#clincial

[kemetic-dreams]

Understanding African American and non-African American eGFR laboratory results

Understanding why eGFR laboratory reports include African American and non-African American results

Glomerular filtration rate (GFR) is the best way to measure how well your kidneys are working, but this test is complicated and cannot be easily done in a doctor’s office. To get around this, laboratories use mathematical equations to estimate the glomerular filtration rate instead of measuring it. This is why laboratories report estimated GFR or eGFR.

Two commonly used estimating equations for eGFR are the CKD MDRD (Modification of Diet in Renal Disease) and the CKD EPI (Chronic Kidney Disease Epidemiology Collaboration) equations. Using these math equations, eGFR is calculated from the amount of creatinine in the blood.

Creatinine is a waste product that comes from the normal wear and tear on your body’s muscles and also from the foods you eat. Everyone has creatinine in their bloodstream. However, creatinine levels can differ between people. This reason for this difference may not only be related to kidney disease – it may be affected by several other factors, such as age, sex, and body weight.

Race was originally included in eGFR calculations because clinical trials demonstrated that people who self-identify as Black/African American can have, on average, higher levels of creatinine in their blood. It was thought the reason why was due to differences in muscle mass, diet, and the way the kidneys eliminate creatinine. Since a patient’s race is not always used when laboratory tests are ordered, laboratories used different eGFR calculations for African American and non-African American and included both numbers in their lab results.

The use of race in calculating eGFR has been a subject of debate. Race is not a biological concept, but a social construct. Using race as a factor for calculating eGFR does not account for the diversity within communities of color. Also, people who self-identify as multiracial might not want to be put in a single racial bucket.

What is the NKF doing to address concerns about using race in measuring eGFR?

In 2020, the National Kidney Foundation (NKF) and the American Society of Nephrology (ASN) formed a joint task force to review the use of race in eGFR calculations. On September 23, 2021, the Task Force announced a new race-free calculation for estimating eGFR. The National Kidney Foundation is working with the nation’s laboratories to get this new calculation into use as quickly as possible.  The NKF is also creating materials to show how this new equation may impact patient care.

How is eGFR used?

Estimated GFR is one of the key tests for diagnosing kidney disease. The earlier kidney disease is detected, the better the chance of managing it or keeping your condition from getting worse. Your eGFR informs healthcare professionals about your kidney function and helps them to recommend the best treatments for you. For instance, eGFR results are used in the following ways:

Confirming that kidney function is normal for a potential living kidney donor

Making sure the right dose of medicine is used

Enrollment in clinical trials that use kidney function as an inclusion or exclusion criterion

Making sure the right type of imaging tests and dyes are used

When to refer someone to a nephrologist or kidney doctor

If and when to plan for dialysis

When to start an evaluation for a kidney transplant

Although the NKF alone cannot solve all inequalities, the NKF is working to help identify, confront and reverse them. NKF advocates for making affordable healthcare more available and making sure that communities of color are not left behind. NKF’s CARES helpline is available to all people with kidney disease. NKF’s educational offerings include the impact of kidney disease on diverse communities, and the reasons why communities of color have been disproportionately affected by COVID-19. NKF is committed to continuing its work to address inequalities in kidney health.

[macaulaytwins]

the Greek class during dinner:

Henry: eats slowly and very clinically, almost like it’s a dissection, very rarely gets a second plate despite his size, will smoke at the table towards the end of the meal— almost like he was trying to hold out as long as he could but eventually gave in, subconciously sits at the head of the table

Richard: hesitant to eat as much as he wanted when he first started dining with the Greek class, became a more ravenous eater towards the end of the novel like he was afraid it would spoil in front of him, doesn’t smoke at the table, always drinks a little too much while eating and feels nauseous after

Camilla: elbows on the table, her food touches and mixes and it doesn’t bother her, never talks while chewing but keeps conversation going during a meal, almost always gets a modest second helping, admonishes Charles for not eating his vegetables, near excessive use of salt and pepper

Francis: under-eats due to nicotine consumption or anxiety, constantly shifts positions in his chair, smokes at the table, pushes his food around his plate, talks the most during dinner, sits next to Henry and is the one who can draw him into conversation with the most ease

Charles: elbows on the table, rarely eats his greens but always finishes what’s on his plate, talks with his mouth full but swears he doesn’t, almost always gets a second helping, rolls his eyes at Francis and Henry smoking at the table but drinks the most at dinner of any of them

Bunny: grew up with all his brothers so he takes heaping helpings of food even if he’s not particularly hungry, eats his veggies, not a lot of table manners, chronically talks with his mouth full and Henry tells him off for it causing Bunny to point out his smoking and they get into an argument about etiquette

[verrixstudios]

GUYS why is making animation-friendly references of fictional dragons SO HARD

[pupsicle-paws]

Wanted to share my kin list!

Note: I am a polytherian, holotherian, suntherian and ahumam. I also name my types/kins for convenience and fun!

I am okay with being referred to as [an] alterhuman if you wanna be vague! :)

Overall, I am an alterhuman and identify fully as a werewolf. I do not identify as being human whatsoever

Theriotypes;;

Julius - Golden Shepherd

Rover - German Shepherd

River/Brutus - Grey Wolf

Atlas - Coyote

Ember - Red Fox

Symmetra - Golden Maine Coon

Aurora - Snow Leopard

Rajah - Tiger

Serene - Cottontail Rabbit

Silo - Fallow Deer

Paris - Shire Horse

Gatsby - Big horn sheep

Tex - Aardwolf

Jesse - Red tailed hawk

Cerberus - Salt water crocodile

Rifle - Eastern diamondback rattlesnake

Paleotheriotypes

Sparrow - Dakotaraptor

Storm - Allosaurus

Therianmythic-types (aka more feral than otherkin)

Reaper - Dragon

Coldstone - Black crested Buzzard Eagle gryphon

--- 🍂🌄🍂 ---

Otherhearted (debatable)

Shark (between leopard shark and tiger catshark)

All/Any reptiles

--- 🍂🌄🍂 ---

Fictionkin

Rainbow Dash - MLP

Lucario - Pokemon

--- 🍂🌄🍂 ---

Other/misc

Cryptidkin[ic]

Misanthropic

Zoochosis

--- 🍂🌄🍂 ---

I would also like to mention;;

I have suspected [clinical] lycanthropy (waiting a diagnosis) which does interfere with my life and sense of self but not my identity. I do also identity as a werewolf, but it is separate from my lycanthropy. I want to make that clear!

Although this can change in the future, even tho lycanthropy is a psychiatric disorder and not an identity, for the time being, they are indeed separate.

Also! Detailed flag list!

--- 🍂🌄🍂 ---

. . . .

[snickiebear]

its just that i hope you know how much fondness and care i carry for you. its all in my hands, its all in my palms, folded. sometimes i read that not-break up letter you wrote me as my own personal knife, that i take it to my chest, my wrists, my arms and legs, letting the reality of it cut through me. maybe if i bleed enough it’ll hurt less.

its as simple as: i love you.

its as complicated as: i love you.

nothing makes sense and yet it does. and i cant help it, i can’t. there’s no cure to this. its you and i cant help but love you so much ill take anything i can get.

it isnt fair to you, and i know i should be thinking of myself, but i feel so selfish for talking to you that its punishable. i cant rid myself of you, i tried. so this is where we are, would you call this standing? i dont know. i dont know anything. thats fine.

i cant let you go and thats the stability you offer, the consistency. i can handle it. its just that… i wonder sometimes. if you feel it too. if you feel that love. if you think about it: about talking about it. about…. about loving me. i wonder if you wonder about it. thats all. i hope you do. and secretly, awfully, i hoped you would be jealous i gave my number to a person who isnt you. i hoped you would because im a terrible person.

i dont know anything except im so in love with you that its become this effortless fondness that i cant express without betraying and revealing myself. its okay. i can hold it back. its okay. i love you and i dont need a thing back. i’d take scraps if thats all i got. thats all im getting.

deep breath. im pathetic. its my own fault. i love you. its my own fault. hopefully you never see this. (if you do, just remember im fragile and i love you. just remember you dont owe me anything but i do love you. just remember we never have to be anything more than what we are, but im so deeply and mundanely in love with you. just dont tell me unless you want to say it back.)

for @nosebleedclub’s prompt i. good as you’ll get

[coldasyou]

i can't deal with tumblr users who get high and mighty about not making jokes about wanting to die or not self deprecating. sorry this is the unhealthy coping mechanism website if you don't like it u can LEAVE

[inutaffy]

im boutta restart st to become relevant on byler tumblr again

[veone]

I’m making a pose pack and deco sims for some unusable objects and very specific cc items.

[loveofmylouis]

.

[caprinetalisman]

WHAT DOES THIS MEAN... (I know a boy just like this but he never talks to me) Ty skeleton balling ur doing me miracles🗣‼️

CUTE BOY FROM CLASS WHO IS GROWING HIS HAIR OUT AND WEARING A HOODIE: thanks for helping me with my homework! hey um... is it okay if I tell you something important? you have to promise to keep it a secret....

SKELETON BALLING:

[ohwaitwhatdamn]

*Brain melting from completing a six-page paper about creating a support group for older adults who live with chronic illnesses and may be suffering from depression* Below are actual photos of my brain melting

[twitchywoman]

December Parkinson's News

2023 has been a good year for PD research. Here is a rundown of a few of the latest discoveries along with a few other important things. What I Didn’t Say – Ending Friday! If you haven’t had a chance to view this 2 person play about living with Parkinson’s, you need to watch it now. After Friday, December 15, it will no longer be available. Get rid of the styrofoam now! From Parkinson’s News…

[davidhencke]

Martyn Pitman tribunal: Patient safety was a big issue as NHS watchdog downgrades Hampshire Trust's maternity services

Dr Martyn Pitman A highly critical report from NHS watchdog, the Care Quality Commission has confirmed fears from whistleblowers, including obstetrician Dr Martyn Pitman, that mothers were at risk using Hampshire Hospital NHS Foundation Trust’s maternity services in Winchester and Basingstoke. The report was not raised during the two week employment tribunal hearing as I gather it came out too…

[merrysithmas]

re: nursing & Nurse Chapel in SNW @ Paramount/the fandom

new trekkies have begun to notice that Nurse Chapel eventually becomes a doctor in TOS canon. i'd like to challenge the stale (and rife with outdated sexism) misconception of that event with a more modern lens that hopefully SNW can retcon...

Christine does not stop becoming a nurse to become a doctor. She can be a doctor AND a nurse.

A DNP (clincial doctor of nursing practice) or nurse phd (researcher) or nurse educator/researcher (phd). One of my main issues with TOS canon is how they made Chapel "upgrade" from a nurse to a doctor which is extremely outdated and inherently insults the field of nursing (implying medicine is a hierarchy which it isnt - and SNW does a good job showing the partnership btwn mbenga &her). Most nurses never venture into physicianship but instead pursue doctorates in their chosen field: nursing. Because they want to be nurses.

I hope this is one thing they retcon and make clear she is a clinical doc of nursing (who have all the same diagnostic/prescriptionist responsibilites as a doctor of medicine) or some other variant of doctor of nursing.

Christine likely became a nurse because nurses have diff freedoms (and a closer patient relationship) and can expand to work in innumerable specialities - as nurses are trained as multi-specialty healthcare providers - whereas doctors are more limited and stick to their specialty. She chose to be a nurse because she wanted to be a nurse.

People choose nursing over becoming a physician for MANY reasons - and let me tell you, it's absolutely 100% not because the doctors are more intelligent lol. Nursing is a multifaceted field which consists of myriad opportunities, learning experiences, specialities, 1:1 patient connections, and freedoms that a physician will never have. Nurses can work in an ER, OR, Labor and Delivery, community health center, an herbalist shop, someone's home at their bedside, and research lab all in the same week. Physicians cannot do that - they have various legal and technical limitations (still a great field, but different).

Nurses are a medical jack of all trades - that is what Christine is.

An accurate portrayal of nursing is hardly ever shown in modern media which either erases nurses entirely (see House or ER or any other medical show), or sexistly mischaracterizes the field and ignores that nurses are hard scientists who partake in research, war, and can attend up to 10 yrs of schooling in their specialities (more than an MD). Not to mention that it is nurses who train in and learn the practical knowledge of medicine (injections, sterilization, IV admin, patient positioning for expelling mucuous, suctioning sputum, etc - doctors do not train in practical medicine and if they do they do not practice it).

If you are at the hospital and you have a head nurse and a physician resident making a call - guess who is going to have the last word. It isn't the doctor. And that is a respected norm.

It is thrilling to watch as Christine participated in research, engages in community outreach, joins fellowships, continues her education, assists surgery, diagnoses patients, engages in war and Starfleet, and cares at the bedside.

The old fashioned notion of "just a nurse for now" is about as stale as some of the sexist/misogynist concepts in TOS - and Christine is a GREAT example of a modern nurse character, highly accurate, and SNW would do well to correct further misconceptions of the field by making her an example of a Doctor of Nursing.

As far as I know, being a trekkie forever, they never stated what kind of doctor Chapel was - perfect opportunity.

[flowersforzoe11]

Alex Rider S1E7 Episode notes

Just had the most hideous combo of back2baack travel weekends, midterms, and canvassing for the upcoming election (reminder to any Americans of age to go vote--it's what Jack Starbright would want<3), so i have not had a single second to think about this show for the past like 3 weeks. HOWEVER my life is slightly less chaotic now and i'm ready for ep7. without further ado...

-WHAT DEATH SCENE FAKEOUT ALEX YOU GENIUS (i was gonna say, i didn't think his injuries were *that* serious in the book but goddamnit what a reveal. the past few episodes are such a love letter to this show)

-sorry i'm literally still in shock that was genius

-okay i haven't read this book in probably 5 or 6 years, but i feel like Alex returning to Point Blanc was way less consentual. i will say my major gripe with this show is that they're downplaying the evil that MI6 was, especially in the beginning (esp. the show's "no signal" vs book Blunt actively ignoring the signal)

-okay! fine! i like this Smithers (the tweak the chromosomes lines is such a funny cop-out line but i will ignore the science and accept it)

-alex yelling at Jones/K unit is the definition of AURA. god i love "defending those he loves" Alex

-and tulip can keep Kyra's name out of her mouth

-scream it for those in the back. MICHAEL ROSCOE WOULD NEVER QUOTE HITLER

-the motorbikes line was soooo Ella Cornell coded it's crazy (read I Spy i dare you)

-ahhHHHHHH CUB (this is such a good inclusion of K unit)

-Otto Farrant was so good during the k unit sniper scene. real loss of innocence moment for tv Alex and i could see it in his face. love love love (also that was just such a good scene in general. absolutely clincial. if i ever go to war, i'm taking all of k unit with me)

-the dr Greif x stellenbosch dynamic is so deliciously fucked up

-"we need greif alive" if i don't get my helicopter murder and shitty pun i RIOT

-CLONE KYRA IS CRAZY I AM GAGGED

-also for the record i'd be pissed if i was Wolf. just had to air the place out with very little back up and Alex just disappears despite having exactly one job (to not disappear)

-if there's one thing about Alex, it's that he gets his shit rocked often

-i love Alex's semi-working knowledge of science (especially because it only seems to exist when things are about to explode). also, as someone who graduated with a STEM degree, the lab fight scene was awesome. when will it be my turn to throw flasks at my enemies...

-well the project gemini information certianly was destroyed !

-the kids seeing their clones scene was absolutely bone-chilling

-okay i'm gonna say it. i feel like tv Alex is a silghtly nerfed version of book Alex. i feel like his role was a lot more important than "tag along and almost get himself killed"

-WOLF BEING SO NICE TO ALEX??? I'LL CRY REAL TEARS I LOVE THEM

-NO HELICOPTER SCENE AND BAD PUN???????? GET YOUR PITCHFORKS BC WE RIDE AT DAWN

-alex you poor shell of a boy you deserve the world (HOWEVER tv point blanc was maybe only 1/2 as traumatic as book point blanc. someone def toned AHorz down)

-god scorpia has their greasy little hands in everything

-JULIUS