Susie Lew - Academia.edu (original) (raw)

Papers by Susie Lew

Nobel and Lasker Laureates of Chinese Descent, 2019

Kidney International, Jul 1, 2000

Letters to the Editor 463 stage renal disease, and anti-HCV-positive patients under-Togo (West Af... more Letters to the Editor 463 stage renal disease, and anti-HCV-positive patients under-Togo (West Africa), where S-hemoglobins represent more than 60% of all hemoglobins investigated by elecwent transplantation in a significantly lesser proportion trophoresis. The urinary sediment of a 25-year-old black than anti-HCV-negative patients (50% vs. 70%). The difwoman, hospitalized for a complicated pregnancy, conferent rate of renal transplantation may have biased the tained 20 to 25 erythrocytes per high power field (400ϫ), result on mortality, because life expectancy is better in several of which were clearly sickled. The presence of a transplanted patients than in patients continuing dialysis. sickle cell disease was confirmed by the Emmel test, which In addition, in Pereira's study the major death risk factor showed a 100% sickling of the peripheral erythrocytes in HCV-positive patients was infection, rather than liver after their incubation for 30 minutes with soda metadisease. Espinosa et al agree with us that histological lebisulphite. sions of the liver are mild and that liver disease shows

PubMed, Nov 1, 2018

Telehealth encompasses a broad variety of technologies and tactics to deliver virtual medical, he... more Telehealth encompasses a broad variety of technologies and tactics to deliver virtual medical, health, and education services. Telemedicine is the use of electronic communications for the exchange of medical information from one site to another to improve a patient's clinical health status.Several studies show that, by providing better patient oversight and communication, telehealth in PD enhances patient care, outcomes, quality of care, and satisfaction. Associated benefits include increased patient retention to home dialysis, reduced use of hospital services, and reduced costs of care.The sustainability of telehealth had been limited by reimbursement and regulatory restrictions. The Centers for Medicare and Medicaid Services (CMS) limited services related to end-stage renal disease by providing reimbursement for telehealth only in rural areas or counties outside of a metropolitan statistical area. Moreover, the dialysis facility and the patient's home were not approved as originating sites. However, effective January 1, 2019, those restrictions will be lifted. Telehealth will require that home dialysis patients be established with 3 initial face-to-face monthly clinical assessments without the use of telehealth; after those initial 3 months, a face-to-face visit at least once every 3 consecutive months will be required. Claims can be submitted using designated Current Procedural Terminology codes and modifiers.The actual extension of telehealth to home dialysis patients will depend on the details of forthcoming CMS regulations.

Cureus, May 11, 2023

A man in his early 20s with kidney biopsy-confirmed focal segmental glomerulosclerosis (FSGS) was... more A man in his early 20s with kidney biopsy-confirmed focal segmental glomerulosclerosis (FSGS) was admitted with one month of nausea and vomiting, intermittent episodes of confusion, shortness of breath, and dysuria. He reported that many people from his native village in Central America, where he harvested sugarcane as a child, have died from kidney disease, including his father and cousin. He believed the source of disease to be agrochemicals found in the village's water supply. Although FSGS would be a rare manifestation, the patient's risk factors strongly suggested chronic kidney disease of unknown etiology (CKDu)-also known as Mesoamerican nephropathy (MeN)-a phenomenon he had never previously heard of. He took lisinopril for the last six years to manage his kidney disease. Due to uremic symptoms and abnormal electrolytes, he was initiated on hemodialysis.

Artificial Organs, Jun 1, 2017

Hemodialysis patients can acquire buffer base (i.e., bicarbonate and buffer base equivalents of c... more Hemodialysis patients can acquire buffer base (i.e., bicarbonate and buffer base equivalents of certain organic anions) from the acid and base concentrates of a three-stream, dual-concentrate, bicarbonate-based, dialysis solution delivery machine. The differences between dialysis fluid concentrate systems containing acetic acid versus sodium diacetate in the amount of potential buffering power were reviewed. Any organic anion such as acetate, citrate, or lactate (unless when combined with hydrogen) delivered to the body has the potential of being converted to bicarbonate. The prescribing physician aware of the role that organic anions in the concentrates can play in providing buffering power to the final dialysis fluid, will have a better knowledge of the amount of bicarbonate and bicarbonate precursors delivered to the patient.

Peritoneal Dialysis International, 2018

Peritoneal Dialysis International, Sep 1, 2017

We examined participant uptake and utilization of remote monitoring devices, and the relationship... more We examined participant uptake and utilization of remote monitoring devices, and the relationship between remote biometric monitoring (RBM) of weight (Wt) and blood pressure (BP) with self-monitoring requirements. Participants on peritoneal dialysis (PD) (n = 269) participated in a Telehealth pilot study of which 253 used remote monitoring of BP and 255 for Wt. Blood pressure and Wt readings were transmitted in real time to a Telehealth call center, which were then forwarded to the PD nurses for real-time review. Uptake of RBM was substantial, with 89.7% accepting RBM, generating 74,266 BP and 52,880 Wt measurements over the study period. We found no significant correlates of RBM uptake with regard to gender, marital, educational, socio-economic or employment status, or baseline experience with computers; frequency of use of BP RBM by Black participants was less than non-Black participants, as was Wt RBM, and participants over 55 years old were more likely to use the Wt RBM than their younger counterparts. Having any review of the breach by a nurse was associated with reduced odds of a subsequent BP breach after adjusting for sex, age, and race. Remote biometric monitoring was associated with adherence to self-monitoring BP and Wt requirements associated with PD. Remote biometric monitoring was feasible, allowing for increased communication between patient and PD clinical staff with real-time patient data for providers to act on to potentially improve adherence and outcomes.

Journal of Telemedicine and Telecare, Jul 12, 2018

Introduction: Peritoneal dialysis is a home-based therapy for individuals with end-stage renal di... more Introduction: Peritoneal dialysis is a home-based therapy for individuals with end-stage renal disease. Telehealth, especially remote monitoring, is making inroads in managing this cohort. Methods: We examined whether daily remote biometric monitoring (RBM) of blood pressure and weight among peritoneal dialysis patients was associated with changes in hospitalization rate and hospital length of stay, as well as outpatient, inpatient and overall cost of care. Results: Outpatient visit claim payment amounts (in US dollars derived from CMS data) decreased post-intervention relative to pre-intervention for those at age 18-54 years. For certain subgroups, non-or nearly-significant changes were found among female and Black participants. There was no change in inpatient costs post-intervention relative to pre-intervention for females and while the overall visit claim payment amounts increased in the outpatient setting slightly (US$511.41 (1990.30) vs. US$652.61 (2319.02), p ¼ 0.0783) and decreased in the inpatient setting (US$10,835.30 (6488.66) vs. US$10,678.88 (15,308.17), p ¼ 0.4588), these differences were not statistically significant. Overall cost was lower if RBM was used for assessment of blood pressure and/or weight (US$-734.51, p < 0.05). Use of RBM collected weight was associated with fewer hospitalizations (adjusted odds ratio 0.54, 95% confidence interval 0.33-0.89) and fewer days hospitalized (adjusted odds ratio 0.46, 95% confidence interval 0.26-0.81). Use of RBM collected blood pressure was associated with increased days of hospitalization and increased odds of hospitalization. Conclusions: RBM offers a powerful opportunity to provide care to those receiving home therapies such as peritoneal dialysis. RBM may be associated with reduction in both inpatient and outpatient costs for specific subgroups receiving peritoneal dialysis.

Journal of Kidney Care, Sep 2, 2019

Kidney transplantation is an excellent treatment option for many patients, providing a quality of... more Kidney transplantation is an excellent treatment option for many patients, providing a quality of life that is superior to that experienced by patients on dialysis. Despite its advantages, there are certain health implications that transplant recipients must face. In this article, Susie Lew et al review the nutritional factors that need to be considered to prevent health issues after kidney transplant

Abstract Gastrointestinal (GI) complications occur in patients with acute kidney injury (AKI) and... more Abstract Gastrointestinal (GI) complications occur in patients with acute kidney injury (AKI) and vary in manifestation and intensity commensurate to the duration and severity of uremia. The signs and symptoms as well as pathogenesis of GI complications are similar to those of chronic kidney disease. Anorexia, nausea, and vomiting are frequent symptoms. GI hemorrhage in AKI patients in the ICU are prevented largely with the introduction of prophylactic use of proton pump inhibitors. When GI hemorrhage does occur, the endoscopic approach leads to early diagnosis and management. This chapter also highlights liver and pancreatic disorders, electrolyte complications, and small and large intestinal complications in AKI patients.

International Journal for Quality in Health Care, Dec 4, 2019

US Medicare beneficiaries receiving home dialysis will have the opportunity to engage in teleheal... more US Medicare beneficiaries receiving home dialysis will have the opportunity to engage in telehealth beginning in 2019. This new paradigm, if successful, will be instituted internationally. Any changes in healthcare delivery, such as using telehealth, will affect the process and quality. Quality of care metrics is discussed, and they can be used to evaluate the three domains of structure, process, and outcome when applied to assess telehealth's impact and quality on the dialysis population.

Peritoneal Dialysis International, Feb 18, 2020

The 2018 Bipartisan Budget Act in the United States extended telehealth access to Medicare benefi... more The 2018 Bipartisan Budget Act in the United States extended telehealth access to Medicare beneficiaries who receive home dialysis in which two of three monthly visits in a quarter may be performed by telehealth after three initial face-toface monthly visits. The originating site (where the patient is located) can be a dialysis unit or the patient's home and without geographic restriction. Patient awareness and interest in this new telehealth benefit in urban patients has not been well characterized. Patients receiving peritoneal dialysis (PD) treatment located in an urban facility completed a survey to ascertain knowledge of telehealth and readiness and willingness to participate in telehealth for their monthly visit. A total of 30 patients participated: 37% who completed the survey had heard of telehealth and 40% were able to define telehealth in words and correctly identify an example of telehealth. None of the patients were aware of the 2018 US Bipartisan Budget Act which extended telehealth assess to Medicare beneficiaries. Almost everyone had a mobile phone (83%), owned a computer (50%), and had access to Internet services (90%). The majority of patients (73%) were willing to use telehealth services for their monthly visit with the physician. PD patients living in an urban setting appear to be ready and interested in using telehealth to perform their monthly visit with the physician.

Frontiers in Medicine, Aug 25, 2020

Elsevier eBooks, 2021

Abstract Patients being treated with peritoneal dialysis (PD) have a high disease burden and may ... more Abstract Patients being treated with peritoneal dialysis (PD) have a high disease burden and may experience psychosocial challenges. Depression and anxiety are the two most common psychiatric disorders in PD patients. The risk factors for sleep disorders, cognitive impairment, sexual function, and chronic fatigue may be multifactorial, and concomitant medical conditions make it difficult to determine whether symptoms stem from medical or psychiatric disorders or a combination of the two. Caregivers who care for children or older adults or participate in assisted PD have all expressed stress, altered quality of life, and burnout. Psychiatric disorders in PD patients affect morbidity and mortality.

American Journal of Kidney Diseases, Jul 1, 2019

, Medicare beneficiaries requiring maintenance dialysis therapy were eligible for telehealth serv... more , Medicare beneficiaries requiring maintenance dialysis therapy were eligible for telehealth services only if the originating site was located in a rural area and the patient was situated in an authorized facility. Free-standing dialysis facilities and the patient's home were clearly restricted sites. Beginning in 2019, new opportunities are available for home dialysis patients in the United States to engage in telehealth; these include existing waivers within End-Stage Renal Disease (ESRD) Seamless Care Organizations (ESCOs) participating in the Comprehensive ESRD Care demonstration project and, more broadly, for most prevalent home dialysis patients based on legislation within the 2018 Bipartisan Budget Act. Under this act, Medicare will pay for a monthly comprehensive telehealth encounter with the patient that originates from his or her home or a dialysis unit without geographic restrictions. The home dialysis patient has the sole power to choose the telehealth option, which may occur twice over a 3-month cycle and cannot occur during the first 3 months of home dialysis therapy. With studies suggesting that effective use of remote monitoring and telehealth encounters may improve patient satisfaction and outcomes while reducing the cost of care, increased use of telehealth has the potential to improve patient-centered care for home dialysis patients. In this perspective, we review the legislative changes, regulatory requirements, and technical and operational challenges for conducting telehealth encounters for home dialysis patients. Complete author and article information provided before references.

Nobel and Lasker Laureates of Chinese Descent, 2019

Kidney International, Jul 1, 2000

Letters to the Editor 463 stage renal disease, and anti-HCV-positive patients under-Togo (West Af... more Letters to the Editor 463 stage renal disease, and anti-HCV-positive patients under-Togo (West Africa), where S-hemoglobins represent more than 60% of all hemoglobins investigated by elecwent transplantation in a significantly lesser proportion trophoresis. The urinary sediment of a 25-year-old black than anti-HCV-negative patients (50% vs. 70%). The difwoman, hospitalized for a complicated pregnancy, conferent rate of renal transplantation may have biased the tained 20 to 25 erythrocytes per high power field (400ϫ), result on mortality, because life expectancy is better in several of which were clearly sickled. The presence of a transplanted patients than in patients continuing dialysis. sickle cell disease was confirmed by the Emmel test, which In addition, in Pereira's study the major death risk factor showed a 100% sickling of the peripheral erythrocytes in HCV-positive patients was infection, rather than liver after their incubation for 30 minutes with soda metadisease. Espinosa et al agree with us that histological lebisulphite. sions of the liver are mild and that liver disease shows

PubMed, Nov 1, 2018

Telehealth encompasses a broad variety of technologies and tactics to deliver virtual medical, he... more Telehealth encompasses a broad variety of technologies and tactics to deliver virtual medical, health, and education services. Telemedicine is the use of electronic communications for the exchange of medical information from one site to another to improve a patient's clinical health status.Several studies show that, by providing better patient oversight and communication, telehealth in PD enhances patient care, outcomes, quality of care, and satisfaction. Associated benefits include increased patient retention to home dialysis, reduced use of hospital services, and reduced costs of care.The sustainability of telehealth had been limited by reimbursement and regulatory restrictions. The Centers for Medicare and Medicaid Services (CMS) limited services related to end-stage renal disease by providing reimbursement for telehealth only in rural areas or counties outside of a metropolitan statistical area. Moreover, the dialysis facility and the patient's home were not approved as originating sites. However, effective January 1, 2019, those restrictions will be lifted. Telehealth will require that home dialysis patients be established with 3 initial face-to-face monthly clinical assessments without the use of telehealth; after those initial 3 months, a face-to-face visit at least once every 3 consecutive months will be required. Claims can be submitted using designated Current Procedural Terminology codes and modifiers.The actual extension of telehealth to home dialysis patients will depend on the details of forthcoming CMS regulations.

Cureus, May 11, 2023

A man in his early 20s with kidney biopsy-confirmed focal segmental glomerulosclerosis (FSGS) was... more A man in his early 20s with kidney biopsy-confirmed focal segmental glomerulosclerosis (FSGS) was admitted with one month of nausea and vomiting, intermittent episodes of confusion, shortness of breath, and dysuria. He reported that many people from his native village in Central America, where he harvested sugarcane as a child, have died from kidney disease, including his father and cousin. He believed the source of disease to be agrochemicals found in the village's water supply. Although FSGS would be a rare manifestation, the patient's risk factors strongly suggested chronic kidney disease of unknown etiology (CKDu)-also known as Mesoamerican nephropathy (MeN)-a phenomenon he had never previously heard of. He took lisinopril for the last six years to manage his kidney disease. Due to uremic symptoms and abnormal electrolytes, he was initiated on hemodialysis.

Artificial Organs, Jun 1, 2017

Hemodialysis patients can acquire buffer base (i.e., bicarbonate and buffer base equivalents of c... more Hemodialysis patients can acquire buffer base (i.e., bicarbonate and buffer base equivalents of certain organic anions) from the acid and base concentrates of a three-stream, dual-concentrate, bicarbonate-based, dialysis solution delivery machine. The differences between dialysis fluid concentrate systems containing acetic acid versus sodium diacetate in the amount of potential buffering power were reviewed. Any organic anion such as acetate, citrate, or lactate (unless when combined with hydrogen) delivered to the body has the potential of being converted to bicarbonate. The prescribing physician aware of the role that organic anions in the concentrates can play in providing buffering power to the final dialysis fluid, will have a better knowledge of the amount of bicarbonate and bicarbonate precursors delivered to the patient.

Peritoneal Dialysis International, 2018

Peritoneal Dialysis International, Sep 1, 2017

We examined participant uptake and utilization of remote monitoring devices, and the relationship... more We examined participant uptake and utilization of remote monitoring devices, and the relationship between remote biometric monitoring (RBM) of weight (Wt) and blood pressure (BP) with self-monitoring requirements. Participants on peritoneal dialysis (PD) (n = 269) participated in a Telehealth pilot study of which 253 used remote monitoring of BP and 255 for Wt. Blood pressure and Wt readings were transmitted in real time to a Telehealth call center, which were then forwarded to the PD nurses for real-time review. Uptake of RBM was substantial, with 89.7% accepting RBM, generating 74,266 BP and 52,880 Wt measurements over the study period. We found no significant correlates of RBM uptake with regard to gender, marital, educational, socio-economic or employment status, or baseline experience with computers; frequency of use of BP RBM by Black participants was less than non-Black participants, as was Wt RBM, and participants over 55 years old were more likely to use the Wt RBM than their younger counterparts. Having any review of the breach by a nurse was associated with reduced odds of a subsequent BP breach after adjusting for sex, age, and race. Remote biometric monitoring was associated with adherence to self-monitoring BP and Wt requirements associated with PD. Remote biometric monitoring was feasible, allowing for increased communication between patient and PD clinical staff with real-time patient data for providers to act on to potentially improve adherence and outcomes.

Journal of Telemedicine and Telecare, Jul 12, 2018

Introduction: Peritoneal dialysis is a home-based therapy for individuals with end-stage renal di... more Introduction: Peritoneal dialysis is a home-based therapy for individuals with end-stage renal disease. Telehealth, especially remote monitoring, is making inroads in managing this cohort. Methods: We examined whether daily remote biometric monitoring (RBM) of blood pressure and weight among peritoneal dialysis patients was associated with changes in hospitalization rate and hospital length of stay, as well as outpatient, inpatient and overall cost of care. Results: Outpatient visit claim payment amounts (in US dollars derived from CMS data) decreased post-intervention relative to pre-intervention for those at age 18-54 years. For certain subgroups, non-or nearly-significant changes were found among female and Black participants. There was no change in inpatient costs post-intervention relative to pre-intervention for females and while the overall visit claim payment amounts increased in the outpatient setting slightly (US$511.41 (1990.30) vs. US$652.61 (2319.02), p ¼ 0.0783) and decreased in the inpatient setting (US$10,835.30 (6488.66) vs. US$10,678.88 (15,308.17), p ¼ 0.4588), these differences were not statistically significant. Overall cost was lower if RBM was used for assessment of blood pressure and/or weight (US$-734.51, p < 0.05). Use of RBM collected weight was associated with fewer hospitalizations (adjusted odds ratio 0.54, 95% confidence interval 0.33-0.89) and fewer days hospitalized (adjusted odds ratio 0.46, 95% confidence interval 0.26-0.81). Use of RBM collected blood pressure was associated with increased days of hospitalization and increased odds of hospitalization. Conclusions: RBM offers a powerful opportunity to provide care to those receiving home therapies such as peritoneal dialysis. RBM may be associated with reduction in both inpatient and outpatient costs for specific subgroups receiving peritoneal dialysis.

Journal of Kidney Care, Sep 2, 2019

Kidney transplantation is an excellent treatment option for many patients, providing a quality of... more Kidney transplantation is an excellent treatment option for many patients, providing a quality of life that is superior to that experienced by patients on dialysis. Despite its advantages, there are certain health implications that transplant recipients must face. In this article, Susie Lew et al review the nutritional factors that need to be considered to prevent health issues after kidney transplant

Abstract Gastrointestinal (GI) complications occur in patients with acute kidney injury (AKI) and... more Abstract Gastrointestinal (GI) complications occur in patients with acute kidney injury (AKI) and vary in manifestation and intensity commensurate to the duration and severity of uremia. The signs and symptoms as well as pathogenesis of GI complications are similar to those of chronic kidney disease. Anorexia, nausea, and vomiting are frequent symptoms. GI hemorrhage in AKI patients in the ICU are prevented largely with the introduction of prophylactic use of proton pump inhibitors. When GI hemorrhage does occur, the endoscopic approach leads to early diagnosis and management. This chapter also highlights liver and pancreatic disorders, electrolyte complications, and small and large intestinal complications in AKI patients.

International Journal for Quality in Health Care, Dec 4, 2019

US Medicare beneficiaries receiving home dialysis will have the opportunity to engage in teleheal... more US Medicare beneficiaries receiving home dialysis will have the opportunity to engage in telehealth beginning in 2019. This new paradigm, if successful, will be instituted internationally. Any changes in healthcare delivery, such as using telehealth, will affect the process and quality. Quality of care metrics is discussed, and they can be used to evaluate the three domains of structure, process, and outcome when applied to assess telehealth's impact and quality on the dialysis population.

Peritoneal Dialysis International, Feb 18, 2020

The 2018 Bipartisan Budget Act in the United States extended telehealth access to Medicare benefi... more The 2018 Bipartisan Budget Act in the United States extended telehealth access to Medicare beneficiaries who receive home dialysis in which two of three monthly visits in a quarter may be performed by telehealth after three initial face-toface monthly visits. The originating site (where the patient is located) can be a dialysis unit or the patient's home and without geographic restriction. Patient awareness and interest in this new telehealth benefit in urban patients has not been well characterized. Patients receiving peritoneal dialysis (PD) treatment located in an urban facility completed a survey to ascertain knowledge of telehealth and readiness and willingness to participate in telehealth for their monthly visit. A total of 30 patients participated: 37% who completed the survey had heard of telehealth and 40% were able to define telehealth in words and correctly identify an example of telehealth. None of the patients were aware of the 2018 US Bipartisan Budget Act which extended telehealth assess to Medicare beneficiaries. Almost everyone had a mobile phone (83%), owned a computer (50%), and had access to Internet services (90%). The majority of patients (73%) were willing to use telehealth services for their monthly visit with the physician. PD patients living in an urban setting appear to be ready and interested in using telehealth to perform their monthly visit with the physician.

Frontiers in Medicine, Aug 25, 2020

Elsevier eBooks, 2021

Abstract Patients being treated with peritoneal dialysis (PD) have a high disease burden and may ... more Abstract Patients being treated with peritoneal dialysis (PD) have a high disease burden and may experience psychosocial challenges. Depression and anxiety are the two most common psychiatric disorders in PD patients. The risk factors for sleep disorders, cognitive impairment, sexual function, and chronic fatigue may be multifactorial, and concomitant medical conditions make it difficult to determine whether symptoms stem from medical or psychiatric disorders or a combination of the two. Caregivers who care for children or older adults or participate in assisted PD have all expressed stress, altered quality of life, and burnout. Psychiatric disorders in PD patients affect morbidity and mortality.

American Journal of Kidney Diseases, Jul 1, 2019

, Medicare beneficiaries requiring maintenance dialysis therapy were eligible for telehealth serv... more , Medicare beneficiaries requiring maintenance dialysis therapy were eligible for telehealth services only if the originating site was located in a rural area and the patient was situated in an authorized facility. Free-standing dialysis facilities and the patient's home were clearly restricted sites. Beginning in 2019, new opportunities are available for home dialysis patients in the United States to engage in telehealth; these include existing waivers within End-Stage Renal Disease (ESRD) Seamless Care Organizations (ESCOs) participating in the Comprehensive ESRD Care demonstration project and, more broadly, for most prevalent home dialysis patients based on legislation within the 2018 Bipartisan Budget Act. Under this act, Medicare will pay for a monthly comprehensive telehealth encounter with the patient that originates from his or her home or a dialysis unit without geographic restrictions. The home dialysis patient has the sole power to choose the telehealth option, which may occur twice over a 3-month cycle and cannot occur during the first 3 months of home dialysis therapy. With studies suggesting that effective use of remote monitoring and telehealth encounters may improve patient satisfaction and outcomes while reducing the cost of care, increased use of telehealth has the potential to improve patient-centered care for home dialysis patients. In this perspective, we review the legislative changes, regulatory requirements, and technical and operational challenges for conducting telehealth encounters for home dialysis patients. Complete author and article information provided before references.