Experience With Nocturnal Hemodialysis

In order to provide a highly efficient, long-duration form of hemodialysis, we developed nocturnal hemodialysis. Patients were dialyzed nightly at home for 8 – 10 hours, 6 – 7 nights/week. We kept the dialysate flow at 100 mL/min and the blood flow at 250 – 300 mL/min. Patients were monitored remotely from the hospital through a computer connection. An internal jugular line was used as an access. We have trained 12 patients over 30 months and have accumulated 160 patient-months worth of data. The patients tolerated the dialysis very well and slept through the night. There was a significant improvement in their sense of well-being. Nightly Kt/V was 0.99. Weekly removal of phosphate was two times as high and β ₂ -microglobulin four times as high as conventional hemodialysis. All patients have discontinued their phosphate binders and have increased their dietary phosphate and protein intake. Hypertension was controlled with fewer medications, and erythropoietin dosages decreased. Complications were infrequent and included catheter occlusion and infections. Reusing the dialyzers decreased the cost of the treatment to levels similar to continuous ambulatory peritoneal dialysis. Nocturnal hemodialysis represents a viable dialysis modality that combines high quality, low cost, and excellent tolerance.     

Nocturnal hemodialysis (NHD) adapted to the in-centre setting--a pilot study

The authors report on a 42-year-old female inpatient with bipolar I disorder, whose dysphoric mania responded rapidly and completely while her antimanic medication (lithium, carbamazepine, clozapine, haloperidol and clonazepam) was supplemented by 20 mg of paroxetine daily. The practical and theoretical importance of this case is briefly discussed.     

Control of serum phosphate without any phosphate binders in patients treated with nocturnal hemodialysis

We compared the efficacy and the long-term effects of nocturnal hemodialysis (NHD) versus conventional hemodialysis (CHD) in controlling serum phosphate levels in patients with end-stage renal disease (ESRD). Patients underwent thrice weekly CHD and were subsequently switched to NHD six nights weekly. In the "acute" study serum and dialysate phosphate were measured during and after dialysis, and the total dialysate was collected to calculate mass solute removal. Although pre-dialysis (1.7 +/- 0.6 vs. 1.5 +/- 0.8 mM) serum phosphate levels were similar in CHD and NHD, respectively, post-dialysis levels were slightly lower with CHD (0.7 +/- 0.2 vs. 0.8 +/- 0.2 mM, P < 0.05). The measured phosphate removed per session of CHD or NHD was comparable, 25.3 +/- 7.5 versus 26.9 +/- 9.8 mumol/session, respectively. On the other hand, the cumulative weekly phosphate removal was significantly higher with NHD as compared to CHD, 75.8 +/- 22.5 versus 161.6 +/- 59.0 mumol/week (P < 0.01). In the "chronic" study serum phosphate levels were measured monthly for five months on CHD and for five months after the patients were switched to NHD. Dietary phosphate intake and the dosage of phosphate binders were tabulated. Serum phosphate levels fell during NHD: 2.1 +/- 0.5 mM at the beginning of the study and 1.3 +/- 0.2 mM five months after being switched to NHD (P < 0.001). At the same time dietary phosphate intake increased by 50%. By the fourth month of NHD therapy none of the patients was taking any phosphate binders. In conclusion, NHD is more effective in controlling serum phosphate levels than CHD, allowing patients to discontinue their phosphate binders completely and to ingest a more liberal diet.     

Effects of counselor response behavior on clients' impressions during vocational counseling.

We examined the effects of four counselor response types—self-disclosure, self-involving, empathy, and open question—on subjects' impressions of the counselor during vocational counseling. A total of 201 undergraduate students viewed videotapes of an initial vocational counseling interview, in which the counselor used either self-disclosure, self-involving, empathy, or open-question statements. Using a 2 (counselor sex)?×?2 (client sex)?×?4 (response type) design, a three-way interaction was found in regard to counselor social influence. However, for the most part, a general lack of significance was found across the dependent measures. These results are interpreted relative to vocational counseling and then compared to the literature on personal–social counseling. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Terminal master's-level training in counseling psychology: Skills, competencies, and student interests.

We surveyed directors of terminal master's-level counseling psychology programs to determine perceptions about (a) the skills and competencies in which their students received training and (b) the interest and commitment of their students to different areas of training and practice. The data were also compared with the survey data of L. J. Schneider et al (see record 1989-13407-001) in an effort to examine similarities and differences between master's-level and doctoral level training in counseling psychology. Discussion about masters-level programs' training emphases and the master's vs. doctoral training issue is provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Conflictual independence, mood regulation, and generalized self-efficacy: Test of a model of late-adolescent identity.

A model for predicting college students' identity was proposed and tested that sequentially considered information on students' reported conflictual independence from parents and their current mood states and generalized (i.e., cross-situational) self-efficacy. Separate hierarchical regressions of identity scores were conducted for the full sample (N?=?224) and for male (n?=?81) and female (n?=?143) students. Results indicated that, whereas the proposed model explained significant variance in the criterion measure for both men and women, the respective contributions of the model components varied according to the student's gender. The counseling and theory-related implications of these results are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Delayed Dialyzer Reprocessing for Home Hemodialysis

Although dialyzer reuse for home hemodialysis (done by patients at home) has been in practice since the 1960s, it is now almost completely abandoned. The need for dialyzer reuse resurfaced with the renewed interest in daily/nightly forms of home hemodialysis and the associated increase in operating costs. We describe a method of dialyzer reuse based on reprocessing of dialyzers at the center, after they had been stored in a refrigerator at home for 1 week by the patient. Transportation of the dialyzers by either the patient or a transportation service was acceptable to the patients. Despite the lower number of reuses, possibly related to the delayed processing, dialyzer reuse in this setting provided significant financial benefits. Experience with this process for 3 years has not disclosed any negative effects after the initial logistical issues related to dialyzer transportation were resolved. In summary, weekly dialyzer reprocessing at the center provides a solution to the need for dialyzer reuse for the home hemodialysis patient.