/wildfires.

And of course people with ESRD have special issues with food and water in the summer:

Diabetic Foot Care

A recent study published in the American Diabetes Association’s (ADA) journal Diabetes Care (http://care.diabetesjournals.org/content/early/2019/05/28/dc19-0296) using 2000-2015 USRDS data has shown that the rates of nontraumatic lower-extremity amputation (NLEA) among adults with ESRD and diabetes fell 44% between 2000 and 2013 from 7.5 to 4.2 NLEA per 100 person-years, while NLEA among ESRD patients without diabetes declined 31% over the same period, from 1.6 to 1.1 per 100 person-years.  Both reductions were highly statistically significant.  However, both rates flat-lined after 2013.

We want to stress the importance of improving patient and staff education on diabetes self-management and preventive foot care, in order to resume the reductions in these rates.  CDC’s recommendations on diabetic foot care can be found at https://www.cdc.gov/features/diabetesfoothealth/index.html.  The ADA’s input is at http://www.diabetes.org/living-with-diabetes/complications/foot-complications/foot-care.html in English and http://www.diabetes.org/es/vivir-con-diabetes/complicaciones/el-cuidado-de-los-pies.html in Spanish.

6/25 CMS Seeks Comment on Rural Hospital Payment Changes

CMS has proposed that they improve their payments to rural hospitals, in an effort to improve rural health in the US.  While this isn’t directly relevant to ESRD, it will certainly be relevant whenever a kidney patient needs services at a hospital in a rural area.  Find the Proposed Rule and Request for Comment at https://www.govinfo.gov/content/pkg/FR-2018-05-07/pdf/2018-08705.pdf, and a Notice of Corrections at https://www.govinfo.gov/content/pkg/FR-2018-06-20/pdf/2018-13152.pdf.  Comments are due by June 25, 2019.  For background information see https://www.cms.gov/blog/putting-our-rethinking-rural-health-strategy-action and https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY2019-IPPS-Proposed-Rule-Home-Page-Items/FY2019-IPPS-Proposed-Rule-Regulations.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=ascending.

Injection Safety, Needle Use, and HAI

The Oregon Patient Safety Commission website, while directed specifically at Oregon, includes many resources that any healthcare provider will find useful, such as:

HDC Fluid Restriction Calculator

Home Dialysis Central has published a Dialysis Fluid Restriction Calculator to answer the question, “How much can I drink between dialysis sessions?” individualized for each patient.  For the Calculator and discussion, see https://homedialysis.org/news-and-research/blog/265-a-new-dialysis-fluid-restriction-calculator.