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Introduction: Uptake rates of home hemodialysis are the lowest among all modality types, despite providing patients with clinical and quality of life benefits at a lower cost to providers. Currently, there is a need to develop dialysis systems that are appealing to patients while also being suitable for use across the continuum of care. The SC+ hemodialysis system was developed by Quanta Dialysis Technologies Ltd. to provide patients with a dialysis system that is small, simple to use, and powerful enough to deliver acceptable dialysis adequacy. Methods: As part of the SC+ design validation, human factors testing was performed with 17 Healthcare Professionals (nephrology nurses and healthcare assistants) and 15 Home Users (patients and caregivers). To assess usability and safety, the human factors testing involved between 4.5 and 6 hours of training and, after a period of training decay, a subsequent test session in which participants independently performed tasks on SC+. Findings: Between the two user groups, there were only 29 errors observed out of 1216 opportunities for errors, despite minimal training. Errors that did occur were minor and attributed to an initial lack of familiarity with the device; none were safety related. Discussion: Among prevalent dialysis patients and healthcare professionals, the SC+ hemodialysis system was easy to use, even with minimal training and a learning decay period, and had a high level of use safety. By taking into account human factors to optimize the user experience, SC+ has the potential to address systemic and patient barriers, allowing for wider self‐care and home hemodialysis adoption.

BackgroundSeveral factors potentially influence outcomes of surgery, including perioperative complications. Complications may take many forms and the Clavien–Dindo (CD) classification is designed to categorize them by degree of severity. The aim of this study was to evaluate the influence of perioperative complications by severity categorization on the 1-and 2-year pain and disability outcomes for patients who received low back surgery.Materials and methodsData used for the study involved a purposive sample (N = 477; 8.1%) from a spine outcomes registry of 5876 patients who received spine surgery and encountered complications. All complications were categorized using the CD classification and were collapsed according to distribution frequencies, i.e., Grade I–II and Grade III–V. Adjusted and unadjusted regression analyses were used to determine the association between CD classification and 1- and 2-year outcomes.ResultsThe majority of surgical complications were Grade III−V (N = 358; 75.1%), with two incidences in which death occurred. For the unadjusted models, there were no significant associations between CD classification categorizations for 1-year outcomes; however, 2-year outcomes were significantly worse (P <0.05) for those with Grade III–V categorization. When adjusted and controlled for baseline characteristics, CD classification did not influence 1-or 2-year pain and disability outcomes.ConclusionsWhen control variables are considered, the severity of perioperative surgical complications does not appear to influence 1- or 2-year pain and disability outcomes.Level of evidenceLevel 4.

T he management of hypertension has traditionally been based on the measurement of blood pressure (BP) in the office using manual devices, such as the mercury sphygmoma-nometer. Manual BP measurement is associated with numerous sources of error, the most important of which relate to human behavior. In the office setting, many patients become anxious, health professionals frequently do not follow proper BP measurement technique, and the presence of a nurse or physician leads to conversation, which increases BP. Also, the phasing out of the mercury sphygmomanometer because of concerns about its potential adverse effects on the environment and human health provides further motivation to reexamine the role of manual BP in clinical practice. In recent years, the pre-eminence of office BP has been challenged by the widespread use of 24-hour ambulatory BP monitoring (ABPM) and self-measurement of BP in the home. The well documented advantages of ABPM 1 and home BP 2 in evaluating the benefits of antihypertensive therapy for individual patients has led to major changes in recent guidelines for the diagnosis of hypertension. ABPM and home BP have been advocated as the methods of choice for determining the BP status of patients, 3-5 whereas manual office BP is being replaced by electronic oscillometric sphygmomanom-eters, most of which are activated by the office staff. Although these semiautomated devices eliminate some of the errors associated with manual BP measurement, the presence of an observer may still provoke inaccurate BP readings. 6,7 This limitation of semiautomated devices has been overcome by the development of accurate oscillometric sphygmo-manometers specifically designed for professional use, which take multiple BP readings automatically with the patient resting quietly and alone, 8 now referred to as automated office BP (AOBP). Numerous studies comparing AOBP to awake ambulatory BP and home BP have shown that AOBP produces Abstract-The risk of cardiovascular events in relation to blood pressure is largely based on readings taken with a mercury sphygmomanometer in populations which differ from those of today in terms of hypertension severity and drug therapy. Given replacement of the mercury sphygmomanometer with electronic devices, we sought to determine the blood pressure threshold for a significant increase in cardiovascular risk using a fully automated device, which takes multiple readings with the subject resting quietly alone. Participants were 3627 community-dwelling residents aged >65 years untreated for hypertension. Automated office blood pressure readings were obtained in a community pharmacy with subjects seated and undisturbed. This method for recording blood pressure produces similar readings in different settings, including a pharmacy and family doctor's office providing the above procedures are followed. Subjects were followed for a mean (SD) of 4.9 (1.0) years for fatal and nonfatal cardiovascular events. Adjusted hazard ratios (95% confidence intervals) were computed for 10 mm Hg increme...

In March 2005 the Department of Health released the Curriculum Framework for the Surgical Care Practitioner for consultation. The curriculum framework has been developed by a working party drawn from The Royal College of Surgeons of England (RCSE) Council and an NHS Changing Workforce Programme steering group, which represented a number of involved associations. As well as inviting responses on the curriculum itself, the consultation invited comments with respect to the title of 'surgical care practitioner'.