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Don't cut dialysis funding - Belleville News-Democrat

As a facility administrator, and a licensed dietitian for DaVita HealthCare Partners here in Belleville, taxpayers need to know that lives are at stake as lawmakers consider budget cuts affecting people who require life-sustaining kidney dialysis treatments.

In Illinois alone, more than 5,000 people who depend on the state’s Medicaid program as their insurance provider receive dialysis treatments. But as lawmakers struggle to make a balanced budget, some people are advocating for a savings of $30 million by eliminating access to dialysis treatments for some patients and reducing reimbursement rates for others.

Cutting services that provide life-sustaining treatment should not be a negotiable budget item. When dialysis clinics can no longer afford to serve uninsured or underinsured patients, then publicly-funded emergency rooms and hospitals will incur the much higher costs of treating these patients on dialysis.

I urge lawmakers to do the right thing and maintain funding for kidney dialysis patients.

DaVita HealthCare Parters

Belleville

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The Chief People Ofcr - Kidney Care of DaVita HealthCare Partners Inc (NYSE ... - OctaFinance.com

The Chief People Ofcr - Kidney Care of DaVita HealthCare Partners Inc (NYSE ... - OctaFinance.com

Laura Mildenberger Insider Sell Transaction

Sale totalling $796,494 U.S Dollars was disclosed online in a form submitted to the Security and Exchange Commission on 22/05/2015. According to which, Laura Mildenberger, the Chief People Ofcr – Kidney Care of DaVita HealthCare Partners Inc (NYSE:DVA) 84.09 +0.60 0.72% also an insider of the -listed Davita Healthcare Partners Inc had sold precisely 9,579 shares – ( at $83.2 for share ). In the last month, she also unloaded 461 shares with value $38,148 USD. Laura Mildenberger now has ownership of 6,273 shares or 0.00% of Davita Healthcare Partners Inc’s market cap.

Davita Healthcare Partners Inc Stock Rating, Sentiment and Fundamentals

In addition, the fifteen equity specialist analysts that are in charge of Davita Healthcare Partners Inc, forecast $3.77 EPS in 2015. This indicates a PE ratio of 22.15 and growth rate YoY of 12.50% with Laura Mildenberger leading. It is difficult to make conclusions about Davita Healthcare Partners Inc’s future just from Laura Mildenberger’s sale because in this filing, the insider also revealed option transactions. In the form, it was reported that Laura exercised options for 20,000 shares with average price 43.4, worth 867,000.

* Read How Our Stock Ratings System Works

The stock price of Davita Healthcare Partners Inc has climbed 16.75% compared to the price last 200 days. And this smooth and strong up trend looks set to continue. Because of our well-know stocks time-momentum system which is shown on the chart below is flashing Buy, Octafinance can’t rate the stock SELL as Laura did with her trade.

Price Chart of Davita Healthcare Partners NYSE:DVA Stock

The Chief People Ofcr - Kidney Care of DaVita HealthCare Partners Inc (NYSE ... - OctaFinance.com

Source: RightEdgeSystems, Yahoo Split & Dividend Adjusted Data and OctaFinance Interpretations

Hedge Funds Ownership

Data gathered from 13F SEC filings, disclose that 468 institutional investors and hedge funds owned shares of Davita Healthcare Partners Inc. In the last quarter, the company in focus had 197.62% institutional ownership. That is a very high interest. They increased by 248.54 million the total shares they hold. As of that quarter these professional stock owners owned 424.89 million shares. There were 30 funds that closed their positions and 158 that reduced them. A total of 50 funds opened new positions in Davita Healthcare Partners Inc and 189 increased their holdings.

Of them, 16 have the stock in their Top 10. These funds are: Foundation Asset Management Lp, Swift Run Capital Management Llc, Summit Partners L P, Timessquare Capital Management Llc, Cognios Capital Llc, Triple Frond Partners Llc, Hikari Power Ltd, Gates Capital Management Inc., Hikari Tsushin Inc., Roundview Capital Llc.

HEDGE-FUNDS-LIST-DATABASE-FREE Bluestein R H & Co is the most positive hedge fund on Davita Healthcare Partners Inc, with ownership of 10,650 shares as of Q4 2014 for 0.05% of the fund’s portfolio. Dock Street Asset Management Inc is another positive investment manager owning 57,383 shares of the company or 2.29% of their stocks portfolio. The stock is also 1.06% of the fund’s AUM. The California-based fund First Republic Investment Management Inc. have 0.01% of their stock portfolio invested in the company for 7,274 shares. Moreover, Foster Dykema Cabot & Co Inc Ma revealed it had acquired a stake worth 2.05% of the fund’s stock portfolio in the company. Geneva Advisors Llc was also a notable follower of the company, possessing 5,435 shares. Davita Healthcare Partners Inc is 0.01% of the fund’s stock portfolio.

DaVita HealthCare Partners NYSE:DVA Company Profile

DaVita HealthCare Partners Inc. offers kidney care and manages and operates medical groups. DaVita HealthCare Partners Inc. operates through DaVita Kidney Care and HealthCare Partners (HCP). The Company’s services include outpatient hemodialysis services, hospital inpatient hemodialysis services, Home-based hemodialysis services, ESRD laboratory services and management services. It operates or provides administrative services through a network of outpatient dialysis centers in the United States that are designed for outpatient hemodialysis. The Company provides hospital inpatient hemodialysis services, excluding physician services, to patients in hospitals throughout the United States. DaVita Kidney Care is a provider of kidney care in the United States, delivering dialysis services to patients with chronic kidney failure and end stage renal disease. HCP manages and operates medical groups and affiliated physician networks in Arizona, California, Nevada, New Mexico, and Florida.

Davita Healthcare Partners Inc was formed in Delaware on 1994-04-04. The company has 57900 employees. At the moment its market capitalization is: $18.08 billion and it has 216.55 million outstanding shares. Now there are 86.57% shareholders and the institutional ownership stands at 86.57%. The stock closed at $83.49 yesterday and it had average 2 days volume of 198303 shares. It is down from the 30 days average shares volume of 240783. Davita Healthcare Partners Inc has a 52 weeks low of $68.10 and a 52weeks high of $85.17. The stock price is above the 200 days Simple moving average. Davita Healthcare Partners Inc last issued its quarterly earnings information on 05/04/2015. The company reported 0.86 EPS for the quarter, above the consensus estimate of 0.85 by 0.01. The company had a revenue of 3.29 billion for 3/31/2015 and 3.33 billion for 12/31/2014. Therefore, the revenue was -40,052,000 down.

* Stock Appreciation Rights granted on 4/13/2011 and vesting 50% each on 4/13/2014 and 4/13/2015.

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Outcomes of In-Hospital CPR in Patients Receiving Dialysis - Geripal

We’ve talked a lot about the prognosis after receiving in-hospital CPR in this blog (here, here, and here to name a few). In a recent issue of JAMA Internal Medicine, Susan Wong and colleagues looked at what happens to individuals on maintenance dialysis when they receive in-hospital cardiopulmonary resuscitation (CPR).  The results are summarized in the infographic above, and discussed in a little more detail below.

The Study

The authors used data from the US Renal Data System (USRDS) registry that enrolls patients after the onset of end stage renal disease, identifying all patients 18 years or older without a prior kidney transplant who initiated maintenance dialysis from January 1, 2000, through December 31, 2010. Importantly, to be included in this study, these patients needed to be on dialysis for at least 90 days (thereby exluding the sickest of the sick). By linking Medicare claims, they determined who in this registry was hospitalized and who got in-hospital CPR (although they excluded ER CPR).

Outcomes of interest included incidence of in-hospital CPR, proportion of patients surviving to hospital discharge after their first inhospital CPR event, and post-discharge survival. Among those who died in the hospital, they also measured the proportion who received CPR during their terminal hospitalization.

What did they find?

Most of the key findings are in the infographic, but I'll just highlight a few here:

  • The vast majority of individuals on maintenance dialysis were hospitalized at least once during the follow-up period (81% of the cohort)
  • Of these individuals who were hospitalized, 6% underwent at least one episode of CPR while hospitalized with a trend toward higher rates of CPR in more recent years. 
  • The proportion of CPR recipients who survived to discharge has increased in from 2000 to 2011 (15.2% to 28%) but there was no substantial change in duration of post-discharge survival.
  • The median survival fromthe time of discharge was 5.0 months among those who survived to discharge.

The Take Home

The results of this study are in line with other studies that suggest less people die in the hospital, but that doesn't mean that their long-term prognosis is any better.  In particular, Joan Teno's work shows that despite a decline in hospital deaths and an increase in hospice use, end of life for Medicare decedents increasingly includes ICU stays, short hospice stays, and multiple health care transitions.   This is particularly true to the dialysis population who undergo CPR.   We are better able to get them out of the hospital alive, but their survival after hospital discharge really has not improved, making them otherwise prognostically eligible for hospice.

by: Eric Widera (@ewidera)


Note: for more on the geriatric and palliative care needs of those with end-stage renal disease see these posts:

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Renal Denervation: Back to Square One - MedPage Today

NEW YORK -- Renal denervation will have to go "back to square one," proving that the blood pressure effect is real, a think-tank report from industry, academics, and government suggested.

"We felt that prior to exposing several hundred, even a thousand people to a pivotal phase III trial, there should be some evidence that the device is efficacious," said William White, MD, chief of hypertension and clinical pharmacology at the University of Connecticut's Calhoun Cardiology Center in Farmington.

His group's reportreleased in the May issue of the Journal of the American Society of Hypertension and discussed at a symposium at the society's annual meeting here came from discussions held before the announcement that the pivotal U.S. trial SYMPLICITY HTN-3 for Medtronic's catheter was stopping for futility and then St. Jude also halted its device's pivotal trial.

Despite the roughly 30/10 mmHg blood pressure drops seen in earlier phase trials, catheter-based renal artery nerve ablation yielded less than half that reduction, and the sham control group unexpectedly did almost as well in SYMPLICITY HTN-3.

Other recent randomized, controlled trials have supported a blood pressure lowering effect but only amounting to the effect of one antihypertensive drug -- far less than initially hoped, Sverre E. Kjeldsen, MD, PhD, of Ullevaal Hospital in Oslo, and colleagues noted in an editorial accompanying the think-tank scientific statement.

There are plenty of explanations for the failure of the SYMPLICITY HTN-3 trial, all raising issues that must be addressed in further trials, experts at the meeting pointed out.

"It remains unclear if the lack of superior efficacy in the only sham-procedure controlled trial is secondary to an ineffective radiofrequency catheter, operator variability, the patient population and their complex antihypertensive treatment regimens, specifics of study design, off-protocol medication use by patients, issues related to study conduct, or 'all of the above,'" the editorialists wrote.

Medtronic has announced that trials are moving forward, and Sidney Cohen, MD, PhD, of the University of Pennsylvania in Philadelphia and a senior adviser for the company, explained what the first will be.

The first phase has two parallel trials:

  • SPYRAL HTN-OFF MED with about 100 patients with 150-180/90+ mmHg hypertension taken off any antihypertensive medications and randomized to ablation with the company's newer generation renal denervation catheter or a sham procedure.
  • SPYRAL HTN-ON MED with about 100 similar patients in the same randomization while on a thiazide diuretic, calcium channel blocker, and ACE inhibitor or angiotensin receptor blocker (ARB). While there is no requirement for being at a maximum tolerated dose, urine and plasma drug adherence testing and witnessed pill-taking before blood pressure checks are mandated.

After those trials, the pivotal SPYRAL HTN trial would commence based on lessons from the initial phase and include cost-effectiveness and quality of life data collection.

The OFF MED trial should "minimize the confounding effect of behavioral issues that likely impacted the SYMPLICITY HTN-3 trial outcomes," Cohen suggested.

All three would use ambulatory blood pressure monitoring in the primary endpoint, rather than office blood pressure as in prior trials, which should reduce variability, White said at the session. The trial ought to at least show 8 mmHg difference against the sham to be declared effective, he said.

"They've put a lot of thought into it," commented William Elliott, MD, PhD, chief of pharmacology at Pacific Northwest University in Yakima, Wash. "In 2018, I would be shocked if we end up with a bunch more negative trials."

Demonstrating safety isn't going to be enough, all agreed.

There's "general agreement we need to approach this in the same manner they do in bringing a new pharmaceutical agent to treating hypertension and first obtain data in the absence of antihypertensive drugs so there's no confusion about the blood pressures and the interactions," Cohen said.

Beyond just efficacy in reducing blood pressure, there ought to be an outcomes study as has been required in diabetes, William Cushman, MD, of the VA and University of Tennessee Medical Centers in Memphis, argued from the audience at the session.

"I don't know that the FDA will make it a requirement," he later told MedPage Today. "They don't have yet the marker, if you will, of potential harm that was seen with some of the diabetes drugs that led to their requiring long-term outcomes studies with the diabetes drugs.

"My personal opinion -- and I think I'm not alone in this -- is that any intervention approved to be given to patients long-term, year-in and year-out, should be submitted to randomized trials," he said. "The postmarketing observation, there are some things they will be able to pick up, but there are other things they won't be able to pick up in a registry because its not randomized.

"You really won't know if mortality is increased. You really don't know unless it's a strong marker that you're increasing the incidence of end-stage renal disease because you have no comparison group."

"I've sat on many guideline committees," he noted. "I was on JNC7 and JNC8. We could not recommend something unless there's data showing that outcomes are benefited. The FDA has more of a perspective that if it lowers blood pressure and it's relatively safe, we can approve it. They're not interested in whether this should be recommended by guideline committees or not. It's a different standard in my opinion."

There's no question that a registry was always going to be required as part of FDA and CMS approval, White noted. But, he said, "it's too soon to talk about that. It's back to square one."

But "right now, we're just happy with showing it works," Cohen said.

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Camping advice from the ESRD - Stony Plain Reporter

Camping is a favourite pastime for many; enjoying the wilderness is quite important for many Albertans. However, it is one of the hardest habits to get into unless they grew up with it. As a first-time camper, the questions often outnumber the answers. Where do I go? What do I bring? What should I look out for?

Luckily, with the help of the Alberta Environment and Sustainable Resource Development (ESRD), first-time campers can have some of their questions answered on their way to a relaxing and rewarding camping experiences.

1. Respect the land

It may seem like common sense for some, but respecting your surroundings is one of the most important rules of camping.

Leaving garbage behind spoils the very environment that campers enjoy. Pack in what you pack out; you would want the site to be in the same shape you found it in.

2. Put out your fires

Many movies depict campers falling asleep around a campfire or leaving it unmanned completely. Considering the extremely dry conditions in May, the ESRD advises campers to put out campfires every time they are unattended by using the soak, stir and soak again method — pour water on the fire, stir it, and pour water on it one more time.

Forest fires have been plentiful this season, with a large majority of them human-caused fires, according to the ESRD. Because it is not lightning season quite yet, most of the blame can be put on humans, whether it’s unattended campfires or a spark from an exhaust pipe of a quad.

ESRD suggests checking out fire conditions and bans before venturing out to camp. Some jurisdictions initiate fire bans at different times, so be sure to check the specific area you are camping before lighting that fire.

3. Visit albertaparks.ca

The website has a bounty of information regarding campsites and amenities, including comfort camping units. Comfort camping is a broad definition that includes anything from cabins to high-quality tents that only require the camper to bring food, bedding and a pillow.

Some campsites have showers, bathrooms, and even concession stands, should the camper desire them. It’s a great way for new Canadians (or those new to camping in general) to transition themselves into being prepared to camp without access to bathrooms and showers. It allows them to realize first-hand what exactly they would need to survive a weekend in the wilderness.

By following these pieces of advice, you can be a happy camper — both literally and figuratively speaking.

Fire season sees sharp increase in May

With the four-year anniversary of the Slave Lake fire just passing, Albertans are reminded of the huge fires that occur within mid-to-late May. British Columbia is seeing this first-hand this season, with the Little Bobtail Lake fire only approximately 15 per cent contained, according to the ESRD.

There are many reasons for a surge in fires in May. Alberta is known to get a long stretch of hot days with little-to-no moisture, drying up grass and trees. Many Albertans go camping and quadding for the first time in the season, and may be careless. Additionally, winds tend to blow from the southeast in May, and will often change directions quite frequently, which causes unpredictable fire patterns.

Only one of those causes is preventable: carelessness. The ESRD urges those venturing into the bush to be careful, especially during conditions such as these. Next week’s forecast is seven days of sun and no moisture, which makes the fire hazard extreme in more than 50 per cent of Alberta.

The ESRD suggests keeping fires small. Don’t play with fire.

The fire season so far

As of May 19, there have been 543 wildfires that have burned 1,937 hectares of land. That’s an average of 3.57 hectares per fire.

Currently, there are 235 firefighters and 12 helicopters fighting fires in Alberta.

The biggest fire of the season so far was a 750-hectare fire near Edson. It has been contained.

For more information, visit wildfire.alberta.ca.

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