Example research essay topic: Kidney Failure Sq Km - 2,426 words

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Access in quality care for dialysis patients in Philadelphia, Pennsylvania Description of selected community (location, statistics, etc) Philadelphia is the second largest city on the East Coast (North America). The city of Philadelphia is located 100 miles south of New York and 133 miles north of Washington, D. C. The city ranks fifth in the nation. Population of Philadelphia reaches 5. 8 million people. (Philadelphia Facts & Figures) Metro: 6, 188, 463 (2000 census) 5, 892, 937 (1990 census) City: 1, 517, 550 (2000 census) 1, 585, 577 (1990 census) Metro Area: 13, 845. 4 sq. km (1996) 5, 345. 7 sq.

mi. (1996) Metro density: 447. 0 inh / sq . km (2000) 1, 157. 7 inh / sq . mi. (2000) Philadelphia City, Pennsylvania Statistics and Demographics (US Census 2000) (web) Number Percent Philadelphia Population: 1517550 100. 00 % Sex and Age Male 705107 46. 46 % Female 812443 53. 54 % Under 5 years 98161 6. 47 % 5 to 9 years 112111 7. 39 % 10 to 14 years 112726 7. 43 % 15 to 19 years 110701 7. 29 % 20 to 24 years 117609 7. 75 % 25 to 34 years 224864 14. 82 % 35 to 44 years 219910 14. 49 % 45 to 54 years 182530 12. 03 % 55 to 59 years 67280 4. 43 % 60 to 64 years 57936 3. 82 % 65 to 74 years 107048 7. 05 % 75 to 84 years 79335 5. 23 % 85 years and over 27339 1. 8 % Median age (years) 34. 2 18 years and over 1134081 74. 73 % Male 510257 33. 62 % Female 623824 41. 11 % 21 years and over 1058316 69. 74 % 62 years and over 247867 16. 33 % 65 years and over 213722 14. 08 % Male 79821 5. 26 % Female 133901 8. 82 % Community concern / issue The health of individuals depends on access to quality care. According to Access to Health Care Among Adults 18 +, Access to health care among adults varies little among the five counties in the region. However, Philadelphia County has the highest percentage of adults without a regular source of care (9. 9 %), who are uninsured (7. 8 %), or have no prescription coverage (12. 4 %). (p. 12).

Many people equate dialysis with slow death. Kidney is very important organ. When one of the kidneys looses its ability to function, the second kidney is able to assure satisfactory functioning of the whole organism. Even 20 % of functioning is enough to assure normal functioning. However, when both kidneys are damaged, an individual suffers kidney failure.

Critical kidney failure means that kidney tissue was destroying gradually, during the long period of time. Such damage is irreversible. Patients suffering kidney failure usually dont feel any symptoms until 80 % of kidney continue to function. When kidneys stop to function, the doctor recommends alternative decision to prevent accumulation of slag and exceed water in organism. There are two alternative ways of treatment: Kidney transplant Kidney dialysis. You are in group risk for kidney disease if: You are African American You have diabetes You have hypertension You have close relative with kidney failure Dialysis patients in Pennsylvania require life-saving therapy to replace the function of kidneys.

Medical News Release informs that There are approximately 280, 000 dialysis patients in the US. The most well known consequence of hyperphosphataemia is the bone disease renal osteo dystrophy, which causes bone pain, skeletal deformities, and can result in fractures. Recent research also suggests that hyperphosphataemia is associated with the development of cardiovascular disease, which accounts for nearly 50 % of all deaths in dialysis patients (p. 1) Dialysis patients have always been great problem in America. Due to some unknown reasons, blacks for times more often than whites suffer kidney failure in America. Dr.

Walter To, a former Philadelphia health commissioner, says that Under a 1972 law, passed after an end-stage kidney disease patient testified before the House Ways and Means Committee while undergoing dialysis in the committee room, Congress expanded Medicare to fully fund the medical costs of kidney patients, whether or not they have private insurance. When it comes to dialysis, the American health care system actually lives up to its promise Sandford T. Reikes, MD, informs that The overall incidence of ESRD is increasing at a rate of 5 % per year, which actually represents a slowdown from the 10 % increase seen in 1988. The steepest rise in incidence over the past 10 years has been in African Americans, diabetic patients, and the elderly.

Since 1988, the prevalence of ESRD has almost doubled, and at the end of 1997, more than 300, 000 patients were being treated for ESRD in the United States. This represents an ESRD prevalence rate of more than one in every 1, 000 persons (p. 12) Dialysis patients have increased risk of anemia, renal osteo dystrophy, and malnutrition. Although those diseases are not obligatory the consequences of dialysis, still, they still are the subject to occur. Although the mortality in dialysis patients has declined, it is still high. Dialysis patients belong to group of population with higher mortality in comparison with the general population. For example, In a study of more than 15, 000 dialysis patients in the southeastern United States, 6 % of new patients died during the first 90 days of treatment (Mcclella, Soucie JM, WM, pp. 2169 - 2175) Styblo TM, Wood WC Compares dialysis patient mortality to the 5 -year survival in locally advanced (stage III) breast cancer, and notices that a patient 50 to 54 years of age who started dialysis in 1992 had a 5 -year (unadjusted) mortality of 53 % (p. 165) A premium aim for Healthy People 2010 is to reduce the new cases of kidney failure.

Chapter 4 of Healthy People 2010 introduces the goal to bring the percentage of dialysis patients registered for a kidney transplant up to 66 percent for all racial groups and genders (Tracking Healthy People 2010) Kidney Failure: Prevention, Dialysis or Transplantation Kidney failure is very dangerous. To make life-saving therapy medical treatment should replace lost function of kidneys involving circulating the blood outside the body to be filtered and cleansed inside a special hemodialyses and to be returned to the body. Prevention. ESRD is always fatal unless recognized and treated appropriately (Sanford T. Reikes, MD, p. 2). The symptoms of kidney failure are usually insignificant and unnoticeable.

Why do we experience situation that causes kidney failure? Hypodinamic way of life is one of the reasons. Just add unbalanced nutrition, misuse of strong medicines and youll have problems with kidney. Kidney failure also can be the consequence of other diseases. Hypertension and diabetes gain epidemiologic character and are well recognized to be the major factors of critical kidney failure. This disease is also caused by complications of other kidney diseases such as glomerulonephritis, interstitial nephrite's, kidney cancer, etc.

If chronic kidney failure is not critical, proper medical treatment and diet will be enough to regulate a problem. However, when kidney activity becomes lower than 20 %, the body is not able to get free from toxins and excessive water. As a result, end products of metabolism accumulate and poison the organism. Water accumulates as edema, especially in the lungs and results in haemostasis. It also causes high blood pressure. Chemical and water balance is unstable.

Diet is one of prevention methods. Nutritional treatment can be successful if the disease is not critical. Any kind of dialysis replaces kidney functioning only to some certain extent. Patient needs complex treatment not to cause kidney complications. These components are medical treatment and diet. Dialysis is not able to replace such function of kidney as producing erythropoietin hormone.

Erythropoietin takes part in synthesis of red corpuscles. Scientists examined the structure of hormone and made its synthetic analog recor mone (erythrostim, exocrine, essex). Doctors give an injection of this synthetic hormone to dialysis patients. The patients also take ferrum to assure successful work of hormone.

The second level of prevention is to cure calcium-phosphorus metabolism disorders. Condition of our muscle and bone system depends on calcium and phosphorus. When an individual suffers from kidney failure, phosphorus is accumulated in organism because it is not able to be completely brought out of organism with urine. Level of phosphorus increases and level of calcium in blood decreases accordingly. If a person lacks calcium, his bones become more brittle. High level of phosphorus causes skin itch.

Lack of calcium in blood causes muscle and blood system disorders. Doctors usually prescribe phosphor-, calcium- and D 3 -containing medicines to improve health condition of dialysis patients. Medical treatment of hypertension remains the third level of prevention. Major part of dialysis patients suffer from hypertension. There are two types of dialysis.

Hemodialysis. The treatment involves circulating the patient's blood outside of the body through an extracorporeal circuit (ECC), or dialysis circuit. Two needles are inserted into the patient's vein, or access site, and are attached to the ECC, which consists of plastic blood tubing, a filter known as a dialyzer (artificial kidney), and a dialysis machine that monitors and maintains blood flow and administers dia lysate. Dialysate is a chemical bath that is used to draw waste products out of the blood (Smith, p. 1) Peritoneal dialysis.

In peritoneal dialysis, the patient's peritoneum, or lining of the abdomen, acts as a blood filter. A catheter is surgically inserted into the patient's abdomen. During treatment, the catheter is used to fill the abdominal cavity with dia lysate. Waste products and excess fluids move from the patient's bloodstream into the dia lysate solution. After a waiting period of 624 hours, depending on the treatment method used, the waste-filled dia lysate is drained from the abdomen, and replaced with clean dia lysate (Smith, p. 1) Access in quality care Access to quality care means being able to get appropriate care when it is necessary. There are many health care alliances, foundations, medical establishments and institutions aimed to provide patients with appropriate medical care.

Patients should have health insurance, higher income level and a primary care provider. Patients also should have accessible care services. According to Access to Health Care Among Adults 18 +, financial barriers to accessing health care include not having enough health insurance to cover needed services, or not having the financial capacity to cover services outside a health plan or insurance program. Persons without coverage for basic health care necessities, such as prescriptions, and who lack sufficient income to pay for these items out of pocket often do not receive appropriate care until their condition is serious. This, in turn, places an additional burden on the patient, the community and the health care system. (p. 11). So, we can assume that prevention methods together with improvements in medical system will improve situation in health care to dialysis patients.

The Medicare ESRD program is very successful program, providing health care to over 90 percent of individuals with end-stage renal disease. The USRDS 1999 Annual Data Report demonstrates that dialysis facilities have been improving mortality rates. Also, the 1999 Annual Report on ESRD Clinical Performance Measures Project, published by HCFA, shows steadily improving numbers on the adequacy of dialysis and anemia management, two key measures of quality of care for dialysis patients (Terry Bahr, n. p. ) According to H.

R. 1298 - Kidney Care Quality and Improvement Act of 2005, there are several ways to improve quality care for dialysis patients: To create public and governmental educative centers to inform people about kidney diseases and to help people learn self-management skills; To optimize and improve trainings for technicians helping in health care for dialysis patients; To ensure quality through improvements in the ESRD payment system, including establishing an annual update framework and evaluating the effect of the new Physician Fee Schedule G-code visit requirements (n. p. ) To find funds for paying for outpatient dialysis services Once patient has diagnosis with kidney failure, he needs to be monitored by different doctors, such as nephrologists and others. We know that health care is a basic human right. However, the dialysis treatment service is the only one that doesnt receive annual cost updates. Adequate funding will give us access to comprehensive and high quality health care for dialysis patients.

I believe there should be also overall program reform that will include quality improvement measures. In conclusion I would like to empathize that without adequate funding of dialysis programs, foundations and facilities it will be difficult to reduce mortality for dialysis patients, which is actually, the measure of level quality care for dialysis patients. Without public and private reimbursements medical institutions and foundations will not be able to improve quality of health care for dialysis patients. Bibliography Access to Health Care Among Adults 18 +. web Allen, A. (2004). Whose Hospital is it?

The Foundation for National Progress. May/June 2004 Issue Fosrenol reduces hypercalcemia risk in end stage renal disease. News Release. Saturday 2 November 2002, 18: 00 GMT H. R. 1298 - Kidney Care Quality and Improvement Act of 2005. web Mcclella, Soucie JM, WM.

Early death in dialysis patients: risk factors and impact on incidence and mortality rates. J Am Soc Nephrol 1996; 7 (10) Philadelphia City, Pennsylvania Statistics and Demographics (US Census 2000) Retrieved September 30, 2005. web Philadelphia Facts & Figures. Retrieved September 30, 2005. web Sandford T. Reikes, MD.

Trends in end-stage renal disease. Epidemiology, morbidity, and mortality. VOL 108 / NO 1 / JULY 2000 / POSTGRADUATE MEDICINE. Smith J.

F. Dialysis, kidney. Copyright 1999 - 2003. The Thomson Corporation. September 30, 2005 Styblo TM, Wood WC. (1998). Traditional prognostic factors for breast cancer.

In: Bland KI, Copeland EM 3 d, eds. The breast: comprehensive management of benign and malignant diseases. 2 d ed. Philadelphia: Saunders U. S. Department of Health and Human Services. Tracking Healthy People 2010.

Washington, DC: U. S. Government Printing Office; 2000 Terry Bahr. the Administrator at Scripps Dialysis Center, the President of the National Renal Administrators Association (NRAA). Retrieved September 30, 2005.

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Research essay sample on Kidney Failure Sq Km