Structural racism embodies the many ways in which society fosters racial discrimination through "mutually reinforcing inequitable systems" that limit access to resources and opportunities that can promote health and well-being among marginalized communities. To achieve health equity, and kidney health equity more specifically, structural racism must be eliminated. In February 2022, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) convened the "Designing Interventions that Address Structural Racism to Reduce Kidney Health Disparities" workshop which was aimed at describing the mechanisms through which structural racism contributes to health and healthcare disparities for people along the continuum of kidney disease; and identifying actionable opportunities for interventional research focused on dismantling or addressing the effects of structural racism. Participants identified six domains as key targets for interventions and future research: 1) apply an anti-racism lens, 2) promote structural interventions, 3) target multiple levels, 4) promote effective community and stakeholder engagement, 5) improve data collection, and 6) advance health equity through new healthcare models. There exists an urgent need for research to develop, implement and evaluate interventions that address the unjust systems, policies, and laws that generate and perpetuate inequities in kidney health.
Patient perspectives can be a valuable component in understanding some of the factors contributing to health inequities. The inclusion of first-person accounts and the patient perspective is in line with recent academic trends (1) and movements within nephrology (2). The following accounts highlight the ways that culture and social determinants of health can combine in complex ways. Social risk can inhibit healthpromoting behavior; increase risk of detrimental environmental and lifestyle exposures; reduce access to, and quality of, health care; and increase stress demand, all of which can lead to negative kidney outcomes, directly and indirectly, through increased prevalence of comorbidities (3). We have chosen to highlight some personal vignettes and stories by placing them along a timeline from diagnosis through treatment.
Purpose of review
Potential causes and consequences of involuntary discharge (IVD) of patients from dialysis facilities are widely unknown. So, also are the extent of racial disparities in IVDs and their impact on health equity.
Recent findings
Under the current End-Stage Renal Disease (ESRD) program
Conditions for Coverage (CFC), there are limited justifications for IVDs. The ESRD Networks oversee dialysis quality and safety including IVDs in US dialysis facilities, with support from the Agency for Healthcare Quality and Research (AHRQ) and other stakeholders. Whereas black Americans constitute a third of US dialysis patients, they are even more overrepresented in the planned and executed IVDs. Cultural gaps between patients and dialysis staff, psychosocial and regional factors, structural racism in kidney care, antiquated ESRD policies, unintended consequences of quality incentive programs, other perverse incentives, and failed patient–provider communications are among potential contributors to IVDs.
Summary
Practicing health equity in kidney care may be negatively impacted by IVDs. Accurate analyses of patterns and trends of involuntary discharges, along with insights from well designed AHRQ surveys and qualitative research with mixed method approaches are urgently needed. Pilot and feasibility programs should be designed and tested, to address the root causes of IVDs and related racial disparities.
Introduction E-Learning has gained popularity amongst doctors in training. We undertook an observational study assessing the quality of online resources for intra osseous (IO) needle insertion. Methods IO needle insertion videos were identified using "You-Tube". 21 pre-defined essential criteria were agreed by the study group based on the Advanced Paediatric Life Support recommendations, considered to be gold standard. Each video was independently scored 0-21 for quality. Results 34 IO videos, 14 manual and 20 electrical were identified. The quality score for the 34 videos, based on the mean score from the 4 raters, ranged from 5.5 to 17.5, mean 11.7, median 12.25. The inter observer variability was 0.76 , 95% confidence intervals 0.65 to 0.86. Conclusion Online resources can have a substandard educational content. To avoid developing poor practice a standard resource for procedural skills in the curriculum should be developed and endorsed by the
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