13 results on '"Michael J. Germain"'
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2. Expecting the unexpected: COVID‐19 in Kidney Transplant Recipients within United Network for Organ Sharing Region 1
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Hannah Gilligan, Nitender Goyal, Sandeep Ghai, Maricar Malinis, Het Patel, Nancy Rodig, Chen S. Tan, Michael J. Germain, Michael Chobanian, Jean M. Francis, Martha Pavlakis, Kenneth A. Bodziak, Ralph Rogers, Nicole Theodoropoulos, Francesca Cardarelli, Steven Gabardi, Emily Wood, Edward Walshe, and Asha Zimmerman
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United Network for Organ Sharing ,medicine.medical_specialty ,2019-20 coronavirus outbreak ,Transplantation ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Incidence ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,COVID-19 ,medicine.disease ,Health Surveys ,Kidney Transplantation ,Kidney transplant ,Postoperative Complications ,New England ,Renal transplant ,Family medicine ,medicine ,Humans ,Letters to the Editor ,business ,Letter to the Editor ,Kidney transplantation - Abstract
There are numerous case reports and a handful of single1–5 center studies reporting on COVID‐19 in kidney transplant recipients. Most reports arise from the epicenters of where the SARS‐CoV‐2 virus was first detected such as New York City1,2,5 and Europe3,4. We in UNOS Region 1 experienced COVID‐19 weeks to a month later and questioned whether our experience was different. The programs within UNOS Region 1 have had a long history of sharing information in an attempt to mitigate the effect of viruses on our patients.
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- 2020
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3. Factors associated with a second deferral among donors eligible for re-entry after a false-positive screening test for syphilis, HCV, HBV and HIV
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Michael J. Germain, Gilles Delage, and Yves Grégoire
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Adult ,Male ,medicine.medical_specialty ,Multivariate analysis ,Human immunodeficiency virus (HIV) ,Blood Donors ,HIV Infections ,030204 cardiovascular system & hematology ,medicine.disease_cause ,Donor Selection ,Serology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,False Positive Reactions ,Serologic Tests ,Syphilis ,Deferral ,Proportional hazards model ,business.industry ,Donor selection ,Hematology ,General Medicine ,Hepatitis C ,Middle Aged ,medicine.disease ,Female ,business ,Biomarkers ,030215 immunology - Abstract
Background and Objectives Since 25 May 2010, all donors at our blood centre who tested false-positive for HIV, HBV, HCV or syphilis are eligible for re-entry after further testing. Donors who have a second false-positive screening test, either during qualification for or after re-entry, are deferred for life. This study reports on factors associated with the occurrence of such deferrals. Materials and Methods Rates of second false-positive results were compared by year of deferral, transmissible disease marker, gender, age, donor status (new or repeat) and testing platform (same or different) both at qualification for re-entry and afterwards. Chi-square tests were used to compare proportions. Cox regression was used for multivariate analyses. Results Participation rates in the re-entry programme were 42·1%: 25·6% failed to qualify for re-entry [different platform: 2·7%; same platform: 42·9% (P < 0·0001)]. After re-entry, rates of deferral for second false-positive results were 8·4% after 3 years [different platform: 1·8%; same platform: 21·4% (P < 0·0001)]. Deferral rates were higher for HIV and HCV than for HBV at qualification when tested on the same platform. The risk, when analysed by multivariate analyses, of a second deferral for a false-positive result, both at qualification and 3 years after re-entry, was lower for donors deferred on a different platform; this risk was higher for HIV, HCV and syphilis than for HBV and for new donors if tested on the same platform. Conclusion Re-entry is more often successful when donors are tested on a testing platform different from the one on which they obtained their first false-positive result.
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- 2018
4. Comparison of stroke volume measurements during hemodialysis using bioimpedance cardiography and echocardiography
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Nathan W. Levin, Yossi Chait, Jyovani Joubert, Michael J. Germain, Daniel O'Grady, and Brian H. Nathanson
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,030232 urology & nephrology ,Hemodynamics ,Repeated measures design ,Hematology ,Stroke volume ,030204 cardiovascular system & hematology ,Doppler echocardiography ,medicine.disease ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Blood pressure ,Nephrology ,Internal medicine ,Linear regression ,medicine ,Cardiology ,Hemodialysis ,business ,Stroke - Abstract
Background: Fluid management remains a major challenge of hemodialysis (HD) care, with serious implications for morbidity and mortality. Intradialytic fluid management is typically guided by blood pressure, an indirect resultant of hemodynamics status. Direct measurements of hemodynamic parameters may improve cardiovascular outcomes by providing rational bases for intervention. We compare stroke volume (SV) measurements using a noninvasive, regional biompedance cardiography device (NiCaS) with Doppler echocardiography (Echo) in HD setting. Methods: Stroke volumes were simultaneously measured using the devices in 17 patients receiving maintenance HD. Measurements were made during 2 weekly HD treatments, and twice within each HD treatment during the first and last hour of each treatment, for a total of 64 SV measurements. Agreement between devices was assessed using linear regression, a Pearson's correlation coefficient, and a Bland-Altman plot all adjusted for repeated measures within patients. Results: Echo and NiCaS SV mean and 95% CIs were 58.0 (50.1, 65.8) and 56.7 (49.4, 64.0) mL, respectively. NiCaS SV correlated strongly with Echo SV during the first and last hours of treatments (r = 0.93, P
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- 2017
5. Blood pressure response to acute and chronic exercise in chronic kidney disease
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Michael J. Germain, Linda S. Pescatello, Richard J. Wood, Britton W. Brewer, Jyovani Joubert, Charles Milch, Elizabeth Evans, Beth A. Taylor, Samuel Headley, and Allen E. Cornelius
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medicine.medical_specialty ,Ambulatory blood pressure ,business.industry ,030232 urology & nephrology ,Renal function ,VO2 max ,General Medicine ,030204 cardiovascular system & hematology ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Blood pressure ,Nephrology ,Anesthesia ,Physical therapy ,Medicine ,Aerobic exercise ,Post-Exercise Hypotension ,business ,Sedentary lifestyle ,Kidney disease - Abstract
Aim The current study was designed to determine if a relationship exists between acute and chronic blood pressure responses to aerobic exercise in pre-dialysis patients. Methods Pre-dialysis kidney patients attended four sessions before being randomized to the treatment (n = 25) or control group (n = 21). In session 1, resting blood pressure was recorded, and these measurements were repeated during the second visit when peak oxygen uptake (VO2peak) was assessed. In the third and fourth sessions, blood pressures were taken prior to a 40 min walk or period of seated rest. After the 40 min walk or seated rest, blood pressures were monitored for 60 min in the laboratory and for the subsequent 24 h. After session 4, subjects in the treatment group trained aerobically at a moderate intensity, three times per week for 16 weeks. Control subjects were asked to be sedentary. All measurements were repeated after 16 weeks of training or sedentary living. Results Training increased VO2peak (mL/kg per minute) in the treatment group (baseline 19.6 ± 6.7 vs 21.2 ± 7.7, P
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- 2016
6. The greatly misunderstood erythropoietin resistance index and the case for a new responsiveness measure
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Christopher V. Hollot, Ravi Thadhani, Joseph Horowitz, Elizabeth Ankers, Michael J. Germain, Yossi Chait, and Sahir Kalim
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Oncology ,medicine.medical_specialty ,Anemia ,business.industry ,medicine.medical_treatment ,030232 urology & nephrology ,Retrospective cohort study ,Hematology ,medicine.disease ,End stage renal disease ,03 medical and health sciences ,0302 clinical medicine ,Nephrology ,Erythropoietin ,hemic and lymphatic diseases ,Internal medicine ,Linear regression ,medicine ,030212 general & internal medicine ,Hemodialysis ,business ,Dialysis ,Cohort study ,medicine.drug - Abstract
Introduction The optimal use of erythropoiesis stimulating agents (ESAs) to treat anemia in end stage renal disease remains controversial due to reported associations with adverse events. In analyzing these associations, studies often utilize ESA resistance indices (ERIs), to characterize a patient's response to ESA. In this study, we examine whether ERI is an adequate measure of ESA resistance. Methods We used retrospective data from a nonconcurrent cohort study of incident hemodialysis patients in the United States (n = 9386). ERI is defined as average weekly erythropoietin (EPO) dose per kg body weight (wt) per average hemoglobin (Hgb), over a 3-month period (ERI = (EPO/wt)/Hgb). Linear regression was used to demonstrate the relationship between ERI and weight-adjusted EPO. The coefficient of variation was used to compare the variability of Hgb with that of weight-adjusted EPO to explain this relationship. This analysis was done for each quarter during the first year of dialysis. Findings ERI is strongly linearly related with weight-adjusted EPO dose in each of the four quarters by the equation ERI = 0.0899*(EPO/wt) (range of R(2) = 0.97-0.98) and weakly linearly related to 1/Hgb (range of R(2) = 0.06-0.16). These correlations hold independent of age, sex, hgb level, ERI level, and epo-naive stratifications. Discussion ERI is strongly linearly related to weight-adjusted (and nonweight-adjusted) EPO dose by a "universal," not patient-specific formula, and thus is a surrogate of EPO dose. Therefore, associations between ERI and clinical outcomes are associations between a confounded EPO dose and those outcomes.
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- 2016
7. Donation by donors with an atypical pulse rate does not increase the risk of cardiac ischaemic events
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Gilles Delage, Pierre Robillard, Yves Grégoire, and Michael J. Germain
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medicine.medical_specialty ,Pulse (signal processing) ,business.industry ,Incidence (epidemiology) ,Hematology ,General Medicine ,Odds ratio ,Coronary heart disease ,Pulse rate ,Donation ,Internal medicine ,medicine ,Cardiology ,Clinical significance ,Cumulative incidence ,business - Abstract
Background and Objectives In many jurisdictions, blood donors who have an atypical pulse rate are temporarily deferred. This practice is not supported by evidence. We evaluated whether accepting donors with an atypical pulse rate increases their risk of cardiac ischaemic events. Methods We measured the cumulative incidence of hospitalizations and deaths for coronary heart disease within 1 year of follow-up among donors who, between 2002 and 2006, were temporarily deferred because of an atypical pulse ( 100 beats/min, or irregular). We compared this incidence to that observed among donors who also had an atypical pulse but who were allowed to donate, following a change in our deferral policy in 2007. The occurrence of cardiac events was determined through hospital discharge and death registries. Results Among 6076 donors who were temporarily deferred for an atypical pulse, the 1-year rate of hospitalization or death for cardiac ischaemic events was 3·5/1000, compared to 2·4 in donors who had an atypical pulse but who were allowed to donate (n = 10 671), for an adjusted odds ratio of 1·7 (95% CI, 0·9–3·0, P = 0·08). Conclusion Regardless of the clinical significance of an atypical pulse rate, our data show that accepting donors with this condition does not increase the occurrence of serious cardiac ischaemic events. We conclude that pulse rate measurement in prospective donors is not warranted.
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- 2012
8. Measuring Quality of Dying in End-Stage Renal Disease
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Michael J. Germain and Lewis M. Cohen
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Advance care planning ,medicine.medical_specialty ,Palliative care ,business.industry ,media_common.quotation_subject ,Benchmarking ,Focus group ,End stage renal disease ,Quality of life (healthcare) ,Nursing ,Nephrology ,Medicine ,Quality (business) ,Workgroup ,business ,Intensive care medicine ,media_common - Abstract
Palliative medicine operates under the presumption that it is possible to improve the quality of a patient's death. Nephrology has justifiably taken pride in its reliance on internal benchmarking and the use of quality targets to shape clinical practice innovations, and this article discusses the efforts that are being made to measure end-of-life care of dialysis patients. A tool called the Dialysis Quality of Dying Apgar is described that examines five domains (pain, nonpain symptoms, advance care planning, peacefulness, and time) which are scored and then summed. A recent interdisciplinary workgroup of renal professionals has commissioned a series of focus groups that have attempted to ascertain patient and family values and preferences for the management of terminal situations. The results are summarized, and they should hopefully form a basis for the development of additional research and clinical measurement tools.
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- 2008
9. PSYCHOSOCIAL FACTORS IN PATIENTS WITH CHRONIC KIDNEY DISEASE: The Psychiatric Landscape of Withdrawal
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Michael J. Germain and Lewis M. Cohen
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medicine.medical_specialty ,business.industry ,Public health ,medicine.medical_treatment ,High mortality ,MEDLINE ,Disease ,Nephrology ,medicine ,business ,Psychiatry ,Psychosocial ,Dialysis ,Depression (differential diagnoses) - Abstract
Withdrawal from dialysis is an appropriate decision for situations in which the burdens of treatment outweigh the benefits. Alternately, it can be viewed as a public health problem and suicide equivalent that contributes to the high mortality of end-stage renal disease (ESRD). More than one in five deaths of patients with ESRD are preceded by dialysis cessation, and approximately 15,000 Americans died last year following a determination to stop this life-support treatment. This article discusses what is known about the psychosocial aspects of the patients who terminate dialysis, the role of depression and other psychiatric disorders, the family perspective, and the relationship of these decisions to suicide.
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- 2008
10. Immediate blood pressure-lowering effects of aerobic exercise among patients with chronic kidney disease
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Charles Milch, Matthew Buchholz, Michael J. Germain, Mary Ann Coughlin, Linda S. Pescatello, and Samuel Headley
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Adult ,Male ,medicine.medical_specialty ,Time Factors ,Ambulatory blood pressure ,Blood Pressure ,Heart Rate ,Post exercise ,Humans ,Medicine ,Aerobic exercise ,Exercise ,Aged ,Control period ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,Blood pressure ,Nephrology ,Anesthesia ,Chronic Disease ,Physical therapy ,Female ,Kidney Diseases ,Blood pressure lowering ,Post-Exercise Hypotension ,Hypotension ,business ,Kidney disease - Abstract
SUMMARY: Aim: The current study was designed to determine the effect of moderate-intensity aerobic exercise on blood pressure responses within the laboratory for 60 min post exercise and in the subsequent 24 h period in patients with chronic kidney disease. Methods: Twenty-four subjects with stages 2–4 chronic kidney disease (age = 54.5 ± 15.2 years, body mass index = 32.0 ± 5.9 kg/m2) on antihypertensive medication completed this study. In random counterbalanced order, subjects were asked to either walk for 40 min at 50–60% VO2peak (oxygen consumption) or, on a separate day, to sit quietly in the laboratory for the same length of time. Following exercise or the non-exercise period, blood pressure was taken at 10 min intervals for 60 min. Subjects then wore an ambulatory blood pressure monitor for the next 24 h. Results: Systolic blood pressure (mmHg) was reduced by 6.5 ± 10.8 compared with the pre-exercise baseline value (130.3 ± 21.1) in the laboratory after exercise and this was greater than after the control period (0.73 ± 10.3, P
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- 2008
11. Withholding and Withdrawal from Dialysis: What We Know About How Our Patients Die
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Sara N. Davison, Michael J. Germain, and Lewis M. Cohen
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Nephrology ,medicine.medical_specialty ,education.field_of_study ,Withholding Treatment ,Palliative care ,business.industry ,Mortality rate ,medicine.medical_treatment ,Population ,MEDLINE ,Internal medicine ,medicine ,Intensive care medicine ,education ,business ,Hospice care ,Dialysis - Abstract
Withholding and withdrawal of dialysis has been a reality since dialysis was invented. Only in the past 20 years has it been formally studied, and we still have a great deal to learn. The nephrology community has slowly come to accept that, for some of our patients, not having dialysis is a better option than continuing or initiating therapy. The principles of palliative care throughout the disease trajectory and hospice care at end of life are germane to this population due to its high symptom burden and mortality rate. We review what is currently known concerning patients who choose to withhold or withdraw from dialysis, and the current barriers (and solutions) to providing them with optimal palliative care.
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- 2007
12. Changes in LDL particle size after aerobic training in CKD patients
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Richard J. Wood, Greg McMahon, Samuel Headley, Sara M. Gregory, and Michael J. Germain
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medicine.medical_specialty ,Endocrinology ,business.industry ,Internal medicine ,LDL Particle Size ,Genetics ,medicine ,Aerobic exercise ,business ,Molecular Biology ,Biochemistry ,Biotechnology - Published
- 2012
13. Ultrasound diagnosis of early renal papillary necrosis
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D R Kozinn, Gregory Braden, Michael J. Germain, T H Parker, and F E Hampf
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Adult ,Male ,medicine.medical_specialty ,Time Factors ,Necrosis ,Vascular renal disease ,Urology ,Renal papillary necrosis ,Nephropathy ,Diabetes mellitus ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Ultrasonography ,Kidney Medulla ,Radiological and Ultrasound Technology ,Tomography, X-Ray ,business.industry ,Ultrasound ,Urography ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Renal papilla ,Kidney Papillary Necrosis ,medicine.symptom ,business - Published
- 1991
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