Monday, September 14, 2020
The streaming Princess Bride cast reunion and script reading last night was one of the brightest lights in my weekend. That movie has been a source of joy for nearly 40 years. Seeing how much the cast savored the reading and hearing their stories was a delightful distraction. Providing an island of serenity through purpose-filled entertainment is a special kind of good deed. And best of all, the Princess Bride presupposed the popularity of mask-wearing.
https://twitter.com/ThePeteEffect/status/1305297452904271872
----Latest Data---
Global-View:
Many European countries, India, and other parts of Asia see increasing case rates
https://www.ft.com/content/a2901ce8-5eb7-4633-b89c-cbdf5b386938
Nationally:
There is a continued slow decline in new cases in the U.S., for now. https://ig.ft.com/coronavirus-chart/?areas=usa&areas=gbr&areasRegional=usny&areasRegional=usca&areasRegional=usfl&areasRegional=ustx&areasRegional=usco&cumulative=0&logScale=0&perMillion=1&values=cases
Also, look at https://covidtracking.com/data
The U.S. Regionally:
The NY Times state-level data visualization:
https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html
About the data:
https://covidtracking.com/about-data/visualization-guide is the best resource to understand data visualization and data integrity.
----
The variance in testing rates (and thus, diagnosis rates) and the definitions of various states' measures continue to dominate the COVID tracking project blog. These variances are critical to understanding the above data:
https://covidtracking.com/blog/testing-in-limbo-hospitalizations-deaths-still-dropping
Morbidity and Mortality Weekly Report (MMWR), a CDC publication, reported on exposures associated with a large cohort of COVID+ patients from July. It is a well-designed, retrospective case review involving detailed interviews with 300+ patients. The most common associated exposure in those COVID+ patients was eating in a restaurant or a Bar/Coffee shop. THIS DATA WOULD SUGGEST EATING INDOORS, IN AN ENCLOSED PUBLIC SPACE, WITHOUT A MASK ON PUTS YOU AT HIGHER RISK FOR CONTRACTING CORONAVIRUS. Check out the figure at the bottom of the article.
https://www.cdc.gov/mmwr/volumes/69/wr/mm6936a5.htm
Some worthy twitter commentary:
https://twitter.com/alinouriphd/status/1304147763723149312?s=10
Andy Slavitt is Tweeting about vaccine impact modeling software. In a world with a reasonable percentage of people refusing to take a vaccine, you can predict those folks' impact on the infection and death rates.
https://twitter.com/aslavitt/status/1305276870028652547?s=10
Irrespective of when a vaccine may arrive, thinking about how to distribute it is a worthy exercise. STAT news offers an editorial from a former CDC Associate Director
https://www.statnews.com/2020/09/14/key-to-efficient-vaccine-distribution-start-preparing-early/
While not directly related to COVID, I found this well written Twitter discussion from a cardiologist from the Institute of Plant-Based Medicine director. She offers some insight into understanding what we know and what we don't know and applying it to healthcare. Interestingly, she purports to be "the most disliked vegan doctor amongst vegans."
https://twitter.com/alinouriphd/status/1304147763723149312?s=10
Infographic of the day: Sampling methods for research.
This topic has been on my mind in the last few weeks.
http://intellspot.com/wp-content/uploads/2017/09/TYPES-OF-SAMPLING-METHODS-Infographic.png
from http://www.intellspot.com/types-sampling-methods/
-----National Nephrology Nurses Week---
This week, instead of a bonus round, I will be sharing some thoughts and data in recognition of National Nephrology Nurses Week.
One of the hallmarks of good nephrology care is the care team. Whether in an office, dialysis facility, or inpatient kidney service, there are increasing amounts of work and not enough healthcare providers. Building a multidisciplinary team with each person working to the top of their professional capacity is critical to meeting the demand. Our nurses are often the captains of those teams. Here are some data about what we are facing (please note I have copied and paraphrased text from various sources below):
CKD remains the ninth leading cause of death in the United States. Over 30 million people, or approximately 15% of U.S. adults, are estimated to have stages 1–5 CKD (1)
The total global number of individuals with CKD increased from approximately 148 million in 1990 to 276 million in 2016 (2), a worldwide increase of 87%.
Expressed as the number of years lost due to ill-health, disability or early death, (disability-adjusted life years or DALY), from 2002 to 2016, CKD DALYs increased by 52.6% in the United States.
While all states exhibited increases in CKD burden, both the rate of change (2002-2016) and the magnitude of burden in 2016 were highly variable by state. Southen states had more than twice the burden seen in other areas (e.g., the age-standardized CKD DALY rate in Vermont was 321 per 100 000 population. In contrast, the rate in Mississippi was 697 per 100,000 people).
In the United States, diabetes and high blood pressure are the leading cause of kidney failure, representing about 3 out of 4 new cases.
In 2017, treating Medicare beneficiaries with CKD cost over $84 billion, and treating people with ESRD cost an additional $36 billion(3). This CKD population represents about 13% of the total Medicare population and accounts for about 25% of all Medicare expenditures for this age group. (4)
1. Centers for Disease Control and Prevention: Chronic Kidney Disease Surveillance System website. https://nccd.cdc.gov/ckd/. Accessed January 2, 2019
2. Xie Y, Bowe B, Mokdad AH, Xian H, Yan Y, Li T: Analysis of the Global Burden of Disease study highlights the global, regional, and national trends of chronic kidney disease epidemiology from 1990 to 2016. Kidney Int 94: 567–581, 2018 PubMed
3. https://www.cdc.gov/kidneydisease/basics.html
4. https://blog.transonic.com/blog/healthcare-expenditures-for-persons-with-ckd-2018
Clean hands and sharp minds,
Adam
The streaming Princess Bride cast reunion and script reading last night was one of the brightest lights in my weekend. That movie has been a source of joy for nearly 40 years. Seeing how much the cast savored the reading and hearing their stories was a delightful distraction. Providing an island of serenity through purpose-filled entertainment is a special kind of good deed. And best of all, the Princess Bride presupposed the popularity of mask-wearing.
https://twitter.com/ThePeteEffect/status/1305297452904271872
----Latest Data---
Global-View:
Many European countries, India, and other parts of Asia see increasing case rates
https://www.ft.com/content/a2901ce8-5eb7-4633-b89c-cbdf5b386938
Nationally:
There is a continued slow decline in new cases in the U.S., for now. https://ig.ft.com/coronavirus-chart/?areas=usa&areas=gbr&areasRegional=usny&areasRegional=usca&areasRegional=usfl&areasRegional=ustx&areasRegional=usco&cumulative=0&logScale=0&perMillion=1&values=cases
Also, look at https://covidtracking.com/data
The U.S. Regionally:
The NY Times state-level data visualization:
https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html
About the data:
https://covidtracking.com/about-data/visualization-guide is the best resource to understand data visualization and data integrity.
----
The variance in testing rates (and thus, diagnosis rates) and the definitions of various states' measures continue to dominate the COVID tracking project blog. These variances are critical to understanding the above data:
https://covidtracking.com/blog/testing-in-limbo-hospitalizations-deaths-still-dropping
Morbidity and Mortality Weekly Report (MMWR), a CDC publication, reported on exposures associated with a large cohort of COVID+ patients from July. It is a well-designed, retrospective case review involving detailed interviews with 300+ patients. The most common associated exposure in those COVID+ patients was eating in a restaurant or a Bar/Coffee shop. THIS DATA WOULD SUGGEST EATING INDOORS, IN AN ENCLOSED PUBLIC SPACE, WITHOUT A MASK ON PUTS YOU AT HIGHER RISK FOR CONTRACTING CORONAVIRUS. Check out the figure at the bottom of the article.
https://www.cdc.gov/mmwr/volumes/69/wr/mm6936a5.htm
Some worthy twitter commentary:
https://twitter.com/alinouriphd/status/1304147763723149312?s=10
Andy Slavitt is Tweeting about vaccine impact modeling software. In a world with a reasonable percentage of people refusing to take a vaccine, you can predict those folks' impact on the infection and death rates.
https://twitter.com/aslavitt/status/1305276870028652547?s=10
Irrespective of when a vaccine may arrive, thinking about how to distribute it is a worthy exercise. STAT news offers an editorial from a former CDC Associate Director
https://www.statnews.com/2020/09/14/key-to-efficient-vaccine-distribution-start-preparing-early/
While not directly related to COVID, I found this well written Twitter discussion from a cardiologist from the Institute of Plant-Based Medicine director. She offers some insight into understanding what we know and what we don't know and applying it to healthcare. Interestingly, she purports to be "the most disliked vegan doctor amongst vegans."
https://twitter.com/alinouriphd/status/1304147763723149312?s=10
Infographic of the day: Sampling methods for research.
This topic has been on my mind in the last few weeks.
http://intellspot.com/wp-content/uploads/2017/09/TYPES-OF-SAMPLING-METHODS-Infographic.png
from http://www.intellspot.com/types-sampling-methods/
-----National Nephrology Nurses Week---
This week, instead of a bonus round, I will be sharing some thoughts and data in recognition of National Nephrology Nurses Week.
One of the hallmarks of good nephrology care is the care team. Whether in an office, dialysis facility, or inpatient kidney service, there are increasing amounts of work and not enough healthcare providers. Building a multidisciplinary team with each person working to the top of their professional capacity is critical to meeting the demand. Our nurses are often the captains of those teams. Here are some data about what we are facing (please note I have copied and paraphrased text from various sources below):
CKD remains the ninth leading cause of death in the United States. Over 30 million people, or approximately 15% of U.S. adults, are estimated to have stages 1–5 CKD (1)
The total global number of individuals with CKD increased from approximately 148 million in 1990 to 276 million in 2016 (2), a worldwide increase of 87%.
Expressed as the number of years lost due to ill-health, disability or early death, (disability-adjusted life years or DALY), from 2002 to 2016, CKD DALYs increased by 52.6% in the United States.
While all states exhibited increases in CKD burden, both the rate of change (2002-2016) and the magnitude of burden in 2016 were highly variable by state. Southen states had more than twice the burden seen in other areas (e.g., the age-standardized CKD DALY rate in Vermont was 321 per 100 000 population. In contrast, the rate in Mississippi was 697 per 100,000 people).
In the United States, diabetes and high blood pressure are the leading cause of kidney failure, representing about 3 out of 4 new cases.
In 2017, treating Medicare beneficiaries with CKD cost over $84 billion, and treating people with ESRD cost an additional $36 billion(3). This CKD population represents about 13% of the total Medicare population and accounts for about 25% of all Medicare expenditures for this age group. (4)
1. Centers for Disease Control and Prevention: Chronic Kidney Disease Surveillance System website. https://nccd.cdc.gov/ckd/. Accessed January 2, 2019
2. Xie Y, Bowe B, Mokdad AH, Xian H, Yan Y, Li T: Analysis of the Global Burden of Disease study highlights the global, regional, and national trends of chronic kidney disease epidemiology from 1990 to 2016. Kidney Int 94: 567–581, 2018 PubMed
3. https://www.cdc.gov/kidneydisease/basics.html
4. https://blog.transonic.com/blog/healthcare-expenditures-for-persons-with-ckd-2018
Clean hands and sharp minds,
Adam
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