Background Informed dialysis selection and greater home dialysis use are the two long-desired, underachieved targets of advanced chronic kidney disease (CKD) care in the US healthcare system. Observational institutional studies have shown that comprehensive pre-kidney failure, conventionally referred to as end stage kidney disease education (CPE) can improve both these outcomes. However, lack of validated protocols, well-controlled studies, and systemic models have limited wide-spread adoption of CPE in the US. We hypothesized that a universal CPE and patient-centered initiation of kidney replacement therapy can improve multiple clinical, patient-centered and health service outcomes in advanced CKD and kidney failure requiring dialysis therapy. Methods Trial to Evaluate and Assess the effects of CPE on Home dialysis in Veterans (TEACH-VET) is a multi-method randomized controlled trial aimed to evaluate the effects of a system-based approach for providing CPE to all Veterans with advanced CKD across a regional healthcare System. The study will randomize 544 Veterans with non-dialysis stage 4 and 5 CKD in a 1:1 allocation stratified by their annual family income and the stage of CKD to an intervention (CPE) arm or control arm. Intervention arm will receive a two-phase CPE in an intent-to-teach manner. Control arm will receive usual clinical care supplemented by resources for the freely-available kidney disease information. Participants will be followed after intervention/control for the duration of the study or until 90-days post-kidney failure, whichever occurs earlier. Results The primary outcome will assess the proportion of Veterans using home dialysis at 90-days post-kidney failure, and secondary outcomes will include post-intervention/control CKD knowledge, confidence in dialysis decision and home dialysis selection. Qualitative arm of the study will use semi-structured interviews to in-depth assess Veterans’ satisfaction with the intervention, preference for delivery, and barriers and facilitators to home dialysis selection and use. Several post-kidney failure clinical, patient-centered and health services outcomes will be assessed 90-days post-kidney failure as additional secondary outcomes. Conclusion The results will provide evidence regarding the need and efficacy of a system-based, patient-centered approach towards universal CPE for all patients with advanced CKD. If successful, this may provide a blueprint for developing such programs across the similar healthcare infrastructures throughout the country. Trial registration NCT04064086.

Background Informed dialysis selection and greater home dialysis use are the two long-desired, underachieved targets of advanced chronic kidney disease care in the US healthcare system. Observational institutional studies have shown that comprehensive pre-end stage kidney disease (ESKD) disease education (CPE) can improve both these outcomes. However, lack of validated protocols, well-controlled studies, and systemic models have limited wide-spread adoption of CPE in the US. We hypothesized that a universal CPE and patient-centered initiation of renal replacement therapy can improve multiple clinical, patient-centered and health service outcomes in advanced chronic kidney disease (CKD) and ESKD.Methods Trial to Evaluate and Assess the effects of CPE on Home dialysis in Veterans (TEACH-VET) is a mixed method randomized controlled trial aimed to evaluate the effects of a system-based approach for providing CPE to all Veterans with advanced CKD across a regional healthcare System. The study will randomize 544 Veterans with non-dialysis stage 4 and 5 CKD in a 1:1 allocation stratified by their annual family income and the stage of CKD to an intervention (CPE) arm or control arm. Intervention arm will receive a two-phase CPE in an intent-to-teach manner. Control arm will receive usual clinical care supplemented by resources for the freely-available kidney disease information. Participants will be followed after intervention/control for the duration of the study or until 90-days post-ESKD, whichever occurs earlier.Results The primary outcome will assess the proportion of Veterans using home dialysis at 90-days post-ESKD, and secondary outcomes will include post-intervention/control CKD knowledge, confidence in dialysis decision and home dialysis selection. Qualitative arm of the study will use semi-structured interviews to in-depth assess Veterans’ satisfaction with the intervention, preference for delivery, and barriers and facilitators to home dialysis selection and use. Several post-ESKD clinical, patient-centered and health services outcomes will be assessed 90-days post-ESKD as additional secondary outcomes.Conclusion The results will provide evidence regarding the need and efficacy of a system-based, patient-centered approach towards universal CPE for all patients with advanced CKD. If successful, this may provide a blueprint for developing such programs across the similar healthcare infrastructures throughout the country.Trial registration: NCT04064086

What does Martin Luther mean for Germany? Formulated in such a way, this is an impossible question, due in no small measure to the existence of many “Luthers” and many “Germanys.” But it also invites historical investigation. Luther has long held a privileged position in the writing of German history, stretching back to his own lifetime, even if the exact nature of that position has hardly remained static or uncontested. Luther’s position in the annals of German historiography testifies to the influence of social and political upheavals on the way in which historians understand the past—and vice versa. Each era’s critical events have encouraged certain aspects of Luther’s person and work to be remembered and others to be forgotten. Like swapping between telephoto and wide-angle lenses, historical perspectives have moved between a narrow concentration on the German reformer’s biography and theology and a broader focus on the Protestant movement he launched in Germany. Historians have regularly enlisted Luther in an expansive, sweeping vision of the German Reformation and the emergence of the modern German nation-state with Otto von Bismarck. Indeed, contemporary ideas of nation and nationalism have had a determining influence on interpretations of Luther. This is true as much for German historians like Leopold von Ranke, writing toward the beginning of history’s professionalization as a full-fledged, independent academic discipline in the first half of the 19th century, as it is for those surveying Luther in the midst of the First World War, in the aftermath of Hitler and the Nazi era, in the postwar German Democratic Republic in the East and Federal Republic of Germany in the West, on the cusp Germany’s “turning point” (die Wende) of 1989–1990—and even for historians now situated in the 21st century.

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The rise of German academic institutions in the nineteenth century considerably altered the landscape of American higher education. American students of theology looked to Germany to develop their discipline, where they found model textbooks that gave directives in learning and piety, transforming academic and theological practice. With sensitivity to the history of the book and the history of the rich cultural traffic across the Atlantic, this article focuses on the reception in English translation of the important and widely read Swiss-German church historian Karl Rudolf Hagenbach, whose textbooks enjoyed a considerable audience in the United States by crossing ideological boundaries and unseating obdurate assumptions. By examining this reception in the United States and Britain and investigating those “transatlantic personalities” who played pivotal roles in bringing his ideas from the “Old World” to the “New,” this article demonstrates Hagenbach's lasting influence on the changing fields of history, church history, and academic theology in America. An “Atlantic” perspective on these themes offers new insights for our understanding of religion in the modern academy, the movement and translation of theological ideas in an age of steamship travel, and the surfacing of commonalities among ostensibly mismatched, if not outright conflicting, Protestant religious cultures.